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

[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.

 

[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.

 

[RCon]

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.

Some might suggest that our high suicide rate is itself an indicator of the poor state of mental health care in this country. I'm not at all sure we should exclude suicide as "not reflective of our health care system".

 

[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).

 

[IvanKaramazov]

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.

 

[Cowboysfan8]

his "manifesto" posted to reddit:


The full manifesto reads:

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, a lot of patience. The spiral notebook, if present, has some straggling notes and To Do lists that illuminate the gist of it. My tech is pretty locked down because I work in engineering so probably not much info there. I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it. Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty."

At some point, "we" the people will realize the "battles" aren't between conservatives and liberals. It's between the politicians and us ("we"). This is direct evidence of this. I saw a stat some time earlier this year showing us that it makes absolutely NO difference how much support an idea/bill/philosophy has with the public. It has about a 30% chance of making it through Congress and becoming law. It doesn't matter if 5% of the electorate supports it or 95% supports it. THAT is appalling in my opinion. It should be obvious to all of us (and I don't know what I'm thinking going into the world of healthcare in the near future) that our healthcare system is pretty terrible sans areas of cancer and research. We spend trillions more than other nations and its clear that we don't get a good ROI when it comes to outcomes.

Preach

 

[Sparky Polastri]

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).

The psychology behind all this is well documented. We have to go beyond the fact that people are choosing to buy processed foods over whole foods and ask why. This particular choice is a symptom of a much deeper problem. Have to keep going.

 

[djmich]

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.

Some might suggest that our high suicide rate is itself an indicator of the poor state of mental health care in this country. I'm not at all sure we should exclude suicide as "not reflective of our health care system".

We have the highest per capita psychological counseling rate in the world. If it's the healthcare systems fault, its not that Americans don't have access to psychological care, it would be that the psychologists suck.

 

[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.

Okay, so you are correct that processed foods generally -- broadly speaking -- cost more 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.

I think you have your statement regarding cost of processed vs healthy food backwards...or maybe I'm misreading it...shrug.

Also, kind of a strange reply from you given the context of my comment in where the conversation was in the thread at the time and a call out for being off topic. My bad for not directly replying to matttyl I guess.

And I'm really unclear on how my post implies assassination is ok.

 

[Joe Bryant]

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.

Some might suggest that our high suicide rate is itself an indicator of the poor state of mental health care in this country. I'm not at all sure we should exclude suicide as "not reflective of our health care system".

We have the highest per capita psychological counseling rate in the world. If it's the healthcare systems fault, its not that Americans don't have access to psychological care, it would be that the psychologists suck.

That's interesting. I did not know we had that rate for counseling. Thanks.

 

[Joe Bryant]

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.

I agree. But with the discussions here on Ozempic, I was surprised to see how many people seem to not believe we have control or a choice in this.

 

[matttyl]

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.

Some might suggest that our high suicide rate is itself an indicator of the poor state of mental health care in this country. I'm not at all sure we should exclude suicide as "not reflective of our health care system".

Might be more a symptom than a cause (debatable). I would think that suicide is a potential ultimate outcome of depression - where we rank #2 in the world. Behind only Ukraine (according to “world population review”).

 

[urbanhack]

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).

 

[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.

 

[fatness]

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.

Sorry you had to go through that. I had several bouts of uncontrollable pain in the months after spinal fusion surgery, oddly none involving back pain. The "steak knife stuck behind kneecap" still reoccurs, but the worst was when all the flesh on my right leg, from hip to ankle, felt like it was boiling. And I could see the skin jumping up and down while it was happening. Screaming didn't help, I couldn't take any more opioids, I couldn't pass out, and I'd just end up sobbing uncontrollably until it went away. Turns out it was just nerves trying to repair themselves after being disrupted by the surgery, and a series of steroid treatments stopped it. I never wanted to die but did have 2 mornings where my first thought upon waking up was "I don't want to be awake today" which scared the **** out of me. If the pain hadn't subsided in 30 minutes, if it had lasted hours or days, I doubt I would have been able to remain rational and I don't know what I would have done.

 

[djmich]

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.

Some might suggest that our high suicide rate is itself an indicator of the poor state of mental health care in this country. I'm not at all sure we should exclude suicide as "not reflective of our health care system".

We have the highest per capita psychological counseling rate in the world. If it's the healthcare systems fault, its not that Americans don't have access to psychological care, it would be that the psychologists suck.

That's interesting. I did not know we had that rate for counseling. Thanks.

Couldn't find the chart that I was referencing when typing that so fact checked myself on Chatgpt which responded "While the U.S. is a leader in psychological counseling usage, countries with robust social healthcare systems may have comparable rates, especially in certain demographics.". So a leader, think the point stands that availability relative to other nations does not appear to be the issue.

Will add that in the US the demographics of who uses the services is very disparate...will leave it there as that conversation can go downhill.

 

[fatness]

It’s no secret that the “end of life” care spending that we have in this country is huge.

People should be able to choose when they want their life to end (with proper safeguards of course) instead of hanging around needlessly racking up medical expenses while enduring empty days of nothing. But that's a different topic.

 

[matttyl]

@fatness thanks again for posting the article this morning with a bit of a timeline of the suspect’s last few years. I took some time out over lunch (chicken wings) to read it. I’m trying to piece together him going after the UHC CEO specifically and I can’t “connect the dots.” It seems he actually had a back surgery, a spinal fusion specifically, and there is no indication that insurance didn’t pay for it. He was happy to receive it apparently, and at least initially he said it worked. If it didn’t, I can’t see why he’d go after the insurance company that perhaps paid for it rather than the doctor or hospital that performed it. He also apparently spent a lot of time earlier this year in Asia, so wasn’t receiving any healthcare from the US system in any capacity. His mother filed a missing persons report last month, but out of San Fran (hadn’t heard any connection there before, only MD and HI). I do hope more information comes out, I’m sure it will.

 

[Dezbelief]

@fatness thanks again for posting the article this morning with a bit of a timeline of the suspect’s last few years. I took some time out over lunch (chicken wings) to read it. I’m trying to piece together him going after the UHC CEO specifically and I can’t “connect the dots.” It seems he actually had a back surgery, a spinal fusion specifically, and there is no indication that insurance didn’t pay for it. He was happy to receive it apparently, and at least initially he said it worked. If it didn’t, I can’t see why he’d go after the insurance company that perhaps paid for it rather than the doctor or hospital that performed it. He also apparently spent a lot of time earlier this year in Asia, so wasn’t receiving any healthcare from the US system in any capacity. His mother filed a missing persons report last month, but out of San Fran (hadn’t heard any connection there before, only MD and HI). I do hope more information comes out, I’m sure it will.

I'm beginning to wonder if the killer just memorized a bunch of faces of insurance executives and Mr Thompson was the unfortunate soul who happened along.

 

[matttyl]

@fatness thanks again for posting the article this morning with a bit of a timeline of the suspect’s last few years. I took some time out over lunch (chicken wings) to read it. I’m trying to piece together him going after the UHC CEO specifically and I can’t “connect the dots.” It seems he actually had a back surgery, a spinal fusion specifically, and there is no indication that insurance didn’t pay for it. He was happy to receive it apparently, and at least initially he said it worked. If it didn’t, I can’t see why he’d go after the insurance company that perhaps paid for it rather than the doctor or hospital that performed it. He also apparently spent a lot of time earlier this year in Asia, so wasn’t receiving any healthcare from the US system in any capacity. His mother filed a missing persons report last month, but out of San Fran (hadn’t heard any connection there before, only MD and HI). I do hope more information comes out, I’m sure it will.

I'm beginning to wonder if the killer just memorized a bunch of faces of insurance executives and Mr Thompson was the unfortunate soul who happened along.

But I’m still wondering why he went after anyone in the insurance industry at all. From the article, he apparently had a spinal fusion surgery covered (at least he never mentioned that it wasn’t covered), d he was happy to obtain it and at least initially said it worked and relieved his pain.

If it didn’t fix him after all, wouldn’t he target (poor choice of word, I know) the doctor or hospital? I see those stories from time to time.

 

[fatness]

@fatness thanks again for posting the article this morning with a bit of a timeline of the suspect’s last few years. I took some time out over lunch (chicken wings) to read it. I’m trying to piece together him going after the UHC CEO specifically and I can’t “connect the dots.” It seems he actually had a back surgery, a spinal fusion specifically, and there is no indication that insurance didn’t pay for it. He was happy to receive it apparently, and at least initially he said it worked. If it didn’t, I can’t see why he’d go after the insurance company that perhaps paid for it rather than the doctor or hospital that performed it. He also apparently spent a lot of time earlier this year in Asia, so wasn’t receiving any healthcare from the US system in any capacity. His mother filed a missing persons report last month, but out of San Fran (hadn’t heard any connection there before, only MD and HI). I do hope more information comes out, I’m sure it will.

Yeah, I couldn't piece it together in a rational cause-and-effect way either. It was just the best timeline I've found so far. I think if/when we know the whole story, it's not going to make sense in a TV show way. There's going to be irrationality involved, due to who knows what? Pain, too much internet rabbit hole, who knows?

 

[uwillbsoon]

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.

To be fair, most of the big insurers also have healthcare facilities. UHG is I believe the largest employer of physicians in the US.

That sort of self-dealing has gotten them into hot water in the past. They were sued for "forcing" their insured to their facilities and jacking up prices.

 

[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.

To be fair, most of the big insurers also have healthcare facilities. UHG is I believe the largest employer of physicians in the US.

That sort of self-dealing has gotten them into hot water in the past. They were sued for "forcing" their insured to their facilities and jacking up prices.

I said “not completely innocent.” But that’s no different than Kaiser Permanente, is it? They are still in competition with other carriers on price, right? If BCBS or Aetna is able to offer a better policy for less, UHG will lose market share, and thus profit.

 

[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.

Care to give some examples, where you think suboptimal patient care is selected to maximize profits?

I think it happens, don’t get me wrong, but not in many of the situations that people believe it is happening.

 

[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%.

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.

We are the undisputed champions of healthcare expenditure, diagnostic testing, and probably medical errors.

 

[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?

 

[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%.

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”?

End of life care specifically should have limits - not because of investment value, but because it is futile.

 

[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.

 

[Judge Smails]

I’m not going to dive into cesspool narratives if they are here. Haven’t read the whole thread. This was a tragedy and of course not the right way to handle it. I’m glad they caught him. He could have organized marches, raised awareness in other ways, etc. The fact United denied twice the rate of any other insurance company and uses AI to do it is an important issue. I for one will lean towards a job with a company that has other insurers if other factors are reasonably equal.

 

[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%.

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.

What if it is mediocre quality and expensive, in part because it isn’t restrictive enough?

Of course, those aren’t dichotomous variables, but I think our system falls somewhere in the range I just described.

 

[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%.

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?

A little of both.

 

[RCon]

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.

Some might suggest that our high suicide rate is itself an indicator of the poor state of mental health care in this country. I'm not at all sure we should exclude suicide as "not reflective of our health care system".

We have the highest per capita psychological counseling rate in the world. If it's the healthcare systems fault, its not that Americans don't have access to psychological care, it would be that the psychologists suck.

I'm not terribly sure per-capita rates tell us much about who has access. For example, if only the top 20% has access (at exorbitant rates), that doesn't help the other 80% much.

 

[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.

 

[uwillbsoon]

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.

To be fair, most of the big insurers also have healthcare facilities. UHG is I believe the largest employer of physicians in the US.

That sort of self-dealing has gotten them into hot water in the past. They were sued for "forcing" their insured to their facilities and jacking up prices.

I said “not completely innocent.” But that’s no different than Kaiser Permanente, is it? They are still in competition with other carriers on price, right? If BCBS or Aetna is able to offer a better policy for less, UHG will lose market share, and thus profit.

Maybe. You probably know this better than me, but defining "better" in health insurance policies is very difficult. Some buyers want networks, some look at premiums, some want low OOP costs. I'd imagine even for you it's hard to differentiate plans, no? The ACA has vastly improved this with required disclosures, but it's still hard.

Throw in most markets are highly concentrated with one insurer owning most of the market share, and competition isn't always a factor. Because having a small risk pool usually means higher prices because it's less predictable/spread out.

But I think we're talking about provider pricing, aren't we? All I'm saying is large insurers have more influence over that than most people realize because they own a significant number of facilities. And it's growing. It's been the fad the past decade for insurers to be vertically integrated. Even providers are getting into the insurance game at a good rate.

But I do agree the cost of insurance is due to the cost of care.

 

[IvanKaramazov]

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.

Yep. We would never have intentionally designed the system this way. That happened by accident, and now we're stuck with it thanks to path dependency.

 

[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.

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.

One might argue homicide, suicide and ODs reflect a failure of mental health, which should be included in healthcare metrics. (ETA like @Rich Conway said)

But even if one excludes “diseases of despair” and accidents from discussions of the quality of American healthcare, our improved numbers hardly warrant the cost, as a percentage of GDP, in comparison to the top ranking countries.

 

[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.

One might argue homicide, suicide and ODs reflect a failure of mental health, which should be included in healthcare metrics.

But even if one excludes “diseases of despair” and accidents from discussions of the quality of American healthcare, our improved numbers hardly warrant the cost, as a percentage of GDP, in comparison to the top ranking countries.

Maybe. Those comparisons are also skewed because the US subsidizes healthcare of the rest of the world. (Even then we're more expensive by a reasonable amount, I'd think.)

 

[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.

 

[Terminalxylem]

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.

If by “provider”, you mean the surgeon, I bet many, if not most, have no idea how the cost of the $30K appendectomy was determined, nor how much the patient actually pays.

 

[hagmania]

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.

 

[hagmania]

Sorry, I just realized this wasn’t the Ozempic thread. Oops.

 

[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.

If by “provider”, you mean the surgeon, I bet many, if not most, have no idea how the cost of the $30K appendectomy was determined, nor how much the patient actually pays.

“Provider” being whatever entity would bill you the $30k directly if you didn’t have insurance. It could be the hospital, surgeon, whomever. For reference, true story, when my wife had her appendectomy 2 years ago, the surgeon bill was only like 1,800 as I recall (and fully paid by insurance), it was the hospital bill that initially was over $40k (which insurance knocked down to something in the teens).

 

[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.

 

[SoBeDad]

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.

Eating junk and processed foods is easy because it's so available and cheap, especially compared to decades ago. But the main problem isn't what we eat, it's how much we eat. See the Twinkie diet by PhD nutritionist Mark Haub of Kansas which led to 28 lbs of weight loss and an improved lipid profile. Twinkies are ~100 years old, don't cancel my Twinkies.

Health insurance is complicated for most people, deductibles, copays, limits, etc. Medicare Advantage programs that offer x, y, z and cover only certain doctors and hospitals. I'm attempting to minimize my use of doctors and hospitals with healthy personal choices. But it's obvious from the obesity epidemic that habits are hard to change. GLP-1s are a game changer for obesity and perhaps other disorders such as addictions. There are even clinical trials for Alzheimer's Disease.

 

[Grace Under Pressure]

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.

This

 

[hagmania]

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.

As someone who struggles with this on a daily basis, even in the face of dropping as much as I have, I have a lot of sympathy to the hooks of food addiction. All I’ll say.

 

[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.

 

[IvanKaramazov]

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.

Eating junk and processed foods is easy because it's so available and cheap, especially compared to decades ago. But the main problem isn't what we eat, it's how much we eat. See the Twinkie diet by PhD nutritionist Mark Haub of Kansas which led to 28 lbs of weight loss and an improved lipid profile. Twinkies are ~100 years old, don't cancel my Twinkies.

Health insurance is complicated for most people, deductibles, copays, limits, etc. Medicare Advantage programs that offer x, y, z and cover only certain doctors and hospitals. I'm attempting to minimize my use of doctors and hospitals with healthy personal choices. But it's obvious from the obesity epidemic that habits are hard to change. GLP-1s are a game changer for obesity and perhaps other disorders such as addictions. There are even clinical trials for Alzheimer's Disease.

This is a really good point that I don't think has been brought up yet. Excellent observation.

I'm a few years from retirement, and I'm hoping to hang up the proverbial cleats when I'm 56. That means buying insurance through the market. I have an advanced degree and I understand how insurance works. I have found the process of researching private health insurance exchanges to be complicated and a little intimidating because it's pretty opaque the first few times you get into it. I feel like I have a decent handle on it now, but my wife, who has a master's degree, does not. I don't think we're stupid. I think the system is probably over-complicated.

Imagine somebody with an 85 IQ. That's just one standard deviation below the mean. Most folks in this forum are one standard deviation or more above the mean, so this person is just the mirror image of the typical FBG poster. There are a gigantic number of people like that in society, and we need to design society in such a way that it is accessible to those folks. That person would have an extremely high level of difficulty navigating this system.

In principle, getting health insurance should be as straightforward as buying car insurance. Now, I get that the person I just described probably doesn't understand auto insurance or homeowners insurance either, but both of those products are easy to get. Health insurance is kind of an ordeal by comparison. I know people who get irritated by open enrollment at work!

 

[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.

 

[IvanKaramazov]

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.

It is, but it's presented in a way that makes it look as warm and inviting as Form 1040 or the FAFSA. There is a certain inhuman way that these kinds of systems work, that I have a high tolerance for but most people don't. Whenever you deal with the government -- whether it's insurance markets/subsidies, SSA, the IRS, whatever -- it's like you're interacting with an alien intelligence compared to Amazon or Wells Fargo or any other customer-facing enterprise. I get why a 30-something would take one look at this and decide for forgo insurance. Just my two cents.