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On applauding the hit murder of a health insurance executive — 87 Comments

  1. Killing an insurance executive is not an answer. But it could be part of an answer, if it causes somebody, maybe Congress, to question how the companies treat their customers.

  2. I know there will be some who say, “If it weren’t a for-profit business we wouldn’t hate its executives so much!” That is, let’s have single payer instead.

    But… do they think the service would improve if it were the government, rather than a for-profit insurance company, in charge of determining what is covered? At least, if a private company provides bad enough service, there is a chance even out of corporation that they’ll be dropped and a company providing better service or better value for money will be brought in. If it’s the government and there’s no other choice, you’re just out of luck.

    Do they pay attention to what happens in Britain or Canada?

  3. Univ of Saigon 68:

    Most people think they’re treated quite well by insurance companies. And there are lots of studies of what’s going on with the others. Do you really think there’s some sort of easy solution that would allow for-profit companies to stay in business or even to want to stay in business? And when the government takes over entirely, do you think that would represent an improvement?

  4. Health insurance is a business, and like all insurance it’s geared to making money. And yet people need it when they are in a state of stress, and sometimes when their lives are at stake. That makes for a real love/hate relationship that I see as inevitable.

    That love-hate relationship reminds me of the public’s relationship with attorneys. Attorneys are expensive, but there may be times when you need one. I have dealt with attorneys in my private life and also as an officer of my HOA. What has impressed me in my dealings with attorneys is that I never got pie-in-the-sky promises–no BS. They were very matter-of-fact: according to the law, this is what you will get. And they were right.

  5. I cant help but feel that much of this has been driven by the soaring number of uninsured people simply stiffing the hospitals.

    I was very happy with my insurance I have had for years. I retired from one job and now I am double covered.

    Strangely about 3 years ago it became much much harder to get things approved. Coworkers have noticed that uptick with similar issues. Now the doctor has been fighting with the insurer FOR OVER A YEAR. To get 2 stents for my wife with congestive heart failure.

    All the while I am paying far more for the insurance. And the co-pays have tripled in 4 years.

    If this is representative of what coverage has become across the industry. I have a feeling we will be seeing much more of this in the future

  6. Meanwhile in the UK, with the National Health Service, there may not be an issue with the denial of *payment* for services, but there are issues with the obtaining *the services themselves* when they are needed. See this guy’s story:

    https://x.com/peterrhague/status/1865184491578265729

    If we had an NHS-type system here, would the people who are applauding the murder of the United Health guy be applauding the murder of a government bureaucrat involved in coverage decisions?

    I was particularly appalled to see that Tim Wu, a Columbia professor who has done some good work (I have his book on the history of telecommunications regulation) seemed to be making excuses for those applauding the murder. His post is now deleted, but not before Aaron Levie @levie responded with ‘this is psycho level stuff’ and Paul Graham @paulg added ”Man, this killing has unearthed a lot of closet psychopaths’.

  7. As a retired doc, I feel I must respond to Neo’s seeming complaint about rising health care costs.
    Medicine is evolutionary, not revolutionary. We take baby steps, not great leaps forward, because previously unknown adverse effects may surface, better in a lower population than in a larger one. I would not want it in any other way. Incremental upward progress is accompanied by rising costs, which strikes me as inevitable.

    If I misunderstood, of which I am surely capable, Neo, I apologize.

  8. I got denied once about year before Medicare. I figured they knew Medicare would pay no questions asked which they did. My surgeon was frustrated. Now the plan B folks want to send someone to my house for various purposes. I refuse because the clinic I use is literally in the same building as the post office, a two mile drive that I make all the time to get my mail. I don’t need a house call for a blood test.

  9. I admit I bypassed supplemental Medicare plans from United Healthcare because of their connection to the AARP, whom I blame for supporting Obamacare. We have traditional Medicare and a BCBS supplement. It’s considerably more expensive than a Medicare Advantage plan, but we can go anywhere in the US with no worries about coverage. We’ve had no problems with denial of care, although they do have to go through the step of getting Medicare pre-approval.

    These Medicare Advantage plans have to restrict coverage to their preferred networks, and they are more likely to deny coverage, because they are a lower-cost plans, and because the government is squeezing Advantage plans to use the funds for other purposes.

    But frustration with the mess in US healthcare which government intervention has only made worse is no excuse for cold-blooded murder. People applauding this should be worried about their souls. Horrible.

  10. Kate:

    I have United Healthcare supplemental Medicare insurance. So far, knock wood, the coverage has been great. I don’t like Advantage plans because I don’t want network restrictions.

  11. Neo: Yes, once long ago we were in an HMO. The restrictions may have had life-changing effects for one of our daughters. We vowed never again, if possible.

  12. No one should applaud an assassination like this.
    We have a Humana Advantage plan. Through my Wife’s cancer treatment, we have had no problems with getting coverage. It does seem that we have paid over the cap. Looking at all the med equipment and medicines, it is truly amazing. That is another reason why med costs are going up.
    When we would get the infusions of the cancer drugs, there would be “immigrants” there, getting the treatments for free. I don’t want someone to die, but I don’t like this either.
    Next yr costs are going up, Medicare is charging more for things. We are changing to a different Humana Advantage plan because of the changes. Cap is going up from $4800 to $5500, new plan will be $5300. Test costs are going up. Right now we pay $35 for Primary Care Doc, new plan will be $45. Some bennies are going away. However, I take Jardiance. and next yr my costs will take a big drop.
    I would not want UK or Canada health care

  13. I think there is a real issue with the US effectively subsidizing drug costs in other high-income countries. Since so much of the cost of a drug is up-front, in the costs for research and in animal/human trials, it does make economic sense for drugs to be sold much more cheaply in impoverished countries, which wouldn’t couldn’t afford them otherwise, as long as the price covers their variable costs of production and distribution. But this doesn’t apply to Britain, German, Canada, France, etc.

  14. If there is any more highly-regulated business than health insurance then I can’t think of what it could possibly be, except maybe health care itself. Every state has an Insurance Commissioner who reports directly to the governor and in some states is elected. Whatever it is people don’t like about health care and health insurance is not due to too little government oversight.

    What insurance companies can and can’t deny and how they have to do it, and what kind of process you get when they do, and what kind of rates they can charge, and how much of the premiums must be spent on health care, is controlled by state and Federal governments.

    If you think health insurance companies are screwing people and making too much money, it’s not because they’re free marketeers maximizing profits. It’s because they operate in a system of tight government oversight and regulation that restricts competition and allows extraction of economic rent and crony capitalism. And more government control or oversight is not the cure.

    As for hospitals, many of them are themselves government entities, but competition among hospitals is actually illegal in most states. You can’t open new facilities in these states without being granted a “certificate of need”, and you get this by proving that existing facilities are not adversely affected by the one you plan to open, and you won’t get that if the existing facilities object.

  15. I am old enough to remember when there was no health insurance – at least in Colorado. My grandparents had serval medical issues and always paid for them on a payment plan. When we went into the local MD’s office there was a sign detailing the charges for various medical services. My mother had a beauty salon and often was able to pay medical bills by doing hair styling for the doctor’s wife.

    I think health insurance came along in the 1960s, and Medicare began in 1966. At first everyone loved their health insurance policies. IMO, EMTALA became the cancer that is now slowly destroying the system.

    I was in the Navy on active duty for thirteen years and eight years active reserve. Military medicine is very good on the battlefield and for battlefield traumas. For routine medicine – not so good. A Navy doctor prescribed a medicine to our two-year-old son that almost killed him. From that point on my wife saw only civilian doctors for her and our children.

    I could write a small book about my misadventures with the Navy’s healthcare system. One short example. I had to have a badly impacted wisdom tooth extracted. The base dentist said I had to go to Oak Knoll Hospital where they had the best oral surgeon in the Navy. The day my appointment was scheduled the best oral surgeon decided to play golf and assigned my operation to a newly minted oral surgeon. When the new oral surgeon had been working on me for two hours, I knew things weren’t going well. A more experienced oral surgeon was called in and they finally managed to get that sucker out after more struggling. The result was a severed mandible nerve, and a swollen jaw that lasted for two weeks. My face is still numb – the operation took place in 1967. That’s 57 years ago.
    The newby oral surgeon felt so bad he visited me at my home several times and apologized profusely. I felt sorry for him. The system had failed both of us.

    And that my friends is what’s wrong with universal medicine.

  16. Forty years ago, my father was diagnosed with terminal lung cancer. He was dead three months after diagnosis. He spent his last six weeks in a first rate hospital in the Boston area. The cost to Medicare for six weeks plus operation(s) was $45,000. The charge to the patient, my father, was $500 or so.

    If I come down with a similar hospital stay, I wager that the cost will be 10 times what it was for my father, and the charge to the patient (me) would be many more ten times. The “good days” of current workers paying into SS many times what current retirees take out are gone.

    My father’s 40 years of smoking, which he stopped 9 years before he died, caught up with him. The most effective care in his last 3 months was industrial grade painkillers. Like the initial diagnosis said, it was terminal. My mother’s history was rather different. Without modern medicine, she would have died 20 years before she did.

    I have thus far lived 7 years longer than my father and mother did. No smoking, minimal alcohol or nonalcoholic “recreational” drug use, weigh what I did in high school and walk 2-3 miles a day. No doctor visits in 20 years.

    If I come down with cancer like my father did, all I want are painkillers.
    I don’t see the point of spending beaucoup dollars under a nauseous chemotherapy regime, all for living 6 months longer.

  17. The grim wages of Democratic-Party-generated hatred and hysteria:
    Insanity (and “Approved Insanity”)…

    + Related (heh)….
    “NOTE TO ALL THE JOURNALISTS WHO ARE CHEERING THE ASSASSINATION OF A HEALTHCARE CEO: Your industry is hated by millions and millions of people too. Just sayin’.“—
    https://instapundit.com/688928/

    + Bonus:
    The next time Democrats try to impress anyone with concern over Trump’s “morals”…
    “ How Democrats ‘Debanked’ Political Opponents In Shocking Attack On American Freedoms”—
    https://blazingcatfur.ca/2024/12/06/how-democrats-debanked-political-opponents-in-shocking-attack-on-american-freedoms/

    + Additional Bonus (for Black Friday / Cyber Monday / etc.
    “ Ana Kasparian Absolutely ERUPTS On The Democratic Party And Exposes Them As Thieves Of Taxpayer Dollars”—
    https://blazingcatfur.ca/2024/12/07/ana-kasparian-absolutely-erupts-on-the-democratic-party-and-exposes-them-as-thieves-of-taxpayer-dollars/

  18. The NY Mayor claims they have a name but won’t publish it yet for investigative reasons. Some sources say they are looking for accomplices. The shooter had, it seems, exact knowledge about where the victim was staying and when he would leave his hotel to go across the street to the conference site.

  19. @J. J. IMO, EMTALA became the cancer that is now slowly destroying the system.

    Drop in the bucket. Most US health care spending is on the small percentage of people who are very ill.

    @Gringo: The “good days” of current workers paying into SS many times what current retirees take out are gone.

    There is a similar underlying issue. Health insurance collects premiums from healthy people today to spend them on sick people today. Most people are healthy when young and sick when old. There’s too many old people relative to working young people; in the 1950s it was 12 working to one retired, now it’s more like 4 to 1.

  20. If they don’t catch this guy in the next couple of weeks, all of the “stupid” stuff (leaving cases behind, using a bike with a built-in gps) has been clever misdirection, and the probability of catching him goes way, way down.

    And, with ALL insurance, the large print giveth, and the fine print taketh away.

  21. “Drop in the bucket. Most US health care spending is on the small percentage of people who are very ill.” – Niketas C.

    You m may have data that shows that, however, I have experience with hospitals. In 1974, I had a very
    serious back surgery done by the best neurosurgeon in Colorado at the time. The entire cost of the surgery, hospital, anesthesiologist, and medications was $2,500. My employer’s insurance paid 80%, I paid the rest.

    In 1992, I had my gallbladder removed. It was done laparoscopically, and I was in the hospital overnight. The bill was $2500 for the surgeon, $1500 for the anesthesiologist, and $10,000 for the hospital. A much simpler surgery, and minimal hospital stay.
    I protested the bill. I sat down with the hospital business office, and they showed me an IBM printout of all the charges. Most of them were for medicines or services I hadn’t received. I averred that I shouldn’t have to pay. She explained to me that their prices were needed to cover their expenses for pro bono medical services. She said that ach night in Tacoma (The hospital was in Tacoma, WA) they had to treat numbers of gunshot/knife wounds drug overdoses, auto accident injuries, etc. for people who couldn’t pay and because of EMTALA, they had to treat them. Because of this they had to charge people with insurance more to cover their costs. She asked why I cared since I had insurance. Well, my company only paid 80% so my share was $2800 when I had expected to be more like $1000. I had not expected medical costs to have risen so quickly during the 80s.

    In addition, I have had to take my wife to the emergency room twice and have taken a neighbor once. All at night. I saw where all the illegals, homeless, and indigent go to get their healthcare. Wall to wall people being triaged and eventually treated by the most expensive care our system offers. I’m sure it has gotten worse over the last four years of open borders. You say it isn’t a problem; I disagree. In fact, I think it’s part of the Democrats’ plan to force universal healthcare on us.

  22. Insurance is an invention to help mitigate against unknown risks (or generally known risks estimated statistically across a “pool” of insured people).
    A decent fraction of what passes for health insurance is really not insurance, but a pass through for the (perhaps) $2K per family member per year that is or should be spent on normal medical actions (vaccinations, dental, vision, hearing, physicals, blood tests, mammograms, bone density tests, colonscopies, etc.), where the set of actions is age related and changes over our life times. But they are not for unkown accidents, cancers, or other diseases, etc.

    Plus over time the more exotic medical treatments become more common and standarized, and then can or perhaps should then fall into the “normal expense” category as well, as generally “to be expected costs going forward”: Lasix, cataract replacement, hip and knee replacement, appendectomies, selected medications, some minor skin cancer treatments, etc.

    We may need or want to subsidize the costs for lower income people to cover those “normal” costs, along with subsidizing the unknown costs for all of us, but with some means tested aspects. Plus those of us who are better off should (and should be able to) complement our IRA retirement planning with long term care insurance and HSA’s for unknown but expected end of life costs (where much/ most of a person’s life time medical costs occur).

    Another factor is the third party nature of most healthcare payments, with too little clear market knowledge of various medical care costs. Better awareness would impact cost decisions and presumably drive costs down (even as the costs for those procedures newly added to the “standard set” are also added to the mix).

    On EMTALA, some years ago I was insensed at the idea of poor people getting excessive benefits in that direction. But then I was surprised to learn that [at that time] the total national cost was only around $41B, in a medical industry costing perhaps $4000B in a $24,000B GDP.

  23. @J. J. You may have data that shows that, however, I have experience with hospitals.

    I don’t question your experience, but your experience is not representative of most health care spending. Hospital care is only about 30% of total health care spending.

    She explained to me that their prices were needed to cover their expenses for pro bono medical services.

    She misled you, those pro bono costs are, like I said, a drop in the bucket. Almost all their costs are paid by insurance, Medicaid, or Medicare. Your insurance pays 2-3 times as much as Medicare and Medicaid do, because Medicare and Medicaid don’t negotiate prices, they set them by law and regulation. Hospitals can’t make money on Medicaid and Medicare payments, so they balance their budgets on the backs of the employed, insured middle class. Medicare and Medicaid spend almost all of their money on old people or sick people.

    You say it isn’t a problem; I disagree.

    I said no such thing. I said it “was a drop in the bucket”. It is also a problem, but it’s nothing compared to what is spent on old people or sick people.

    $4.5 trillion was spent in the US on health care last year. 40% of that was Medicare and Medicaid. 90% of that $4.5 trillion is for chronic conditions and mental disorders.

    Cancer alone is about $200 billion annually. Heart disease alone is over $400 billion annually. Diabetes alone is about $250 billion annually.

  24. “Heart disease alone is over $400 billion annually. Diabetes alone is about $250 billion annually.” – Niketas C.

    MAHA!

    It is ironic that Republicans that fancy themselves lovers of liberty are now the party that’s going to force Americans to lose weight. That’s got to be cheaper than the $650 billion we’re spending now.

    Maybe we incentivize weight loss by tax credits for target BMI’s.

  25. I agree that the outpouring of hate and scapegoating of the murder victim is abhorrent.
    However, my comment is slightly tangent to the main topic — although it might be a palliative diversion.

    I was intrigued from the beginning because of the same questions so many people have asked about the killer: how did he know Thompson’s location and schedule; why was he so nonchalant about the killing; what was his motive?

    The three inscribed bullets have the smell of a red herring to me, so clearly suggesting that one of the people threatening Thompson finally took action, and yet people with that kind of grievance are not usually so cryptic.

    And why was his tradecraft so abysmal in some way (exposing his face to cameras, buying food close to the scene, renting an ebike) and yet so efficient in others (using fake ID, acquiring the gun, eluding the chase).

    Because they haven’t found him, even if they police think that they might know who he is.

    Being an unashamed consumer of crime and detective novels since my youth, the scenario that first came to my mind on then hearing about Thompson’s financial problems was that he had hired a hit man to relieve him of that burden, without negating what are probably some fairly generous insurance policies, and perhaps avoiding some other considerations that suicide, or just fleeing the country, would generate.

    There are precedents, although I haven’t taken time to nail them down.

    Second scenario was that the wife was ridding herself of her husband with the same financial considerations in mind.

    Third scenario, if you are fans of the really convoluted suspense thrillers, or possibly a Donald Westlake farce, is that they both hired the same gunman.

    Facetiousness aside, because it is a serious subject, today I found an independent corroboration of scenario one.
    https://www.dailymail.co.uk/news/article-14167591/CNN-guest-theory-UnitedHealthcare-CEO-Brian-Thompson-assassination.html

    A CNN guest his suggested that UnitedHealthcare CEO Brian Thompson may have orchestrated his own assassination.

    Law enforcement veteran Neill Franklin told Dana Bash that such an idea was not out of the realm of possibility when he made the claim on Friday.

    Bash had asked the former Maryland officer if he believed that the New York Police Department knew the identity of Thompson’s shooter.

    He said: ‘It’s a very good possibility that they already know who he is, there’s a very good chance of that.

    ‘There have been times when people have orchestrated their own demise for certain reasons.’

    Clearly shocked, Bash can be heard saying, ‘wow’, as Franklin continues: ‘I am not saying this is the case’, before Bash asks if it relates to insurance purposes.

    ‘Maybe they fear some type of investigation down the road, maybe they want to leave their family in a good light.

    ‘There have been cases when people have orchestrated their own demise, it is a possibility. It cannot be ignored.’

    Franklin continued: ‘This is what is digging at me as a former investigator, this guy knew too much about where he was going to be at a specific time.

    ‘It’s a very small window, it is not like he was roaming around. He was there, he was laying in wait. Who would have that specific type of information?’

    And they advertise another post:
    “UnitedHealthcare boss was facing a DoJ investigation and lawsuit when he was executed”

    Without knowing the background of the investigation and lawsuit, it’s hard to say that his death was suspiciously timely, but it’s a factor the police may be considering.

  26. A lot of people on the right seem to be reflexively defending the insurance industry in response to this crime.

    It is possible for two things to be true at the same time…i.e. It is possible to recognize the corruption and unfairness of the health insurance industry while condemning the murder of one if its CEOs.

    I condemn the murder without reservation, but don’t understand the people defending the insurance industry under the premise that “it’s a business, it’s there to make money”.

    It appears they’re saying that anything goes when it comes to businesses who need to make a profit to stay afloat.

    It is also a false dichotomy to claim that the only alternative to the current health insurance bureaucracy is for government bureaucracy to take over. Much of the problem in our health insurance industry is a result of government regulation and lawmaking…often at the behest of insurance industry lobbyists. It’s much easier for a business to institute egregious policies on their customers when they can legitimately say “sorry, out of our control…it’s the law”. And it prevents any potential competitors from being able to offer alternatives that would be more palatable to customers when it’s illegal for them to do so.

    There are many, many ways that the health insurance industry in this country could be improved without just turning it over to the government.

  27. I mean, the question is always, what was done about healthcare before?
    https://www.youtube.com/watch?v=fFoXyFmmGBQ

    The issue here isn’t whether the insurance companies are good or bad – the issue is people believing killing will be a solution to their problems. As if healthcare is a fruit going on this bountiful tree and if we could just shoot the guards and tear down the fence we’d all be able to reach it and eat our fill.

    But it’s not. Healthcare – like anything else in life – takes work and effort to produce. You can’t kill your way into production and prosperity (if you could, then communism would work). Everyone keeps forgetting that “nothing” is always an option:
    https://natewinchester.substack.com/p/nothing-is-always-an-option

    Kill enough executives, and you could easily find yourself with no healthcare at all.

    Briggs also had a great post on reminding people what is health insurance:
    https://wmbriggs.substack.com/p/what-health-insurance-should-be-but

  28. The reported investigation into the UHC CEO involves alleged insider trading, and several other executives are also being investigated.

  29. The share of the population in this country uninsured is not increasing and the insurance business is not peculiarly profitable, The ratio of gross revenue in ‘health care and social assistance’ to total gross output was 0.053 in 1997 and is 0.068 today. The ratio of value-added in that sector to total value added was 0.06 in 1997 and is 0.0735 today.

  30. Basically, you have bean-counters at the insurance companies that are making medical decisions about patient health-care, although those bean-counters do not have a license to practice medicine!

    But I can see how the insurance companies try to rein in costs by not wanting to pay for some procedures. Of course, doctors began to run way more tests than were medically necessary just to keep from being sued by people claiming malpractice on the part of the doctors. So it is a vicious circle.

  31. Prescription drugs are expensive for a variety of reasons: Other countries cap the cost at an amount which is often less than what it really costs, so that difference is made up by Americans; the US is a very litigious society and the costs of lawyers for bringing a drug to market had to be made up some how; R&D costs are insane — not just for the insurance coverage, but the IRB fees, etc.

    Healthcare and insurance costs are crazy because, well, Obamacare forced coverage of a lot of stuff that either shouldn’t be covered or should be out of pocket. While I do like my MyChart, I know that the hospital I worked at when Obamacare came into effect had to hire over 200 people just for Epic. And hospital administration has gone through the roof! So many overpaid people!

    The other thing worth noting is that once upon a time, hospitals were almost all charitable organizations.

    When the WHO came out with a ranking of healthcare by county, what went into calculating the rank was pretty much slanted such that the US could never track high. Things like how much public money per capita spent on healthcare, how far someone needs to travel to a hospital, how many patients per doctor. (The last statistical point doesn’t consider PAs or NPs or other medical paraprofessionals, which we have a LOT of in the US.)

  32. Healthcare and insurance costs are crazy because, well, Obamacare forced coverage of a lot of stuff that either shouldn’t be covered or should be out of pocket.
    ==
    Obamacare may have been an ill-considered idea. It may have made certain problems marginally worse. The expense of medical and nursing care being what it has been for decades, you cannot attribute ‘crazy’ to Obamacare.
    ==

  33. $4.5 trillion was spent in the US on health care last year. 40% of that was Medicare and Medicaid. 90% of that $4.5 trillion is for chronic conditions and mental disorders.
    ==
    A. Your links don’t work.
    ==
    B. Gross revenue for ‘health care and social assistance’ in 2023 was $3.3 tn. (datum courtesy the Bureau of Economic Analysis).
    ==
    It is ironic that Republicans that fancy themselves lovers of liberty are now the party that’s going to force Americans to lose weight.
    ==
    He never suggested that. Taking this a little personally, aren’t we?

  34. @Art Deco: Your links don’t work.

    Sorry about that. I don’t have time to redo all the links right now. But my source for the $4.5 trillion is CMS, National Health Expenditures. Not sure what “Gross revenue for health care and social assistance” would refer to, but NHE is what is spent for health care by all payers in the United States, including pharmacy, hospitals, physician services, insurance, public health, residential care, etc. It’s almost 20% of national GDP.

    There’s probably more than one way to calculate that, but everyone in health care or health insurance would accept CMS’s methodology, since they are largest payer as well as the Federal regulator.

  35. but NHE is what is spent for health care by all payers in the United States, including pharmacy, hospitals, physician services, insurance, public health, residential care, etc. It’s almost 20% of national GDP.
    ==
    GDP is a measure of value-added, not gross output.
    ==
    The national income accounts are kept by the Bureau of Economic Analysis and that is who I quoted.

  36. The assassin appears to be an amateur, yet he has managed to elude authorities for several days. Here’s a detailed update:
    ==
    They’ve told us he entered the Port Authority Bus Terminal and released some security cam footage of him so doing. I’m going to wager there are security cameras in the terminal itself and they have a satisfactory idea of which route he took out of town. They’ve been able (by their account) to identify the bus he took into town and to determine he stepped on that bus somewhere between Atlanta and Washington.
    ==
    If they actually do have his DNA profile, he’d better hope none of his 2d cousins have sent data to 23 and Me.

  37. GDP is a measure of value-added, not gross output.” – Art D.

    Hmmm. What Is Gross Domestic Product (GDP)?
    “Gross domestic product (GDP) is the total monetary or market value of all the finished goods and services produced within a country’s borders in a specific time period. As a broad measure of overall domestic production, it functions as a comprehensive scorecard of a given country’s economic health.”
    https://www.investopedia.com/terms/g/gdp.asp

    IMO, what Art Deco and Niketas C. are missing is that statistics are the view from 30,000 feet. They give you information that can be useful in planning and budgeting. But there’s another view from ground level/. It’s called anecdotal evidence because each anecdote is unique, but they also show the personal effects of the system on hummin beings, not numbers.

    When EMNTALA was passed in 1984, the number of illegals, indigents, and homeless people was considerably smaller than today. Additionally, no one dreamed that we would see the increase in those populations that has occurred. It seemed imminently sensible, even though most cities at the time had hospitals that were providing charity care to the uninsured.

    I doubt that the amount spent on pro bono medical care shows up in the statistics because the costs are paid by the insured patients. I maintain that we don’t really know the costs. What we do know is that medical costs are increasing faster than the official inflation rate.

    Most people over the age of 80 have at least one chronic condition. If most of our medical costs are spent on them, what is the answer? Allow them to die? Force them into bankruptcy? Force them to lose weight? 🙂 That group amounts to1.97% of the adult population, yet Niketas says they cost much more for their medical care than the approximately 40 million people (or approximately 12%) who are illegals, homeless, or have no health insurance. Maybe so. I don’t think we know because our healthcare system and the way it’s all paid for is somewhat opaque.

    What we do know, and have known since Obama introduced Obamacare, is that our healthcare system is becoming much more expensive.

    Another anecdote: My personal doctor had to close his practice and join a regional clinic staff because he could not afford to do the paperwork require by Obamacare.
    Doctors are now mostly working for clinics that are becoming regional monopolies. And the salaries that are being paid to the administrators of these clinics are breathtakingly high. Statistics may not show it,
    but anecdotal evidence shows our healthcare system is in trouble. The assassination of the United Healthcare CEO, and approval of that assassination are further anecdotal evidence.

  38. My guess is that the $4.5 tn figure being used by CMS combines the revenue of those providing health care and social assistance with the revenue to the insurance business of vending medical plans. Since the insurance is a means of securing final sales in the health care &c sector, I believe this is double counting. Not sure.

  39. What we do know, and have known since Obama introduced Obamacare, is that our healthcare system is becoming much more expensive.
    ==
    It does account for more in the way of value-added and revenue as compared to the whole, but the difference cannot be described as ‘much more’.
    ==
    I suspect if we want efficiencies in the health care sector, we need to do what Milton Friedman suggested in 1999 – have high deductible plans. Friedman’s idea was that half of total costs would be financed out of pocket from medical savings accounts and the other half financed through insurance provided by public treasury appropriations. I think we’d need a regulatory architecture to enforce price transparency.

  40. I an guessing that the approval of the assination by the left is fueled by hate for some who are wealthy, some, not those of the left who are wealthy.

  41. FWIW:

    I am paying $435/month for my Blue Cross/Blue Shield full coverage. I have been paying for the best plan (service) since I turned sixty five. Never tried to cheat the system and fortunately for me so far I have not needed anything other than my yearly exams and a small episode of TIA a few years ago. However, now that I am old they take it upon themselves every year to try to talk me into a “less expensive” plan. HA HA HA yeah baby, now that I am probably going to start costing you folks some money you want me to disqualify myself from your gold star service!! sheesh!

  42. Art Deco, you’re correct. Uncle Miltie was right about high deductibles and HSAs as a way to afford them. However, the Democrats don’t want people to have control over their healthcare. So, it hasn’t happened.

    From Alinsky’s eight steps to topple a nation:
    “1) Healthcare — Control healthcare and you control the people.”
    I always try to remember Sail Alinsky’s writings when I see what the Democrats are pushing.

  43. “He never suggested that. Taking this a little personally, aren’t we?” – Art Deco

    Not sure which part you think I’m taking personally. Americans are FAT.
    That increases the costs to healthcare subsidized/paid by taxpayers. Diabetes and heart disease are where it shows up among other health problems. The level of obesity in children is only going to increase the costs. Most of this is preventable with exercise and a healthy diet.

    Notice I did suggest we use incentives to encourage people to lose weight.

    My position is if we are going to subsidize/pay for peoples healthcare costs, we should require they participate with lifestyles that minimize their health risks.

    As to me personally, I had gone up to 220 lbs from 170 during a time I had a very sedentary job 20 years ago. I started exercising and watching what I ate and lost the 50 lbs. Most of it was from running and was working my way down to 160 when the knees went out. My weight has crept up and I need to lose 10-15 lbs. to get my BMI back to down to a healthy weight.

  44. Round is a shape most people get into.

    Beware, progressives and worse, use the logic of societal cost of personal choices to nudge or force individual compliance.

    Should there be a limit on the number of miles you run daily, the type of running environments, how often you change your shoes, the intensity of your running? After all, someone has to pay for your knee replacements? And when are you going to shed those excess pounds of adipose tissue?

    They mean well …

  45. Being an unashamed consumer of crime and detective novels since my youth, the scenario that first came to my mind on then hearing about Thompson’s financial problems was that he had hired a hit man to relieve him of that burden …

    AesopFan:

    I like they way you think!

    I recall at least two films which worked off that premise:

    –Orson Welles, “The Lady from Shanghai” (1947)
    https://archive.org/details/Lady_from_Shanghai_trailer

    –Warren Beatty, “Bulworth” (1998)
    https://www.youtube.com/watch?v=OferuuBo6eI

    I assume readers are aware of “The Lady from Shanghai.” Although it’s more complicated than that.

    Warren Beatty plays Senator Bulworth D-CA, a 60s liberal who has lost his fire and slid into casual political hypocrisy and dire financial straits. It’s actually not a bad film.

  46. om, you don’t have to run to lose weight.

    We need to improve the health of the country.

  47. Brian E:

    You brought that specific type of aerobic exercise to the table and provided an example, anecdote, of an injury that resulted. An overzealous progressive would conceivably step in to protect society (medical costs) from your poor judgement.

    Overuse injuries are not limited to running.

  48. @Art Deco:My guess is that the $4.5 tn figure being used by CMS combines the revenue of those providing health care and social assistance with the revenue to the insurance business of vending medical plans.

    No, it is not based on revenue at all, but on spending (CMS of course has access to paid medical claims), and it is not a double-count, and it is very close to the BEA estimates for health care expenditure historically (with the exception of 2020 and 2021, probably due to COVID payments). Since you accept the BEA as a source, this is what they say about the CMS National Health Expenditure, which they accept as an authoritative source:

    The Centers for Medicare & Medicaid Services’ National Health Expenditure Accounts (NHEA) produce detailed national data on spending by place of service and by payer. BEA’s National Income and Product Accounts produce national health care statistics, but do not produce statistics split out by payer. There are methodological differences between the two accounts.

    NHEA is one of the most widely cited sources for measuring expenditures in the health sector and is commonly used to measure health care as a share of GDP. BEA Data Applying NHEA Framework utilizes BEA data to produce timely estimates using NHEA health sector mapping to generate greater comparability between the estimates. Policymakers and the public can use these estimates to obtain a snapshot of the health sector, in a form comparable to the NHEA data.

    If you examine the 2nd row of the spreadsheet here you will see that the BEA figure for health care spending for 2023 is $4.653 trillion.

  49. @J. J.It’s called anecdotal evidence because each anecdote is unique, but they also show the personal effects of the system on hummin beings, not numbers.

    You made a sweeping claim about why health care is so expensive now for the whole country. That sweeping claim is simply wrong, regardless of what you personally experienced, because you are only one of the 350-ish million people contributed to that experience and your experience is valid, but only 1/350 millionth of what is happening for the whole country.

    I doubt that the amount spent on pro bono medical care shows up in the statistics because the costs are paid by the insured patients.

    Did you know that every hospital in Washington State has to publicly post their financial statements? You don’t have to guess. You can just look it up for that hospital that tried to tell you they have to overcharge you to make up for charity care. They have to tell the public where their money comes from and where it goes. The vast majority of it comes from Medicare, Medicaid, and commercial insurance and they charge commercial insurance 2-3 times as much as Medicare, to make up for the shortfall from Medicaid and Medicare, they say.

    The prices that Medicare FFS pays providers are set administratively through laws and regulations, and providers can either take them or leave them.

    CBO’s analysis and a review of the research literature found that commercial insurers pay much higher prices for hospitals’ and physicians’ services than Medicare FFS does. In addition, the prices
    that commercial insurers pay hospitals are much higher than hospitals’ costs.

    Here’s an article from the Kitsap Sun about the charity care in Washington. In that year, 2021, all charity care in all Washington State hospitals was $370 million. According to Washington State Hospital Association it is currently $180 million annually. Their 2023 total operating revenue was $33.7 billion. Like I said, a drop in the bucket.

    It is very important not to try to solve the wrong problem, or there will be a lot of time and effort just wasted.

  50. om, it wasn’t an overuse injury.

    This is just deflection on your part. We need to MAHA. Obesity is not healthy.

  51. Brian E:

    Obesity is unhealthy, but simple overweight is not necessarily unhealthy, and underweight is also unhealthy. What’s more we don’t know the long term effects of the newer meds to lose weight, and without those meds (or enormous interventions like gastric surgery) we also don’t know effective ways to treat overweight long-term. Please see this, this, this, and this.

  52. Neo, I’ll look at your links, but I’m not talking about being overweight. Right now, I’m overweight. I’m talking about obesity– and morbid obesity.

    According to the CDC:

    Obesity is a disease that can cause many health conditions such as asthma, heart disease, stroke, type 2 diabetes, some cancers, and severe outcomes from respiratory illnesses.

    https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

  53. @Brian E:We need to MAHA.

    Perhaps, but who can tell us how to do this? I don’t know how old you are, but in my half-century experts have not been able to provide consistent advice for “staying healthy”, not in one year, not over time. They cannot agree on why Americans, and also the rest of the developed world, are now so much more obese. They can’t tell us how to live so that you won’t get cancer, though they can tell you about some things you can stop doing that might lead to cancer if kept up (like smoking, though even most smokers don’t get lung cancer). There’s certainly vaccines that can prevent some diseases most of the time and certainly some drugs and interventions that can treat some diseases, but if there is any ambiguous and widely-agreed upon scientific information about how to “live healthy” that works for everyone so that you don’t develop chronic disease, I’m not sure what it would be.

  54. There are sweeping statements and there are these

    your experience is valid, but only 1/350 millionth of what is happening for the whole country.

    JJ’s experience may actually be 1/155 millionth. Because I says so.

    Brian E:

    If you had burned your calories on a bicycle or swimming you wouldn’t have injured your knees? Maybe.

    I’ve ran 8 marathons and have run pretty regularly since high school (50 + years). The knees are fine but it is hard to outrun the fork.

    Who is this we?

    It is a me or I choice of how to live.

  55. No, it is not based on revenue at all, but on spending (CMS of course has access to paid medical claims), and it is not a double-count, and it is very close to the BEA estimates for health care expenditure historically
    ==
    No, it differs from the BEA figures in just the way I told you. BEA figures on personal income and its disposition also list household expenditure on health care &c. which is actually about $200 bn lower than that of the revenue figure I gave you. (The discrepancy is accounted for, I believe, by the expenditures of non-profits on health services. General expenditures of non-profits are to be found in the personal income figures, but these are not broken down on purpose).

  56. @Art Deco: You won’t need the eight years I had in the finance department of a health insurance company to learn which figures mean what, but you will need more time than you have put in so far, and if you in isolation decide you want to use a different measure from everyone else, you can’t expect to get much into or out of the discussion.

    I already gave the NHE, that is the right measure that everyone who studies health care uses since about 1960, and everyone quotes including BEA, and I quoted BEA acknowledging that and producing a very similar number of its own. Maybe you didn’t look at their spreadsheet I linked to:

    “Total selected health expenditures in GDP: 4652.987 billion”

    They itemize what goes into that sum and you don’t have speculate about what is and is not in there.

    Here’s American Medical Association using NHE: $4.1 trillion for 2020 ($12,530 per capita). Their capsule description:

    The NHE are the official estimates of total U.S health care spending (Centers for Medicare and Medicaid Services, 2021a). These estimates provide a comprehensive picture of health spending as they incorporate all the main components of the health care system. The NHE not only includes expenditures for medical goods and services, but it also incorporates the financiers/origin of these expenditures. As such, it exhaustively encompasses all dollars flowing in and out of the health care system. Additionally, the estimates utilize common definitions and methods that allow for comparisons over time (dating back to 1960) and across categorization schemes.

    Here’s Kaiser Family Foundation using NHE: $14,944 per capita for 2023, $12,808 for 2020.

    Here’s US Department of Health and Human Services quoting NHE.

    World Health Organization database uses NHE: they have $4.2 trillion for 2022 and they report PPP-adjusted equivalents for other countries.

    If you are convinced everyone is just using the wrong number and has been for 60 years, each of those linked sites somewhere on it has a contact page where you can let them know that and why you think so.

  57. I can read their interactive data sets as well as you can, including those on personal income and gross output. These are the 2023 figures
    ==
    Table 2.3.5 is “Personal Consumption Expenditures by Major Type of Product”
    ==
    Household consumption expenditures for…
    “Health care” $3057.6 billion
    ==
    “Final consumption expenditures of nonprofit institutions serving households (NPISHs)”…
    $554.1 bn.
    ==
    Another table “Gross Output by Industry”
    ==
    “Health Care and Social Assistance”
    $3,287.5 billion.
    ==

    You have a complaint with the BEA, you get in touch with them.

  58. The AMA document I linked to has a short summary of where the NHE is spent (for 2020), and where it comes from, so you can see what’s included:

    Spending:

    In 2020, 4.7 percent of NHE went towards investment (or $192.7 billion) and, as discussed earlier, 5.4 percent towards public health activities (or $223.7 billion). Net cost of health insurance (i.e., the difference between what insurers incur in premiums and the amount paid in benefits that goes towards insurers’ administrative costs, taxes, fees, net profits/losses, etc.) made up 7.3 percent of total spending (or $301.4 billion). Government administration, which includes the administrative cost of running government health care programs, made up 1.2 percent of total spending (or $48.4 billion).

    The remaining 81.4 percent of total spending (or $3357.8 billion) went towards personal health care spending. The main categories of personal health care spending are hospital care (30.8 percent of total spending or $1270.1 billion), physician services (14.4 percent or $593.1 billion), clinical services (5.2 percent or $216.3 billion), and prescription drugs (8.4 percent or $348.4 billion)…

    …Personal health care spending also includes spending on nursing care facilities (4.8 percent of total spending or $196.8 billion), home health care (3.0 percent or $123.7 billion), and other personal health care services (14.8 percent or $609.2 billion).

    Sourcing:

    In 2020, the federal government was by far the largest sponsor, financing over one third of total spending (36.3 percent or $1498.7 billion), followed by households which financed over a quarter of total spending (26.1 percent or $1078.3 billion)… The smallest sponsors in 2020 were private businesses (financing 16.7 percent of total spending or $690.5 billion), state and local governments (14.3 percent or $588.0 billion), and then other private revenues (6.5 percent or $268.6 billion)

  59. @Art Deco: personal income and gross output.

    That is not health care spending, and I’ve linked already to where the BEA measures health care spending and gets basically the same number as the CMS NHE. I’m sure you know a lot of things, but in this case you are looking at the wrong measure. It’s up to you if you want to learn why one is and has been used for 60 years by people who work within health care, by people who administer and pay for health care, and by people who study health care, and not the other measure you’ve selected just now that is not trying to measure the same thing.

    I’ve given you plenty of links to learn more from if you’re so inclined, and if you’re not, well no one has time to try to learn everything and you have to pursue what interests you, as we all do.

  60. However did my grandparents survive, one hundred twenty years past, with
    NO HEALTH INSURANCE?

    How did doctors market their services, one hundred twenty years past, with
    NO HEALTH INSURANCE?

    Instead of murder we should push to abolish ‘Health Insurance’.

  61. Don’t consume seed oil, Cut out most carbs, eat meat , cheese and vegetables . Real food , just a little bit. You will loose weight. It’s simple, but may not be easy.
    Americans prefer easy. But also remember a patient cured is a customer lost. My previous Doc ,retired Flight Surgeon and grumpy old fart. Said ,,Avoid doctors. Only go to hospital if you’re close to death. Eat real food ,just a little.

  62. Apparently I’m the only one who shops at Walmart. Otherwise there wouldn’t be such surprise at the level of obesity in the country.

    We spend hundreds of millions of dollars on research on the sex lives of fruit flies, but we don’t know for certain why people are obese?

    Karen Hacker is director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion. She said there is not a singular approach to addressing obesity: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics and certain medications. This means that there is no one-size-fits-all approach.

    It seems likely, since our experts are unable to diagnose the condition, that genetics and medications will be a small subset of obese people. It would be helpful if our experts would spend some of the hundreds of millions of dollars on research on the sex habits of worms and discover exactly why too many Americans are obese.

    That leaves us with physical activity, eating and sleep. We don’t exercise, we supersize too much fast food, and we stay up to late watching garbage on TV.

    We need to tackle the problem beginning in grade school. One of my son-in-laws is a PE teacher in middle school. According to him, a subset of his students just tells him to f-off during his classes and refuse to exercise, and there is nothing he can effectively do about it.

    So that’s a problem.

    Even if we provide healthy food at a subsidized price, many/most Americans will continue to supersize their McDonalds/Burger King/Jack in the Box meals, which they eat too many times during the week.

    So that’s a problem.

    We could outlaw supersized meals, but I remember the outrage in Bloomberg tried to limit the size of soft drinks in NYC.

    So that’s a problem.

    Maybe we start with a little shame culture– and a heaping handful of forced help.

    We’ve taken “freedom” to the outer limits and we’re unable/unwilling to provide boundaries on unhealthy lifestyles.

    Case in point. We’ve just installed a Narcan vending machine in our library to keep the homeless drug addicts alive. Our city provides sleeping shelters and a warming center/showers during the night, but the residents have to leave during the day, and many spend the day keeping warm in the library. Needless to say, the local community isn’t pleased (not so much with the idea of providing Narcan, but the fact it’s at the library).

    We’re such “freedom” loving Americans we’re fine with leaving these people to live in their squalor and keep them alive if they OD, but not to help/force them to change their live choices.

  63. Brian E:

    I’m a Walmart shopper.

    Do you really think obesity hasn’t been studied enough? It’s been studied and studied and studied, and little seems to work for obese people except drugs and/or gastric surgery. The drugs have to be taken forever and have such bad side effects in a lot of people that they stop them. The surgery is a major major thing.

    I know two obese people – by the medical definition of obese, that is – who don’t eat any more than the thin people I know. I imagine that may be hard to believe, but it’s the case. These are people whom I’ve known for many many decades and at times have stayed with for extended periods of time, and I’m well aware of their eating habits both day and night. Neither ever eats fast food and one is inactive because of injuries, whereas the other is very physically active. They don’t live in any sort of “squalor” and are intelligent people and good friends.

    And yes, we as Americans allow people to make their own choices about food, in the name of liberty.

  64. Brain E:

    I am a Walmart shopper also.

    You want to nag and manage other peoples lives? Because money and taxes or for their own good because you are so wise?

  65. Where we used to live, about five miles apart were a version of Walmart and an upscale some kind of place. Where I would go if we expected guests who needed fair-trade, free-range, organic coffee flavoring or something. Forty seven varieties of olive oil. That sort of place. The customers all looked as if they were training for marathons. Not so much in the other place. By a lot.
    My father used to say that when your life is consistently unfortunate, a belly full of comfort might be the best you can manage.
    I recall a drawing in a psych class where a human’s features were exaggerated or shrunk by the number of nerve endings. The mouth was enormous. If nothing else is going on, you eat, smoke, chew a toothpick, drink something. Maximum stimulus to fill the blank of nothing going on. If your life is busy, maybe you don’t need it.

    Years ago, there was an article in the local paper about a hugely, morbidly obese woman in the hospital. By luck, I encountered a woman working on that floor. I observed that the hospital could control the calories going in. No, she said, the friends bring pizza and donuts.
    There is a neurological fault where, no matter how much is eaten, hunger is not satisfied and you must eat more and more and more. Wonder if that comes on a spectrum.

  66. @neo:The surgery is a major major thing.

    It doesn’t even work for everyone. Some people are refused it because they will still overeat despite the surgery. One of the requirements for getting the surgery is that you control your food intake and keep it controlled for some time before it. For example, UPMC requires a six month lifestyle program in advance, which includes “Begin and maintain a workout routine to reach and keep your weight loss goals.
    Lower your daily calories to a range between 1200-1500 calories (or in a range discussed with your doctor).”

    Once you have learned to do that, I guess the surgery makes it harder to backslide, but to me it seems the lifestyle changes would be sufficient if one stuck to them.

    @Richard Aubrey:Years ago, there was an article in the local paper about a hugely, morbidly obese woman in the hospital.

    In every one of the cases where someone is so obese that they have to be removed through the wall of their home, someone is feeding that person enough to maintain that obesity. Sometimes you have to dig way down into the article to ferret that information out.

  67. Neo, yes genetics can be a factor. But we should know what percentage of obesity is related to genetics or prescriptions and what is related to exercise/diet.

    As to squalor I was referencing the homeless drug addicts. A genetic/medical condition is something these folks have learned to deal with, but it does mean it’s physically harder for them to perform tasks others don’t face.

    But unless you have evidence to the contrary, I would expect the majority of obese people are in fact obese because of diet/exercise.

    I included my little sidebar about the Narcan because helping people not die from an overdose is only slightly more compassionate than allowing them to take the drugs that cause the overdose.

    We’ve made the drugs illegal because of the harm they do, but then are willing to cast a blind eye when they take the drugs and ignore the harm they do.

    Is sugar less addictive than fentanyl? It’s certainly less deadly in the short term, but still has negative effects. Are food processors putting additives that might make us want to eat their food more often?

    We banned smoking ads because of the psychological messaging that made smoking seem cool. We can approach food ads the same way.

    But I said in my first comment, we can add incentives to achieve a particular BMI.

    Eating healthy at first is painful. Quitting smoking is painful. Getting off drugs is painful. But to those who have dealt with all of these addictions, I doubt most would say it wasn’t worth the struggle.

    AI may actually benefit the research on how predispositions to various conditions interact. The key to that is recognizing early on who has markers for the various predispositions.

  68. @Brian E: I think you might have missed my question, but it was, if you want to “make America healthy again”, what actions are those supposed to be? Because there is not agreement that we know what kind of lifestyle would actually make people healthy in the sense of avoiding chronic disease, or that we know why people are so much more obese these days or how stop them being obese, or that we know how people should live so that they don’t get cancer.

    The magic bullets I can remember in my lifetime just off the top of my head include fiber, unsaturated fat, avoidance of salt, avoidance of red meat, avoidance of cholesterol, avoidance of sugar, avoidance of high fructose corn syrup, avoidance of seed oils, avoidance of white flour, avoidance of dairy products, low-carb diets, low-fat diets, oat bran, aerobic exercise, strength training, lots of multivitamins, and the food pyramid. Some of those are probably some good for some people, but who can say with assurance which those are and for whom?

    It’s all very well to say we can somehow change people’s lifestyle to make them more healthy, but no one can say what those changes should look like with any assurance they’d work for most people. So many times in my lifetime experts have proclaimed that this or that thing does it, only to find out later that it isn’t really true.

  69. Incidentally, I would love to see a study of life expectancy and chronic disease prevalence among doctors and nurses, controlling of course for education, income, socioeconomic status, etc compared to the general population. I strongly suspect they would not be different. And if the results showed that, I think it would be good evidence that either doctors and nurses don’t really know how to live healthier than other people, or that they simply don’t choose to live healthier despite knowing how.

  70. “…if you want to “make America healthy again”, what actions are those supposed to be?” – Niketas C

    Why don’t you ask me a hard question?

    I would change your list to moderation rather than avoidance, and whether low-carb diets or low-fat diets are the ticket is subject to much debate. It’s probably not one or the other.

    I tried using the glycemic index as a reference to healthy eating– but it’s probably too complicated for most people (including me).

    I would focus on helping kids eat healthy and learn the benefits of exercise. If our education system approached teaching healthy eating and exercise with the same enthusiasm as teaching gender fluidity, it could make a real change in attitudes. I remember when Michelle Obama tried to bring healthy menus into the cafeteria with limited/not much success. I’m not sure if the budgets for school lunches allowed for healthy and appealing meals.

    President Kennedy took on physical fitness. I’m not sure where that program is today (if it still exists), but we need to build/reintroduce on that idea.

    We need to create a program which is tied to BMI and provide payments for meeting goals of reducing your BMI. This will require making the federal government bigger– or it could be a pilot program which is then given to the states to institute.

    So MAHA needs to be encompassing in both insuring highly processed foods aren’t actually harming us as well as developing programs to incentives healthy lifestyles.

    There is certainly more than one diet program to get healthy.

    I would encourage fast food chains to quit offering super-sizing as a marketing tool. No more triple meat quarter pounders, huge fries and 64 oz. sugar drinks. I’d probably limit a meal to 1,200 calories and while a person could order higher calory meals they would have to order them separately. 1,200 calories is just off the top of my head– but that’s a large big Mac meal.

    I would create a national advertising campaign on healthy lifestyles– MACA (Making it Cool Again) to be healthy.

    When I first started losing weight (from 220 to 170) I used the app My Fitness Pal, which tracked nutrition using bar codes. Because I know have CKD and had a AKI event when given an antibiotic, I’m using it again to limit my intake of sodium and potassium (which is very hard by the way).

    That app should be installed on every phone. People would be shocked when they actually knew what they were eating. Knowledge is power.

    Why do different people respond differently to the same foods? Where is the research? We should be able to correlate certain reactions to food based on DNA/genes.

    I would be surprised if healthcare workers are significantly healthier (or marginally healthier) than the general population.

    https://www.healthline.com/nutrition/glycemic-index#gi-of-foods

  71. I was about 70 before realizing that I was getting old. At around 73-74 I knew I had become old.

    Had drank alcohol since about 17—stopped in 2006. Had smoked cigarettes since 30—stopped in 2009. Did all kinds of drugs starting at around 21-22—stopped…forget when I stopped, but around 55.

    Diet…puuuuuuuuuuleeeeeease! I do take multi vitamins at Dr. suggestion if I didn’t have a proper diet.

    Body had probably been in the process of dying before I noticed…

    Scientists discover the brain’s three ageing ‘waves’…and it starts before the age of 60

    Whether you’re turning 60, 70 or 80, everyone starts to feel ‘old’ at very different times.

    But our brains go through three distinct ‘ageing peaks’ throughout our lives, according to a new study.

    Experts have identified that levels of 13 proteins linked to brain ageing spike at 57, 70 and 78.

    One protein in particular, called Brevican (BCAN), is associated with the onset of dementia, stroke and movement issues.

    Another protein, called GDF15, has also been linked to age-related diseases.

  72. @Brian E:If our education system approached teaching healthy eating

    What exactly are they going to teach about “healthy eating” and on what scientific evidence will it be based? What will be the effectiveness of that teaching in preventing obesity and chronic disease, and on what evidence will effectiveness be judged, and what are you making kids do in the meantime until you have this evidence and everyone agrees on what it means?

    Why do different people respond differently to the same foods? Where is the research? We should be able to correlate certain reactions to food based on DNA/genes.

    Until that research is accomplished, what are we going to teach kids and make everybody do?

    That app should be installed on every phone.

    Are we also going to force everyone to make use of it? Make everyone have a phone so they can use the app? And what is the app going to guide us to do, and on what scientific evidence is that based, and how effective will it be and based on what evidence?

  73. Niketas, don’t let the perfect be the enemy of the good.

    We know enough about nutrition that will help the majority of Americans.

    I would stress in a MAHA school based program exercise and moderation. Reinforcing those two attributes would put kids on the path to healthy lives.

    As to a nutrition app, I think a majority/significant minority would respond to seeing what the makeup of the food they’re eating– which would lead to better outcomes.

    My company had annual fitness programs– mostly a steps program with a $50 gift card at the end. It was pretty successful. I would try and make it fun and competitive– maybe city against city, or state against state.

    What we do know is once a person has gained weight it’s harder to lose it long-term. Nutrition apps would help people make lifestyle changes that help keep weight off.

    There are lots of ways to lose weight– keeping it off is the challenge.

    My wife uses a plant based diet, one daughter uses intermittent fasting. Another daughter uses Ozempic– after losing weight using the plant based diet, she put weight back on. All have worked for them. Part of the challenge is we’re looking for magic fixes that don’t require any sacrifice.

    It’s certainly true the issues are complex why the growing obesity/chronic diseases in the country. Stress/anxiety/hectic lifestyles/too much fast food. Controlling stress/anxiety with alcohol/drugs.

    I think RFKjr will be good for the country. He might restore some confidence that the alphabet agencies overseeing much of the food/drug industries have the best interests of the people vs. captured by special corporate interests.

    Doing nothing isn’t going to make the problem go away.

  74. My oldest daughter is elementary school principal of an inner city school. I’ll talk to her about the effectiveness of a real effort to teach/influence these principles at that level.

    This brought to mind something I had read sometime ago about the difficulty of the military meeting its recruitment goals and a short search produced this:

    “The military has experienced increasing difficulty in recruiting soldiers as a result of physical inactivity, obesity, and malnutrition among our nation’s youth. Not addressing these issues now will impact our future national security.”

    Mark Hertling, Lieutenant General, U.S. Army (Retired)

    19% of active-duty service members had obesity in 2020, up from 16% in 2015.

    These individuals are less likely to be medically ready to deploy.
    Between 2008 and 2017, active-duty soldiers had more than 3.6 million musculoskeletal injuries.
    One study found that active-duty soldiers with obesity were 33% more likely to get this type of injury.

    Unfit to Serve
    Obesity and Physical Activity are Impacting National Security
    https://www.cdc.gov/physicalactivity/resources/unfit-to-serve/index.html

  75. @Brian E:Niketas, don’t let the perfect be the enemy of the good.

    I’m not looking for perfection. I’m looking for what is known to work for most people, and I’m pretty sure no one knows what that is.

    We know enough about nutrition that will help the majority of Americans.

    Help them to accomplish what, and what is it we know that will accomplish that and upon what evidence is that based?

    I assume “reducing obesity” is one of those things, and I know you don’t know what works for most people because I know nobody knows that.

    As for reducing chronic illnesses such as cancer, heart disease, or diabetes, why don’t you pick one, tell us what you’d have all the people in the country do, and on what evidence you know you would be able to get them to do that and that it will actually work if they do?

  76. I assume “reducing obesity” is one of those things, and I know you don’t know what works for most people because I know nobody knows that. – Niketas

    How do you know that nobody knows what works for most people to reduce obesity? If you know that, it will save me a lot of research.

    From What’s My Line, you don’t live in Yakima, but on the westside. Are you an actuary?

  77. I don’t want another busybody nudging, encouraging, hectoring, or legislating what my BMI should be.

    It is none of your business. What part of F off don’t you understand?

  78. om, stay healthy.

    The government incentivizes, subsidizes, penalizes all sorts of behavior. We see it most often in the form of taxes– but then wasn’t Obamacare just a tax?

  79. Brian E:

    I don’t need the government or some NGO telling me how to be healthy.

    Have you paid attention to Niketas’s recitations of all the government incorrect advice over the years?

    Beyond smoking they have a very poor track record (yeah I ran track as a teenager); notice their incorrect fearmongering about second hand smoke?

    So save you breath on MAHA or is it MAHA , HA, HA, HA?

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