These are hedge funds, tax shelter funds and investment funds of overseas buearcrats funneling money out of their countries. FWIW:$69 billion is a barely a drop in the US Treasury market, and these accounts have been around for a very long time. In 2002 there was about $60 bullion held in the Caribbean.

The Fed can directly purchase and sell treasuries and does so frequently without using offshore banking accounts.

The other big issue is the huge effect of diminishing returns with medical technology.  The classic example is laparoscopic surgeries.  At first doing surgery through a scope seemed like a great cure for many of medicine's woes- fewer complications, shorter hospital stays, fewer post-operative infections, lower costs, greater patient satisfaction.  But what happened was that laparoscopic surgeries are so much better that patients are more willing to receive them and surgeons are more willing to do them since the risk and recovery for the patient is less.  If you had gall bladder problems 20 years ago, the surgery required weeks off of work and months before full recovery.  You'd be left with a 4 to 8 inch scar on your abdomen. You likely would have been inclined to try losing weight, avoid high fat foods and avoid alcohol.  Today, realizing you can be in and at of the hospital in 24 hours with just 3  half inch button hole incisions, you're more likely to just say, OK take it out.  The number of gall bladder surgeries has more than grown to cancel out the cost benefits of laparoscopic techniques.  
Furthermore, the better we are at keeping people alive, the more difficult and complicated it becomes.  More and more hospitalized patients today have a laundry list of medical problems.  So treating pneumonia today is not the same as it was 40 years ago.  Today's pneumonia patient is likely also to have lived through 2 prior heart attacks, be diabetic and hypertensive, and take 12 medications on a daily basis.  We might be a little better at treating this or that, but ultimately all of us will die and for most of us it will be after prolonged (and expensive) illness.
Finally, the fear of litigation also cannot be overestimated.  Many unnecesary tests and procedures are done to "cover you ass" creating more inefficiencies in the system.  

I realize this is off topic for Peak Oil, but being a non-energy person, I rarely get to contribute on anything where I am expert and I just can't resist!

Phineas Gage, MD

Looking at it from an Energy perspective, all that has changed is energy substitution. Electricity as opposed to people.

As an american physician, I fully expect to make far less money and be in a completely different (and more frustrating for me) healthcare system before I retire, probably in the next 5 to 10 years

Phineas, I know you don't mean it that way, but it's quite a statement to say the changes will be bad for you. If I were you, I would reserve the no.1 spot for the people who receive no care. That's really frustrating.

You should seriously consider the option that our society is on a slow but sure slide towards a situation where people become disposable. We'll rationalize this after the fact, as we do everything. It's nothing new, millions die every day somewhere in the world who could be saved with less than a dollar.

It will take some adapting when this starts happening in your town.

The US is fast on its way to having millions of people who can neither produce (no manufacturing left) nor produce (debts). They will be economically useless, and hence disposable. They just take up space.

I want to stay focused and apply this to St. Louis mostly, but be able to fit most circumstances.  Can you help point me to some scholarly texts that I may pull info from?  Also can you send another link to your excellent outline on electrfying the rail that you've posted before?  Any help would be appreciated.