What Could Possibly Go Wrong?

[7Wannabe5]

Since I am somebody who once sat for the actuarial exams, and I have recently been blighted with a very expensive to treat disease with approximately .25% incidence in the general population, I have been pondering how many other such possibilities exist. The purpose of this thread will be to rationally examine the wide variety of health related issues and expenses that might be encountered by any of us. IOW, this thread seeks to go beyond simple strategy such as "I will exercise, eat right, and not ride on motorcycles while drunk."

This will also be a space in which to discuss such matters as the benefits of health tourism, how best to "play" the current American healthcare system, and whether having your genome mapped might be a good investment.

A first resource/reference I will share is this link to Medical Standards for Military Service. I looked for this after learning that my condition, Crohn's Disease, would disqualify me from service. I think it might be a document beneficial to study for much the same reason that there are benefits to be derived from actually reading the tax code. For instance, if you read the tax code line by line, you might learn that you could be earning income as a fisherman or obtaining free housing as a member of the clergy, and if you read this document line by line, you might learn that you could suffer from Familial Atypical Multiple Mole Melanoma Syndrome or a painful curvature of the penis.

https://www.esd.whs.mil/Portals/54/Docu ... rGvA%3D%3D

Of course, one could simply conjecture that all of these possibilities are reflected in the current average price of health insurance, deductibles and other costs not covered by health insurance, and costs covered through governement programs or private foundations etc. , but it seems to me that the default of the will-powered rational is to assume better results = less cost than average, so it might be useful to break down the expenses/likelihoods into quadrants such as Preventable/ Not Preventable, One Time Expense/Continuing Expense, and Catastrophic/Can Make Do etc.

[Stahlmann]

Can't you marry one of your lovers who has reasonable insurance?
What's risk/benefit ratio, including going to the jail in case of "false marriage"?

As far I remember, there was guy from Scandinavia which you have affair on this forum (wood?)?
Ditching American citizenship and claiming political asylum in Scandinavia on grounds of capitalist exploitation in USA?

Do you know anyone who is older, senile and don't have dependents?

[7Wannabe5]

@Stahlmann:

Yes, I could possibly enter into a marriage of convenience with one of my polyamours who has good government job insurance. However, this would not constitute an independent universal solution at spending level of less than 1JAFI ERE1.

According to my calculations, the best independent, retired, universal solution for my particular medical expense would be at least $8400 per year with ACA plan.

Calculations at the level of ERE2 (energy usage) would require more information about rational pricing and embedded energy in the medical services realm. For instance, the drug I am currently being treated with costs anywhere between $5 and $4000 per dose depending on your insurance/income status.

BTW: I have not had an affair with anybody on this forum inclusive of wood One of my polyamours is in Costa Rica, but I don’t see much play with that option.

[7Wannabe5]

In part what I am trying to answer here is can we theoretically afford modern medical care for 8-10 billion humans without burning the planet up? There are many solutions to the easier problem of how I will cover my own medical expenses given no limit on spending.

[jacob]

In part what I am trying to answer here is can we theoretically afford modern medical care for 8-10 billion humans without burning the planet up? There are many solutions to the easier problem of how I will cover my own medical expenses given no limit on spending.

Not saying that it would solve all or your problem, but much of the care (at least the western perspective) treats the body as something that can be fixed with some technological single-point solution once something goes rather than an organism with a focus of maintaining it in a good state. An ounce of prevention equals a pound of cure. Again, there are individual exceptions but statistically it holds. It's just that western health care systems aren't wired for this perspective.

A lot of this [outdated] perspective came about a century ago when single-point interventions DID make a difference such as appendicitis surgery, broken bones, or treating infectious diseases. However, now the same philosophy is being used to treat what in the majority of cases are lifestyle diseases. The current allocation schemes aren't optimal either. It's either fee per service which leads to overtesting and prescribing something for everything XOR capitation which encourages the exact opposite behavior of doing as little as possible. I'm not aware of any health care systems where providers are paid based on the quality health state or longevity of the local population. It probably exists somewhere...

Add: Also much of the behavior creating lifestyle diseases also burns the planet in other ways. E.g. driving cars for lack of activity and extra air pollution, using methane fertilizer to grow corn and losing topsoil to eat corn syrup products for metabolic issues, ...

The simple strategy really is the best strategy for society as such. However, it conflicts with our culture... in particular our culture has in many ways been created to take advantage of our weakness as a species in a prevailing situation of caloric abundance: a preference for salt, sugar, fat, and moving as little as possible. Within that culture there are a lot of interlocking interests that prevents changing it.

[ether]

on a off topic note, you may be able to get SSDI due to Crohn's and that may auto enroll you in Medicaid depending on the state

[7Wannabe5]

@ether:

I already qualify for Medicaid due to low income. My condition would have to be worse to qualify for SSDI, although borderline fecal incontinence, chronic pain, and extreme exhaustion do somewhat limit my employment possibilities. I’m already retraining for work that I can do at home on a computer or sitting at a desk near a bathroom.

An ounce of prevention equals a pound of cure. Again, there are individual exceptions but statistically it

I agree that this is most bang for buck strategy. I am just interested in exploring its limitations. I mean there is a range from Not Preventable Nothing You Could Have Done Little You Can Do Now which is where my condition is currently rated (much to my frustration)to something like Alzheimer’s to something like cancer which is maybe 40 % preventable to something like Diabetes 2 which might be 90% preventable. Currently, 75% of medical cost can be assigned to the 5 most common preventable diseases with 80% being a high conservative estimate of actual preventability. So, that still leaves almost half of medical expenses as not preventable. Also, the likelihood of acquiring a non preventable medical condition given that you didn’t previously die from preventable condition would have to be taken into the accounting. For example, the high likelihood of eventually contracting cancer which is simply due to cellular senescence.

[GandK]

As I'm speaking to a systems-level thinker:

The discussions of this topic in the west are usually best understood as death avoidance and/or pain avoidance as opposed to health care, which is a losing game no matter which way one plays it. It also creates perverse financial incentives and sets up situations where health decisions are made based on numbers-based goals instead of what the patient himself wants, which is usually simple self-determination as opposed to being "under care" or at a random pain level of 3 vs 5. It may even include death.

As someone who lives with an autoimmune condition that most doctors have not even heard of (antiphospholipid syndrome)... after two decades of navigating the main symptoms, I now see symptom management as an idiotic endeavor apart from overall life management. For example: my overall health is most affected by having high quality relationships. Not my medication or my eating habits. A lot of my symptoms are so aggravated by stress that stress management IS symptom management. Someone with my diagnosis should immediately seek good psychological care. It can completely remove the "need" for certain expensive medications. I have to wonder how many other illnesses are likewise so influenced by non-medical or lifestyle factors that to not examine the entire life upon a new diagnosis is criminally negligent. Suppose the truth is that someone needs a friend more than a fentanyl.

I do not say that all this would also be the same for you @7w5 (I'm increasingly convinced that intestinal disorders have a lot to do with pesticides) but the older I get the more aggravated I am with the medical establishment treating us all as if the highest good is to extend life as long as possible, period... irrespective of the experience of actually living that life to the patient.

[Jean]

Someone has to do it. You asked for advice, you'll get some.
I've met people with crohn's disease or inflamatory colliques. None of thème was prescribed an expensive médication. They all followed a similar strategy. Find out which food makes thème shit blood, and avoid this food. And they don't shit blood, unless they eat their Némésis food. For some reason, you were extremly Quick to believe your doctor when hé told you that controlling your food was no option, and maybe hé was right, because you are unable to control your food.
That's an advice. If you just wanted to vent it out, There is nothing wrong with it. It's actually a very good idea. But then stop pretending you want advice. I really wish you well. I can't Say it more nicely, because for some reason, thé way i percieve your bahavior pisses me off. But i believe There is more good in saying it. Maybe i'm completly wrong, you have a very spécial version of your condition, and you Can ignoré me. Maybe i'm right, and i'll be one more kick away from what looks like an incoming crash. I don't like thé Idea of you painfully throwing all your money and your blood trough your ass.

[7Wannabe5]

I now see symptom management as an idiotic endeavor apart from overall life management. For example: my overall health is most affected by having high quality relationships. Not my medication or my eating habits

Yes, I agree with this perspective. One of the most useful things I’ve read is “You don’t get over Crohn’s, you get on with Crohn’s.” However, I’m still processing through the 5 stages, so not quite there yet.

@Jean:

Anecdote, Schmanecdote. Diet definitely can influence symptoms in the moment, but there are limits to its long term effectiveness, and little evidence that it influences the course of the disease. Many people with the disease become very thin because they become afraid of eating at all. Very small, frequent, fairly bland meals are what works best for me so far. But it’s kind of unpredictable. I recently became thoroughly ill after eating a bowl of boiled carrots with olive oil. Oat milk is my current safety food, but it doesn’t supply complete nutrition.

Anyways, I really was more interested in discussing the general topic of combined financial/lifestyle risk from lower likelihood unexpected and/or non-preventable conditions. How many conditions like the one Gandk suffers from or Crohn’s disease are out there? What sort of general risk do all these small risks add up to?

[mountainFrugal]

whether having your genome mapped might be a good investment.

The price of sequencing is getting cheaper and cheaper. As an example, I think that 23andMe is less than $100 now. They are a larger provider of these services and get economies of scale for sequencing and data insights. You will only get a small conservative report of an increase/decrease in risk profile for certain diseases based on your genotype alone (there are also large environmental and gene/environment interaction factors at play). Examples include BRCA1/BRCA2 for breast cancer among others that show up later in life. This could be a good investment to know if you had these large effect alleles for well studied diseases and include that in your ERE plan. However, as I understand it, the laws are currently hazy (and likely vary by state) as to what these companies can do with your data. I am damn certain that insurance companies are trying to get this data to include in their coverage premiums. This would be the main reason (besides cost) to not do this. Not sure how easy it would be to submit "anonymously". Maybe there are options with your primary care provider?

[edit] In thinking about more rare understudied diseases...unless there is a known genetic link it would unlikely be a part of these sequencing services. It can be a liability for the companies to offer advice on understudied things that have health consequences without the peer reviewed genetic studies to back it up. So I am not sure having this knowledge would help you prepare for more rare medical conditions unless there was a strong genetic link.

[Married2aSwabian]

0.02%

That’s the incidence in the general US population of pancreatic cancer (about 62,000 / year). When you lose your mom to this disease, it’s a double whammy, because it hits home that it runs in families. Her uncle died from it as well. Pretty much everyone dies from it within 5 - 10 years at most. Even Steve Jobs. Preventable risk factors include smoking, being overweight and diabetes. The fact remains that it’s also genetic. No matter how much kale you eat, no matter how many miles you ride on your bike or push ups you can do, you could still get it. With my dad having had three severe bouts with diverticulitis requiring surgery, I sometimes feel like there’s a ticking time bomb somewhere in my gut.

Edit: I’ll add that while we were living in Germany again 2011-13, my primary doctor said that she thought it reasonable to do an ultrasound of the abdomen once per year as a check for any tumors around pancreas, based on family history, low cost and v good chance of early detection. Upon returning to the States, when I mentioned that to my doc here, he said, “oh, well if you have it, you’re gonna die anyway.”. Thanks, pal. I guess doing an ultrasound right in the office (5 minutes) is too efficient and not profitable enough for the US healthcare system.

[bostonimproper]

I’ll be honest, my experience with the medical system has been hit or miss.

When I was in my junior year of college, after weeks of upside down stomach pain, I was diagnosed with IBS/GERD, handed some omeprazole, and told to go on my way. It didn’t help at all and made my stomach pain significantly worse as I tapered off them, but I was told the same thing multiple times by multiple physicians. Fast forward, I figured out in within about a year that I was lactose intolerant. Which, in hindsight, was so stupidly obvious— I’m half Chinese and it’s not like lactose intolerance is particularly uncommon— but had I relied exclusively on the medical system to tell me what was wrong, I would have been led down the path to believing my symptoms were something I’d have to live with for the rest of my life (they were not).

That said, there are medical interventions that do work. For example, I’ve definitely been witness to the power of SSRIs on clinical depression, something that I was very against for a long time.

In general, for lack of answers, I think the only thing you can do is find community and experiment. Particularly drawing from other non-Western medicine traditions. Sometimes that may lead you down the road of getting scammed by snake oil salesmen. At other times it may lead to a miraculous turnaround that you didn’t expect. To vet, I recommend checking on if there has been research on [insert your favorite home remedy here] on PubMed— if there are multiple researchers saying, “Yeah, this doesn’t work.” then it probably doesn’t work. But if nobody’s studied it, and the downside risk is low, then why not try it?

I’m sorry you’re going through Crohn’s though. Not feeling in control of your body and health sucks.

[Ego]

There are some things we control, some things we don't and a whole lotta things we might control but are not sure. My approach is to assume I have some measure of control unless it is a meteor-type event. In other words, I err on the side of control rather than lack-thereof, knowing that there are whole industries trying to convince me otherwise.

That said, there are things we do not control. Aging and death are the ultimate uncontrollables. So what do we do in the meantime?

Someone smart once said something like: As long as you are breathing, there is more right with you than wrong with you, no matter how bad you feel.

So I guess the answer is to really live. Love. Laugh. Enjoy what we have. Be fully alive while we are breathing.

[Colibri]

Genetic Hemochromatosis a.k.a. iron overload

Many people only get diagnosed when very sick, years or decades after onset of first symptoms. Mainly found in people of Celtic ancestry, meaning A LOT of Canadians, Americans, Australians and some European countries.

I can bet large amount of money that some of you have the full genetic make up to develop the disease and don't know about it.

Treatment is as old as mathusalem : regular bleeding to get rid of the excess iron.

Google it, it might save you a lot of ( future ) pain and health care money.

[JamesR]

I suspect a surprising amount of health problems could be improved dramatically with some sort of intermittent fasting scheme. Minimize eating windows and maximize the body's chance to drop into autophagy and do self-repair. Fasting tends to lower blood pressure, and reduce inflammation - it's like taking ibuprofen, very noticeable on longer 24 hour - 32 hour fasts. Also a lot of hormonal problems, insulin resistance, etc can be corrected with fasting. Testosterone/growth/repair hormones levels also get a big boost after 16 hours of fasting - which means a powerful anti-aging effect.

tl;dr: Eat larger & higher caloric meals and dramatically increase the duration between meals for improved health & healing.

Perhaps we as society should be doing ADF (alternate day fasting) - 32 hour fasts & 12 hour eating windows as the natural pattern of living. We're highly evolved to go through feast & famine cycles. Our modern world completely lacks this, so ADF is probably the the most effective way to bring that back.

Jason Fung on fasting:
https://www.youtube.com/watch?v=ZEr9AjjL3No (this one is about fixing diabetes 2)
https://www.youtube.com/watch?v=tIuj-oMN-Fk (this one is more about the 2-body compartment problem, aka fat storage)

[chenda]

@mountainFrugal - Right, this is happening in Iceland right now.

In the future, U.S. researchers will be able to press a button and reliably identify the thousands of people who carry cancer-causing genes, including those that trigger breast cancer.

In Iceland, that day is here. With a relatively uniform population and extensive DNA databases, Iceland could easily pinpoint which of its people are predisposed to certain diseases, and notify them immediately. The government has refused to do so. Why?

Since the late 1990s, tens of thousands of Icelanders have agreed to contribute their DNA to a public-private science projects aimed at delivering medical breakthroughs. But in contributing their DNA — and in many cases, their medical records — these people never explicitly consented to be notified of personal health risks that scientists might discover

https://www.seattletimes.com/nation-wor ... cer-genes/

[7Wannabe5]

The price of sequencing is getting cheaper and cheaper. As an example, I think that 23andMe is less than $100 now. They are a larger provider of these services and get economies of scale for sequencing and data insights. You will only get a small conservative report of an increase/decrease in risk profile for certain diseases based on your genotype alone (there are also large environmental and gene/environment interaction factors at play). Examples include BRCA1/BRCA2 for breast cancer among others that show up later in life. This could be a good investment to know if you had these large effect alleles for well studied diseases and include that in your ERE plan.

this is happening in Iceland right now.

Another reason health care is so expensive in the U.S. is the lack of centralized record keeping which is kind of a ridiculous way to waste money in this day and age UNLESS keeping everything a mess is the preferred method for maintaining privacy.

Modern data science methods might be able to do even more. Like the bit in "Don't Look Up" where a character is predicted to die by being eaten by a Bronteroc. Generally, I am in favor of knowing more, although the only thing I might have been able to do in my situation would have been avoiding the use of Nsaids. I think I will sign up for the study mentioned in the article or see if there are any other free/inexpensive offers out there.

the incidence in the general US population of pancreatic cancer (about 62,000 / year)...“oh, we’ll if you have it, you’re gonna die anyway.”

Yikes! I was kind of surprised to learn that in general cancer is only believed to be about 40% preventable. So, given overall high rate of incidence of all forms combined, it would have to be the top "plan killer." One of my sisters had to declare bankruptcy after two serious bouts with cervical cancer, but that was before ACA era and vaccine for HPV virus related to cervical cancer. She created a performance art piece which she performed on college campuses which was meant to encourage young women to get the vaccine.

HPV vaccine might be a good example of why maybe we aren't nearly done with Level Orange modern medical research. A holistic approach is best, but Level Yellow is supposed to be inclusive of Level Orange. But, modern medical research does cost money/burn some energy, so...?

At other times it may lead to a miraculous turnaround that you didn’t expect. To vet, I recommend checking on if there has been research on [insert your favorite home remedy here] on PubMed— if there are multiple researchers saying, “Yeah, this doesn’t work.” then it probably doesn’t work. But if nobody’s studied it, and the downside risk is low, then why not try it?

I'm willing to try just about anything. However, I don't like trying everything at once, UNLESS I can come up with some way to figure out what was effective. Unfortunately, Crohn's is a disease that naturally flares up and flares down in default mode, and sometimes symptoms are not well correlated with current measurable level of inflammation, so all of the scientific studies for treatments have fairly large false positives. The danger in not proceeding with the most recommended treatment is permament damage due to scarring and adhesions. I know there is some method of analysis that engineers use when they change multiple things at once, so maybe I will try harder to look into that. So far I know that oral anti-inflammatories are not very helpful for me, and prednisone is somewhat helpful but has terrible side effects, especially if taken frequently over long term. I also know that I now have zero tolerance for coffee even though I drank it in large quantities for 40 years. I always told my kids "Don't pull the plug as long as I can enjoy a cup of coffee and Jane Austen." I guess I need to alter that directive

That said, there are things we do not control. Aging and death are the ultimate uncontrollables. So what do we do in the meantime?

Maybe the silver lining attached to suffering from borderline fecal incontinence is that it has given me a new firmly embodied perspective on the whole notion of "control." Something I read recently, maybe somewhere on this forum, was take Action until you run out of Action, then do Research until you run out of Research, then Rest. I also agree that mental health, relationships, etc. can easily trump physical health issues, but that doesn't mean that they disappear from your list of problems you can't easily ignore. That's why we might metaphorically refer to an overly attention seeking human as being a pain in the ass.

Genetic Hemochromatosis a.k.a. iron overload

I wonder if it is another Neanderthal gene problem?

intermittent fasting scheme.

I want to keep this thread off endless debate about what constitutes best dietary habits. Discussion to start from level of agreement that approximately 60-65% of medical problems/expense could be eliminated through some form of better diet, physical activity, and seat belts/helmets. What, if anything, can we do about the other 35-40% of problems/expenses? So far I'm hearing "Take more holistic approach. Treat the person, not the numbers associated with the disease." and "Eliminate rigid bureaucratic and/or profit seeking inefficiencies." Comparing the U.S. to other countries with more efficient systems might lead to an estimate of 30% reduction in costs if system of delivery was improved. So, that would maybe get us down to 40% X 70% = 28% of current expenses which are now approximately 20% of U.S. GDP or over $10,000 per capita- year.

So, if everybody did everything possible in preventable realm and efficiency was improved, per capita-year expense might be reduced to around $2800. It's more difficult to estimate impact of more holistic approach. For instance, what could improve in my life that would make me equally as happy as regaining full control of my bowels? Win a million dollars? Nope. Find the love of my life? Ha, ha, ha...nope. Finally complete a permaculture project? Getting closer, but still nope.

[7Wannabe5]

Medical research and development in the U.S. only costs around $500 per capita, so that along with $2800 per capita best behavior scenario estimate makes me believe that it could be possible to theoretically afford modern medical care within budget that avoids climate change disaster. Especially if you throw in a few other measures such as home care and hospice for frail elders, which would obviously be more doable if entire extended family/friend groups are living together in retro-fitted McMansions surrounded by permaculture.

So, the remaining question is what is the variable risk for an individual enacting own best behavior scenario? Does the current pretty crappy behavior scenario serve to increase or decrease this risk for the better behaved individual?

[mathiverse]

I may be misunderstanding the purpose of this thread given the discussion of whether healthcare can be covered under a budget of one Jacob for everyone on Earth. But here are my thoughts given what I think it's asking.

Getting to FI with a very low withdraw rate helps with this. If you get to FI at any point and then you practice ERE, then you will probably get incidental income and/or your stash will grow over time, then you end up FI with extra money to spare in many cases. Using Jacob as an example he has 2x or 3x or 4x what he needs, so if he had an extra $10k per year of medical expenses like 7 does, then he'd be covered.

In general, if you really overaccumulated, then you may have enough extra money to cover these kinds of issues without going back to work. Adopting ERE and ending up at a high Wheaton level makes it pretty likely you'll overaccumulate, probably it's case by case whether you'll overaccumulate to the extent of covering future potential health issues.

If someone is planning to go the semiERE, then this scenario might be a good example to show why aiming for FI in the medium/long term (maybe within a decade of semiERE?) is worthwhile even if you are fully bought into the semiERE premise. The older you are, maybe the shorter the timeline to FI should be in order to match the increasing risk that health catastrophe strikes? I don't know.

If you get an illness that you couldn't have prevented despite all the other ERE methods of healthcare (ie holistic, preventative measures) and you are FI, then you'll still have your lifestyle expenses covered or at least you'll have a decade or two of higher expenses covered with time to come up with a new game plan.

Another option is to go somewhere where you won't have to worry about huge healthcare bills in the future. I know a fellow who immigrated to South Korea (and will become a citizen in another two years) because he had health issues that he knew would cost him a lot in the United States. Canada and several other European countries could also have you covered. You have to plan ahead for that solution, however.

EDIT: I think it's useful to point out that a lot of the illnesses we are worried about in this thread strike a lot more often in the 40+ crowd. For those of us in our 20s/30s that means we have one or two decades to accumulate before a likely issue. Plenty of time to accidentally overaccumulate. Even someone doing semiERE (especially the people on this forum doing semiERE who tend to make more than 2x JAFI per year during the years they work) for one or two decades has enough time to overaccumulate by accident and especially enough time to overaccumulate on purpose if they try to keep their expenses below one JAFI and explicitly have that goal in the long term.