HEALTHCARE IS ALL ABOUT WHO PAYS FOR WHAT

[LetsGoBrandon]

$400,000



The same National Healthcare System is implemented throughout the European Union - that's 27 countries and 448 million people - about 120 million more than the US!

If the US post-office can work in every state, why not a National Healthcare System? Americans are too dumb to handle it? Is that what you are saying!?!

Ditto post-secondary education. An American student from a middle-class family likey cannot pay the average annual cost of college and tuition. From here:


Here's the spread of annual household income in the US:

Annual household income in U.S. dollars	Percentage of U.S. households
35,000 to 49,999	11.6%
50,000 to 74,999	16.5%
75,000 to 99,999	12.2%
100,000 to 149,999	15.3%

How many of those families earning less than $50K a year can afford to send their kids to university? How many in the next range from $50-to-75K? My guess is that not more than 20% of households can afford the cost of a post-secondary degree in the US - and a good-many would have to go into debt to finance it!

My Conclusion: Without a major effort to upscale state-school post-secondary education affordably by the Federal government without a post-secondary level degree the middle-class kids are going to have one-helluva-hard-time making a decent living in the US ... !

So what's the problem that Americans do not seem to grasp? Too many think that nothing has changed. When in fact since the 1990s significant changes in the America economy have actually occurred. Manufacturing jobs have gone downhill (barely 8% of the workforce nowadays) and Services Jobs have exploded. But the services-industries jobs (typically-but-not-all) require a higher degree-level - called "post-secondary"! (The cost of which is shown above!)

You are all over the map attempting to justify nanny government.

 

[JasperL]

Oh, there is merit to the argument about whether productivity is the metric for quality,

Just to be clear, I'm not arguing which system is 'superior' overall. Healthcare is incredibly expensive, and huge numbers of any population including in the developed world simply cannot afford care without subsidies from employer or government. How to deliver care to the population will require significant decisions about trade-offs, and deciding among them creates big winners and losers, in ANY system.

Not all doctors are equal. France/UK specifically have a lot of GP physicians, but far fewer specialists. Good GPs are going to get you a bang for your buck, but life saving issues are almost always in specialist land. I would argue that the primary reason France has good results is that they are far healthier as a society. It's obesity, obesity, and obesity. Fat people chew up resources like crazy and then die sooner.

That's ultimately an objective claim - what's better overall. I don't have the answer, but there's also a downside to being specialty driven. Several in this thread mentioned MRI machines as a metric. Well, we have lots of them. My last ortho appt for a sore knee required a $700 MRI before my first appointment, the practice very helpfully and profitably owned the machine. He looked at it, said there's nothing he can do, rest. Total cost about $900 for a prescription for 'rest.' I'm sure if I needed surgery, he'd have been a great person to do it - he does many of them per week, and it was covered by insurance. But then we'd add more costs on top of that so I could exercise, bike, do a bit of jogging, as usual - didn't interfere with my normal activities. It's not at all clear that this 'luxury' item should be part of my insurance, or out of pocket, but that's the kind of decision we have to make as society to bring costs down. I could afford it, but many can't, and if you start making that like cosmetic surgery, lots of angry people.

Well, you can look at class ranks being accepted into med school. You can look at the USMLE scores for match rankings. You could look at the competitive program match rates. They are all showing more or less the same thing. The physicians being churned out today don't resemble their peers from a decade or two ago, let alone three or four.

I'll take your word for it, but I don't see how to track this over time, and I'm not sure it's evidence of a decline in the quality of doctors if true.

I would counter that our docs get paid more because they are simply working longer and doing more, certainly because they are incentivized to do so.

And we have half the number of doctors. That's by design, part of our system.

FWIW, there are no more 100 hour weeks in residency. ~20 years ago they shifted to the 80 hour week, then ~10 years ago to the 60 hour week. Most attendings will tell you that has had a serious negative impact on the quality of resident at graduation, dangerously so.

My point is being a doctor requires someone to take what is effectively a crap job, with long hours and crap pay for about a decade, post college.

 

[JasperL]

So I was out at dinner last night with some friends, 4 of whom happen to by physicians (ENT, Neuro, Ortho, ENT) and this came up. I asked them how often their weight loss counseling has made a difference, the answer universally was give or take 1%. This has been shown in various studies as well. Americans don't want to take responsibility for their health, instead they want a gastric sleeve and a pill.

I will address this separately because it's such a huge issue. As you suggested, obesity is at the heart of everything.

There are two options. 1) 99% (almost every single obese person) is a lazy, fat, worthless, POS slob who is unwilling to do what's asked, which seems unlikely, or 2) the advice is terrible, hence why it fails nearly every single patient. If success was, say, 30%, then a variation of option 1) would make sense. It's hard to lose weight, takes discipline, and those who do the work are a minority, but they DO succeed, so the advice is likely fine, at least for most. But I just don't believe good advice fails 99% or more of every single obese person.

I'd suggest the doctors look at that, and figure out why their efforts fail nearly all their patients. My guess is the advice is "eat less, move more" i.e. CICO, something about fat, sugar, or a variation, then a handout, or referral to a nutritionist who says the same thing in more words. Well, if that doesn't work for 99%, then it's useless, terrible advice. Easier to blame the patients as irresponsible moral failures than admit the advice is crap.

But the real problem is your doc friends are not paid to be nutritionists, or to walk a patient through weight loss. Everything in our system, from those doctors to the hospitals where they work, and all the jobs along the way, are incentivized to not give a damn about the obesity, just do the procedure, do the total knee, prescribe the very profitable drugs, and move on. Maybe that's why the advice that fails 99% or more is the "standard" advice, because the obese predictably failing the advice 99% of the time makes all those docs the most amount of money, and the most money for their hospitals, and the drug companies, and the food companies who still sell the refined, sugary, seed oil crap, and the sodas, and the fruit juices, and all the rest of the garbage food that got them, and about 40% of our population, obese.

To be clear, I'm not blaming them. They don't know crap about nutrition, they didn't learn it in med school, or if they did it's almost surely wrong in 2022, because they're not paid to know, and nothing in their job or pay provides them ANY incentive to know or to care. All the incentives are to not care, and they ARE giving the 'standard' advice, which is all they know. That it fails? Well, that's not their job description to figure out. If there was better advice, they'd give it out if they knew.

 

[Eriech]

Our entire healthcare system is built on a foundation of perverse incentives.

At least 9 new billionaires thanks to the vaccines that are now being mandated. This article from last spring when the vaccines were "free". They still are "free" I am told. Wonder how much members of government have invested in big pharma?

Covid vaccine profits mint 9 new pharma billionaires

Covid-19 vaccines have created at least nine new billionaires after shares in companies producing the shots soared.

www.cnn.com

 

[MamboDervish]

At least 9 new billionaires thanks to the vaccines that are now being mandated. This article from last spring when the vaccines were "free". They still are "free" I am told. Wonder how much members of government have invested in big pharma?

Looks like Trump did an excellent job of expediting that vaccine, eh?
Record time - record profits.

 

[Eriech]

Looks like Trump did an excellent job of expediting that vaccine, eh?
Record time - record profits.

He did. Mandating and shaming for "free" vaccines and tests not hurting their bottom line either.

 

[Lafayette]

You are all over the map attempting to justify nanny government.

This is a debate-forum. With your one-liners you should be on a Message Board ...

 

[Eriech]

Looks like Trump did an excellent job of expediting that vaccine, eh?
Record time - record profits.

I wonder how Mr and Mrs Fauci did in pharma stock selling "free" vaccines and test. Not that I am a cynic......

 

[jaeger19]

I will address this separately because it's such a huge issue. As you suggested, obesity is at the heart of everything.

There are two options. 1) 99% (almost every single obese person) is a lazy, fat, worthless, POS slob who is unwilling to do what's asked, which seems unlikely, or 2) the advice is terrible, hence why it fails nearly every single patient. If success was, say, 30%, then a variation of option 1) would make sense. It's hard to lose weight, takes discipline, and those who do the work are a minority, but they DO succeed, so the advice is likely fine, at least for most. But I just don't believe good advice fails 99% or more of every single obese person.

I'd suggest the doctors look at that, and figure out why their efforts fail nearly all their patients. My guess is the advice is "eat less, move more" i.e. CICO, something about fat, sugar, or a variation, then a handout, or referral to a nutritionist who says the same thing in more words. Well, if that doesn't work for 99%, then it's useless, terrible advice. Easier to blame the patients as irresponsible moral failures than admit the advice is crap.

But the real problem is your doc friends are not paid to be nutritionists, or to walk a patient through weight loss. Everything in our system, from those doctors to the hospitals where they work, and all the jobs along the way, are incentivized to not give a damn about the obesity, just do the procedure, do the total knee, prescribe the very profitable drugs, and move on. Maybe that's why the advice that fails 99% or more is the "standard" advice, because the obese predictably failing the advice 99% of the time makes all those docs the most amount of money, and the most money for their hospitals, and the drug companies, and the food companies who still sell the refined, sugary, seed oil crap, and the sodas, and the fruit juices, and all the rest of the garbage food that got them, and about 40% of our population, obese.

To be clear, I'm not blaming them. They don't know crap about nutrition, they didn't learn it in med school, or if they did it's almost surely wrong in 2022, because they're not paid to know, and nothing in their job or pay provides them ANY incentive to know or to care. All the incentives are to not care, and they ARE giving the 'standard' advice, which is all they know. That it fails? Well, that's not their job description to figure out. If there was better advice, they'd give it out if they knew.

Actually it's because the insurance companies don't pay for weight loss.
Only after you have barbaric surgery.
There is a lot of lip service that goes toward preventative medicine..but the system and that includes Medicare and especially Medicaid don't pay for it.
I have patients who could really benefit from therapy. It's hard to move more when your back hurts. Physical therapy with a licensed expert that can assess and supervise a program for them would be great. Their Medicare replacement requires a 40 dollar copay for each treatment.

 

[MamboDervish]

I wonder how Mr and Mrs Fauci did in pharma stock selling "free" vaccines and test. Not that I am a cynic......

?? Do you have any evidence that Fauci owns stock in Pfizer, Moderna, or J&J? It should be easy enough to verify, if you were more concerned with the truth, than with covering him in over-sprayed innuendo.

Fact checked from the Austin American-Statesman: "There is no evidence that Fauci is personally financially invested in a coronavirus vaccine, and scientists still don’t know if hydroxychloroquine is effective in treating COVID-19."

 

[JasperL]

Actually it's because the insurance companies don't pay for weight loss.
Only after you have barbaric surgery.

Right, that's my broader point. All the incentives in the healthcare system are for the obese to remain so, then treat the many predictable problems that will happen, including T2 diabetes. I'm positive very few if any doctors look at the problem that way, and purposely keep patients obese so they have a recurring income stream, but the point is the financial incentives are to do exactly that. If an endocrinologist reverses T2 diabetes, he's lost a patient for life. If he does the normal thing and just prescribes insulin etc. to an obese person, that requires regular and profitable checkups, testing, etc. And then the insulin makes the person more obese, then they have more joint problems, liver problems, etc. that all require very costly medical interventions.

Again, I'm sure the doctor would recommend something that works if they knew it works, but it's incredible to me that 4 doctors can all agree that their weight loss advice works MAYBE 1% of the time, and that's consistent across our entire healthcare system, and we aren't burning down the theories behind that advice and in desperate search of new ones, that do work.

And why that is can be explained by the financial incentives. No one makes money off a successful dietary 'prescription' that can be replicated for free. The 'plans' that appear to work also all start with eliminating sugar and processed food, especially processed carbs, so anything with wheat flour. Well, we can see what our biggest food and beverage companies mostly sell, and it's what everyone would agree are the first foods to eliminate. Who has a financial incentive to effectively zero out sales in many of the middle aisles of the typical grocery store, and maybe 90% of what's sold in convenience stores?

 

[Court Jester]

Healthcare in the US is a "racket" run by private-enterprise companies for a profit and individuals for a damn fine salary. The center-point of which are the healthcare-professionals who also earn high salaries. Yes, the doctors and nurses who are key to the profession.

Without a profit motive, what else can drive innovation and competition? Because as soon as you take away the profit motive, and then you instill government run anything, healthcare for all just ends up being as poorly run and inefficient as your department of motor vehicles is.

According to the Medscape Physician Compensation Report, in 2018, Primary-Care Physicians in the United States earned on average $237,000, while Specialists earned $341,000.

That isn't a lot of money. I live in California, and cops and high school teachers can expect to earn at least 150k per year.

 

[Lafayette]

DIFFERENCE OF OPINION

Without a profit motive, what else can drive innovation and competition? Because as soon as you take away the profit motive, and then you instill government run anything, healthcare for all just ends up being as poorly run and inefficient as your department of motor vehicles is.

What should be the profit-motive of healthcare if its purpose is both longevity and cure of illness?

None. These are afflictions of mankind simply because we exist on this planet. And we deserve help to overcome them, which is why we pay taxes.

Governments run the military, don't they? Any complaints there about spending too much money? Nope, no complaints!

The key attributes of any country are a decent pay-scale so that people/families can live comfortably. It is not for a tiny group to amass billions of dollars (that they do not even need) which should taxed-away and spent on educating our youth and helping all to obtain decent medical-attention!

These are two very important attributes of EU-countries, which is why they run public National Healthcare Systems and also why getting a post-secondary education is so inexpensive.

HOWEVER

there is another side to this coin as regards education. I went looking for an analysis of Best Education Systems. And I find a stark difference in ranking from two different sites:

From here US is the best: World Population Review
What country has the best education system 2020?

• United States. #1 in Education Rankings. No Change in Rank from 2020. ...
• United Kingdom. #2 in Education Rankings. ...
• Germany. #3 in Education Rankings. ...
• Canada. #4 in Education Rankings. ...
• France. #5 in Education Rankings. ...
• Switzerland. #6 in Education Rankings. ...
• Japan. #7 in Education Rankings. ...
• Australia. #8 in Education Rankings.

From here the US is in 20th place: 2021 World Best Education Systems

So, this particular issue seems to have a stark division of opinion regarding the best national education system from at least two studies ...

 

[Lafayette]

THE CHANCE OF SUCCESS

Without a profit motive, what else can drive innovation and competition? Because as soon as you take away the profit motive, and then you instill government run anything, healthcare for all just ends up being as poorly run and inefficient as your department of motor vehicles is.

Do you think Albert Einstein, Nikola Tesla, Charles Darwin (etc., etc.) needed a profit motive to accomplish what they did?

I don't - because innovation is natural to human nature. We all have a drive to do better but not all of us succeed in that goal.

My point being that earning megabucks in a modern-economy is mostly a brainless effort that takes just one good idea and its application successfully to the market system. And anybody can have that "one good idea" - all they need do is look for financial backers and some brilliant marketeers.

But the chance of success is not necessarily automatic ...

 

[Court Jester]

What should be the profit-motive of healthcare if its purpose is both longevity and cure of illness?

None. These are afflictions of mankind simply because we exist on this planet. And we deserve help to overcome them, which is why we pay taxes.

Why shouldn't there be a profit motive in healthcare same as other human needs? You accept a profit motive in farming and ranching don't you? Everybody needs to eat, but we don't expect a restaurant not to charge for food. How about housing? Should a landlord not be allowed to collect rent?

I see no inherent right to free healthcare unless it is to care for people who are too old or infirm, or cognitvely impaired to pay for it themselves. In my opinion you cannot have really good healthcare when it all becomes the same for everyone at no fee, or when paid for by the taxpayer. Just like a great restaurant, it will attract people willing and able to pay more for better service.

Governments run the military, don't they? Any complaints there about spending too much money? Nope, no complaints!

That is the job of the government, to defend a nation. I have no problem with tax payers supporting the military. What annoys me is the more than half of people in my country who pay no taxes; don't support the miltiary, and then are the same ones who expect free education, free healthcare, and free housing. For somebody to no pay for something, only means somebody else had to pay more. Nothing is really free.

The key attributes of any country are a decent pay-scale so that people/families can live comfortably.

Why? If people cannot afford to support their own children, then don't have children. I believe everyone needs to be encouraged to live within their means. If somebody cannot afford something, then that is great way to encourage them work harder, strive for a better education, save, and then beyond that go into business for themselves and benefit from their own profit motive.

It is not for a tiny group to amass billions of dollars (that they do not even need) which should taxed-away and spent on educating our youth and helping all to obtain decent medical-attention!

Why not? Why do you care if somebody has billions, millions, or thousands if they earned it? Truth is that billionaires and for profit companies actually employ people and then raise their standards of living to be higher. Problem with socialism is that it all seems great, until they run out of other people's money.

These are two very important attributes of EU-countries, which is why they run public National Healthcare Systems and also why getting a post-secondary education is so inexpensive.

I hate to break this news to you, and it isn't something which is just affecting EU countries, we have it here too. But the very success of capitalist democracies ends up becoming unsustainable as more and more immigrants from other places like Africa and the middle east arrive and exploit your great social programs, but then don't contribute to the society.

HOWEVER

there is another side to this coin as regards education. I went looking for an analysis of Best Education Systems. And I find a stark difference in ranking from two different sites:

From here US is the best: World Population Review
What country has the best education system 2020?

• United States. #1 in Education Rankings. No Change in Rank from 2020. ...
• United Kingdom. #2 in Education Rankings. ...
• Germany. #3 in Education Rankings. ...
• Canada. #4 in Education Rankings. ...
• France. #5 in Education Rankings. ...
• Switzerland. #6 in Education Rankings. ...
• Japan. #7 in Education Rankings. ...
• Australia. #8 in Education Rankings.

From here the US is in 20th place: 2021 World Best Education Systems

So, this particular issue seems to have a stark division of opinion regarding the best national education system from at least two studies ...

Best education needs to be analyzed not by how much money is spent, but by results. I can tell you that some of the school districts here in the USA which get the most money, have the worst results. Los Angeles unified school district would be one of those.

 

[Court Jester]

Do you think Albert Einstein, Nikola Tesla, Charles Darwin (etc., etc.) needed a profit motive to accomplish what they did?

Not everything is motivated by money, but eventually it will need to be funded or sustained by money. Tesla probably should have watched over his money a well as he put into coming up with his technologies, which later on people made money from.

I don't - because innovation is natural to human nature. We all have a drive to do better but not all of us succeed in that goal.

Yeah, we get that. Cavemen wanted fire to keep warm because freezing to death is not fun. But do you really think that the guy who collected the most firewood was just doing it keep other cavemen warm? He was likely bartering his labor efforts for something else of value. In other words: profit motive.

My point being that earning megabucks in a modern-economy is mostly a brainless effort that takes just one good idea and its application successfully to the market system. And anybody can have that "one good idea" - all they need do is look for financial backers and some brilliant marketeers.

But the chance of success is not necessarily automatic ...

Success is not impervious to either good luck or bad luck. However, most wealthy people didn't just find buried treasure. Most took a risk and then worked hard before ending up rewarded.

 

[Lafayette]

Success is not impervious to either good luck or bad luck. However, most wealthy people didn't just find buried treasure. Most took a risk and then worked hard before ending up rewarded.

What you are talking about is "success of the individual", what I am talking about is success of the individuals. Plural!

We are thus on two different planets. Yours purely selfish, mine more open and encompassing of humanity.

Which are two alternately different "ways of living" - yours is highly self-centered malarkey and thus puerile ...

 

[Lafayette]

THE MASTERS OF THE UNIVERSE OF WEALTH

At least 9 new billionaires thanks to the vaccines that are now being mandated. This article from last spring when the vaccines were "free". They still are "free" I am told. Wonder how much members of government have invested in big pharma?

Covid vaccine profits mint 9 new pharma billionaires

Covid-19 vaccines have created at least nine new billionaires after shares in companies producing the shots soared.

www.cnn.com

Which is why the US needs badly an upper-income level that is a "cut-off" in terms total income earned. All income beyond that level should be confiscated by the government!

Of course that is "Selfish Communism" or some other similar epithet for these Masters of the Universe of Wealth ...

 

[Eriech]

THE MASTERS OF THE UNIVERSE OF WEALTH



Which is why the US needs badly an upper-income level that is a "cut-off" in terms total income earned. All income beyond that level should be confiscated by the government!

Of course that is "Selfish Communism" or some other similar epithet for these Masters of the Universe of Wealth ...

Or not have businesses selling to the government in bulk a product that they have no liability for.

 

[Lafayette]

Or not have businesses selling to the government in bulk a product that they have no liability for.

Do you mean the government cannot sell to 50-states the same communications-software to interface a satellite network across the country?

Or is it that the Feds do not WANT such a network to be their responsibility. It is likely to be one BIG pain in the arse to manage its development across the 50-states. And, of course, there's the "international connexion" that must done as well.

It aint gonna be easy even if by satellite ...

 

[jaeger19]

Right, that's my broader point. All the incentives in the healthcare system are for the obese to remain so, then treat the many predictable problems that will happen, including T2 diabetes. I'm positive very few if any doctors look at the problem that way, and purposely keep patients obese so they have a recurring income stream, but the point is the financial incentives are to do exactly that. If an endocrinologist reverses T2 diabetes, he's lost a patient for life. If he does the normal thing and just prescribes insulin etc. to an obese person, that requires regular and profitable checkups, testing, etc. And then the insulin makes the person more obese, then they have more joint problems, liver problems, etc. that all require very costly medical interventions.

Again, I'm sure the doctor would recommend something that works if they knew it works, but it's incredible to me that 4 doctors can all agree that their weight loss advice works MAYBE 1% of the time, and that's consistent across our entire healthcare system, and we aren't burning down the theories behind that advice and in desperate search of new ones, that do work.

And why that is can be explained by the financial incentives. No one makes money off a successful dietary 'prescription' that can be replicated for free. The 'plans' that appear to work also all start with eliminating sugar and processed food, especially processed carbs, so anything with wheat flour. Well, we can see what our biggest food and beverage companies mostly sell, and it's what everyone would agree are the first foods to eliminate. Who has a financial incentive to effectively zero out sales in many of the middle aisles of the typical grocery store, and maybe 90% of what's sold in convenience stores?

The problem isn't the theories behind the advice.
The reason that 1% of their advice works isn't because tge advice is bad it's because.
1. Patients don't want to follow it.
2. If they want to follow it there are roadblocks to following it..like time and expense.

By the way..the financial incentive for an endocrinologist reversing diabetes would be far greater in the number of patients he would be seeing.
The thing is..by the time somone is seeing an endocrinologist..the time for reversal is likely over.
In fact by the time a person is seeing a general.practitioer for diabetes..the time for reversal is likely over for most patients.

 

[JasperL]

The problem isn't the theories behind the advice.
The reason that 1% of their advice works isn't because tge advice is bad it's because.
1. Patients don't want to follow it.
2. If they want to follow it there are roadblocks to following it..like time and expense.

I don't believe that 99% of their patients don't "want" to follow it. To me it's both arrogant and cruel to blame people for not succeeding on a plan that the people dispensing knows will fail 99 of 100.

The typical advice is CICO, eat less, move more. Put another way, it's to be hungry, therefore tired and irritable, all the time, for maybe a year. And when you deprive your body of calories with simple calorie restriction, we know the body adjusts by lowering metabolism, then a weight loss plateau, which means you have to cut more calories, be more hungry, to maintain the weight loss. Then you're hungry when you reach your goal weight, and so the advice is in practice to be hungry for the rest of your life. Wonder why that fails?

What makes more sense to me is obesity is a hormonal problem - basically too much insulin - and if the advice doesn't fix that it will fail. If the advice does fix that, it can and does often succeed. You should look into LCHF diets. They make sense to me, and there's a growing body of literature to support that idea. The short answer is to get people adapted to burning fat, which then frees up the 100s of thousands of calories stored as fat as 'ready' food when we don't consume calories. It's still hard, and requires daily discipline, but instead of nearly 100% failure, it's more like 70%. I'm a little biased because I did this, LCHF and IF, and lost 50lbs with very little effort or discomfort. As we speak today, at noon, I've had no food and am not hungry. I'll eat around 2 after an appointment, and I'm at goal weight, so it's just that I don't need to eat, not that I'm trying to skip meals.

By the way..the financial incentive for an endocrinologist reversing diabetes would be far greater in the number of patients he would be seeing.
The thing is..by the time somone is seeing an endocrinologist..the time for reversal is likely over.
In fact by the time a person is seeing a general.practitioer for diabetes..the time for reversal is likely over for most patients.

Again, I don't think that's true. Seriously, there's growing research that T2 diabetes can be reversed very quickly. The problem is, essentially, that a person's blood sugar is too high. Well, if you consume minimal carbs such as on a keto diet, blood sugar stays low, without drugs.... And the number of essential carbs per day is 0g.

There are lots of practitioners doing this routinely and getting people off insulin in days or weeks. Continuous glucose monitors are critical in this, because they give instant feedback on what foods shoot a given person's blood sugar up, and then allow for people to control what they eat to prevent it. They also show instantly that it's very possible to control blood sugar with diet, without drugs.

 

[danielpalos]

Should the Justice Department have their domestic terrorism team look into instances of unequal protection of the laws as well; especially if it can be proved the problem is Institutional not Individual? Unequal protection of the laws results in an abridgment of the ability to function conveniently in our market based economy. We should have no homeless problem and our healthcare coverage should be more market friendly to lower the Cost of Government.

 

[jaeger19]

I don't believe that 99% of their patients don't "want" to follow it. To me it's both arrogant and cruel to blame people for not succeeding on a plan that the people dispensing knows will fail 99 of 100.

The typical advice is CICO, eat less, move more. Put another way, it's to be hungry, therefore tired and irritable, all the time, for maybe a year. And when you deprive your body of calories with simple calorie restriction, we know the body adjusts by lowering metabolism, then a weight loss plateau, which means you have to cut more calories, be more hungry, to maintain the weight loss. Then you're hungry when you reach your goal weight, and so the advice is in practice to be hungry for the rest of your life. Wonder why that fails?

What makes more sense to me is obesity is a hormonal problem - basically too much insulin - and if the advice doesn't fix that it will fail. If the advice does fix that, it can and does often succeed. You should look into LCHF diets. They make sense to me, and there's a growing body of literature to support that idea. The short answer is to get people adapted to burning fat, which then frees up the 100s of thousands of calories stored as fat as 'ready' food when we don't consume calories. It's still hard, and requires daily discipline, but instead of nearly 100% failure, it's more like 70%. I'm a little biased because I did this, LCHF and IF, and lost 50lbs with very little effort or discomfort. As we speak today, at noon, I've had no food and am not hungry. I'll eat around 2 after an appointment, and I'm at goal weight, so it's just that I don't need to eat, not that I'm trying to skip meals.

Again, I don't think that's true. Seriously, there's growing research that T2 diabetes can be reversed very quickly. The problem is, essentially, that a person's blood sugar is too high. Well, if you consume minimal carbs such as on a keto diet, blood sugar stays low, without drugs.... And the number of essential carbs per day is 0g.

There are lots of practitioners doing this routinely and getting people off insulin in days or weeks. Continuous glucose monitors are critical in this, because they give instant feedback on what foods shoot a given person's blood sugar up, and then allow for people to control what they eat to prevent it. They also show instantly that it's very possible to control blood sugar with diet, without drugs.

Well you may not want to believe it but yes.. a very good portion of people do not want to follow our advice when it comes to weight loss.
I have asked patients to do simple things. Like " let's start with just a food diary. Just write down or put in your phone what you have eaten for the next month..
Then we will go over it to see the changes you could make..I'll see you after clinic hours so no charge to you. "
Invariably the will call to say for me not to stay after because they didn't fill it out.
Now in the extremely rare case they do comply..invariably I can find some wasted calories they can get rid off.. like soda. For example.." see here.. you had two twenty ounce sodas a day. If you cut to just one twenty ounce soda. That saves 250 calories a day. That means you could lose 1 pound every two weeks..
( and then I mention exercise to prevent the body fromowering its metabolism long term)
Frankly it's an even smaller percentage that get rid of even that one soda.

Now there are lots of barriers to it.. for example a large soda at McDonald's is 99 cents while the small is also 99 cents etc.
But yes..patient compliance is a major issue.

And low carb high fat diets also have their problems.. especially in people uneducated about healthy sources of fat vs just fatty foods. And they can be dangerous in people with liver problems gallbladder pancreas or thyroid issues.

And ultimately...most people cannot adhere to a strict keto diet.

By the way..cutting out 250 calories from soda and going for a walk everyday does mot mean people are going to have feel starved all the time.

 

[JasperL]

Well you may not want to believe it but yes.. a very good portion of people do not want to follow our advice when it comes to weight loss.

99% isn't "a very good portion." That's nearly universal, and you're condemning 99% as effectively being fat, lazy, undisciplined slobs who don't give a shit they are killing themselves, and they know it. I do not think that is fair.

I have asked patients to do simple things. Like " let's start with just a food diary. Just write down or put in your phone what you have eaten for the next month..
Then we will go over it to see the changes you could make..I'll see you after clinic hours so no charge to you. "
Invariably the will call to say for me not to stay after because they didn't fill it out.
Now in the extremely rare case they do comply..invariably I can find some wasted calories they can get rid off.. like soda. For example.." see here.. you had two twenty ounce sodas a day. If you cut to just one twenty ounce soda. That saves 250 calories a day. That means you could lose 1 pound every two weeks..

That kind of advice doesn't work. If it was as easy as that, everyone would succeed, and we wouldn't have an obesity epidemic. Do you really think 99% of the obese are unwilling to cut out one soda?

( and then I mention exercise to prevent the body fromowering its metabolism long term)
Frankly it's an even smaller percentage that get rid of even that one soda.

The studies show that exercise is great for lots of reasons, just not for weight loss.

Now there are lots of barriers to it.. for example a large soda at McDonald's is 99 cents while the small is also 99 cents etc.
But yes..patient compliance is a major issue.

And low carb high fat diets also have their problems.. especially in people uneducated about healthy sources of fat vs just fatty foods. And they can be dangerous in people with liver problems gallbladder pancreas or thyroid issues.

And ultimately...most people cannot adhere to a strict keto diet.

By the way..cutting out 250 calories from soda and going for a walk everyday does mot mean people are going to have feel starved all the time.