Author Topic: Avoidable Health Care Costs  (Read 17740 times)

geekette

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Re: Avoidable Health Care Costs
« Reply #50 on: May 04, 2015, 08:41:14 PM »
And for all those who like to play the blame game, this...well, it won't change your mind because of conformation bias.  But here it is anyway:  Why diets don't work

Using your head rather than hands is where the big money is now.  The first of those was probably the stereotypical rotund banker in Monopoly.  Food's too available, too easy, too cheap.  On the one hand, society cheers labor saving devices, and then turns around and charges for access to a place to exercise. 

Is it the western diet? or the western jobs that we're exporting (along with obesity).

grantmeaname

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Re: Avoidable Health Care Costs
« Reply #51 on: May 04, 2015, 10:05:56 PM »
I get the feeling there are a lot of young people posting on this thread who have not yet had much experience of aging. There are genetic predispositions that don't show themselves until later in life. There is the wear and tear of normal living--which includes the wear on your joints from healthy exercise. There is the unavoidable fact that most of us live in places with some air and water pollution, which we cannot control as easily as we can control what we eat. There is plain old bad luck--you can eat right and exercise and everything and be struck down in your 30s by breast cancer or in your 50s by a sudden, unanticipated stroke.
I think it's a valid point that even the environmental contributors to chronic disease are not all lifestyle choices and that even some of the ones that are lifestyle choices are things like where to live rather than the 'sins' that people look down their noses at. But I don't see what age has to do with it - several people have already said as much to this point in the thread. And no age group escapes chronic disease; Gin1984 is just a couple years older than I am, and I'm 22 with a chronic disease I was born with and plenty of appreciation for wear and tear on joints. You can't blame a cavalier attitude towards chronic illness on age and inexperience.

Gin1984

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Re: Avoidable Health Care Costs
« Reply #52 on: May 04, 2015, 10:09:27 PM »
I get the feeling there are a lot of young people posting on this thread who have not yet had much experience of aging. There are genetic predispositions that don't show themselves until later in life. There is the wear and tear of normal living--which includes the wear on your joints from healthy exercise. There is the unavoidable fact that most of us live in places with some air and water pollution, which we cannot control as easily as we can control what we eat. There is plain old bad luck--you can eat right and exercise and everything and be struck down in your 30s by breast cancer or in your 50s by a sudden, unanticipated stroke.
I think it's a valid point that even the environmental contributors to chronic disease are not all lifestyle choices and that even some of the ones that are lifestyle choices are things like where to live rather than the 'sins' that people look down their noses at. But I don't see what age has to do with it - several people have already said as much to this point in the thread. And no age group escapes chronic disease; Gin1984 is just a couple years older than I am, and I'm 22 with a chronic disease I was born with and plenty of appreciation for wear and tear on joints. You can't blame a cavalier attitude towards chronic illness on age and inexperience.
Oh aren't you a sweetheart?  ;)

grantmeaname

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Re: Avoidable Health Care Costs
« Reply #53 on: May 05, 2015, 05:44:10 AM »
Oh are you actually 1984 years old?

goatmom

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Re: Avoidable Health Care Costs
« Reply #54 on: May 05, 2015, 07:28:16 AM »
Well, I don't have any fixed numbers but from working in health care I can tell you that I think MMM is probably about right on target.  Clinic are filled with people with Type II diabetes that don't eat right and don't exercise, people with HTN that smoke, people that drink too much, people that sit too much (me probably included).  Then studies show (again- don't have the numbers) that many people never even pick up the prescriptions the doctors write and of those that do there are some that don't finish taking them.  People don't follow up on tests.  People don't get lab work done.  People don't get recommended vaccinations and screenings.  People drive too fast, text and drive, share meds, steal meds, unsafe sex, etc. 

This doesn't mean that if you have a chronic illness it is your fault.  Or your kid's fault.  Sometimes it just happens.  Or just bad luck of genetics.  But I think probably about 50 percent of the time (at least) the person sitting in front of me bears some of the responsibility for the health problems they have.


Mr. Green

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Re: Avoidable Health Care Costs
« Reply #55 on: May 05, 2015, 08:37:22 AM »
It's obvious. If you want some report to give you some numbers to verify his statement, good luck with that because there are lots of companies that have their money on the line for you to continue eating High Fructose Corn Syrup and doing other things that are bad for your health. And they spend money on politics. It's doesn't take a genius to just look around you and know that his statement is true. I would argue that what he says is such an understatement that asking for evidence is blatantly unnecessary.

Bob W

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Re: Avoidable Health Care Costs
« Reply #56 on: May 05, 2015, 09:01:58 AM »
I'm not a doctor but ---

I was a public health administrator for several years.  Our target health issues were unplanned pregnancies,  obesity, healthy diets,  drugs, alcohol, smoking, exercise and oral health.   All categories were what I consider Behavioral Health.   So yeah,  pretty much avoidable.

Some of the big ones that are considered standard of care practice in the U.S.  are heart surgery and heart procedures (statistically a massive fail),  statin medications ( a marketing ploy that generally does not extend life).

For most folks with high blood pressure and diabetes these can be reversed by going to a whole foods, non grain diet and losing weight.

So yeah,  living a healthy lifestyle that includes plenty of whole foods and exercise goes a long way.    The obesity epidemic is pretty much killing people. 

This is not to say that a person that checks off all the healthy living boxes will not become very ill.   It is just that in general they will live a fuller and longer life than their couch potato, potato chip chomping contemporaries. 

forummm

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Re: Avoidable Health Care Costs
« Reply #57 on: May 05, 2015, 11:24:22 AM »
Quote
You cannot avoid nor treat mood disorders by exercise.  I seriously would like you to show one citation.  Not that in addition to treatment, exercise is good, but that mood disorders can be avoided or treated that way.  My professors would love to know that, you know those who are studying diseases in the brain and sure don't seem to think this.

I can say from personal experience that exercise absolutely has a effect on my depression symptoms.  Every doctor that I've seen have told me to exercise more as part of my treatment.  In fact, I have been able to get off my medication completely when my physical activity is at a high enough level.  Unfortunately for me, that level isn't sustainable, but I have been able to lower my medication dosage with a sustainable level of exercise. 

Exercise isn't going to have an effect on all mood disorders, or even for all people with the same disorder.  Harvard Medical School seems to think that exercise has a place in a depression treatment program: http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt

+1. Exercise is really important for mood. It's associated with improved outcomes overall--even just simple walking.

forummm

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Re: Avoidable Health Care Costs
« Reply #58 on: May 05, 2015, 11:26:18 AM »
All the people I happen to know with asthma are thin, eat healthy & exercise, never smoked etc. HOw is this there fault?  My son was diagnosed with asthma at the age of 1. I guess it was his fault.

Other than exposure to tobacco or other pollutants, we don't know what causes a lot of asthma. I don't think people blame non-tobacco using asthma sufferers for their health condition.

forummm

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Re: Avoidable Health Care Costs
« Reply #59 on: May 05, 2015, 11:31:42 AM »
I get the feeling there are a lot of young people posting on this thread who have not yet had much experience of aging. There are genetic predispositions that don't show themselves until later in life. There is the wear and tear of normal living--which includes the wear on your joints from healthy exercise.

Actually, sustained moderate exercise throughout life can help maintain healthy joints. Your body responds to moderate stressors by strengthening the affected areas. This is why astronauts spending time on the space station have to keep up certain kinds of resistance-based exercise while in orbit otherwise their bones will literally get less strong. Resistance-based exercise on Earth is helpful for maintaining bone health and preventing osteoporosis. Now if you sit around all the time and age, your joints will age and deteriorate as well. And there is some aging you can't prevent, but I have known quite a few older folks who stayed active their whole lives and were able to keep pretty healthy.

Bob W

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Re: Avoidable Health Care Costs
« Reply #60 on: May 05, 2015, 11:46:02 AM »
I get the feeling there are a lot of young people posting on this thread who have not yet had much experience of aging. There are genetic predispositions that don't show themselves until later in life. There is the wear and tear of normal living--which includes the wear on your joints from healthy exercise.

Actually, sustained moderate exercise throughout life can help maintain healthy joints. Your body responds to moderate stressors by strengthening the affected areas. This is why astronauts spending time on the space station have to keep up certain kinds of resistance-based exercise while in orbit otherwise their bones will literally get less strong. Resistance-based exercise on Earth is helpful for maintaining bone health and preventing osteoporosis. Now if you sit around all the time and age, your joints will age and deteriorate as well. And there is some aging you can't prevent, but I have known quite a few older folks who stayed active their whole lives and were able to keep pretty healthy.

Yes,  I've seen information that muscles can atrophy at the amazing rate of 10 - 15% per week and even faster in older folks. 
http://physical-therapy.advanceweb.com/Article/Bed-rest-can-set-off-a-chain-of-complications.aspx

forummm

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Re: Avoidable Health Care Costs
« Reply #61 on: May 05, 2015, 11:47:59 AM »
And for all those who like to play the blame game, this...well, it won't change your mind because of conformation bias.  But here it is anyway:  Why diets don't work

Using your head rather than hands is where the big money is now.  The first of those was probably the stereotypical rotund banker in Monopoly.  Food's too available, too easy, too cheap.  On the one hand, society cheers labor saving devices, and then turns around and charges for access to a place to exercise. 

Is it the western diet? or the western jobs that we're exporting (along with obesity).

Like nearly everything in the popular culture about diet, this article gets it wrong. The "calories in, calories out" model isn't how the body actually works. There are a variety of complicated hormone responses to the kinds of foods you eat, not just the quantity. If you eat a bunch of sugar or refined carbs, your corresponding blood sugar spike will trigger an insulin spike, and insulin triggers the fat in your fat cells to stay locked up and for the sugar to get turned into fat quickly and for you to get hungrier more quickly because your muscle cells aren't getting fuel. If you consistently inject mice with insulin they will literally starve to death while getting more and more obese. I don't 100% agree with everything Taubes says, but a good book (and quick read) on this topic is Why We Get Fat. He goes a bit to far on eliminating all carbs. Most people can handle non-refined carbs in reasonable amounts just fine (for example, nearly everyone in Asia lived on rice for centuries, until our western diet got there).

So diets (as we normally do them) don't work because you're sending the wrong signals to your body. If you eat more fat and less sugar/refined carbs and reasonable meal sizes, you will get less hungry and feel better. Protein is important too.

forummm

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Re: Avoidable Health Care Costs
« Reply #62 on: May 05, 2015, 11:57:24 AM »
...
statin medications ( a marketing ploy that generally does not extend life).

For most folks with high blood pressure and diabetes these can be reversed by going to a whole foods, non grain diet and losing weight.

So yeah,  living a healthy lifestyle that includes plenty of whole foods and exercise goes a long way.    The obesity epidemic is pretty much killing people. 

This is not to say that a person that checks off all the healthy living boxes will not become very ill.   It is just that in general they will live a fuller and longer life than their couch potato, potato chip chomping contemporaries.
+1
Statins are the wrong treatment. You can have a high cholesterol because of genetics. But most people with high cholesterol get it from eating refined carbohydrates. You actually do not get a high cholesterol from eating reasonable amounts of food that have cholesterol in them. If you eat at McDonalds, your blood cholesterol goes up from eating the bun and the fries, and has no response to the beef. You can eat 6 eggs every morning and be fine. But not Coke! This was another inexplicable misinformation spread by people who should know better. I saw a poster in a physician's office recently with this fallacy on it. Even the USDA's new dietary guidelines have just finally admitted that dietary cholesterol has no role in blood cholesterol. Fixing your diet is more important than statins.

Hypertension, diabetes, and obesity can all be reversed by better diet--even without exercise, and even while eating the same number of calories.

Gin1984

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Re: Avoidable Health Care Costs
« Reply #63 on: May 05, 2015, 12:10:14 PM »
Oh are you actually 1984 years old?
LOL, nah but telling a 30 year old woman she is only a couple years old than 22 is bound to get you some sweatheart points.  :D

Gin1984

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Re: Avoidable Health Care Costs
« Reply #64 on: May 05, 2015, 12:11:08 PM »
...
statin medications ( a marketing ploy that generally does not extend life).

For most folks with high blood pressure and diabetes these can be reversed by going to a whole foods, non grain diet and losing weight.

So yeah,  living a healthy lifestyle that includes plenty of whole foods and exercise goes a long way.    The obesity epidemic is pretty much killing people. 

This is not to say that a person that checks off all the healthy living boxes will not become very ill.   It is just that in general they will live a fuller and longer life than their couch potato, potato chip chomping contemporaries.
+1
Statins are the wrong treatment. You can have a high cholesterol because of genetics. But most people with high cholesterol get it from eating refined carbohydrates. You actually do not get a high cholesterol from eating reasonable amounts of food that have cholesterol in them. If you eat at McDonalds, your blood cholesterol goes up from eating the bun and the fries, and has no response to the beef. You can eat 6 eggs every morning and be fine. But not Coke! This was another inexplicable misinformation spread by people who should know better. I saw a poster in a physician's office recently with this fallacy on it. Even the USDA's new dietary guidelines have just finally admitted that dietary cholesterol has no role in blood cholesterol. Fixing your diet is more important than statins.

Hypertension, diabetes, and obesity can all be reversed by better diet--even without exercise, and even while eating the same number of calories.
Some diabetes. 

beltim

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Re: Avoidable Health Care Costs
« Reply #65 on: May 05, 2015, 12:19:53 PM »
...
statin medications ( a marketing ploy that generally does not extend life).

For most folks with high blood pressure and diabetes these can be reversed by going to a whole foods, non grain diet and losing weight.

So yeah,  living a healthy lifestyle that includes plenty of whole foods and exercise goes a long way.    The obesity epidemic is pretty much killing people. 

This is not to say that a person that checks off all the healthy living boxes will not become very ill.   It is just that in general they will live a fuller and longer life than their couch potato, potato chip chomping contemporaries.
+1
Statins are the wrong treatment. You can have a high cholesterol because of genetics. But most people with high cholesterol get it from eating refined carbohydrates. You actually do not get a high cholesterol from eating reasonable amounts of food that have cholesterol in them. If you eat at McDonalds, your blood cholesterol goes up from eating the bun and the fries, and has no response to the beef. You can eat 6 eggs every morning and be fine. But not Coke! This was another inexplicable misinformation spread by people who should know better. I saw a poster in a physician's office recently with this fallacy on it. Even the USDA's new dietary guidelines have just finally admitted that dietary cholesterol has no role in blood cholesterol. Fixing your diet is more important than statins.

Hypertension, diabetes, and obesity can all be reversed by better diet--even without exercise, and even while eating the same number of calories.

I thought that the body made cholesterol from saturated fats, not carbohydrates.  Do you have a reference for this?

beltim

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Re: Avoidable Health Care Costs
« Reply #66 on: May 05, 2015, 12:25:47 PM »
And for all those who like to play the blame game, this...well, it won't change your mind because of conformation bias.  But here it is anyway:  Why diets don't work

Using your head rather than hands is where the big money is now.  The first of those was probably the stereotypical rotund banker in Monopoly.  Food's too available, too easy, too cheap.  On the one hand, society cheers labor saving devices, and then turns around and charges for access to a place to exercise. 

Is it the western diet? or the western jobs that we're exporting (along with obesity).

Like nearly everything in the popular culture about diet, this article gets it wrong. The "calories in, calories out" model isn't how the body actually works. There are a variety of complicated hormone responses to the kinds of foods you eat, not just the quantity. If you eat a bunch of sugar or refined carbs, your corresponding blood sugar spike will trigger an insulin spike, and insulin triggers the fat in your fat cells to stay locked up and for the sugar to get turned into fat quickly and for you to get hungrier more quickly because your muscle cells aren't getting fuel. If you consistently inject mice with insulin they will literally starve to death while getting more and more obese. I don't 100% agree with everything Taubes says, but a good book (and quick read) on this topic is Why We Get Fat. He goes a bit to far on eliminating all carbs. Most people can handle non-refined carbs in reasonable amounts just fine (for example, nearly everyone in Asia lived on rice for centuries, until our western diet got there).

So diets (as we normally do them) don't work because you're sending the wrong signals to your body. If you eat more fat and less sugar/refined carbs and reasonable meal sizes, you will get less hungry and feel better. Protein is important too.

Having read the article and your comment, I don't think what you said contradicts the article at all.

beltim

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Re: Avoidable Health Care Costs
« Reply #67 on: May 05, 2015, 12:44:37 PM »
It's obvious. If you want some report to give you some numbers to verify his statement, good luck with that because there are lots of companies that have their money on the line for you to continue eating High Fructose Corn Syrup and doing other things that are bad for your health. And they spend money on politics.

And there aren't companies that have an interest in saving health care costs?  Even using a 25% number, the potential savings for the government, health care companies, and individuals is $725 BILLION every year, or over $2,300 per person per year.

No company with a vested interest in selling unhealthy products can come anywhere close to that.

forummm

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Re: Avoidable Health Care Costs
« Reply #68 on: May 05, 2015, 12:55:42 PM »
...
statin medications ( a marketing ploy that generally does not extend life).

For most folks with high blood pressure and diabetes these can be reversed by going to a whole foods, non grain diet and losing weight.

So yeah,  living a healthy lifestyle that includes plenty of whole foods and exercise goes a long way.    The obesity epidemic is pretty much killing people. 

This is not to say that a person that checks off all the healthy living boxes will not become very ill.   It is just that in general they will live a fuller and longer life than their couch potato, potato chip chomping contemporaries.
+1
Statins are the wrong treatment. You can have a high cholesterol because of genetics. But most people with high cholesterol get it from eating refined carbohydrates. You actually do not get a high cholesterol from eating reasonable amounts of food that have cholesterol in them. If you eat at McDonalds, your blood cholesterol goes up from eating the bun and the fries, and has no response to the beef. You can eat 6 eggs every morning and be fine. But not Coke! This was another inexplicable misinformation spread by people who should know better. I saw a poster in a physician's office recently with this fallacy on it. Even the USDA's new dietary guidelines have just finally admitted that dietary cholesterol has no role in blood cholesterol. Fixing your diet is more important than statins.

Hypertension, diabetes, and obesity can all be reversed by better diet--even without exercise, and even while eating the same number of calories.
Some diabetes.

Yes, type II.

forummm

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Re: Avoidable Health Care Costs
« Reply #69 on: May 05, 2015, 01:50:58 PM »
It's obvious. If you want some report to give you some numbers to verify his statement, good luck with that because there are lots of companies that have their money on the line for you to continue eating High Fructose Corn Syrup and doing other things that are bad for your health. And they spend money on politics.

And there aren't companies that have an interest in saving health care costs?  Even using a 25% number, the potential savings for the government, health care companies, and individuals is $725 BILLION every year, or over $2,300 per person per year.

No company with a vested interest in selling unhealthy products can come anywhere close to that.

Not really. The incentives are generally the other direction. Big agriculture and food processors and distributors profit by shoveling food into us. Pharma profits by selling us drugs to combat the effects of the diseases. TV news is paid for by ads from Coke, McDonalds, and pharma, so they don't want to upset that gravy train. Doctors and hospitals profit by providing more and more services to combat the effects of the diseases--their incentive is for you to get sicker! How perverse right? Insurance companies are just pass-throughs for the cash coming from the people who purchase the policies. And insurance companies actually make more money when healthcare costs go up because profits are generally a percent of premium dollars. Employers have an incentive to lower costs because they are the ones footing a lot of the bill, but employers are a diffuse bunch and are focused on whatever business they are in and not on changing the monstrous health system. Government is the biggest single payer, but anytime government tries to pay less for something, the lobbyists for that industry march over to the politicians that they bought with campaign contributions and get them to put a stop to it. There's a reason why Medicare is forbidden by law from negotiating prescription drug prices with manufacturers. It's totally insanity, and a gift to pharma's profits at taxpayer expense. Remember that our wasted spending on healthcare is a bunch of people's income and profit, and they will fight to defend it.

The politics on the issue are so bad, that Obama didn't even try to get much cost control into the ACA. There's a small amount, but not too much. He immediately had to cut deals with AHIP, PhARMA, and AHA to get them to not kill the whole thing--and even then they bitched and moaned about it (while watching their stock price soar because it meant so much more profit for them). If the Republicans really cared about anything other than lining the pockets of their rich donors (and Democrats aren't much better--they suckle at the teat of campaign cash too), they could have put a lot of great cost control into the bill. But they decided to fight it as though it were the antichrist for pure political reasons. It's very similar to the Heritage Foundation, Orrin Hatch, Bob Dole plan from the 90's (and Romney's plan from '05). They refused to let anything in about allowing people to make informed decisions about what they want to do at the end of life (DEATH PANELS!!!!). They refused to allow (not just fund, but allow) any research that would let us see which treatments actually work compared to others and whether that provides any good value.

So I'm not especially hopeful. Some of the ACA stuff is good and may continue to slow the growth of costs. But what we really need is a transformational shift where costs start to drop 5 or 10% per year instead of just increasing less rapidly.

beltim

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Re: Avoidable Health Care Costs
« Reply #70 on: May 05, 2015, 02:02:42 PM »
It's obvious. If you want some report to give you some numbers to verify his statement, good luck with that because there are lots of companies that have their money on the line for you to continue eating High Fructose Corn Syrup and doing other things that are bad for your health. And they spend money on politics.

And there aren't companies that have an interest in saving health care costs?  Even using a 25% number, the potential savings for the government, health care companies, and individuals is $725 BILLION every year, or over $2,300 per person per year.

No company with a vested interest in selling unhealthy products can come anywhere close to that.

Not really. The incentives are generally the other direction. Big agriculture and food processors and distributors profit by shoveling food into us. Pharma profits by selling us drugs to combat the effects of the diseases. TV news is paid for by ads from Coke, McDonalds, and pharma, so they don't want to upset that gravy train. Doctors and hospitals profit by providing more and more services to combat the effects of the diseases--their incentive is for you to get sicker! How perverse right? Insurance companies are just pass-throughs for the cash coming from the people who purchase the policies. And insurance companies actually make more money when healthcare costs go up because profits are generally a percent of premium dollars.

The total profits of the groups you mentioned total around $110 billion (84 from pharma, 8.6 billion from Coke, 4.7 billion from McDonalds, 12 billion from health insurance companies).  Much of those are worldwide profits, not just isolated to the US.

So no, $110 billion in industry profits isn't going to measure up to $725 billion in savings.

http://healthcareforamericanow.org/2013/04/08/pharma-711-billion-profits-price-gouging-seniors/
http://assets.coca-colacompany.com/2b/b7/ae8656a5414cbead4aa741b08d92/coca-cola-fourth-quarter-and-full-year-2013-results.pdf
http://news.mcdonalds.com/Corporate/Press-Releases/Financial-Release?xmlreleaseid=123060
http://opinionator.blogs.nytimes.com/2011/11/03/less-than-26-billion-dont-bother/?_r=0

Edit: These data also discuss ALL profits, not just those related to unhealthy products.
« Last Edit: May 05, 2015, 02:10:07 PM by beltim »

beltim

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Re: Avoidable Health Care Costs
« Reply #71 on: May 05, 2015, 02:08:28 PM »
The politics on the issue are so bad, that Obama didn't even try to get much cost control into the ACA. There's a small amount, but not too much. He immediately had to cut deals with AHIP, PhARMA, and AHA to get them to not kill the whole thing--and even then they bitched and moaned about it (while watching their stock price soar because it meant so much more profit for them). If the Republicans really cared about anything other than lining the pockets of their rich donors (and Democrats aren't much better--they suckle at the teat of campaign cash too), they could have put a lot of great cost control into the bill. But they decided to fight it as though it were the antichrist for pure political reasons. It's very similar to the Heritage Foundation, Orrin Hatch, Bob Dole plan from the 90's (and Romney's plan from '05). They refused to let anything in about allowing people to make informed decisions about what they want to do at the end of life (DEATH PANELS!!!!). They refused to allow (not just fund, but allow) any research that would let us see which treatments actually work compared to others and whether that provides any good value.

So I'm not especially hopeful. Some of the ACA stuff is good and may continue to slow the growth of costs. But what we really need is a transformational shift where costs start to drop 5 or 10% per year instead of just increasing less rapidly.

I mostly agree with your perspective on all of this.  Which may make you wonder how I reconcile that with the idea that I don't think companies that profit off unhealthy foods can possibly outcompete the potential savings for lifestyle changes.  I attribute it not to special interest lobbying, but instead to partisan politics.  Ask yourself this question: if AHIP, PhARMA, and AHA all decided that ACA reform should begin immediately to help reduce health care costs, would that happen?  I think the answer's pretty obviously no - look at the Republican narrative of the ACA, in particular the expansion of Medicaid on the state level.  There's no substantial lobbying Republican governors to refuse expanding Medicaid -- every major constituency in their state would benefit.  But many still refuse, due entirely to partisan politics.

forummm

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Re: Avoidable Health Care Costs
« Reply #72 on: May 05, 2015, 03:00:03 PM »
It's obvious. If you want some report to give you some numbers to verify his statement, good luck with that because there are lots of companies that have their money on the line for you to continue eating High Fructose Corn Syrup and doing other things that are bad for your health. And they spend money on politics.

And there aren't companies that have an interest in saving health care costs?  Even using a 25% number, the potential savings for the government, health care companies, and individuals is $725 BILLION every year, or over $2,300 per person per year.

No company with a vested interest in selling unhealthy products can come anywhere close to that.

Not really. The incentives are generally the other direction. Big agriculture and food processors and distributors profit by shoveling food into us. Pharma profits by selling us drugs to combat the effects of the diseases. TV news is paid for by ads from Coke, McDonalds, and pharma, so they don't want to upset that gravy train. Doctors and hospitals profit by providing more and more services to combat the effects of the diseases--their incentive is for you to get sicker! How perverse right? Insurance companies are just pass-throughs for the cash coming from the people who purchase the policies. And insurance companies actually make more money when healthcare costs go up because profits are generally a percent of premium dollars.

The total profits of the groups you mentioned total around $110 billion (84 from pharma, 8.6 billion from Coke, 4.7 billion from McDonalds, 12 billion from health insurance companies).  Much of those are worldwide profits, not just isolated to the US.

So no, $110 billion in industry profits isn't going to measure up to $725 billion in savings.

http://healthcareforamericanow.org/2013/04/08/pharma-711-billion-profits-price-gouging-seniors/
http://assets.coca-colacompany.com/2b/b7/ae8656a5414cbead4aa741b08d92/coca-cola-fourth-quarter-and-full-year-2013-results.pdf
http://news.mcdonalds.com/Corporate/Press-Releases/Financial-Release?xmlreleaseid=123060
http://opinionator.blogs.nytimes.com/2011/11/03/less-than-26-billion-dont-bother/?_r=0

Edit: These data also discuss ALL profits, not just those related to unhealthy products.

That's not how politics works. It's not about what makes the most sense. If you have 310 million people who have an extra couple grand taken out of their pockets by taxes, wages, and copays, and they believe that they can't do anything about that situation, they will complain but not take action. And what could they really do on their own anyway? However, if you did try to take away hundreds of billions of dollars of income from a much smaller group of people, they will notice and they will organize (which is easy to do in smaller numbers through trade organizations) and they will fight and fight effectively.

forummm

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Re: Avoidable Health Care Costs
« Reply #73 on: May 05, 2015, 03:10:21 PM »
The politics on the issue are so bad, that Obama didn't even try to get much cost control into the ACA. There's a small amount, but not too much. He immediately had to cut deals with AHIP, PhARMA, and AHA to get them to not kill the whole thing--and even then they bitched and moaned about it (while watching their stock price soar because it meant so much more profit for them). If the Republicans really cared about anything other than lining the pockets of their rich donors (and Democrats aren't much better--they suckle at the teat of campaign cash too), they could have put a lot of great cost control into the bill. But they decided to fight it as though it were the antichrist for pure political reasons. It's very similar to the Heritage Foundation, Orrin Hatch, Bob Dole plan from the 90's (and Romney's plan from '05). They refused to let anything in about allowing people to make informed decisions about what they want to do at the end of life (DEATH PANELS!!!!). They refused to allow (not just fund, but allow) any research that would let us see which treatments actually work compared to others and whether that provides any good value.

So I'm not especially hopeful. Some of the ACA stuff is good and may continue to slow the growth of costs. But what we really need is a transformational shift where costs start to drop 5 or 10% per year instead of just increasing less rapidly.

I mostly agree with your perspective on all of this.  Which may make you wonder how I reconcile that with the idea that I don't think companies that profit off unhealthy foods can possibly outcompete the potential savings for lifestyle changes.  I attribute it not to special interest lobbying, but instead to partisan politics.  Ask yourself this question: if AHIP, PhARMA, and AHA all decided that ACA reform should begin immediately to help reduce health care costs, would that happen?  I think the answer's pretty obviously no - look at the Republican narrative of the ACA, in particular the expansion of Medicaid on the state level.  There's no substantial lobbying Republican governors to refuse expanding Medicaid -- every major constituency in their state would benefit.  But many still refuse, due entirely to partisan politics.

Well the members of AHIP, PhARMA, AHA, and AMA all would make much less money if health care costs went down, so their lobbyists/trade organizations would never lobby for that. So I don't understand what you're trying to say.

If for some magical reason these groups all decided to be charitable, and lobbied the other direction as aggressively, you would absolutely see action from the Republicans. They would just try to repeal ACA and replace it with something called Elephant Care or whatever, and they would put in it whatever their interest groups and ideological leanings told them to put in it. You're already seeing them try this--but it's more of the same old stuff. When they've given an answer about what they'd replace the ACA with, people like Boehner have said they'd get rid of that hideous, job-killing, government takeover of the health care system and replace it with something where you could buy insurance that would cover your pre-existing conditions through a competitive marketplace and there would be tax credits to help you pay for it, etc, etc, describing the ACA. It's all framing and lies (or "spin") to play politics. McConnell said that he wanted to pull out the ACA "root and branch" but keep KYnect (i.e. the ACA's branded Kentucky marketplace). Kasich also says we have to get rid of that monstrous ACA, but praises Medicaid expansion.

forummm

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Re: Avoidable Health Care Costs
« Reply #74 on: May 05, 2015, 03:17:26 PM »
I think almost nothing positive will happen in government until we get the money out of the electoral system. Pick almost any issue you care about, and the deciding factor in it is generally money. There are a few exceptions like abortion or gay marriage that are emotional triggers and no one really profits off of it. But nearly anything else big like wars, climate change, healthcare, etc, it's all about the campaign money. Independent expenditures are amplifying this effect.

I don't have anything to do with this group, but they are working to remove this corrupting influence from politics and I think it's a good cause: http://www.wolf-pac.com/

forummm

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Re: Avoidable Health Care Costs
« Reply #75 on: May 05, 2015, 03:29:10 PM »
But if you want some good news, here's an example of one of the ACA's provisions reducing costs for Medicare a little, with the possibility of more to come. They do this by changing the incentives for physicians and providers, where they get paid a little more for keeping people healthier instead of just doing a lot of services.

http://www.reuters.com/article/2015/05/04/usa-healthcare-medicare-idUSL1N0XV14W20150504

Cassie

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Re: Avoidable Health Care Costs
« Reply #76 on: May 05, 2015, 05:07:27 PM »
Some hypertension not all. Some have it genetically inherited no matter how good of shape they are in, etc.

NoraLenderbee

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Re: Avoidable Health Care Costs
« Reply #77 on: May 05, 2015, 05:25:56 PM »
I get the feeling there are a lot of young people posting on this thread who have not yet had much experience of aging. There are genetic predispositions that don't show themselves until later in life. There is the wear and tear of normal living--which includes the wear on your joints from healthy exercise.

Actually, sustained moderate exercise throughout life can help maintain healthy joints. Your body responds to moderate stressors by strengthening the affected areas. This is why astronauts spending time on the space station have to keep up certain kinds of resistance-based exercise while in orbit otherwise their bones will literally get less strong. Resistance-based exercise on Earth is helpful for maintaining bone health and preventing osteoporosis. Now if you sit around all the time and age, your joints will age and deteriorate as well. And there is some aging you can't prevent, but I have known quite a few older folks who stayed active their whole lives and were able to keep pretty healthy.

Yes, moderate exercise is good, no argument there. However, your joints will still age, albeit more slowly. The effects of years of exercise can take a toll--people who play tennis get tennis elbow, runners get knee and foot problems, people who lift weights (aka resistance-based exercise) get rotator cuff syndrome and shoulder problems, etc. I'm 52, an active cyclist for years. So many of my cycling friends are used-tos: used to run, used to play soccer, used to play football, until their knees didn't allow it anymore.

Merrie

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Re: Avoidable Health Care Costs
« Reply #78 on: May 06, 2015, 09:20:26 PM »
Well, I don't have any fixed numbers but from working in health care I can tell you that I think MMM is probably about right on target.  Clinic are filled with people with Type II diabetes that don't eat right and don't exercise, people with HTN that smoke, people that drink too much, people that sit too much (me probably included).  Then studies show (again- don't have the numbers) that many people never even pick up the prescriptions the doctors write and of those that do there are some that don't finish taking them.  People don't follow up on tests.  People don't get lab work done.  People don't get recommended vaccinations and screenings.  People drive too fast, text and drive, share meds, steal meds, unsafe sex, etc. 

This doesn't mean that if you have a chronic illness it is your fault.  Or your kid's fault.  Sometimes it just happens.  Or just bad luck of genetics.  But I think probably about 50 percent of the time (at least) the person sitting in front of me bears some of the responsibility for the health problems they have.

I am in healthcare as well (pharmacist) and I completely agree with this. There's nothing like ringing people up for their diabetes/hypertension meds while they're eating fast food, or for their asthma meds while they're smoking. Of course there are people who are chronically ill through no fault of their own, but a lot of people do contribute to their chronic conditions.

forummm

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Re: Avoidable Health Care Costs
« Reply #79 on: May 08, 2015, 07:52:53 PM »
Another source of avoidable health care costs and how things have changed since the first article 6 years ago (2nd link)
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

An article by the same author 6 years ago
http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum