Broken US Healthcare System

[Dayton3]

If everyone was successful all the time, we wouldn't have bothered with civilization.

shouldn't a certain percentage of your population failing (and suffering), say 10% be acceptable to everyone?. More than half of my dads family were losers and failures and he didn't go off on a crying jag.

 

[Hamish Howl]

shouldn't a certain percentage of your population failing (and suffering), say 10% be acceptable to everyone?. More than half of my dads family were losers and failures and he didn't go off on a crying jag.

You don't get it. You are one car accident away from being a failure.

 

[Dayton3]

You don't get it. You are one car accident away from being a failure.

I'm disabled you know. I am a failure. But thanks to my dad, I have plenty of money.

 

[Hamish Howl]

I'm disabled you know. I am a failure. But thanks to my dad, I have plenty of money.

You have a really dismal view of the world.

 

[Dayton3]

You have a really dismal view of the world.

The current world is pretty dismal in my view Hamish. It isn't all peace and love.

 

[skeptic llc]

The problem is, sure, we CAN all eat a healthier diet. There's just precious little if any evidence that a diet change on its own solves the obesity epidemic, here and really all over the western world, wherever 'westernized' diets are introduced. So it's not just a U.S. problem, we're just ahead of the pack here.

Just for example, I'm pretty sure Oprah Winfrey has a cook for all her meals, and she's lost weight, and gained it back. It's not because she's eating McD, and given her success over decades I imagine she's as disciplined in her personal life as anyone. No one gets to her perch, and stays there, being lazy or weak willed. I'd imagine her diet is very 'healthy' as those things go and compared to everyone else. And she with all her money, a personal cook, the best food ingredients available to her, still can't keep her weight in the healthy zone. And there are 100 million like her, plus or minus. 35% of adults in my state are obese. Did their laziness or character or whatever really change that much in the last 20-30 years, as the obesity rate more than tripled?

I don't think you can look at the data and conclude it's eating out at what we consider unhealthy 'fast food' restaurants. So the 'cause' isn't really well known, and there is really nothing in the data to point to a single cause. It's likely a bunch of related factors all doing their bit. Part of it no doubt is our food industry that spends $billions telling us to eat processed garbage and them convincing us all it's healthy. Part of it might be we have a 'culture' of eating many times a day, 6 on average, 10-12 times pretty common, when you include all the snacks, drinks, etc. that contain calories. That's up from 3 in the 1970s. I've had my own nutrition experts tell me several snacks is healthy, but maybe it's actually terribly unhealthy, as it keeps blood sugar and insulin elevated all day long, leading to insulin resistance and a vicious downward cycle. The data aren't clear on that, but the fasting proponents believe it to be true, and have a ton of anecdotal evidence of fasting working.

We really don't know as we sit here, which is why the experts disagree, and recommend things that are contradictory. Eat fat! Don't eat fat! Carbs are bad!! Eat 60% of your diet from carbs!! Vegetarian! Keto!! Paleo!! Lots of small meals!! One big meal per day!!

Yeah, sure if our society puts a bunch of food companies out of business, and a bunch of restaurants fold for lack of customers, as we all eat better and avoid half of what's for sale in the local Kroger, we'd be better off. But wishing for that without KNOWING the cause of obesity and why it's growing just is nothing but wishful thinking, IMO, and when we don't know, and we don't, blaming the victims isn't helpful and won't work except to make smug thin people feel better.

Holy hell, that was a great serious answer. I was baiting a bit (but no mods, not in the way that should earn me points) to see the response, and you rose to the challenge. We clearly have problems with unhealthy habits, but as your response explains better than I ever could, there is something else crucial missing in our current ability to even understand what is going on. Thanks for the thoughtful reply.

 

[Dayton3]

Yes, people are free to not get medical care they could just die instead.

Saying medical care is optional is moronic.

Implying or saying that a lack of medical care is a death sentence is equally "moronic".

 

[Peter]

Implying or saying that a lack of medical care is a death sentence is equally "moronic".

Yes, all those people going for cancer care or injecting insulin should just stop and save some money.
I'm sure they'll be just fine and dandy.

 

[Paradoxical]

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.

We need to take away the lawsuits against doctors and hospitals. If we do that, premiums will plummet.

 

[Dayton3]

Yes, all those people going for cancer care or injecting insulin should just stop and save some money.
I'm sure they'll be just fine and dandy.

You have evidence that a significant number of those without health insurance are cancer or diabetes sufferers?

Thought not.

 

[Peter]

You have evidence that a significant number of those without health insurance are cancer or diabetes sufferers?

Thought not.

The number of US people without health insurance is in the tens of millions.
Approximately 39.5% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2015–2017 data).

Cancer Statistics

Basic information about cancer statistics in the United States and how they are used to understand the impact of cancer on society and to develop strategies that address the challenges that cancer poses.

www.cancer.gov

 

[RealityChecker]

Holy hell, that was a great serious answer. I was baiting a bit (but no mods, not in the way that should earn me points) to see the response, and you rose to the challenge. We clearly have problems with unhealthy habits, but as your response explains better than I ever could, there is something else crucial missing in our current ability to even understand what is going on. Thanks for the thoughtful reply.

Well it was not really a great answer and unlike JasperL I actually am an expert on diet and nutrition. Oprah maintained a healthy weight a long time while actually consuming a healthy diet that had a low calorie density, plenty of fiber, very limited beverage calories, and ate only when hungry and until comfortably full. Penn Gillette lost even more weight eating only plain potatoes when hungry and until comfortably full. Oprah now following Weight Watchers guidelines, which perhaps coincidently came about after Weight Watchers expert sat in on my "Biology of Weight Control" lecture about 15 years ago. And the rocket scientist (literally) who recommended Penn go on the potato diet came up with that approach after watching me dismantle wannabe nutrition experts on LinkedIn discussion groups. Contrary to popular mythology potatoes are not fattening but are a high satiety per calorie food. Hell if potatoes were fattening all the Irish peasant whose diet consisted of about 90% potato calories would have been overweight and far more likely to have survived the potato famine when their main food source was largely wiped out by a Mexican fungus that arrived in Ireland in 1945 and spread rapidly wiping out more and more subsistence farmers who mostly survived on potatoes alone.

Of course, French fries, potato chips, and Pringles are fattening because they are calorie dense and low in fiber and far more prone to be eaten when not hungry than a plain baked or microwaved potato (or sweet potato), which was all Penn ate when is lost 100lbs and dramatically improved his very high BP and dyslipidemia that were likely to have killed him had he not stopped eating a typical American diet full of fattening foods. Importantly Penn lost that weight without counting calories and eating a potato whenever he was hungry. Potatoes are a high satiety food so do not promote obesity. Food For Thought

 

[Dayton3]

The number of US people without health insurance is in the tens of millions.
Approximately 39.5% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2015–2017 data).

Cancer Statistics

Basic information about cancer statistics in the United States and how they are used to understand the impact of cancer on society and to develop strategies that address the challenges that cancer poses.

www.cancer.gov

Prove it. The first line. And not with "evidence" from a health care advocacy organization. For example you cannot count illegal aliens in that "millions" number.

And being "diagnosed with cancer" is a very misleading play on words.

 

[Peter]

Prove it. The first line. And not with "evidence" from a health care advocacy organization. For example you cannot count illegal aliens in that "millions" number.

And being "diagnosed with cancer" is a very misleading play on words.

So, you ask for evidence and I provide it and you just decide that NIH is somehow not good enough?
I also have a feeling that people being told they have cancer will want treatment and I said nothing about illegal aliens.

The number of people without health insurance is a well known figure and is a huge part of the discussion and the 40% rate of people getting cancer is also well known.

What exactly do you disagree with? Do you think the uninsured are somehow less likely to get cancer?

 

[Dayton3]

So, you ask for evidence and I provide it and you just decide that NIH is somehow not good enough?
I also have a feeling that people being told they have cancer will want treatment and I said nothing about illegal aliens.

The number of people without health insurance is a well known figure and is a huge part of the discussion and the 40% rate of people getting cancer is also well known.

What exactly do you disagree with? Do you think the uninsured are somehow less likely to get cancer?

I refer to an American Spectator article a few years back that challenged the oft repeated figure that "40 million Americans didn't have health care insurance".

The article broke down that number and the first to pulled out were the millions of those counted who are illegal aliens.

Not all cancers need to be (or even should be) treated. Some types of prostate cancer for example.

 

[bave]

Why do you think that? Huge numbers of seniors on Medicare buy supplemental policies to cover what Medicare doesn't. You can't have missed the ads on TV selling these policies that are in addition to Medicare....

Medicare is more generous in terms of coverage, availability, and quality than what is available in places like France and England through their state sponsored payors. You can pull the statistics, but you can compare some pretty basic things like joint replacements, heart surgery, spine surgery, etc. A lot of things that, honestly, don't make financial sense for the nation but keep older people alive longer with a higher quality of life.

Americans are very weirdly protective of their private health care system even though I believe that most bankruptcies there are health care related.

That is inaccurate. If you look at the actual data collection on this topic you can see right thru it and realize it is a pretty big falsehood in an attempt to make the healthcare system look horrendous. In a nutshell they look at bankruptcies and if you have any portion of unpaid medical expense, then they are attributing the cause of the bankruptcy to medical bills. So, if you have $100,000 in credit card debt and owe $50 to a doctor's office, that is a medical bankruptcy in their world. I'm not saying it doesn't create financial pressure in some circumstances, but it is extraordinarily rare to be the primary cause of bankruptcy. The simple fact is that if you have a family of four in the US your max OOP for total healthcare expenses is capped reasonably low. Will it hurt if you get hit with repeated medical bills? Yes, but it isn't going to be a bankrupting even in isolation.

I think you'll find the biggest complaint in America is the cost of things like insulin.

The cost in the US is absolutely outrageous compared to the rest of the world and you can't blame the cost of R&D because it was invented decades ago by a guy who gave the patent away for free because he wanted such a life-saving drug to be cheap.

This is another poor representation of the facts. You can buy insulin all day long in the US for ~$10-20/month supply. The issue is that all insulin is not the same. The standard, generic, insulin you are referring to is pig isolated and not nearly as effective as the new synthetics that are specifically created and targeted. The results between the various types of insulin are dramatic and wide, especially as the disease progresses. The difference in the analyses on global insulin prices is that they are often comparing the average price of insulin distributed in the US (where almost no standard insulin is dispensed) and they compare that to countries like France where obesity is far less severe and the majority of the insulin is the old cheap variety.

My point is it isn't apples to apples.

 

[Aunt Antifa]

I refer to an American Spectator article a few years back that challenged the oft repeated figure that "40 million Americans didn't have health care insurance".

The article broke down that number and the first to pulled out were the millions of those counted who are illegal aliens.

Not all cancers need to be (or even should be) treated. Some types of prostate cancer for example.

Do you support death panels then, eh?

 

[RealityChecker]

We are discussing the broken US healthcare system. A major reason Americans pay more than people in other countries is that our healthcare system is not focused on preventing disease but on treating diagnosing disease and treating disease mostly with drugs and surgeries. Many medical treatments cost a lot and do little or no good at increasing quality of life years. For many Americans they will rack up more medical bills in their last several months of life as they will the rest of their lives. Is this money well spent? If you look at cost effectiveness much of that late in life medical treatments are not extending life as much as they are delaying the dying process. Indeed, for many people even if the treatments do prolong their life a bit those extra days or weeks are likely to be hardly worth living. People often opt for usually futile medical treatments because they believe they may be cured and get to enjoy living again. But for most I suspect if they could have known the results of those often very expensive medical interventions they would have opted for hospice care.

There are too many people arguing that less access to medical care means a dramatic increase in morbidity and mortality. But if you look at the top 10 causes of death in America most are caused largely by smoking, alcohol, recreational drugs, poor dietary habits, sleep habits, and/or inactivity. Research suggests we could reduce heart disease, cancer, COPD, stroke, diabetes, and kidney disease far more by changing our diet and lifestyles than relying on modern medical care rather than addressing the causes of pre-mature mortality. Our current healthcare system enriches the medical establishment. If funneling more tax dollars to cost ineffective medical tests and treatments was stopped it would save tens of billions of dollars and have very little or no impact on how long people live on average. By contrast, there are few financial incentives and even some disincentives to adopt healthier diets and lifestyles. If you want to reduce your risk of earlier in life morbidity and mortality access to "free" or low cost medical care is not nearly as import as diet and lifestyle choices and avoiding risky behaviors.

 

[RealityChecker]

Do you support death panels then, eh?

All socialized medical care programs do not pay and even deny access to high cost medical interventions that do little to no good when it comes to increasing quality of life years. What you call "death panels" are part of every country's tax payer funded medical care policies. Do you believe Medicare and Medicaid pay for any and all medical tests and procedures? If so you do not understand how these work. Indeed, most private health insurance plans do not pay for any and all medical efforts to keep people alive a bit longer no matter the cost.

 

[Aunt Antifa]

All socialized medical care programs do not pay and even deny access to high cost medical interventions that do little to no good when it comes to increasing quality of life years. What you call "death panels" are part of every country's tax payer funded medical care policies. Do you believe Medicare and Medicaid pay for any and all medical tests and procedures? If so you do not understand how these work. Indeed, most private health insurance plans do not pay for any and all medical efforts to keep people alive a bit longer no matter the cost.

So death panels.

 

[JasperL]

Well it was not really a great answer and unlike JasperL I actually am an expert on diet and nutrition.

You have an opinion like all other experts, and many of those opinions of the experts are contradictory. You've said, several times, IF doesn't work, then you cite a study that shows it does work. You've never cited a study showing it fails, and are oblivious, apparently, of the studies that show some IF plans dramatically improve metabolic markers. Here's a NEJM link that summarizes that research.

https://www.nejm.org/doi/full/10.1056/NEJMra1905136

Here's a recent study at the Univ. of Alabama showing the gains aren't tied to weight loss, but restricted feeding times - in this case from 7am to 3pm.

Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes

Intermittent fasting (IF) improves cardiometabolic health; however, it is unknown whether these effects are due solely to weight loss. We conducted th…

www.sciencedirect.com

Men with prediabetes were randomized to eTRF (6-hr feeding period, with dinner before 3 p.m.) or a control schedule (12-hr feeding period) for 5 weeks and later crossed over to the other schedule. eTRF improved insulin sensitivity, β cell responsiveness, blood pressure, oxidative stress, and appetite. We demonstrate for the first time in humans that eTRF improves some aspects of cardiometabolic health and that IF’s effects are not solely due to weight loss.

You dismiss the results I've had by inventing my diet pre and post and concluding it was changes to what I ate, but you don't know anything about my diet.

Oprah maintained a healthy weight a long time while actually consuming a healthy diet that had a low calorie density, plenty of fiber, very limited beverage calories, and ate only when hungry and until comfortably full.

Can you cite a study of Oprah's daily eating, what she ate over months and years? I'd love to see that in detail.

 

[bave]

Do you support death panels then, eh?

With regards to government spending, yes. We shouldn't be throwing vast sums of money into lost causes. If someone wants to eat, drink, or abuse drugs then the government should cap what they spend on them. As you age that scale should slide. The idea that we are going to spending $3MM doing organ transplants on 70 year olds is insanity.

 

[RealityChecker]

You have an opinion like all other experts, and many of those opinions of the experts are contradictory. You've said, several times, IF doesn't work, then you cite a study that shows it does work. You've never cited a study showing it fails, and are oblivious, apparently, of the studies that show some IF plans dramatically improve metabolic markers.

Actually, IF largely succeeds only in people who lose weight and keep it off. That almost always is accompanied by changes in what they are eating. Research in animals shows losing even 5-10% of body weight and keeping it off is far more efficacious for improving health and longevity than IF in animals. The data in humans is not as convincing but it is clear most of the long term benefits seen in people are likely largely due to reduced calorie intake and maintaining a lower body weight. There are some minor changes in some metabolic markers in small short term studies that suggest there may be some metabolic changes that may be partially independent of changes in body weight. However, there are both positive and negative changes reported in small short term studies. We have no data from long term RCT in humans of the independent impact of IF on health outcomes.

FYI -Not all nutrition experts are equally expert so many have opinions that are out of sync with a logical and critical assessment of all the relevant research data available on a given topic.

You dismiss the results I've had by inventing my diet pre and post and concluding it was changes to what I ate, but you don't know anything about my diet.

You said when you adopted the IF approach you stopped eating those fattening foods late at night. And the fact that you lost a lot of weight tells me you did not just eat them earlier in the day but were eating far less fattening foods. If you just ate them for breakfast instead you would not have lost weight. One does not need to be much of a nutrition expert to figure that out. Generally, when people gain or lose a lot of weight it is because they calorie intake went way up or down, respectively.

Can you cite a study of Oprah's daily eating, what she ate over months and years? I'd love to see that in detail.

There are no studies of Oprah, but it is no secret she kept off a lot of weight along time when she had a personal chef and fitness trainer. It was when she stopped eating healthy foods and went back to the foods that promoted her obesity in the first place and stopped exercising that she became obese again. More here:

Oprah's Weight Loss Confession

Oprah speaks candidly about her weight gain and the medical and emotional issues that made her fall off the wagon. How she's getting back on track with the help of Bob Greene and making a commitment to live her best life.

www.oprah.com

 

[RealityChecker]

With regards to government spending, yes. We shouldn't be throwing vast sums of money into lost causes. If someone wants to eat, drink, or abuse drugs then the government should cap what they spend on them. As you age that scale should slide. The idea that we are going to spending $3MM doing organ transplants on 70 year olds is insanity.

Agreed. Public funds spent on healthcare must be limited and the least cost effective medical tests and treatments ought not be paid for. Doing everything medically possible to keep very old and seriously ill people alive a bit longer does more to harm society than benefit it. If people want everything possible to be tried to keep them alive even for another day or two they ought to be using their own money and not asking others to pay for what should be viewed as selfish behavior.

 

[JasperL]

Actually, IF largely succeeds only in people who lose weight and keep it off. That almost always is accompanied by changes in what they are eating.

And you ignored the cites showing you are wrong.

"Men with prediabetes were randomized to eTRF (6-hr feeding period, with dinner before 3 p.m.) or a control schedule (12-hr feeding period) for 5 weeks and later crossed over to the other schedule. eTRF improved insulin sensitivity, β cell responsiveness, blood pressure, oxidative stress, and appetite. We demonstrate for the first time in humans that eTRF improves some aspects of cardiometabolic health and that IF’s effects are not solely due to weight loss."

The subjects here lost no weight at all - they just restricted eating to an 18:6 IF diet.

Also, yes, IF is generally most useful to the obese and the #1 goal for someone obese is to get the weight off and keep it off. So your suggestion here is IF only works when people are successful in losing weight and keeping it off. Well, if people use IF to lose weight and keep it off, that's fantastic, awesome, an ideal outcome! That's where calorie restriction diets fail, nearly everyone.

The data in humans is not as convincing but it is clear most of the long term benefits seen in people are likely largely due to reduced calorie intake and maintaining a lower body weight.

But of course one main goal, THE main goal for most, of an IF diet is to lose weight, and keep it off. So why do we care about this distinction?

There are some minor changes in some metabolic markers in small short term studies that suggest there may be some metabolic changes that may be partially independent of changes in body weight. However, there are both positive and negative changes reported in small short term studies.

What are the negative changes? Can you list them, and cite your study that finds these negative metabolic changes?

You said when you adopted the IF approach you stopped eating those fattening foods late at night. And the fact that you lost a lot of weight tells me you did not just eat them earlier in the day but were eating far less fattening foods.

You mean less fattening foods like eggs, sausage, hamburger, steak, cheese, nuts, peanut butter, olive oil? I eat all those on a weekly basis, nuts and cheese daily, and lose weight under IF. I also eat berries 2-3 times a week, the occasional apple or peach or watermelon in this season, and veggies/salad/beans daily.

If you just ate them for breakfast instead you would not have lost weight. One does not need to be much of a nutrition expert to figure that out. Generally, when people gain or lose a lot of weight it is because they calorie intake went way up or down, respectively.

But again, you're fighting windmills. Obviously to lose a lot of weight on IF or any other diet, you have to consume fewer calories than you burn. What works for me under IF is that if I just have a snack around 3-4pm, usually nuts and/or cheese, then one big meal a day at 7pm roughly, I can easily cut calories, feel great, and burn a lot of fat during the fasting hours. The 'feel great' part is key - alert, only a small baseline amount of 'hunger' that's easily ignored, and with plenty of energy to do everything I want to do during the day, including exercise, all while in a fasted state. The 'feel great' part is also not surprising, since long fasting periods are what our bodies are designed to do, and function at a high level while fasted. Would be a disaster for the species if when we were in a fasted state and needed food, our bodies shut down and made us lethargic and dull-witted.

There are no studies of Oprah....

Exactly - you don't have a clue what her diet was like, and her experience is a cautionary tale. Even someone with all the resources in the world available to them, a huge amount of self discipline, amazingly successful in all other areas of her life, still couldn't lose weight and keep it off, failing very publicly multiple times. But you want to expect better results from some poor person working at Kroger.... And then blame them for being lazy and worthless for not keeping the weight off...