This is going to make me sound like a callous a-hole

[KTP]

Actually the bulk of our healthcare costs come from the elderly. The longer you live the more your medical care costs.

I think this has to be true. It would seem things are going to get a little bit worse too as the baby boomers start aging.

[cardtrick]

Actually the bulk of our healthcare costs come from the elderly. The longer you live the more your medical care costs.

Yes, and those costs are covered by medicare and not by private insurance. By that reasoning, private insurance shouldn't cost as much since it doesn't have to take on medical costs incurred by folks over 65. Even if you look at what individual medical procedures cost, they're way too expensive.

[Mjenn]

Edited - nevermind

[asmom]

I know the government shutdown should not be about the Affordable Care Act, but they are making it about that. It's all unfortunate, but I can't help but think about the ACA and how unfair it seems to me.

I realize that everyone wants healthcare and they all want it to be cheap, but is that even fair? I spend my life watching what I eat, exercising six days a week, maintaining my mental health (as much as possible), not smoking, seldom drinking, etc. The majority of our country is overweight. The biggest killer of our nation is heart disease. The strong and healthy are now supplementing the sick and weak. If it were an army, we would be doomed.

It's like all of the people who sat on the couch eating donuts get rewarded and all of the health nuts who pass on the cheesecake and get up for their morning run whether they feel like it or not, get to pay out the nose.

Of course there are exceptions, hereditary cancers and other diseases. But even many of the cancer patients are better off with a healthy diet and exercise.

Just seems like a few people sacrifice to build up a stockpile and those who didn't, get to come and raid it.

I am thankful for my health, but it doesn't get dropped in my lap. I really work hard for it. I should realize that it is it's own reward and leave it at that.

Would we allow everyone to pay the same amount for car insurance regardless of how reckless they drive?

Despite everything we've he been told, all bad health is not due to lifestyle. All good health is not due to lifestyle. Luck and genetics factor into both. Good health is it's own reward as you admit, why not enjoy it instead of judging others especially since your continued good health is not guaranteed. Resentment is such a wasted emotion.

[disneysteve]

Despite everything we've he been told, all bad health is not due to lifestyle. All good health is not due to lifestyle. Luck and genetics factor into both. Good health is it's own reward as you admit, why not enjoy it instead of judging others especially since your continued good health is not guaranteed. Resentment is such a wasted emotion.

All true. Genetics plays a big part and, at least at the moment, isn't correctable. But lifestyle is SO important. I think the vast majority of people don't really grasp how important it is. Smoking, drinking, doing drugs, not exercising, eating a crappy diet, etc. plays into so much of what I treat on a daily basis.

The single biggest health problem threatening this country by far is obesity (regardless of how you measure it). I agree that there are some limitations to BMI but it is a good solid starting point to evaluate someone. And I don't need any fancy calculation to know there are serious health risks to someone weighing 250 pounds or more as an alarming number of my patients do, and that number is steadily growing.

We had to replace our office scale because it "only" went to 350. It was perfectly adequate for years but little by little, the number of patients we could no longer weigh got too high so we needed a scale that could accommodate them. And the number of children in my practice who are at least 100 pounds overweight is mind-boggling and incredibly alarming.

We used to have one oversize BP cuff that floated between all of the exam rooms. Now, we have one in every room and it gets used on a majority of patients. Not only that, but there is a growing number of patients who are too big for that one and we can no longer check their BP.

Until there is a serious effort to combat obesity, the healthcare system is going to be more and more overwhelmed. No government healthcare system or private healthcare system is going to be able to manage the health and cost consequences if people don't start taking responsibility for their own well being.

And again, that's not to say that every health problem is self-induced. It is not. But if we could focus on fixing the ones that are, costs would plummet and we'd have a lot more resources to help the people that aren't able to fix the problems themselves.

[JoeP]

All true. Genetics plays a big part and, at least at the moment, isn't correctable. But lifestyle is SO important. I think the vast majority of people don't really grasp how important it is. Smoking, drinking, doing drugs, not exercising, eating a crappy diet, etc. plays into so much of what I treat on a daily basis.

The single biggest health problem threatening this country by far is obesity (regardless of how you measure it). I agree that there are some limitations to BMI but it is a good solid starting point to evaluate someone. And I don't need any fancy calculation to know there are serious health risks to someone weighing 250 pounds or more as an alarming number of my patients do, and that number is steadily growing.

We had to replace our office scale because it "only" went to 350. It was perfectly adequate for years but little by little, the number of patients we could no longer weigh got too high so we needed a scale that could accommodate them. And the number of children in my practice who are at least 100 pounds overweight is mind-boggling and incredibly alarming.

We used to have one oversize BP cuff that floated between all of the exam rooms. Now, we have one in every room and it gets used on a majority of patients. Not only that, but there is a growing number of patients who are too big for that one and we can no longer check their BP.

Until there is a serious effort to combat obesity, the healthcare system is going to be more and more overwhelmed. No government healthcare system or private healthcare system is going to be able to manage the health and cost consequences if people don't start taking responsibility for their own well being.

And again, that's not to say that every health problem is self-induced. It is not. But if we could focus on fixing the ones that are, costs would plummet and we'd have a lot more resources to help the people that aren't able to fix the problems themselves.

Excellent post, Steve.

[dojo]

If you allow me .. a view from the 'outside'.

1. Obesity in the US is staggering

I have never in my life seen what I was able to see in my 18 months spent in the US. I saw KIDS who were twice my weight at the tender age of 10-14. And we're not talking one kid. I have seen people who we can't call obese in my country (since we usually use this word for those who are around 200-250 lbs.), I don't think we have a word for it, honestly. This is not normal.

And it's clear that someone who's BMI is so off the charts cannot be healthy. So the entire medical system is losing money trying to give them all a chance for a normal life (which is not bad in itself), while others (like me for instance and the member who opened the thread), eat healthy and exercise, while the 'system' has to care for us when we give birth or have an operation we do need (which is not caused by being obese)

2. Medical care in the US is EXPENSIVE

Our friend had a knee surgery: 60k bucks. His wife gave birth 7 years ago, 14k for a natural birth with epidural. I will give birth in Europe in 4 months and I'm looking at around 2K bucks. Private hospital, excellent conditions. I wanted to also get the surgery at my knee (similar to what my friend in the US had, we seem to be both very lucky) - it's again around 2K. Don't think I'd be operated in the woods, we talk private modern hospitals.

Why is the medical service this expensive in the US compared to Europe? We don't have cheap services here either, there are lots of amazing doctors and wonderfully built hospitals .. and still ...

3. The insurance companies in the US are something themselves

I am shocked to read about the issues you guys have with them. I mean you are paying MONTHLY some insane fees and yet, if you need a doctor, you still need to pay. Yeah, co-payment. If you, god forbid, have a heart attack, you might sell your house to cover the bills. It's not normal for someone's health to bankrupt them. It's not normal for your bills to not be paid by the insurance company, cause they found a loophole. Totally shocking.

4. The people who game the system

We all have them. People who could get their butts to work, but would rather not. People who game the system anyway they see it's possible, while YOU are paying the bills. It's a huge deal in my country and I'm sure in yours too.

And it's not OK to pay for someone else's mistakes. It's not OK to pay for someone else's laziness. I really keep my fingers crossed for all of you, we have dear friends in the US and don't like seeing them having to suffer from a sick system.

[JoeP]

My take is that some people treat the health care field as a giant shopping mall. With the staggering number of advertisements that suggest we "see our doctor" to learn more about how this or that drug can treat our conditions, this clearly increases demand and load on our doctors and put more money into the insurance companies' pockets.

It used to be you'd go out and exercise and control your weight through healthy eating. Now, you're given a free pass to treat your body like a landfill, and when your joints start hurting, you can simply ask your doctor if Jointevia is right for you. Or if Coronaria will take care of those stabbing chest pains you get walking from Coldstone to your car. Or if Intestina is the right medication for the gluten issues you've developed over the years.

[Nika]

I don't know where people get the idea that if it was free, than everyone would go to doctors just for kicks. That is ridiculous. I have excellent health insurance (much better than my DH's federal one). They pay for everything.

And I barely manage to keep up with recommended yearly visits (behind half a year on some of them) because it is hard to find time. And I try to be as responsible as possible and do things like yearly physicals. (Preventative care might save money in the long run.)

Yes, I see some problems caused by irresponsible consumers -- I am on a local facebook group for moms, and those moms seem to think that ER is the proper route to go whenever anything is wrong with the child.

In my almost 3 years of parenting, I have yet to take my child to the ER once. He had crazy high fevers, like every child, and what I do is get emergency appointment with my pediatrician (who has been really good about that), or if it is 1 a.m., call emergency service of my pediatrician's office and talk to the Dr. on duty.
(I keep a record of his fever progression, time and dosage of his medication, when was the last time he peed, etc. to give the most accurate information I can.)
They call back in 5 minutes always. So not only do I not incur an ER bill (which I would not have to pay, it would be covered by insurance) but I don't drag my sick child to sit in the ER waiting room for hours, slowing down service for people who need it. All just to get the same treatment he would get from his pediatrician (who knows him and his history).

But when I suggested in most tactful terms that if I am concerned enough to consider taking my child to the emergency room, I would not ask advice of strangers on the internet, but would instead call an MD who has training and responsibility to his patient, my response was called rude.

But I don't know, perhaps it is a culture of not having proper health insurance that trained people to think that ER is the main route for all their concerns.

[Reggie]

Steve has it right. The obesity problem is breaking us.

[TBH]

I don't know where people get the idea that if it was free, than everyone would go to doctors just for kicks. That is ridiculous. I have excellent health insurance (much better than my DH's federal one). They pay for everything.

And I barely manage to keep up with recommended yearly visits (behind half a year on some of them) because it is hard to find time. And I try to be as responsible as possible and do things like yearly physicals. (Preventative care might save money in the long run.)

Yes, I see some problems caused by irresponsible consumers -- I am on a local facebook group for moms, and those moms seem to think that ER is the proper route to go whenever anything is wrong with the child.

In my almost 3 years of parenting, I have yet to take my child to the ER once. He had crazy high fevers, like every child, and what I do is get emergency appointment with my pediatrician (who has been really good about that), or if it is 1 a.m., call emergency service of my pediatrician's office and talk to the Dr. on duty.
(I keep a record of his fever progression, time and dosage of his medication, when was the last time he peed, etc. to give the most accurate information I can.)
They call back in 5 minutes always. So not only do I not incur an ER bill (which I would not have to pay, it would be covered by insurance) but I don't drag my sick child to sit in the ER waiting room for hours, slowing down service for people who need it. All just to get the same treatment he would get from his pediatrician (who knows him and his history).

But when I suggested in most tactful terms that if I am concerned enough to consider taking my child to the emergency room, I would not ask advice of strangers on the internet, but would instead call an MD who has training and responsibility to his patient, my response was called rude.

But I don't know, perhaps it is a culture of not having proper health insurance that trained people to think that ER is the main route for all their concerns.

The parents I know who take their children to the ER a lot do so because their children have specific health issues that make it necessary. My child is almost 10 and he has only been to the ER once when he needed stitches. We took him to his pediatrician first, and they sent us to the ER. We have had many late-night calls to the pediatrician with fevers, asthma attacks, and other ailments. I consider it a matter of luck, not superior parenting, that has kept us out of the ER. I am very glad your almost-3-year-old has not required an ER visit. I sincerely hope that it never becomes necessary.

I also sincerely hope that the OP never finds out the hard way that exercise and a healthy diet cannot prevent the scariest medical conditions. The arrogance of healthy people is really mind-boggling.

[hamchan]

I got Medicaid for a short time as a newly single mom living on a sub poverty income. I did get more medical care, because, well... at the time I was sick. That's why I couldn't work full time and my income was low. But I didn't get unnecessary stuff done just for the hell of it. If I got anything unnecessary it was because I trusted my doctors and didn't know any better.

Contrast that to now, where my husband and I each have a 2k deductible. Now I largely ignore medical issues until they cannot be ignored any longer because we can't afford any more medical bills than my DH already has. Is that really better?

The concept of moral hazard doesn't exist when it comes to healthcare. People may consume less healthcare if they have to pay more for it, but they still have unneccesary stuff done (because their doctor tells them they need it) and they don't get care they do need. This has been studied and confirmed.

As for premiums going up, I'm not seeing that. I spent some time yesterday on my state's health plan exchange, and premiums for comparable plans beat out the cost of any Cobra coverage I've ever been offered by hundreds. This is not even considering the fact that my husband and I would never have been able to get a private policy in the past due to preexisting conditions. We don't qualify for any subsidies at all either. It gives me a lot of peace of mind, knowing that will be an option if we ever lose employer coverage.

[hamchan]

http://www.forbes.com/sites/timworstall/2012/03/22/alcohol-obesity-and-smoking-do-not-cost-health-care-systems-money/

As much fun as it might be to scapegoat fat people and smokers, it's not reality.

[disneysteve]

I don't know where people get the idea that if it was free, than everyone would go to doctors just for kicks. That is ridiculous.

As someone in the field, I can tell you it is not ridiculous at all. I deal with it every day. When a patient of mine goes to a local ER, I get a report of that visit. The report says the date and time they were seen, the reason for the visit, and the length of time they were having the problem before they presented to the ER. I would say conservatively that 75% of the visits occur during the time that our office is open and available to see them but they don't bother to call us. They just go straight to the ER. Those reports also show that the presenting symptoms have been present for anywhere from several days to several weeks. In other words, they aren't going for emergencies. But those visits cost the system 10 times as much (or more) than if they would have come to see me in the office instead.

Another phenomenon is repeat ER users. Patient goes to hospital A on Monday morning. They don't feel any better later so that evening they go to hospital B. The next day they go to hospital C. In some cases, that all happens without them even filling the prescriptions ordered at hospital A or B.

I can post lots of other stories and examples that I assure you are not rare or unusual but I don't have time at the moment.

[bjl584]

http://www.forbes.com/sites/timworst...systems-money/

As much fun as it might be to scapegoat fat people and smokers, it's not reality.

Tim Worstall (the author of that article) is a blogger and a precious metals trader. He is also an activist for environmental causes. I'm not sure what his credibility is so far as being a nutritionist or an expert on human health issues. I would like to know where he is getting the information in that article, but he didn't provide sources. So, what he is saying should probably be taken with a grain of salt.