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Broken US Healthcare System

RealityChecker

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With nearly half of the Federal government's budget going to healthcare it seems to me if we are to deal with government spending and the Federal governments growing debt one obvious place to reduce our growing national debt would be to figure out ways to reduce spending on healthcare or more specifically medical care. The US spends far more than any other country on healthcare and yet there are dozens of countries that spend far less than the US does on medical care and yet the people in those countries live longer and arguably healthier lives than do Americans on average. Marty Makary, MD has a new book titled "The Price We Pay" in which he shares his perspective on what he believes are the main problems with the US healthcare establishment. He shares his perspective on problems with the US healthcare system in this 5 minute video. I believe Dr. Makary makes some good points in this video and a discussion on the points he makes may be a good place to start a discussion about how Americans become healthier and live longer, while at the same time reducing the high cost of our current healthcare system. Here's a link to Dr. Makary's video: https://www.prageru.com/video/overm...tm_medium=email&utm_campaign=campaign_2438143
 

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The whole concept of better health care is far to big to argue in a general way. You need to consider so many things that are involved such as politics and economics and legality before you even get close to delivering health.

Let's start with the biggest hurdle. The fact that america needs a socialist health care provider system. And no I have no interest in arguing with americans over their most stupidest way of doing socialism. So here is an example of what I mean.

https://www.newzealandnow.govt.nz/resources/acc-helping-to-meet-the-costs-of-personal-injury
The Accident Compensation Corporation (ACC) provides compulsory insurance cover for personal injury for everyone in New Zealand, whether a citizen, resident or visitor.
This means if you are injured by an accident in New Zealand, ACC may pay some of your medical and rehabilitation costs.
ACC is a no-fault scheme – the only one of its kind in the world. It applies regardless of who caused the accident – including you. But it also means you can’t sue for any costs that relate to the injury or its negative effects.
ACC is paid for by employers. If you are an employer check your obligations. Employers who do not pay ACC can be liable for significant penalties. Most employees are automatically covered and the levies are an employer cost – they cannot be deducted from your wages or salary.
 

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With nearly half of the Federal government's budget going to healthcare it seems to me if we are to deal with government spending and the Federal governments growing debt one obvious place to reduce our growing national debt would be to figure out ways to reduce spending on healthcare or more specifically medical care. The US spends far more than any other country on healthcare and yet there are dozens of countries that spend far less than the US does on medical care and yet the people in those countries live longer and arguably healthier lives than do Americans on average. Marty Makary, MD has a new book titled "The Price We Pay" in which he shares his perspective on what he believes are the main problems with the US healthcare establishment. He shares his perspective on problems with the US healthcare system in this 5 minute video. I believe Dr. Makary makes some good points in this video and a discussion on the points he makes may be a good place to start a discussion about how Americans become healthier and live longer, while at the same time reducing the high cost of our current healthcare system. Here's a link to Dr. Makary's video: https://www.prageru.com/video/overm...tm_medium=email&utm_campaign=campaign_2438143


How much was the total fed budget, both mandatory and discretionary, and how much of that has for healthcare that has you come up with "nearly half of the Federal government's budget going to healthcare"? Evidence of fact helps.
 

MrWonka

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Dr. Makary makes some good points in this video and a discussion on the points
Why don't you tell us what these so-called "good points" are instead of making us watch a stupid video?

Prageru is a right-wing crap site that purports itself to be educational.

The fundamental problem with Health care in America is that it is one big gigantic Nash Equilibrium. An Economic catch 22 if you will. This problem cannot be solved by the free market.
The free market is only concerned about convincing individuals to purchase a specific companies health insurance policies, but in doing so they end up making all of our health care more expensive.
The only solution is government intervention to ensure universal coverage, to ensure each individual is contributing monthly what they can reasonably afford, and to mandate basic minimum standards that must be met in order for something to be considered "health insurance."
Any other right-wing garbage talking points that don't accept that fundamental reality are worthless.
 

aociswundumho

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The whole concept of better health care is far to big to argue in a general way. You need to consider so many things that are involved such as politics and economics and legality before you even get close to delivering health.

Let's start with the biggest hurdle. The fact that america needs a socialist health care provider system. And no I have no interest in arguing with americans over their most stupidest way of doing socialism. So here is an example of what I mean.

https://www.newzealandnow.govt.nz/resources/acc-helping-to-meet-the-costs-of-personal-injury

New Zealand has a two tier healthcare system - private and public. Guess which one makes you wait 3 months for cancer treatment:

 

reflechissez

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With nearly half of the Federal government's budget going to healthcare it seems to me if we are to deal with government spending and the Federal governments growing debt one obvious place to reduce our growing national debt would be to figure out ways to reduce spending on healthcare or more specifically medical care. The US spends far more than any other country on healthcare and yet there are dozens of countries that spend far less than the US does on medical care and yet the people in those countries live longer and arguably healthier lives than do Americans on average. Marty Makary, MD has a new book titled "The Price We Pay" in which he shares his perspective on what he believes are the main problems with the US healthcare establishment. He shares his perspective on problems with the US healthcare system in this 5 minute video. I believe Dr. Makary makes some good points in this video and a discussion on the points he makes may be a good place to start a discussion about how Americans become healthier and live longer, while at the same time reducing the high cost of our current healthcare system. Here's a link to Dr. Makary's video: https://www.prageru.com/video/overm...tm_medium=email&utm_campaign=campaign_2438143
Prager U? No thanks.
 

aociswundumho

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Why don't you tell us what these so-called "good points" are instead of making us watch a stupid video?

Prageru is a right-wing crap site that purports itself to be educational.

Nothing "right wing" in that video. He wants Americans to live healthier lives, and therefore spend less on healthcare.

This problem cannot be solved by the free market.

Actually, that's the only way to solve it.
 

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The only way we lick this problem is by people understanding that if we live healthy, eat healthy and stay active, the costs for everyone go down and as a nation we will be more competitive on the global stage. Unfortunately this requires two things:

1. People with strong wills to make good life choices (given our obesity epidemic etc., we're at a clear deficit here)

2. Willingness to support legislation to encourage people with weak wills (the majority of Americans) to make better choices without crying 'freedom!' or 'Marxist!' or <random race-related argument> every time the idea is discussed.

So long as we can't make progress on increasing the number one people who fall under #1 and/or the number who are willing to fall under #2, throwing more money at the problem is a bandaid at best.
 

BlueTex

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Nothing "right wing" in that video. He wants Americans to live healthier lives, and therefore spend less on healthcare.



Actually, that's the only way to solve it.


How does a traffic accident victim shop around?
 

soylentgreen

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New Zealand has a two tier healthcare system - private and public. Guess which one makes you wait 3 months for cancer treatment:

While I agree that there are faults in the system it is still a far improvement over what america has at the moment.

That is the point of intelligent socialism as opposed to the stupid version americans keep parroting. A private and public health care system can actually work together. Many smaller nations than america have proven this point.
 

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With nearly half of the Federal government's budget going to healthcare it seems to me if we are to deal with government spending and the Federal governments growing debt one obvious place to reduce our growing national debt would be to figure out ways to reduce spending on healthcare or more specifically medical care. The US spends far more than any other country on healthcare and yet there are dozens of countries that spend far less than the US does on medical care and yet the people in those countries live longer and arguably healthier lives than do Americans on average. Marty Makary, MD has a new book titled "The Price We Pay" in which he shares his perspective on what he believes are the main problems with the US healthcare establishment. He shares his perspective on problems with the US healthcare system in this 5 minute video. I believe Dr. Makary makes some good points in this video and a discussion on the points he makes may be a good place to start a discussion about how Americans become healthier and live longer, while at the same time reducing the high cost of our current healthcare system. Here's a link to Dr. Makary's video: https://www.prageru.com/video/overm...tm_medium=email&utm_campaign=campaign_2438143
I watched the video and didn't see anything new. For starters, he blames obesity and related ailments on what someone eats and claims, remarkably, that to fix that we just need to eat better - go on diets, effectively. The problem is diets almost always fail. Every bit of data shows this - no matter the diet, after a year or two all the gains are reversed for the VAST majority of those trying them. And it cannot be because everyone going on a diet is a weakling, with no willpower, who we can blame because diets the data show almost never work don't work for them. If something fails maybe 90% of those who try it, maybe that something is the problem, not the person. We even know why - diets reduce base metabolism, so when you cut calories, your metabolism slows and you get on a cycle of having to cut ever more calories to lose weight, and as you do that, metabolism slows some more, requiring fewer calories, etc. So the person is hungry all the time. No wonder they fail. So suggesting cooking classes, as he did, as an answer to the problems of obesity and Type 2 diabetes is just nonsense. Yes, they might help a bit for a small number of people, but WHAT someone is eating appears to be at best only part of the problem.

Further, even if you could get individual A to change his diet, and lose weight, and exercise every day, and keep the weight off for years, for that to work at the level of the population would require a lot of food companies in the U.S. to go to zero, as we all ditch everything in about half the aisles of the grocery store, freezer section and restaurants to only eat veggies, lean protein and lots of olive oil. Well, those companies spend $billions each year to convince us NOT to do that but consume ever more of their offerings, in part subsidized by government that promotes corn and wheat and sugar, makes them cheaper to us, and also cheaper to those buying food for themselves and their families. When we went 'healthy' on our diet a few years ago, our grocery bill about doubled. Fresh veggies and berries and other healthy fruits aren't cheap, neither is lean protein. And not everyone can take the 2 hours per night it takes roughly to cook, eat, then clean up afterwards.

The best answer I've seen to obesity is some form of fasting - intermittent fasting effectively. When you don't eat anything, you don't spike blood sugar, and insulin doesn't spike and you don't have barriers to using your fat as fuel. But the point is that approach takes as a given that 'diets' fail, and promoting diets such as Atkins or low carb, etc. that just do not work are guaranteed to fail the vast majority of patients, and so offers a different and simple alternative. Whether that works long term is an open question, but what is simplistic and essentially worthless advice is to just say - eat better, and exercise. That's where the video is - promoting simplistic notions as solutions.
 

RealityChecker

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How much was the total fed budget, both mandatory and discretionary, and how much of that has for healthcare that has you come up with "nearly half of the Federal government's budget going to healthcare"? Evidence of fact helps.
Dr. Makary stated in the video about 30 seconds in that "....48% of all Federal spending is related to healthcare." That is about 50% although I am not sure if there is a difference between Federal spending and the Federal budget. The Federal spending on healthcare is greater now than on Social Security and far more than it spends on Defense. So healthcare spending is certainly the greatest single item in the Federal budget. For 2020 the Federal budget was $4.79 trillion dollars. Americans spent a bit more than $4 trillion on healthcare with the Federal government paying for about half of that mostly via Medicare, Medicaid, and subsidies for Obamacare health insurance plans. Of course, a big junk of Federal government's funding of research also goes toward healthcare so perhaps Dr. Makary is counting that as healthcare spending too?

Also healthcare spending is increasing faster than inflation and has been for decades. Healthcare spending is projected to be close to 20% of the US GDP by 2028. So healthcare spending which is already the #1 Federal budget expenditure will likely be an even larger % of the Federal budget by 2028. So you may well be correct that healthcare spending may not be that close to 50% of the Federal budget today. Perhaps we can agree spending related to healthcare is already the largest % of the Federal budget today and seems on track to become even a greater percent of total Federal spending in the years ahead?
 

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How does a traffic accident victim shop around?
Lots of ways.

Since u don't specify what kind of "traffic accident" then I will. Someone gets a sprain & has time to go across town to some clinic. How about someone living outside the U.S. & gets in a traffic accident & goes to an overseas hospital. We're getting into so many details that mess it all up that it's about time for Americans to rethink Obamacare, take a deep breath about "pre-existing conditions", and then make the hard choice of opening the medical care market to all and confining government intervention to charity work.
 

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Nothing "right wing" in that video. He wants Americans to live healthier lives, and therefore spend less on healthcare.
Sure, live healthier lives!!! But look at the data - diets almost always fail. Hard to get around that little problem with talking points....
Actually, that's the only way to solve it.
No, the free market encourages us to eat lots of stuff that is really unhealthy and do so many times a day. Billions are spent every year to encourage that, drink sugar laden beverages, eat lots of simple and cheap carbs, load up with HFCS and sugar.
 

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Lots of ways.

Since u don't specify what kind of "traffic accident" then I will. Someone gets a sprain & has time to go across town to some clinic. How about someone living outside the U.S. & gets in a traffic accident & goes to an overseas hospital. We're getting into so many details that mess it all up that it's about time for Americans to rethink Obamacare, take a deep breath about "pre-existing conditions", and then make the hard choice of opening the medical care market to all and confining government intervention to charity work.

Nice dodge...
 

ElChupacabra

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Sure, live healthier lives!!! But look at the data - diets almost always fail. Hard to get around that little problem with talking points....

No, the free market encourages us to eat lots of stuff that is really unhealthy and do so many times a day. Billions are spent every year to encourage that, drink sugar laden beverages, eat lots of simple and cheap carbs, load up with HFCS and sugar.
+1000

Add to that generally sedentary lifestyles and you end up with a pretty bad combination. I'm not sure how much of the "MAH RIGHTZ!!!" plays into this as well, since you will have the folks who will argue this is more of a "freedom" issue than a medical one.
 

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New Zealand has a two tier healthcare system - private and public. Guess which one makes you wait 3 months for cancer treatment:

Well I agree healthcare and healthcare policy is a big topic. I am not so sure socializing our healthcare system will fix it. Why? For the five decades before America socialized much of its healthcare system (mid-1960s) via LBJ's creation of Medicare and Medicaid and the CMS, healthcare was about 5% of the US GDP. Once the Federal government got involved the % of GDP has increased far faster than inflation and is now close to 18% of GDP and is on a trajectory to be close to 20% by 2028. So it is clear that what the US and Federal government is currently doing now has us spending more than all other countries while there are many countries where life expectancy is greater than in the US at far lower cost. So coming up with policies to effect changes that will cut cost and/or improve the health of Americans seem something we should all be interested in.

I will check out your link to the NZ healthcare system soon.
 

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Lots of ways.

Since u don't specify what kind of "traffic accident" then I will. Someone gets a sprain & has time to go across town to some clinic. How about someone living outside the U.S. & gets in a traffic accident & goes to an overseas hospital. We're getting into so many details that mess it all up that it's about time for Americans to rethink Obamacare, take a deep breath about "pre-existing conditions", and then make the hard choice of opening the medical care market to all and confining government intervention to charity work.
No need to put scare quotes around 'pre-existing conditions.' They are a real barrier in the 'free market.' If you've been sick, and have a chronic illness, who will insure you in a 'free market'?

What does 'opening the medical market to all' mean?

And there isn't a government on the planet that confines government intervention to "charity work" - whatever that means.
 

RealityChecker

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I watched the video and didn't see anything new. For starters, he blames obesity and related ailments on what someone eats and claims, remarkably, that to fix that we just need to eat better - go on diets, effectively. The problem is diets almost always fail. Every bit of data shows this - no matter the diet, after a year or two all the gains are reversed for the VAST majority of those trying them. And it cannot be because everyone going on a diet is a weakling, with no willpower, who we can blame because diets the data show almost never work don't work for them. If something fails maybe 90% of those who try it, maybe that something is the problem, not the person. We even know why - diets reduce base metabolism, so when you cut calories, your metabolism slows and you get on a cycle of having to cut ever more calories to lose weight, and as you do that, metabolism slows some more, requiring fewer calories, etc. So the person is hungry all the time. No wonder they fail. So suggesting cooking classes, as he did, as an answer to the problems of obesity and Type 2 diabetes is just nonsense. Yes, they might help a bit for a small number of people, but WHAT someone is eating appears to be at best only part of the problem.

Further, even if you could get individual A to change his diet, and lose weight, and exercise every day, and keep the weight off for years, for that to work at the level of the population would require a lot of food companies in the U.S. to go to zero, as we all ditch everything in about half the aisles of the grocery store, freezer section and restaurants to only eat veggies, lean protein and lots of olive oil. Well, those companies spend $billions each year to convince us NOT to do that but consume ever more of their offerings, in part subsidized by government that promotes corn and wheat and sugar, makes them cheaper to us, and also cheaper to those buying food for themselves and their families. When we went 'healthy' on our diet a few years ago, our grocery bill about doubled. Fresh veggies and berries and other healthy fruits aren't cheap, neither is lean protein. And not everyone can take the 2 hours per night it takes roughly to cook, eat, then clean up afterwards.

The best answer I've seen to obesity is some form of fasting - intermittent fasting effectively. When you don't eat anything, you don't spike blood sugar, and insulin doesn't spike and you don't have barriers to using your fat as fuel. But the point is that approach takes as a given that 'diets' fail, and promoting diets such as Atkins or low carb, etc. that just do not work are guaranteed to fail the vast majority of patients, and so offers a different and simple alternative. Whether that works long term is an open question, but what is simplistic and essentially worthless advice is to just say - eat better, and exercise. That's where the video is - promoting simplistic notions as solutions.
I agree with much of what you posted. However, the research on intermittent fasting is not all that encouraging for effecting long term weight control. The scientific evidence on diet and its role in promoting obesity is something I am very familiar with. I think you are correct that calorie restriction and low carb diets have high failure rates. Part of the reason is no doubt all the fattening foods and drinks that now make up the bulk of the calories most Americans are consuming.

We now close to 40% of Americans being obese (BMI of 30 or more), and the majority of those who are not obese are overweight with those being normal weight (BMI<25) now a shrinking minority of Americans. In the 1960s nearly 3/4 of Americans had BMIs <25 and only about 10% had BMIs of 30 or more and are considered obese. So what has changed since the 1960s to cause this major increase resulting in far more Americans ending up overweight and obese? More on this latter but in the interim I would like to hear your perspective. Thanks
 

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The only way we lick this problem is by people understanding that if we live healthy, eat healthy and stay active, the costs for everyone go down and as a nation we will be more competitive on the global stage. Unfortunately this requires two things:

1. People with strong wills to make good life choices (given our obesity epidemic etc., we're at a clear deficit here)

2. Willingness to support legislation to encourage people with weak wills (the majority of Americans) to make better choices without crying 'freedom!' or 'Marxist!' or <random race-related argument> every time the idea is discussed.

So long as we can't make progress on increasing the number one people who fall under #1 and/or the number who are willing to fall under #2, throwing more money at the problem is a bandaid at best.
I largely agree with your post. One caution though is that will power alone is not likely to prevent weight gain and improve long term health. Will power has to be focused on making diet and lifestyle changes that promote the loss of excessive body fat stores and improve overall health. Pitting will power against hunger ends up with a battle between hunger and intellectual will that largely fails to result in long term weight control, but appears to be the main reason most people develop eating disorders.

What kind of legislation and policies do you think may help incentivize Americans to adopt healthier diets and lifestyles? From my perspective it seems most healthcare laws and regulations if anything remove incentives for people to be more pro-active in taking care of their own health. Your Thoughts?
 

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No need to put scare quotes around 'pre-existing conditions.' They are a real barrier in the 'free market.' If you've been sick, and have a chronic illness, who will insure you in a 'free market'?

What does 'opening the medical market to all' mean?

And there isn't a government on the planet that confines government intervention to "charity work" - whatever that means.
The prob w/ socialism is that eventually u run out of other people's money. Healthcare will always be limited, either by cost or by long lines --so long that u could die while waiting. Let's not play games like wondering what "charity work" means. We can work together or u can play by yourself, but I'll warn u, if u play it by yourself too much u can go blind.
 

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How does a traffic accident victim shop around?

First of all emergency care is only 2% of all Health Care spending Id provide a link but I'm on my phone right now.

Second bleeding accident victims do shop for a ride to the hospital. They often take an Uber instead of calling the local government-granted ambulance monopoly.

I'll provide evidence for both claims when I get home later if you need it
 

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No, the free market encourages us to eat lots of stuff that is really unhealthy and do so many times a day. Billions are spent every year to encourage that, drink sugar laden beverages, eat lots of simple and cheap carbs, load up with HFCS and sugar.

That's only a problem if other people have to pay because of your bad diet choices.
 

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While I agree that there are faults in the system it is still a far improvement over what america has at the moment.

The American system is terrible, but it's terrible because of government intervention, not because of private property in the means of production regarding healthcare.

That is the point of intelligent socialism as opposed to the stupid version americans keep parroting.

Socialism is public control of the means of production. That means making production and distribution decisions by politics. Can you think of any example from building a car to running a factory to planting crops on a farm or even cutting hair, where decisions would be better off made by a bunch of dumb-ass politicians?

A private and public health care system can actually work together. Many smaller nations than america have proven this point.

Regarding your first point, you have to have private health care available because if you don't people will end up dying in the streets.

Yes socialism works best with small homogeneous countries. It works worse the bigger it gets.
 

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I agree with much of what you posted. However, the research on intermittent fasting is not all that encouraging for effecting long term weight control.
I've not seen the long term studies on IF, but I have seen the long term studies on diets and they all come to the same, sad conclusion - they nearly always fail.
The scientific evidence on diet and its role in promoting obesity is something I am very familiar with. I think you are correct that calorie restriction and low carb diets have high failure rates. Part of the reason is no doubt all the fattening foods and drinks that now make up the bulk of the calories most Americans are consuming.
What's a 'fattening food?'
We now close to 40% of Americans being obese (BMI of 30 or more), and the majority of those who are not obese are overweight with those being normal weight (BMI<25) now a shrinking minority of Americans. In the 1960s nearly 3/4 of Americans had BMIs <25 and only about 10% had BMIs of 30 or more and are considered obese. So what has changed since the 1960s to cause this major increase resulting in far more Americans ending up overweight and obese? More on this latter but in the interim I would like to hear your perspective. Thanks
Part of it is we believed 'low fat' was healthy. It's really not, at least when 'low fat' means simple carbs, which is what has happened - we switched from fat to various forms of sugar or sugar equivalents, pasta, bread etc.

Also, I've seen lots of data that we used to eat, on average, 3 meals a day. That meant an 'intermittent fast' of about 12-14 hours per day for everyone on average. Now we eat from sunup to bedtime and a 'fast' of 7 or 8 hours. Well, when each meal spikes blood sugar, and insulin, and we are eating all day, every day, that leaves us in a constant state of fat storage, versus fat burning, and store fat is what we do really well on that diet of eating 10-12 times per day.

I know what works for me - cut out simple carbs, eat nothing after dinner. When I do that I lose weight. When I don't do that, no matter what I eat, I lose weight. And it's because the crap we (or I at least) eat as snacks at 11pm right before bed isn't a salad or an apple, but chips or ice cream or crackers with cheese or peanut butter - something to spike blood sugar and insulin and put me into fat storage mode right as I'm going to sleep.

For the past few months, all I've done is extend that norm from the 1960s (something like a 12-12 or 14-10 IF just as a lifestyle for most of us) to a roughly 18-6 IF. So I don't eat except after about 1pm, and then quit with dinner around 7pm. And without caring at all what I eat (except to drastically reduce sugars and refined carbs like bread, cookies, etc.) I've dropped 24lbs.
 
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