NYC assassination news thread - Please no politics (1 Viewer)

[KarmaPolice]

Grocery stores have more space for processed foods vs Whole Foods because more individuals are making the choice to buy processed foods. If more people purchased whole food rather than processed foods, the grocery stores would have to provide more floor space for it. They are a business after all.

As to the obesity example - you’re blaming the advertising of the pharmaceutical company if I’m reading you correctly. To me, that’s not the health care (provider) company - nor is it the health insurance company.

ETA - sounds like a lot of assigning blame not on the individuals making their own choices (and consequences of those choices), and placing it on other targets (who might be easy to point at, granted).

People buy processed foods because the are cheaper (subsidies) and addidictive (Big Food). Food companies pay for shelf space.

In the 1980s, R.J. Reynolds and Philip Morris, another tobacco company, acquired several major food companies, including Kraft and General Foods. These acquisitions gave tobacco companies a large share of the American food supply and allowed them to make billions of dollars in sales.

A study found that foods owned by tobacco companies were more likely to contain high levels of carbs, sodium, and fat. The study also found that tobacco companies used the same colors and flavors they developed for cigarettes to create popular children's beverage brands, such as Kool-Aid, Hawaiian Punch, Capri Sun, and Tang

The food industry is by no means innocent, I’m not trying to argue that they are. My point is that we (as individuals) have a choice. We have lots of choices, far more than just about any human has had, ever.

I can tell you one choice I don't seem to have - a family health insurance plan that doesn't cost $1K/month+ and still spend $1000s on health costs a year.

First, I totally get where you’re coming from, but You can choose to go uninsured. I wouldn’t recommend it. I have clients/prospects who do just that, purposely. (And I don’t mean to get personal with you specifically with this, but depending on your or your spouse’s skill set, you could choose to work for an employer that provides better coverage or a lower premium plan, or both - it was a very large deciding factor for my wife in her last job search).

Yes, I get I have a choice: expensive, subpar insurance or no insurance.

And yes, we made choices in our careers. I work part time (used to be stay at home dad), and she is a vet. We made that choice so somebody could be home more for the kids. What you are getting at is something else that I think is a terrible system - making the insurance tied to work. It is pretty messed up that people have to make that choice. I know too many people detesting where they work and are miserable because they had to get better insurance or their spouse's changed and got too expensive. She now works for a more regional company as a relief vet for the area. It is slightly better insurance because it's a bigger company, but we just submitted those forms and our insurance is about $1200/month, and that is just medium tier with probably too high of deductibles for us, but that's where we are at. It's not uncommon for our health bills (premium + OoP) to approach $20K in a year. Again, outrageous. I fully understand the hatred people have for the system and insurance companies.

First off, thank you for sharing. I didn’t mean for you to get into your personal story, but I do thank you for doing so. I agree with a lot of what you’re saying here.

I will say that if we did de-couple health insurance from employers/employment (without something also happening in conjunction with it), the uninsured rate would skyrocket. Said another way, a huge percentage of our population has coverage only because of their employment, and wouldn’t obtain it on their own if it wasn’t.

As for the $20k a year - yeah, I get it. In the individual market, if you don’t receive a subsidy, it’s not out of the question for a 60 year old to be paying g $1k a month in premiums alone, before the first claim. $20k all in for a family of 4+? That’s Im sure what my family of three is at as well, if you account for the portion my and my wife’s employer pays towards the coverage they provide. Why is that? Because the appendectomy is $30k.

Again, thank you for sharing - I didn’t mean to “get personal” or anything.

Not that I doubt you, as you are obviously in the know here. Just curious what you base the bolded on. I would think that more competition and detaching it from the workplace would drop prices a bit and give people more choices and flexibility. Or at the very least get them the insurance and doctors they WANT for the same price instead of just whatever package their employer decided to offer.

 

[Mitchie]

One reason people consume processed versus healthier choices is cost, with healthier choices being significantly more expensive.

And if you don't have FBGs money, choosing the healthy option might not even be an option for you.

Okay, so you are correct that processed foods generally -- broadly speaking -- cost more less than healthy foods. That is true, but of course, that also has nothing whatsoever to do with the health insurance industry or your provider. It certainly doesn't justify assassinating anybody who works at UHC.

To your second point, let's be real here. People don't eat junk food because they're poor, or because they don't know any better. They eat junk food because junk food tastes good and broccoli doesn't. It's entirely an issue of personal choice. Maybe it's different for people below the poverty level or something, but the average American is overweight and poorly-nourished because they chose that. You have agency, and what you choose to eat is in your locus of control.

Edit: Whoops.

Many people prefer the taste of broccoli to junk food (i would be one), people get used to the foods they eat when they're young, if they're raised on crappy food they'll be more likely to continue to eat it. I do think many people are poorly educated on proper nutrition and that's a factor. Also cooking healthy meals takes time vs. buying processed meals. Some people may have the time but many people are just lazy.

 

[matttyl]

Grocery stores have more space for processed foods vs Whole Foods because more individuals are making the choice to buy processed foods. If more people purchased whole food rather than processed foods, the grocery stores would have to provide more floor space for it. They are a business after all.

As to the obesity example - you’re blaming the advertising of the pharmaceutical company if I’m reading you correctly. To me, that’s not the health care (provider) company - nor is it the health insurance company.

ETA - sounds like a lot of assigning blame not on the individuals making their own choices (and consequences of those choices), and placing it on other targets (who might be easy to point at, granted).

People buy processed foods because the are cheaper (subsidies) and addidictive (Big Food). Food companies pay for shelf space.

In the 1980s, R.J. Reynolds and Philip Morris, another tobacco company, acquired several major food companies, including Kraft and General Foods. These acquisitions gave tobacco companies a large share of the American food supply and allowed them to make billions of dollars in sales.

A study found that foods owned by tobacco companies were more likely to contain high levels of carbs, sodium, and fat. The study also found that tobacco companies used the same colors and flavors they developed for cigarettes to create popular children's beverage brands, such as Kool-Aid, Hawaiian Punch, Capri Sun, and Tang

The food industry is by no means innocent, I’m not trying to argue that they are. My point is that we (as individuals) have a choice. We have lots of choices, far more than just about any human has had, ever.

I can tell you one choice I don't seem to have - a family health insurance plan that doesn't cost $1K/month+ and still spend $1000s on health costs a year.

First, I totally get where you’re coming from, but You can choose to go uninsured. I wouldn’t recommend it. I have clients/prospects who do just that, purposely. (And I don’t mean to get personal with you specifically with this, but depending on your or your spouse’s skill set, you could choose to work for an employer that provides better coverage or a lower premium plan, or both - it was a very large deciding factor for my wife in her last job search).

Yes, I get I have a choice: expensive, subpar insurance or no insurance.

And yes, we made choices in our careers. I work part time (used to be stay at home dad), and she is a vet. We made that choice so somebody could be home more for the kids. What you are getting at is something else that I think is a terrible system - making the insurance tied to work. It is pretty messed up that people have to make that choice. I know too many people detesting where they work and are miserable because they had to get better insurance or their spouse's changed and got too expensive. She now works for a more regional company as a relief vet for the area. It is slightly better insurance because it's a bigger company, but we just submitted those forms and our insurance is about $1200/month, and that is just medium tier with probably too high of deductibles for us, but that's where we are at. It's not uncommon for our health bills (premium + OoP) to approach $20K in a year. Again, outrageous. I fully understand the hatred people have for the system and insurance companies.

First off, thank you for sharing. I didn’t mean for you to get into your personal story, but I do thank you for doing so. I agree with a lot of what you’re saying here.

I will say that if we did de-couple health insurance from employers/employment (without something also happening in conjunction with it), the uninsured rate would skyrocket. Said another way, a huge percentage of our population has coverage only because of their employment, and wouldn’t obtain it on their own if it wasn’t.

As for the $20k a year - yeah, I get it. In the individual market, if you don’t receive a subsidy, it’s not out of the question for a 60 year old to be paying g $1k a month in premiums alone, before the first claim. $20k all in for a family of 4+? That’s Im sure what my family of three is at as well, if you account for the portion my and my wife’s employer pays towards the coverage they provide. Why is that? Because the appendectomy is $30k.

Again, thank you for sharing - I didn’t mean to “get personal” or anything.

Not that I doubt you, as you are obviously in the know here. Just curious what you base the bolded on. I would think that more competition and detaching it from the workplace would drop prices a bit and give people more choices and flexibility. Or at the very least get them the insurance and doctors they WANT for the same price instead of just whatever package their employer decided to offer.

As a “low hanging fruit” example - WalMart employs 1.6 million people in the US. Assuming some have spouses and kids, let’s call it 2.5-3M total people covered. You think if they dropped their plan that all of those folks would go to the individual market and obtain coverage for themselves? Of course they wouldn’t. They’d think the cost is too high - as just about anyone does when they see the offer of COBRA continuation if/when they leave a job. What they might not realize about that COBRA amount is that it’s the same amount it was while you were working, it’s just that the employer was paying a large portion of it (for instance I myself pay $172 a month to me on my employer group plan - because they pay $688 (80%) a month of the $860 total - if I leave/get fired my cobra offer will be $860/m).

But you might then ask, ok, so the employer isn't paying that so they’ll give you that money in your income instead. thats likely wishful thinking, but even if they did, would everyone then turn that money around and send it right back to an insurance company for coverage? Some would, but not nearly the nearly universal coverage we see from large employers.

When you look at the 25-30m uninsured in the US today, they are that way because they don’t have an offer of coverage through an employer and/or they see the cost as being too high. KFF reported in 2022 that 64% of the uninsured specifically cited cost as their reason why. They don’t see it as valuable. Even if they did get an income bonus after their employer coverage was cancelled, they’d spend that money on a new car, pay off debt, maybe invest, hookers and blow, or they’d just waste it. It wouldn’t be used on health insurance (for a large portion of them).

 

[KarmaPolice]

There's no question that there is plenty of blame to go around. My initial comment on this current thread of posts was that the healthcare industry is absolutely part of our culture and a lot of the cause for where we are is because of them. That doesn't mean that individual choice isn't a component. Obviously, it is. Here's one of the problems. Take obesity as a great example. How many times is a person told that their lifestyle and/or eating habits etc can help fix their problems with obesity in a year? How many times do we hear that message? How many times a day do we hear that drug X is the solution to that same problem? I am willing to bet that we here the later more in a day than we do the former in a year. Take a similar question to the grocery store. How much space is allocated to whole foods vs processed foods in boxes and bags?

So while I agree with the premise that personal choice is one of the factors in our performances, I also acknowledge that we make those choices based in the info that's put in front of us. The echo chamber of life choices is just as real as any other echo chamber. Problem is, individuals aren't really choosing this particular echo chamber. Money and profits are dictating what is put before us most of the time. This is a psychological battle as much as a physical one and the average American is losing.

My model of the world differs tremendously from yours. Like we live on different planets. Maybe you're right, but we are starting from a completely set of facts on the ground.

Seems that way. My world is one in which we see roughly $600M spent on advertising for athletics and/or fitness equipment (adding this to the list to be generous. I know we haven't talked about this aspect), $320M spent on healthy food/drinks, $23B on "healthcare advertising" from the big pharma companies (their drugs and products), roughly $1B on specific drugs for weight loss and diabetes, etc. So when I make the comments I do, it's coming from that lens. This doesn't include generic "food and alcohol" industry (which is around 15% of the mass media advertising market) that promotes sugar, snacks, fast food and candy. Those promotions are roughly 80% of what they put out on the airways.

The above is off memory from the 2022 era when I was doing a research assignment on this topic in grad school, so these might have changed some in the last two years. Apologies for not providing that perspective earlier to make things clearer.

Okay, but have you talked to other human beings about this? For example, let's say we grabbed ten random people off the street and asked them "When you think of ways to lose weight, what's the first thing that comes to mind?"

How many people do you think would say diet or exercise, versus how many people would say Ozempic?

Genuine question. I am very curious to know what sort of result you would expect to get.

Spoiler

I think 9/10 would say "diet and exercise." Maybe I'm wrong.

Here’s how much weight the average American is struggling to lose: survey

Four in five adults who are trying to lose weight are eager to reach their goal as soon as possible (81%), according to new research.

nypost.com

I think you are close to right about your supposition above, but of 2000 people surveyed about their weight loss goals, a staggering 57% responded they would use medication if it were accessible. Also in that survey, a large majority of respondents acknowledged they would need to change their diet and exercise in conjunction with such medication.

I think the waters are a bit choppier than you imagine in this regard, but only slightly more so.

Yes, and for the record, I think Ozempic is (potentially) a god-send for a society that is struggling with obesity. I'm just pushing back against the idea that Americans are somehow uninformed about the role of diet and exercise. It seems obvious to me that they are.

It's kind of like the related argument about how people have been tricked into buying processed foods instead of healthy foods. My guess is 95% of the adult population knows perfectly well that they should eat fewer Doritos and more broccoli. They just choose not to. I don't begrudge anybody for that choice. I don't eat enough vegetables - my wife helpfully reminds me of this on a regular basis to no effect - and I know that and I'm okay with that. I have agency and this is something that is 100% under my control. If I develop an illness caused by not eating enough vegetables, that will be entirely on me and nobody else.

My slight push-back on that last part is there are other forces involved that often override our natural decision making. We also have a country that subsidizes the crap out of corn leading to an overabundance of junk food. We get bombarded with ads for the crap food. We have stores using psychological tactics to push us towards the crap. Our portion sizes are ridiculously huge. We could go on. IMO we could make different and better choices on those fronts if our health was truly a priority in the country. We surely don't make it easy on ourselves to make good choices.

 

[opensourcebeer]

I just had supper with one of my daughters (age 24) and we talked about this topic.

She thinks Luigi is a patsy.

 

[the moops]

Health insurance is much simpler than a lot of folks make it out to be. I mean if I can understand it enough to explain it to folks it can’t be that complex.

Damn. Here I thought those couple phone and email convos we had you were espousing wicked smart knowledge from that giant brain of yours

 

[IvanKaramazov]

There's no question that there is plenty of blame to go around. My initial comment on this current thread of posts was that the healthcare industry is absolutely part of our culture and a lot of the cause for where we are is because of them. That doesn't mean that individual choice isn't a component. Obviously, it is. Here's one of the problems. Take obesity as a great example. How many times is a person told that their lifestyle and/or eating habits etc can help fix their problems with obesity in a year? How many times do we hear that message? How many times a day do we hear that drug X is the solution to that same problem? I am willing to bet that we here the later more in a day than we do the former in a year. Take a similar question to the grocery store. How much space is allocated to whole foods vs processed foods in boxes and bags?

So while I agree with the premise that personal choice is one of the factors in our performances, I also acknowledge that we make those choices based in the info that's put in front of us. The echo chamber of life choices is just as real as any other echo chamber. Problem is, individuals aren't really choosing this particular echo chamber. Money and profits are dictating what is put before us most of the time. This is a psychological battle as much as a physical one and the average American is losing.

My model of the world differs tremendously from yours. Like we live on different planets. Maybe you're right, but we are starting from a completely set of facts on the ground.

Seems that way. My world is one in which we see roughly $600M spent on advertising for athletics and/or fitness equipment (adding this to the list to be generous. I know we haven't talked about this aspect), $320M spent on healthy food/drinks, $23B on "healthcare advertising" from the big pharma companies (their drugs and products), roughly $1B on specific drugs for weight loss and diabetes, etc. So when I make the comments I do, it's coming from that lens. This doesn't include generic "food and alcohol" industry (which is around 15% of the mass media advertising market) that promotes sugar, snacks, fast food and candy. Those promotions are roughly 80% of what they put out on the airways.

The above is off memory from the 2022 era when I was doing a research assignment on this topic in grad school, so these might have changed some in the last two years. Apologies for not providing that perspective earlier to make things clearer.

Okay, but have you talked to other human beings about this? For example, let's say we grabbed ten random people off the street and asked them "When you think of ways to lose weight, what's the first thing that comes to mind?"

How many people do you think would say diet or exercise, versus how many people would say Ozempic?

Genuine question. I am very curious to know what sort of result you would expect to get.

Spoiler

I think 9/10 would say "diet and exercise." Maybe I'm wrong.

Here’s how much weight the average American is struggling to lose: survey

Four in five adults who are trying to lose weight are eager to reach their goal as soon as possible (81%), according to new research.

nypost.com

I think you are close to right about your supposition above, but of 2000 people surveyed about their weight loss goals, a staggering 57% responded they would use medication if it were accessible. Also in that survey, a large majority of respondents acknowledged they would need to change their diet and exercise in conjunction with such medication.

I think the waters are a bit choppier than you imagine in this regard, but only slightly more so.

Yes, and for the record, I think Ozempic is (potentially) a god-send for a society that is struggling with obesity. I'm just pushing back against the idea that Americans are somehow uninformed about the role of diet and exercise. It seems obvious to me that they are.

It's kind of like the related argument about how people have been tricked into buying processed foods instead of healthy foods. My guess is 95% of the adult population knows perfectly well that they should eat fewer Doritos and more broccoli. They just choose not to. I don't begrudge anybody for that choice. I don't eat enough vegetables - my wife helpfully reminds me of this on a regular basis to no effect - and I know that and I'm okay with that. I have agency and this is something that is 100% under my control. If I develop an illness caused by not eating enough vegetables, that will be entirely on me and nobody else.

My slight push-back on that last part is there are other forces involved that often override our natural decision making. We also have a country that subsidizes the crap out of corn leading to an overabundance of junk food. We get bombarded with ads for the crap food. We have stores using psychological tactics to push us towards the crap. Our portion sizes are ridiculously huge. We could go on. IMO we could make different and better choices on those fronts if our health was truly a priority in the country. We surely don't make it easy on ourselves to make good choices.

Yes, I agree with all of those things. I think we're on the same general page.

 

[the moops]

I generally eat very well cause I love cooking and we can afford the time and money it requires.

To use the broccoli example though. Raw or even steamed broccoli is fine, but certainly not really good. A good broccoli dish takes like 30 minutes to prep and cook though and will be the cost of good broccoli and good oil/butter and some garlic and whatever else. Certainly not expensive, but not as cheap as other stuff.

Doritos are also awesome though and cost 89 cents and require no prep or cook time.

And I get it. We resort to doritos and frozen burritos and fast food sometimes, but if we made half as much money and worked twice as hard, we would rely on those things way more often.

 

[eoMMan]

BROCCOLI!?!?! YOU GUYS TALKING ABOUT BROCCOLI!?!?

 

[CletiusMaximus]

I love broccoli. Smother it in butter and salt with some chopped up bacon and cheese.

 

[culdeus]

Grocery stores have more space for processed foods vs Whole Foods because more individuals are making the choice to buy processed foods. If more people purchased whole food rather than processed foods, the grocery stores would have to provide more floor space for it. They are a business after all.

As to the obesity example - you’re blaming the advertising of the pharmaceutical company if I’m reading you correctly. To me, that’s not the health care (provider) company - nor is it the health insurance company.

ETA - sounds like a lot of assigning blame not on the individuals making their own choices (and consequences of those choices), and placing it on other targets (who might be easy to point at, granted).

People buy processed foods because the are cheaper (subsidies) and addidictive (Big Food). Food companies pay for shelf space.

In the 1980s, R.J. Reynolds and Philip Morris, another tobacco company, acquired several major food companies, including Kraft and General Foods. These acquisitions gave tobacco companies a large share of the American food supply and allowed them to make billions of dollars in sales.

A study found that foods owned by tobacco companies were more likely to contain high levels of carbs, sodium, and fat. The study also found that tobacco companies used the same colors and flavors they developed for cigarettes to create popular children's beverage brands, such as Kool-Aid, Hawaiian Punch, Capri Sun, and Tang

The food industry is by no means innocent, I’m not trying to argue that they are. My point is that we (as individuals) have a choice. We have lots of choices, far more than just about any human has had, ever.

I can tell you one choice I don't seem to have - a family health insurance plan that doesn't cost $1K/month+ and still spend $1000s on health costs a year.

First, I totally get where you’re coming from, but You can choose to go uninsured. I wouldn’t recommend it. I have clients/prospects who do just that, purposely. (And I don’t mean to get personal with you specifically with this, but depending on your or your spouse’s skill set, you could choose to work for an employer that provides better coverage or a lower premium plan, or both - it was a very large deciding factor for my wife in her last job search).

Yes, I get I have a choice: expensive, subpar insurance or no insurance.

And yes, we made choices in our careers. I work part time (used to be stay at home dad), and she is a vet. We made that choice so somebody could be home more for the kids. What you are getting at is something else that I think is a terrible system - making the insurance tied to work. It is pretty messed up that people have to make that choice. I know too many people detesting where they work and are miserable because they had to get better insurance or their spouse's changed and got too expensive. She now works for a more regional company as a relief vet for the area. It is slightly better insurance because it's a bigger company, but we just submitted those forms and our insurance is about $1200/month, and that is just medium tier with probably too high of deductibles for us, but that's where we are at. It's not uncommon for our health bills (premium + OoP) to approach $20K in a year. Again, outrageous. I fully understand the hatred people have for the system and insurance companies.

First off, thank you for sharing. I didn’t mean for you to get into your personal story, but I do thank you for doing so. I agree with a lot of what you’re saying here.

I will say that if we did de-couple health insurance from employers/employment (without something also happening in conjunction with it), the uninsured rate would skyrocket. Said another way, a huge percentage of our population has coverage only because of their employment, and wouldn’t obtain it on their own if it wasn’t.

As for the $20k a year - yeah, I get it. In the individual market, if you don’t receive a subsidy, it’s not out of the question for a 60 year old to be paying g $1k a month in premiums alone, before the first claim. $20k all in for a family of 4+? That’s Im sure what my family of three is at as well, if you account for the portion my and my wife’s employer pays towards the coverage they provide. Why is that? Because the appendectomy is $30k.

Again, thank you for sharing - I didn’t mean to “get personal” or anything.

Not that I doubt you, as you are obviously in the know here. Just curious what you base the bolded on. I would think that more competition and detaching it from the workplace would drop prices a bit and give people more choices and flexibility. Or at the very least get them the insurance and doctors they WANT for the same price instead of just whatever package their employer decided to offer.

As a “low hanging fruit” example - WalMart employs 1.6 million people in the US. Assuming some have spouses and kids, let’s call it 2.5-3M total people covered. You think if they dropped their plan that all of those folks would go to the individual market and obtain coverage for themselves? Of course they wouldn’t. They’d think the cost is too high - as just about anyone does when they see the offer of COBRA continuation if/when they leave a job. What they might not realize about that COBRA amount is that it’s the same amount it was while you were working, it’s just that the employer was paying a large portion of it (for instance I myself pay $172 a month to me on my employer group plan - because they pay $688 (80%) a month of the $860 total - if I leave/get fired my cobra offer will be $860/m).

But you might then ask, ok, so the employer isn't paying that so they’ll give you that money in your income instead. thats likely wishful thinking, but even if they did, would everyone then turn that money around and send it right back to an insurance company for coverage? Some would, but not nearly the nearly universal coverage we see from large employers.

When you look at the 25-30m uninsured in the US today, they are that way because they don’t have an offer of coverage through an employer and/or they see the cost as being too high. KFF reported in 2022 that 64% of the uninsured specifically cited cost as their reason why. They don’t see it as valuable. Even if they did get an income bonus after their employer coverage was cancelled, they’d spend that money on a new car, pay off debt, maybe invest, hookers and blow, or they’d just waste it. It wouldn’t be used on health insurance (for a large portion of them).

Do this with self directed retirement. Get even more depressed.

 

[dickey moe]

My question would be... are these chronic conditions a result of subpar healthcare or does the American way of life contribute more to unhealthy lifestyles and the healthcare system is struggling to keep up?

This is an easy one IMO. If you travel outside the US at all, one of the things you notice immediately is that Americans are fatter than everybody else. We all know that's true because we've seen the statistics, but when you actually see it with your own two eyes in the real world, it's impossible to ignore. Why are Americans so fat? It's probably not mono-causal and we can debate how assorted cultural and policy variables play into this, but it's obviously not your doctor's fault or your insurance company's fault.

And once you see that the US is an outlier on obesity, it should occur to you that we're an outlier on other dimensions too. We drive a lot more than people in other first-world countries. More driving means more auto accidents, and those are clustered among younger people. We have way more guns and much more gun violence than other first-world countries, and gun fatalities are clustered among younger people. Those types of things really mess up "life expectancy at birth" calculations and result in excess deaths that seem out of whack but have nothing to do with health care.

No, obviously the health care industry is not causing people to get diabetes or monkeypox or a gunshot wound. Those are all things that people chose, in a manner of speaking.

This is all true, but i also think our for profit system compounds the issue and leads to poor outcomes too often.

We are fat, other countries' populace still smoke like crazy. We all have our differences in risks and poor choices, and that is certainly one part of the equation.

If you don't know people that don't take of minor things because they aren't covered, its not worth their insurance rates increasing, etc. then we have very different experiences. Imo the way our heath system is set up also greatly contributes to people not taking care of themselves and just waiting until it is something catastrophic.

For being the bestest, richest country on the planet it is embarrassing to see stats on the things I believe should be basic things like health and education.

I do know people who don’t take care of the minor things because they aren’t covered (though their insurance rates wouldn’t increase because of that). I see it all the time (as an insurance agent) and I try to talk folks (mainly the younger and healthier folks) out of going uninsured and obtaining a policy. They either don’t think it’s worth it (and honestly, they are often correct there), they don’t trust insurance companies, but often it’s because they don’t think it’s affordable/valuable - yet they are fine with Starbucks, new/newer cars, on and on. I mean I’m literally quoting folks on the exchanges (individual market) all the time who are eligible for a subsidy which would knock their premium down substantially, to under $200 a month for decent coverage and they say no. I see the same thing with employees of some of my employer group plans choosing not to enroll for themselves and family members, even though the employer would pick up 80% of the cost. Again, just like is often the case with poor health outcomes, it comes down to personal responsibility.

I get all this, but I still circle back to my main point that humans are humans. There has to be a good number of these choices and behaviors going on around the world. We can't be the only country who makes dumb choices for ourselves.

When it comes to “health insurance”, we pretty much are as we’re the only country that has a system like ours. People in most of Europe, for instance, don’t have the choice to go uninsured/not pay for health insurance.

I would say we’re now getting way off topic, but actually this might be getting us back on topic re the motive of the accused killer.

But that's also the point.

Compared to a European hospital bill, a US hospital bill will typically be significantly higher for the same procedure, with individual line items like room charges, doctor fees, and even basic tests often costing considerably more in the US due to the structure of the healthcare system, where costs are often driven by profit margins rather than standardized pricing in most European nations; essentially, a US bill will show a much higher overall cost for similar medical services.

Key differences:

• Overall Cost:
  A US hospital bill for a standard procedure will generally be several times higher than a comparable bill in most European countries.
  
  
• Itemized Charges:
  • Room Charges: While room costs can vary depending on the facility and location, US hospital rooms often have significantly higher per-night charges compared to European hospitals.
    
    
  • Doctor Fees: Physician fees on a US bill can be substantially higher than in Europe, as doctors often have greater billing flexibility.
    
    
  • Diagnostic Tests: Even routine lab tests and imaging procedures may be priced much higher on a US hospital bill.
    
    
  • Administrative Fees: US bills might include additional administrative charges not commonly seen in Europe.

Reasons for the disparity:

• Private vs. Public Healthcare:
  Most European countries have primarily public healthcare systems with price controls, while the US relies heavily on private insurance companies, leading to higher costs due to market competition.
  
  
• Profit Incentives:
  US hospitals and healthcare providers often operate with a profit motive, leading to higher charges compared to European systems focused on patient care.
  
  
• Drug Costs:
  Prescription drugs can be significantly more expensive in the US compared to Europe, further inflating medical bills.

Example Comparison:

• Appendectomy in the US: Could cost upwards of $30,000.
  
  
• Appendectomy in Europe (average): Might cost around €600 (equivalent to roughly $650).

Oh, fully agree 100%. I’m the one on the top of the mountain screaming that the reason your health “insurance” costs as much as it does is because the cost of the care that it’s paying for is so high. If your appendectomy costs $650 rather than $30k, then the cost of the insurance to cover that appendectomy wouldn’t need to be so high.

Now while the insurance industry might not be completely innocent in allowing the cost of that appendectomy to reach $30k, ultimately it’s the provider who is choosing to charge that amount for it. Maybe they can justify that cost, maybe they can’t - but I’d like to at least have them explain why it is.

Amen. There is very little price discovery/transparency in U.S. medical care.

 

[Navin Johnson]

Why are we talking about denial rates and insider trading as if somehow that makes the case any less egregious? We don’t know why the killer did what he did so this isn’t about figuring out the specifics of his motive.

It’s about how justified this murder is and the people concentrating on it can go to hell as far as I’m concerned.

No kidding. Denial rates and insider trading. Silly.

We all know we should be talking about Teen Vogue's political coverage or posts from seven years ago.

Straw man and goalposts. I never said those topics weren’t relevant—just that given what we know, they’re not really relevant to the topic at hand unless we’re establishing a personal motive, which you aren’t. You skipped “Go" and went straight for the besmirching of character. Of a dead man.

I never go to motive or assume things about people they already haven’t said. So why don’t we just make this easier and why don’t you just say what you really want to say and not hide behind plausible deniability?

Go ahead. I remember bananafish said he wanted Trump assassinated as far back as 2020. Why don’t you join him in the ranks of people who have truly stupid brass ones on the board?

Nah, forget it. I know you won’t.

You must have me confused with someone else. I provided information about UHC from a lawsuit that I was hoping helped clarify some comments about their denial rates. I said nothing about Brian Thompson. By all accounts he was an impressive guy. It's sad he was killed.

I think you'd agree both things can be true. Their CEO can be a great guy. And the company can have a culture - dating back decades - of questionable activity.

For all we know, he was trying to change that culture. He's only been CEO for what, 3 years?

Why do denial rates matter? Sounds an awful lot like “What was she wearing?” A man was caught on camera executing another man. Yes, we’d like to know why. We know why. Now why is it important whether the executed man was wanted for insider trading whether his company had high denial rates? Watch, they’ll try to get that into court and the court won’t even find it relevant and will discipline the lawyers and charge the jury to ignore it.

So don’t even come back to me and say it’s relevant.

Did you really just compare denial rates to "what was she wearing?"

 

[rockaction]

Why are we talking about denial rates and insider trading as if somehow that makes the case any less egregious? We don’t know why the killer did what he did so this isn’t about figuring out the specifics of his motive.

It’s about how justified this murder is and the people concentrating on it can go to hell as far as I’m concerned.

No kidding. Denial rates and insider trading. Silly.

We all know we should be talking about Teen Vogue's political coverage or posts from seven years ago.

Straw man and goalposts. I never said those topics weren’t relevant—just that given what we know, they’re not really relevant to the topic at hand unless we’re establishing a personal motive, which you aren’t. You skipped “Go" and went straight for the besmirching of character. Of a dead man.

I never go to motive or assume things about people they already haven’t said. So why don’t we just make this easier and why don’t you just say what you really want to say and not hide behind plausible deniability?

Go ahead. I remember bananafish said he wanted Trump assassinated as far back as 2020. Why don’t you join him in the ranks of people who have truly stupid brass ones on the board?

Nah, forget it. I know you won’t.

You must have me confused with someone else. I provided information about UHC from a lawsuit that I was hoping helped clarify some comments about their denial rates. I said nothing about Brian Thompson. By all accounts he was an impressive guy. It's sad he was killed.

I think you'd agree both things can be true. Their CEO can be a great guy. And the company can have a culture - dating back decades - of questionable activity.

For all we know, he was trying to change that culture. He's only been CEO for what, 3 years?

Why do denial rates matter? Sounds an awful lot like “What was she wearing?” A man was caught on camera executing another man. Yes, we’d like to know why. We know why. Now why is it important whether the executed man was wanted for insider trading whether his company had high denial rates? Watch, they’ll try to get that into court and the court won’t even find it relevant and will discipline the lawyers and charge the jury to ignore it.

So don’t even come back to me and say it’s relevant.

Did you really just compare denial rates to "what was she wearing?"

Yes. And I was right to do so. Why else do you care other than to justify a murder?

 

[Sparky Polastri]

There's no question that there is plenty of blame to go around. My initial comment on this current thread of posts was that the healthcare industry is absolutely part of our culture and a lot of the cause for where we are is because of them. That doesn't mean that individual choice isn't a component. Obviously, it is. Here's one of the problems. Take obesity as a great example. How many times is a person told that their lifestyle and/or eating habits etc can help fix their problems with obesity in a year? How many times do we hear that message? How many times a day do we hear that drug X is the solution to that same problem? I am willing to bet that we here the later more in a day than we do the former in a year. Take a similar question to the grocery store. How much space is allocated to whole foods vs processed foods in boxes and bags?

So while I agree with the premise that personal choice is one of the factors in our performances, I also acknowledge that we make those choices based in the info that's put in front of us. The echo chamber of life choices is just as real as any other echo chamber. Problem is, individuals aren't really choosing this particular echo chamber. Money and profits are dictating what is put before us most of the time. This is a psychological battle as much as a physical one and the average American is losing.

My model of the world differs tremendously from yours. Like we live on different planets. Maybe you're right, but we are starting from a completely set of facts on the ground.

Seems that way. My world is one in which we see roughly $600M spent on advertising for athletics and/or fitness equipment (adding this to the list to be generous. I know we haven't talked about this aspect), $320M spent on healthy food/drinks, $23B on "healthcare advertising" from the big pharma companies (their drugs and products), roughly $1B on specific drugs for weight loss and diabetes, etc. So when I make the comments I do, it's coming from that lens. This doesn't include generic "food and alcohol" industry (which is around 15% of the mass media advertising market) that promotes sugar, snacks, fast food and candy. Those promotions are roughly 80% of what they put out on the airways.

The above is off memory from the 2022 era when I was doing a research assignment on this topic in grad school, so these might have changed some in the last two years. Apologies for not providing that perspective earlier to make things clearer.

Okay, but have you talked to other human beings about this? For example, let's say we grabbed ten random people off the street and asked them "When you think of ways to lose weight, what's the first thing that comes to mind?"

How many people do you think would say diet or exercise, versus how many people would say Ozempic?

Genuine question. I am very curious to know what sort of result you would expect to get.

Spoiler

I think 9/10 would say "diet and exercise." Maybe I'm wrong.

This is a completely different line of thought than what you replied to. There is a knowledge aspect, which you are referring to. Then there is a messaging/psychological aspect, which I am referring to. There is a well documented subconscious approach here that almost always wins over knowledge. What we "feel" typically wins out and those feels are what are pushed constantly because they make companies WAY more money.

 

[Sparky Polastri]

I'm just pushing back against the idea that Americans are somehow uninformed about the role of diet and exercise.

That was NOT my argument. See post above for clarification.

 

[Terminalxylem]

One reason people consume processed versus healthier choices is cost, with healthier choices being significantly more expensive.

And if you don't have FBGs money, choosing the healthy option might not even be an option for you.

Okay, so you are correct that processed foods generally -- broadly speaking -- cost more less than healthy foods. That is true, but of course, that also has nothing whatsoever to do with the health insurance industry or your provider. It certainly doesn't justify assassinating anybody who works at UHC.

To your second point, let's be real here. People don't eat junk food because they're poor, or because they don't know any better. They eat junk food because junk food tastes good and broccoli doesn't. It's entirely an issue of personal choice. Maybe it's different for people below the poverty level or something, but the average American is overweight and poorly-nourished because they chose that. You have agency, and what you choose to eat is in your locus of control.

Edit: Whoops.

Many people prefer the taste of broccoli to junk food (i would be one), people get used to the foods they eat when they're young, if they're raised on crappy food they'll be more likely to continue to eat it. I do think many people are poorly educated on proper nutrition and that's a factor. Also cooking healthy meals takes time vs. buying processed meals. Some people may have the time but many people are just lazy.

Broccoli baked with a little olive oil and pepper is delicious, as good as French fries imo.

It and Brussels sprouts are staples in our diet, things I rarely ate growing up - I was a latchkey kid, raised on fast food and tv dinners. Though it requires some effort, it’s amazing how malleable the palate can be.

 

[Terminalxylem]

I generally eat very well cause I love cooking and we can afford the time and money it requires.

To use the broccoli example though. Raw or even steamed broccoli is fine, but certainly not really good. A good broccoli dish takes like 30 minutes to prep and cook though and will be the cost of good broccoli and good oil/butter and some garlic and whatever else. Certainly not expensive, but not as cheap as other stuff.

Doritos are also awesome though and cost 89 cents and require no prep or cook time.

And I get it. We resort to doritos and frozen burritos and fast food sometimes, but if we made half as much money and worked twice as hard, we would rely on those things way more often.

It’s not that difficult. Break florets into smallish pieces and arrange on foil/baking pan. Drizzle with olive oil + a dash of pepper (salt if you must, but not necessary). Can add minced garlic or garlic salt as well. Bake at 425 (IIRC, wife always cooks this). It’s done when it starts to brown, about 16 minutes.

 

[IvanKaramazov]

There's no question that there is plenty of blame to go around. My initial comment on this current thread of posts was that the healthcare industry is absolutely part of our culture and a lot of the cause for where we are is because of them. That doesn't mean that individual choice isn't a component. Obviously, it is. Here's one of the problems. Take obesity as a great example. How many times is a person told that their lifestyle and/or eating habits etc can help fix their problems with obesity in a year? How many times do we hear that message? How many times a day do we hear that drug X is the solution to that same problem? I am willing to bet that we here the later more in a day than we do the former in a year. Take a similar question to the grocery store. How much space is allocated to whole foods vs processed foods in boxes and bags?

So while I agree with the premise that personal choice is one of the factors in our performances, I also acknowledge that we make those choices based in the info that's put in front of us. The echo chamber of life choices is just as real as any other echo chamber. Problem is, individuals aren't really choosing this particular echo chamber. Money and profits are dictating what is put before us most of the time. This is a psychological battle as much as a physical one and the average American is losing.

My model of the world differs tremendously from yours. Like we live on different planets. Maybe you're right, but we are starting from a completely set of facts on the ground.

Seems that way. My world is one in which we see roughly $600M spent on advertising for athletics and/or fitness equipment (adding this to the list to be generous. I know we haven't talked about this aspect), $320M spent on healthy food/drinks, $23B on "healthcare advertising" from the big pharma companies (their drugs and products), roughly $1B on specific drugs for weight loss and diabetes, etc. So when I make the comments I do, it's coming from that lens. This doesn't include generic "food and alcohol" industry (which is around 15% of the mass media advertising market) that promotes sugar, snacks, fast food and candy. Those promotions are roughly 80% of what they put out on the airways.

The above is off memory from the 2022 era when I was doing a research assignment on this topic in grad school, so these might have changed some in the last two years. Apologies for not providing that perspective earlier to make things clearer.

Okay, but have you talked to other human beings about this? For example, let's say we grabbed ten random people off the street and asked them "When you think of ways to lose weight, what's the first thing that comes to mind?"

How many people do you think would say diet or exercise, versus how many people would say Ozempic?

Genuine question. I am very curious to know what sort of result you would expect to get.

Spoiler

I think 9/10 would say "diet and exercise." Maybe I'm wrong.

This is a completely different line of thought than what you replied to. There is a knowledge aspect, which you are referring to. Then there is a messaging/psychological aspect, which I am referring to. There is a well documented subconscious approach here that almost always wins over knowledge. What we "feel" typically wins out and those feels are what are pushed constantly because they make companies WAY more money.

Yeah, I understand what you're saying, and that's just not really my model of world. On the topic of obesity (but this would be true of many/most topics TBH), I don't think people are "pushed" against diet and exercise. They have diet and exercise flung in their face constantly, day after day. They simply choose not to go that diet/exercise route because diet and exercise involves delayed gratification in a physically unpleasant way, and people generally don't choose that option. It's really not that much deeper than that.

Now, having said that, is the food pyramid misleading? My understanding is that it is. Do companies make processed foods hyper-delicious on purpose? Sure. Do we subsidize grains too much and vegetables not enough? Probably. Those things are all true, and I freely concede that they make a difference on the margin. But at the end of the day, the real reason why Americans are fat is because of choices freely made by people who know what they're doing. Modeling people primarily as actors just seems to me to make better predictions than modeling them as being acted upon.

If you feel otherwise, that's fine. Maybe I'm wrong.

 

[IvanKaramazov]

"People don't like delayed gratification" is one of those things that you don't need a social science degree to appreciate, and you can get a lot of mileage out of that observation. It explains why Americans are overweight, and it also explains why they don't save for retirement. It explains (partly) why teen pregnancies happen. It explains why people didn't abide by pandemic restrictions, and why they speed. This is a very robust observation about human behavior.

 

[Atomic Punk]

"People don't like delayed gratification" is one of those things that you don't need a social science degree to appreciate, and you can get a lot of mileage out of that observation. It explains why Americans are overweight, and it also explains why they don't save for retirement. It explains (partly) why teen pregnancies happen. It explains why people didn't abide by pandemic restrictions, and why they speed. This is a very robust observation about human behavior.

I agree completely but wonder if this is more common in American society than other countries.

 

[matttyl]

My question would be... are these chronic conditions a result of subpar healthcare or does the American way of life contribute more to unhealthy lifestyles and the healthcare system is struggling to keep up?

This is an easy one IMO. If you travel outside the US at all, one of the things you notice immediately is that Americans are fatter than everybody else. We all know that's true because we've seen the statistics, but when you actually see it with your own two eyes in the real world, it's impossible to ignore. Why are Americans so fat? It's probably not mono-causal and we can debate how assorted cultural and policy variables play into this, but it's obviously not your doctor's fault or your insurance company's fault.

And once you see that the US is an outlier on obesity, it should occur to you that we're an outlier on other dimensions too. We drive a lot more than people in other first-world countries. More driving means more auto accidents, and those are clustered among younger people. We have way more guns and much more gun violence than other first-world countries, and gun fatalities are clustered among younger people. Those types of things really mess up "life expectancy at birth" calculations and result in excess deaths that seem out of whack but have nothing to do with health care.

No, obviously the health care industry is not causing people to get diabetes or monkeypox or a gunshot wound. Those are all things that people chose, in a manner of speaking.

This is all true, but i also think our for profit system compounds the issue and leads to poor outcomes too often.

We are fat, other countries' populace still smoke like crazy. We all have our differences in risks and poor choices, and that is certainly one part of the equation.

If you don't know people that don't take of minor things because they aren't covered, its not worth their insurance rates increasing, etc. then we have very different experiences. Imo the way our heath system is set up also greatly contributes to people not taking care of themselves and just waiting until it is something catastrophic.

For being the bestest, richest country on the planet it is embarrassing to see stats on the things I believe should be basic things like health and education.

I do know people who don’t take care of the minor things because they aren’t covered (though their insurance rates wouldn’t increase because of that). I see it all the time (as an insurance agent) and I try to talk folks (mainly the younger and healthier folks) out of going uninsured and obtaining a policy. They either don’t think it’s worth it (and honestly, they are often correct there), they don’t trust insurance companies, but often it’s because they don’t think it’s affordable/valuable - yet they are fine with Starbucks, new/newer cars, on and on. I mean I’m literally quoting folks on the exchanges (individual market) all the time who are eligible for a subsidy which would knock their premium down substantially, to under $200 a month for decent coverage and they say no. I see the same thing with employees of some of my employer group plans choosing not to enroll for themselves and family members, even though the employer would pick up 80% of the cost. Again, just like is often the case with poor health outcomes, it comes down to personal responsibility.

I get all this, but I still circle back to my main point that humans are humans. There has to be a good number of these choices and behaviors going on around the world. We can't be the only country who makes dumb choices for ourselves.

When it comes to “health insurance”, we pretty much are as we’re the only country that has a system like ours. People in most of Europe, for instance, don’t have the choice to go uninsured/not pay for health insurance.

I would say we’re now getting way off topic, but actually this might be getting us back on topic re the motive of the accused killer.

But that's also the point.

Compared to a European hospital bill, a US hospital bill will typically be significantly higher for the same procedure, with individual line items like room charges, doctor fees, and even basic tests often costing considerably more in the US due to the structure of the healthcare system, where costs are often driven by profit margins rather than standardized pricing in most European nations; essentially, a US bill will show a much higher overall cost for similar medical services.

Key differences:

• Overall Cost:
  A US hospital bill for a standard procedure will generally be several times higher than a comparable bill in most European countries.
  
  
• Itemized Charges:
  • Room Charges: While room costs can vary depending on the facility and location, US hospital rooms often have significantly higher per-night charges compared to European hospitals.
    
    
  • Doctor Fees: Physician fees on a US bill can be substantially higher than in Europe, as doctors often have greater billing flexibility.
    
    
  • Diagnostic Tests: Even routine lab tests and imaging procedures may be priced much higher on a US hospital bill.
    
    
  • Administrative Fees: US bills might include additional administrative charges not commonly seen in Europe.

Reasons for the disparity:

• Private vs. Public Healthcare:
  Most European countries have primarily public healthcare systems with price controls, while the US relies heavily on private insurance companies, leading to higher costs due to market competition.
  
  
• Profit Incentives:
  US hospitals and healthcare providers often operate with a profit motive, leading to higher charges compared to European systems focused on patient care.
  
  
• Drug Costs:
  Prescription drugs can be significantly more expensive in the US compared to Europe, further inflating medical bills.

Example Comparison:

• Appendectomy in the US: Could cost upwards of $30,000.
  
  
• Appendectomy in Europe (average): Might cost around €600 (equivalent to roughly $650).

Oh, fully agree 100%. I’m the one on the top of the mountain screaming that the reason your health “insurance” costs as much as it does is because the cost of the care that it’s paying for is so high. If your appendectomy costs $650 rather than $30k, then the cost of the insurance to cover that appendectomy wouldn’t need to be so high.

Now while the insurance industry might not be completely innocent in allowing the cost of that appendectomy to reach $30k, ultimately it’s the provider who is choosing to charge that amount for it. Maybe they can justify that cost, maybe they can’t - but I’d like to at least have them explain why it is.

Amen. There is very little price discovery/transparency in U.S. medical care.

A little story that has be told here before (in other threads) - and some background, I’ve been a life/health insurance agent for 20+ years.

When my son was going to be born, wife and I go to hospital and we get her all nice and settled in the delivery room. We have some time, so one of the nurses says to me that the billing dept will need her insurance info (they kinda rushed her in and didn’t have a chance to do that part). I said no problem, got her insurance card and made my way to their billing office. I have the nice lady the card, she input the information into the system, confirmed that it was valid and active coverage (I guess their “system” could directly communicate with Aetna’s), and she said it was all good. I then asked her, knowing I wouldn’t get an answer, but really just to see what response I’d get - “so how much will this all cost?” She looked confused and answered, “what do you mean?” I responded - “well, my wife is about to have a baby, she’s upstairs in a room in your hospital - let’s assume she has a normal deliver and she and baby come home tomorrow or the next day, you have her insurance information on the computer in front of you, you see her plan info, what will the total charges be that the hospital will bill under that assumption?”

She looked at me like I had three heads. “I have no idea, and I have no idea how to even get that answer for you.” I mean, I knew I wouldn’t get an answer, but let’s be real here - this person works in the hospital billing department, if they don’t know and don’t even know where to get that answer, how would anyone else?

 

[Joe Bryant]

Here's one of the problems. Take obesity as a great example. How many times is a person told that their lifestyle and/or eating habits etc can help fix their problems with obesity in a year? How many times do we hear that message? How many times a day do we hear that drug X is the solution to that same problem? I am willing to bet that we here the later more in a day than we do the former in a year.

I can't speak for your world. And I'm not going to try and dispute how much money is spent by either side.

But in my world, I don't hear "A drug is the cure for obesity" 365 times for every one time I hear "lifestyle and eating habits will cure obesity".

Granted, I think the right answer for most people IS lifestyle and eating habits. And I wish we saw more of that talk. But in my world, it doesn't feel like 365-1.

 

[Joe Bryant]

With that said, I'd also be fine with weighing out restricting or eliminating pharmaceutical ads on television the way other countries do.

A related effect would be the catastrophic impact on media revenue and that moves into a different conversation as well.

 

[Max Power]

A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy

This seems like such a simplistic and misguided view for someone who is supposedly higher on the IQ scale. Our life expectancy has a lot to do with our culture and shouldn't fall at the feet of the healthcare industry. Medical professionals are telling people every day how to live healthier, Americans just often choose not to.

#42 though? Yes, it's one data point, but it's also one that used as a general measurement of health of a country. It's not like we are leading the charge in other common stats either, like infant mortality and others. Also, for those stats and frustration with our system, we spend way more than other countries (if I remember correctly, 50% more than #2??)

My position is that unfortunately I would say that "profits over people" are very much a part of our country's culture and that is front and center when we talk about our healthcare industry. IMO humans aren't that different, and I would imagine that the populations of those countries ahead of us also choose not to do healthy things too. Yes, it's simplistic, but I also think it's an indicator that something is amiss with the system when you see that big of a discrepancy between $$ spent and those outcomes.

The system is a mess. Despite the astronomic cost, access to care is one of the big issues.

A good summary of some of the problems

ETA We spend 16% of our GDP on healthcare, compared to other top countries, who spend 10-12%.

I the Max's stance and agree that people need to make better choices for themselves (including me). My experience is that even when people make the proper choice the culture of our healthcare system is to generate profits. That is often at odds with what is the best option for care for the patient seeking it, and we all know it.

I believe there is some "groupthink" within the medical community where it's easier for a doctor to go along with a treatment option that maximizes profits because the rest of the community is doing something similar, and it won't be questioned.

What treatment(s) were you thinking, specifically?

Without derailing the thread (Because I suspect we'll be in disagreement here), I felt covid prevention and treatment was reduced to a single line of thinking and anything outside the box was "misinformation" and came with threats of revoking medical licenses. I parted ways with my primary care doctor over a couple interactions we had during the covid years. He went from working with me on an individualized prevention plan to a follow up appointment where he pushed Pfizer products only and disparaged all other options.

I think a lot may boil down to pharmaceutical companies paying doctors to prescribe their products. I don't see this as being in the best interest of public health.

 

[matttyl]

"People don't like delayed gratification" is one of those things that you don't need a social science degree to appreciate, and you can get a lot of mileage out of that observation. It explains why Americans are overweight, and it also explains why they don't save for retirement. It explains (partly) why teen pregnancies happen. It explains why people didn't abide by pandemic restrictions, and why they speed. This is a very robust observation about human behavior.

I agree completely but wonder if this is more common in American society than other countries.

Off topic, but an interesting question that some studies that I’ve seen have looked into. It’s very cultural. For instance Japanese kids wait longer for food rewards than American kids do (which they state is 100% cultural), though the inverse was true with gifts (generally Americans wait until the gift giver is present before opening).

You can look up the Walter Mischel “marshmallow test.” They told kids you can have one marshmallow now, or wait and have two later. They found those kids who did wait had better life outcomes - more academic success, better social behavior, and even better health.

 

[djmich]

One reason people consume processed versus healthier choices is cost, with healthier choices being significantly more expensive.

And if you don't have FBGs money, choosing the healthy option might not even be an option for you.

Okay, so you are correct that processed foods generally -- broadly speaking -- cost more less than healthy foods. That is true, but of course, that also has nothing whatsoever to do with the health insurance industry or your provider. It certainly doesn't justify assassinating anybody who works at UHC.

To your second point, let's be real here. People don't eat junk food because they're poor, or because they don't know any better. They eat junk food because junk food tastes good and broccoli doesn't. It's entirely an issue of personal choice. Maybe it's different for people below the poverty level or something, but the average American is overweight and poorly-nourished because they chose that. You have agency, and what you choose to eat is in your locus of control.

Edit: Whoops.

Many people prefer the taste of broccoli to junk food (i would be one), people get used to the foods they eat when they're young, if they're raised on crappy food they'll be more likely to continue to eat it. I do think many people are poorly educated on proper nutrition and that's a factor. Also cooking healthy meals takes time vs. buying processed meals. Some people may have the time but many people are just lazy.

Broccoli baked with a little olive oil and pepper is delicious, as good as French fries imo.

It and Brussels sprouts are staples in our diet, things I rarely ate growing up - I was a latchkey kid, raised on fast food and tv dinners. Though it requires some effort, it’s amazing how malleable the palate can be.

Cauliflower. Cook in air fryer with a little olive oil. Add a little salt, pepper and a bit more Tajin. Thank me later.

 

[Sparky Polastri]

There's no question that there is plenty of blame to go around. My initial comment on this current thread of posts was that the healthcare industry is absolutely part of our culture and a lot of the cause for where we are is because of them. That doesn't mean that individual choice isn't a component. Obviously, it is. Here's one of the problems. Take obesity as a great example. How many times is a person told that their lifestyle and/or eating habits etc can help fix their problems with obesity in a year? How many times do we hear that message? How many times a day do we hear that drug X is the solution to that same problem? I am willing to bet that we here the later more in a day than we do the former in a year. Take a similar question to the grocery store. How much space is allocated to whole foods vs processed foods in boxes and bags?

So while I agree with the premise that personal choice is one of the factors in our performances, I also acknowledge that we make those choices based in the info that's put in front of us. The echo chamber of life choices is just as real as any other echo chamber. Problem is, individuals aren't really choosing this particular echo chamber. Money and profits are dictating what is put before us most of the time. This is a psychological battle as much as a physical one and the average American is losing.

My model of the world differs tremendously from yours. Like we live on different planets. Maybe you're right, but we are starting from a completely set of facts on the ground.

Seems that way. My world is one in which we see roughly $600M spent on advertising for athletics and/or fitness equipment (adding this to the list to be generous. I know we haven't talked about this aspect), $320M spent on healthy food/drinks, $23B on "healthcare advertising" from the big pharma companies (their drugs and products), roughly $1B on specific drugs for weight loss and diabetes, etc. So when I make the comments I do, it's coming from that lens. This doesn't include generic "food and alcohol" industry (which is around 15% of the mass media advertising market) that promotes sugar, snacks, fast food and candy. Those promotions are roughly 80% of what they put out on the airways.

The above is off memory from the 2022 era when I was doing a research assignment on this topic in grad school, so these might have changed some in the last two years. Apologies for not providing that perspective earlier to make things clearer.

Okay, but have you talked to other human beings about this? For example, let's say we grabbed ten random people off the street and asked them "When you think of ways to lose weight, what's the first thing that comes to mind?"

How many people do you think would say diet or exercise, versus how many people would say Ozempic?

Genuine question. I am very curious to know what sort of result you would expect to get.

Spoiler

I think 9/10 would say "diet and exercise." Maybe I'm wrong.

This is a completely different line of thought than what you replied to. There is a knowledge aspect, which you are referring to. Then there is a messaging/psychological aspect, which I am referring to. There is a well documented subconscious approach here that almost always wins over knowledge. What we "feel" typically wins out and those feels are what are pushed constantly because they make companies WAY more money.

Yeah, I understand what you're saying, and that's just not really my model of world. On the topic of obesity (but this would be true of many/most topics TBH), I don't think people are "pushed" against diet and exercise. They have diet and exercise flung in their face constantly, day after day. They simply choose not to go that diet/exercise route because diet and exercise involves delayed gratification in a physically unpleasant way, and people generally don't choose that option. It's really not that much deeper than that.

Now, having said that, is the food pyramid misleading? My understanding is that it is. Do companies make processed foods hyper-delicious on purpose? Sure. Do we subsidize grains too much and vegetables not enough? Probably. Those things are all true, and I freely concede that they make a difference on the margin. But at the end of the day, the real reason why Americans are fat is because of choices freely made by people who know what they're doing. Modeling people primarily as actors just seems to me to make better predictions than modeling them as being acted upon.

If you feel otherwise, that's fine. Maybe I'm wrong.

I'll see if I can find a nonpay study showing the psychology of all this (not having much luck). It starts with specific foods and commercials/exposures around them. And it starts in adolescence. We are conditioned WELL before we are adults (and able to make the decisions consciously) to lean towards all the crap foods. Its very much deeper than decisions. Its deep like "person abused by parent when a kid now abuses kid" deep. Many won't take the time to go this path, but if you decide to, it's very eye opening. I am here telling you this isn't either/or. It's both. I don't absolve people from making the choices they make. However, I also understand all the time and effort companies put into trying to alter the subconscious so it appears they have little to no influence in those decisions.

 

[Sparky Polastri]

Here's one that I haven't read completely, but is similar to those I used in my research papers. Not the best, but it wets the appetite if one wants to look at the psychological side of it all.

The Effects of Food Advertisements on Food Intake and Neural Activity: A Systematic Review and Meta-Analysis of Recent Experimental Studies - PMC

Food advertisements are ubiquitous in our daily environment. However, the relationships between exposure to food advertising and outcomes related to ingestive behavior require further investigation. The objective was to conduct a systematic review ...

pmc.ncbi.nlm.nih.gov

This one appears to be making a similar argument that the current vape lawsuits are. Targeting kids with poor choices and making sure their brand is front of mind. Valid, but there are better arguments to be made IMO.

 

[the moops]

I generally eat very well cause I love cooking and we can afford the time and money it requires.

To use the broccoli example though. Raw or even steamed broccoli is fine, but certainly not really good. A good broccoli dish takes like 30 minutes to prep and cook though and will be the cost of good broccoli and good oil/butter and some garlic and whatever else. Certainly not expensive, but not as cheap as other stuff.

Doritos are also awesome though and cost 89 cents and require no prep or cook time.

And I get it. We resort to doritos and frozen burritos and fast food sometimes, but if we made half as much money and worked twice as hard, we would rely on those things way more often.

It’s not that difficult. Break florets into smallish pieces and arrange on foil/baking pan. Drizzle with olive oil + a dash of pepper (salt if you must, but not necessary). Can add minced garlic or garlic salt as well. Bake at 425 (IIRC, wife always cooks this). It’s done when it starts to brown, about 16 minutes.

I didn't say it was difficult, just that with prep and cook time you are looking at 30 minutes.

 

[matttyl]

Re advertising - growing up in the 80s I saw tobacco ads all over. TV, radio, on football stadiums, billboards, magazines, on and on. I had family members who all smoked (not my parents, though). You know what I never ever did? Smoked. Mainly cause I knew my mother would whip my butt if I did but I never wanted to either. Today I see ads for cheap beer brands all over. You know what I don’t drink? Cheap beer. I have choices. So does everyone else. They may not be easy choices, granted, but they are still choices.

 

[Mitchie]

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

 

[matttyl]

Back to the original topic - now a Florida woman has been arrested for threatening a BCBS agent (which is what I am, scary stuff for me). She’s recorded saying “Delay, Deny, depose…you people are next.”

 

[GoBirds]

CNBC had an interesting segment this morning on if society has reached an all time low with this and people showing support for a murderer. A comparison they made I didn’t think of is when people were cheering on OJ. Sadly we’ve been here before. Billy the Kid was another comparison from before my time.

 

[matttyl]

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do you they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

Of course that answer is no. But a lot of those same people can fully break down the current NFL playoff picture, or tell you who won last seasons “The Voice”, or tell you the backstory of every “housewife of wherever.” The information about just about everything is out there if you’re will to take the time and effort to look into it.

 

[Payne]

Health insurance is much simpler than a lot of folks make it out to be. I mean if I can understand it enough to explain it to folks it can’t be that complex.

It’s like my wife who says she over complicates personal financial planning because she thinks it’s super complicated - but she can tell you the difference between Roth and traditional accounts, and I tell her that’s most of it.

My wife is in the field and I can say, without question, it's far more difficult than you think it is.

 

[the moops]

Health insurance is much simpler than a lot of folks make it out to be. I mean if I can understand it enough to explain it to folks it can’t be that complex.

It’s like my wife who says she over complicates personal financial planning because she thinks it’s super complicated - but she can tell you the difference between Roth and traditional accounts, and I tell her that’s most of it.

My wife is in the field and I can say, without question, it's far more difficult than you think it is.

Mattyl is in the field

 

[Atomic Punk]

@matttyl bringing the (not so) common sense into the discussion.

 

[matttyl]

Health insurance is much simpler than a lot of folks make it out to be. I mean if I can understand it enough to explain it to folks it can’t be that complex.

It’s like my wife who says she over complicates personal financial planning because she thinks it’s super complicated - but she can tell you the difference between Roth and traditional accounts, and I tell her that’s most of it.

My wife is in the field and I can say, without question, it's far more difficult than you think it is.

Well, it is a legal contract that can be tens if not hundreds of pages of “legalise” (sp?) long, granted. What I mean is that I get very basic questions all the time about what a deductible is/means, how it applies, the difference between a copay and coinsurance, stuff like that.

 

[Nugget]

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

During 4 years of medical school, most students spend less than 20 hours on nutrition

The model is set up to treat the symptom, and get paid by the billing code.

Doctors are paid bonuses for prescribing medications - not diet and exercise. UHC Link

 

[Stoneworker]

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

During 4 years of medical school, most students spend less than 20 hours on nutrition

The model is set up to treat the symptom, and get paid by the billing code.

Doctors are paid bonuses for prescribing medications - not diet and exercise. UHC Link

The problem isn't a lack of nutritional knowledge or advice in the medical community.

The problem is that many (most?) people choose to ignore this advice. Or even common sense (e.g. consume more calories than you burn = weight gain)

 

[matttyl]

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

During 4 years of medical school, most students spend less than 20 hours on nutrition

The model is set up to treat the symptom, and get paid by the billing code.

Doctors are paid bonuses for prescribing medications - not diet and exercise. UHC Link

This is mostly correct, but a bit of context if I may. This is for Medicare advantage folks (who are all 65+). It’s a small (but growing) part of their overall portfolio. Perhaps telling an 80 year old to start exercising isn’t the best care route, but I’m no doctor.

The “bonuses” being referred to here are for “quality care activities”, some of which are when the patient adheres to a prescription regime for things like diabetes, cholesterol and high blood pressure. Pretty much if the member takes insulin for their diabetes, the doctor gets $20. There are other even larger “bonuses” for the member getting an annual health screening, a breast exam, or for “controlling high blood pressure” which in fact could be done with diet and exercise.

 

[Joe Bryant]

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

During 4 years of medical school, most students spend less than 20 hours on nutrition

The model is set up to treat the symptom, and get paid by the billing code.

Doctors are paid bonuses for prescribing medications - not diet and exercise. UHC Link

Yes. I've mentioned it a couple of times but this is really moving to a Callie Means - Good Energy discussion.

Her interview on Rogan was eye opening. https://youtu.be/G0lTyhvOeJs?si=cOe0ugdY2EZJBkKR

She was a Standford educated MD that gave it all up seeing how broken she felt the medical industry is.

- Not focused on nutrition and instead they focus on treating symptoms with surgery and pharma.
- Food companies allowed to put things in the food others countries don't allow
- Food companies engineering the food to be addictive
etc

 

[Mitchie]

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

During 4 years of medical school, most students spend less than 20 hours on nutrition

The model is set up to treat the symptom, and get paid by the billing code.

Doctors are paid bonuses for prescribing medications - not diet and exercise. UHC Link

The problem isn't a lack of nutritional knowledge or advice in the medical community.

The problem is that many (most?) people choose to ignore this advice. Or even common sense (e.g. consume more calories than you burn = weight gain)

yes people ignore advice that is part of the problem no doubt, but lack of knowledge and awareness also plays a big role.

 

[Terminalxylem]

Here's one of the problems. Take obesity as a great example. How many times is a person told that their lifestyle and/or eating habits etc can help fix their problems with obesity in a year? How many times do we hear that message? How many times a day do we hear that drug X is the solution to that same problem? I am willing to bet that we here the later more in a day than we do the former in a year.

I can't speak for your world. And I'm not going to try and dispute how much money is spent by either side.

But in my world, I don't hear "A drug is the cure for obesity" 365 times for every one time I hear "lifestyle and eating habits will cure obesity".

Granted, I think the right answer for most people IS lifestyle and eating habits. And I wish we saw more of that talk. But in my world, it doesn't feel like 365-1.

Right, as in ideal, or right, as in the answer that will work?

Unfortunately, in our non-ideal world, the right answer often isn’t what people choose, so we’re left doing what is practical. Obesity stats suggest most people cannot/will not choose appropriate diet and activity levels, so when should we adopt a harm reduction model, using medications instead?

 

[Terminalxylem]

A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy

This seems like such a simplistic and misguided view for someone who is supposedly higher on the IQ scale. Our life expectancy has a lot to do with our culture and shouldn't fall at the feet of the healthcare industry. Medical professionals are telling people every day how to live healthier, Americans just often choose not to.

#42 though? Yes, it's one data point, but it's also one that used as a general measurement of health of a country. It's not like we are leading the charge in other common stats either, like infant mortality and others. Also, for those stats and frustration with our system, we spend way more than other countries (if I remember correctly, 50% more than #2??)

My position is that unfortunately I would say that "profits over people" are very much a part of our country's culture and that is front and center when we talk about our healthcare industry. IMO humans aren't that different, and I would imagine that the populations of those countries ahead of us also choose not to do healthy things too. Yes, it's simplistic, but I also think it's an indicator that something is amiss with the system when you see that big of a discrepancy between $$ spent and those outcomes.

The system is a mess. Despite the astronomic cost, access to care is one of the big issues.

A good summary of some of the problems

ETA We spend 16% of our GDP on healthcare, compared to other top countries, who spend 10-12%.

I the Max's stance and agree that people need to make better choices for themselves (including me). My experience is that even when people make the proper choice the culture of our healthcare system is to generate profits. That is often at odds with what is the best option for care for the patient seeking it, and we all know it.

I believe there is some "groupthink" within the medical community where it's easier for a doctor to go along with a treatment option that maximizes profits because the rest of the community is doing something similar, and it won't be questioned.

What treatment(s) were you thinking, specifically?

Without derailing the thread (Because I suspect we'll be in disagreement here), I felt covid prevention and treatment was reduced to a single line of thinking and anything outside the box was "misinformation" and came with threats of revoking medical licenses. I parted ways with my primary care doctor over a couple interactions we had during the covid years. He went from working with me on an individualized prevention plan to a follow up appointment where he pushed Pfizer products only and disparaged all other options.

I think a lot may boil down to pharmaceutical companies paying doctors to prescribe their products. I don't see this as being in the best interest of public health.

This has certainly happened, but isn’t very common ime. Personally, I’m aware of more docs who profiteer from misinformation.

 

[Sparky Polastri]

The problem isn't a lack of nutritional knowledge or advice in the medical community.

The problem is that many (most?) people choose to ignore this advice. Or even common sense (e.g. consume more calories than you burn = weight gain)

I'd suggest this is PART of the problem. I know many here want this to be an either/or situation. It's not. It's a both/and situation. We need to address both sides of this. We need to figure out how to educate people in a way that they make the right decisions while also removing the forces that are directly/indirectly telling them to do otherwise.

 

[FiredMartz]

Is this now a health care thread?....no new info on the case?

 

[Stoneworker]

The problem isn't a lack of nutritional knowledge or advice in the medical community.

The problem is that many (most?) people choose to ignore this advice. Or even common sense (e.g. consume more calories than you burn = weight gain)

I'd suggest this is PART of the problem. I know many here want this to be an either/or situation. It's not. It's a both/and situation. We need to address both sides of this. We need to figure out how to educate people in a way that they make the right decisions while also removing the forces that are directly/indirectly telling them to do otherwise.

Avoid salt, sugar and fatty foods. Balance your intake of meats, carbs and vegetables. Don't eat too much. Whole foods are better than processed foods.

That's going to solve 90% of so-called "nutritional" problems.

It's not rocket science

 

[uwillbsoon]

I think we can all agree that UHG owning insurance, facilities and a PBM and being beholden to shareholders can lead to anti-consumer actions, right?

I don't believe people know much about nutrition, and also don't pay a lot of attention to the foods they eat. do they know that broccoli is better than a candy bar yes, but do they know how bad unprocessed white flour is for you vs. eating whole grains, do they look at labels on foods and know how much sugar is in a box of raisin bran or how much sodium is in the food they buy at Trader Joe's? I'd bet a lot of money the answer is no for a lot of people.

During 4 years of medical school, most students spend less than 20 hours on nutrition

The model is set up to treat the symptom, and get paid by the billing code.

Doctors are paid bonuses for prescribing medications - not diet and exercise. UHC Link

This is mostly correct, but a bit of context if I may. This is for Medicare advantage folks (who are all 65+). It’s a small (but growing) part of their overall portfolio. Perhaps telling an 80 year old to start exercising isn’t the best care route, but I’m no doctor.

The “bonuses” being referred to here are for “quality care activities”, some of which are when the patient adheres to a prescription regime for things like diabetes, cholesterol and high blood pressure. Pretty much if the member takes insulin for their diabetes, the doctor gets $20. There are other even larger “bonuses” for the member getting an annual health screening, a breast exam, or for “controlling high blood pressure” which in fact could be done with diet and exercise.

Some more context: It may be a small part of their portfolio, but they have the biggest market share in the MA market. I believe they have around 25-30% of the MA market. Humana is probably 15-20%.

Some of these activities are individual measures in Star Ratings. So CMS pays quality bonuses to MA Plans with high star ratings that are in the billions of dollars annually. UHG (and others) incent providers on these medication adherence activities to earn high star ratings and more federal dollars. There's other perks to high star ratings (greater enrollment, marketing opportunities, extended enrollment periods).

So, realistically, some of these bonuses are really the result of government intervention.