Who'd a thunk it? Obamacare not repealed

[7Wannabe5]

Having your testes removed will also greatly extend lifespan and reduce other major health AND behavioral risks. So, given the ease, low-cost and safety of such a surgery under modern medical conditions, you could say that choosing to manifest an adult male hormone profile is a lifestyle disease. If, for selfish reasons, you don't choose to undergo surgery, probably your next best bet is to engage in vigorous sexual activity with great frequency so that your average levels are kept on the lower side.

If Ego will volunteer to work as personal trainer two days a week with the high risk/expense morbidly obese group, I will continue to "just do the work in front of me " towards reducing the poorly processed aging androgen burden on the healthcare system. No rest for the weary (sigh.)

[BRUTE]

Obviously, you are not responsible for the lifestyle of your grandparents. Is it fair that you'd be kicked off of your health insurance policy because your grandfather was pre-pubescent in a time of plenty?

this assumes the (false) null-hypothesis of "health insurance". is it fair that other humans have to pay for the effects that behavior of another human's grandfather had? no. having non-famished grandparents does not entitle to the money of other humans.

[George the original one]

Was talking with a colleague today who cited a recent report he'd seen (can't give a reference, sorry, just don't remember), that on average Americans live 18 months after they retire. That is in line with numbers I've heard in the past (for my employer, it's even shorter allegedly). Mind boggling to me. Certainly provides a sense of urgency to me that counterbalances my conservative (not in the political sense) nature.

Doesn't pass the sniff test when USA life expectancy is age 78.

[OTCW]

Tax fast food corporations the same way big polluters get hit, and for the same reasons collateral damage

Probably more effective to tax the end user. Using smoking as a comparison, high prices are the only thing that proved useful in getting people to stop that. $8 for a Route 64/Big Gulp would probably make a dent in consumption.

[IlliniDave]

Was talking with a colleague today who cited a recent report he'd seen (can't give a reference, sorry, just don't remember), that on average Americans live 18 months after they retire. That is in line with numbers I've heard in the past (for my employer, it's even shorter allegedly). Mind boggling to me. Certainly provides a sense of urgency to me that counterbalances my conservative (not in the political sense) nature.

Doesn't pass the sniff test when USA life expectancy is age 78.

That's why I said it was mind boggling! Obviously they are not subtracting 65 from the average American's age at death.But I've heard those sorts of numbers enough times over the years that I'm mildly curious how they are arrived at. Not curious enough to expend any of my life energy pursuing it though. Just makes me disinclined to grind it out in the corporate world to age 67 or whatever and count on having a decade or more of vibrant retirement.

[7Wannabe5]

The reason the two statistics seem at odds is likely due to the fact that in the not so distant past many more men worked until retirement age than women, and the average life expectancy for men was only around 71, inclusive of a large clump of deaths of men in their 60s due to heart disease and cancer. So, if in 1989, you had a group of men in their 60s who were all working full-time at some establishment, their average life expectancy due to having already survived to 60 might have been around 75, but the smaller group of individuals who will survive into their 80s and 90s skew the results away from the fairly high number of deaths that will occur to members of this group in their 60s. So, if you include those who retire due to health necessity (most likely cancer), and those who were bound to topple over due to sudden infarction whether on the golf course or in the office, it is within the realm of possibility that slightly more than half will die within 18 months of retirement. Also, it is possible that this statistic includes retirement benefits paid to widows of men who died while still working.

I would also note that there are a variety of much more specific calculators and tables available with which to access your own personal risk. Throwing males and females together in health statistics is one of the most misguided gender neutral policies ever. A 52 year old man who has high-blood pressure and the same BMI as not-yet-post-menopausal me will very likely not be attending my 90th birthday party.

[Ego]

That's why I said it was mind boggling!

Despite the fact that it happened to my father, those numbers seemed strange to me as well.

http://www.bbc.com/news/magazine-18952037

A paper attributed to the aircraft-maker Boeing shows that employees who retire at 55 live to, on average, 83. But those who retire at 65 only last, on average, another 18 months.

The "Boeing study" has been quoted by newspapers, magazines and pundits. It's circulated on the internet for years. The problem with it is that Boeing itself says it's simply not true.

[IlliniDave]

Urban legend then. Well, I'm still not taking any chances!

[Dragline]

Yeah, that sounds more like data from when the U.S. social security system was first implemented as a reason why it wouldn't cost too much.

But even in 1940, a person who was 65 could expect to live about another 12-15 years. https://www.ssa.gov/history/lifeexpect.html

On the other hand, the average life expectancy itself (all people) was only about 60 in 1940, so a lot of people who paid into the system would never see a dime and would probably die within a short period of time after they stopped working, because they "retired" because they could not work anymore.

[BlueNote]

I think the following incentives in Universal (single payer) are strong enough that they overwhelm any minor incentive benefit provided by alternate systems:

1) Natural survival instinct.
2) "Free" preventative care like vaccines, advice etc. are much more helpful "carrots" then attempting to punish people with financial "sticks" when they don't comply. If they're already willing to knowingly do their health damage then I don't think throwing sand in their financial gears is going to help that much. I do however believe that when there's a resource shortage (doctors, organs etc.) that there should be a reasonably fair ranking system based on expected effectiveness and deservedness.
3) Almost nobody wants to go to the doctor or hospital. It's a lot like the fire department, few would call the fire department on a whim but it would suck (personally and to society in general) if you had to pay privately for the service. Imagine someone sets your house on fire and the fire department shows up and puts out the fire, but before they leave they give you an invoice and demand payment in 90 days. You don't have insurance so you end up going bankrupt dragging your whole innocent family into abject poverty with you, not a good outcome for society IMHO.

I've always been surprised that the US has been able to maintain it's archaic semi-private health care system for so long with all it's inefficiency and negative consequences to that society. A pure private system would be about as effective as a private fire department or a private road system, i.e. not a good fit for privatization and a detriment to society by imposing massive barriers on those least able to overcome them.


Single payer costs less and delivers great healthcare in many countries. People who take care of their health live longer , better lives than those who don't under single payer, that's probably a much better incentive than a bit of money. Maybe they pay slightly higher taxes then they would under a private system but I don't consider that to be anywhere near a good argument for private healthcare.

[Ego]

I think the following incentives in Universal (single payer) are strong enough that they overwhelm any minor incentive benefit provided by alternate systems:

1) Natural survival instinct.

Hum. We've learned a lot from trying to get people to quit smoking. Probably the most striking lesson is that appealing to a person's natural survival instinct in early and mid-life does not work well at all. For the early and mid-life smoker, the consequences are too far away.

If universal healthcare provided smoking cessation programs worked then those countries with universal healthcare would rank low on smoking incidence. The reality is quite different.

https://en.wikipedia.org/wiki/Prevalenc ... onsumption

One thing that works well is social shaming through various second-hand smoke legislation. Light up in a park in California and you are likely to get doused with a drink.

Taxes also work well. The cigarette tax in New York is $4.35 per pack (15% of the population are smokers) vs Kentucky with a tax of 60 cents per pack (30% percent of the population are smokers).

It would be impossible to legislate social shaming for obesity, heart disease, and other lifestyle diseases so that leaves us with taxes.

[classical_Liberal]

...

[BRUTE]

The problem with such a system is that insurance companies would not insure high risk people at all

uh - of course. why would insurance be provided for a very high-risk or pre-existing condition? that renders the concept of insurance absurd. what classical_Liberal is talking about is a subsidy - which is fine to talk about, but should not be confused with insurance. muddling of the terms is 1/2 the problem in the "health insurance" debate.

In the current environment I would argue no purely private health care insurance model will work, even a libertarian will except the need for government when private organizations are unable or unwilling to provide a needed service effectively.

brute agrees. as he posted above, he thinks the current system is "unfixable" - because of high-risk, high-cost conditions.

[BRUTE]

Single payer costs less and delivers great healthcare in many countries.

false. brute knows several single payer "customers" that pay way more for their health care than brute pays, yet their health care is inferior (in terms of doctor quality, waiting times, ..)

for the healthy, or the sick who can afford their doctors, single payer is a terrible deal in terms of cost for the former, and quality for the latter.

[BlueNote]

I think the following incentives in Universal (single payer) are strong enough that they overwhelm any minor incentive benefit provided by alternate systems:

1) Natural survival instinct.

It would be impossible to legislate social shaming for obesity, heart disease, and other lifestyle diseases so that leaves us with taxes.

Sure there's special cases like addiction. However you'll never eliminate tobacco use with taxes anymore then you could eliminate Heroin, Cocaine or other addictive substances. It would simply move to the black market if you priced it high enough. Then you end up with a law enforcement problem for a non-violent drug crime and probably end up with yet more drug related prisoners costing even more tax money. It makes sense to tax the smokers so they pay their share of health care, hell that's basically how we do it in Canada. I think at this point you could even consider banning smokable tobacco products and favouring vapour products which are arguably much safer. However I wouldn't , for example, expect a reasonable single payer system to put such a person into an organ transplant program for new lungs unless they were proven to be a reformed non-smoker and I'd penalize them in the selection process for being a smoker in the first place.

[BlueNote]

Single payer costs less and delivers great healthcare in many countries.

false. brute knows several single payer "customers" that pay way more for their health care than brute pays, yet their health care is inferior (in terms of doctor quality, waiting times, ..)

for the healthy, or the sick who can afford their doctors, single payer is a terrible deal in terms of cost for the former, and quality for the latter.

Single payer does seem to cost less overall (heck almost all countries seem to have a lower cost system then the US) and does deliver great healthcare in many countries. The issue is definitely not black and white and will vary by individual but on aggregate I stand by my argument and I don't think it is falsified by such a small personal sample.

[Dragline]

What people don't get is that we already have single payer health coverage in the US. Its just extremely badly managed single payer health coverage, because we don't want to admit that's what it is and we entertain pipe dreams of market solutions that never existed and never will, unless we are willing to just let people die by refusing admission to emergency rooms -- which we are not. Some people just need to stop dreaming that that will ever become a reality.

In the US system, everyone qualifies for single-payer if they are either old enough, broke enough or broken down enough. Its just a dumb, badly constructed system. That's why we pay more for inferior results overall.

[7Wannabe5]

Taxing junk food will likely prove to be very ineffective because it has been my observation that very obese people eat more of everything most people eat, not just more junk food. Also, unlike nicotine or caffeine, there are an almost infinite number of plants and animals from which sugar and/or fat can be fairly easily refined. We have all observed how as soon as one food is declared to be unhealthy, the industrial food complex will almost instantly come up with another cheap product to take its place. I mean, you can't make a cookie out of spinach, but nobody can survive on spinach. You can make a cookie out of rice and beets. Also, any component of taste that can be added to a recipe can also be simply bred into a species. A cup of juice pressed from a crop of HoneyCrisp apples is not likely to be more nutritious than some tart cherry juice sweetened with cane sugar, whether or not it is also rendered fizzy with carbonation.

I attended the funeral of a 90 year old woman yesterday. The slide show of pictures revealed that she had been quite slim as a young woman. Then she put on a bit of weight throughout the course of having and raising 5 children. In late mid-life she became quite chubby, and then as she became elderly she eventually slimmed back down to being quite thin when she died. I think this is what used to be "normal" for most humans, and so many young people being overweight is the main thing that has changed in our culture.

[IlliniDave]

What people don't get is that we already have single payer health coverage in the US.
...
In the US system, everyone qualifies for single-payer if they are either old enough, broke enough or broken down enough. Its just a dumb, badly constructed system. That's why we pay more for inferior results overall.

In addition, we're all collectively paying medical expenses for the uninsured/can't pay portion of the population even when they are not on Medicaid. Providers simply pass along costs they cannot collect (and the cost of unsuccessful collections and costs associated with cash flow problems) by raising prices which ultimately wind up reflected in insurance premiums.

The healthcare system at present is far too regulated for any meaningful free market innovation.

[Dragline]

Correct. There cannot be a free market in health care unless we are willing to let people just die who can't afford it. Since that is a non-starter for about 80-90% of the voting population, even talking about it is a waste of time because its like pretending you have a sailboat and talking about how the magic free market wind will power you when you have a motorboat.