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

[KarmaPolice]

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.

 

[bagger]

what is the difference between a manifesto and a diatribe?

Calligraphy?

 

[ShamrockPride]

Time for some people in here to take some time away from the thread before they ruin a quality conversation for all of us.

 

[fatness]

Interesting longer article on Mangione: https://www.businessinsider.com/who-is-luigi-mangione-charged-unitedhealthcare-ceo-murder-2024-12

It's really worth a read in the "what led up to all this?" way. There's way too much to summarize, but here's some of it:

For years before he was accused of killing the CEO of one of America's largest health-insurance companies, Luigi Mangione suffered from debilitating pain that doctors didn't seem able to fix. He detailed the pain, and what he felt to be the healthcare system's inadequate response, in dozens of posts on Reddit between 2018 and 2024. None of them, though, mention UnitedHealthcare or its CEO, Brian Thompson, whom he's now accused of killing. And none of the posts blame UnitedHealthcare — or Thompson — for his health issues. The only insurer mentioned is Blue Cross Blue Shield, in a brief post describing how it covered a medical test.

In 2022, he described "near-constant burning/twitching in both ankles/calves." By 2023, he wrote on Reddit, he'd been experiencing "back and genital pain" on and off for a year, including numbness in his groin. (Details shared by the Reddit account match biographical details about Mangione sourced from public documents.) He underwent surgery later that year. An X-ray image Mangione posted on social media depicted a spinal fusion, with rods and screws reinforcing the position of his bones. At first, he appeared jubilant — his pain was gone. But by June this year, he was castigating doctors as "basically worthless" on X.

He appeared active in his fraternity, photos posted on Instagram show. Still, his health appeared to drag him down. In posts on Reddit, he described experiencing "brain fog." His "cognitive decline" started after he contracted Lyme disease at 13, he wrote, and worsened after his "very tame" but sleepless fraternity initiation. The fraternity did not respond to a request for comment. He considered dropping out of college, he wrote, and felt that his condition restricted him to "what feels like 10% of a college experience."

In Hawaii, Mangione experienced another health setback. He'd had mild back pain since he was a child, but while surfing in early 2022, he "experienced sciatica for the first time," he wrote on Reddit. "A few weeks later I slipped on a piece of paper and my right glute locked and right leg shut down for a week. Couldn't support any weight on it."

"Tell them you are 'unable to work'/do your job. We live in a capitalist society," he wrote. "I've found that the medical industry responds to these key words far more urgently than you describing unbearable pain and how it's impacting your quality of life."

His final Reddit post, in May, was to the Kaczynski subreddit; he shared a video lambasting Chinese social-media culture. On X, his final posts, on July 8, revealed a disenchantment with both the Democratic and the Republican political parties and support for Robert F. Kennedy Jr. The previous month, he'd reposted another user's skepticism with doctors.

 

[Scoresman]

Interesting. So his beef was with the healthcare industry, but from the sound of that not specifically insurance?

 

[Jayrod]

I had a similar massive back issue 5 months ago (different cause though) with enough sciatic pain I writhed on the floor for literally days with minimal and even 2 nights of no sleep.

I legit wanted to die. Not commit suicide but thought it would have been preferable to what I was going through. Opiods made a dent, but nothing stopped it. And there was real hesitation by doctors to giving me anything strong.

Finally was told I had a degenerative disc. Could try rehab, pain injection or even surgery. I tried rehab and it worked. After 4 weeks I was back to 100% mobility and no pain.

Still never wanted to kill anyone, but I wouldn't have lasted a year in that condition. Would have either numbed myself too much with anything I could get or had an accident with a train.

 

[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%.

 

[STEADYMOBBIN 22]

I have phenomenal health insurance. God tier insurance.

Every single good doctor in the area eventually goes to a concierge service and I have to find a new doctor. This has happened with my last three GPs.

So I have access and coverage for everything- but I STILL have to come further out of my pocket to actually get good heath care.

 

[KarmaPolice]

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.

 

[KarmaPolice]

I have phenomenal health insurance. God tier insurance.

Every single good doctor in the area eventually goes to a concierge service and I have to find a new doctor. This has happened with my last three GPs.

So I have access and coverage for everything- but I STILL have to come further out of my pocket to actually get good heath care.

We don't make a ton (a FBG rarity). Through my wife's clinics the insurance has always been ungodly expensive (because they are small businesses, I get it). We have had family rates teetering on $1400/month for coverage. More than our mortgage. That would be one thing, but as you said - the bills always pile up on top of that beacuse of co-pays, something not covered, deductables, etc.. , and we have had 10K+ in bills at points in time. I get other people's grumbles about other country's care as well, but it is bananas how common debts are because of medical care in this country. If I remember a recent article correctly, it's the most common debt?

 

[Chemical X]

I had a similar massive back issue 5 months ago (different cause though) with enough sciatic pain I writhed on the floor for literally days with minimal and even 2 nights of no sleep.

I legit wanted to die. Not commit suicide but thought it would have been preferable to what I was going through. Opiods made a dent, but nothing stopped it. And there was real hesitation by doctors to giving me anything strong.

Finally was told I had a degenerative disc. Could try rehab, pain injection or even surgery. I tried rehab and it worked. After 4 weeks I was back to 100% mobility and no pain.

Still never wanted to kill anyone, but I wouldn't have lasted a year in that condition. Would have either numbed myself too much with anything I could get or had an accident with a train.

yeah, i’ve hurt myself a bunch of times and going to the doctor is a trial and error thing sometimes to figure out what is wrong, but i never blamed the doctor nor the insurance company for my ills. as i’ve said many times here, our society has a foundation of scapegoating and blaming. we love to blame others, it’s what we do. mix that with unsocial media glorifying acts of violence and you get nuts with guns seeking justice. just my .02. to discuss why people seem to feel more emboldened nowadays would be a lengthy conversation that i’m not willing to undertake. i blame the message board.

 

[matttyl]

Interesting. So his beef was with the healthcare industry, but from the sound of that not specifically insurance?

This is exactly how I’m reading this, too. This doesn’t seem to be the case of someone unable to obtain/receive care. He wasn’t denied coverage (as far as we can tell thus far) - he got the (likely expensive) surgery, but that surgery didn’t cure what ailed him.

 

[matttyl]

I have phenomenal health insurance. God tier insurance.

Every single good doctor in the area eventually goes to a concierge service and I have to find a new doctor. This has happened with my last three GPs.

So I have access and coverage for everything- but I STILL have to come further out of my pocket to actually get good heath care.

Because those doctors choose to not be part of the insurance network (most likely because they think the insurance network wouldn’t pay them enough). For them to be a part of that network the reimbursement the insurance company pays them would have to be higher, and this that insurance would need to cost more. Lots of these “concierge” practices are selling their own “insurance”/dues/memberships - it’s really just additional insurance for a much smaller network.

 

[matttyl]

I have phenomenal health insurance. God tier insurance.

Every single good doctor in the area eventually goes to a concierge service and I have to find a new doctor. This has happened with my last three GPs.

So I have access and coverage for everything- but I STILL have to come further out of my pocket to actually get good heath care.

We don't make a ton (a FBG rarity). Through my wife's clinics the insurance has always been ungodly expensive (because they are small businesses, I get it). We have had family rates teetering on $1400/month for coverage. More than our mortgage. That would be one thing, but as you said - the bills always pile up on top of that beacuse of co-pays, something not covered, deductables, etc.. , and we have had 10K+ in bills at points in time. I get other people's grumbles about other country's care as well, but it is bananas how common debts are because of medical care in this country. If I remember a recent article correctly, it's the most common debt?

I’m not sure it would be the most common “debt”, I’d think more people have mortgages or car payments or credit card balances than medical debt. Possibly even student loans. It is, though, the second most common cause of bankruptcy, with #1 being job loss (which often comes with health insurance loss).

 

[Sparky Polastri]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

 

[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.

 

[matttyl]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

 

[IvanKaramazov]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

I've always thought that was a weird argument too. Every health care system is either going to be (a) low quality or (b) restrictive in what it covers or (c) expensive. Every country has to choose, one way or another, which of those faults it is most willing to live with, and to what degree. It makes intuitive sense to me that the richest country in the world might opt for a very expensive health care system that features highly-paid doctors, lots of specialists, the Mayo Clinic, and MRIs in small city hospitals. That's not at all surprising.

Obviously that glosses over a lot of policy details. But the broad, big-picture choice seems rational.

 

[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%.

My takeaway from the link would be that the US spends more time and resources on chronic diseases than other peer countries. The healthcare system needs to find a better way to manage this aspect and provide access to care.

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?

 

[Sparky Polastri]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

That's part of how we determine if capitalism is working right? That said, I don't think healthcare should be "for profit" personally. We see what it produces. And I have a big philosophical issue with "end of life" care and how we approach it in this country. Might sound cold, but I don't believe "longevity" is the primary lens to be looking through.

 

[Fat Nick]

Interesting. So his beef was with the healthcare industry, but from the sound of that not specifically insurance?

I'm not so sure on that. If his beef was with healthcare in general and not UHC specifically, he could've walked 2 more blocks on that exact same day, and gone on a shooting rampage at another conference that included the CEO's of the top dozen or so healthcare companies.

 

[matttyl]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

That's part of how we determine if capitalism is working right? That said, I don't think healthcare should be "for profit" personally. We see what it produces. And I have a big philosophical issue with "end of life" care and how we approach it in this country. Might sound cold, but I don't believe "longevity" is the primary lens to be looking through.

Yet you list it twice in the post I responded to. I agree it’s a complex question to even attempt to answer, and we can all have different answers.

Full disclosure - I'm coming at that question with a father who was diagnosed with stage 4 colon cancer (metastasized to his lungs) last fall, and we honestly thought he was in his last year, possibly last few months of life. Fast forward 15 months later and dad is doing great, in fact moving this month to a house better suited for he and mom, and doing a lot of the moving himself. Spirits high, masses/nodules in his lungs fewer and smaller. All is great, considering the circumstances. I have no idea how much it’s all costing him (he’s on Medicare), but I also don’t care. He’s still here with us. It’s worth it.

 

[IvanKaramazov]

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.

 

[Scoresman]

Interesting. So his beef was with the healthcare industry, but from the sound of that not specifically insurance?

I'm not so sure on that. If his beef was with healthcare in general and not UHC specifically, he could've walked 2 more blocks on that exact same day, and gone on a shooting rampage at another conference that included the CEO's of the top dozen or so healthcare companies.

I based that comment on the article that got posted about his possible motive. It mentions a lot about healthcare but nothing about insurance.

 

[urbanhack]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

That's part of how we determine if capitalism is working right? That said, I don't think healthcare should be "for profit" personally. We see what it produces. And I have a big philosophical issue with "end of life" care and how we approach it in this country. Might sound cold, but I don't believe "longevity" is the primary lens to be looking through.

There's also no money or profit in preventative care. I guess there outside of the traditional healthcare sector with things like Noom or other tech built to help improve your life.

 

[urbanhack]

The for-profit healthcare industry is also focused on treating symptoms and not the cause.

 

[Max Power]

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.

I basically agree with everything you've said. Obesity is a problem that compounds almost every other health issue someone faces. We are an unhealthy nation, and a lot of that falls on us.

My macro view of the healthcare situation in the US is pretty mild. Of course, there is room to improve, and I wish there was less "for profit" within our healthcare system but, I feel a lot of the poor health outcomes come from the US health system working with a less than healthy population.

Another topic for another day, but I'm interested to see what changes come out of the FDA in the near future.

 

[Joe Bryant]

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 gets into the Dr. Callie Means "Good Energy" area. I don't know how accurate it is, but some feel the food industry with crappy cheap (profitable) ingredients engineered to be addictive doesn't mind at all moving customers along to the diabetes industry. At the end of the day, there are plenty of "customers" for the various industries.

 

[KarmaPolice]

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.

 

[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.

 

[Sparky Polastri]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

That's part of how we determine if capitalism is working right? That said, I don't think healthcare should be "for profit" personally. We see what it produces. And I have a big philosophical issue with "end of life" care and how we approach it in this country. Might sound cold, but I don't believe "longevity" is the primary lens to be looking through.

Yet you list it twice in the post I responded to. I agree it’s a complex question to even attempt to answer, and we can all have different answers.

Full disclosure - I'm coming at that question with a father who was diagnosed with stage 4 colon cancer (metastasized to his lungs) last fall, and we honestly thought he was in his last year, possibly last few months of life. Fast forward 15 months later and dad is doing great, in fact moving this month to a house better suited for he and mom, and doing a lot of the moving himself. Spirits high, masses/nodules in his lungs fewer and smaller. All is great, considering the circumstances. I have no idea how much it’s all costing him (he’s on Medicare), but I also don’t care. He’s still here with us. It’s worth it.

Well of course, because that's the situation we're in. In the current model that's one of the big measures.

To be clearer. You asked if we should be or not be using ROI. In the current model, we don't really have a choice. We can take ROI out of the equation completely and those lists I mention don't change at all. IMO, return on investment is salt in the wound when we realize how much we spend to perform so poorly. Happy to discuss the poor performances alone. We can have a thread of its own talking about the ill thought out measures like longevity etc.

 

[Nugget]

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 gets into the Dr. Callie Means "Good Energy" area. I don't know how accurate it is, but some feel the food industry with crappy cheap (profitable) ingredients engineered to be addictive doesn't mind at all moving customers along to the diabetes industry. At the end of the day, there are plenty of "customers" for the various industries.

Exactly. I've listened to Dr. Casey Means talk to Andrew Huberman as well as the Tucker Carlson podcast with Casey and Callie Means. It sounds like a conspiracy theory, but looking at the food/pharma/insurance industries it isn't much of a stretch.

 

[Grace Under Pressure]

While it may seem counterintuitive, health insurance companies are interested in keeping their covered populations healthy, and they have all sorts of programs designed to have screenings and interventions in order to catch things early and prevent catastrophic outcomes. It's not like they do this from the "goodness of their heart" so to speak, they do it to minimize expensive claims and keep their costs down. They want to collect premiums and minimize costly claims. It's loss-ratio stuff, these are insurance companies after all.

 

[opensourcebeer]

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 gets into the Dr. Callie Means "Good Energy" area. I don't know how accurate it is, but some feel the food industry with crappy cheap (profitable) ingredients engineered to be addictive doesn't mind at all moving customers along to the diabetes industry. At the end of the day, there are plenty of "customers" for the various industries.

Exactly. I've listened to Dr. Casey Means talk to Andrew Huberman as well as the Tucker Carlson podcast with Casey and Callie Means. It sounds like a conspiracy theory, but looking at the food/pharma/insurance industries it isn't much of a stretch.

And when you include the $5.8 billion ( pharmaceutical companies) and $3.5 billion (insurance companies) have spent lobbying in the last 25 years, coupled with the 2010 Citizens United Supreme Court ruling, it's easy to conclude why the vast majority of our politicians (both sides) haven't done much to improve the situation for your average person.

It's also not much of a leap to hypothesize that this is one of the underlying causes (maybe subconsciously) to why people are posting the kind of stuff they are on social media about this thread's topic.

 

[matttyl]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

That's part of how we determine if capitalism is working right? That said, I don't think healthcare should be "for profit" personally. We see what it produces. And I have a big philosophical issue with "end of life" care and how we approach it in this country. Might sound cold, but I don't believe "longevity" is the primary lens to be looking through.

Yet you list it twice in the post I responded to. I agree it’s a complex question to even attempt to answer, and we can all have different answers.

Full disclosure - I'm coming at that question with a father who was diagnosed with stage 4 colon cancer (metastasized to his lungs) last fall, and we honestly thought he was in his last year, possibly last few months of life. Fast forward 15 months later and dad is doing great, in fact moving this month to a house better suited for he and mom, and doing a lot of the moving himself. Spirits high, masses/nodules in his lungs fewer and smaller. All is great, considering the circumstances. I have no idea how much it’s all costing him (he’s on Medicare), but I also don’t care. He’s still here with us. It’s worth it.

Well of course, because that's the situation we're in. In the current model that's one of the big measures. You asked if we should be or not. In the current model, we don't really have a choice. We can take ROI out of the equation completely and those lists I mention don't change at all. IMO, return on investment is salt in the wound when we realize how much we spend to perform so poorly. Happy to discuss the poor performances alone.

As am I. And I also believe that a lot of the “poor performance” we see is because of individual personal choices. While we aren’t the #1 fattest country by rate, pretty much all who top us are very small populations. Roughly 43% of our adult population has a BMI over 30. That’s a lifestyle choice (diet and exercise, we all know it). While we don’t have the highest overall smoker rate, when you look at tobacco consumption per smoker in addition to the overall rate, we’re up at the top vs our peers. That’s a lifestyle choice.

Those two are the “low hanging fruit” to pick, and there are others that are more culturally specific to us. Car accidents per million people in US - a shade under 6k a year. Same metic in say France - 833. The UK - 1,800. Yeah, our culture leads to more people driving than theirs does. Gun accidents/injuries, yeah, that one is obvious.

I can list out the estimated costs we as a society face because of poor diet ($50B), or physical inactivity ($$117B), or smoking ($170B) - and all projects show high blood pressure, CVD, stroke, obesity and diabetes rates only going higher.

 

[Stoneworker]

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 gets into the Dr. Callie Means "Good Energy" area. I don't know how accurate it is, but some feel the food industry with crappy cheap (profitable) ingredients engineered to be addictive doesn't mind at all moving customers along to the diabetes industry. At the end of the day, there are plenty of "customers" for the various industries.

Exactly. I've listened to Dr. Casey Means talk to Andrew Huberman as well as the Tucker Carlson podcast with Casey and Callie Means. It sounds like a conspiracy theory, but looking at the food/pharma/insurance industries it isn't much of a stretch.

And when you include the $5.8 billion ( pharmaceutical companies) and $3.5 billion (insurance companies) have spent lobbying in the last 25 years, coupled with the 2010 Citizens United Supreme Court ruling, it's easy to conclude why the vast majority of our politicians (both sides) haven't done much to improve the situation for your average person.

It's also not much of a leap to hypothesize that this is one of the underlying causes (maybe subconsciously) to why people are posting the kind of stuff they are on social media about this thread's topic.

Since 2010 (the last time politicians "got involved"), employer health insurance premiums for family coverage has nearly doubled, from $13,770 per family to $25,572.

Not a great track record for "improving the situation."

2024 Employer Health Benefits Survey | KFF

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, worker contributions, cost-sharing provisions, offer rates, and more. This year’s report also looks at how employers are addressing a growing need for mental health services.

www.kff.org

https://www.kff.org/wp-content/uploads/2013/04/8085.pdf

 

[Sparky Polastri]

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%.

There are dozens and dozens of measures like "life expectancy" we read about. There MIGHT be 1 or 2 where the US ranks at or near the top. Most of the rest are below the half way mark. Our ROI is complete crap compared to everyone else. Take your pick. Life expectancy? Preventable mortality? Maternal mortality? Excess death? Substance abuse? We can go on and on and on. The placement on lists gets WORSE the more comparable the countries are. When you look at "wealthy countries" only, we are at the bottom of most of those lists.

Throw on top of that the corporations writing our legislation and there's no secrets around why this is all true. This industry is firmly interwoven into our culture at this point. They can't be separated.

Honest question that I’m wrestling with - but should ROI be a metric we use? What I mean is that if it is, then we should be using a system more like what the UK has (which I outlined earlier) - and we’re going to have denials/rationing of more expensive care that isn’t expected to greatly prolong quality life. It’s no secret that the “end of life” care spending that we have in this country is huge. Or should we say “we’re the richest country in the world, cost shouldn’t matter”?

That's part of how we determine if capitalism is working right? That said, I don't think healthcare should be "for profit" personally. We see what it produces. And I have a big philosophical issue with "end of life" care and how we approach it in this country. Might sound cold, but I don't believe "longevity" is the primary lens to be looking through.

Yet you list it twice in the post I responded to. I agree it’s a complex question to even attempt to answer, and we can all have different answers.

Full disclosure - I'm coming at that question with a father who was diagnosed with stage 4 colon cancer (metastasized to his lungs) last fall, and we honestly thought he was in his last year, possibly last few months of life. Fast forward 15 months later and dad is doing great, in fact moving this month to a house better suited for he and mom, and doing a lot of the moving himself. Spirits high, masses/nodules in his lungs fewer and smaller. All is great, considering the circumstances. I have no idea how much it’s all costing him (he’s on Medicare), but I also don’t care. He’s still here with us. It’s worth it.

Well of course, because that's the situation we're in. In the current model that's one of the big measures. You asked if we should be or not. In the current model, we don't really have a choice. We can take ROI out of the equation completely and those lists I mention don't change at all. IMO, return on investment is salt in the wound when we realize how much we spend to perform so poorly. Happy to discuss the poor performances alone.

As am I. And I also believe that a lot of the “poor performance” we see is because of individual personal choices. While we aren’t the #1 fattest country by rate, pretty much all who top us are very small populations. Roughly 43% of our adult population has a BMI over 30. That’s a lifestyle choice (diet and exercise, we all know it). While we don’t have the highest overall smoker rate, when you look at tobacco consumption per smoker in addition to the overall rate, we’re up at the top vs our peers. That’s a lifestyle choice.

Those two are the “low hanging fruit” to pick, and there are others that are more culturally specific to us. Car accidents per million people in US - a shade under 6k a year. Same metic in say France - 833. The UK - 1,800. Yeah, our culture leads to more people driving than theirs does. Gun accidents/injuries, yeah, that one is obvious.

I can list out the estimated costs we as a society face because of poor diet ($50B), or physical inactivity ($$117B), or smoking ($170B) - and all projects show high blood pressure, CVD, stroke, obesity and diabetes rates only going higher.

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.

 

[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.

 

[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).

 

[opensourcebeer]

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.

 

[djmich]

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.

A thread with some relevant, interesting data. 1% / 42%

 

[RCon]

Since 2010 (the last time politicians "got involved"), employer health insurance premiums for family coverage has nearly doubled, from $13,770 per family to $25,572.

Not a great track record for "improving the situation."

2024 Employer Health Benefits Survey | KFF

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, worker contributions, cost-sharing provisions, offer rates, and more. This year’s report also looks at how employers are addressing a growing need for mental health services.

www.kff.org

https://www.kff.org/wp-content/uploads/2013/04/8085.pdf

Figure 1.15 seems to show that health insurance premiums are doing much better from 2009 on than during the 10 years prior, no? If your argument is whether the situation improved or not beginning in 2010, this figure seems to show that the situation improved greatly right at that time.

That said, "employer health insurance premiums" isn't a very good indicator of the total cost of care. For example, my company offers three different plans, with significantly different premiums. The plan with the lowest premiums is also the worst coverage, meaning more out of pocket costs for care.

 

[Fat Nick]

Interesting. So his beef was with the healthcare industry, but from the sound of that not specifically insurance?

I'm not so sure on that. If his beef was with healthcare in general and not UHC specifically, he could've walked 2 more blocks on that exact same day, and gone on a shooting rampage at another conference that included the CEO's of the top dozen or so healthcare companies.

I based that comment on the article that got posted about his possible motive. It mentions a lot about healthcare but nothing about insurance.

I get that - it's just odd to target insurance if you have a broader beef with healthcare, but maybe they all get lumped in together in his eyes - and based on some of the wording, he likely had additional targets beyond insurance that would have made that more obvious.

 

[matttyl]

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.

All depends on what you’re buying, obviously. I took a stroll to my local grocery store for lunch (I’m here now). Local apples 1.29 lb. 5 pound bag of potatoes, 1.99. Bananas .50 lb. Yellow onions 1.29 lb. Gallon of spring or “drinking water 1.49 vs over 2.00 for only 2 liter of soda. You get the idea, I could do more but I’m on the way to their chicken wing bar.

 

[Sand]

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.

Agreed. I hate to muddy this thread, but unfortunately this statistic is taken at face value and promulgated without proper scrutiny or in many cases intentionally. It is gaslighting of the highest order. If you take out the effects of things like homicide, suicide, and drug overdoses our ranking goes way up. These exogenous events aren't and should not be a reflection on our health care system.

#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.

Infant mortality, no. Homicide, suicide, drug overdoses, car fatalities, yes.

 

[opensourcebeer]

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.

All depends on what you’re buying, obviously. I took a stroll to my local grocery store for lunch (I’m here now). Local apples 1.29 lb. 5 pound bag of potatoes, 1.99. Bananas .50 lb. Yellow onions 1.29 lb. Gallon of spring or “drinking water 1.49 vs over 2.00 for only 2 liter of soda. You get the idea, I could do more but I’m on the way to their chicken wing bar.

Mmm...chicken wings.

 

[Nugget]

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

 

[matttyl]

Since 2010 (the last time politicians "got involved"), employer health insurance premiums for family coverage has nearly doubled, from $13,770 per family to $25,572.

Not a great track record for "improving the situation."

2024 Employer Health Benefits Survey | KFF

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, worker contributions, cost-sharing provisions, offer rates, and more. This year’s report also looks at how employers are addressing a growing need for mental health services.

www.kff.org

https://www.kff.org/wp-content/uploads/2013/04/8085.pdf

Figure 1.15 seems to show that health insurance premiums are doing much better from 2009 on than during the 10 years prior, no? If your argument is whether the situation improved or not beginning in 2010, this figure seems to show that the situation improved greatly right at that time.

That said, "employer health insurance premiums" isn't a very good indicator of the total cost of care. For example, my company offers three different plans, with significantly different premiums. The plan with the lowest premiums is also the worst coverage, meaning more out of pocket costs for care.

To piggyback on your last point (where you are totally correct), I now view health insurance more like “health care financing”. The lowest premium comes with the highest deductibles/out of pockets - and the highest premium comes with the lowest. Over the course of a year (with a large enough population), they come out to roughly the same math wise.

 

[KarmaPolice]

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.

 

[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.