How health reform may help ... or hurt

[ziggy29]

By definition if it is genetic driven it is not a behavior.

That's my point. Not everything we associate with "bad lifestyle choices" is because of a bad lifestyle choice.

Some people are genetically predisposed to higher cholesterol and higher blood pressure. The default assumption is that people with higher cholesterol and higher blood pressure have that problem because of poor diet and lack of exercise. (In other words, it must be their own fault that they have high cholesterol/blood pressure.) So if our desire is to "stick it to the behavior," you can't just stick to everyone with a high BP because it's not necessarily because of poor lifestyle choices.

For what it's worth, my genetics lean toward high blood pressure and a very healthy level of "good" HDL cholesterol.

 

[Martha]

I wonder if this discussion will go the route of the long closed obesity thread. I almost blew a gasket over that one and had to take forum break.

http://www.early-retirement.org/forums/f27/the-obesity-epidemic-23271.html

 

[REWahoo]

I wonder if this discussion will go the route of the long closed obesity thread.

Fat chance.

 

[dex]

After universal coverage?

BBC NEWS | Health | Is health rationing the answer?
The NHS cannot pay for every treatment that every patient wants. But does that mean that healthcare has to be "rationed"?

+++++++++++
EDITORIAL: Rationing health care - Washington Times

estimate that we could take as much as $700 billion a year out of our health care system." Let's be clear - Mr. Summers is talking about rationing. Total health care expenditures in the United States in 2008 came to $2.5 trillion. The implication of his statement is that health care expenditures can be cut by almost 30 percent. That's a major amputation to the system. Mr. Summers tried to kill the pain by saying it all wouldn't have to be cut right away. That's only comforting if it's not your loved one's transplant that bureaucrats reject.

+++++

The same people who can't get the Post Office to break even or fix Amtrak are going manage health care? Sounds good to me!

 

[Texas Proud]

Ziggy,
I have heard the statement before, that there are people that can't loose weight. However, I have never seen a picture of a fat prisoner coming from WWII concentration camps or Japanese Prisoner of War Camps. My mother use to say she could not use weight. However, she would then say 'Unless I get my diet below a 1,000 calories a day, and you can't live on that.' She died at 80 over weight but happy. She would have a bowl of ice cream and say 'This is how I keep my girlish figure'. She was 5'2" and well over 200lbs. She would have given up Medicare before she gave up that ice cream!

I know this is off the original subject... but I saw one of the news magazines that disputed a bit of what you say...

They showed this guy that looked fat... had to be over 300 lbs... he had started to run to lose weight... and eventually was running a marathon... but was still fat.. and looked it... one example that is extreme and not any kind of study... but it surprised me

as for your prisoner of war example... sure, if you starve someone they will lose weight.. and die... not a good sign for healthcare...

 

[ziggy29]

The same people who can't get the Post Office to break even or fix Amtrak are going manage health care? Sounds good to me!

Nobody is seriously suggesting nationalizing all the hospitals and insurers, and nobody is seriously suggesting making doctors and nurses federal employees. I certainly haven't heard the president suggest that.

I think that's a significant breakdown in the comparison.

 

[Rustic23]

Martha, there are several things I would have never thought I would see in this country. Like government ownership of GM. Never say Never! When seat belt laws were passed we were told that police would never stop someone just because they don't have a seat belt on. Now we have Click it or Ticket and we just accept it. It's the law.

 

[ziggy29]

They showed this guy that looked fat... had to be over 300 lbs... he had started to run to lose weight... and eventually was running a marathon... but was still fat.. and looked it... one example that is extreme and not any kind of study... but it surprised me

Another thing is: one can't be a slave to the height/weight charts. Listed at 5' 10" and 221 pounds, San Diego Chargers running back LaDainian Tomlinson is considered "obese" by the usual standard. It's pretty hard for a running back to be a star in the NFL if they are "obese."

 

[dex]

That's my point. Not everything we associate with "bad lifestyle choices" is because of a bad lifestyle choice.

Some people are genetically predisposed to higher cholesterol and higher blood pressure. The default assumption is that people with higher cholesterol and higher blood pressure have that problem because of poor diet and lack of exercise. (In other words, it must be their own fault that they have high cholesterol/blood pressure.) So if our desire is to "stick it to the behavior," you can't just stick to everyone with a high BP because it's not necessarily because of poor lifestyle choices.

For what it's worth, my genetics lean toward high blood pressure and a very healthy level of "good" HDL cholesterol.

That "assumption" is only made by those who don't understand the issues. So why interject ill informed opinions into the discussion?

 

[ziggy29]

That "assumption" is only made by those who don't understand the issues. So why interject ill informed opinions into the discussion?

Because ill informed opinions vote and pay taxes?

 

[dex]

Nobody is seriously suggesting nationalizing all the hospitals and insurers, and nobody is seriously suggesting making doctors and nurses federal employees. I certainly haven't heard the president suggest that.

I think that's a significant breakdown in the comparison.

The "no one" argument doesn't work and is a bit of clutter. There are a lot of things that "no one" is suggesting.
The point of the post was rationing.

 

[Rustic23]

There was a special on TV, I don't remember the name, but the jest was to get out of shape people to in condition to run a marathon. While most got into good enough shape to run the marathon, few lost weight, because they did not change their eating habits. That's why they say 'diet and exercise'

Yes the POW example is extreme. I use it just to point out that weight loss is possible. I will concede that there are folks, that due to a medical condition, find it very hard to loose weight. However, from the materials I have seen, even these folks will loose weight with diet and exercise. Most, however, are unwilling to stay on the plan. I am 40 lbs over weight. I know it and I know what it's cause is. I am currently unwilling to do what it takes to take it off, and I don't think it is governments business to tax fat food to help me. As this has been proposed and is in being is some states, don't try and tell me the government won't do it.

 

[Notmuchlonger]

Need to put a sin tax on fast food. If its good enough for smokes and booze. Why not junk and fast food.

 

[ziggy29]

Need to put a sin tax on fast food. If its good enough for smokes and booze. Why not junk and fast food.

That creaking you hear in the distance is the hinges on Pandora's Box that are starting to open...

 

[Notmuchlonger]

That creaking you hear in the distance is the hinges on Pandora's Box that are starting to open...

Oh that started along time ago..

 

[MichaelB]

Anyone interested in reading what is actually being considered should read this Ezra Klein - The Finance Committee's "Comprehensive Incrementalism"

which links to this http://www.washingtonpost.com/wp-srv/politics/documents/health_care_reform_draft_proposal_061809.pdf

 

[Midpack]

Indeed, among developed countries, the United States is the biggest spender. It spends 52% more on heath per person than the country ranked second, which is Switzerland. Despite that, the United States does not necessarily do better in terms of health care access, quality or outcomes.

To Holtz-Eakin, who advised John McCain in last year's presidential race,failed health reform wouldmean that "everyone gets coverage but we don't change the underlying cost dynamics. Health care spending goes up and we haven't solved our deficit problem."

These are the two thoughts (from the OP link) that keep coming back to me. The United States spends much more than any other country, developed or not, and is "less healthy" by most measures. And our costs are rising much faster than we can sustain. I watched a good PBS special (you still can here FRONTLINE: sick around the world | PBS) a while ago, they look at the United Kingdom, Japan, Germany, Taiwan and Switzerland and they all spend considerably less and get more without much rationing. We can't simply nationalize the current system, that will only add more bureaucracy cost. I would love the see the system from Japan, Germany, Taiwan, the UK or Switzerland implemented here. But special interests (health care, pharma, insurers, attorneys, etc.), and fear of the unknown (voting population & consequently politicians) keep us frozen with the status quo that we all know can't continue. We can keep talking about all the reasons we can't do anything, or wait until we have no choice...

 

[MichaelB]

These are the two thoughts (from the OP link) that keep coming back to me. The United States spends much more than any other country, developed or not, and is "less healthy" by most measures. And our costs are rising much faster than we can sustain. I watched a good PBS special (you still can here FRONTLINE: sick around the world | PBS) a while ago, they look at the United Kingdom, Japan, Germany, Taiwan and Switzerland and they all spend considerably less and get more without much rationing. We can't simply nationalize the current system, that will only add more bureaucracy cost. I would love the see the system from Japan, Germany, Taiwan, the UK or Switzerland implemented here. But special interests (health care, pharma, insurers, attorneys, etc.), and fear of the unknown (voting population & consequently politicians) keep us frozen with the status quo that we all know can't continue. We can keep talking about all the reasons we can't do anything, or wait until we have no choice...

Perhaps our lifestyle is so much worse we simply are unable to spend ourselves into comparable health - even though we try so very hard on both aspects.

 

[Midpack]

Perhaps our lifestyle is so much worse we simply are unable to spend ourselves into comparable health - even though we try so very hard on both aspects.

I am sure lifestyle exacerbates our costsand I wonder why - and what can be done about it, but that's not the only difference. Our "unit cost" of health care is demonstrably higher as well and there are models all around us that are better.

 

[FUEGO]

Fat chance.

Is that the same meaning as "slim chance"?

 

[Independent]

I have trouble believing that the US has dramatically poorer lifestyles than other rich countries - certainly not enough to justify the difference in medical spending. For example, this is what I could find on per capita cigarette consumption:

4,313 Greece
3,023 Japan
2,779 Spain
2,428 Belgium
2,323 Netherlands
2,236 Ireland
2,079 Portugal
2,073 Austria
2,058 France
1,976 Canada
1,919 Denmark
1,907 Australia
1,901 Italy
1,702 Germany
1,691 US
1,351 Finland
1,202 Sweden
725 Norway

(Unfortunately, I got most of the data from NationMaster, but had to use InfoPlease for the US number. UK appears to be about 1,060.)

 

[Notmuchlonger]

I have trouble believing that the US has dramatically poorer lifestyles than other rich countries - certainly not enough to justify the difference in medical spending. For example, this is what I could find on per capita cigarette consumption:

4,313 Greece
3,023 Japan
2,779 Spain
2,428 Belgium
2,323 Netherlands
2,236 Ireland
2,079 Portugal
2,073 Austria
2,058 France
1,976 Canada
1,919 Denmark
1,907 Australia
1,901 Italy
1,702 Germany
1,691 US
1,351 Finland
1,202 Sweden
725 Norway

(Unfortunately, I got most of the data from NationMaster, but had to use InfoPlease for the US number. UK appears to be about 1,060.)

I used the same site as you for obesity.

Obesity statistics - countries compared - NationMaster

Guess where the US ranks?

 

[FUEGO]

I used the same site as you for obesity.

Obesity statistics - countries compared - NationMaster

Guess where the US ranks?

We're number 1! We're number 1! Oh wait, crap...

 

[Independent]

I used the same site as you for obesity.

Obesity statistics - countries compared - NationMaster

Guess where the US ranks?

Yep:

30.6% United States:
23.0% United Kingdom:
21.9% Greece:
21.7% Australia:
20.9% New Zealand:
14.3% Canada:
13.1% Spain:
13.0% Ireland:
12.9% Germany:
12.8% Portugal:
12.8% Finland:
11.7% Belgium:
10.0% Netherlands:
9.7% Sweden:
9.5% Denmark:
9.4% France:
9.1% Austria:
8.5% Italy:
8.3% Norway:
7.7% Switzerland:
3.2% Japan:
3.2% Korea, South:

Putting the smoking and obesity together, does it really make sense that "lifestyle" forces the US to spend 50% more than anybody else?

This is the first thing I could find on the extra expenses associated with obesity:

The excess medical expenditures that result from treating these obesity-related diseases are significant. Roland Sturm used regression analysis to show that obese adults incur annual medical expenditures that are $395 (36 percent) higher than those of normal weight incur.

Now if the excess obesity rate in the US is 20% of the population, and they incur 36% more expense, I get an overall increase of 7.2%. That's meaningful, but I'm trying to explain 50%.

National Medical Spending Attributable To Overweight And Obesity: How Much, And Who's Paying? -- Finkelstein et al., 10.1377/hlthaff.w3.219 -- Health Affairs

 

[jdw_fire]

I think if we studied the reasons why people don't have health ins. we would find a whole range of answers.

anybody see this Video - CNBC.com

maybe we dont really have a problem with people being uninsured