American proudly leads the world in preventable leg amputations (150,000 per year). Racism, ignorance and innumeracy is a huge drag on the economy. Looks like moving from Texas to Washington State added about 3 years to my life expectancy.
intercst
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You all know what I am going to say
PUBLIC HEALTH policy knowledge basically does not exist in the USA.
My takeaway from the article was noticing that Nicolas Kristof, a leading “progressive” columnist, seems to have no knowledge about the mere existence of the crux proven effective strategy for economically radically universally delivering fundamental health services – Public Health!
This is more proof of how/why we USAians suffer for being arrogant ignorant idiots.
The solutions are out there all over the world.
david fb
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One option is to call the industry by its real name, Disease Care.
Chronic diseases are GOLD MINES! But many are not really chronic as they are reversible but that would ruin the Disease Care Industry.
The Captain
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Disease care is one-seventh of the economy in the US and a major source of “skim” for economic elites. You’re not going to change it without revolution.
intercst
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Indeed. You can certainly rely on the overeating Sedentarians to keep that sector of the economy rolling…and let’s not forget the smokers etc.
However, in a way, shouldn’t medical care actually be for those who’re sick …even with those “chronic” diseases…from the stuff that gets a person unexpectedly, in spite of being a Good Custodian of their body and through no discernable action on their part?
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Revolutions almost always (always?) result in a decline of health care and a decline in life expectancy. At least for a few years or even decades, after said revolution, in some cases.
Correct but one can reduce one’s own spending by getting healthy when the condition is driven by insulin resistance which is caused by eating the CRAP produced and packaged by the AgroIndustrial (so called) Food industry.
Today I was looking for fresh dill weed to make a salmon dish. Only one supermarket carries it but it has been missing off the shelfs. Thinking I could use something else I checked out basil. The fresh ones did not look fresh at all but they had a long shelf life variety. Reading the ingredients it sounded like a chemistry lab. Next I found a jar of pesto, would they be using olive oil? In large letters it said that it was made with olive oil. Great! So I read the ingredients list, a whiff of olive oil but the bulk was sesame seed oil.
This is a top of the line supermarket that caters to the Portuguese 1% and sells them crap at high prices.
I went from regular quarterly medial exams and eight medications to an occasional visit and zero medications. All one needs is to take one’s health seriously and it starts by the mouth, stop eating poison.
Scott Galloway (Marketing Professor at NYU Stern School of Business) on uTube said that he was self insured. This is the first person I have heard it from. I’ve been self insured for the past three decades. If you are going to buy health insurance, buy only major medical and accident insurance. One should be able to cover ordinary healthcare costs out of regular income. It’s a risk that does not need to be transferred when one is generally healthy.
Scott Galloway on AI disrupting healthcare at minute 43:26
Unlike david fb, I want private healthcare.
The Captain
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Works wonderfully well for those fortunate enough to have chosen a disease state voluntarily…by eating so called poison or even just eating too much of a so called healthy diet. Not so useful for those who’ve actually made the “good” lifestyle choices at a young age but gotten sick from actual real diseases.
I asked the husband a while back if he thought there’d be an adequate supply of livers for transplantation if waiting lists were limited to folk who didn’t inflict their liver disease on themselves. Probably not, was the reply…more people on the waiting list would just get a liver earlier and fewer would die waiting.
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The current system is already producing a decline of health care and a decline in life expectancy for the average American even though we’re spending twice as much as other large industrialized countries. Of course, none of the excess spending is making it to the patient. It’s being skimmed off in the 20% skim rate on private health insurance, 15% on Medicare Advantage, price gouging in hospital services and drugs, etc.
A couple of days ago someone posted the Propublica story about the 2.5% payment fee scam engineered by Bain Capital (Mitt Romney’s old firm) and Zelis Payment Systems. That’s 2.5% on $1 Trillion of Medicare and Medicaid spending or $25 Billion per year. Because of the bipartisan corruption of our economic and political elites, we’re no more likely to investigate and prosecute the Bain Capital scam than the $4 Trillion flushed down the toilet in the Iraq & Afghanistan Wars with half that money never getting any further than the Washington DC suburbs before it was skimmed off.
Then there’s this article from Becker’s Hospital Review reporting that Bain Capital is skimming as much as 5% in some cases – all with no improvement in anyone’s health care.
intercst
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You need to be a one-percenter or above to have any conceivable means of self-insuring against a $1 million+ hospital admission. It’s totally unrealistic for the vast majority of Americans. But it’s typical of a lot of the financial nonsense you see on youtube.
intercst
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Ironically, the “JCs” that pull down 8 figures/year, so could conceivably pay out of pocket, generally negotiate a rich retirement package with company paid pension and medical, the benefits they took away from their workers, so being able to self-insure is irrelevant to them.
Steve
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Captain, I also prefer private healthcare, and living in Mexico I pay for my private doctor and use a private hospital EXCEPT
I have my Medicare set up in Texas and have “Medi-vac” insurance to get me to Houston if anything particularly bad happens to me. With a little luck that will never happen.
and
for my HIV care, which is handled by Mexican Public Health, and is efficient and excellent.
Public Health does NOT mean “Health care” in the USAian sense. It means providing basic testing, education, treatment against epidemic diseases that are public hazards, and treatment of frequently encountered minor problems and processes of life (pregnancy, birth, death). That makes up most of what a sensible population needs (and education includes everything you, me, and many others here preach about food and so a whole lot of good gets done).
david fb
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Public Health is anathema in America. The whole reason we have the “20% that Medicare doesn’t pay” is so that blacks and Hispanics can’t benefit from the program. Tom Hartman wrote a book on the hidden history of American health care. Check out the story of Frederick Hoffman, a German immigrant who rose to become a top actuary at Prudential Insurance. Start at about 11 minutes into video.
intercst
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Do you need to be a one-percenter or above to eat real food?
The Captain
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Before Chavez Venezuela had a mixed economy where the public and private healthcare lived side by side. Before going into private practice doctors had to put in time in remote areas. Many doctors worked in both the public and private sectors. That kind of mixed economy works quite well.
The way you phrased your earlier reply sounded like you approved of everyone having to seek treatment at the NIH or similar public institutions. That is not the kind of service I want to rely on and seemingly neither do you.
The Captain
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Of course not…but you can be as rich as Croesus and be unable to avoid the car driven head on into you by the fat uninsured Sedentarian who has a stroke behind the wheel just seconds before veering into your lane. A fat Sedentarian who’d decided to also let his car insurance lapse…i.e. self insure.
You are of course right which is why I suggested major medical and accident insurance.
When you self insure it does not mean you avoid buying any and all insurance. It means fashioning a workable wealth backup plan. Get quotes on major medical and accident insurance to see how much money you save by not buying prepaid sickcare which is the standard practice.
The Captain
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Maybe it’s just an American phenomenon but availability of fresh food is correlated with income. Places without access to fresh food, food deserts, are strongly correlated with neighborhood income and with more rural areas. It’s a complicated issue and yes, poor people can and often do seek out healthy food. But it’s an extra burden on top of the already difficult struggle to manage health. In general, healthy food is more expensive, harder to find, and has less advertising dollars behind it.
Food deserts can be described as geographic areas where residents’ access to affordable, healthy food options (especially fresh fruits and vegetables) is restricted or nonexistent due to the absence of grocery stores within convenient traveling distance.
Lower diet quality separates lower-income from the more affluent Americans. Higher-income households are more likely to buy whole grains, seafood, lean meats, low-fat milk, and fresh vegetables and fruit. Lower-income households purchase more cereals, pasta, potatoes, legumes, and fatty meats.
First, the highest rates of obesity occur among population groups with the highest poverty rates and the least education. Second, there is an inverse relation between energy density (MJ/kg) and energy cost (US dollars/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer. Third, the high energy density and palatability of sweets and fats are associated with higher energy intakes, at least in clinical and laboratory studies. Fourth, poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption, and lower-quality diets.
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But that’s exactly what it means in the US. When an individual announces that they’re “self insured” it means that they’re uninsured, going bare-arsed, freeloading etc for the simple reason that universal healthcare/socialised medicine…call it what you want … doesn’t exist here. As a consequence, the major medical and accident plans that act as a personal umbrella policy don’t exist in lieu of a group health plan/Medicare/Medicaid…because the needs of a community extend far beyond what the average “self insurer” can imagine.
You’re currently residing in a country that does provide universal access to care for its citizenry. I don’t doubt that it’s possible to get quotes for a top up insurance policy such as you describe. One that provides for something beyond the basic at premiums that look remarkably cheap in comparison to the annual cost of a group health plan here. That’s because those premiums are subsidised by the publicly funded option which takes care of the needs of the community. If that didn’t exist, those premiums would be significantly higher.
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Years ago when we still lived in the UK and the NHS was a decidedly different animal than today, I had a convo with a neighbour about this. She and her new husband (a bloke who’d walked out on his wife and two kids in Belgium to shack up with his secretary) had recently moved in and somehow, we got to talking about medical insurance. Now her husband actually worked for one of the big multinational pharma companies and, as these businesses oftentimes do, had a medical insurance plan as part of his compensation package. She was adamant that they shouldn’t have to pay the taxes and National Insurance contributions to NHS treatment as they would “go private”. I pointed out that their personal plan wouldn’t help in the event of a major road traffic accident, say, as the private hospitals weren’t set up with ER departments and existed for, primarily, stuff like tonsils and adenoids, piles etc…non urgent stuff that the NHS puts at low priority/long wait lists etc. I also pointed out that the NHS…and everyone’s N. I. contributions provided for the care of one of the neighbours kids who had cerebral palsy, say, and my very young daughter’s safe delivery and subsequent immunisations …which you’d imagine any rational person could fathom, right? Manifestly, not someone who’s enough of a dim bulb as to trust a bloke who walks out on his wife and kids. You know what…her only reply was that she didn’t have kids so shouldn’t have to pay for someone else’s.
Shortly before we moved, I went round to say goodbye to them both. Turned out he’d buggered off back to his wife and two kids and they were getting divorced. I fully admit that my expressions of sympathy weren’t at all sincere.
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