Broken US Healthcare System

[Greenbeard]

ACA and all other government policies starting with Medicare and Medicaid have only resulted in far higher health care cost. Why? They ignore the causes of disease and subsidize and reward those who simply treat diseases largely with drugs and surgery. This has worked well for the medical establishment that has lobbied for policies that work for them but not for society and certainly do not incentivize healthier diets and lifestyles. But when government policies fail the result is usually bigger government and more naïve policies that do not really fix vexing societal problems.

All of Title IV of the ACA is about the causes of disease: Title IV. Prevention of Chronic Disease and Improving Public Health. And all of Title III of the ACA is about changing the business model underpinning health care by starting to pay health care providers for restoring and maintaining health, not simply dispensing more drugs and surgery: Improving the Quality and Efficiency of Health Care.

Meanwhile health care cost growth in the years after the ACA was enacted was the lowest on record.

 

[Taylor]

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.

Avoid sugar.

You're welcome.

 

[JasperL]

Exactly correct. Freedom requires personal responsibility. The progressive left believes others should be forced to pay for the mistakes and misfortunes of others. What other people eat in a free society is their responsibility. If they make poor choices they should pay the price. What others eat does not impact my health but if I am required to pay more taxes because of choices others make I am losing my individual liberty and the authoritarian state is forcing me to pay for choices others make.

The problem with that is no one can really identify the cause of the obesity 'epidemic' and there is no known 'diet' or other intervention that doesn't have a near perfect record of failure. In just a few decades, obesity went from rare to over one third of all adults in some states. No one really knows the causes, but I think we can safely assume 100 million Americans didn't suddenly all lose their willpower overnight, become weak fat slobs, who let themselves go for no reason but sloth. Something at the core of our society changed, and every other western society, and much of the rest of the world changed, all at the same time, because obesity is a growing problem pretty much everywhere. And lots of people are victims. Studies of twins and adoptive kids show some of it is clearly genetic - have thin parents and the odds are you'll be thin, and vice versa. So luck of birth has a lot to do with it, but certainly not all, given how rapidly obesity has increased in recent decades.

So you're blaming people for something we don't really know the cause. Worse, the kind of 'dieting' that is suggested simply fails, nearly everyone. Once a person becomes obese we pretty much know that current diets will fail to take the weight off and keep it off. So this approach says - F*** you! - to the obese when we as society can't identify what causes them to become obese, and nothing in medical science or nutrition or anything else provides any hope that a given obese person can realistically 'solve' their problem with better choices - eat less!! Exercise more!!! Show me a study of that approach and you'll show me a study that it nearly always fails.

Socialized medicine reduces the consequences or at least the costs of poor diet and lifestyle choices. Private insurance ought to be based on risk. Drive recklessly and get a lot of tickets or accidents and you ought to pay more for auto insurance. That discourages reckless or risky driving. Justice demands people be held accountable for the choices they make. Progressive leftist seek to force others to pay for the choices other make. That is simply not fair and it actually encourages bad behavior by removing the monetary cost for taking risks.

If the conservative rightists want to say to my deep red state - hey, all you fat people, about 1 in 3 of all adults, who are otherwise red blooded Americans who work hard and go to church but are fat, to hell with you. **** you. You're a fat slob and it's good and proper that you all get charged out the rear end for healthcare!! Do it, see how that goes. I have a feeling that conservative rightists will agree with those "Progressive leftists" who aren't all that keen on charging 1/3 of their voters a surcharge for bad life choices. And it wouldn't just be eating and obesity. Smoking. Drinking too much. Sitting on your ass watching football too much. Not enough sleep. Working too many hours and too much stress. Not getting a colonoscopy or breast cancer screening as recommended. Etc.

And we need to apply this to Medicare (should be a winner for the senior vote!!) and obviously employer plans. Nearly everyone who wants a free market approach has insurance at work, and of course they don't have to worry about pre-existing conditions there, because of federal law, but want different rules to apply to those who don't get it at work but on the ACA exchanges, and maybe Medicaid. Free markets for them, the nice cozy rules of employer provided insurance for ME!!!

 

[JasperL]

Avoid sugar.

You're welcome.

Wouldn't it be grand if life were as easy as trite talking points....

 

[Taylor]

Wouldn't it be grand if life were as easy as trite talking points....

Don't want to cut the sugar? By all means, continue to throw up your hands and complain about how impossible everything is -- maybe there's a secret DNA sequence that only Americans have that makes them fat no matter what they do.

 

[RealityChecker]

JasperL claims: "The problem with that is no one can really identify the cause of the obesity 'epidemic' and there is no known 'diet' or other intervention that doesn't have a near perfect record of failure. In just a few decades, obesity went from rare to over one third of all adults in some states. No one really knows the causes, but I think we can safely assume 100 million Americans didn't suddenly all lose their willpower overnight, become weak fat slobs, who let themselves go for no reason but sloth. Something at the core of our society changed, and every other western society, and much of the rest of the world changed, all at the same time, because obesity is a growing problem pretty much everywhere. And lots of people are victims. Studies of twins and adoptive kids show some of it is clearly genetic - have thin parents and the odds are you'll be thin, and vice versa. So luck of birth has a lot to do with it, but certainly not all, given how rapidly obesity has increased in recent decades." JL

Well no doubt genes play a role in obesity as they do with most diseases. But you cannot blame the four fold increase in obesity since the late 1960s on genes because most children today are fatter than their parents and far fatter than their grandparents. And your claim that no one really knows why people are getting fatter is not known. One big factor is the increase in beverage calories that provide little satiety per calorie. In the 1950s and 1960s the average American consumed 5 to 10% of their calories from beverages. Today for most Americans it is up to 20 to 30% of calories from beverages. A bottle of coke out of a vending machine was 6oz. You go to the movies today and the "small" soda is 12 to 16oz. And the average Americans consumes far more calorie dense foods - mostly as snacks and often when not even hungry. You may not know why people are far fatter today but it ain't genes. We are getting fatter mainly because we consume more calories from foods and drinks with a low satiety per calorie ratio. And we more often consume those low satiety per calorie foods and drinks when we are not even hungry. The solution to any problem starts with understanding what is causing it. Sadly most MDs who get to diagnose and treat diseases largely focus on treating diseases after they become rather advanced. hey may talk about prevention but our healthcare system pays little to prevent disease and hundreds of billions to MDs, hospitals, and drug companies for medical treatments for ills that are mostly (certainly not always) caused by poor diet and lifestyle choices.

Indeed, health insurance does not assure health. Mostly it insures that MDs, hospitals, drug companies, medical equipment makers, and the rest of the medical establishment increasingly funded via tax dollars and government mandated so-called health insurance. RC

 

[RealityChecker]

Don't want to cut the sugar? By all means, continue to throw up your hands and complain about how impossible everything is -- maybe there's a secret DNA sequence that only Americans have that makes them fat no matter what they do.

Genes cannot be changed. However, our genes evolved long ago and do not equip us to maintain a healthy body weight in the modern toxic food environment. Do you think it is a coincidence that wherever modern foods and drinks displace more traditional diets obesity rates increase dramatically in those places? Obesity is hardly unique to America. So genes that once prepared our ancestors for famines today have most Americans better prepared for a famine than ever, but the risk of that famine is now as remote as it has ever been. You can take man out of nature but you cannot take the nature out of man. We are genetically equipped for a diet and lifestyle that fewer and fewer people on the planet are consuming.

It is very possible to adopt a diet and lifestyle that will largely prevent obesity and other ills but finding someone who understands what does and does not promote weight gain is a challenge. And even if you find an expert trying to get your "health" insurance plan to pay for an education is going to be challenging too.

 

[soylentgreen]

Laissez faire means "hands off". Which part of the American healthcare system is hands off? As far as I know, every aspect of it is highly regulated by the government.



Ah, you mean the Hitler kind of socialism, where the state directs "private" firms.



Sure, like the Post Office. It really proves your point too, because US postal workers have an incredible reputation for speed, competence, and efficiency.



The reason to prohibit private healthcare is to create more equal outcomes. In NZ, you have one system for the wealthy and one for the poor. The rich get cancer treatment immediately, while the poor wait for 3 months, and some of them will die while they wait. Leftists do not like unequal outcomes like this. In fact, leftists in Quebec tried to outlaw private health insurance, but the Supreme Court of Canada struck the law down, basically because the public system sucks donkey dick.

Chaoulli v Quebec (AG) - Wikipedia

en.wikipedia.org

Being a socialist today is the intellectual equivalent to being a flat earther.



Not for the same reason. Socialism is centralized control from the top down, and when the central planner makes a mistake, millions and millions of people pay the price, while he gets off scot free.

Capitalism is decentralized, and when firms perform poorly they are killed by the market. Capitalism scales well, socialism does not.

No, in this case laissez faire refers to the fact that your medical industry from production to delivery is based on maximum profit .

No, of course not. Once again you demonstrate that your only real argument is to think up really stupid ways of doing socialism as the only way you have of any defense. I have named the kind of countries that I am referring to so it can only be that you are disingenuous to suggest otherwise.

Really, your going to use an example of how americans run a government owned public service. Again I accuse you of thinking up really stupid ways of doing things.

There is no good reason to prohibit private health care. I am not responsible for your attempt to create a silly way of doing socialism. A waiting period is far more sensible than bankrupting a person and forcing them to sell their house in order to pay for treatment as people do in america.

https://www.npr.org/sections/health...ills-maddening-errors-and-endless-phone-calls

Not being a socialist is the equal of being a trump supporter.

And again, your only defense is to try and create the belief that ideology is all that matters. But worse still you always think up really dumb ways of doing that ideology. Why would anyone want to let people who defraud the system get away with it? So why have an ideology as you describe it?

America is not capitalist. Your country is owned by corporates that span the entire globe. That is laissez faire capitalism. Which is not the capitalism you keep harking on about.

 

[jonny5]

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

Just because other countries spend less and have different results doesnt make them better or worse. We should not be trapped in looking at things relative to other big groups, but instead look at individuals. Personally I think we need to get out of this mindset of there being a govt solution to everything. We dont need the govt to design a better system, we need to get the govt out of it entirely.

Im not here to watch videos though. What point is he making that you agree with?

 

[Taylor]

Genes cannot be changed. However, our genes evolved long ago and do not equip us to maintain a healthy body weight in the modern toxic food environment. Do you think it is a coincidence that wherever modern foods and drinks displace more traditional diets obesity rates increase dramatically in those places? Obesity is hardly unique to America. So genes that once prepared our ancestors for famines today have most Americans better prepared for a famine than ever, but the risk of that famine is now as remote as it has ever been. You can take man out of nature but you cannot take the nature out of man. We are genetically equipped for a diet and lifestyle that fewer and fewer people on the planet are consuming.

It is very possible to adopt a diet and lifestyle that will largely prevent obesity and other ills but finding someone who understands what does and does not promote weight gain is a challenge. And even if you find an expert trying to get your "health" insurance plan to pay for an education is going to be challenging too.

It's not a challenge at all. If there's sugar on the label, don't eat it. You'll feel run down and maybe nauseated for a week or two while your body adjusts, but then the weight will come off. If you're a Cheez-it nut, throw out the refined flours as well.

 

[RealityChecker]

It's not a challenge at all. If there's sugar on the label, don't eat it. You'll feel run down and maybe nauseated for a week or two while your body adjusts, but then the weight will come off. If you're a Cheez-it nut, throw out the refined flours as well.

I have seen no convincing evidence that sugar somehow promotes obesity. Nor have I seen any evidence showing eliminating sugar causes nausea. Perhaps you are talking about ketogenic diets in which all carbohydrates are severely restricted resulting in ketosis that can certainly cause nausea? No doubt a lot of sugar is added to beverages and most beverage calories do promote excess calorie intake and weight gain. I (and other researchers) have shown free access to sugar water promotes weight gain and increased fat stores in rodents compared with free access to dry refined sugar. So cutting out sugar is certainly a good idea. But the idea that sugar is uniquely obesogenic (obesity promoting) is dubious. Cheese-Its are certainly going to promote weight gain like sugar sweetened drinks. This is because they are calorie dense and low in fiber and not because high-carbohydrate diets promote weight gain.

The suggestion that refined grains or high carbohydrates diets promotes obesity is dubious because we have seen obesity and type 2 diabetes increasing markedly in Japan as their dietary carbohydrate intake, from mostly white rice, declined and their intake of more Western-style foods increased. Indeed, in every population that has started consuming more highly processed and refined foods and more fatty animal products we have seen an increase in obesity, diabetes, and other disease that are all too common in the US and other modern countries adopting a more Westernized diet. Such diets also promote elevated serum cholesterol levels and atherosclerosis. Atherosclerosis is the biggest modifiable risk factor for heart attacks and a major promoter of stroke too.

Eating fried pork rinds instead of potato chips is not associated with weight loss as far as I know even though only the chips have much carbohydrate. It appears to me you may have bought into the false narrative of the late Dr. Robert Atkins and other low-carb diet promoters?

 

[RealityChecker]

Just because other countries spend less and have different results doesnt make them better or worse. We should not be trapped in looking at things relative to other big groups, but instead look at individuals. Personally I think we need to get out of this mindset of there being a govt solution to everything. We dont need the govt to design a better system, we need to get the govt out of it entirely.

Im not here to watch videos though. What point is he making that you agree with?

I largely agree with what you stated although the fact that the US spends a far higher % of its GDP on healthcare than any other developed country and yet life expectancy does strongly suggest that our healthcare system is not all that cost effective. I believe Chile spends per capita only about 1/7 what we do and yet they have almost the same life expectancy as Americans.

The video is only 5 minutes and Dr. Makary suggests that the best way to reduce American's high medical expenses is people adopting healthier diets and lifestyles rather than more government regulations, mandates, and and subsidies. I tend to agree with Dr. Makary. From your comment I suspect you may agree with Dr. Makary too? Am I wrong?

 

[jonny5]

I largely agree with what you stated although the fact that the US spends a far higher % of its GDP on healthcare than any other developed country and yet life expectancy does strongly suggest that our healthcare system is not all that cost effective. I believe Chile spends per capita only about 1/7 what we do and yet they have almost the same life expectancy as Americans.

The video is only 5 minutes and Dr. Makary suggests that the best way to reduce American's high medical expenses is people adopting healthier diets and lifestyles rather than more government regulations, mandates, and and subsidies. I tend to agree with Dr. Makary. From your comment I suspect you may agree with Dr. Makary too? Am I wrong?

Well again, who cares what other countries do? Our govt doesnt exist to spend more or less on healthcare than somewhere else. It exists to provide a secure and free country for YOU to spend or not whatever you want on whatever you want. Maybe you spend 0 on healthcare, and live long or die early. Thats up to you. I dont say 'you dont spend enough/more compared to me' and i should do something about it.

I agree though, people need to take better care of their health, on their own. And that will likely cost them less in personal health care spending. Heres an even better way to reduce the cost to me though: stop making me pay for others. I spend $7000 a year on other peoples health care (through payroll and income tax). Stop doing that, and my spending on healthcare goes way down.

 

[JasperL]

Don't want to cut the sugar? By all means, continue to throw up your hands and complain about how impossible everything is -- maybe there's a secret DNA sequence that only Americans have that makes them fat no matter what they do.

Cutting out sugar, by itself, won't solve anything. It helps.

JasperL claims: "The problem with that is no one can really identify the cause of the obesity 'epidemic' and there is no known 'diet' or other intervention that doesn't have a near perfect record of failure. In just a few decades, obesity went from rare to over one third of all adults in some states. No one really knows the causes, but I think we can safely assume 100 million Americans didn't suddenly all lose their willpower overnight, become weak fat slobs, who let themselves go for no reason but sloth. Something at the core of our society changed, and every other western society, and much of the rest of the world changed, all at the same time, because obesity is a growing problem pretty much everywhere. And lots of people are victims. Studies of twins and adoptive kids show some of it is clearly genetic - have thin parents and the odds are you'll be thin, and vice versa. So luck of birth has a lot to do with it, but certainly not all, given how rapidly obesity has increased in recent decades." JL

Well no doubt genes play a role in obesity as they do with most diseases. But you cannot blame the four fold increase in obesity since the late 1960s on genes because most children today are fatter than their parents and far fatter than their grandparents.

As I said..... "So luck of birth has a lot to do with it, but certainly not all, given how rapidly obesity has increased in recent decades."

And your claim that no one really knows why people are getting fatter is not known. One big factor is the increase in beverage calories that provide little satiety per calorie. In the 1950s and 1960s the average American consumed 5 to 10% of their calories from beverages. Today for most Americans it is up to 20 to 30% of calories from beverages. A bottle of coke out of a vending machine was 6oz. You go to the movies today and the "small" soda is 12 to 16oz. And the average Americans consumes far more calorie dense foods - mostly as snacks and often when not even hungry. You may not know why people are far fatter today but it ain't genes.

If you know, show the research. It's not happening just in America but pretty much everywhere, Europe, Asia, etc. Anecdotes about serving sizes isn't evidence of anything.

We are getting fatter mainly because we consume more calories from foods and drinks with a low satiety per calorie ratio.

That claim needs evidence. What kind of foods have a 'low satiety per calorie ratio?' You seemed to imply that includes fats, but I don't think the evidence shows consuming fats is the cause of the obesity problem all over the planet. More likely it's sugar and highly refined carbs.

And we more often consume those low satiety per calorie foods and drinks when we are not even hungry.

Really? How do you know this? We get signals from our bodies to tell us when we are hungry, when we are not, and those signals worked for a very long time. What happened in the last 50 years to screw that up for 100 million people? That's just in this country - same thing happened to 100s of millions more in other countries.

The solution to any problem starts with understanding what is causing it. Sadly most MDs who get to diagnose and treat diseases largely focus on treating diseases after they become rather advanced. hey may talk about prevention but our healthcare system pays little to prevent disease and hundreds of billions to MDs, hospitals, and drug companies for medical treatments for ills that are mostly (certainly not always) caused by poor diet and lifestyle choices.

Indeed, health insurance does not assure health. Mostly it insures that MDs, hospitals, drug companies, medical equipment makers, and the rest of the medical establishment increasingly funded via tax dollars and government mandated so-called health insurance. RC

You've not actually told us what's is causing it. You have opinions. My point above is I really don't believe you can point to evidence that indicates anyone really knows the cause. That's part of the problem. Then you want to blame 1/3 of the country for being weak willed slobs and charge them a premium for not dieting in a way that is almost guaranteed to fail, according to all the evidence.

 

[JasperL]

It's not a challenge at all. If there's sugar on the label, don't eat it. You'll feel run down and maybe nauseated for a week or two while your body adjusts, but then the weight will come off. If you're a Cheez-it nut, throw out the refined flours as well.

Amazing that 100 million obese people haven't figured out this easy solution!! You should write a short book. Would sell millions.

 

[RealityChecker]

Well again, who cares what other countries do? Our govt doesnt exist to spend more or less on healthcare than somewhere else. It exists to provide a secure and free country for YOU to spend or not whatever you want on whatever you want. Maybe you spend 0 on healthcare, and live long or die early. Thats up to you. I dont say 'you dont spend enough/more compared to me' and i should do something about it.

I agree though, people need to take better care of their health, on their own. And that will likely cost them less in personal health care spending. Heres an even better way to reduce the cost to me though: stop making me pay for others. I spend $7000 a year on other peoples health care (through payroll and income tax). Stop doing that, and my spending on healthcare goes way down.

Do you think I am advocating for more government spending on healthcare? My point is the US healthcare system is corrupt and overpriced in large part because of the Federal government's involvement. If it were up to me the Federal government would get out of the healthcare business completely. But how do you propose we get the Federal government out of the healthcare industry? Is there any chance of either major political party supporting the elimination of Medicare, Medicaid, and Obamacare? I rather doubt it. And what do you tell people now on dependent on Medicare who paid taxes for a program for 50 or more years based on the promise Medicare would be there for them when they retired?

 

[RealityChecker]

Amazing that 100 million obese people haven't figured out this easy solution!! You should write a short book. Would sell millions.

Actually I published a book on how to lose weight and keep it off without any need to count calories or go hungry back in the 1980s. It sold maybe 30,000 copies. Why? Turns out most Americans are not all that interested in what the scientific evidence shows are the foods and drinks promoting obesity.

Americans would rather take a drug to lower their elevated cholesterol level that stop eating foods loaded with saturated fat and cholesterol. And they'd rather take one or more drugs to lower their elevated blood pressure than cut back on dietary salt and adopt a DASH-style diet which we know can eliminate the need for most BP-drugs. Hell people are undergoing bariatric surgery to lose weight rather than stop eating the fattening foods drinks they crave. Health insurance pays for the surgery for many obese people who could lose weight and keep it off by cutting out all or at least most of the fattening foods and drinks that make up the majority of calories in the typical obese person's diet. You do not really need a nutritionist to tell you what they are. Even you figured out the foods you were eating late at night made you fat. You just mistakenly thought it was because of when you were eating them.

Our healthcare system [pays for medical interventions but pays little or nothing for health education and dietary counseling until after you have had the heart attack, heart bypass surgery, bariatric surgery or develop diabetes and/or failed kidneys because of elevated BP, cholesterol, and/or body fat stores. Our healthcare system is based on diagnosing a treating disease after it has developed. And it pays far more for MD visits and prescription drugs to treat diseases we know are caused largely by the typical modern diet. That is your reality check for the day. If you want to lower healthcare costs and have healthier Americans perhaps it is time to alter the policies that reward the status quo and consider rewarding those who adopt healthier diets and lifestyles rather than have the government rigging our healthcare industry with the perverse financial incentives that reward the medical-pharmaceutical complex and the hospitals and insurance companies while paying little more than lip service to the scientific reality of what is causing most serious illnesses in the USA.

 

[JasperL]

Actually I published a book on how to lose weight and keep it off without any need to count calories or go hungry back in the 1980s. It sold maybe 30,000 copies. Why? Turns out most Americans are not all that interested in what the scientific evidence shows are the foods and drinks promoting obesity.

Americans would rather take a drug to lower their elevated cholesterol level that stop eating foods loaded with saturated fat and cholesterol. And they'd rather take one or more drugs to lower their elevated blood pressure than cut back on dietary salt and adopt a DASH-style diet which we know can eliminate the need for most BP-drugs. Hell people are undergoing bariatric surgery to lose weight rather than stop eating the fattening foods drinks they crave. Health insurance pays for the surgery for many obese people who could lose weight and keep it off by cutting out all or at least most of the fattening foods and drinks that make up the majority of calories in the typical obese person's diet. You do not really need a nutritionist to tell you what they are.

If you want to cite the study that shows any diet, yours or anyone else's, has a long term record of success for someone obese, cite it. What I've seen is once a person is obese, the evidence is crystal clear - the diets fail 90% or more.

And the nutritionists don't agree. Some say a low carb diet works, and it does work, for some people. The Mediterranean is a big favorite currently, others promote vegetarian diets, others keto diets. So some say avoid fats, and others say you should get the large majority of your calories from fat. Eat fruit! Don't eat fruit because it has too much sugar!! Eat lots of small meals!! No, only eat one big meal per day!

Even you figured out the foods you were eating late at night made you fat. You just mistakenly thought it was because of when you were eating them.

That's not actually what I said. I know chips and ice cream and cheese and crackers = lots of calories, and they can all be fattening, and other than the cheese, really aren't part of anyone's healthy diet.

What makes sense to me and what has worked for me is fasting for maybe 18-20 hours per day. That system by definition cut out the late night snacks, whether refined carbs or pistachios or almonds or cheese - the last three part of my diet now. I'm not a shill for that diet, except to say it works for me, and it's the easiest thing I've ever done to lose weight. Almost effortless. I have a low level of 'hunger' that is with me all day, but I feel great, have lots of energy, work out fasted, hike fasted, walk the dogs fasted, fish fasted, and am clear headed, and it's easy to ignore the 'hunger' until 2 or 3pm, or dinner some days.

perhaps it is time to alter the policies that reward the status quo and consider rewarding those who adopt healthier diets and lifestyles rather than have the government rigging our healthcare industry with the perverse financial incentives that reward the medical-pharmaceutical complex and the hospitals and insurance companies while paying little more than lip service to the scientific reality of what is causing most serious illnesses in the USA.

We know obesity follows the 'western' diet - you've acknowledged this much - so let's punish, shame those, for taking part in...our western diet. And MASSIVE government subsidies go to the raw ingredients for what I think you'd agree are 'fattening' - refined carbs, HFCS, various oils, mostly wheat and corn derivatives. So those foods are very, very cheap, very satisfying, and our government effectively pays us to eat more and more and more and more of them. And the subsidies make it more affordable for those companies to spend billions telling us that's what we should be eating, many times a day! What a deal!

What's not subsidized? What is more expensive to eat? Everything we should be eating.

Anyway, we rig the system to make people fail, lots of them do fail, wherever our 'western' diet is introduced, and now your suggestion is we punish them for being suckers and doing what the government tells them to do, effectively pays them to do.

 

[Taylor]

I have seen no convincing evidence that sugar somehow promotes obesity.

And yet it's commonly listed as a primary causal agent in the literature.

Nor have I seen any evidence showing eliminating sugar causes nausea.

You probably haven't studied it - or better, haven't tried it yet! If you do, you won't be one of those people on the diet infomercials saying "I feel great! Like I'm 21 again!" You'll feel awful. Run down, jittery, depressed, and yes may have some nausea or headaches. But it will be worth it. The weight will come off, and the symptoms will go away.

You can get the gist here:

Sugar Detox: Symptoms, Side Effects, and Tips for a Low Sugar Diet

When giving up sugar, which some people refer to as a sugar detox, people may notice side effects. This article looks at the bodily effects of doing so and shares tips for a low sugar diet.

www.healthline.com

Perhapspsps you are talking about ketogenic diets in which all carbohydrates are severely restricted resulting in ketosis that can certainly cause nausea? No doubt a lot of sugar is added to beverages and most beverage calories do promote excess calorie intake and weight gain. I (and other researchers) have shown free access to sugar water promotes weight gain and increased fat stores in rodents compared with free access to dry refined sugar. So cutting out sugar is certainly a good idea. But the idea that sugar is uniquely obesogenic (obesity promoting) is dubious. Cheese-Its are certainly going to promote weight gain like sugar sweetened drinks. This is because they are calorie dense and low in fiber and not because high-carbohydrate diets promote weight gain.

No - this is just eliminating added sugar. You still maintain a balanced diet, including lots of carbs, proteins, and fats. I'm not saying you can just eat tubs of buttered popcorn everyday and lose weight so long as you cut sugar. Common sense applies.

The suggestion that refined grains or high carbohydrates diets promotes obesity is dubious because we have seen obesity and type 2 diabetes increasing markedly in Japan as their dietary carbohydrate intake, from mostly white rice, declined and their intake of more Western-style foods increased.

I mentioned "refined flours" not grains. I don't see anyone getting fat off of rice.

Grind it into a powder and mix it with some grease and you have a very different story - something that's much higher in calories and much easier to eat a lot of.

It's not so much that the refined flour is bad in itself - it's how it's usually prepared (with lots of added sugar and/or fat). If you could remove just the flour from 5 or 6 Oreos, you could reconstitute it and have the equivalent of a bowl of cream of wheat. Rice contains a lot of water, and that helps keep you from overeating.

 

[Taylor]

Amazing that 100 million obese people haven't figured out this easy solution!! You should write a short book. Would sell millions.

The best thing about it is that you don't need to read a book.

 

[Taylor]

Cutting out sugar, by itself, won't solve anything. It helps.

Try it out and you'll understand. It's a heuristic. By eliminating added sugars, you might be eliminating half of what you eat. Your body does take time to adjust, but eventually what you crave changes as well.

Not only are you forced to buy healthier food, it stops you from needless snacking - no more office donut. No more slice of cake from your coworker. No more free samples of cheesecake at Costco. No more treating yourself to a signature latte at Starbucks. No more ice cream before bed...

And yes, it does work. Lost enough weight doing this for 90 days to be ranked in the top 10 nationally for fat loss for my gym - those who did better were all much bigger people with more fat to lose. And the only exercise I did was walking for 30 minutes on the treadmill each week because I had to go to get weighed.

 

[Peter]

Healthcare should have a simple premise.
Nobody should avoid or go without healthcare because of an inability to pay.

Things like Insulin which people need to stay alive should not be expensive and should be as cheap as humanly possible or free.

 

[jonny5]

Do you think I am advocating for more government spending on healthcare? My point is the US healthcare system is corrupt and overpriced in large part because of the Federal government's involvement. If it were up to me the Federal government would get out of the healthcare business completely. But how do you propose we get the Federal government out of the healthcare industry? Is there any chance of either major political party supporting the elimination of Medicare, Medicaid, and Obamacare? I rather doubt it. And what do you tell people now on dependent on Medicare who paid taxes for a program for 50 or more years based on the promise Medicare would be there for them when they retired?

My point is we have a mindset problem. Everything is put in in the box thinking: this is the system, other people have the same system, but spend less. We need to make the system more efficient.

No, we need to get out of the box. Start over. How do we get the federal govt out? Thats a good question and I dont have a great answer. A few options are:

-allow opt out for young people. phase out for older people
-block grants to states to do whatever they want

Effectively, start by shifting responsibility to people and their states to come up with replacements and phase out the federal govt role. I pay for an HMO, i save for my retirement. Why am I still paying for federal healthcare?

 

[RealityChecker]

All of Title IV of the ACA is about the causes of disease: Title IV. Prevention of Chronic Disease and Improving Public Health. And all of Title III of the ACA is about changing the business model underpinning health care by starting to pay health care providers for restoring and maintaining health, not simply dispensing more drugs and surgery: Improving the Quality and Efficiency of Health Care.

Meanwhile health care cost growth in the years after the ACA was enacted was the lowest on record.

So tell us how much money is going to prevent disease and who it is going to out of the total being spent on healthcare dollars being spent on healthcare as a result of the ACA (a.k.a. Obamacare)? It is little more than lip service to prevention. Many of the disease prevention requirements are are costly and ineffective and do not address the cause of disease so they do not prevent it. One example. Under ACA there is a huge deductible that discourages people from seeking care. The ACA does pay for one so-called "wellness" office visit to an MD each year. What does that cover? The same thing people used to get for free at "health fairs". Thy check your BMI, BP , cholesterol, blood sugar, and maybe a more complete blood tests. Why did hospitals and other healthcare clinics do these for free? They often led to discovering some health issue that needed medical care. And ACA plans were required by law to pay for mammograms and I think PSA tests. Do these tests prevent breast cancer and prostate cancers and save lives? Nope most research suggests they make little or no difference in the outcomes of these cancers. They are used to detect cancers earlier but the best research suggests such screening drive up costs of treating these diseases but make very little or no impact on the risk of dying from these diseases.

Meanwhile you are parroting my main point and that is that the more involvement of the Federal government in healthcare has not resulted in lower costs nor made Americans healthier. The main way ACA likely helped slow the rise in healthcare has not improved outcomes. Indeed once Obamacare plans were mandated and people lost their private insurance plans they were required to buy heath insurance plans that had high deductibles. So was switching people from their private health insurance plans they liked and that paid for nearly all their medical expenses to an ACA plan that often cost more and covered nothing of value until the deductible was met? What that did was cause people forced on to these high deductible plans often with new doctors they did not want but ended up with because they lost the doctors they and their kids had been seeing for years that were not on the Obamacare plans. With a high deductible and a new MD they were unfamiliar with but whom they had to pay out of pocket for seeing and any treatment prescribed. Under their old plan that was all covered with perhaps a small co-pay. So what happened? Predictably people waited until they we far sicker before seeking medical care. Does that sound like good healthcare policy to you Greenbeard?

And let's take a look at how well it worked. For the first 3 years after ACA eliminated the private insurance plans people liked (despite lies told by Obama, Pelosi and Reed to sell the plan to Congress and mislead the public). Any idea Greenbeard what happened to life expectancy over the next 3 years of ACA mandated "health insurance" plans? Life expectancy fell for 3 straight years!!!

Let's review. Under ACA or Obamacare healthcare cost continued to climb albeit at a slightly slower rate (likely because most people saw MDs less and waited until they were even sicker because they could not afford the now for them far higher medical expenses). And life expectancy? Well that declined for 3 straight years. So net-net as the Federal governments role in healthcare expanded prices moved higher at a claimed slower pace likely because people were more reluctant to see an MD when sick but not terribly ill, and life expectancy declined. And you supported this brain dead fiasco Greenbeard?

 

[RealityChecker]

My point is we have a mindset problem. Everything is put in in the box thinking: this is the system, other people have the same system, but spend less. We need to make the system more efficient.

No, we need to get out of the box. Start over. How do we get the federal govt out? Thats a good question and I dont have a great answer. A few options are:

-allow opt out for young people. phase out for older people
-block grants to states to do whatever they want

Effectively, start by shifting responsibility to people and their states to come up with replacements and phase out the federal govt role. I pay for an HMO, i save for my retirement. Why am I still paying for federal healthcare?

Sounds like a reasonable goal to me. However, I think we need to do a lot of education about how badly government run healthcare is before it becomes politically viable. You know it will be opposed by the medical establishment, Federal healthcare bureaucrats, and those whose special interest in maintaining the status quo lose out if the Federal government's role is reduce and free enterprise is unleashed to solve this problem The progressive left and Democrats and too many Republicans see government as the solution and not inefficient wasteful bureaucracy it invariably turns in to.