Anesau - Just Starting Out

[Anesau]

Any bike would get me a further distance, my concern is that there are no bike lanes, sidewalks randomly disappear, and car traffic is usually 6 lanes at ~55mph with killer unpainted intersections. So while a bike would reduce the physical effort, it seems way more dangerous. My area is known for having very bad drivers — many very elderly, uninsured, or both — and a lot of accidents. I only feel somewhat safe as a pedestrian because it's easy to offroad and jump over obstacles when there are no safe paths (and I can keep stuff like telephone poles between myself and the road).

People here surely have a lot more biking experience than me — maybe I'm just being oversensitive to small dangers?

[mathiverse]

Nope. You are not being oversensitive. That is a very reasonable point of view in a situation with that kind of public infrastructure.

The difference between biking on a street with cars going at 25 mph or less and biking on a street with cars going greater than 25 mph is significant because the damage to your body and risk of death from a crash is nonlinear with respect to an increase speed.

It was estimated that only 5 percent of pedestrians would die when struck by a vehicle traveling at 20 miles per hour or less. This compares with fatality rates of 40, 80, and nearly 100 percent for striking speeds of 30, 40, and 50 miles per hour or more respectively.

[Slevin]

The difference between biking on a street with cars going at 25 mph or less and biking on a street with cars going greater than 25 mph is significant because the damage to your body and risk of death from a crash is nonlinear with respect to an increase speed.

As someone who has gotten hit by a car going <15 MPH while biking (car ran a stop sign) and still needed 1 year of physical therapy to "fix" those issues (i.e. be able to reach behind me at all, and there's still a difference between my two shoulders), I can confirm it really sucks regardless of the speed, and there are many many places I wouldn't bike around in the US.

[loutfard]

Any bike would get me a further distance, my concern is that there are no bike lanes, sidewalks randomly disappear, and car traffic is usually 6 lanes at ~55mph with killer unpainted intersections. ...
People here surely have a lot more biking experience than me — maybe I'm just being oversensitive to small dangers?

Not at all. Many forum members live in people hostile areas. Living in a less dangerous place, it's easy for me to forget that. Just to give you an idea of the different context here:
- Regular needs and wants, like groceries, (art) cinema, concert halls, exhibitions, doctor, pharmacy, hospital, post, railway station are all within walking distance in a low-car 30km/h zone with priority for cyclists.
- Getting somewhere further away.
- My parents live 70km away. Direct train link every hour to a station 6km from there, or a connecting train every hour to a station within walking distance. By ebike, over 90% is dedicated cycle highway.
- Trains. I can cycle to the railway station on the other side of the city in 10', or walk there in 30'. Barely any cars on that trajectory. Almost every place in this country is within 5 km of a railway stop. 20' to Brussels. Faster and cheaper than by car. Add 1h22' to Paris, <2h to London, 3h to Frankfurt. Two direct trains to the seaside per hour.
- To work. I work on site two to three times a week. Hourly trains direct trains, plus bicycle. Work pays back train and pays 0.225€/km for the cycling.
- To the airport, on the way to my wife's native country. By bus, it's a 2' walk to the bus stop, plus a 60' ride to the departure hall for 2.5€. By train, it's a walk 30' to the station, and a 13' ride to the departure hall for 9€. By bicycle, 90% of the 20km is dedicated high speed cycle highway. The rest is almost entirely 30km/h restricted, mostly with extra high priority for cyclists. The parking area closest to the departure hall is reserved for free bicycle parking.

[Anesau]

Well, at least I'm not imagining it. Thanks for the added info, @mathiverse, I hadn't realized just how much speed matters. @Slevin, that really sucks — glad you've regained some mobility, but that accident sounds pretty terrible.

And @loutfard, I'm convinced you're writing these forum posts from an alternate universe and/or heaven. I've lived in 9 different U.S. states and never seen anything like what you describe... the closest I've gotten is living on a military base, but even military bases lack bigger cultural items (concert halls, exhibitions) and any sort of infrastructure connection to the outside world (by design). If places like that exist in the U.S., I'm betting they're either the urban hubs, or concentrated in the north east.

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Re: my lease, I'm currently leaning toward doing a 6 month extension (which would raise my monthly cost by ~$100, putting me firmly over the $1000 mark even though I have two roommates). There doesn't seem to be anything else rentable within a reasonable distance from my current job. The 6 months is hopefully long enough to either find a job in a less housing-constrained area, find a different apartment close by, or find some change in my current work that makes the situation make more sense.

[Anesau]

It's that time of the year where I usually schedule a doctor's appointment and dental cleaning.

I am a healthy twentysomething. My last yearly health checkup, the doctor asked me a bunch of very obvious questions (do you smoke? do you exercise?) and weighed me, but there was no special equipment used. Now that I think about it, I was supposed to get a blood draw a few days later but didn't bother (I feel good, I eat much better than the SAD, and I donate blood frequently enough to know if I were iron deficient or had one of the big illnesses they check for). When current healthcare prices indicate a major constraint on doctors' time and equipment, it just feels like a waste to go sit in an office and talk about how I still don't smoke.

Dental cleaning is less obvious. I've never had a cavity or something the hygienist needed to actually fix, but it seems at least more plausible to me for a yearly dental visit to have a net positive ROI. However, I'm finding a lack of evidence of usefulness (on Google Scholar), and mostly just dentists saying it's Absolutely Necessary to go in twice a year without citing their sources.

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To be clear, I'm not wondering about the cost side, as both are covered by my current insurance (and I actually get a small bonus to my HSA in exchange for doing the doctor's appointment). From a purely self-centered POV this is totally worthwhile, but me using up these resources seems like a net negative for the system as a whole.

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"Very few screening tests have been proven to identify diseases before they begin to cause noticeable problems. The U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that does tough-minded assessments of health care interventions, recommends that only a handful of them be performed regularly (if not annually). These include checking for unhealthful behaviors such as smoking, alcohol abuse, poor diet, and lack of exercise; monitoring stats such as weight and blood pressure; and testing for cholesterol. Once the doctor finds a problem, he or she may prescribe preventive treatments..." [source]

I feel like if this is what a yearly exam includes, I'm just as qualified as my doctor to "find problems". Cholesterol / blood pressure is checked when donating blood.

[theanimal]

Comprehensive blood panels are useful to establish a baseline (especially when you are healthy) to notice any changes as they develop. It is much easier to spot a trend when you have previous information to go off of than trying to pinpoint problems at one specific point in time. I just did my first comprehensive blood test at 30. I wish I would've started a few years ago. Just a thought for your consideration.

[Anesau]

Interesting — I guess taking a baseline would make sense, so maybe I should do that at least once. A friend recommended I get blood work after I made a major change to my diet a couple years back, which in retrospect would've been a good schelling point.

I didn't see doctors regularly growing up (except to get vaccinations or stitches), so it just seems weird to go while healthy. The articles I can find seem to agree that annual physicals are a bit much for a healthy young person, but even they seem to think a person should go at least every few years.

[Scott 2]

I see my dental hygienist every 3 months, the most insurance will pay for. With dentistry, preventive care is where it's at. Problems build over decades and cannot be reversed. Only managed.

[jacob]

Count me in on "team health theater/waste of resources". It's noteworthy that only a few countries actually engage in the annual physical ritual for the entire population. Elsewhere, doctors won't see you unless there's something wrong with you.

Personally, I managed to avoid it for 18 years until DW's work health insurance said they'd hike annual premiums by about $500 for anyone who didn't go and got a form signed. Apparently her employer contracted with some company that provides a "health app" and sold their services of lowering corporate health insurance costs by punting the long and boring lifestyle conversations about drinking, eating, smoking, weighing, or sitting too much to the app and your doctor. Brilliant! Frankly, I find the whole process rather paternalistic although I understand some enjoy it.

My main concern is overtesting and overtreatment and getting dinged with bills for random services, so I approach the ritual with a politely recalcitrant attitude of "is this test really necessary?" The answer is usually "no" in which case "lets just skip it then".

I understand the baseline/record argument, but this requires committing to maintaining such a record which in turn requires regular contact with the medical system to ensure that records follow you around the world from doctor to doctor. (This does not apply to someone who has had the same doctor for decades.)

I do think people tend to stand where they sit. Someone who is in regular contact with the system (1+ times per year) due to actual health issues is probably well served doing a physical as part of going anyway---the doctor would probably have the data akin to a physical anyway. For a healthy person, I do not see the point in seeing the doctor just to see the doctor and neither do most health care systems in the rest of the world.

[Frita]

+1 to Jacob’s views

Regarding dentistry: We go to the dentist every 10 months which is “right sized” for our needs, so we aren’t getting yearly x-rays. Genetically-speaking, we did not win the dental lottery. Our 18 year old had braces for three years, ages 9 to 12. (My spouse and I also had braces.)

I notice a few issues with the system:
1) What I do is most important. I do diligently brush and floss, eat well, and am not chasing a movie star look of whitening/Botox/capping.
2) There is a culture of marketing, up selling, and fear mongering in the medical industry. I have no to little trust in someone who peddles services this way. Viewing it as such, I have to think and have conversations with those unable or unwilling to do so.
3). The medical system, combined with insurance/pharmaceutical/industrialized work systems, do not want clients/consumers or providers thinking. There are secondary gains for insured people maximizing their benefits and providers to be able to maximize their profits.

[theanimal]

To be clear, I agree with the points being made above regarding regular visits and the standard approach of US "health care". I have not seen a doctor in over 10 years and a dentist in over 5.

I understand the baseline/record argument, but this requires committing to maintaining such a record which in turn requires regular contact with the medical system to ensure that records follow you around the world from doctor to doctor. (This does not apply to someone who has had the same doctor for decades.)

In Alaska there is a non profit that operates a "health fair" that offers low cost, direct blood tests. I made an appointment online and went in on a Saturday morning. I filled out one sheet of forms, then paid (no health insurance involved) $180 for the comprehensive blood panel and an additional $55 for total testosterone. They took my blood pressure and took me back to draw my blood. On my way out, some woman associated with the state bribed me with A LOT of free food to talk to me about resources available for elderly and disabled. I was in and out in 25 minutes. The results were mailed directly to me in just under 2 weeks. No doctors or doctors offices involved. I keep the records in a folder in my desk. I'd be very surprised if there weren't similar services like this available elsewhere.

[Anesau]

@Scott 2 - if you don't mind me asking, what are you going every 3 months for? Most info I can find says irreversible damages (ex. cavities) take years to form, and in advanced cases (bad brushing + high sugar + genetic predisposition) maybe down to ~6 months. Are there any particular services you find useful on a 3-month interval?

@jacob - at least I'm not alone on thinking it mostly theater. My insurance is similar, but my employer tried for carrot instead of stick ($500 deposited to HSA if you get an annual physical).

Though I don't seem to have enough charisma to pull off "is this really necessary?" without nurses getting very upset. Some months ago I got sick and asked "is taking these antibiotics necessary?", where I was trying to say "I have a high pain tolerance and good immune system and would like a professional opinion on how much antibiotics will help (in a world where antibiotics are overprescribed)", but the nurse seemed to interpret it as "I deny science and all its works, don't even bother explaining anything."

I think I also have a tainted view of some preventative medical care from personal experience. Ex. every ~2 years during a screening my mom is told she almost certainly has cancer, and is sent for multiple tests and a surgery, only for it to turn out that she, again, is completely cancer-free. Bayes's theorem strikes again. Screenings are useful, just (probably) overdone.

@theanimal - my local lab will do comprehensive blood for $170, and my health insurance would make it "free", so sounds about similar to your access. The only negative is externalities.

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I wonder if the real problem here is just that health/dental care tends to filter the wrong way for conscientiousness.

Low-conscientiousness people probably do need someone to check their blood and talk about lifestyle choices, but are less likely to do the annual checkup. High-conscientiousness people probably eat & act healthier and are faster to go to a doctor if there's an actual issue, but also are the ones going to the annual checkup. Incentives for everyone to do routine health/dental care makes it more likely for low-conscientiousness people to get resources that are actually helpful to them, but as a side-effect wastes a lot of resources on high-conscientiousness people for whom more health care is neutral or negative.

Similarly for dentists... the people that most need dental care (don't regularly brush, live off sugar) are also the people least likely to be visiting a dentist every 6 months.

[Scott 2]

@Scott 2 - if you don't mind me asking, what are you going every 3 months for?

Get any tartar buildup removed ASAP. Have the depth of the gum pockets around my teeth charted. Confirm my general hygiene is keeping gum tissue healthy. I currently have braces, but will continue the pattern once they are done.

When I was younger, I went with a "minimum effective dosing strategy" for dental care. Every 6 months at the basic local dentist. Remove any tartar build up and get the nod on no cavities. Only it wasn't fully effective. So I had an untreated gum disease, which caused bone loss, which caused gum recession. Since I was young and healthy, it felt fine until it wasn't. Everyone bleeds a little at their cleaning, right? Now I'm contending with mild root exposure at 40, which if not managed well, means tooth loss and maybe implants as I age. Way more expensive than preventive care. I also now need to be extremely diligent, because my margin for error is gone. And those exposed roots are sensitive. It's a bummer.

In my specific case, there is a strong argument for orthodontia, which wasn't made well until I got access to a modern dentist.

I also think it's worth fixing any cavities while they are small. Old school strategy is wait until it's a problem. That's not how modern dentistry approaches things. My dentist will burn early decay out with his laser and make the tiny fix. Since he's not relying upon the drill first, it is minimally invasive. Having experienced both now, I much favor the proactive approach.

The x-rays are monitoring for early cavities and watching the health of existing fillings. Fillings do not last forever. You want to replace them as they start to break down. The alternate path is a cavity underneath the filling, eventually leading to a root canal or tooth loss. Preventive care is preferable, IMO.


I'm also happy to see my doctor for an annual physical and get the blood work done. So I have my bias.

[Anesau]

I feel the genetics thing. I also lost the orthodontal lottery... headgear as a kid, braces, palate expander, oral surgeries. Luckily I'm not prone to cavities, so as long as I wear my retainer it should be smooth sailing from here.

I'm with you on 1. Reminds me of Fight Club ("I say, deliver me from clear skin and perfect teeth!"). Strong agree on 2 and 3. Everyone with money (the well-insured, doctors, employers, and insurance companies) benefits from people maxing out their healthcare usage. It only screws the poorly-insured, those who would be better served by the wasted resources, governments/taxpayers, and the global population (since I'm guessing excess healthcare alone pushes a lot of people over their ~$6200 share of GDP ÷ population ÷ global resources).

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@Scott 2 - I'm surprised your past dentists weren't concerned. I was always told bleeding while cleaning the teeth or flossing was a bad sign that the mouth wasn't being kept healthy enough. Though maybe that's more of a recent advice update?

I've visited the dentist at least once a year before now and never had any early cavities or messed up fillings (yet), so my base chance of needing dental work in a given year looks lower.

Seems like routine cleanings do make more sense in your case, since you have a reasonable expectation of needing dental work. Thanks for indulging my curiosity

[Anesau]

Have a lot of travel packed within 1 month (graduation, wedding, family reunion). Probably the highlight of the graduation trip was helping a friend move out of her dorm. It is nice to feel valuable for something other than my work (still in the specialized ant phase...) and I forgot how much I liked having the chance to talk about nothing.

Sitting on plane flights always reminds me of the page of The Little Prince where he's talking to the railway switchman [https://blogs.ubc.ca/edcp508/files/2016/02/TheLittlePrince.pdf, page 49]. A lot of this travel feels like unnecessary friction caused by choosing to live away from people I love for work reasons. Probably I would be better-served by just locating near the people I can't bear not to see, then avoiding most travel.

I'm not sure how much ~3 days a year of seeing an old friend is actually of any use for either of us, so random "visit friend!!!" travel seems like a waste. My friends are very scattered, but I have family & extended family all living in a small radius.

There are the selfish costs of plane flights being both expensive and extremely unpleasant. But also, since reading the JAFI thread, I find myself thinking of the portion of global resources I could fairly use and me spending multiple days at airports throughout the year seems like such a stupid way to burn limited shared resources.

[Henry]

I will never get on an airplane again in my life unless at some point I say fuck it, I want to see Italy. The whole thing, soup to nuts, is the most extraordinary waste of resources in creation. Money, emotions, time. Driving to the airport to park your car to get on a bus to get on a conveyor belt to sit in a plastic chair to walk onto an airplane balls to ass to bench press your luggage to sit in some seat that thousands of people have previously farted into in order to stare out a little window and get a little bag of peanuts and plastic cup with ice chunks to see people that at some point many years ago you kind of liked. . Travel? See the world? The world is different places with the same douchebags speaking different languages. And now it's like a flying MMA event. And fat people. Sorry, you're fat. Your right to fly does not eclipse my right not to worry about my nutsack getting crushed during turbulence. Anthony Bourdain got so fucked up trying to figure out what he liked more, coming or going, departing or arriving, taking off or landing, saying hello or saying goodbye that he topped himself. Oh wow I ate squid in some Asian sea town with a three hookers that cost less than the meals I bought them while my wife banged guys who could sit in one place for more than five minutes. Move to a place you like, fuck the grass is greener bullshit and if you get the urge to see some other bullshit part of the world watch some travel videos.

[Anesau]

I return! It's been a while since I posted. I'm kind of eh on everything right now, so there's not much to add here. Sorry to visitors to the journal for a boring update, but (ideally) having snapshots of my actual life & progress will be useful to a future-me.

Having obligations hanging over me tends to sap a lot of my joie de vivre. I felt it a lot in college with the constant homework; there was never a time when I was just free and able to fully focus on enjoying myself, because a little piece of my brain was always fretting about due dates. Now I have a paid side project with a hard deadline, and it's causing a very similar mental experience. Even though the project doesn't take that much time, I find myself super reluctant to "waste" time on stuff like long walks or reading books. Not fun, but good to know about myself.

Another good-to-note: I'm a lot more sensitive to status than I thought. It's easy to think I don't feel certain things just because I don't pay attention to them (I thought I didn't ever really get angry until about age 20). When I pay attention to my own actions, it's clear that the threat of losing status bothers me more than I previously thought. I'll have to work on thinking through that instead of just ignoring it.

I finished all the travel I posted about in my previous message as well as some work travel, and I completely agree with you @Henry. Travel being "the most extraordinary waste of resources in creation" is about how I feel about it too, after taking >10 plane flights in 2 months.

[Anesau]

Update, re: car insurance & bad drivers in my area - just got in my first ever car accident. I was hit from behind while stopped at a red light.

Dealing with insurance and the repairs shop is a massive pain. I aggressively do not care about the aesthetic-only damage and the monetary cost of fixing it is way higher than it's worth (~1/20th of the car's value to fix something that has zero effect on the car's usefulness!!!), but since I'm holding this (pretty nice) car in trust for someone else, I am socially obligated to go through the whole song & dance of replacing bits so they don't have to look at bent plastic.

I have been offered an ongoing series of decently-paid contract work, so I'm a little tempted to say f it, quit my day job, give the car back, and move to a city where I won't need one. The only things stopping me are fear and my pet hamster (who would be the most difficult part of moving).

[ertyu]

so, in other words, the only thing stopping you is fear