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2012-01-08 13:23 by Karl Denninger
in Health Reform , 153 references Ignore this thread
Medical Care And Medical Choices *
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I may be beating on a dead horse here, but this topic keeps coming up on the forum and I think it needs substantive expansion and more pounding of nails.

Look folks, this is mathematics at a "macro" (that is, "everyone's involved") level.  The Federal Government went from spending $53 billion on health care (all forms) in 1980 to over $800 billion last year.  Private insurance costs have risen by some 9% annually for the last 30 years.  The Federal Government's spending has tracked this rate of expansion as well, which means that the commonly-held claim that this is all about "more elderly people on the government tit" is false; the working population is roughly constant in age.

The Republican Party (and the "Tea Party" contingent within it) have repeatedly stated that "nobody over 50" is going to have their Federal Government medical benefits tampered with.  Roughly, your life expectancy in the US is 85.  This means that if you're 50 today you have some 30 years of life left.

At a 9% escalation per year your medical costs -- whether insurance or government spending -- will multiply by a factor of 13.3 over the next 30 years.

That is, if you spend $600 a month now, assuming you did not get older or sicker, you would spend $7,980 a month in 30 years on your health insurance, or some $95,760 per year.

The Federal Government will spend not $800 billion but $10.64 trillion on health care at this rate in 30 years.

Neither of those things is going to happen; the money does not exist.

But this is the path we are on when you can demand a bypass, a hip replacement and $200 tests.  When the cost of Juanita the illegal Mexican, giving birth is forced upon you as an American Citizen.  When you may make lifestyle choices that severely impact your health and yet force someone else to pay for them.

If you keep believing in this, America, you are going to die sooner than you should, because what you believe in will not happen.

You therefore have two choices: You can either go "baaaaaaahhhh!" like a Sheep right up until the medical system collapses, at which point if you are dependent on it for a drug, procedure or device you will die or you can do what you can to change the course of your life and with a reasonable probability avoid that outcome.

That's all there is folks.  This is not about what someone wants and it is not about what you think you can demand.  It is about mathematics.

Let's talk about the cost picture for a minute.  I'm going to pick on one common test -- HbA1c, used to measure long-term glucose control.  It is commonly used among diabetics to monitor not their instant blood sugar but how well they control it over time.  The test measures the amount of damage in the blood caused by excessive swings in blood sugar over the last four months or so (the normal lifespan of a red blood cell); once a cell is damaged in this fashion it remains damaged.  A "normal" range for a non-diabetic person is between 4 and 6%; diabetics with excellent control can approach normal but few achieve it.  Elevated values are very bad; levels over 7% are strongly associated with serious complications.

For an apparently-healthy person who is not attempting any sort of intervention for diabetes this test is far better in diagnosing trouble than a single fasting glucose test, since it checks damage over time as opposed to "at the present instant."

Ok, so there's the background.  Now why do I bring this specific (and common) medical test up as an example?

That's easy: I can easily find prices for this as a lab test and outside the lab.

The lab price of this test is about $65 from my survey around the web of various medical labs.  But at WalMart I can buy two tests for $30 and perform the test myself at home in three minutes.

In other words the "doctor" price -- where cost-shifting, monopoly behavior and other games are present is four times that of the competitive price in an open market.

Never mind the privacy issues -- if I go to a lab the lab gets to choose who obtains the information.  If I have "insurance" then that data becomes part of my indelible record for anyone who has "a financial interest" in my medical care to look at forever.  If I buy the test and take it at home, I control who gets the information and on what terms since I paid for it with my own money and only one pair of eyeballs sees the result.

But on a cost-control basis, even leaving the privacy issues aside, why doesn't the local doctor's office simply buy these boxed products from WalMart and use them?  They're approved by the FDA and as such they have to be "lab-style accurate" or they wouldn't be.  Both use blood samples so the testing methodology is the same.

Here's the answer: The entire medical system is built upon the premise of intentionally distorting price and cost-shifting on a massive scale, along with controlling you by denying you the right to control information about your own medical status and how it's used.  Since "profit" is typically a percentage of price this inures to the benefit of providers in the space.  And since there is no free market for these services -- Juanita can "pop in" and pop out a kid, billing you indirectly for her care (along with Dear old Granddad who can do the same thing!) there's zero incentive to solve the problem.  If it becomes common knowledge that the test in the store is just as good as the one in the lab and you have to pay for one or the other what do you need the doctor's office for in performing that test?  You might need his advice on how to interpret the results but he loses the mark-up on the lab work and so does the lab, and now you control the data instead of him.

Never mind the other issues that arise in our massively-fraudulent medical system, such as with drugs.  Some people claim that other nations have a "better controlled" cost structure.  That may be true but a big part of how they achieve it is by forcing you, the American citizen, to cover the cost of development of new drug and device therapies!  In Canada, for example, Viagra is a couple of bucks a pill.  In the US it's $25 or so.  The drug is the same, the manufacturer is the same, and the price disparity is maintained by the drug companies getting laws passed making it illegal for you to import those Canadian pills into the US, forcing a price collapse in the United States. 

I've written about all this before in depth, and it figures prominently in Leverage as well.  But today I want to draw your attention to something very important -- that avoiding the consequence of the collapse of the system is at least partially within your control.

We're not going to stop the stupidity folks.  There's been zero attention paid to this by any politician from the left or right, and in fact they're intentionally lying to the people on a literal daily basis in this regard.  This is not going to change and the system is going to collapse upon itself.  We are merely trying to figure out when, but if you're under 60 today it's a good bet you will live to see it.

When I pointed out the mathematical impossibility of what Steve Southerland and Jeff Miller were claiming (that nobody over 50 would see their Medicare changed) in a town hall meeting last year I was shouted down and told that I was out-of-order to state that they were lying in their claims.  The problem is that they were lying and they both knew it; it is never out of order to state the plain truth.  Mathematics is an exact thing and the record in this regard on Federal Spending is a fact, not supposition.  That this cannot continue is also a mathematical fact and since the lion's share of federal medical spending is in fact on Medicare it is mathematically inevitable that major reductions in that spending and the program itself will occur before those who are currently 50 die, if the program doesn't collapse entirely!

Every one of the people involved in this scheme and scam -- some 20% of our GDP -- are financial rapists and terrorists.  The entire corrupt system and its enabling politicians all deserve to have an asteroid fall on them when they go to the mailbox this afternoon.   Escaping from this corruption and outrage in its entirety is not possible.  Ultimately, you will have to either face your own mortality or become subject to the medical system's perversities. 

However, this doesn't mean you can't change the outcome between here and there in a positive fashion for you as an individual, because you can.

Let's start with the simple.  If you smoke, stop.  Right now.  Throw the cigs in the trash can and never buy or smoke another cigarette.  Ever.  It is the single-most productive thing you can do to change your health prognosis over time.  If you wish to keep smoking that's fine, but understand that you are likely to take years, and perhaps decades, off your life and you will not be able to force society to pay for whatever medical care you need as a consequence of this choice in the near future and beyond.

Second, look at this picture:

Which of these two men would you like to be?  One has a far greater chance of needing "intervention" by the medical industry some time in the next 30 years or so.  There's a roughly-50lb difference between those two pictures, and the change from #1 to #2 - 205 to 157, several pant sizes, a 42 suit jacket to a 39, along with two full shirt sizes (from XL to M in a T-shirt) and an inch of neck size in a dress shirt - took about nine months.  #1 was what I had been for more than a decade.  #2 is what I was when I was roughly 17, and am now again today.  The bad news was that several grand worth of business suits went to Goodwill as there was no reasonable way to alter them to fit.  The good news is that I haven't been in this good of condition since I was a teenager, and it's not just "being fat" (or not) -- it's also how I feel.

To get from #1 to #2 I did two things: I cut the crap from going down the piehole -- specifically, refined carbohydrates.  I also removed all manufactured fats from my diet (e.g. anything with the word "hydrogenated" on the label); if I want a "butter taste" on something (e.g. microwaved brussel sprouts, which I really like) I use butter, not Frankenfood. I also downloaded the program "Myfitnesspal" for my Android phone and started using it to log my weight, what I stuffed down the pie hole and how much exercise I was actually doing.   It works as it keeps what you're doing in your face.  It also has calorie and nutritional information for a lot of restaurant chain menu items which makes it easy to consult before you order when eating out -- and that makes a big difference.  For those of you who just can't get rid of the crazy carb stuff, I understand from my research that you can do either low fat and high carbohydrate or low carbohydrate and high fat -- both moderate protein (NOT high protein!) but you cannot stuff both high-glycemic carbs and fats in your body without becoming fat.  Since I just cannot deal with the idea of not eating steak or ribs, two of my personal favorite foods, the choice that I could actually live within was easy.

Second, I "moved more."  Google up "Couch to 5k" and do it.  If you can't do jogging for physical reasons (e.g. bad knees, hips or ankles) double or triple the distances and get a bicycle.  If you still can't do it for physical reasons then choose swimming (an essentially-zero-impact physical exercise) instead.  There are damn few people who cannot manage the physical requirements of swimming no matter how bad your joints and similar are and it is an excellent form of whole-body exercise.  I also found and bought a weight machine from a guy over in Destin who looked like he never used it. It needed a couple of cables replaced but was otherwise in pristine condition at a tiny fraction of the cost of buying one new.  I don't use it as much as I should, but it does get used and it matters.  I also found that it's easier on the joints of this old fart if I use the Vibram "Five Fingers" shoe-like things -- it's basically running barefoot with a pad to keep rocks from embedding themselves in your toes, and with them you're forced into good form which stops the injuries (fancy that -- the human body was designed better than all those crazy ideas from shoe companies?)  Beware that when you start using those, if you choose to, your calf muscles will complain loudly as they probably haven't been used extensively in years.

I'm not going to tell you that the "move more" part was easy.  It wasn't.  In fact, it was really hard when I started.  If you don't know if you have cardiac problems go see a doc and take a stress test first where he can watch your heart rhythm while you crank up the METS so you have a reasonable expectation you won't fall over and die when you begin.  That would be bad.  Starting out I couldn't run a mile without feeling like someone had hit me with a truck, but what I found is that the only way to keep from plateauing is to hit that wall and push through it -- just a bit further, a bit harder pace, and then keep at that level of exertion on further workouts until it becomes not-so-tough.  Then push again.

Having gotten here I've found it's not hard at all maintaining what I've achieved.  I jog a couple of times a week and ride a bicycle for grins, giggles and fitness, usually putting in at least half an hour of "working out" in some form three to five times a week.  I live near the MidBay bridge and when the weather is nice I sometimes choose to ride over it to the Crab Trap in Destin for lunch -- a roughly 15 mile round-trip, and an hour and a half including the time eat (on the beach, natch, so that's the reward.)  I can now crank off three miles at a 9 minute pace, a modest jog, without my heart rate going materially over 150 -- I can talk with you while jogging in a reasonably-normal tone of voice.  Nine months ago all of that was impossible.

It's a choice folks and one you need to make now, because at the present pace we're a couple of years -- maybe four or five at the outside -- before the medical system collapses under its own weight.  You can't make these changes in a day -- if you wait until it all comes apart it's too late. 

The politicians are all liars and they're going to sit back and watch you die as a consequence of your reliance on their lies.

If I, as a fat bastard pushing 50 years of age can accomplish this with nothing more than a decision to do so then anyone can in one form or another.  And yet when I look around at the Mall, at WalMart or just walking about the perception changes.  That first picture was what I thought of as "average" and I was about that in terms of American men.  Now I know differently -- I was on my way to an earlier death and whether I wanted to admit it or not I was fat.  I might have been "average" for America, but on an absolute scale I was overweight and pushing toward obese -- and that's a fact.

I know there are a million excuses as to why you can't do it, but just take a look at the picture above and then tell me again, with a straight face, that you want to be "Guy #1".  You're lying to yourself if you do -- you can do it, but don't want to, and thus far you've been able to get away with it because the government has always been there to "pick up the pieces."

That day is coming to an end folks, and this aspect of being prepared is, for many Americans, far more important than any other.  If you're rich and dead you're still dead, so if you look like the left-side photo (or worse) take care of that issue first.

It's a new year.  Turn the new year into a new you and avoid, to the extent possible, what's coming.

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Clintb350 1k posts, incept 2008-01-19

The Federal Government went from spending $53 billion on health care (all forms) in 1980 to over $800 billion last year.

Constant dollars?
In 1980 my engineering job paid $30K. Now they start at $55-60K.

Abn0rmal 9k posts, incept 2009-01-10

Genesis wrote..
But at WalMart I can buy two tests for $30 and perform the test myself at home in three minutes.
It's even better online; they sell one there for $8.98
Truthseeker 9k posts, incept 2007-10-07


Your demonstration of both control and awareness of the macroeconomic facts on the ground, the various players' positions and rationale, and willingness to exert your own responsibility is a powerful combination. This message cannot get wide enough distribution. Bravo.

'...But people better realize that the worst-case scenario could actually happen.9/11 happened. This can happen. An economic 9/11, the likes of which we've never seen.' Gerald Celente
Jpg 905 posts, incept 2009-03-23

In 1980 my engineering job paid $30K. Now they start at $55-60K.
Engineering salary doubled.

Healthcare expenses increased by a factor of (approximately) 15.

Doesn't matter if it's "constant dollar" or not.
Howardnyc 152 posts, incept 2007-11-01

i am proud of you and happy you changed your life by altering your diet and activity. not surprised, though. that kd stubbornness and hard headed-ness comes in handy. great pictures. thanks for sharing this, and it will be personal inspiration for me.


losing the weight is hard work. keeping the weight off (which is but the primary symptom) and maintaining the life changes is harder work. i wish you and everyone else the best in the tougher job of continuing to eat healthy, real food, keep those refined carbs at a minimum, and continuing that daily exercise.

the follow through has been my downfall a couple of times; i've regained large chunks of hard-lost weight. gotta keep it off. as usual, the rare good advice i have to offer applies doubly to myself.

congrats, kd.

kd told me (and i believe him) that
"We (Americans) deserve a Depression."
Clintb350 1k posts, incept 2008-01-19

Yeah, I know, just want the Ticker to be clear about that, about an 8X multiple if it's not in constant dollars.
Fisticuffs 1k posts, incept 2007-07-28

KD and others,

I would urge you to do some research into "sarcopenia" (age-related muscle deterioration). You will likely come to the conclusion that you should add resistance exercise to your regimen. There are many ways to obtain this, whether weight training, high resistance cycling (I don't mean simply riding a bike, rather, attaching your bike to a magnetic resistance trainer and doing long intervals (4 to 5 minutes each) where you're struggling to stay at 75-80 rpm pedaling cadence, climbing, or other forms. You need the effort to affect your skeletal muscle more than your cardiac muscle. In combination with aerobic exercise you will promote optimal health and fitness, especially as you age.

Tickerguy 202k posts, incept 2007-06-26

losing the weight is hard work. keeping the weight off (which is but the primary symptom) and maintaining the life changes is harder work. i wish you and everyone else the best in the tougher job of continuing to eat healthy, real food, keep those refined carbs at a minimum, and continuing that daily exercise.

No it's not.

I'd love to tell you that it is, but it isn't. I don't find it difficult at all.

"Perhaps you can keep things together and advance playing DIE games.
Or perhaps the truth is that white men w/IQs >= 115 or so built all of it and without us it will collapse."
Dakine2004 9k posts, incept 2007-10-23

Need some muscle...157? how tall...5'8"...
Truthseeker 9k posts, incept 2007-10-07

I lost >50 pounds in 2005, and have stayed within 10 lbs of the target weight since. It is *simply* about diet and exercise.

'...But people better realize that the worst-case scenario could actually happen.9/11 happened. This can happen. An economic 9/11, the likes of which we've never seen.' Gerald Celente
Onelegged 1k posts, incept 2009-11-13

157 is about right. Everyone seems to equate "big" with healthy. Not necessarily. I'm 6'1" + and weigh 162. When I was a semi-competitve cyclist I was 145 and could ride for 12 hours in hilly terrain without a break.

The biggest key to keeping up the exercise it to find an activity that you like to do. That makes it super easy to find time for it. Karl obviously loves to be on his bike. That trip across the bridge for lunch, I bet, is a joy for him.

Congratulations again Karl on the new lifestyle.

I hate to admit it, but Nike's old slogan "Just do it." is the best advice going.

All The News That Fits, We Print.

New York Times
Icanhasbailout 9k posts, incept 2009-03-10

I was shouted down and told that I was out-of-order to state that they were lying in their claims.

Let me just suggest that you adopt a habit of replacing accusations of lying with an assertion that the person is simply factually incorrect, unless you know for sure that they know their claims are wrong. That way you don't get ruled out of order and you don't piss off people who may eventually be convinced of the truth.

Lying means intent to deceive and people get really pissed off when accused of lying when they are stating what they sincerely believe to be true, but in reality just don't have the correct facts. That burns bridges - you never know when you might need to cross them.

Raftermanfmj 5k posts, incept 2010-09-06

If you enjoy butter, buy some Kerry gold pure Irish Butter. From milk from grass-fed cows. You can taste the difference.

Only place I can find it is wholefoods - but it freezes well so it's worth the trip.

This world is a comedy to those that think, a tragedy to those that feel. - Horace Walpole

The universe is not only stranger than we imagine; it is stranger than we can imagine. - Haldane's Law
Howardnyc 152 posts, incept 2007-11-01

wrt keeping it off, it is more difficult 1) for most people, as shown by the good ol' scientific studies as well as my (limited) professional experience; 2) for me, so i have the good ol' personal anecdotal bias. lots of folks drop 30-50 lbs, only to put it back on either quickly or slowly. of course, there are lots of unsustainable methods for quick weight loss that are doomed to this kind of failure. but (and i'll lean on my personal case here as an example) it is oh so tempting to ease the carbs back into the routine, and decrease the running/gym/exercise routine.

if it is no more difficult for you (kd, truth and any others), bless you. that's great.

kd told me (and i believe him) that
"We (Americans) deserve a Depression."
Marvinmartian 759 posts, incept 2011-03-16

Raftermanfmj wrote..
From milk from grass-fed cows

Normal feedlot beef is fed corn, soybean meal, has antibiotics in feed.

Grass fed beef not only tastes better, its got more essential omega-3 fatty acids which are healthier.

The antibiotics in feed lot cattle causes bacteria to evolve to be resistant to them, thus creating the possibility of cross-species transfer to humans even if the antibiotics dont make it into the meat itself.
Frankschoenburg 181 posts, incept 2011-08-05

What's wrong with a high protein diet?
Themortgagedude 12k posts, incept 2007-12-17

Karl has done a remarkable job. I can vouch for him. Had lunch with him at that Crab Shak. I would say hes a little too skinny. I need to do the same. Off to the basement for a little Total Gym time.

I think its time we ask ourselves if we still know the freedoms that our founding fathers intended for us. Ronald Reagan 1964
Rjazz117 18k posts, incept 2007-09-11

Karl is right on all of this. The choice to live a healthier lifestyle and to lose the excess weight we have accumulated is easy. Actually doing those things is more difficult, especially at the beginning...but anybody CAN do it...they just choose not to.

Before I got sick again (early November) I weighed 170. Now, with two months of sitting on my ass (coughing all the time) I am back to 190ish (194 last evening) but I am not at all concerned. I know exactly how to remove the 20# of excess RJazz: Quit eating refined carbs, and start exercising again. It really is that simple.

It's amazing how many people are ashamed of their body. It's even more amazing how many people aren't ashamed of their brains.
Frankschoenburg 181 posts, incept 2011-08-05

Then do it!
Bluebird 2k posts, incept 2008-05-02

Excellent ticker. I've always tried to maintain a healthy diet and exercise program all my life. What concerns me is spouse who turns 65 in March. We are getting dozens of mail from various companies to not only sign up for a supplemental insurance plan but also we need a drug plan.

My rant is about the Medicare drug plan. We don't take routine prescriptions now, so why spend $30 a month for a plan for drugs that we don't use.

Currently, we pay our own medical insurance that does not include prescriptions. So for an occasional prescription, it is paid out-of-pocket.

But everyone says sign up for that Medicare drug plan now, because there will be a penalty in the future to get a drug plan. But if am healthy, why would I ever want a drug plan?

Templar223 805 posts, incept 2008-04-28

Damn Karl, you're skinny!

Congrats on the lifestyle change.

Divorce did about half that for me last fall. I'm fighting to shed those remaining pounds with smaller portion sizes and increased exercise myself.
Blueskies 72 posts, incept 2011-05-15

you look terrific Karl. i commend you. it's funny when you mention "average." I tried on line dating for awhile and it never seemed to amaze me how many men put down their body type as average, when you can see by their picture that they were... well what i would call FAT! my preference has always been slender men. but goes to show that people in general don't perceive themselves as overweight as they are comparing themselves to a generally overweight population. i came to realize that average was codeword for "need to lose some pounds."

anyway... yes, everyone needs to take responsibility for their own health. you cannot depend on anyone else for that. i have always cooked meals at home, i grew organic when i had a place for a garden, had chickens, had a pig, got hormone free, unpasteurized milk from the farmer up the road. made butter and mozzarella from that milk. yeah takes time (and i was working full time!) but what else ya gonna do with your time? watch TV???? i also was lucky enough to grow up in the same fashion, so i really didn't know any different.

good butter is key, cod liver oil every day, and i also use lard to cook with or butter or olive oil as did my parents, and my cholesterol has always been low. 10-20% carbs and the rest in fat and protein. i have done this my whole life and am 57, no health issues, hardly any gray hair, 5'7" and fluctuate between 122 and 128. my weight hasn't changed since i was a senior in high school.

it's doable!! but it's a lifestyle. i never feel deprived watching other people gorge themselves with crap. hey i eat desserts sometimes. i make a wicked good key lime cheesecake, and apple pie :) it's all about balance.

wishing everyone a healthy new year! would love to hear what others do to keep ahead of the doctors, hospitals, and insurance companies. personally, all three scare the crap out of me and i want to stay as far away from them as possible.

Viper 1k posts, incept 2007-08-28

Good for you on getting in shape Karl. I got a kick out of the doctor the last time I went. She asked me if I had lost weight recently. Confused, I said no. She said that my chart showed I was "obese" according to BMI, but that I looked lean and muscular...No shit, I lift weights, exercise regularly, and have very low body fat. Maybe I should apply for "disability" for being "obese" (not).

Apparently the last time I was at the doctor some nurse weighted me and measured my height and just plugged the numbers into my chart without bothering to actually look.

Cputhoff 8 posts, incept 2010-09-18

Good stuff Karl. Congrats on the weight loss. I've worked out 5 days a week for 2 decades now and seldom miss. I also own a few restaurants and it just blows me away how fat people are in this country. How can we change the culture or habits of the masses? Being a complete SLOB should NOT be acceptable.
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