The Older Brother Explains “Magic”

Hey Fat Heads! Long time.

Tom’s still off on the Low Carb Cruise, so I get to staff the Big Chair for a bit. Folks on the cruise are going to get to see the almost final cut of the Fat Head Kids DVD. Tom, being Tom, in order to avoid disaster (long time Fat Heads may recall there was an audio issue on one of the first cruises), took a copy on his laptop, a DVD, a backup drive, an extra laptop, and an extra projector. Just in case. He’s also left copies at home, and at the in-laws, just in case the ship sinks and his house burns down at the same time. I asked him if the odds weren’t pretty astronomical on that kind of coincidence, and all he said was

“Three words: President. Donald. Trump.”

That pretty much took care of that argument.

I meant to post last week, but, in addition to a flooded basement (again) and a mouse-infested camper to deal with, I also officially passed into old age last Tuesday. The Big Six-Oh. Doesn’t actually feel any worse than the day before, to tell you the truth. Tom called to rub it in a bit under pretense of “Happy Birthday” wishes, and we agreed that hitting a calendar date really never had much psychological impact.

Over the years, I’ve only had a couple of those “OMG, I’m getting OLD” moments. The first was a couple of months past forty — which I’d pretty much shrugged off – when the friend who’d been cutting my hair for the previous ten years or so was finishing up and nonchalantly went for my face with the scissors, explaining “I’m just going to trim those eyebrows up.” I was thunderstruck – “holy crap, my eyebrows have forgotten which direction to grow!”

The next time was a few years later. The same friend had just finished my hair (okay, and eyebrows) and then — just as casual as can be — shifted to my side and said “let’s get those ear hairs taken care of.” Fortunately for my self esteem, she retired shortly thereafter, and I was able to find a new barber with bad eyesight.

Anyway, on account of the milestone, I thought I’d give myself a present and commandeer the Big Chair and talk a little about health care and piss everyone off.

You were warned.

The source of my most current irritation wasn’t at the health care system, per se, but at some really good news. The good news being the amazing story of Jimmy Kimmel’s son. The boy was born late last month (April), and Kimmel did an emotional monologue on returning to his show on how the baby was rushed into surgery immediately after birth with the deadliest version of a rare heart condition. During the monologue, as he described the procedure he said the surgeon “did some kind of magic I can’t even begin to explain…”

And then kind of turned the whole experience into a morality tale on why we need to keep Obamacare, only bigger.

I don’t have a problem with Kimmel projecting his personal experience onto a larger issue that I’m sure he’s not particularly well-informed on. I do have a problem with how the media instantly elevated Jimmy to the status of Economic Savant, and I find it sadly not surprising that politicians on both (wrong) sides of the issue felt compelled to rush for a camera and pontificate as if this was some new large issue that hadn’t been debated.

As it turns out, I’m actually familiar with the condition and can also explain the “magic” to Mr. Kimmel.  The condition is called a Tetralogy of Fallot with pulmonary atresia, where there’s a blocked valve with a hole in the baby’s heart. It requires immediate surgery, with a couple of more “upgrade” heart surgeries as the child grows, because the replacement valves don’t grow along with the child.

See, the Oldest Grandson — the one we lucked into when the Middle Son got married last year – was born with the exact same thing. He’s nine now, so it turns out that treatment was available before Obamacare. Within a couple of hours of being born, he was whisked via helicopter from Springfield — where we have pretty damned good neonatal hospital departments – to Saint Louis, MO, ninety miles away where they had specialized facilities and pediatric cardiologists.

The actual Magic — the reason Jimmy Kimmel’s son and my grandson are alive – is called “the Market.” You see, if Jimmy and his wife, despite the blessings of wealth his talent and hard work have brought him, had been in Canada (the current darling of the “free” health care advocates) I suspect it would’ve been a much darker monologue.

Not necessarily, of course. They might’ve been lucky enough to have their baby in a city with one of the seven pediatric cardiology units within Canada’s 3.8 million square miles of land mass. There are 122 in the continental U.S., despite having 20% less area (3.1M). Caring, forward-thinking Canada has 81 Pediatric Cardiologists. Here in health care’s evil empire, we’ve got 2087 on tap.

And I do mean in a city. Ninety miles away doesn’t get it in Canada, like it works here. If you don’t believe me, ask Liam Neeson. In case you don’t recall, his wife died because it took over three hours to transport her 77 miles by ambulance as helicopters weren’t available where she was injured. But hey, what are the odds of needing an airlift for emergency medical care at a ski resort, right?

[Another helicopter story – several years ago, my brother-in-law’s niece was critically injured in an early morning slippery roads/tree vs. car accident on her way to school. This was in very rural North Carolina. They got a helicopter shortly after the accident was discovered. She flat-lined three times in the air, but she pulled through.]

It’s not like we don’t have major issues with the health care system in the good old U.S. of A. But the issues are with the availability of dollars, not doctors, and Obamacare makes both worse, not better. And Jimmy Kimmel is a terrific entertainer and wonderful human being and I am truly overjoyed at his good fortune, but he’s not a very good economist. Better than Paul Krugman. But not very good.

I’m going to address those dollars next, and my thoughts on that happen to dovetail nicely with Dr. William Davis’ book that Tom just reviewed. If you haven’t got your own copy yet, you’re missing a really good read that can do more to improve your health than any elected official can possibly do for you.


The Older Brother


42 thoughts on “The Older Brother Explains “Magic”

  1. Elenor

    Ah, Elder Brother, how lovely to hear (well, read!) from you! (You whiny young pup: Keep working on this obnoxious aging crap and maybe you’ll catch up! {wink})

    I second, third, and fourth, your entry above! The biggest and most fundamental “problem” with health care is: MPAI. (“Most people are idiots.”) Okay-so that’s not kind. They don’t, won’t, or can’t LEARN about medical care, medicine, health, or insurance (either at all or as against health “care”). (Oh yeah, nor about money and health care!), and have neither interest nor willingness to get off their butts and find out!

    There is this blind childish faith that “they” can fix anything, heal anything, make anything better — and keep us all from dying no matter what! And so, the MPAI don’t, won’t, or can’t be bothered to educate themselves about what is possible — or reasonable! “Death panels”?! There have always been death panels, and always will be “death panels.” There is not enough money (nor skill, time, personnel, and equipment) on the planet to “save” everyone! I cannot recommend highly enough Atul Gawande’s book “Being Mortal”: warm, compassionate, deeply full of truth — and astonishingly useful information — about “end of life” care (which you and I are approaching, and way faster than we want to!)

    From here:
    We need to reckon with the reality of the body’s eventual decline, he argues, think about what matters most to us, and adapt our society and medical profession to help people achieve that.

    Gawande writes: “For many, such talk, however carefully framed, raises the specter of a society readying itself to sacrifice its sick and aged. But what if the sick and aged are already being sacrificed — victims of our refusal to accept the inexorability of our life cycle?”
    In the last part of the book, Gawande argues against the treatment-at-all-costs model that once prevailed in medicine. “People with serious illness have priorities besides simply prolonging their lives,” he writes. “If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.”

    One of Gawande’s most important observations is that reassessment is crucial. “Arriving at an acceptance of one’s mortality and a clear understanding of the limits and the possibilities of medicine is a process, not an epiphany.”

    A point I dimly remember from reading the book when it came out (and am probably presenting inaccurately on details): nearly every oldster wants to die at home, surrounded by family — not chained to a bed by pipes and tubes and beeping monitors, refused the slightest ability to decide what is and isn’t done TO them… even when to pee! Most doctors, because they know the reality of medical care and what’s possible, have set up their own end-of-life care directives, which usually include hospice, and no heroic measures — because they don’t want to spend their last year, month, or week tied to a bed! Yet almost no doctor will tell an oldster who comes in for “care” that that will be their end-point if they try to outwit Mother Nature. Oldsters DIE – it’s how the game is set up! If you go in for a broken hip at 95, the doctors will not tell you that your chances of ever recovering enough to get out of the hospital (or nursing home) are beyond dismal. (But the doctors know, and decide for themselves on true knowledge, not on “kind” lies — or bragging claims!)

    There, do I sound old grouchy ‘get off my lawn’ enough?! {sigh} Gawande’s book is well well well worth reading… especially as Father Time begins sniffing around outside your house!

    1. The Older Brother Post author

      Having seen what Dad’s and The Wife’s Mom’s final days were like, I’m sitting in the lawn chair next to you. In the last couple of years I’ve become more comfortable, at least intellectually, with my own mortality, especially after having read of some of the Stoic/Epicurean philosophical outlooks among other things. I’m not in a hurry, mind you. It’s just that at some point you start to get that there really are things worse than death.

      Mark Sisson had something on his website (I don’t know why he’s not selling it on a T-shirt because I’d totally buy one) that says:


      I think we need a little more of that.


  2. Kathy in OK

    Thanks for stirring up the old brain cells first thing this morning! Checked to see if you had started posting to your old blog again, but sadly no. Oh well, welcome back to the big chair for however long you can stay.

    1. The Older Brother Post author

      The WordPress version my old blog is on is so old that I can’t do a routine update, which I’ve been using as a convenient excuse to not let Bad Jerry out in the wild. Plus, my local paper — most of my posts were letters to the editor that I submitted — put in a 250 word limit (less than I need for an opening statement) and has become increasingly pathetic, so I lost that as a motivator. Finally, I had no intention of distracting my techie/guru/consultant with a silly request to get my blog updated when she had a much more important task at hand. Meaning, it would’ve been criminal to ask Chareva for help when Fat Head nation was still waiting on the Kids book. Maybe after they get the video out and rest up, I’ll bother her about a resurrection. Lord knows there’s never been more material out there!

  3. Elenor

    Oh, and p.s., yes, I DO know the horror, the grief, the complete sense of desperation when a loved one is struck down. I was medical affairs director for an ambulance corps many (many!) years ago. I taught EMT classes and have a dilettante’s knowledge of medicine and the medical field, and I ‘keep my hand in’ (or at least, my knowledge base from completely failing) by reading.

    And when I found my husband who had died, alone in the garage, of a heart attack, {sigh}, I desperately performed CPR (though I knew it was too late) and I, like anyone, turned a hopeful / hopeless eye to the EMTs, asking if THEY saw any flicker of life (even though I knew they didn’t: they couldn’t, there wasn’t one). My neighbor, who ran over when she saw the ambulance arrive, said later that she was amazed at how calm I was (it was mostly numbness overlaid on knowledge), how organized I seemed in providing info to the EMTs ({shrug} I KNEW it didn’t matter, but if they knew everything I knew had probably happened… maybe, maybe please??), and how steady I seemed, both in the garage, and later at the hospital (she bless her warm heart, came up to be with me).

    WOULD that I had been there sooner! But I wasn’t, and humans, especially men, have died of heart attacks for millennia. Reality is: everyone dies, and there is no such things as “too soon.” It’s always too soon for the survivors! (And reality always wins!)

    (Funny thing — (I guess?) — when I found him, sitting dead in his “changing his shoes” chair — as an EMT, I slapped his face SO hard and yelled WAKE UP!” but (of course) there was no response; he’d been dead for probably a couple hours. I don’t have any self-directed feelings towards not being able to save him — but I adored him and I would not normally have ever struck him. THAT echoes! Funny what makes a permanent ‘dent’ in our psyches.)

    Even with a helicopter ride and 2,000+ peds cardiologists in the U.S., Kimmel’s baby might not have made it. The baby is mainly lucky he did. But — life is a sexually transmitted, fatal illness. WE ALL DIE! And if we don’t begin to deal with the REALITY of health and healthcare and medical care and medical insurance … there’s nothing left but the fighting over the scraps!

    (Sorry for the lectures; it’s a sore spot for me! And your blessed brother, for which I will sing his praises evermore, recognized my name when he met me, three weeks after Michael died, at the first Ancestral Health Symposium. (It was Michael’s last gift to me- he was SO pleased I was going — and my family lives out in LA — so: unintentional double gift!) Tom, when he heard Michael had died, gave me a big hug, and then made a point to sit near me in the sessions we shared, and we even went to lunch the first day. A kind, kind man. And Tom, it’s okay if you blush, the praise was massively earned!)

    1. The Older Brother Post author

      I appreciate you sharing your story, Elenor. As you know, lectures are also always welcome here.

      We live in an age where things that would be beyond miraculous less than a hundred years ago are routine, so it does tend to give one a reduced grasp of one’s mortality. This has combined with the baby boom generation (who still think of ourselves as young) and a health care spending bubble where money has been no object to create the current disaster. One of the syndicated columnists in this week’s paper was lamenting how badly the Republicans have destroyed health care (without having actually changed anything) and using Iowa as an example; where the sole remaining insurance provider is contemplating leaving (again, completely the R’s fault). She used as a point of persuasion a single patient whose health care was costing one million dollars per month. Her intention was to point out how costly this would be if this expense got pushed back to consumers in a market-based system or to the state’s welfare system. My reaction was more along the lines of “JESUS H CHRIST — JUST FREAKING SHOOT ME!” OF course, no one without Donald Trump or Bill Gates kind of money would ever pay out a million dollars a month to stay alive. But more importantly, no health care facility or treatment would ever be able to charge a fraction of that in a non-make-believe system. Either the treatment would have a reasonable cost to risk ratio, or it would never come into existence. We’re way far away from that kind of sanity.

      Thanks for commenting.

      The Older Brother

  4. Dianne

    Good post. To me, one of the silliest aspects of our culture is that so many people take anything spoken by a celebrity as gospel truth, as though words automatically become wise if they emerge from a famous face — even one whose own life is totally messed up and marked by bad choices. Not that Jimmy Kimmel’s life is — I never watch his show and know nothing about the man — but let any rock singer or movie star back a cause or a candidate and hordes of people flock to do the same. Could it be a desire to identify with that person? I dunno, but it is pretty silly.

    BTW, years ago my friend’s uncle came down to the States from Canada to stay with her family while he sought medical treatment which he would have to pay for out of his own pocket. It seems that an x-ray had shown a mass in his intestine and his doctor wanted him to see an oncologist, but there were so few in the part of Canada to which he belonged that he couldn’t get an appointment for six months. That wouldn’t happen here.

    1. The Older Brother Post author

      Exactly what I was trying to gt at. Jimmy Kimmel seems to be a wonderful person who went through a wrenching experience with his wife and child, and I have no criticism of his combining that emotional experience with a relative ignorance of economics. It’s the media I find completely despicable. If he’d stood up and said “thank God there are still enough vestiges of our medical care system left over to provide my child with treatment that would’ve only been available a few other places in the world, and then only through sheer luck!” we wouldn’t have heard another word about his monologue, except for maybe a headline like “Jimmy Kimmel suffers brain damage due to son’s birth.”

      I remember years ago (during the HillaryCare debate days) that Canadians who needed MRI’s for things like cancer, neurological issues, etc., figured out that veterinarians had the same MRI equipment as hospitals, and they could pay to get one immediately instead of waiting the six month average for one of the “free” ones. The government, stung by this exposure of mis-allocation of resources, immediately addressed the problem by making it illegal. Meanwhile in the States, when I had as sudden onset of back pain, I had to wait until the very end of the same day before I could one done.

      The Older Brother

  5. Drew @ Willpower Is For Fat People

    I’m sure you’ll be getting into these details in the followup, but what I’m wondering is how much of this is about population density vs. dollars?

    * We have about 9 times the population with about 17 times the pediatric cardiology units. With their larger landmass, getting to the same ratio of units to population as we have would be far more expensive per-unit.

    * For transport it’s even more about population density. Choppers are expensive. Does it make sense to keep one near every ski resort for the one or two times per year someone would need it? (Numbers pulled out of thin air.)

    Also, if Americans without insurance coverage wouldn’t be approved for airlift, or for the pediatric cardiologist, is our system better for them?

    1. The Older Brother Post author

      Hi, Drew. Yeah, I considered that. For instance, I don’t believe (without looking the report back up) there is a facility in Montana here in the states. But it really comes down to the fact that when government (or any other “committee” without skin in the game) is going to allocate resources, those resources will be allocated without regard to individual preferences, and will tend to be allocated in favor of the largest groups of constituents (i.e., young healthy people in Canada, boomers in the US).

      I’d happily pay more in premium to know pediatric cardiology and helicopters would be available for my grandkids, and skip the coverage options for insulin, metformin, statins, and viagra. Except those aren’t options. And those decisions will get made for everyone, which concentrates a lot of money in one spot. Or more accurately, one trough.

      Even as a Central Planner, though, I’m thinking a helicopter makes more sense (from both a dollars and demand standpoint) near a resort for the rich and famous than in Backwoods, NC, but somehow one miraculously appeared in NC when needed. They don’t leave you on the ground if you don’t have insurance, or see if you’ve paid your premium before they open your baby’s chest to replace a valve. That can be a financial disaster later, but odds are you (or your child) will be alive for it to be a burden for.

  6. Glenn

    Reminds me of some folks from Canada my wife and I became acquainted with some years back. One of the women was in her late 60s and needed heart surgery. She was put on a waiting list of 6 months, so they opted to come and have it done in the US, since they could get immediate access to the procedure. I try to avoid them, but doctors and procedures here are usually available when you need them, although I’ve observed the insurance companies, HMOs, and government have managed to make that much more difficult, and have definitely made it more expensive. I kinda miss the “good ole days” when we dealt with our health care professionals directly…

    1. The Older Brother Post author

      I know there used to be insurance plans sold in Canada that would cover coming to the US for care in that type of situation.

      One of many major frustrations for me with the whole issue is how people consider the current state HMO’s, insurance companies, etc. as the result of the “free market.” The insurance companies, HMO’s, Big Pharma, skyrocketing premiums, declining availability, etc. are all reactions as the market adjusts to serial meddling in the health care system, each time making it less patient oriented and more expensive. Then as things get worse, they again holler “market failure!” and start the next round.


  7. Trish

    To play devil’s advocate, Natasha Richardson repeatedly refused treatment at the time of the accident. I’m not saying that she would have survived even if she’d been taken for treatment straightaway, but that does need to be taken into consideration. You can’t make someone go to a hospital.

    With that being said, I got quite irritated with people who were going on and on about Jimmy Kimmel. If your baby is born with that sort of ailment, the doctor’s not going to ask you “hey, are you gonna be able to pay for this surgery? It’s kind of pricey. You can’t? Oh, well, guess what surgery your kid’s not getting.” That’s nonsense, and it drives me crazy when ostensibly smart people honestly believe that doctors will refuse to treat a child if their parents can’t pay.

    1. The Older Brother Post author

      She did decline treatment a few times before she started showing symptoms of a serious brain injury. But once she assented to treatment, it became a three-plus hour, two hop trip by ambulance to get her to a qualified facility less than 80 miles away. The write-ups I reviewed were pretty clear that the “antiquated” health care system and its inability to allocate resources were the deciding factor. If she had what would be considered routine airlift facilities here available, she’d very likely still be alive.

      The Older Brother

  8. Katie in FL

    I completely agree. I work in the healthcare industry in a nonclinical position and speak with patients daily. It really is an issue of dollars, not doctors. If health insurance could be sold across state lines and increase competition, it would be wonderful. I also believe that one should be able to buy health insurance comparable to car insurance – pay for maintenance out of pocket and catastrophic is paid with insurance.

    1. The Older Brother Post author

      It would sure be a great start. Oddly, both of these basic, fundamental, economically sound ideas are absent in the Republicans’ version of health care reform, even though they’ve talked about them continuously since Obamacare passed. Weird.

      The Older Brother

      1. S

        “pay for maintenance out of pocket and catastrophic is paid with insurance.”

        This is actually similar to the NZ health-care system. Doctors visits cost a small amount, about $40 (free for kids), and medicine is heavily subsidized or free. Catastrophic is covered.

        But many people pay for health insurance that covers the big things while still using government services for everyday things. I suppose they do this to avoid long wait times for non-urgent, out-of-the-ordinary care.

    1. The Older Brother Post author

      I simply can’t decide if he’s a genius, or just some kind of evil Peter Sellers “Being There” character.


  9. S

    I don’t think health-care is a good thing to apply a market to. It’s guaranteed to cut out a portion of the population, and provide sub-standard care to another portion. And people can’t choose to not get sick.

    I come from a country with government-provided health-care for all (like most OECD countries). It’s great. Amazing. And half the cost of US health-care, again, like most other OECD countries.

    I’m not saying I support obamacare… But perhaps the US should start thinking about *evidence based* health-care policies. There’s plenty of evidence out there if one is willing to look…

    1. The Older Brother Post author

      Here’s the thing — if someone wants to get paid, IT’S A MARKET.

      By definition, With a limited supply compared to the amount of goods or service desired, it’s guaranteed to cut out a portion of the population. Cars, phones, haircuts, lawn care, HEALTH CARE, massages, appliances, houses, HEALTH CARE, steak, tofu, and HEALTH CARE. If it’s not something that’s got a limited supply compared to the amount of goods or services desired, it’s not an economic question. It’s a fairy tale. Some people will get what they want, some people will get some of what they want, and some will do without.

      Well, maybe not tofu. That crap is disgusting.

      The only question then is “who gets to decide?” If you let individuals decide for themselves if they want to purchase risk coverage for illness (because they realize they can’t choose to not get sick, or not have their house burn down, or not get hungry), that’s a “free market.” Even most individuals who didn’t want to pay as much will still receive some care, and some haircuts, and some phones, but they won’t be as good. Oddly enough, they can still gets LOTS of tofu.

      The other option is actually also a market, but it’s where the individuals don’t get to decide. It’s a “command” market or economy. Bureaucrats decide, and the decisions are generally once-size-fits-all (with notable exceptions for favored groups). Resources get allocated via planners to get maximum coverage for the dollar. So everyone gets a piece of paper guaranteeing them the same level of benefits as everyone else. So, by magic of commanding the economy to produce as much service as everyone wants, everything appears and it’s amazing.

      No wait — that was in the fairy tale. What happens is lines. That’s the other way to allocate scarce resources. The. Only. Other. Way. Pay or wait. So you can maybe get to see a primary care physician without a hitch. Great. And everyone else can, too! Amazing. But if your primary detects a mysterious mass and wants you to get an MRI, well, those are pretty expensive machines, and not as many people need them, soooooooo, just take a number here and wait in this line and they’ll get to you just as soon as possible, right after the they clear the six month backlog of other people with totally free health care. Or, if you have the means and consider your health a priority, you purchase a policy that will ship you the US and you can get that taken care of this week.

      “Half the cost” may be ok as shorthand in a tangential point, but it’s completely misleading if you want to compare healthcare cost. What you need to say is “half the spending.” If I have a health issue and spend $175 on a prescription or advanced medical procedure and can return to work the next day at a $100/day job, my cost is $275 — the $175 spend and a lost day at $100. If my OECD colleague has only an old tech procedure available that costs $50 and loses five days of work at the same position, her spending is indeed ~ 70% less than mine, but she’s out $550 so my real out of pocket cost is 50% less than hers. We do spend more in the US, but that delta largely disappears when you factor out our annoying habits of shooting and stabbing each other, and tendency to drive into one another. This leads to “health care spending” but is unrelated to system cost or efficiency. We also spend TONS of money of preemies and end-of-life care, for which our more compassionate OECD brethren simply do not allocate those resources. Those lines form at the morgue instead of the hospital. Also, I’m sure tofu is involved in this somehow, but I’m still digging into that angle.

      If Tom doesn’t realize by next week that he has again failed to secure The Big Chair, I may stick around and give “evidence-based” a full blog post. Anyone hearing this latest rhetorical sleight of hand used by a member of the credentialed intelligentsia should adopt the simple device of inserting “circumstantial,” “cherry-picked,” or “observational” in front to get the correct meaning of whatever follows after. Galileo didn’t use “evidence-based.” Newton didn’t use “evidence-based.” Einstein didn’t use “evidence-based.” They used “science.”

      You know who uses “evidence-based?” Teachers’ unions. Bureaucrats. Lobbyists. Politicians.

      Thanks for your comment. I started to get a little panicked when more people weren’t disagreeing with me. Thought I’d walked into the wrong room for a minute there.


      1. S

        I hear what you’re saying, and wait times definitely exist (although I have yet to experience any). But private health insurance still exists here, and you can buy that if you want, and many do. But for the other half that can’t afford it, waiting in line (if at all) is infinitely better than no treatment at all.

        Face it: Letting people rot (literally) is unethical.

        (I’m from New Zealand BTW.)

        1. The Older Brother Post author

          Well, we don’t let people rot here, either. We never have. Prior to Obamacare, hospitals were required to treat anyone that showed up, and couldn’t be turned away without an evaluation (thanks to that socialist Ronald Reagan! — before that, indigent care was normally handled by teaching hospitals and/or charity care). That’s how the ER — the galaxy’s most expensive health delivery system — became the “family doctor’s office” for our welfare state. That was the old line. Obamacare just took threw some money at the problem, exacerbating it instead of improving it. So now more people have a piece of paper that says they have health insurance, and a few more have actually been able to find a PCP that will take a government promise to pay them someday. We’ve shifted the waiting line for them to clinics, but there’s still plenty in line at the ER.

          From your description then, it sounds like we have more in common with the NZ system than I thought.

          The Older Brother

      2. S

        We also have mandatory paid sick leave (1 week?) and mandatory paid holiday (4 weeks?) for full-time, permanent employees, so your example about “costing more to wait” doesn’t really apply to most people.

        1. The Older Brother Post author

          Well, that was one example. My point was that “cost” gets routinely and inaccurately used in place of “spending,” and it matters. Mandatory holidays, vacations, sick time, etc. are all examples of things that appear to be “free” to the delight of constituents and the politicians who mandate them, but are completely factored into the wage rate and labor utilization. We also tend to “spend” more on pharmaceutical treatments, arthroscopy, and other innovations that reduce lost productivity and increase the quality of life, but those “costs” don’t get into the equation when the question is “how big of a check did we write to the health care industry compared to other countries.”


  10. Linda

    Really good to see you again, Older Brother! And I’m looking forward to your next post! Yes…President. Donald. Trump!! How could this country sink so low?? I have to take a deep breath before reading the paper anymore. In fact I sometimes skip a week or so. It simply amazes me that people don’t realize what it going on! Great writing about Jimmy Kimmel and his son! I’m looking forward to more from you before Tom comes back! I’m a retired Emergency RN and can tell stories that would curl your hair, but in the end no one in our current government would care! We MUST look to ourselves for solutions to our problems, and quit looking to government for them. They are only going to make things WORSE!!

    1. The Older Brother Post author

      Thanks. I’ve actually found that not watching more than about 10 minutes of news a day keeps me way calmer. Still read our local fish wrapper just to keep up with the parochial idiots, but skip a lot — I was formerly an “every word” kind of guy. My emotions on Trump remix about every fifteen minutes. He’s not America’s disease, he’s a symptom. He doesn’t really have any discernible core political principles, but I love that he seems to drive all of the right people batsh*t crazy. Ultimately, the “enemy of my enemy is my friend” has never turned out well in my book, but it’s been an interesting four months!


  11. Brandon

    Older Brother,

    Thanks for the post and the thoughtful comments. I’m interested to hear your opinion regarding mental health coverage. I’m a school psychologist by training and have practiced largely in low SES urban districts. One of the concerns with not requiring comprehensive coverage is that it has the potential to limit those with rare and debilitating conditions (e.g., bipolar disorder or schizophrenia) who could potentially be “priced out” of purchasing more comprehensive coverage in such a system. Thoughts?

    In regards to “evidence-based,” I often laugh as I see this. This has infiltrated the public school system, in my opinion, having both positive and negative effects. First, it’s great that we emphasize using methods based on research and the scientific method. I think this has helped us understand how to be more effective. For example, we have a great understanding of how to teach reading, how to quickly identify kids who aren’t showing mastery of basic skills and interventions to use that are most likely to improve identified deficits. On the other hand, I noticed over the last few years that every book, manual, guide, etc. has the label “evidence-based” on it. It’s funny how quickly everything that major publishers sell is magically “evidence-based” right? Few too many people take the time to examine what the actual “evidence” is and scrupulously evaluate it. The field of education is, however, infamous for relying on personal anecdotes in absence of any empirical support or despite a plethora of empirical support opposing the practice (e.g., grade retention). So, while I often cringe when I see people blindly believing the “evidence-based” sticker on the cover of a book, maybe that represents progress?

    1. The Older Brother Post author

      My concern is that as soon as something becomes required comprehensive coverage, rare conditions have the potential (and tendency) to become unlimited.

      Not sure how long you’ve been in the business, but once Special Ed became a mandated right including dictated instructor:student ratios, individual plans, counseling — along with an prioritized, automatic per pupil funding increase (I believe it was around and extra $7,000 per pupil 20 years ago) it was astounding how many kids, especially young minority boys, contracted ADHD over the next several years.

      Whereas before that moment, resources for Special Ed had to be allocated in balance with what was available and the needs of the rest of the school system, the system would now receive a large financial reward for labeling some of its more energetic charges with a “condition” and removing them from regular classrooms to a stigmatized program where performance is measured on anything other than scholastic achievement.

      I don’t mean to understate the mental issues some people have to deal with, but I also question how much of these could be dealt with on their government-provided lunch plate when they’re young. I’d refer you to Dr. David Perlmutter’s “Brain Maker” and “Grain Brain,” if you’re not already familiar with his work as to how much of our mental health — especially children’s — is affected by diet and the gut biome. If you don’t fix that, no amount of dollars dedicated to counseling or pharmaceuticals will get a long term win.

      “Evidence-based” is strictly a rhetorical (or perhaps more accurately — “marketing”) device. It’s used by people who’ve already been wrong so many times that even they realize people are onto them. It’s a term invented to give the impression there is something like science involved (or even more so, since it’s got “evidence!”), when it’s the exact opposite of science. I’m not saying some good people also use the term, but it’s only due to intellectual inattention, or thinking that’s now the cool way to say “scientific.” As I said earlier, the best thing is to automatically prepend one of my suggestions. So when an education bureaucrat is shilling for This Year’s New Thing as “evidence-based” (replacing, of course Last Year’s New Thing, which is already failing), your mind should automatically process it as “circumstantial evidence-based” or “cherry-picked evidence-based.” Doesn’t mean they can’t be right. It just means they should have to go do some real science before we write them another check.

      The Older Brother

  12. Thomas E.

    I started to write yesterday, but, well, got distracted by work.

    There are 4 things that I figure could massively help healthcare in the US.

    1) Limit vertical integration – That is, your orthopedic surgeon can only own his practice, not the PT clinic, not a surgical center, not a imagine center. Those other parts *MUST* be arms length with no financial entanglements. That is, the orthopedic surgeon can not receive any compensation for ordering an MRI or PT for example.

    2) No, none, zilch discounts on price, and *ALL* prices for medical devices, procedures, services, must be itemized and made freely available.

    3) Outcome records must be transparent for a provider. Kinda optional on this one, sorta??

    4) And we talk around this one, heck this blog and a lot of what Tom does is all about this, but I’ve yet to hear a single politician talk about this, but we this needs to be brought out front a center.

    We need a top to bottom review of the standard of care. I know duh right. But I have not heard a single peep out of the media, politicians. It is only us. And we really only stick to little hot topics.

    But seriously, and this has been said here countless times probably. But other than billing practices (see #2) it has to be the biggest thing.

    We need to slash epidemiological studies, and put all that money into real clinical studies. All of the data from pharmacological studies must be published for all studies for a drug. Let me repeat, absolutely all data from absolutely all drug studies must be open. All drugs must have multiyear studies, even if they get interim permission to release the chemical to patients, the multiyear trial must continue and be revealed. Far too many drugs are being taken by patients for years on end based on studies that lasted weeks.

    All standard of care treatments must be studied.

    And here is where my I show off some of my ability to dream. If we actually did this, and maybe a little help from looking at the research that shows Ethanol in the gas is a net loss, and maybe a little help from Allan Savory, we could turn millions of acres back to grass from corn fields and land left to desertification for cattle, buffalo, and so on. Get back to a better diet to treat CVD, Diabetes and so on nutritionally. Just think of the money that could be save. Think of the environmental healing, turn crop farmers back into to cattle farmers. Remove tonnes and tonnes of fertilizer use.

    I know, I am so very much preaching to the choir.

    But I really, think pressure needs to be brought to bear to look at pharma and the AMA in terms of the standard of care, may actually be priority number #1. And honestly, if we fix the standard of care first, the money will likely follow.

    All figuring out the insurance and how to get more money into the healthcare system does is assist on of the largest transfers of wealth of modern man. Right now 17% of the GDP of the US goes to “healthcare”, and the insiders say they are shooting for a short term goal of 19% of the GDP. Obama care and Trump care are designed to help hospitals and pharma achieve that 19% goal!

    Rock on older-brother!


    1. The Older Brother Post author

      Philosophically, we agree. As to specifics:

      I’m completely opposed to your proposal #1. Keep in mind, this business model is only suspect because of the rest of the current economic arrangement of having third-party payers. Put another way, if you’re going to have to whip out your checkbook or Health Savings debit card for that PT appointment, what’s it matter if your Ortho owns the joint? If it’s too much, I can go down the street to another PT provider, and if I’m not certain of my provider’s intentions, I can find a different Ortho. But not in a system where my doctor gets picked for me based on lowest bid.

      I’m halfway with you on #2. Understandable, cash-discounted prices should be available on request. In other words, “how much will you charge me, all in, for this if I pay you cash today?” Not the BS price that will get submitted to the insurance company before their 60% “adjustment,” not the Medicare approved price, not the “oh, by the way, you’ll also need to pay bills from the hospital, the anesthesiologist, the consulting surgeon, etc., etc.” Again, the Byzantine system we have now is the sum result of all of the previous meddling. I’ve told the the story before of having my then Primary Care Physician recommend a colonoscopy at I approached my 50th birthday, and the clinic where I was scheduled for the procedure being completely unable to tell me what it was going to cost(!). I cancelled the appointment.

      I think that if you’re even modestly motivated, we’ve pretty much got #3 available, thanks to the interwebs and the Wisdom of the Crowd effect. This is also starting to help with #2.

      As to #4 and the rest of your comment, that’s going to be the focus on my next post, coming this weekend!

      The Older Brother

    2. Deb

      Great ideas for discussion, even if I don’t agree with all of them! And I would love, love if someone in the Trump administration would appoint Allan Savory to head the Bureau of Land Management, William Davis as surgeon general, and Paul Stamets to the FDA or FEMA. Other people put together fantasy sports teams, I put together fantasy administrations, LOLOL!

      1. The Older Brother Post author

        I like it. Not sure how long it would last. I expect the first cabinet meeting would go something like:

        VP: “Secretary Savory, your report please.”
        Secretary Savoy: “Thank you. I recommend we close the Bureau of Land Management. That is my report.”
        VP: “Um, thank you Mr. Secretary. Dr. Davis, your report, please.”
        Dr. Davis: “Good morning, Mr. Vice President. I propose that we abolish the position of Surgeon General and urge people to inform themselves on health issues. This concludes my report.”
        VP: “Oooookaaaay. Perhaps you could recommend something for heartburn first? Mr. Stamets, will you be proposing we abolish the FDA and FEMA”
        Mr. Stamets: “No, sir.”
        VP: “Thank goodness.”
        Mr Stamets: “Not until after all of the FDA has been tried for malpractice and fraud. And we’re moving all FEMA personnel into those surplus formaldehyde trailers as permanent headquarters. I do expect some attrition.”

        …as long as we’re dreaming!

        The Older Brother

  13. Steven Grajeda

    For me, it’s about getting everyone to put some money in the pot for healthcare, and use preventative care to increase savings in the long run. Too many people use emergency care, and if they don’t have insurance, the cost falls on the tax payer. Plus, we have to much money not going to actual healthcare. It’s going to insurance companies. I have Kaiser, and I like the fact that my money goes to the place that actually provides my care.

    1. The Older Brother Post author

      If everyone were putting something into the pot, politicians wouldn’t be involved.

      As I’ll be expanding on a bit in the next post, I think it’s safe to say that almost zero money is going into actual health care, even if the insurance companies got nothing for overhead or (horrors) profit. All of that money is going to medical care. Eating low carb, getting good fats and some meats, avoiding processed foods, engaging in regular physical activity is health care. Metformin, Insulin, statins, stents, joint replacements, and dietitians who tell you to eat grains and avoid saturated fat are medical care. Choose!


  14. bill

    Apropo of nothing, here’s what we do in our little town:
    What: Low Carb – High Fat (LCHF) “Meat Up” Group
    A supportive informal group that meets monthly at a restaurant in
    San Luis Obispo County to discuss strategies for healthy eating.

    When: Monday, June 12, 2017 at 6:00 PM

    Where: SLO Dining, 1000 Olive St., San Luis Obispo
    Park in the Ramada Inn parking lot or on the street in front

    “Science for Smart People”
    An entertaining presentation about the science
    behind the ketogenic way of eating
    Tom Naughton, Comedian, Former Health Writer
    Producer of the Documentary Fat Head Movie

    You must RSVP
    Call or email:
    or post on our Facebook page: “LCHF California Central Coast”
    by Saturday, June 10
    No charge, but space is limited to 20 people, so You must RSVP to be assured of a table

    Can’t make the June get together? Don’t worry!
    We’ll meet again, next month.

    Listen to
    Low Carb High Fat Radio on 97.3 FM The Rock
    Saturdays at 3:30 PM
    In Morro Bay, Los Osos and Cayucos

    Or, listen to our live stream from anywhere at:

    Also, listen anytime to show recordings by visiting:

    We’ve been going for about 3 years now.

  15. mabelle

    hi big brother, thank you for the post i enjoyed the part about you griping about aging best. I cant comment much about obamacare as Im not american. I live in singapore, and singapore has a great all round healthcare for the citizen. In fact the government takes care of us in every way, housing, health, education, jobs etc etc etc, we are spoilt. I hope one day countries all over will get to have a uncorrupted, just, intelligent government as we do, so everyone can truly start to focus on living, than to fret over what should be right.

    have a great 60th year and may you flourish with many more healthy happy years to come, that goes for tom too, because he saved my life.

    1. The Older Brother Post author

      Mabelle, Thanks for your comment.

      I was a bit floored by your description of your system, and went looking for an explanation. My understanding is that those areas you describe as being taken “care of” by the government is in fact financed largely through forced savings rates up to 50%, with those under age thirty paying around 20% of their income (with another 16% from employers) into this system, which is then drawn on for those goods and services you listed. So, although in the US (and most countries) we have a massive welfare system that doesn’t tie benefits to personal responsibility, the Singapore system is highly discouraging of public welfare. It also resists the ideas of minimum wage and unemployment benefits. You would of course have a better grasp of the reality of the situation, but that’s the picture I get from this side of the globe.

      The government seems to also have a core principle that each generation will pay for itself, without getting to vote itself money from another generation.

      I think it’s safe to say that there is almost no chance that any country with a “modern” welfare state and a democratic system will move towards your country’s system.

      In the sense that “demographics are destiny,” Singapore is also currently enjoying an economy with 78% of its citizens in the 15-64 (wage-earning) age groups, where we’ve got 66%. That can have an impact. My despicable Baby Boomer generation is also starting to age rapidly into retirement years, and we’re intent on keeping ourselves alive (although not necessarily healthy) at any cost — to somebody else, of course!

      Thanks again for writing. I’m constantly amazed at how far away some of our fellow Fat Heads are. It’s also nice they’re so smart!

      the Older Brother

      1. mabelle

        yes i have to agree the welfare system here is not as supportive as some countries I have lived in before i.e. switzerland, and UK. We do have a welfare system in place, with rooms for improvement of course. Welfare system is great to have but it has its downfalls too. I could be biased, as I grew up without using it, and I grew up being taught to rely on myself and save up for rainy days instead of relying on welfare. That said we do now have a much better welfare system than we used to get just 10 years back. As the population is aging, we are seeing more dependent older generations, just recently we have this mandatory insurance system like the one in switzerland where everyone has to pay a certain amount from the “pension account” (CPF) you mentioned about the 20% employee and 16% employer. However we get to enjoy free hospitalisation if we pay only $300 a year. That CPF account is something i am very grateful for, because it helped me saved up for my old age, and my medical expenses. Still, the expenses are not costly, its subsidised about 70% for citizens. So if u have a bill of 10,000, u are paying only 3grand out of the pension account. But since the recent mandatory yearly contribution, its even lower than 3grand. And the housing, i will tell u most singaporeans become richer from housing scheme. We buy a standard 4 room flat at around 200grand and it triples by end of 7 years which u must hold as owners until u can sell it off. So u earn CASH of 400,000, which most people put into a new flat and once again u pay 200,000. But u can only do that twice, because thats the housing scheme, to help people get a chance to have their own house. So technically, the housing help isnt from our own forced savings. We were given priviledges and profit from the property economy. Education, well, the idea of studying hard is drilled into us since age 5, or we will have to be binmen or roadsweepers, is the common saying here, to tell kids, that academic meritocracy is important. That has its cons too, as everything else does. We produce robotic unopinionated individuals who are just textbook smart, unless u are smart enough to look beyond the little island and go out have a look at the world and really learn something. With the cons and pros, i still believe in our system, as i look at myself, i came from a poor family, which is pretty broken and abusive in more ways than one. I stayed on the right path because of the right education system that encourages further education, there is always some kind of help if u are financially tied. I got myself into varsity, because i was able to save up from a good paying job right off graduating from a polytechnic, thanks to government help, and i got good paying jobs after graduating from university because the job opportunities are always there for fresh grads. i got a house because i got help from government. My life would have been different if i relied on a public welfare system that may often encourage complacency. Public welfare only keeps people afloat but not living a proper life, as what i have seen of UK’s system.

        I may have a different viewpoint if i had grown up in a different system. Its great to hear how others look at our system as its often not that I get to critically look at our very own and its less than desired side.

        And i like that u think of me as smart XD thank you for the compliment.


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