48 words to good health?

OMG I love this “How to Be Healthy, in Just 48 Words” in the NYT:

Don’t smoke(2).

Get vaccinated (4).

Avoid trans fats(7).

Replace saturated fats with unsaturated if you can(15).

Cook from whole ingredients — and minimize restaurant meals(23).

Minimize ultraprocessed foods(26).

Cultivate relationships(28).

Nurture sleep(30).

Drink alcohol at most moderately(35).

Exercise as often as you can enjoy(42).

Drink only the calories you love(48).

I’m doing pretty damn good on most of these.  Could probably do better with fewer restaurant meals and more whole ingredients (but, really, is my daily restaurant-made pizza slice so bad?).  Also, as I think I’ve mentioned earlier, I think the “ultraprocessed” definition is too broad.  Pop tarts and granola bars are “ultra processed.”  But, so is Kashi Go Lean which I have for breakfast everyday (with fresh blueberries and raspberries) and has a hell of a good nutrition profile in my book.

Anyway, not a bad general guideline for healthy living.


Why health care reform is so, so damn hard

Last month some legislation with bipartisan elite support and overwhelming support from ordinary Americans who knew about the issue, was killed in Congress.  It would have ended the abominable practice of an in-network hospital employing an out-of-network group of ER physicians and you getting the killer bill to show for it.  There was a bill in Congress to solve this problem with support from politicians in both parties.  If anything should be able to pass, it should be something like this.  And yet… Margot Sanger-Katz:

Democratic voters eager to see “Medicare for all” or some other major health overhaul pass the next time they control the White House may want to take a close look at what happened this week in Congress.

Leaders from both parties had unveiled legislation to stop surprise medical bills, the often exorbitant bills faced by patients when they go to a hospital that takes their insurance but are treated by a doctor who does not. The White House and major consumer groups had also endorsed the plan, which was to be included in the year-end spending bill.

But to the negotiators’ consternation, the spending package that emerged on Monday — and was passed on Tuesday by the House — had nothing about surprise bills. The proposal’s apparent demise was not a result of partisan division, but instead reflected certain lawmakers’ reluctance to pursue an approach that would reduce doctors’ pay. Several of the key lawmakers who scuttled the deal were Democrats. [emphasis mine]

Very much related, another recent health care story in the Upshot, also from Sanger-Katz, “In the U.S., an Angioplasty Costs $32,000. Elsewhere? Maybe $6,400. A study of international prices finds American patients pay much more across a wide array of common services.”

Why does health care cost so much more in the United States than in other countries? As health economists love to say: “It’s the prices, stupid.”

As politicians continue to lament the system’s expense, and more Americans struggle to pay the high and often unpredictable bills that can accompany their health problems, it’s worth looking at just how weird our prices really are relative to the rest of the world…

The International Federation of Health Plans, a group representing the C.E.O.s of health insurers worldwide, publishes a guide every few years on the international cost for common medical services. Its newest report, on 2017 prices, came out this month. Every time, the upshot is vivid and similar: For almost everything on the list, there is a large divergence between the United States and everyone else.

Patients and insurance companies in the United States pay higher prices for medications, imaging tests, basic health visits and common operations. Those high prices make health care in the U.S. extremely expensive, and they also finance a robust and politically powerful health care industry, which means lowering prices will always be hard. [emphasis mine]

For a typical angioplasty, a procedure that opens a blocked blood vessel to the heart, the average U.S. price is $32,200, compared with $6,400 in the Netherlands, or $7,400 in Switzerland, the survey finds. A typical M.R.I. scan costs $1,420 in the United States, but around $450 in Britain. An injection of Herceptin, an important breast cancer treatment, costs $211 in the United States, compared with $44 in South Africa. These examples aren’t outliers.

This is why meaningful reform in the U.S. is so damn hard.  Lots of people make lots of money.  And money far out of line with what medical professionals and administrators make in other advanced democracies.  And nobody wants to give up all that money!  From the surgeons, to the GP’s to the radiology technicians, to the MRI machine sales force, to the hospital VP for marketing there a lot of money and nobody (for the most part) wants to give up a dollar of it.  And real reform means that they will have to.

The failure of the surprise medical billing legislation shows just how hard this is and how hard entrenched interests will fight to protect their profits.  I very much think we need more robust and substantial reform such that truly all Americans have health care coverage they can afford, but damn do I know it will be a really, really hard fight.  And, from my perspective, whatever can get us there politically is the right approach because it is so damn hard to get us there.

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