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