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You want to fix today's health cost in the US?

That's wrong, even though it's right, First, we could fix end-of-life care decisions by requiring Medicare beneficiaries to have living wills that specify what they actually want done. Although this was demonized by partisan Republicans, it would vastly improve the status quo. In practice, most people really don't want the pointless crazy expensive stuff with which guilty families now afflict their dying days.

Meanwhile, and because I apparently haven't said it enough to get everyone's attention:

IT IS A MATTER OF DOCUMENTED EFFING FACT THAT WE JUST PAY WAY TOO MUCH FOR EVERYTHING, WHETHER IT'S THE STUFF WE NEED AND WANT OR THE STUFF WE DON'T NEED AND DON'T WANT. WE SHOULD STOP PAYING SO EFFING MUCH FOR EVERYTHING.
That is all. (For now.)
Oh my. You really are naive about this

Advanced directives about end life care don't do much about costs. Even hospice care is expensive. A friend recently took a year to die of cancer. Costs were high and advanced directives were even in effect. The costs to get to the point of futility of treatment to kick in the directives are significant.

You are making stuff up again. Nobody demonized end of life directives.
 
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Oh my. You really are naive about this

Advanced directives about end life care don't do much about costs. Even hospice care is expensive. A friend recently took a year to die of cancer. Costs were high and advanced directives were even in effect. The costs to get to the point of futility of treatment to kick in the directives are significant.

You are making stuff up again. Nobody demonized end of life directives.

So we didn't all see that dimwit numbskull Palin running around screaming "DEATH PANELS" every time end of life care or advanced directives was brought up? Really? And now you're saying you guys didn't demonized it. Wow, you have even less credibility than that Alaskan Idiot and that's saying something.
 
Oh my. You really are naive about this

Advanced directives about end life care don't do much about costs. Even hospice care is expensive. A friend recently took a year to die of cancer. Costs were high and advanced directives were even in effect. The costs to get to the point of futility of treatment to kick in the directives are significant.

You are making stuff up again. Nobody demonized end of life directives.
It's odd that you bang on and on about the cost of end-of-life care while denying that advance directives can reduce such costs. There's good evidence that this commonsense measure can in fact reduce costs.

And I'm gobsmacked by your claim that "Nobody demonized end of life directives." Your heartthrob Sarah Palin famously did, and like the rest of the GOP, you joined in.
 
So we didn't all see that dimwit numbskull Palin running around screaming "DEATH PANELS" every time end of life care or advanced directives was brought up? Really? And now you're saying you guys didn't demonized it. Wow, you have even less credibility than that Alaskan Idiot and that's saying something.

Give it a rest. You simply don't know what you are talking about.

The death panel issue is different from the advance directive issue. The former applies to treatment that could be effective, such as do we 90-year-old granny a heart transplant. A death panel must be convened to weigh in on that treatment so long as the public pays. Each patient is different and there wouldn't be a one-size-fits all answer. The advance directive issue has to do with when a patient is terminal and treatment is futile. The issue is do we needlessly keep the patient alive. Nobody demonized advance directives.
 
It's odd that you bang on and on about the cost of end-of-life care while denying that advance directives can reduce such costs. There's good evidence that this commonsense measure can in fact reduce costs.

And I'm gobsmacked by your claim that "Nobody demonized end of life directives." Your heartthrob Sarah Palin famously did, and like the rest of the GOP, you joined in.

Still naive

Yeah advanced directives help some with costs but not a lot. The real issue is how much treatment do we allow for an otherwise healthy granny when she isn't terminal? Do we give her a new hip? A new heart? The answer to questions like these have nothing to do with advanced directives because granny can tell us what she wants.* There is no one size fits all answer. Each patient is different. So long as limited public funds are at risk we must have death panels to set priorities.

* edit: This is where skin in the game could save some money. If granny's decision has finanicial implications for her family, she might live with a sore hip.
 
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Still naive

Yeah advanced directives help some with costs but not a lot. The real issue is how much treatment do we allow for an otherwise healthy granny when she isn't terminal? Do we give her a new hip? A new heart? The answer to questions like these have nothing to do with advanced directives because granny can tell us what she wants.* There is no one size fits all answer. Each patient is different. So long as limited public funds are at risk we must have death panels to set priorities.

* edit: This is where skin in the game could save some money. If granny's decision has financial implications for her family, she might live with a sore hip.
Our main problem isn't overutilization. We pay about twice what other developed countries pay because our health care providers charge much more for every item from ambulance rides to prescription drugs to medical devices to hospital stays. If we paid the same unit prices that prevail in other developed countries we could afford to give Granny a new hip.
 
Our main problem isn't overutilization. We pay about twice what other developed countries pay because our health care providers charge much more for every item from ambulance rides to prescription drugs to medical devices to hospital stays. If we paid the same unit prices that prevail in other developed countries we could afford to give Granny a new hip.
 
Both sides are right, the crux of our health care spending problem is morbidly obese health care executives.
 
Rock: My family has just gone through two major medical procedures. It depends on what you mean by "overutilization". From what I have seen in the last week, overutilization and abuse of test and procedures, is a very real problem.

You're probably right on the cost. The bills haven't started coming in yet. But the reasons for those high charges have been documented here many times.
 
Our main problem isn't overutilization. We pay about twice what other developed countries pay because our health care providers charge much more for every item from ambulance rides to prescription drugs to medical devices to hospital stays. If we paid the same unit prices that prevail in other developed countries we could afford to give Granny a new hip.

Why should we ever give granny a new hip? Government heath care resources will always be limited and some how we need to establish priorities. Most all of the countries you want us to imitate have done that. In those places urgent care is fine, almost anything else has to wait.

Also, the problem i'm talking about isn't over-utilization. Health care in the last years of life is the question I am talking about. That is a different issue because that is when everything starts falling apart.
 
Okay, Dr. Welby. Surely your 47 years of experience have given you the basis to do something more useful than diss me and express contempt for your patients. I'm sure you must be chock full of helpful policy suggestions. By all means, heal both our discourse and our policy. I'm all ears.
Now that's funny! Can't wait to hear Dr. Welby reply. :)
 
Why should we ever give granny a new hip?
Because she needs one.
Government heath care resources will always be limited and some how we need to establish priorities.
Why are only government resources limited?
Most all of the countries you want us to imitate have done that. In those places urgent care is fine, almost anything else has to wait.
Some developed countries have what we'd consider long wait times for elective procedures, but others don't. For example, France, Switzerland, the Netherlands, and Germany all have wait times comparable to ours, and they all pay much less than we do for coverage we'd regard as generous. (See the chart at page 42.)
Also, the problem i'm talking about isn't over-utilization. Health care in the last years of life is the question I am talking about. That is a different issue because that is when everything starts falling apart.
Whatever you call it, you're arguing that we should save money by affording less care to the elderly. I think that ought to be the last thing we do. Instead, we should pay less money to health care providers -- which is the way that every other developed country keeps health care costs down.
 
Give it a rest. You simply don't know what you are talking about.

The death panel issue is different from the advance directive issue. The former applies to treatment that could be effective, such as do we 90-year-old granny a heart transplant. A death panel must be convened to weigh in on that treatment so long as the public pays. Each patient is different and there wouldn't be a one-size-fits all answer. The advance directive issue has to do with when a patient is terminal and treatment is futile. The issue is do we needlessly keep the patient alive. Nobody demonized advance directives.

Advance directives are end of life directives. And the "death panel" that you're trying to scare everyone with already existed, it just consisted of one doctor instead of a "panel". If you wanted your 117 year old mother to have a heart transplant to keep her alive, the cardiologist would have refused to do the surgery anyways. It would be considered malpractice because any reasonable person would see that as excessive. Advanced directives take effect when someone is either 1) no longer able to make their wishes known 2) actively dying 3) already dead and we need to know whether or not to attempt CPR. So actually you can give it a rest. And for you to deny your own party didn't demonized advanced directives, well, you're either purposefully lying or you have Alzheimer's and we need to implement any advanced directives you may have in place.
 
Advance directives are end of life directives. And the "death panel" that you're trying to scare everyone with already existed, it just consisted of one doctor instead of a "panel". If you wanted your 117 year old mother to have a heart transplant to keep her alive, the cardiologist would have refused to do the surgery anyways. It would be considered malpractice because any reasonable person would see that as excessive. Advanced directives take effect when someone is either 1) no longer able to make their wishes known 2) actively dying 3) already dead and we need to know whether or not to attempt CPR. So actually you can give it a rest. And for you to deny your own party didn't demonized advanced directives, well, you're either purposefully lying or you have Alzheimer's and we need to implement any advanced directives you may have in place.

Because she needs one.

Why are only government resources limited?

Some developed countries have what we'd consider long wait times for elective procedures, but others don't. For example, France, Switzerland, the Netherlands, and Germany all have wait times comparable to ours, and they all pay much less than we do for coverage we'd regard as generous. (See the chart at page 42.)

Whatever you call it, you're arguing that we should save money by affording less care to the elderly. I think that ought to be the last thing we do. Instead, we should pay less money to health care providers -- which is the way that every other developed country keeps health care costs down.

Yes, all health care dollars are limited

But public funds are limited by budgets and appropriations. And disbursements are controlled by policy and politicians. Private funds are limited by what we pay for insurance contracts and the level of care is established when the contract is entered into.

So we have enough money in the budget for one hip replacement and two patients needing them, how do you decide?

I'm not defending the amount we pay per unit of care. That is a huge problem. My issue is, which you ignore, is that Obamacare not only didn't address this item, in some ways made it worse.

We started this subthread with talking about end of life care costing too much. Stay focused here. We may need to provide "less care" to the elderly. That is what advanced directives do. There are other areas where less care might be appropriate. But more importantly, we need to provide the same care for less money. The fee for service model is the enemy of our system and it is made worse with eldercare because the need for services goes up dramatically. . With Obamacare the democrats doubled down on fee for service in medicare while it cut funds to further develop the capitation plans that were a sensible GOP idea. At least we must work towards eliminating all fee for service for all of medicare and then establish a way to set priorities.

Finally, no GOP official demonized advanced directives. That is simply made up either because people lie or are ignorant.
 
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And these people that can't find grocery stores somehow still find the ability to stuff 5000 calories a day into their gut. Shocking!!
As I explained above, poor people are disproportionately likely to be obese due to the circumstances of poverty:

Limited resources and lack of access to healthy, affordable foods.
  • Low-income neighborhoods frequently lack full-service grocery stores and farmers’ markets where residents can buy a variety of fruits, vegetables, whole grains, and low-fat dairy products (Beaulac et al., 2009; Larson et al., 2009). Instead, residents – especially those without reliable transportation – may be limited to shopping at small neighborhood convenience and corner stores, where fresh produce and low-fat items are limited, if available at all. One of the most comprehensive reviews of U.S. studies examining neighborhood disparities in food access found that neighborhood residents with better access to supermarkets and limited access to convenience stores tend to have healthier diets and reduced risk for obesity (Larson et al., 2009).
  • When available, healthy food is often more expensive, whereas refined grains, added sugars, and fats are generally inexpensive and readily available in low-income communities (Drewnowski, 2010; Drewnowski et al., 2007; Drewnowski & Specter, 2004; Monsivais & Drewnowski, 2007; Monsivais & Drewnowski, 2009). Households with limited resources to buy enough food often try to stretch their food budgets by purchasing cheap, energy-dense foods that are filling – that is, they try to maximize their calories per dollar in order to stave off hunger (Basiotis & Lino, 2002; DiSantis et al., 2013; Drewnowski & Specter, 2004; Drewnowski, 2009). While less expensive, energy-dense foods typically have lower nutritional quality and, because of overconsumption of calories, have been linked to obesity (Hartline-Grafton et al., 2009; Howarth et al., 2006; Kant & Graubard, 2005).
  • When available, healthy food – especially fresh produce – is often of poorer quality in lower income neighborhoods, which diminishes the appeal of these items to buyers (Andreyeva et al., 2008; Zenk et al., 2006).
  • Low-income communities have greater availability of fast food restaurants, especially near schools (Fleischhacker et al., 2011; Larson et al., 2009; Simon et al., 2008). These restaurants serve many energy-dense, nutrient-poor foods at relatively low prices. Fast food consumption is associated with a diet high in calories and low in nutrients, and frequent consumption may lead to weight gain (Bowman & Vinyard, 2004; Pereira et al., 2005).
Fewer opportunities for physical activity.
  • Lower income neighborhoods have fewer physical activity resources than higher income neighborhoods, including fewer parks, green spaces, bike paths, and recreational facilities, making it difficult to lead a physically active lifestyle (Estabrooks et al., 2003; Moore et al., 2008; Powell et al., 2004). Research shows that limited access to such resources is a risk factor for obesity (Gordon-Larsen et al., 2006; Sallis & Glanz, 2009; Singh et al., 2010b).
  • When available, physical activity resources may not be attractive places to play or be physically active because poor neighborhoods often have fewer natural features (e.g., trees), more visible signs of trash and disrepair, and more noise (Neckerman et al., 2009).
  • Crime, traffic, and unsafe playground equipment are common barriers to physical activity in low-income communities (Duke et al., 2003; Gordon-Larsen et al., 2004; Neckerman et al., 2009; Suecoff et al., 1999). Because of these and other safety concerns, children and adults alike are more likely to stay indoors and engage in sedentary activities, such as watching television or playing video games. Not surprisingly, those living in unsafe neighborhoods are at greater risk for obesity (Duncan et al., 2009; Lumeng et al., 2006; Singh et al., 2010b).
  • Low-income children are less likely to participate in organized sports (Duke et al., 2003). This is consistent with reports by low-income parents that expense and transportation problems are barriers to their children’s participation in physical activities (Duke et al., 2003).
  • Students in low-income schools spend less time being active during physical education classes and are less likely to have recess, both of which are of great concern given the already limited opportunities for physical activity in their communities (Barros et al., 2009; UCLA Center to Eliminate Health Disparities, 2009).
Cycles of food deprivation and overeating.
  • Those who are eating less or skipping meals to stretch food budgets may overeat when food does become available, resulting in chronic ups and downs in food intake that can contribute to weight gain (Bruening et al., 2012; Dammann & Smith, 2010; Ma et al., 2003; Olson et al., 2007; Smith & Richards, 2008). Cycles of food restriction or deprivation also can lead to an unhealthy preoccupation with food and metabolic changes that promote fat storage – all the worse when in combination with overeating (Alaimo et al., 2001; Dietz, 1995; Finney Rutten et al., 2010; Polivy, 1996). Unfortunately, overconsumption is even easier given the availability of cheap, energy-dense foods in low-income communities (Drewnowski, 2009; Drewnowski & Specter, 2004).
  • The “feast or famine” situation is especially a problem for low-income parents, particularly mothers, who often restrict their food intake and sacrifice their own nutrition in order to protect their children from hunger (Basiotis & Lino, 2002; Dammann & Smith, 2009; Dietz, 1995; Edin et al., 2013; McIntyre et al., 2003). Such a coping mechanism puts them at risk for obesity – and research shows that parental obesity, especially maternal obesity, is in turn a strong predictor of childhood obesity (Davis et al., 2008; Janjua et al., 2012; Whitaker, 2004).
High levels of stress.
  • Low-income families, including children, may face high levels of stress due to the financial and emotional pressures of food insecurity, low-wage work, lack of access to health care, inadequate and long-distance transportation, poor housing, neighborhood violence, and other factors. Research has linked stress to obesity in youth and adults, including (for adults) stress from job-related demands and difficulty paying bills (Block et al., 2009; Gundersen et al., 2011; Lohman et al., 2009; Moore & Cunningham, 2012). Stress may lead to weight gain through stress-induced hormonal and metabolic changes as well as unhealthful eating behaviors (Adam & Epel, 2007; Torres & Nowson, 2007). Stress, particularly chronic stress, also may trigger anxiety and depression, which are both associated with child and adult obesity (Anderson et al., 2007; Simon et al., 2006).
Greater exposure to marketing of obesity-promoting products.
  • Low-income youth and adults are exposed to disproportionately more marketing and advertising for obesity-promoting products that encourage the consumption of unhealthful foods and discourage physical activity (e.g., fast food, sugary beverages, television shows, video games) (Institute of Medicine, 2013; Kumanyika & Grier, 2006; Lewis et al., 2005; Yancey et al., 2009). Such advertising has a particularly strong influence on the preferences, diets, and purchases of children, who are the targets of many marketing efforts (Institute of Medicine, 2006; Institute of Medicine, 2013).
Limited access to health care.
  • Many low-income people lack access to basic health care, or if health care is available, it is lower quality. This results in lack of diagnosis and treatment of emerging chronic health problems like obesity.
 
With Obamacare the democrats doubled down on fee for service in medicare while it cut funds to further develop the capitation plans that were a sensible GOP idea. At least we must work towards eliminating all fee for service for all of medicare and then establish a way to set priorities.
As I point out every time you repeat this claim, it is false. Obamacare included provisions to encourage reliance on accountable care organizations that would move away from fee-for-service, and under Obama Medicare is moving rapidly away from fee-for-service:

HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.​
 
Wow, those stats are really depressing: "the average American woman now weighs 166.2 pounds – nearly identical to what American men weighed in the 1960s. And U.S. men have expanded greatly in the same time period, having gained nearly 30 pounds from the 1960s to 2010 – 166.3 pounds to 195.5 pounds today."

I also find it interesting that the average male waist is now 39.7 inches. Does anyone else think that seems really big for an average weight of 195.5?

I was the local international grocery store last weekend (Jungle Jim's--a must see place if you are ever in Cincinnati with time to kill). I was shocked by the number of people I saw riding motorized scooters; all of them using a scooter because they were morbidly obese. And then I saw the family with a couple of obese kids under 10, everyone in the family sipping on a soda they had picked up in the store.

What makes all of this even sadder is that Americans are getting fatter and fatter by eating pure crap. It's not like we're getting obese because we eat too many chicken thighs in a butter-tarragon sauce, or homemeade apple pie a la mode, or too many third glasses of Bordeaux after dinner. No, we're eating and drinking crap!
I would be happy to get down to 195. 72 pounds to go. (So far I have lost 27)
 
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Rock: My family has just gone through two major medical procedures. It depends on what you mean by "overutilization". From what I have seen in the last week, overutilization and abuse of test and procedures, is a very real problem.

You're probably right on the cost. The bills haven't started coming in yet. But the reasons for those high charges have been documented here many times.

Holy crap . . . things alright at Joe's?

You one of the majors?
 
They lied about a provision of the then-bill that would reimburse doctors for providing end-of-life counseling. Politifact made this the lie of the year.

As I said, nobody demonized advanced directives

Your link is talking about a different issue. The law, medicine, and counseling, about advanced directives was very well developed and implemted across the country before Obama ever took office. The obama care proposal did two things (1) allowed yet another fee for service for somehting that was happening anyhow, and (2) was scoped to go into the issues not inolved with advanced directives and to discuss what we have been talking about, that is appropriate care for people not in a situation where an advanced directive would apply.
 
As I point out every time you repeat this claim, it is false. Obamacare included provisions to encourage reliance on accountable care organizations that would move away from fee-for-service, and under Obama Medicare is moving rapidly away from fee-for-service:

HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.​
Yes you mentioned this often

But it isn't working and the abuses with fee for service are worse than ever. And the quality assurance stuff is okay, but not as effective as capitation plans. Plus the administrative overhead for the obamacare solution is horrendous, both for the providers and for the payers. Under pure capitation plans, the incentive to have effective care is structural, not an accessory. As I said, public mental health has been out of fee for service for years, the system isn't great because of lack of fundings, but it is much better than Medicare which Obama is doing its damnest to perpetuate without material changes.
 
As I explained above, poor people are disproportionately likely to be obese due to the circumstances of poverty:

Limited resources and lack of access to healthy, affordable foods.
  • Low-income neighborhoods frequently lack full-service grocery stores and farmers’ markets where residents can buy a variety of fruits, vegetables, whole grains, and low-fat dairy products (Beaulac et al., 2009; Larson et al., 2009). Instead, residents – especially those without reliable transportation – may be limited to shopping at small neighborhood convenience and corner stores, where fresh produce and low-fat items are limited, if available at all. One of the most comprehensive reviews of U.S. studies examining neighborhood disparities in food access found that neighborhood residents with better access to supermarkets and limited access to convenience stores tend to have healthier diets and reduced risk for obesity (Larson et al., 2009).
  • When available, healthy food is often more expensive, whereas refined grains, added sugars, and fats are generally inexpensive and readily available in low-income communities (Drewnowski, 2010; Drewnowski et al., 2007; Drewnowski & Specter, 2004; Monsivais & Drewnowski, 2007; Monsivais & Drewnowski, 2009). Households with limited resources to buy enough food often try to stretch their food budgets by purchasing cheap, energy-dense foods that are filling – that is, they try to maximize their calories per dollar in order to stave off hunger (Basiotis & Lino, 2002; DiSantis et al., 2013; Drewnowski & Specter, 2004; Drewnowski, 2009). While less expensive, energy-dense foods typically have lower nutritional quality and, because of overconsumption of calories, have been linked to obesity (Hartline-Grafton et al., 2009; Howarth et al., 2006; Kant & Graubard, 2005).
  • When available, healthy food – especially fresh produce – is often of poorer quality in lower income neighborhoods, which diminishes the appeal of these items to buyers (Andreyeva et al., 2008; Zenk et al., 2006).
  • Low-income communities have greater availability of fast food restaurants, especially near schools (Fleischhacker et al., 2011; Larson et al., 2009; Simon et al., 2008). These restaurants serve many energy-dense, nutrient-poor foods at relatively low prices. Fast food consumption is associated with a diet high in calories and low in nutrients, and frequent consumption may lead to weight gain (Bowman & Vinyard, 2004; Pereira et al., 2005).
Fewer opportunities for physical activity.
  • Lower income neighborhoods have fewer physical activity resources than higher income neighborhoods, including fewer parks, green spaces, bike paths, and recreational facilities, making it difficult to lead a physically active lifestyle (Estabrooks et al., 2003; Moore et al., 2008; Powell et al., 2004). Research shows that limited access to such resources is a risk factor for obesity (Gordon-Larsen et al., 2006; Sallis & Glanz, 2009; Singh et al., 2010b).
  • When available, physical activity resources may not be attractive places to play or be physically active because poor neighborhoods often have fewer natural features (e.g., trees), more visible signs of trash and disrepair, and more noise (Neckerman et al., 2009).
  • Crime, traffic, and unsafe playground equipment are common barriers to physical activity in low-income communities (Duke et al., 2003; Gordon-Larsen et al., 2004; Neckerman et al., 2009; Suecoff et al., 1999). Because of these and other safety concerns, children and adults alike are more likely to stay indoors and engage in sedentary activities, such as watching television or playing video games. Not surprisingly, those living in unsafe neighborhoods are at greater risk for obesity (Duncan et al., 2009; Lumeng et al., 2006; Singh et al., 2010b).
  • Low-income children are less likely to participate in organized sports (Duke et al., 2003). This is consistent with reports by low-income parents that expense and transportation problems are barriers to their children’s participation in physical activities (Duke et al., 2003).
  • Students in low-income schools spend less time being active during physical education classes and are less likely to have recess, both of which are of great concern given the already limited opportunities for physical activity in their communities (Barros et al., 2009; UCLA Center to Eliminate Health Disparities, 2009).
Cycles of food deprivation and overeating.
  • Those who are eating less or skipping meals to stretch food budgets may overeat when food does become available, resulting in chronic ups and downs in food intake that can contribute to weight gain (Bruening et al., 2012; Dammann & Smith, 2010; Ma et al., 2003; Olson et al., 2007; Smith & Richards, 2008). Cycles of food restriction or deprivation also can lead to an unhealthy preoccupation with food and metabolic changes that promote fat storage – all the worse when in combination with overeating (Alaimo et al., 2001; Dietz, 1995; Finney Rutten et al., 2010; Polivy, 1996). Unfortunately, overconsumption is even easier given the availability of cheap, energy-dense foods in low-income communities (Drewnowski, 2009; Drewnowski & Specter, 2004).
  • The “feast or famine” situation is especially a problem for low-income parents, particularly mothers, who often restrict their food intake and sacrifice their own nutrition in order to protect their children from hunger (Basiotis & Lino, 2002; Dammann & Smith, 2009; Dietz, 1995; Edin et al., 2013; McIntyre et al., 2003). Such a coping mechanism puts them at risk for obesity – and research shows that parental obesity, especially maternal obesity, is in turn a strong predictor of childhood obesity (Davis et al., 2008; Janjua et al., 2012; Whitaker, 2004).
High levels of stress.
  • Low-income families, including children, may face high levels of stress due to the financial and emotional pressures of food insecurity, low-wage work, lack of access to health care, inadequate and long-distance transportation, poor housing, neighborhood violence, and other factors. Research has linked stress to obesity in youth and adults, including (for adults) stress from job-related demands and difficulty paying bills (Block et al., 2009; Gundersen et al., 2011; Lohman et al., 2009; Moore & Cunningham, 2012). Stress may lead to weight gain through stress-induced hormonal and metabolic changes as well as unhealthful eating behaviors (Adam & Epel, 2007; Torres & Nowson, 2007). Stress, particularly chronic stress, also may trigger anxiety and depression, which are both associated with child and adult obesity (Anderson et al., 2007; Simon et al., 2006).
Greater exposure to marketing of obesity-promoting products.
  • Low-income youth and adults are exposed to disproportionately more marketing and advertising for obesity-promoting products that encourage the consumption of unhealthful foods and discourage physical activity (e.g., fast food, sugary beverages, television shows, video games) (Institute of Medicine, 2013; Kumanyika & Grier, 2006; Lewis et al., 2005; Yancey et al., 2009). Such advertising has a particularly strong influence on the preferences, diets, and purchases of children, who are the targets of many marketing efforts (Institute of Medicine, 2006; Institute of Medicine, 2013).
Limited access to health care.
  • Many low-income people lack access to basic health care, or if health care is available, it is lower quality. This results in lack of diagnosis and treatment of emerging chronic health problems like obesity.
Ok, for the small percentage of Americans that live in poverty, far away from a decent grocery store, and have no transportation to a get to one, I will concede that they may have problems with a healthy diet.

But as the linked article shows, obesity is not drawn along socio-economic lines. In fact, in many cases, obesity is growing at a far faster pace, and is more prevalent in higher income situations. People with means are getting fat faster, period.

I am not sure why you are so intent about defending the people that don't give a rip about health and diet themselves. I often tell my kids, whether it be schoolwork, athletics, music etc that I can't want it more than you. Why do you want it more than them?

http://frac.org/initiatives/hunger-...le-at-greater-risk-for-overweight-or-obesity/
 
No

Zeke set an arbitary age. i'm on board with the principle, but I'll apply it given consideration of all the circumstances at the time.

He admitted it was arbitrary and personal, and that he might push it back as it approached. I'm on the same page, too, as long as it's a personal choice, not a government restriction on beneficial health care).

Glad to see you don't have a knee-jerk reaction because someone from Obama's health policy sphere is thinking similarly.
 
then get off your lazy ass and start exercising and eating less. And for those that smoke....stop!

http://atlanta.cbslocal.com/2015/06...can-woman-now-weighs-as-much-as-1960s-us-man/

Screw you.

I quit smoking in 1993.

I use to play volleyball 3 times a week, walk 18-54 holes of golf a week, and walk every night.

I quit volleyball because I also had flat feet and I'd wake up in the middle of the night with calf muscle cramps so severe I woke my kids up screaming. Went to 4 different podiatrists and tried all their remedies. Nothing helped. Most recent one said "don't use treadmills either."

I quit walking the golf course because discs in my back caused me to feel like I was getting stabbed in the left side.
Doc won't operate because he says "can't guarantee relief when its a nerve issue." On top of that, I now have rheumatoid arthritis - which has nothing to do with being fat. I no longer golf.

I went through a clinical weight loss program 3 times. Lost 69 pounds the first time, 38 pounds the second and 25 the third. Cost me thousands each time. Thousands I don't have for my kids college.

Recent case law decision here in Kentucky involved the issue whether morbid obesity is a "disability" under the law. Prior cases - based on federal regulations - said "only if/when it is “the result of a physiological condition.” The expert witness in the case had performed over 2000 gastric bypass surgeries. He was asked what caused the plainitiff's morbid obesity. He answered, “Boy, if you could tell me the answer to that we would both get rich.” He added that “[n]obody has been able to elucidate the cause of anybody's morbid obesity anywhere in the world…”.

You think you know why people are fat? You don't.
If you think its just overeating, you're probably wrong.
 
Ok, for the small percentage of Americans that live in poverty, far away from a decent grocery store, and have no transportation to a get to one, I will concede that they may have problems with a healthy diet.

But as the linked article shows, obesity is not drawn along socio-economic lines. In fact, in many cases, obesity is growing at a far faster pace, and is more prevalent in higher income situations. People with means are getting fat faster, period.

I am not sure why you are so intent about defending the people that don't give a rip about health and diet themselves. I often tell my kids, whether it be schoolwork, athletics, music etc that I can't want it more than you. Why do you want it more than them?

http://frac.org/initiatives/hunger-...le-at-greater-risk-for-overweight-or-obesity/
No surprise that you don't even read your own links.

People shouldn't get too focused on this food desert problem. Yes, not having access to a good grocery store is a problem, but it's not going to magically go away just by putting a Kroger in the middle of the ghetto. Poor people have been taught to eat like crap. They grew up that way. It's what they know. For many of them, switching to fresh and whole foods isn't even attractive. They like Kraft mac & cheese. They don't like pears.

And the crappy food is usually cheaper, to boot.
 
Screw you.

I quit smoking in 1993.

I use to play volleyball 3 times a week, walk 18-54 holes of golf a week, and walk every night.

I quit volleyball because I also had flat feet and I'd wake up in the middle of the night with calf muscle cramps so severe I woke my kids up screaming. Went to 4 different podiatrists and tried all their remedies. Nothing helped. Most recent one said "don't use treadmills either."

I quit walking the golf course because discs in my back caused me to feel like I was getting stabbed in the left side.
Doc won't operate because he says "can't guarantee relief when its a nerve issue." On top of that, I now have rheumatoid arthritis - which has nothing to do with being fat. I no longer golf.

I went through a clinical weight loss program 3 times. Lost 69 pounds the first time, 38 pounds the second and 25 the third. Cost me thousands each time. Thousands I don't have for my kids college.

Recent case law decision here in Kentucky involved the issue whether morbid obesity is a "disability" under the law. Prior cases - based on federal regulations - said "only if/when it is “the result of a physiological condition.” The expert witness in the case had performed over 2000 gastric bypass surgeries. He was asked what caused the plainitiff's morbid obesity. He answered, “Boy, if you could tell me the answer to that we would both get rich.” He added that “[n]obody has been able to elucidate the cause of anybody's morbid obesity anywhere in the world…”.

You think you know why people are fat? You don't.
If you think its just overeating, you're probably wrong.

Kudos, I think you hit it. People think it is so easy. It isn't, if it were we would not have the problem. But for whatever reason people want to view obesity as a simple thing, exercise more. Duh, if only I were smart enough to think of that.
 
Ok, why has weight changed so much in just one generation. You say it is hard? Fine. I get that. What has the current generation done to increase weight by 30 lbs on average vs generations prior?
 
No surprise that you don't even read your own links.

People shouldn't get too focused on this food desert problem. Yes, not having access to a good grocery store is a problem, but it's not going to magically go away just by putting a Kroger in the middle of the ghetto. Poor people have been taught to eat like crap. They grew up that way. It's what they know. For many of them, switching to fresh and whole foods isn't even attractive. They like Kraft mac & cheese. They don't like pears.

And the crappy food is usually cheaper, to boot.
Cmon Goat.....this is nothing but excuses. Yes I read the link, and it basically said that even in higher income areas, obesity is an issue. I live in an upper middle class area, and there are fat people galore. Fat people that eat crap, never exercise, and drink too much. Between you and Rock, all you want o do is give me some extreme examples.
 
Cmon Goat.....this is nothing but excuses. Yes I read the link, and it basically said that even in higher income areas, obesity is an issue. I live in an upper middle class area, and there are fat people galore. Fat people that eat crap, never exercise, and drink too much. Between you and Rock, all you want o do is give me some extreme examples.
I'm not giving extreme examples of anything. I'm describing exactly what it's like to be dirt poor. Shitty food is affordable. Healthy food isn't. It's a fact of life for the very poor. I know this from experience.
 
I'm not giving extreme examples of anything. I'm describing exactly what it's like to be dirt poor. Shitty food is affordable. Healthy food isn't. It's a fact of life for the very poor. I know this from experience.
And I said that the extreme cases of poverty I concede. What about all of the fat asses in upper-middle class suburbia?
 
And I said that the extreme cases of poverty I concede. What about all of the fat asses in upper-middle class suburbia?
What about them? For them, I suspect (but don't know for sure) that food isn't the biggest problem. It's laziness. We aren't as physically active as we used to be.

But it doesn't change the fact that poverty does correlate with obesity (and according to your link, especially with women and children), and since we're talking about who pays for health care and how, you can't do that without addressing the fact that they are related.
 
What about them? For them, I suspect (but don't know for sure) that food isn't the biggest problem. It's laziness. We aren't as physically active as we used to be.

But it doesn't change the fact that poverty does correlate with obesity (and according to your link, especially with women and children), and since we're talking about who pays for health care and how, you can't do that without addressing the fact that they are related.
Well, I suppose we just chalk it up to bad luck and unfairness, the fact that both men and women have gained an average of 30 lbs in just one generation. My guess is that is probably an all time record, go back to the beginning of man, but let's not blame anyone, that is just not right.
 
Well, I suppose we just chalk it up to bad luck and unfairness, the fact that both men and women have gained an average of 30 lbs in just one generation. My guess is that is probably an all time record, go back to the beginning of man, but let's not blame anyone, that is just not right.
Huh?

Fault isn't a binary state. You don't have to choose between, "It's all the fat guy's own fault" and "He couldn't do anything about it."
 
Ok, why has weight changed so much in just one generation. You say it is hard? Fine. I get that. What has the current generation done to increase weight by 30 lbs on average vs generations prior?
I am really busy this weekend, but will offer an explanation next week. Since it is clear you are using "lazy fat ass" as a pejorative, maybe you can take some time to explain why it is so hard to stop being a dumb ass? I thought it was pretty easy personally, what did I miss? I was going to let the first few times slide as posting while drunk, but now the root cause is more clear.

Which is harder to stop being, a fat ass or a dumb ass?
 
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It's clear that obesity is rising and that rising obesity contributes to rising health care costs. But shaming supposed lazy fat asses -- particularly poor "lazy fat asses" -- is cruel, unproductive, and mostly beside the point.

As to obesity, where are the policy proposals? When New York Mayor Bloomberg tried to ban Big Gulps conservatives ridiculed him, but at least he was trying to address the problem. How about banning trans fats? Ending subsidies that make high fructose corn syrup such a ubiquitous additive? Requiring producers of unhealthy foods to place a conspicuous warning label on them? How about making health a priority in childhood education? Instead of shaming "lazy fat asses" it would make much more sense to actually think about the problem.

Having said so, it just isn't true (as the OP claims) that we can solve our problems by shaming people who are overweight. It's impossible to assess the costs of our own system without comparing our system to those that exist in other countries. As I've pointed out countless times, the other developed countries spend about half of what we pay per capita for outcomes that are at least as good as ours -- and they cover everyone. Americans are more likely to be obese than those in other developed countries, but people elsewhere drink and smoke a lot more than we do. I'm unaware of any study that has established that our much higher costs are due to an unhealthier American population.

It is beyond doubt, however, that our unit prices -- for everything from ambulance rides to prescription drugs to medical devices to (especially) hospital stays -- are much higher. That's because, unlike every other developed country, our government doesn't involve itself in rate-setting:

Steven Brill started his cover story in this week's Time magazine with a simple health-policy question: "Why exactly are the bills so high?"

His article is essentially a 26,000-word answer, the longest story that the magazine has ever run by a single author. It's worth reading in full, but if you're looking for a quick summary, the article seemed to me to boil down to one sentence: The American health-care system does not use rate-setting.

Much of Brill's piece focuses on the absurdly high prices that hospitals and doctors charge for the most mundane items. A single Tylenol tablet can cost $1.50 when "you can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power." One patient gets charged $6 for a marker used to mark his body before surgery. Another is billed $77 for each of four boxes of gauze used.

One hospital, according to Brill's math, bills $1,200 per hour for one nurse's services.

"Over the past few decades, we’ve enriched the labs, drug companies, medical device makers, hospital administrators and purveyors of CT scans, MRIs, canes and wheelchairs," Brill concludes. "Meanwhile ... we’ve squeezed everyone outside the system who gets stuck with the bills."

In other countries, that cannot happen: Their federal governments set rates for what both private and public plans can charge for various procedures. Those countries have tended to see much lower growth in health-care costs.

What sets our really expensive health-care system apart from most others isn't necessarily the fact it's not single-payer or universal. It's that the federal government does not regulate the prices that health-care providers can charge.
This is in effect a massive ongoing redistribution of income to health carer providers from everyone else -- for which we get nothing but what residents of other countries get at half the price. It's in this context that I reject suggestions that we seek to cut our health care costs by shaming "lazy fat asses".
 
I am really busy this weekend, but will offer an explanation next week. Since it is clear you are using "lazy fat ass" as a pejorative, maybe you can take some time to explain why it is so hard to stop being a dumb ass? I thought it was pretty easy personally, what did I miss? I was going to let the first few times slide as posting while drunk, but now the root cause is more clear.

Which is harder to stop being, a fat ass or a dumb ass?
Don't bother, Marv. Rock laid it all out above

And for the record, I have said all through this thread that I agree about the poor and impoverished.

What about the piece I linked above that speaks about the higher income folks becoming obese at 2X the rate as the poor. These people have the means for fitness, but in MOST cases, choose not to.

I grilled out last night. Grilled fish and fresh veggies. We did have potatoes as well, and I had ice water to drink. After, my wife and I walked our 3.1 mile route. Now, if my doctor told me I had told me I had 6 mos to live, I probably would have had a greasy double cheeseburger, or 5 pieces of pizza, and beer. And would have enjoyed that a heck of a lot more than more than fish and veggies. But I didn't.

I am not speaking of the urban core and its issues with obesity. I am talking about Carmel, and Avon, and Center Grove (where I live), and its issues with sedentary lifestyles (see, I didn't use lazy. I am learning). Kids that come home from school and sit in front of their $400 Xbox and eat Cheetos for hours. And don't tell me they don't. I see it first hand from my kids friends, and hear it from their parents. My wife works at the middle school, and obesity is every bit the problem in Center Grove Middle as it is Shortridge Middle.

Until somebody figures out how to fix this epidemic, (and yes, that is what it is), and not just tell me the 15 excuses for it, we are going to continue down this road.

You and Rock like charts, so here are a couple.




But, by all means, let's continue to stick our heads in the sand.

And no, it is 9:50am Friday morning, and I am not drunk.
 
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