The Older Brother Checks Under the Medical Couch Cushions, Finds a Trillion Dollars

Greetings Fat Heads!

Well, still here. Hope you had a great Memorial Day weekend. Special thanks to all vets and their families. Tom and family are back from the 2017 Low Carb Cruise, happily exhausted. I’m looking forward to getting the full report. I told him if he wanted to wait until next week, I’d fill in Thursday with an “evidence-based” rant.

Anyway, when I left off at the last post, Jimmy Kimmel’s son was doing great and I was in a bad mood. Not about Mr. Kimmel’s son of course. That was the wonderful part. The level of care we have available in this time and in this country is beyond the imagination of what was available to the richest people and kings even a few decades ago.

I wasn’t even particularly stirred up over Mr. Kimmel’s making the availability of the miraculous procedure that saved his son somehow tied in with keeping Obamacare intact. Between being a dad just past a major health scare and living in La La Land among the economically illiterate (seldom right, but never in doubt) I’m okay with him calling it any way he wants. I put it in there with the “all brides and babies are beautiful” protocol. It accomplishes nothing to argue, and it’s just plain rude.

The rest of the Idiocracy, however, deserves no so respect. Instead of politely giving Jimmy’s emotional description props and then moving on, they treated his completely sincere and completely uninformed comments on insurance and Obamacare as the Magnum Opus of the health care debate.

At any rate, I stated toward the end “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, …”

There are issues with dollars. As I mentioned, I was aware of Kimmel’s son’s condition because The Oldest Grandson had the same thing – and the same miraculous treatment – when he was born just about ten years ago (yes—before Obamacare).

His mom, my daughter-in-law, pointed out that back then just his hospital tab was over $300,000, which would break anyone without insurance, not to mention that he’s facing at least two more surgeries. Under insurance as it mostly existed prior to the current debacle, there could be real issues with lifetime spending caps and him trying to get health insurance as an adult with that type of pre-existing condition.

To paraphrase an old politician, $300,000 here, $300,000 there – pretty soon you’re talking real money! Definitely a dollars issue.

So what’s a libertarian to do? Is there a solution other than “I’m sorry, Mr. Kimmel, there’s nothing we can do?” That’s what you would hear in most of those countries where it’s “free.” Don’t we want to save babies in this country? Wouldn’t it be nice to be able to do that and not go broke? How can we do that today, and still be able for that kid to afford reasonable health care later?

Fortuitously, Dr. William Davis’ new book – “Undoctored” came out just recently, and Tom did a book review.

[Confession time – I don’t read Tom’s book reviews any more. When I see he’s written one, I just save myself the time and buy the damned book.]

Now, if you want a great book on the disastrous macro-economics of our health care system, and policy proposals to address insurance and health system availability at a national level, don’t buy this book. That’s totally not what it’s about.

What it is about is you getting control of your health, which Dr. Davis reiterates throughout is not particularly connected to medical care. In fact, unless you get yourself informed and proactive, medical care can often be inversely related to your health. Although he doesn’t do a deep dive on the economic history of the health care system, he does do a great job illuminating how the money and incentives in the current system don’t line up with attaining real health as an individual. Then you’re off on a terrific primer in how to evaluate, improve, and monitor your health, in conjunction with health care professionals who will work with you and at your direction when needed.

Seriously, buy the book.

Okay, so how’s that tie in with the subject at hand? Well, the idea that the medical industry is more responsive to money than patient outcomes was nothing new to me – or probably any Fat Head, really. “Have a $tatin with that hearthealthywholegrain muffin” vs. “have the bacon and eggs and take a walk,” right? So, I was already on board with the concept.

Right in the introduction to “Undoctored,” Dr. Davis noted that we spend (endlessly pointed out with delight by the single-payer cheerleaders) over $3 trillion dollars a year – 17% of our GDP — on health care. Which I also already knew.  But this time when I read it I’d been thinking about Kimmel’s performance, and my daughter-in-law’s point, and then pretty close in to the beginning of the book Davis points out that:

“The system is ready and willing to commit you to a life of taking drugs and injectable insulin for diabetes, … providing “education” designed by people who put commercial interests first, while no one provides the handful of inexpensive health strategies that have been shown to reduce, even fully reverse, type 2 diabetes.”

Once again, nothing I didn’t already know, but it kind of all came together at that point and I thought, “well, just how the hell much do we spend on all of this crap?!?”

So I looked it up.

I tend to do that. I just stopped reading and went Googling for info on how much money we spend on the various medical substitutes for good habits. I’d like to think it’s due to my insatiable inquisitiveness when I’ve got an intellectual conundrum, but it’s probably just ADD.

I struck gold fairly quickly when I found a JAMA paper from 2016 titled “US Spending on Personal Health Care and Public Health, 1996-2013.” They collected seven years of data from 183 sources and sorted them into 155 conditions. The numbers, which, once again, we’ve probably all heard at different times, are stunning when you look at the whole picture.

The total spending for 2013 – the last year in the study – was $2.1 trillion. The estimate for 2014 was $2.9 trillion, so Dr. Davis’ $3 trillion seems to line up well with the reports info, and it would be safe to assume that the numbers I’ve got increased proportionately.  So, pretty much every number I’ve got has likely gone up by 50%. But here are some of the things we see:

Right off the bat, “diabetes had the highest health care spending in 2013, with an estimated $101.4 billion in spending, including 57.6% spent on pharmaceuticals…”

Keep in mind, that’s more like $150 billion today. One hundred and fifty billion dollars. A year. For a “disease” that’s easily 90% treatable by just stepping away from carbs.

Heart disease – the one that Dr. Davis put himself out of business from treating by getting people to change their lifestyles vs. post factum medical treatment — was $88.1 billion, so I’m calling it $130 billion.  I’m not saying no one would ever have a heart attack if we all stopped cooking with vegetable oil and started taking an evening walk, but it wouldn’t be an industry that by itself would rank in the top quarter of the rest of the world’s GDP’s.

Plus, that $130 billion does NOT include treatment for hyperlipidemia (i.e., statins) which earns itself $52 billion ($75B?) all by itself, or high blood pressure.

Here’s some other big ticket items, almost all of which the case studies of folks in “Undoctored” either completely reversed or substantially improved – often within weeks – of making the simple changes that Dr. Davis promotes:

Blood Pressure:  $84 Billion

Back & neck pain (think largely obesity and sedentary lifestyle related, so I’m counting it): $88 Billion

Depression (think mood disorders and gut biome dysbiosis. Not considered are other “mental” health issues – ADD, bipolar, etc): $70 Billion

Dental (tooth decay, inflammation): $66 Billion

Skin conditions: $55 Billion

Alzheimers and other dementias (i.e., Type III diabetes): $36.7 Billion

The 2013 numbers for all of those come up to about $469 Billion, which scales up to over $700 Billion in today’s spending. Mostly avoidable by straightforward, understandable lifestyle modification.

Like I said, some people will still have heart attacks, or pull a back muscle, or get depressed and need some help so you don’t have a 100% savings on the table; but the largest part of these diseases are self-inflicted and self-treatable.

I also left out other categories (Osteoarthritis – $47.9B; Asthma – $32.5B; Endocrine, metabolic, and immune disorders – $19.6B; and cancers, which were disaggregated into 29 separate conditions); so there’s some pickup available from the same lifestyle changes in areas I’m not counting. The point is that nearly one quarter of our health care spending is going to conditions that we have the capability of exerting a large degree of control over. Quickly.

Preterm birth complications, BTW, ranked 73rd at just under $5 Billion, so it seems like if we could get a handle on our grain and industrial foods habit, Jimmy Kimmel’s son and my grandson shouldn’t cause too much financial discomfort to the system.

After thinking about this, I had an epiphany.

I know Tom and many others, including myself, have compared the various and sundry mandatory coverages — dictated via Obamacare and other legislated and regulatory bodies — to requiring your auto insurance provider to include free oil changes, tire rotation, tune-ups, etc.  in your policy. The point being that these are known conditions that are a routine part of automobile ownership. Inclusion in a policy would only increase overhead and incentivize over-utilization, resulting in inevitable, recurring premium increases.

We completely misrepresented the argument. It’s correct as far as it goes, but it stops so short of reality that I count it as a huge error.

Our entire medical cost reimbursement system, as currently comprised, is like requiring that all auto insurance companies include DUI coverage in your policy.

It was stupid that my health insurance covered the two or three doctor office visits for the ear infections we knew The Sons were each going to get each year when they were toddlers. Same for the bottle of pink stuff we’d pick up at the pharmacy after each visit.

But it’s insane that insurance would pay for insulin for the 90% of people who could avoid the pharmacy if they’d stop blasting their system with sugar in all its forms. Same with all those other diseases of civilization driving a quarter of our spending. We’re making it convenient and cheaper for people to engage in behavior that’s harming them.

Add in the USDA budget with its massive grain subsidies and the SNAP (food stamp) program, and it’s like after adding the DUI coverage, we then pass out free booze to the people with the worst driving records.

So what about this — I say we should remove mandated coverage of all of those lifestyle diseases – Type II diabetes, blood pressure, non-emergency heart disease treatment, etc.

Companies would be free to make them available, but they’d be add-on items to a base policy and they’d also be rateable. I’m not interested in preventing someone from purchasing diabetes “treatment” coverage with their insurance, but I don’t want to be forced to “chip in.”

Rateable means they could adjust the premium, for example, based on a periodic A1C, fasting insulin, or some other marker to account for the risk and behavior of the policy owner. Behavior instantly gets coupled to economic consequences.

So people could pay higher premiums for diabetes treatment coverage, pay out of their own pocket for drugs and medical attention, or eat more veggies and fat and cut back on the sugar. I predict immediate, dramatic changes.

I don’t see why we couldn’t reduce medical spending by half a trillion dollars, plus another $100 billion a year by driving a stake through the USDA’s heart.  Putting money aside for just a moment, can you begin to imagine the quality of life improvements people would get?

Of course, I do see why we can’t. Politics. Money. Bureaucracy. Power. The usual suspects. But that doesn’t mean it’s not technically possible or the right thing to do.

It also doesn’t mean that you can’t get started, or step up your game so that you can limit your interaction with the medical system as much as possible. Just because you have to sacrifice them your money doesn’t mean you have to sacrifice your health, too!


The Older Brother


32 thoughts on “The Older Brother Checks Under the Medical Couch Cushions, Finds a Trillion Dollars

  1. Justin Elliot McCullough

    Time to jump into politics as well Tom? I’ll volunteer hours to help educate ppl on controlling their diet. Maybe turn around TN and set an example for the rest of the US? geez…

    1. The Older Brother Post author

      Well, TN is ranked fifth nationally for its rate of diabetes, so it would be a target-rich environment (I know I keep picking on on diabetes, but it’s a co-morbidity with most of the rest of the big money lifestyle-driven medical spending categories).

      My point is that I don’t think people would need to spend much time getting educated if, all of a sudden, they’re told that the cost of drugs and medical interventions isn’t going to be “shared” with people who aren’t interested. Mac n’ Cheese is only cheaper than broccoli if insulin is “free.” They’ll figure it out.


  2. Mike

    Granted there are problems with the system, but you are off the mark on the mandates.

    It seems you do get it that health insurance is a cost sharing instrument. We all put $$ into the pool and hope that we are not the one to need them.

    To get rid of the mandates (a minimum level of coverage for essential services), and provide them a-la-carte , you place extra burdens on the consumer. To compare plans, you need serious research – and you need to predict what services you might need. Do you want coverage for cancer? Skip it to save money?

    We must remove the profit motive from health care and medicare for all – single payer is the well known way to reduce costs.

    1. The Older Brother Post author

      True insurance isn’t a “cost sharing” instrument. It’s a “risk sharing” instrument. It’s an extremely important distinction, like “cost” vs. “spending.”

      It’s to protect against major financial loss from events (house burns down, get hit by bus, baby needs a heart operation) that have reasonably well-known costs and frequency in the aggregate, but are highly unpredictable for the individual.

      Would you buy an insurance policy without cancer coverage? Me neither. Most people wouldn’t. This creates a market “mandate” for insurance companies. However, I’d love an option to leave off coverage for medical expenditures that can be “treated” via lifestyle modification in return for knocking a quarter off my premium. Or perhaps have premium discounts available for things like maintaining my fasting glucose and blood sugar levels within a certain range.

      I am amazed at how appealing the idea of removing the “innovation motive,” or the “find a way to do the same thing cheaper motive,” or the “find a way to do it better for the same cost motive,” or the “create a disruptive idea that will improve people’s lives in ways they never imagined motive” is to people.

      That’s the only way you generate those evil profits in a market economy. Naturally, none of those are needed to generate obscene amounts of income if you can get government to step in to throttle competition, pick winners and losers, and guarantee profits to incumbents. There’s going to be “profits” either way. I prefer having consumers determine who is profitable through their personal decisions. I’m also not sure how you’re going to get a doctor or other medical care once you tell all of them that they’re working for free.

      Single payer is the well known way to reduce spending. If you can’t get a pediatric heart operation because there are no doctors, or dialysis because you’re over 70, or die from cancer because you’ve been on a waiting list for 6 months, well, they’ve certainly showed us how to reduce spending. If you do it my way, though, our spending drops down under 13% of GDP. Still a couple percent over what Canada spends, but this way comes with actual medical services when you need them.


      1. Brandon

        What do you think about going more in the direction of a reward-based system? You used the example of a premium discount for maintaining fasting glucose. What about other things like bi-yearly rewards for not taking antibiotics, meeting other metabolic indicators like blood pressure. Some insurance companies offer very modest “incentives” for using step trackers and such, maybe this could be expanded on (rebates based on 5k times, exercise minutes per week, etc.). Do you think more of this would motivate people to seek improvements or maintain health with reduced pharmaceutical intervention? If it’s a reward-based system, then it may not seem like people are being “punished” for having to pay more for comprehensive coverage at the front end, cause everyone would pay for that but then offer opportunities to substantially reduce the cost by meeting certain goals. Might this motivate individuals to avoid asking for an antibiotic every time they have a sniffle, or seek out a physician that will help them get off insulin to treat their Type II diabetes?

        1. The Older Brother Post author

          What I’d really like to see is to turn the insurance companies loose into a competitive marketplace. Given the ability to innovate with ideas such as my and your examples would certainly get things moving.

          It’s a fairly safe bet that innovations like these wouldn’t be the ones that result in the biggest health gains/cost savings — they’d be “discovered” by someone trying things in the market. Most likely by a new or small player. It’s also a dead sure bet that the insurance industry Bigs would be the biggest opponents of such an approach.

          I think if you simply allowed insurance companies to sell people the coverage they wanted, being able to buy a policy without prophylactic antibiotic or metabolic medication coverage would be plenty of motivation for most people.

          The Older Brother

    2. Lori Miller

      The minimum level of coverage for essential services in the state of Colorado was part of the reason I was uninsured for part of my 20s. I had major medical before Colorado regulated it out of existence; after they mandated a gaggle of benefits, COBRA was $300 per month. Being laid off and doing low-paying temp work, I couldn’t afford it. Had I been forced to buy health insurance at that price, I’d have lost my house. But hey, I’d have had all the mammograms and maternity care that a happily childless, 28-year-old woman could ask for.

  3. Beatrix Willius

    What I don’t get is why the hospital costs are so high in the US. 300.000 bucks is for how many months in hospital? Here in Germany we don’t see the original costs. I only know that a hospital bed costs about 1000 Euros a night and we pay 10 Euros. This excludes the doctors and ICU.

    I like the idea of excluding diabetes et al from the coverage of health insurance.

    1. The Older Brother Post author

      I didn’t write that as clearly as I should have. The $300,000 included the surgery and care The Oldest Grandson received while at the pediatric facility. It was, I believe, well over a month in intensive care. It didn’t include charges for transport, ongoing care, the initial delivery at the Springfield hospital, and others.

      Part of why it costs so much is the structure of our third-party payer system. No one really cares — especially in a critical situation — what something is going to cost. Even things that can be addressed at one’s relative leisure — say a routine colonoscopy — it doesn’t matter “what it costs.” The cost to the person is going to be their $100 copay or whatever their deal is. The fact that it’s probably an employer-provided policy reinforces the idea that it’s “free,” especially since there is no tax consequence to me.


  4. Kathy in OK

    Man, I’ve missed you. Tom tells it like it is, gently. You do it with a sharp stick and I like it!

    I’ve read Undoctored and now I’m on my way through it a second time. My systolic blood pressure (which has always been drug-resistant) has dropped an astounding 30-40 points in a week. I’ll save the price of the book on one Rx refill that I won’t be getting.

    My biggest problem is keeping my mouth shut around desperately unhealthy relatives.

    1. The Older Brother Post author

      The funny thing is, I usually feel I’m being circumspect when I write these. But when I look back in 6 months, I think, “oops, let Bad Jerry out again!”

      Congratulations on the terrific health improvement. Just think if we could get the other 74,999,999 Americans with hypertension to get it under control and either completely drop or greatly reduce the $84 billion (2013 dollars) the JAMA study detailed we spend each year. Hey, even if it took TWO weeks we’d still be in pretty good shape.

      After being a libertarian for years, I’d already become used to people avoiding eye contact and trying not to engage me in conversation way before Tom introduced me to the Bizarro World that is our nutrition and medical care system.

      The Older Brother

  5. Firebird7478

    Here is a nice lecture on blood pressure. Over the course of 20 years they have moved the goal posts several times regarding what “normal” blood pressure is.

  6. Mike

    You are proposing a model where consumers will need a wish list of diseases they might get and advanced knowledge of the risks and consequences of literally millions of adverse medical events.

    And a lawyer to review the agreement.

    Is that what you are proposing?

    1. The Older Brother Post author

      Of course not. I’m proposing that consumers be allowed to enter the market as free adults and select products offered by insurance companies whose filthy greed for profits forces them to compete by offering risk products that I feel best suit my needs.

      Perhaps They would offer a checkbox declining coverage for metabolic disorders, for example, with a reduced rate. Just like I can decline flood insurance now on my homeowners’ policy. Somehow, I was able to complete that transaction without thousands of pages of paperwork or hundreds of lawyers — that would be Obamacare. I also had nothing but quick and fair claims processing when I had an unfortunate incident with a turkey fryer.

      There were 155 categories of medical care in the JAMA study, most of which could be consolidated into a couple dozen supergroups. Probably half of the line items would be included in any base policy. Offering an option to opt out using the rest as a checklist, I’m sure I’d decline at least 1/2 of them, and most other people would, too. Sorry, kids, no more “free birth control”. But hey, I’m not signing up for the viagra coverage, either.


  7. Gerard Pinzone

    The analogy between health insurance and auto insurance also has another major difference: what to do for those who refuse to change their lifestyle? Do you simply refuse to cover those people who practice proper behavior? I doubt anyone would balk at a driver who constantly gets DUI’s from being denied access to an automobile and auto insurance. Are we as a society willing to do the same when a person who is a type 2 diabetic continues to consume sugar and refined carbs? What of their children who grow up and become sick due to their parent’s behavior? Do they get a pass or do we deny them healthcare they cannot afford, too?

    1. The Older Brother Post author

      Yes. I do. I have no problem with anyone consuming as much sugar, grain, industrial food, etc. as they’d like. But why should I be forced to subsidize that any more than having to have DUI coverage built into my auto premium? What’s the difference? Both behaviors are free-will decisions to engage in behavior with predictable adverse outcomes.

      What kind of crap parent keeps feeding a kid sugar if they’re already metabolically trashed? What kind of “compassion” is it to insist we spend thousands of other people’s dollars to buy the kid metformin or insulin, instead of broccoli and some bacon?

      I’m also ready for some kind of corollary to Godwin’s Law, where bringing up “the children” as an excuse to do something entirely senseless automatically forfeits the argument.


    2. Lori Miller

      What about the children? If Bill Gates (and other philanthropists) can send their money to Africa, they can send it to eastern Kentucky, where kids’ adult teeth are rotted from drinking a six-pack of Mountain Dew a day. And still keep drinking it. If you want to send your money there, too, that is very nice of you.

  8. JR62

    I think the biggest problem in your proposed system is that those who now are at getting side the trillion dollars won’t give up those. Trillions dollars has so much power that nothing will stop it. Not until the dollar flood itself dries.

    1. The Older Brother Post author

      Currently, most of those trillions get funneled through a few agency “gatekeepers” nationally, with a couple of agencies also in each state. The power isn’t in the total dollars, the power is in being able to concentrate control of access and decisions for millions of people.

      Those on the “getting side” understand that completely. Make for some great meals, fact-finding trips, and lucrative future consulting and employment opportunities for those on the “deciding side.”

      I’m not saying an outbreak of freedom is likely. I’m just saying it’s the only thing that would actually work.

      The Older Brother

    1. The Older Brother Post author

      An epi competitor is out now with a pair for around a hundred bucks, maybe less with a coupon. Their stock had crashed and burned 50% from two years ago and is at the same price as 4 years ago, while the S&P is up 50%.

      Lesson: Don’t screw your customers. The Market will screw you back.

      Shkreli developed a business where he would buy small companies with off-patent drugs that had very small markets. Then he jacked the price up exponentially. He didn’t have to worry about competition because the costs of getting through the regulatory system were too exhorbitant to make it worthwhile. If you sell 5 pills a year that cost 15 cents to produce, but it cost $100 million to get a new drug approved, you can charge anything up to $20 million per pill.

      Lesson #1: If you DO want to screw your customers, do it in a highly regulated environment where The Market has a hard time reaching your sorry a$$.

      He did this with several drugs, one of which was part of an AIDS treatment protocol.

      Lesson #2: If you do want to screw your customers, DO NOT screw with the AIDS lobby, regardless of Lesson #1. Just Sayin’.

      After Big PhRMA, in a case of 100% unadultured hypocrisy, decided to pile on, he started a web site detailing the exact same types of gouging all the Bigs routinely engage in using similar regulatory and patent manipulation. On then being subpoenaed by Congress for the only function they perform well — sanctimonious Kabuki theatre In favor of the special interests they represent — he took the fifth, then tweeted “Hard to accept that these imbeciles represent the people in our government.” He has naturally been arrested by the F — “what server?” — BI for securities fraud.

      Lesson #3 If you want to screw your customers and operate away from the market, you better play ball with the Big Boys or you’re going to get the bat shoved up your a$$. And they’ve got some pretty big bats.

      That’s what I got. You?


      1. Thomas E.

        A complete tangent, but that is where VW made their huge mistake with the diesel debacle. If VW immediately admitted that they screwed up in the USA, went to congress and took their beating, and offered up emission equivalents exceed their screw up by a reasonable amount, they would have gotten a slap on the wrist.

        Emission equivalents, well there are still dozens of cement factories and probably 100’s of coal power plants in the US that each spew out a comparable amount of particulates into the air as the entire VW diesel-gate issue. VW could have spent a billion or so on a scrubber here, scrubber there, new stack here, and so on, and thus reducing nation wide particulate emissions.

        But VW did not, they fought the system, the system won, to the tune of what, $16B or more?

        1. The Older Brother Post author

          I think they took a permanent hit to their reputation.

          The irony is that all of the corporate chicanery was done to support an image of a sweet, innocent, earth-loving company. The cars are well built, run well, and get great mileage. Their customers still felt justifiably betrayed because part of what they thought they were buying was a certain level of tree-hugging sanctity.

          I agree that they then completely blew the follow-through. Apparently, once you start getting paid more than a couple million dollars a year, you have some kind of ethical lobotomy and they replace that part of your brain with the same playbook. See “United Airlines,” et. al.

          The Older Brother

          1. Walter

            That ethical lobotomy probably is a requirement in most companies for getting a salary that large or is given in other ways such as stock options so that you have to sodomize the public with a pine cone to collect.

      2. Mike

        My take is that, ungoverned, the “big whatever’s” will take everything they can get. How much is your life worth? You grandsons?

        I want a government to protect the people from the “big whatever’s” abuse.

        But our government is rapidly becoming a fascist one (the merger of state and corporations).

        Before that our government changed from a government “for the people” to a government corrupted by, and in service to the billionaires.

        I hope we can reverse that, but we have to stop worshiping greed first.

        1. The Older Brother Post author

          No. We have to stop worshipping government first. The government is the source of all The Bigs’ power.

          The Older Brother

  9. Mike

    Here is why we should have universal health care in two simple examples.

    Don’t you want the people who prepare and serve your food to be healthy (to have access health care and to sick days)?

    If there were ever an epidemic, a pandemic or even some bio attack, don’t we want a health care infrastructure that can meet the challenge? Right now, we have an infrastructure sized to suit the population that can pay.


    1. The Older Brother Post author

      That’s your best argument then? — we need to have a massive, fascist bureaucracy dictate the medical system so no one will sneeze on my pork chop? The Wife and I are quite capable of preparing and serving our own food, so apparently we have options I didn’t realize most of the population lacked. Like not patronizing establishments with sick employees. Wonder how we’ve stayed alive this long with all of those diseased restaurant workers out there.

      I have to admit, handing over the entire already bloated medical establishment to Nancy Pelosi, Paul Ryan, Donald Trump, Chucky Schumer, etc. to run just in case of a pandemic outbreak is one of the more, umm, unique justifications I’ve heard.

      I guess that way we could handle an outbreak with the same efficiency as the CDC handled the Ebola instances here, right? Remember that one — first “The Experts” told us it couldn’t hit the U.S. (lie); then they said it wouldn’t spread in the general population (lie); then they said they’d issued fail-safe medical protocols so it could be safely treated with local medical staff (lie); then when some nurses contracted it they said the nurses hadn’t followed the protocols (lie).

      Yeah, still gonna go with a nice tall glass of NOPE on that.


  10. Leif Terry

    I think most of this makes a lot of sense but you’ve completely lost me with the analogy about car maintenance.

    Seems to me that offering free oil changes would drastically lower the overall cost of maintaining automobiles. Even if there were “over-utilization”, i.e. if somehow, for some reason, folks were getting more oil changes that they needed, you would likely come out way ahead. Oil changes cost tens of dollars; replacing an engine costs thousands.

    I think that is true for healthcare as well – preventative care is relatively cheap; treating chronic disease is costly and painful.

    1. Tom Naughton

      I’m sure The Older Brother will have a reply of his own, but I can tell you absolutely, positively that if oil changes appeared “free” because they were covered by insurance, two things would happen: 1) some people would decide they need an oil change every two weeks, just to be sure, and 2) the price of an oil change would soon reach $200 … but nobody would pay attention or care very much, because it’s “free” after all.

      I loved my maternal grandmother, but once she went on Medicare and everything was “free,” she ran to the doctor every time she got a sniffle. That wasn’t preventing an expensive chronic disease; it was just a waste of taxpayer dollars.

      The one area of health care where prices have actually gone down is elective procedures: plastic surgery, getting your vision corrected, etc., etc. Totally against the trend of prices increasing by double digits each year. That’s because elective procedures don’t appear “free” to the consumer, so everyone cares about prices … the consumers of course, and the doctors offering the services, because they now have to attract and compete for consumers.


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