The Home of Steven Barnes
Author, Teacher, Screenwriter

Tuesday, July 28, 2009

Obesity and Health Care

I can understand doubt about the degree to which an UHC system would impact obesity statistics. No one can make an absolute statement about how much improvement would take place. But, again, the following cases can be made from my perspective:

1) the argument that weight is not a matter of calories in and out is simply specious. I know it doesn't seem that way, but it is simple truth, a fact of physics, and cannot be effectively argued against. The fact that so many people with weight problems insist that this is NOT true demonstrates that one of the largest problems is lack of accurate information. Every time you argue against this, you make my point for me: a medical system that included accurate education would certainly have a positive effect.

2) People with weight issues who don't control BOTH calories in AND out simultaneously are asking for failure. So when you tell me about so-and-so who went on a 1400 calorie diet and failed to lose weight...I have to shake my head. Drop the calorie level, and your body will slow its metabolic rate to try to compensate. Exercise alone, and you'll unconsiously add calories. Living systems crave homeostasis. If you want to deal with the issue, you have to control both sides. Again, the amount of arguing about this reinforces my point: people don't really know what works. Or if they do...

3) Weight issues involve self-image, fear, grief, anger, and power. The actual behaviors are relatively simple (even if difficult. I never said it wasn't hard. I said that there is a vast amount of disinformation). But people would rather believe that their bodies are somehow malfunctioning than believe that their emotions and/or intellect may not be operating at peak efficiency. We can argue about how much use therapy is--that is valid. But note that I believe that our mental and emotional health impacts our physical health, and that therefore that would be a part of an effective national health program.

4) Again, I'm not talking about "a little chubby." But if you are obese enough that it impacts your health, social life, energy, or whatever, I suspect that there are actually reasons you want the armor. Any time people complain about social rejection, hurting joints, lack of sex life, problems at work, and so forth, all connected with an issue that can be affected by behaviors, I have to think that they are concealing information from themselves. When pain exists, and we fail to move away from it, either we are confusing short and long-term pleasure (a primary test of adulthood) or there is a hidden benefit. I simply have too much respect for people to assume that this is all accidental. No...this shit fell on us like a bomb post WW2. Marty asked if I would abandon writing if I discovered ditch-diggers lived longer.

Nope. Quality of life matters as well. But I might ask WHY ditch diggers live longer, note that they get fresh air and exercise, and incorporate that into my plan. The major reason I believe that a huge amount of weight is emotional and/or ignorance is the simple fact that so few people can look directly at the physics of it and cop to the fact that they have made a choice. So few people look at the "my friend went on a 1000 calorie diet and didn't lose weight" and not automatically trip to the flaw in the experiment: maintaining the same caloric output despite the metabolic tendency to slow down under starvation conditions.

The vast amount of just basic confusion and misinformation reminds me of the various Cell Phone and Long Distance plans, or Credit Card plans--so incredibly complicated that there was obviously never any intention of a customer being able to actually figure out what they are paying for. Anyone who grasps the cold equation of calories in/calories out cannot blame their body for its weight. They can say they DECIDED to be fat, but then they lose all rights to complain, don't they? By believing in things that are insanely complex (it's my blood type! My moon sign! My mother's sister had the problem! etc.) but less probable than UFOs (I wouldn't be surprised if an alien contact is verified. I would be shocked to hell if anyone ever produced so much as a hamster whose body broke the laws of conservation of matter and energy.) they get to have their cake and eat it too. So to speak.

I don't believe in lazy people. I believe in people who have no clear goals, or see no path to them, or have no internal permission and belief that would let them move in that direction. Such people then create mythologies to explain why they "can't." And when you listen to excuses from the poor, or black, or whatever about how life is bending them over the long horse, and you think "wow, what's wrong with them? Can't they see the opportunity around them?" remember that it is a totally human tendency to bend reality to try to make the external world responsible for our own fears and flaws.

This flaw, which infects most human beings one way or another, will surface in one of the three major arenas: fitness, career, or relationship. I've met damned few people who didn't have it in one of the three. Those who didn't, in general, had vast compassion for those who do--they know what it actually costs to look directly into our wounds, and suture them up.

And why do I say "wounds"? Well, once again, I'm not talking about "a little chubby." But by the time you are suffering emotional or physical pain, or reducing life span, or costing money...either you move away from that pain, or it is reasonable to assume something is blocking you. If you keep confusing short and long term pleasure, it is reasonable to assume that, in that arena, you are still a child. And it is seeing that tendency to confuse the simple if the simple doesn't give you the answers you want that makes me shake my head when it comes to political debates. As you know, I think that people start with a world view, and then look for the information to back it up. And the information is always there, no matter how radical the basic world view.

My own? According to at least three tests, I come out "slightly left of center" politically. If I seem more than that, might I suggest that means that you are simply far enough right to skew your perspective.

Human beings are deletion creatures (thank you, Tony Robbins). When I see people confusing something they are more than intelligent enough to grasp it, then I assume that they have an emotional need to confuse the issue. And if I see this in an arena like body, mind, or relationship, I automatically assume that their reality map is suspect--they will do the same thing elsewhere. Of course, the truth is that it is the safest assumption that we ALL do that. Which is the reason that I look at all three arenas. If someone has no lasting relationships, an alarm goes off. If they are intelligent but unsuccessful with their money, an alarm goes off. If they are healthy enough to walk but carry enough weight to make another human being (say...more than about 50 pounds?) an alarm goes off.

I recently was dumbfounded by all of the outpouring of surprise about Michael Jackson. People acted as if we had no clue there was anything wrong. That it was shocking beyond belief to learn of his drug use, yada yada yada. All I could think was: if this was surprising to you, I'll bet you have had many disappointments in the arena of relationships. That you have been lied to, and cheated, and never saw it coming. That you think men, or women, are somehow alien creatures beyond understanding. Because if you couldn't see the vast dysfunction that was Jackson, I strongly suspect you are editing reality to avoid seeing the truth of your own existence.

We do these things. Relationships require honest communication and time, as well as boundaries. Finances demand control of both income and expenditure. Physical fitness requires both as well. But the reason fitness is such an indicator is that, of the three, it is the only one you can really improve without serious cooperation from others. You can't have a relationship without at least one other person saying "yes." Otherwise, I believe that's called stalking. You can't make money without the cooperation of dozens, sometimes hundreds of people. But our bodies, to a unique degree, are about us--our actions, our values, our behaviors, our emotions, our minds. And that is one of the reasons we would like to complicate the issue. We don't want people looking at us and saying: I know what you do, and I know how you feel. I know your values.

We all do this to each other, but it is embarrassing, and we want our privacy. Look--fewer than half of Americans say they love their jobs. But they work them, because they want the results. So saying "I don't like to exercise" is all well and good, but it requires more than "I don't like" to explain aversion to something which, in less than two hours a week, can provide such benefits. Human beings do far more, for far less. To me, the explanation is that the body stores our pain, is a repository for all the negative stuff we don't want to deal with. That it armors us against grief and loss, makes us seem less vulnerable to an uncaring or dangerous world. Unless I believed there was a pay-off for the pain, I would think Americans were stupid and lazy...and I believe the exact opposite.

I believe that most of us are good, decent, hard-working, honest people with an average problem-solving ability that would take us to our dreams, if only we could unhook the brakes. That the 20th Century brought us massive success but with it some environmental shifts that created some of them being obesity. And that we will solve them as soon as the map is clarified.


None of this "means" that Nationalized health care IS a good idea. This is just one of the reasons I support it. Of course, I could be wrong. But so far, modeling the results others have gotten has worked just fine. I see no reason not to apply this to nations as well as people.


Reluctant Lawyer said...

One piece of annecdotal evidence regarding obesity and UHC. My wife is an occupational therapist who worked in the UK system as well as the US. She frequently deals with people rehabing after orthopedic operations such as hip and knee replacements. The replacement parts used in these surgeries simply will not last as long as they should if the person is significantly overweight. Doing such operations simply leads to having to perform the same operation again when the part wears out. Under the UK system, she said that the doctors often would refuse to perform the operation until the person loses weight. Under the US system, the doctors would still perform the surgery.

Marty S said...

Steve: if its really all about physics, calories in and calories out, explain this portion of my life experience. Prior to puberty my doctor was concerned about how underweight I was. He would ask my mother if I ate enough. The word skinny is how people would describe me. My mother fed me malteds, puddings with whip cream and cherries, anything I would eat in an effort to fatten me up. Nothing worked. I stayed skinny. Then I went through puberty. Same calories in, same amount of exercise so same calories out, but in a year's time I was buying cloths in the husky department.

Marty S said...

Just had another thought. I drive Ford contour. Lets say Dan drives a 400 horsepower supercharged Vanden Plas. I suspect that no matter how well I keep my Ford contour tuned and no matter how lazy Dan is about maintaining his 400 horsepower supercharged Vanden Plas. His car is still going to out perform mine in a race. So why can't you accept the idea that some people are Ford Contours and need to exercise a lot more and eat a lot less to maintain the same weight as people who are 400 horsepower supercharged Vanden Plas and use calories more efficiently.

Daniel Keys Moran said...

I don't believe in lazy people.

Probably the two most useful things anyone has ever told me came from you and my sister.

Part of the lifewriting exercise was to find the "wino in your heart." A wino will lie in the gutter in his own urine ... until you tell him there's a bottle of wine waiting for him across the street. Then he'll get up and trot on over. He's not lazy; he has bad desires -- but he has desires and will act to fulfill them.

I've always done a decent job of entertaining myself, but the conscious use of the wino in my heart dates to that lifewriting seminar, 20 years ago. It's made a huge difference in my ability to motivate myself over the years.

The second useful advice came from my sister, also almost 20 years ago. One day I was completely paralyzed with indecision about what to do next -- had a todo list past 5 pages -- and Jodi said, "Do what's in front of you." In my head that's the "wash the dishes" advice -- even if you're procrastinating, which I don't do much, at least you're procrastinating with something productive instead of something useless or even harmful.

Find the wino in your heart. Do what's in front of you. Those may not be anyone else's most useful advice, but I have to think they'd be at least somewhat useful for anyone.

Steve Perry said...

Marty --

Most people don't know how much they eat. If they are skinny and trying to gain, they tend to believe they eat way more than they do; if they are fat, they believe they eat less than they actually do.

One of the first things most diets will ask of you is to make a list. Every bit of everything that goes into your mouth should be written down. Every bite.

All of a sudden, what you thought you were doing meets what you are really doing, and it's very often not the same. Broken cookies count.

Obese people who say they eat like birds tend to find out that such is true -- but the birds are vultures, not parakeets.

You remember that your mother fed you baskets of food, but I suspect nobody kept actual track. It seemed like a lot, but the fact is -- and this is where the science stuff comes is -- that if you take in more than you burn, the surplus has to go somewhere. If you hold steady, then you aren't eating too much or too little.

When I was twelve, I started lifting weights like crazy, to get big and muscular. It didn't work. The quality and quantity of food I ate wasn't enough to allow me to gain mass. I didn't know any better, and that one protein shake a day wasn't enough to offset the exercise I was doing.

I'm not making this up. It's how the universe as we know it runs. You can't hold steady if you burn more or less than you consume, you will gain or lose. Period.

Anybody tells you anything else is trying to sell you something. If you believe this, you are fooling yourself. So are the other people who are massively obese and scratching their heads in wonder. Three in a hundred might have a genetic/metabolic excuse. The rest are simply ignorant, and most of them don't really want to know.

Listen to yourself. You are the exception to the way the universe works? Really?

There are a host of things than can affect your metabolic rate and most people don't think about them. Did you know that if you are lean and fit, you burn more calories just sitting still than you do if you are fat?

Exercise doesn't have to be formal -- X-number of hours playing ball or in the gym, you can get it by accident.

Lot of kids are fidgety. They can't sit still. In a chair, they waggle a foot, stretch, move around, and they do it constantly and unconsciously. It burns juice.
If you hit puberty and stop wiggling and everything else is the same, you'll start to gain weight. Over a year, five years, ten years, this can build up into major pounds.

Your life experience is that you thought you ate like four horses and you didn't gain weight. The reality is that you didn't really eat as much as you thought.

Marty S said...

Steve Perry: You never ate dinner at my house. My mother always put a lot of food on your plate and let you know she was hurt if you didn't finish it. Anyhow let me try one more analogy to make my point. You have two houses that are identical accept for their heating systems. They have identical furnaces that produce identical amounts of heat when burning identical amounts of identical fuel. But they have different delivery systems. One uses forced warm air and the other uses baseboard heating. If the two houses start at the same temperature and you simultaneously turn on the two heating system and measure the changes in temperature in the two houses after say ten minutes you will get two different results because the two types of delivery systems have different efficiencies. To get the two houses to the same temperature you have to burn different amounts of fuel. All I am postulating is that different people have different delivery systems so to do a certain amount of work, i.e. lift a dumbbell or walk a mile, they burn different amounts of fuel.

Steve Perry said...

Marty --

I'm not saying we are all cookie-cutter the same. I am staying that the leeway allowed by physics only stretches so far. You might burn four calories a minute walking while I burn seven, but that variation doesn't speak to the law that you take in ten and only burn five, you'll have extra, and it that energy, if not used, doesn't just ... go away.

You might have to work harder or less so. Your motor might be more or less efficient, but the base equation, no matter how you gussy it up, comes down to the same for both of us: If we burn more than we take in, we will lose weight.

Stop feeding anybody, sooner or later they starve.

I'd be happy to recant with but one example that said different -- only nobody has ever produced one. A truly obese person can go a long time burning fat and drinking water and survive, but eventually, the stored fuel runs out.

If we burn less than we take in, it stays with us. If we burn more, we lose. If it is equal, we stay the same.

Sure, some people have slow metabolisms and they need fewer calories than those who have fast ones. But the process is the same, and the end result is always the same.

What we hear, over and over again, is "Well, my metabolism is weird. I can eat one grain of rice and balloon up like a whale. So it's not my fault and I can't do anything about it."

This is a rationalization, and it's simply not so. You might have to work harder to do it. You might not want to bother, it might not be worth the effort, and that's your right, you don't have to, it's your life. But it is almost always -- lacking two or three percent -- because you won't, not because it is impossible.

What Barnes -- and I -- get on rants about here is the notion that obese folks think they are special cases untouched by the laws of the universe. And a willful ignorance that won't let them see that.

It doesn't mean they are bad people. It means they don't want to hear it. Hard to get out of a cage if you refuse to believe you are in one.

Marty S said...

Steve and Steve: I don't disagree that if someone eats little enough and/or exercises enough that they can lose weight. What I am saying is for some people maintaining a normal weight is easy, while for others because of they way their body work it is much harder. There are two women in my neighborhood who are heavy, and who I see walking all the time at a good pace. They have been doing this for at least several years, but look just as fat as they did when I first saw them. Maybe they spend the rest of the day eating up storm. But if they are bothering to exercise I am imagine they watch what they eat at least some what. The walking is just not enough exercise to burn whatever they do eat. The problem with most people including myself is we don't exercise enough. But the only type of exercise I like is sports, when I've tried exercising for the sake of exercising its always bored me and I given up in a short time. Drop me in the middle of a Yellowstone or some other place worth seeing and I'll walk till I drop, but walking around the neighborhood seeing the same houses all the time is not how I want to waste my life.

Anonymous said...

"... modeling the results others have gotten has worked just fine. I see no reason not to apply this to nations as well as people."

In principle, there isn't any reason you shouldn't do this.

In the practical case of health care, it's not clear that you're going to really be modelling what you want to model, partly because the U.S. really isn't just France or Japan with higher costs, and partly because the savings being promised from Obamacare are deeply unlikely.

--Erich Schwarz

Bennett said...

If you've got about half an hour to listen, the above interviews present three different viewpoints, from people who have actually experienced and/or run Canadian health care, which might shed some light on what the system is like.

The gist of what I got from it is that it's neither superior nor inferior, simply different, and that some Middle European countries like Germany and Switzerland are doing even better by hybridizing the best elements of /all/ world systems.

On a semi-related note, about this whole 'black bag' theory on the body. I sat around for years in college and immediately after just getting softer and physically lazier. This impacted me emotionally, in relationships, you name it. And I have to give Mr. Barnes credit for helping me out of that tailspin. I was looking around at writing courses, and the philosophies of Lifewriting didn't just get me writing, it got me back into martial arts, playing the guitar, and actually /doing/.

But the weirdest thing is... when I'm lifting weights or doing yoga or the like and don't play the radio or something to distract me, when I do it as moving meditation? That's when the bad thoughts come. Worries about other people, stresses about future. It's like all that stuff bottled up in my body is coming to the surface. And it tempts me to just bag it, curl up into a ball, and accept mortality. But if I keep going, it boils off and I feel better, I think better, and I live better. There really is something to be said for squeezing the bag until it empties. Some bad shit will come up to the surface, but there's some major goodies underneath.

And thank you, Steven. I know sometime back you asked what brought people out of depression? I've tried medications, therapy, everything. And what did it was learning how to /live/, and I give your teachings a goodly amount of credit for that.

Daniel Keys Moran said...

Life Expectancy for the US versus countries with universal health care.

Anonymous said...

Great diagram, Dan, but do you seriously expect Obamacare to give us the behavioral patterns and eating habits of the Japanese? Because I don't. And if it doesn't, then trying to ape the Japanese -- and, in all likelihood, instead getting Britain's NHS on steroids -- isn't going to turn the tide.

Which leads me to a more general point. Steve, you've kept repeating two assertions -- one of which I agree with from personal experience, the other of which I shake my head in astonishment at.

Assertion 1: obesity can be seen as an illness that reflects both the body and the spirit, and teaching people to become more conscious of the interconnection between the two can help them achieve previously impossible goals of fitness and weight reduction.

I wholeheartedly agree, not least because I took your advice and found that it worked! I've been thinner for four years because of it. Allegedly, that's impossible. So I take this point very seriously.

Assertion 2: Adopting Obamacare will somehow lead to everybody in America feeling that "we're all in this together," which in turn will lead to generally accepted social encouragement and mild shaming that will encourage people to pursue integrated mind-body wellness.

And at this point ... I just roll my eyes. There are so many non sequiturs here I hardly know where to start. But I'll start with the most obvious one:

you can't mass-market personal revelation!

You can't, as a top-down mass marketed coercive government program, make tens of millions of people all start doing Tibetans, keeping an absolutely strict calorie intake book, and eating a lot of fresh foods at home (which is how I ended up implementing your advice four years ago). There's lots of reasons why you can't, best summarized as:

the Christians will think you're teaching devil worship (!);

the feminists will think you're teaching misogynistic lessons about female body image;

people who are just plain terrified of their inner psyches -- which, to be brutally honest, is about 98% of the population -- will go absolutely kittywumpus if they even start trying your advice and start experiencing greater awareness of the pain they buried under fat.

That latter group includes a lot of your own political allies, like Al Gore. And it's a huge group.

From time to time my friends have asked me how I've gotten in shape. I've pointed them at your stuff. So far, not one of them that I know of has really taken it up and tried it -- even with the evidence, in front of their eyes, that I've got a hold of something that works way better in real life than any fad diet or quack nostrum. Their lying eyes can tell them that I'm fitter and even younger-looking. And I just hand them the instruction manual for how I did it -- literally, I have bought extra copies of your Five Minute Miracle DVD and given them away to people who I hoped would try them.

No luck. And I think I know why. That fat and out-of-shapeness really is an anesthetic -- and most people are not even dimly used to the idea that ramping up their awareness, in some sense, is supposed to hurt at first, but that the pain is basically OK.

You're expecting Obamacare to make that sort of thing not only accepted, but universal? And advocated by the government? Over the objections of the Christians, the feminists, and everybody else with an axe to grind who likes keeping people as unconscious victims?

Dude, I wish!

--Erich Schwarz

Daniel Keys Moran said...

but do you seriously expect Obamacare to give us the behavioral patterns and eating habits of the Japanese?

Nope. But the French are second on that list, and their diet's not wildly different from ours; but they live (just eyeballing the chart there) about three years longer, on average.

And then there's the other 17 countries that live longer than we do ....

I'll tell you this much, though: I'd bet good money the U.S. is near the top of that list ... for Americans who've had medical insurance their whole lives. Compare insured Americans with insured Japanese or insured French, I bet we come out pretty good, once you've omitted the uninsured who drag down those stats.

A little rough on the uninsured Americans, of course, but perhaps we can feel better about American medicine.

Anonymous said...

"But the French are second on that list, and their diet's not wildly different from ours..."

You're kidding, right? We eat and drink just like the French do? In the same quantities of daily calories and the same amounts of red wine? The French eat as many Fatburgers as we do? Wow.

"A little rough on the uninsured Americans, of course..."

...which tend to get used as a blanket rationale for completely witless permutation of the existing medical system, rather than rationally analysed:

"On the 47 million people without health insurance point, that too is a statistic where there is less than meets the eye. First, health insurance does not equal health care (there are not just emergency rooms but cash-based clinics, and conversely, a lot of people with insurance don't get good health care). Second, of that 47 million, 14 million are already eligible for existing programs (Medicare, Medicaid, veterans' benefits, SCHIP) yet have not enrolled, 9.7 million are not citizens, 9.1 million have household incomes over $75,000 and could but choose not to purchase insurance, and somewhere between 3 and 5 million are uninsured briefly (<2 months) between jobs. That leaves about 10 million Americans who are chronically without insurance. Needless to say, extending the blanket of coverage to this group should not cost $1.5 trillion and require a wholesale overhaul of all of medicine."

--Erich Schwarz

Anonymous said...

I don't agree that people do not have the proper information about how to lose weight. Again, I will use the example of my husband. He is an educated man from a financially average background. He has never been poor and uninformed. He knows how to lose weight. He has done it before. He graduated second in his class at the police academy and holds a brown belt and several trophies from Karate competitions. He made his way through college on a baseball scholarship. We are insured, he has access to medical care and he has information about nutrition and fitness. And he has been obese since the death of his mother, whose food was his only childhood comfort.

Let me tell you about my sister and her husband. They are both registered nurses and are both obese. Her husband is near being morbidly so and has even taken to drinking every night since the weight has become a more pressing issue that can no longer escape his attention.

And then there is my mother. She is a fat doctor from a very large family where she suffered emotional neglect (and god knows what else). I have seen things like this around me all of my life (and I'm getting a little long in the tooth, but don't tell anyone as I hide it well with my size 8 jeans and expensive face slop even though I come from the same family as my mother and like to drink. I am an educated woman with money and health insurance, mind you. It doesn't stop me. I hurt.)

I don't believe in lazy people, either. And I don't believe in 'educated idiots'. I think there is a lot more going on with weight than not having the knowledge about how to correct the problem. As I said, I believe access to healthcare is very important for people, but I don't think it's going to change obesity rates as much as we might hope.

It's not about medical information. It's about very personal information and the ability to look at it. That is not something that medical insurance can provide. As soon as I find out what can provide it, I will let you know. And I won't stop looking until I find it.

Marty S said...

Life is made up of a lot of little choices that add up. Everyone makes these little choices because of who they are and what's important to them and not necessarily because they are emotionally sick. I am a diabetic who started out as a hypoglycemic. I still have a problem that frequently my blood sugar suddenly drops and I become faint if I don't eat something to bring it up. Consequently when I leave the house I carry with me a fruit cereal bar in case this occurs. I buy a variety of these bars each of which has a different number of calories. I could only buy the one with the fewest calories and this would be a small contribution to keeping my weight down. But, I make the choice for variety and always take a different bar than I did the last time. I don't think this means I am either depressed or otherwise psychologically ill.

Daniel Keys Moran said...


You're kidding, right?

Lessee ... there are 19 countries with universal health insurance where people live longer than in the U.S. You have objections to comparing the U.S. with the Japanese, because we're so very different. You have objections to comparing the U.S. with the French, because though we're much less different, we're still so very different.

I suppose you can post "You're kidding, right," 17 more times, but it's not much of an argument.

Anonymous said...

"You have objections to comparing the U.S. with the French, because though we're much less different, we're still so very different."

My objections aren't to the comparison, but to the inference you're drawing from it -- namely, that rearranging the entire existing health care system in the U.S. will be a good idea.

Seeing the comparison tells me that the French and many other countries manage to do adequately with their existing set-up. It doesn't tell me how much of these successes depend on free-riding on the American market for innovation in pharmaceuticals or medical technology, which the U.S. tends to pioneer because it actually allows innovations to be sold at a profit. It also doesn't tell me, on the one hand, how much of the U.S.'s inferiority in aggregate life expectancy depends on lifestyle issues that are likely to be recalcitrant to top-down social engineering, or, on the other hand, how much of our statistics depends on things like trying to save premature infants instead of letting them die unrecorded as live births.

My specific incredulity about France is the one I've expressed before about obesity statistics and diet: do you really think that our current statistics are independent of the substantially higher level of obesity we have here in the U.S. versus much of the rest of the industrialized world, e.g., France, or essentially any of those 17 other countries? And do you really think that saying giddily "we're just like the French" makes it true, in the case of the pretty nontrivial variable of excess body weight and diabetic predisposition?

Believe it or not, I have no objection to adopting best practices from other countries that actually can be usefully implemented here. My problem is that, when I look at Obamacare, I see something that'll be much more effective at damaging the positive -- and rather scarce -- virtues of the existing American health care system, than it has any chance of being effective at making everybody in America eat smaller meals, eat fewer cheeseburgers and more lean meats, fruits and vegetables, walk around more, etc. I also see something that's likely to give us the same problems that the British and Canadian health systems infamously have, which aren't captured well by a simple life-expectancy stat but which are bloody awful if your mother just died in the hospital of iatrogenic Clostridium difficile.

--Erich Schwarz

Daniel Keys Moran said...

namely, that rearranging the entire existing health care system in the U.S. will be a good idea.

Yes, I think universal health care is a good idea. If we can get there without rearranging the entire system, I'm OK with that -- but I don't value the system as you do and would be OK with it being done away with entirely and replaced with something like single payer.

Right wing critics of universal health care have been floating horror stories of what Will Happen ... but the horror stories about what Has Happened are much worse and, more to the point, real. Anyone who's interested can google up case after case after case of people who died because their private health care screwed them in the name of profits. Republicans did zero to fix this, and are now howling because Democrats are attempting to.

Our priorities are different. Zero question about that.

Anonymous said...

"Right wing critics of universal health care have been floating horror stories of what Will Happen ... but the horror stories about what Has Happened are much worse and, more to the point, real."

The whole point of being an adult, I thought, was that one did not have to jump off the Empire State Building to find out, first-hand, that yes jumping off tall buildings is a bad idea even if all the cool kids think it's neat, and even if you haven't tried it yourself yet.

We're currently seeing the Democratic Party advocating a bill that, by the most impartial estimates of the Congressional Budget Office, will cost an extra one trillion dollars to extend medical insurance to 10 million chronically noninsured people. If we lived in a society that had 10x the per capita GDP of the actual U.S., I could shrug that off. But not only do we not live in that society, we are living in a society that's simultaneously about to have its productive economy kneecapped by a combination of cap-and-trade-and-rent-and-seek with a complete, continuing ban on large-scale expansion of any domestic energy source capable of carrying gigawatts of peak load demand (e.g., nuclear fission).

In other words, we're about to shoot ourselves both in the medical and in the macroeconomic foot simultaneously -- all so that the Democrats can feel like they're Doing Something and Showing Those Republicans. Glorious.

I don't object to Obamacare because it's compassionate, I object to it because it's economically wasteful, medically unlikely to achieve its alleged goals, and technologically very likely to cripple biomedical innovation -- one of the few things that our biomedical system in the U.S. does uniquely well.

I'm not opposed to compassion, I'm opposed to stupid compassion.

"Our priorities are different. Zero question about that."


--Erich Schwarz

Daniel Keys Moran said...

:-) Good thing they don't need your vote.

Anonymous said...

"Good thing they don't need your vote."

Let's hope I'm wrong about my reasons for withholding my vote. If Obamacare really is the greatest thing since canned beer -- if it really manages to improve medical care for the needy without crippling future improvements in medicine, and without costing a vast amount of wasted money that we can't spare -- then, great! I'll be delighted to have been wrong.

Conversely, if Obamacare does end up being the gigantic screw-up that I'm dreading, then the fact that my vote wasn't needed will be the least interesting fact about it. In that case, we'd all better hope that the Blue Dog Democrats manage to derail it, "Waterloo" or not.

--Erich Schwarz

Pagan Topologist said...

I still believe that there are certain toxins which a person's body cannot excrete, ever. Some of these are stored and sequestered in fat tissue so that they do not cause bad toxicity problems, and yes, the person can lose weight, but only by accepting that he or she will be sick all the time. A recent study in the March issue of Occupational and Environmental Medicine demonstrated that women whose mothers had large exposures to DDT and its metabolites while they were pregnant with them were up to 20 pounds heavier on average.