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PaperclipPerfector  12d ago (text post)   30491 thread views

Culture War Roundup for the week of December 9, 2024

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In his 261 word "manifesto"[1], the UnitedHealthcare CEO assassin cited that the US is 42nd in the world in life expectancy but first in health care spending. Cremieux reviews it in more detail here and makes something similar to the RCA argument that the US spends more because it's wealthier and gets more medical procedures done and offers alternative explanations for why the US has low numbers.

By coincidence, while this CEO shooter drama was going down, I was listening to Peter Attia's podcast where he interviews Saum Sutaria, the CEO of a health care system[2]. He drops the following claim (copied from the show notes):

Life expectancy has improved remarkably. A lot of that has to do with infectious disease and other things. So when we say our life expectancies in the US are paltry, what we’re really asking is, “Why are we 3 years behind everybody else?”. Especially when we’re spending 60-100% more. “Spending the most, we’re not getting the best out. And I think you make a really good point… somewhere between 60 and 75, the equations slip" Somewhere between age 60 and 75, we go from dead last to first (and the lifespan is the best in the developed world) Because the medical system we’ve created that optimizes for access, quality, sophistication, technology, the best drugs, flips It’s actually quite effective at creating longevity from that standpoint We can discuss whether the lifespan is improving with or without the healthspan

He further argues that US life expectancy is reduced by factors like cultural issues: gun violence, car accidents, etc. Indeed, the US has high infant mortality but also high rates of teenage pregnancy, which are risk factors for higher infant mortality. This echoes Crimeiux from earlier.

Anyway, I went about looking for a source for the claim that longevity rankings increase as we age in the US and found one in Ho and Preston (2010)

US life expectancy at birth sucks versus peer countries, and even still sucks around age 40. But as you get into retirement years it reverses, and the US eventually climbs to 4th place among the 18 countries

The paper tries to explain this but mostly doesn't find anything satisfying.

One interpretation (not from the study, mine and perhaps the Tenet Health CEO's) suggests if you don't get murdered, or into a car wreck, or overdose, or kill yourself, or your mom didn't attempt a home birth at age 16, you actually have good survival odds. The best in the world. The health care system can actually help you. That's what that $10k/capita is all about.

There's some obvious alternate explanations too. Maybe those extra ten years of life are when you're stroked out and have a pretty terrible quality of life and it would've actually been great to meet a health care system with a death panel that said "mmmm actually, there's no treatment available for this condition. so sorry" and you could die with dignity and your family (or someone's family, or maybe collectively) could have an extra $400,000.

Whatever this is, I think it's pretty clear that the health care system in the US exists and can deliver results. Whether or not these results translate to best QOL is more murky and we can debate that effectiveness. Either way, that doesn't have the same revolutionary zeal!

Coming up for air here, and approaching the #assassinbae story from a different angle, at what point can we consider misinformation surrounding this life expectancy vs health expenditure chart as stochastic terrorism? I don't know a single left-of-center person who has more than 2 brain cells to rub together who doesn't allude to this as Exhibit A in every discussion about how corrupt the US health care system clearly is[3]. And it's arguably wrong. And it's now getting people murdered. It's not quite as psychotic and singular as Alex Jones, but it's definitely something sinister. Maybe even more dangerous if it's the start of a trend.

  1. people are beating him up for writing such a short and lame manifesto but he might not have intended it as a manifesto, more of a confession

  2. guessing this is the last we're going to hear from a CEO of a health care system for quite awhile, so this was well timed

  3. which isn't to say it can't be corrupt, just, again, the health care system failing to save people from high rates of car accident deaths and also for maybe keeping grandpa alive because their family doesn't want them to die is not exactly a stinging indictment of health care itself

his 261 words

At least we know he's not a member of this forum

Spending 3x more to prolong the life of terminally old people for a couple of months is perverse. You can't cheat death. Gompertz rule is unbeatable.

I have relatives who are doctors and this saddens them too. Relatives demanding heroic medical procedures for someone so decrepit they'd have probably die next year anyway if it wasn't for their dire medical emergency.

Common claim from them is that the less they cared about the ancestor when they were healthy, the more demanding they are on medicalll procedures to show they care.

I am often thinking about how I must take a one way walk into the woods once I become too weak to take care of myself, even if I end up having a family. All things end, and if I'm 87, cognitively declining, unable to even read consistently, why fight it?

My grandpa was..beginning to be senile. Insisted on getting his beginning bowel cancer fixed. Anaesthesia made him go from slow, rigid , 5% totally confused to 66% confused, requiring constant supervision. Died 8 months later. He never liked me for understandable reasons but I still wish I hadn't seen him even once in his last months. He was a formidable man when younger, so it was pretty sad to see it even briefly.

Another corollary to this is looking at PISA scores by race. I frequently see people on both the left and the right complain that the results of the American education system aren't very good, when the reality is that Asian and white Americans are doing great relative to comparable nations while black Americans are "only" doing about as well as Greeks and Chileans. Perhaps we do spend too much on education, but we actually do have an education system that produces what I would consider to be pretty good results.

I suppose I don't know what to do with that as a conclusion that will be compelling to anyone. It's not like the large, underperforming demographics that weigh down life expectancy and educational results aren't real or don't deserve the best education and medicine that can reasonably be provisioned by a society. It's just that I think they're pretty much already getting those and the results are what they are. For people on the left side of things, they're not going to find it even slightly compelling to reply, "hey, our systems aren't so bad, we just have a large underclass that doesn't really get educated and dies from violence, drugs, and obesity". I guess all I really want out of pointing it out is making sure we're actually having the conversation from the same starting point. If someone think it's bad, actually, that Americans die young, we can talk about that. But if they think the medical system just doesn't work, they're wrong.

when the reality is that Asian and white Americans are doing great relative to comparable nations

Are they? If that is the case, why do people even in this forum always claim that high school cannot be expected to teach people anything and that's why it is absolutely necessary for colleges / universities to teach liberal arts to vast amount of people?

US highschools usually don't teach Latin, or philosophy, or formal logic, or most of the other things that you need to have a balanced liberal arts education. Of course you can teach yourself these things on youtube, but most people won't.

One issue is that the US is unusually strict about recording babies who took one breath as live births. Other countries are much less strict and record babies that died a few ours after birth as stillborn. Or even a few days.

Even then it's only apples to apples for certain countries. I remember someone arguing that China had a better infant mortality rate than the US and I looked it up. From what I could find China's IMR is measured at over 28 weeks gestation or greater than 1000g but you'll still find people that will claim the US has worse IMR than China because arguments are soldiers and their fingers are in their ears.

From what I remember looking up about this if you adjust for pre-term births the US's IMR ranking doesn't quite get to comparable countries but rises dramatically and the IMR rate of black, native american, and pacific islander was double that of white, asian, and hispanic. I'm sure those factors are going to make the US numbers look bad comparatively as long as higher portions of its population have those demographics.

US life expectancy at birth sucks versus peer countries, and even still sucks around age 40. But as you get into retirement years it reverses, and the US eventually climbs to 4th place among the 18 countries

Thanks for the link - this is fascinating data. My interpretation:

  • The big reversal (when US age-specific mortality drops below the OECD average) is around age 80 for men, 85 for women.
  • This isn't an advertisement for "the US healthcare system" as discussed in political ranting (i.e. mostly-private insurance and a freeish market for providers) because the age groups with good results get almost all of their healthcare via Medicare, which is a single-primary-payer system with price controls on providers.
  • It isn't an advertisement for Medicare either, because the age at which US relative mortality starts to improve is well above Medicare eligibility, and in any case the pattern of falling US mortality relative to peer countries predates Medicare.
  • The authors thought that smoking would be a big driver (US boomers smoked more than European boomers, particularly women, and smoking kills you before 80 so smokers don't really show up in the over-80 mortality rates), but it doesn't seem to be. Excluding smoking-related deaths makes a big difference to the figures, but not enough to lift the US off the bottom of the league table for under-75 mortality.
  • A big cause of the difference, but by no means all of it, is resource allocation decisions. At the margin, Medicare is more likely to pay for advanced cancer treatments or open heart surgery for older patients who a European system would send to palliative care. [As someone who is involved in UK politics, I can confirm that the NHS does discriminate by age making resource allocation decisions, and that a 65-year old is much more likely to get their cancer treated aggressively then an octogenarian] This is a choice, but not one that has really been discussed with the demos on either side of Atlantic. In the case of the UK, it was a deliberate choice taken by elites. (It isn't covered up, but we aren't exactly trying to make the issue salient in the public debate either - we think, mostly correctly, that the plebs are incapable of engaging in discussions about healthcare resource allocation in a sane way). In the US, it appears to have been a decision stumbled into rather than taken deliberately. I have no idea what is going on in Continental Europe.
  • Guns and car crashes aren't big enough to explain the effect, although they contribute by raising US mortality at lower ages.
  • Obesity-related deaths don't have the correct age structure to explain the effect.
  • I suspect this is related to the black-white crossover - US black mortality is higher than US white mortality at almost all ages, but increases more slowly with age leading to a crossover in the late 80's. The paper also suggests this, but doesn't come to a conclusion.

So the age pattern doesn't answer the key political question, which is "Is the high working-age mortality in the US an indictment of how the US healthcare system performs for non-Medicare-eligible Americans?"

Coming up for air here, and approaching the #assassinbae story from a different angle, at what point can we consider misinformation surrounding this life expectancy vs health expenditure chart as stochastic terrorism?

Only if all political discourse is stochastic terrorism. Indicting the US healthcare system doesn't incite violence against any particular group. I suppose you could argue that "The US spends most and gets least, ergo executives of for-profit health insurers are bad people who should feel bad." is stochastic terrorism, but "The US spends most and gets least." is no more incendiary than "taxes are too high" or "someone should fix the potholes".

US boomers smoked more than European boomers, particularly women

Really? I guess it shouldn't surprise me, but it does. It's startling how quickly the cultural changes happened in the United States, nowadays smoking tobacco is rare and even vaping is uncommon. Although I do notice a much higher rate when I visit the south. The US went from a smoking society to a smoke-free society; I'm old enough to remember when restaurants had smoking sections, but in hindsight I'm astounded they ever did.

I don't have anyone in my extended family who smokes, but I do have several who used to, including my father, grandfather, great grandfather, etc. Getting people to quit smoking is possibly the greatest public health triumph of the late 20th century.

At the margin, Medicare is more likely to pay for advanced cancer treatments or open heart surgery for older patients who a European system would send to palliative care. [As someone who is involved in UK politics, I can confirm that the NHS does discriminate by age making resource allocation decisions, and that a 65-year old is much more likely to get their cancer treated aggressively then an octogenarian]

I get why saying this out loud is bad politics, but this approach is the only sane way to deal with terminal illness. In general, I seriously question the value of non-palliative treatments for advanced or aggressive cancer and I worry we put people through unnecessary suffering to prolong their life for miniscule amounts of time. I've seen too many family members go under the knife and come out butchered, only to suffer for a few more months and die anyway. We place so much value on life extension and so little on life enrichment.

Very good post. There's a lot of detail here and I appreciate the inside baseball.

One interpretation (not from the study, mine and perhaps the Tenet Health CEO's) suggests if you don't get murdered, or into a car wreck, or overdose, or kill yourself, or your mom didn't attempt a home birth at age 16, you actually have good survival odds. The best in the world. The health care system can actually help you. That's what that $10k/capita is all about.

Are teenage girls giving birth not covered by their parents' insurance?

I've been informed by LLMs that, despite how biblically popular it is, that teenage women are still physically immature and giving birth is higher risk as well.

See also other underclass issues raised separately in replies.

Think selection bias here, not causation. Especially given that teen pregnancy has become "more unhealthy" ever since it was relegated to a vice of the lowest of the underclass.

Pointing to biology is like suggesting that Lincoln Navigators must have a design defect that causes drive-by shootings and running red lights.

that teenage women are still physically immature

A minimum of 200,000 years of evolution (this stretches much further back than mere humanity, so this is probably closer to 225 million years of evolution) suggests otherwise, though of course that depends on what you mean by "physical maturity".

An organism that dies after copying itself once is obviously going to be less fit than one that stays alive to copy itself multiple times. If we assume that it was common (outside of the last 100 years... but a lot about the last 100 years is anomalous) for women to get pregnant quite soon after that was physically possible, and they died at outsized rates (because it would injure their body too much in an age where medicine did not exist), then we should expect that the average age of "ability to survive a pregnancy" [which is probably not what you mean by 'physical maturity'] should match the average age of "ability to get pregnant" reasonably closely.

And, for the most part, it does; whether an LLM (or the society that trained it) believes biological truths about maturity are secondary.

and giving birth is higher risk as well

Probably explained more by the demographics of who is more likely to do this than anything else (and the fact this is more likely to be handled through unofficial channels; it is irrefutable evidence of a quasi-capital offense in the modern West, after all). Other than that serious confounding factor, environmental endocrine disruptions and better nutrition may be able to push the age of "able to get pregnant" under "able to survive pregnancy" more often, but we don't have good data on that which isn't statistical noise and modern medicine is miraculously effective at trivializing the health risks of pregnancy (I'm not convinced the youngest documented mother survives that pregnancy 1000 years earlier).

I mean, it's an LLM. I suspect that giving birth at 16 and giving birth at 22 have identical risk profiles if everything else is equal(and obviously sixteen year old mothers and twenty two year old mothers are different populations), but ChatGPT is not very eager to point out that sixteen year old births are dramatically lower risk than thirteen year old births(which was widely recognized as extremely dangerous so far back as to be an aside in Romeo and Juliet).

There are very few teenage girls getting pregnant and on insurance. Teen pregnancy exists but it's an underclass thing outside of deep rural parts of the south where damn-fool girls get pregnant on purpose to marry their boyfriends(these girls are not giving birth in a closet).

Now medicaid exists but the underclass is, as a rule, bad at paperwork. You can just show up to a hospital to give birth and then not pay the bill they give you(this is your right as someone present in the USA), but pregnant teenagers mostly don't know this.

At the end of the day I suspect most teenage home births are the end result of trying to hide a pregnancy from parents(or, as is more likely to be the case, parent), and that the girls who attempt this are almost definitionally bad at future planning(see 'pregnant teenager', 'believes she can hide having a baby')

I'd expect they'd be railroaded into an abortion if they tried. "Ohh, we'll have to report this... or we can just make it go away for you"

Most of the teen births that actually happen seem to be the "gave birth in a toilet because she was so obese nobody realized she was pregnant" sort.

I think what is meant there is the occasionally reported situation of the (often heavily obese, or else it would be too obvious) teenage mom and her family being in denial of the pregnancy right until birth, and then it's too late.

In large part, USA life expectancy is dragged down by non-trivial amount of blacks. If you compare Japanese Americans lifespans vs Japanese in Japan, the latter have it shorter despite "better healthcare".

Did you mean to say "the former" instead of "the latter"?

It’s intended as written: the claim is that Japanese in Japan have lower life expectancy than Japanese-Americans, despite Japan having nominally better healthcare than the US (n.b.: I have not verified whether this is actually true)

In large part, USA life expectancy is dragged down by non-trivial amount of blacks. If you compare Japanese Americans lifespans vs Japanese in Japan, the latter have it shorter despite "better healthcare".

I guess I know what I'm spending some ChatGPT o1 credits on.

Being in charge of a health insurance company is like being a world leader: you are going to be making decisions that result in some people living and other people dying. There's no way around it. Your whole job is allocating scarce healthcare resources.

The scarcity is the real problem. But we'd rather murder a scapegoat, in cold blood, than face reality.

And scarcity is not going away. Not when it's possible to pour a near-infinite amount of money into eking out another year or two at end of life. Stop and think about what that means. I honestly question whether health is "insurable" even in principle.

Healthcare in America has problems but we cannot even begin as a society to discuss those problems with anything resembling sanity until we as a society learn to memento mori.

So if you're gonna murder a guy you might wanna have a better reason than some people get their claims denied.

I honestly question whether health is "insurable" even in principle.

This becomes perfectly obvious when we consider the different products that are wrapped up in Health Insurance in America.

If I wanted similar coverage for my car, I would need all of Car Insurance, a Warranty, and a prepaid Service plan. All are available on the market for most cars, all can be priced out, but they are different products completely. Comp Car Insurance makes sure that if I get into an accident, I won't be left without a car, but does not cover mechanical failures or ordinary wear and tear. A warranty makes sure that if my car breaks down, it will be fixed, but doesn't cover ordinary wear items. A Service plan allows me to bring my car into the dealer for regular service for wear items, fluids, etc, but doesn't cover those other things. Health insurance, by comparison, covers all three situations at the same time. It is true insurance, in that if I have an accident, it will cover my medical costs. It is a warranty, in that if I suffer from a genetic condition it will cover me. And it is a service plan, in that it covers my regular expected doctor's visits. But I expect to make the same payment for all three, and it is not clear how to distinguish among them.

This is what's attractive about those health ministry things that (ironically) aren't allowed to be called "health insurance". Some of them are more like "really big surprise medical bill from casualty events" insurance, and those are way more affordable. They have a high deductible for that and cover nothing else.

Does it mean you have to pay out of pocket for checkups and other routine stuff? Yes. Do you shop around sometime for competitively priced MRIs? Yes. Do you find yourself traveling a bit for providers? Yes. Are you looking for coupons on goodrx.com for prescription meds? Yes. Are your (family) premiums $5,000/year instead of $24,000/year? Absolutely.

If you have a warranty condition, that's on you to cover. Which, you know, is expensive. But so is covering everyone else's when you don't.

It is a warranty, in that if I suffer from a genetic condition it will cover me.

It sounds weirdly blasphemous when you put it like that. “We take responsibility for this product not being delivered in useable condition.” I wonder if your warranty should be issued by the Church…

I guess the warrant is for your body, with your mind/soul is the intended owner, but that raises all sorts of philosophical questions.

I guess the warrant is for your body, with your mind/soul is the intended owner

Except that it covers your mind, assuming coverage would also include psych/mental health stuff, which it reasonably should inasmuch as we're not going full Szasz-pilled. The blasphemy disappears inasmuch as you stop thinking of a warranty as coming from the manufacturer, and moreso assuring the consumer a roughly median experience.

The more concerning part to me is that warranties always restrict uses. Your factory warranty on your car won't pay out for damage that results from racing. Your consumer warranty on your washer-dryer set won't pay out if you open a laundromat.

Interestingly, the Knights of Columbus looked into offering health insurance for its members but couldn't find a good enough loophole on paying for abortifacients. This has been told to me personally by high ranking members and I'm really not sure what the relevant law(well, I guess section of the ACA) was, but that is how the Church would offer a warranty on genetic conditions, at least in the US.

I've always been curious: would refusal to pay for birth control or plan B etc actually make the plan cheaper, or more expensive?

For a single man, almost certainly cheaper. For a family, the major confound is that the knights of Columbus would expel a member who admitted to using birth control. Even if there's probably some cheating, a KofC healthplan would be covering lots of childbirths anyways.

As long as something can in principle be fabricated by cells fed Gatorade in your basement, I question the necessity of its scarcity.

Even if this made any sense at all, neither Gatorade nor my basement is free nor available in unlimited quantities.

The demand for off brand cell medium (gatorade) is so outstripped by the supply that its almost too cheap to meter unless you're doing industrial bulk. I suppose I can't speak for your basement. But surely someone you know has room for a petri dish.

There are drugs that cost hundreds of dollars even though we can engineer cells to just bioprint them. These cell cultures can be shared by moving them from one petri dish to another. We should mandate the open sourcing of such cultures. To do otherwise is ethically obscene.

Being in charge of a health insurance company is like being a world leader: you are going to be making decisions that result in some people living and other people dying. There's no way around it. Your whole job is allocating scarce healthcare resources.

Do you think it's always a tradeoff between who gets treatment, never a tradeoff between profit and treatment?

That trade-off certainly exists sometimes, but is overdetermined. Under Obamacare they're heavily regulated and their profits are bounded.

  • They must pay at least 85% of premiums collected on claims
  • The remaining 15% must be used for admin and then profit if any is left over
  • They can't just not pay all claims if they collect too few premiums, they have to park capital in the company in case of severe mis-modeling issues, which has opportunity costs
  • If they spend less than 85% on claims, they must rebate the pro-rated premium

It's not totally grim of course, they can earn a return on the parked capital and the float on premiums but it does complicate the picture. And they are incentivized to scale.

In the limit they actually prefer "the standard of medical care" to go up[1], because it means premiums go up, because the pie is bigger and the 15% of the bigger pie is more absolute profit.

Nevertheless, these corporations may be big, and profit-seeking, but you would not get rich quick by investing in them.

  1. Though you can imagine failure modes where medicine becomes more expensive but doesn't improve health outcomes. They're indifferent to that.

That is a destructive question. The tradeoff between profit and treatment is discussed ad nauseam. The gradual accumulation of treatments that extend life, without restoring its quality, and are expensive, is painful to think about. So we don't. But we need to, and the profit question helps us procrastinate and never get round to the uncomfortable issue :-(

I frame it with an equation life-span = health-span + grim-span. Modern medicine is extending the health-span. But for every extra year of health-span, we get three or four years more grim-span. (3? 4? I'll admit that I'm guessing wildly. I just don't want to follow my grand-mother and my parents down the care-home, dementia-unit, nursing-home, route.) Expensive grim-span.

We are well down the road of nibbling away at the quality of the health-span with taxes (or insurance premiums) to pay for expensive medical treatments. When do we say: there is a cash limit. That is a scary thing to say. Perhaps I will fall ill, find out that there is a treatment to save my life, find out the cost is over the cash limit, and get told "sorry, you'll have to die". Maybe the cash limit will be low because I decide to opt out of insurance for expensive treatments, enjoy spending the money I save, and die when my luck runs out.

There are two battles. One is around opting out. If I opt out of paying for the more expensive treatments for others, and therefore (by fairness) for myself, can I change my mind when I fall ill? Obviously not. Can I still whine about it, or must I die quietly? The other battle is about the future. More expensive treatments are coming. When is the breaking point when the money runs out?

Returning to the profit question, the British National Health Service (the NHS) is funded out of general taxation and free at the point of use. Do we Britbongs escape the profit issue? We should, because the NHS is a non-profit. But it doesn't work out like that. At constant funding there is a tradeoff between the wages of doctors and nurses and treatment. At constant funding, higher pay means fewer doctors means less treatment. Alternatively there is a tradeoff between funding and taxes. The politicians in charge need to keep in touch with fluctuating public sentiment. What will get them re-elected? More taxes and more health care? Lower taxes and scandals about people dying waiting for treatment? Perhaps the warning sign of the impending breaking point is no-one can get re-elected. The low tax politicians cannot get re-elected because of the deaths. The health care spenders cannot get re-elected because of the taxes.

We need to learn to memento mori least we build a world in which we spend our lives working long hours in health care, before eventually falling ill and taking a very long time dying, kept alive by the strenuous efforts of many younger people.

I don't have enough insight into their inner workings to be able to answer this. But my guess is they are targeting some positive profit margin (since they would have to) and creating actuarial rules to target this number. Then claims etc are mostly following an algorithm. But then again given as I have alleged the "non-insurable" nature of health, they are probably having to constantly tweak this.

I doubt they're frequently making individual case-by-case decisions to deny somebody for the sake of let's-get-rich-and-do-coke, but maybe I inappropriately assume people aren't monsters.

In any case I'd want to see evidence of such backroom decisions because it's quite an allegation. But that would be hard because I'd also want to see that it's not just "this guy is trying to spend infinite money to eke out another month and unfortunately we don't have that" sort of thing. Like my point is it's actually really hard to prove actual malice here.

I think directionally, yes. It’s just good resource allocation to look at the actuarial data and say “this drug might marginally improve your life for a few months, but you’re old or in bad shape physically and thus your treatment makes no sense.”

He is right that the system has failed to promote life expectancy that goes along with the spending.

United Healthcare isn't the culprit for life expectancy being low but food industry, or Purdue pharma would be corporations that have played a role in that. The Sacklers are a target that genuinely carry blame for falling life expectancies.

Dunno how damaging or helpful the covid vaccines have been. Undoubtedly the people involved with the covid research problem have contributed to falling life expectancies, but certainly not just in the USA.

It is important to note that someone who commits an act of violence because X reasons might have a point about X reasons being a thing, and a genuine problem regardless of whether they should or shouldn't have committed an act of violence. We shouldn't be deprived of the right of as a society of freely discussing and dealing with X.

Indeed, minor acts of violence are a much smaller issue than not being free to deal with X problem, whether is reasons for falling life expectancy.

Now, it is also possible that American healthcare is wasteful in terms of $ but that isn't the reason for life expectancy differences. I believe it is also true that American pharma companies are very innovative and they also make most of their money from the American market.

It is also possible that united healthcare by denying disproportionate insurance claims has played a role in life expectancy problems even if not the major role which has to do more with opioids, obesity and therefore food, how active Americans are, and maybe for blacks gun violence is also a factor.

Regarding violence as a response to big problems or crimes. I would neither encourage it but nor categorically discourage violence from ever occurring as a response to perceived crimes.Thomas Jefferson had a point that fear of reprisals is one way to get rulers to be accountable. Those in charge must be afraid of screwing up. But obviously it can go out of hand and we can have people harming people they falsely blame, in addition to it being unsuitable in circumstances for them to take matters over their own hand over the justice system. But you should be afraid that if you screw up people would put a magnifying glass over it, and you will be held accountable, one way or the other, rather than assured that bad actors will cover it up.

Too much fear of never allowing backlash leads to worse evils being allowed than anything that would be immoral from the backlash. It also leads to a lack of recognition that punishment can be proportionate and good at those who deserve it and to people actually supporting evil acts and evil doers. Important to note that much of the fearmongering about violent backlash is also pretextual and it is about protecting reputations of wrongdoers. It is about wrongdoers who deserve a negative reputation to keep getting away with it. Which they would have more difficulty to do so if their reputation is sufficiently negative.

Indeed, there are in fact cases of child rapists being shot by the parents of the victims. I sympathize fully with the parents. Especially in cases where the justice system did not punish the child rapists adequately, or at all.

A strong emotional reaction on issues that are moral and it is logical and reasonable to strongly care about the injustice of the issue is a virtue. While the unemotional person who chooses to side with corrupt people who are doing something unjust is someone who exhibits a vice. To be fair, we tend to see emotional haters of people who oppose the regime who sometimes try to present themselves as neutral and not strongly ideologically motivated. But they are trying to push for an apathetic society. They promote compliance and passivity as virtues. An apathetic compliant society which doesn't rock the boat about their rulers decisions isn't good, just like a society that people are in a frenzy about wrong theories like a society under communist revolution isn't good neither. So you need a combo of passion with correct instincts and relatively accurate understanding.

It make sense though that in a corrupt society, the corrupt elites would try to fund and support groups that advance the notion that people shouldn't rock the boat and avoid being "psychotic conspiracy theorists" to blame for oh no a possible violent backlash. At the same time that the elites who own media, or journalists and editors are inciting violence by inflaming the passions of blacks against the whites and the police, and nobody other than me and a few other people, say that for such purposes these people who are the problem through their gross exaggerations, need to be removed from power and the position to push their lies.

Like the pharmaceutical industry shouldn't get people addicted to opioids, the journalist proffession should genuinely speak truth to power, and not promote anti-white, pro black criminal lies. In events were there are people of different races that one kills the other, should try to side with what is correct based on the facts.

People should care and people in positions of power should feel the precariousness of them screwing up or getting involved with nefarious plots that harm the public. Like conducting biological weapons research that could lead to epidemics if there is a leak. Or trying to sell addictive opioids to people and present it as good remedy to pain. And various more.

Fear of backlash for wrongdoing is good and should exist in combination with the inevitable backlash and punishment towards those who genuinely deserve it though.

which isn't to say it can't be corrupt, just, again, the health care system failing to save people from high rates of car accident deaths and also for maybe keeping grandpa alive because their family doesn't want them to die is not exactly a stinging indictment of health care itself

You are very biased in favor of defending the system.

Coming up for air here, and approaching the #assassinbae story from a different angle, at what point can we consider misinformation surrounding this life expectancy vs health expenditure chart as stochastic terrorism? I don't know a single left-of-center person who has more than 2 brain cells to rub together who doesn't allude to this as Exhibit A in every discussion about how corrupt the US health care system clearly is[3]. And it's arguably wrong. And it's now getting people murdered. It's not quite as psychotic and singular as Alex Jones, but it's definitely something sinister. Maybe even more dangerous if it's the start of a trend.

Ah yes more censorship of problems and calling everyone bad names and conspiracy theorists. I think we need the opposite, an intolerance towards those who want to censor any dissent and discussion of real problems, and also a growing attitude towards them that people who want to do that aren't protecting society but are badly motivated. Usually they are partisans in favor of the group they defend from any criticism and hostile and out to get the kind of people they call conspiracy theorists and other labels, as well as the groups the later are defending.

Of course, while the "no problem here whatsoever" bias of those who are motivated to throw everything under the carpet, enforce a stupid party line by shaming and intimidating people into silence is the wrong approach, I wouldn't suggest we censor people who correctly show that some things are taken out of proportion.

It is also possible for people who get some things wrong and are biased in one or another direction also get things right.

In any case, if the goal is to have a limited discussion that excludes people, for the purposes of improving outcomes, regime pro censorship types who always overreach, and usually slander and find some excuse to censor others must be the kind of people who are targets of censorship, and of being labeled with a nasty label. Dunno what the equivalent of conspiracy theorist would be. Albeit conspiracy theorist is a ridiculous label that people shouldn't use because by using puts you in the company of CIA types who want to suppress genuine conspiracies and to stupefy discussion. It is obvious that it often used not merely to criticize inherently unreasonable and ridiculous theories but to suppress actual truths of what groups have genuinely done and do and to suppress discussion for any and all of the wrongdoing and even plots for the party they protect and to shut up any and all legitimate complaints. Usually in favor of different factions influential in the regime. Indeed regime supporters seem to try to promote the party line that there are no nefarious or criminal plots going on among people with power which is just false and ridiculous.

So, they should be excluded. Conversely a decent number of the people they would exclude must be allowed to have access to influence and to decision making discourse. I dunno who is going to be the gatekeeper of this, but it can't be the current figures who overreach by nature and would actually would be the targets of censorship.

The aspiring political commissars of the current regime that are defending zealously its conduct are in fact people who both take the freedom of others away, and create a political environment that also takes away peoples freedom and brings forth disaster by fanatically pushing that doing things that are bad is actually good. And not just good but unquestionably good. They try to make only one way to operate as unquestionable since only X bad labeled people would think otherwise. And of course they remove dissenters from platforms or reduce their reach. Their censorship and manipulation of discussion is dangerous and destructive, and so I actually not just as a "rules applied fairly", in favor of actual suppression and punishment of such political commissars. We will be both freer and have better without the regime political commissars.

In all honesty, in the way I see it, freedom is valuable, but I am also interested in the duty of people following the role they have in the manner they should do so, within reasonable expectations. That can constrain some freedoms but also is part of certain freedoms and means we ought to suppress those who constrain them. For example the freedom to criticize wrongdoing towards those who violate their duty in an important position. Their duty is about what role their position serves in society and at least not screwing things up. It isn't the cultural leftist dogma, nor is the ethical obligation of a company to only make money regardless of how they make the money. That is if you make money by making the public's health worse off, and making them addicts, you are engaged in wrongdoing.

One of the issues that mustn't be suppressed is accountability towards those who genuinely deserve it.

While I wouldn't be in favor of delusional commies harming people who aren't to blame, the Sacklers and those who collaborated with them haven't been held sufficiently accountable. There is too much "lets forget the old thing and care about current issue" while ideally society should remember, go back and punish people who are responsible for significant enough crimes. And also remove from decicion making positions people who screwed up. Some people lower on the food chain who for example protected people like Anthony Fauci might deserve not to go to prison but to be notorious and have a negative reputation and lose their position, while others deserve much harsher punishment.

The biological weapon program research backers and/or gains of function research, and all sorts of bad actors of the covid episode haven't been held sufficiently accountable. Including those who overly censor discussion on such issues, which must be done today as well. We also have no assurance that their disasters wouldn't repeat. So discussion should be done for the purpose of uncovering genuine problems and those to blame, and where sufficient blame, for the purposes of holding them accountable. Certainly there can be changes without punishing people, but there also issues where sufficient crimes or huge errors have been made. Accountability of genuinely blameworthy parties is necessary and good.

You are very biased in favor of defending the system.

The irony in facing accusations like this is that I irrationally refuse to sign up for any company like UH or Cigna or whatever because I find them too triggering to work with and instead use some low-cost possibly-a-scam health ministry and just pay out of pocket the rest of the time.

I'm also a rare person who has experienced health care in multiple US states, including extreme Cadillac insurance and also Medicaid, and also "socialized medicine" in countries like the UK and Italy. At the end of this I'm generally burned out and annoyed by simplistic rationalizations and explanations.

The system sucks. Everywhere. In the sense that it's run by humans and have to deal with impossible demands and mis-aligned incentives. I don't think simple-minded analyses move the needle in a helpful direction. In fact they're usually wrong and sometimes just get people killed!

Ah yes more censorship of problems and calling everyone bad names and conspiracy theorists

I was not calling for censorship.

Beautifully balanced and thoughtful comment here. Thank you for taking the time to write it out.

I 100% agree that pharma and food industry companies are more to blame than health insurers, but I also find health insurance to be detestable as well.

Your point about violence sometimes being necessary is well taken also. Rulers nowadays have little to no skin in the game, and they need to be reminded of consequences from time to time.

A healthcare system is a system that produces health. If we were talking about the US Baby Boomer Maximization System, or the Senescence Sustainment program then it would be appropriate to consider life expectancy for sixty year olds primarily.

But for health, we should be considering lifespan for everyone. We should also be considering obesity and fitness, whether there's lots of chronic pain, drug addiction, mental illness and so on. Sustaining morbidly obese people in hospital with vast feats of medical engineering is not really what healthcare should mean.

Cherrypicking where the US does best doesn't justify all the areas where it does poorly. Why are so many people on anti-depressants? Why are so many fat or addicted to drugs? Failings of the US health system are root causes for both (bad nutrition advice and improper dietary additives +opiate mass marketing). Being shot can hurt your health just as much as a tumour and while generally police and troops are supposed to deal with that side of healthcare, they clearly aren't doing a great job of it in America. These problems are not solely caused by a bad health system of course, it's massively multicausal and there are other root causes.

I could even buy that US governance institutions are too inadequate to improve health without causing more damage than they fix, so it's best to keep on plugging away and hope for a technical fix. Or redirect energy to reforming governance first.

But defending the strengths of this system shouldn't silence the critics of its weaknesses. I agree that there is a lot of money and technology in the US medical system. They have lots of MRI machines per head. But what is the purpose of all those things if there are cheaper ways of producing more health?

Opioid crisis aside, it’s not fair to blame the medical system for America not hanging enough criminals so we have lots of drug addicts and shootings. It’s not fair to blame it for Americans putting too many groceries down their maw when the doctors are screaming at them to stop. Etc, etc.

Cherrypicking where the US does best doesn't justify all the areas where it does poorly. Why are so many people on anti-depressants? Why are so many fat or addicted to drugs? Failings of the US health system are root causes for both (bad nutrition advice and improper dietary additives +opiate mass marketing). Being shot can hurt your health just as much as a tumour and while generally police and troops are supposed to deal with that side of healthcare, they clearly aren't doing a great job of it in America. These problems are not solely caused by a bad health system of course, it's massively multicausal and there are other root causes.

Those things aren’t even necessarily fixable by medical intervention, in fact I think in the case of mental health, better results would be had by de-medicalizing mental health in all but the worst cases. Therapeutic culture has somehow managed to turn 3/4th of ordinary human experience into trauma, while at the same time creating a culture hyper focused on feelings and especially negative feelings as facts. If I were to try to cure depression and anxiety I’d spend more time trying to get the person to understand that bad things happen to everybody, that you’ll get better with time, and that focusing on how broken you feel just makes things worse. And until you start living despite the hurt and the “trauma” (which unless you’re fleeing a literal war zone or horrific abuse, is probably something fairly normal to human life) you just aren’t going to heal.

As far as obesity, while I’d try to nudge our food manufacturers to make better quality stuff, the vast majority of obesity is caused by neglecting fork-put-downs and overeating. You, unless you have a severe medical condition, are capable of simply not eating at every opportunity. Likewise, a lot of other health issues are caused by basically not moving. None of this is mysterious, it’s just that following the treatment isn’t fun. You have to count calories and macros. You have to spend thirty minutes a day doing exercise.

The problem of course is that medicine as a practice cannot do much for these problems except mask the symptoms or do very crude repairs of the damage done. And until we can somehow rewind culture back to the point where people generally took responsibility for their lives rather than turning to others to fix the damage later, you simply cannot make a lot of progress here. The problems are cultural and social. Returning to the ethos of the past, where you learned to keep a stiff upper lip and carry on, and where you took a large degree of responsibility for things in your own life, I don’t see how the medical system can be blamed. It sounds very much like the parents who barely pretend to care about whether their kids put forth effort in school, then get mad when 12 years later, their kid can’t read or do basic math, and now they’re mad at the teacher. The teacher can’t make the child do homework, and unless the child does homework, he’s not going to learn much. It’s too late, the damage has been going on for 12 years and there’s no intervention that’s going to undo what’s been done.

I think most problems in America are not so hard to solve. We’re just losing our ability to knuckle down and actually do the work. We’re the people looking for ways around having to do work. We want gamification of education, because why should we study, it’s boring and feels like work. We don’t want to count calories and macros and stick to a healthy diet because it’s not as exciting as deep fried raviolis and white sauce pasta. We don’t want to exercise. Instead we’re looking for quick fixes.

Therapeutic culture has somehow managed to turn 3/4th of ordinary human experience into trauma, while at the same time creating a culture hyper focused on feelings and especially negative feelings as facts. If I were to try to cure depression and anxiety I’d spend more time trying to get the person to understand that bad things happen to everybody, that you’ll get better with time, and that focusing on how broken you feel just makes things worse. And until you start living despite the hurt and the “trauma” (which unless you’re fleeing a literal war zone or horrific abuse, is probably something fairly normal to human life) you just aren’t going to heal.

Hard agree.

I think most problems in America are not so hard to solve. We’re just losing our ability to knuckle down and actually do the work. We’re the people looking for ways around having to do work. We want gamification of education, because why should we study, it’s boring and feels like work. We don’t want to count calories and macros and stick to a healthy diet because it’s not as exciting as deep fried raviolis and white sauce pasta. We don’t want to exercise. Instead we’re looking for quick fixes.

Hard disagree. While there's more room for gluttony now, and fat acceptance movements certainly don't help, I don't believe the people of today are fat while our people of the 1970s were thin because the people in the 1970s worked harder at being thin.

Also I'm pretty sure never-becoming-obese-and-staying-thin is a lot easier than becomes-obese-and-now-must-become-thin.

I don't have a study for this but I simply don't believe if you take two thin identical twins, force-feed one until they gain 100 pounds, and then challenge them to lose it, if they even succeed, the one that loses 100 pounds will not be the same as the one who never gained in the first place. The one who lost 100 pounds will almost certainly be ravenously hungry for ever. Like 95% chance of this. Maybe higher.

They probably didn’t think about food as much, but they also lived in a culture where physical activity was normal and expected. Kids were told to play outside, and often played youth sports as well. There were also norms around eating— smaller portions, less snacking, fewer fizzy drinks. A lot of foods are nearly double the size they were in 1970 which doesn’t help, but at the same time, it we had the same food norms as 1970, and cut portions to about 1/2 of what we eat now, ate three meals and a light snack per day, you’d look about like the average person in 1970. (https://www.yourweightmatters.org/portion-sizes-changed-time/)

I think some forms of processing change food such that it doesn’t trip your satiety system. It’s something I’ve observed. A potato is much more filling than the equivalent amount of potato chips. A chicken breast is more filling than the equivalent in nuggets, one homemade cookie is as filling as 4-5 Oreos. I can’t explain why that works, but it seems to.

I'm not convinced that people even need to put down the fork. I can eat as much as I want and exercise very little but remain thin. Mostly I don't eat ultra-processed food, I just eat whole food.

https://openknowledge.fao.org/server/api/core/bitstreams/5277b379-0acb-4d97-a6a3-602774104629/content

Formulations of ingredients, mostly of exclusive industrial use, made by a series of industrial processes, many requiring sophisticated equipment and technology (hence ‘ultra-processed’). Processes used to make ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances using industrial techniques such as extrusion, moulding and pre-frying; use of additives at various stages of manufacture whose functions include making the final product palatable or hyper-palatable; and sophisticated packaging, usually with plastic and other synthetic materials. Ingredients include sugar, oils or fats, or salt, generally in combination, and substances that are sources of energy and nutrients that are of no or rare culinary use such as high fructose corn syrup, hydrogenated or interesterified oils, and protein isolates; classes of additives whose function is to make the final product palatable or more appealing such as flavours, flavour enhancers, colours, emulsifiers, and sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling, and glazing agents; and additives that prolong product duration, protect original properties or prevent proliferation of microorganisms.

Doesn't sound very appetizing! But it obviously is, ultra-processed food is 60% of US calorie consumption: https://www.cbsnews.com/news/ultra-processed-foods-calories-american-diet/

It seems very reasonable that eating things full of strange chemicals causes unusual health problems. Circus freaks from 1900 have nothing on the physiques you can see waddling around these days, they wouldn't even make it onto my 600 pound life. And the US is exporting this all around the world.

I can eat as much as I want and exercise very little but remain thin.

The obvious retort is that the amount you want to eat is less than the amount fatties want to eat.

Yes but why is that? I never bothered counting calories or exercising any restraint. My willpower is pretty low, all things considered. I barely do much exercise, I guess I walk longer distances than most people but that's about it, I don't go to a gym or anything. I occasionally do some bodyweight exercises, I can do sixty pushups but that's probably mostly because I'm thin. It takes only a few minutes each day for a few months to get to that level and I plateaued since.

My BMI is 20. Australia is a pretty fat country: https://en.wikipedia.org/wiki/Obesity_in_Australia

I can only assume that a diet of fruit, good bread, milk and whole foods is superior to a diet of largely processed foods. I have chips and icecream sometimes, I'm not a puritan about these things.

This sounds like humblebragging and I guess it technically is but I think there must be something that can be learnt. Back in the 1960s everyone was like me. They could eat whatever they liked, drink a lot of alcohol and still not get fat like we see today. They were working desk jobs too! They just got sated. I get sated. When I eat a big dinner, I might not feel any need to eat even in the next morning, it doesn't cross my mind. I barely ever feel hungry.

I just don't see how I can be a genetic freak when this is how everyone used to live.

It's probably something in the water, given that obesity rates are lower in the mountains and highest at the mouths of long rivers....

I mean, I think the steelman for chemicals causing obesity is 'endocrine disruptors changing desires' more than 'microplastics make you hold on to fat'. But for another, everyone in the sixties smoked cigarettes(which does control appetite). Everyone fatshamed. Snacking was very expensive so people didn't do a lot of it. People were just more active in general. Etc, etc.

I am crazy overweight, I eat zero 'ultra-processed' food, and unless you count things like 'bread' and 'cheese' as processed, I eat basically zero processed foods.

Personally, I think I just enjoy food more than other people. God I love food. I love eating. It is basically the only thing I really enjoy in life. When I bite into a home made migas taco, the melted cheese, the crunch of the fried tortilla strips*, the creamy avocado, it makes my whole brain light up. I am salivating just writing this.

This is just a single datapoint though, maybe I am the weirdo and most people are like you.

*Does frying corn tortillas in some avocado oil count as 'processed'?

I run 6 days a week, lift weights 3 days a week and intermittent fast from 6pm to 10am. I don't eat "processed" foods either. I've still been gaining weight and DEXA scans confirm that it's actually fat that's being gained.

I've been struggling with obesity since I was a teenager[1]. I had a foothold on it in my 30s in that I was simply overweight and not obese but now it feels out of my control completely. Until...

Personally, I think I just enjoy food more than other people. God I love food. I love eating. It is basically the only thing I really enjoy in life. When I bite into a home made migas taco, the melted cheese, the crunch of the fried tortilla strips*, the creamy avocado, it makes my whole brain light up. I am salivating just writing this.

Have you considered... Semaglutide!? I went on it recently and the effect is pretty interesting. Mostly it's a lot more psychological than "physical", for me, so far. I can feel hungry and be in the kitchen, and feel like snacking, but all of the snacks seem like too much work to get out and eat. So I don't.

Cue meme where person with ADHD does Adderall and they're bewildered at their insane focus and energy and cry that this must be how normal people feel all of the time. But non-ironically.

  1. And no it did not magically get fucking better living in Europe. The food in America is not uniquely poisonous.

Yeah I am probably going to try to get on one of the GLP-1 drugs and see how it goes.

You might even want to try more than one, if the first one doesn't give you amazing results. My husband got okay results on semaglutide, then after several months tried switching to tirzepatide and it's doing a whole lot more for him.

Bread is very processed. You take a wheat grain, remove the hull, and maybe the bran and germ, grind it into powder, mix with water, yeast, salt, and some sweetener (probably itself refined), and then you pound and roll that a few times and then cook it. That's a lot of processing.

Cheese is also very processed. It doesn't come out of the cow that way.

*Does frying corn tortillas in some avocado oil count as 'processed'?

OK, so first you take corn. Remove the kernels from the cob, then soak it in alkali water. Then wash it, remove the hull, grind it, Mix with water to make dough. Make the dough into balls, flatten, and cook on a hot flat surface. Just because a Latin American peasant can do it the way she learned from her abuela who learned from hers all the way the back to when it wasn't abuela but na’chin doesn't mean it isn't processing.

Frying it again is also processing. Avocado oil is also processed, though fairly minimally by pressing it out of avocados.

The difference between traditional forms of processing and the modern is that the modern kind is hyper optimized by capitalism, through vast amounts of capital and chemical engineering, for addictiveness and thence profitability. Healthiness could also be optimized for, but unfortunately it’s opaque to most consumers and doesn’t function as a schelling point in any case.

While it is true that Communism in general causes weight loss, there is nothing about capitalism that makes processing worse for you. It's just that capitalism tends to make more food available to most.

Sounds like I'm doomed.

I believe that most American food, even seemingly normal food, is full of weird chemicals.

Brown bread with seeds that goes stale in a few days is better than the kind of cheaper, longer-lasting white bread. Why is white bread so much cheaper and longer-lasting? Because it's full of strange ingredients. I don't know what kind of bread you're getting of course but just look at what Walmart puts in theirs. This was the first American bread that came up in my search: https://www.walmart.com/ip/Great-Value-White-Round-Top-Bread-20-oz/10315355?classType=REGULAR&athbdg=L1200

Enriched Wheat Flour (Wheat Flour, Niacin, Reduced Iron, Thiamine Mononitrate, Riboflavin, Folic Acid), Water, Sugar, Yeast, Soybean Oil, Salt, Vital Wheat Gluten, Dough Conditioners (Mono- & Diglycerides, Sodium Stearoyl Lactylate, Ascorbic Acid), Calcium Propionate (to Retain Freshness), Soy Flour, Encapsulated Sorbic Acid (Sorbic Acid, Hydrogenated Vegetable Oil, Mono- and Diglycerides) (to Retain Freshness), Yeast Nutrients (Calcium Sulfate, Ammonium Sulfate, Calcium Carbonate, Monocalcium Phosphate), Soy Lecithin.

Likewise, there's cheese and there's cheese. Cheese can be minimally processed or intensively processed.

Some common ultra-processed products are carbonated soft drinks; sweet, fatty or salty packaged snacks; candies (confectionery); mass produced packaged breads and buns, cookies (biscuits), pastries, cakes and cake mixes; margarine and other spreads; sweetened breakfast ‘cereals’ and fruit yoghurt and ‘energy’ drinks; pre-prepared meat, cheese, pasta and pizza dishes; poultry and fish ‘nuggets’ and ‘sticks’; sausages, burgers, hot dogs and other reconstituted meat products; powdered and packaged ‘instant’ soups, noodles and desserts; baby formula; and many other types of product. See table 1, below

Industrial breads made only from wheat flour, water, salt and yeast are processed foods, while those whose lists of ingredients also include emulsifiers or colours are ultra-processed. Plain steel-cut oats, plain corn flakes and shredded wheat are minimally processed foods, while the same foods are processed when they also contain sugar, and ultra-processed if they also contain flavours or colours.

It all depends in what's in those corn tortilla chips. I reckon it would be processed, even ultra-processed depending on ingredients.

Based on the search results, here are the ingredients commonly used to make corn tortillas in the USA:

Masa Harina: A type of corn flour made from nixtamalized corn, which is dried and ground into a fine powder. Brands like Masienda, Maseca, and Bob’s Red Mill are popular choices. Water: Warm water is used to rehydrate the masa harina and “bloom” its flavor. Salt (optional): Some recipes include salt to bring out the flavor of the corn. Some store-bought corn tortilla brands in the USA may also include additional ingredients, such as:

Cellulose Gum: A thickening agent used to improve texture and shelf life. Guar Gum: A thickening agent used to enhance texture and prevent drying out. Amylase: An enzyme used to break down starches and improve texture. Propionic Acid: A preservative used to extend shelf life. Benzoic Acid: A preservative used to prevent spoilage. Phosphoric Acid: A preservative used to maintain freshness.

I just made myself dinner. I went through the ingredients, this is far and away my most common meal and I make this or a slight variation on this for probably 60% of my meals in a year. Butter - Cream(milk), Salt. Ground Beef - Beef, Barilla Brand Pasta - Semolina (Wheat), Durum Wheat Flour, Pasta Sauce - Water, Tomato Paste, Diced Tomatoes, Tomato Juice, Extra Virgin Olive Oil, Garlic, Onions, Basil, Black Pepper, Oregano, Dried Basil. Extra Virgin Olive Oil - Extra Virgin Olive Oil. I also added up the calories, the whole thing comes out to almost 4000. I normally make this for lunch, eat half of it, and eat the other half for dinner. It should be obvious to anyone why this combined with a sedentary life style will result in my becoming very fat without the need for any weird chemicals (Although maybe Semolina is full of weird chemicals?).

I think it is highly unlikely that these chemicals are very important in the broader picture of American obesity. These chemicals are just as common in all of Latin America, who do about the same as most of the EU on obesity, and Japan (who does better than basically everyone on obesity?) also puts this junk in all their, enormously popular, convenience store bread products.

Although maybe Semolina is full of weird chemicals?

Semolina is coarsely ground durum wheat (as opposed to "durum wheat flour" which is finely ground durum wheat). No more weird chemicals than any wheat.

I mean, all the ingredients and cooking seems perfectly fine here.

As a fellow food enjoyer, the obvious problem seems to be portion size. You're going to eat everything because it's delicious, so just make less of it.

Latin America, who do about the same as most of the EU on obesity

? Latin America is a very fat region. Mexico is literally the fattest country in the world, moreso than the US. And in any case, a region where food insecurity is an actual problem that needs to be worried about(albeit not the normative experience) is not a fair comparison to the second richest region in human history.

But to your point- yes, if you eat 4k calories a day before accounting for breakfast, drinks, snacks, and desert, it does not take 'chemicals' to explain obesity. I will make a similar dish to what you do and eat leftovers for lunch for an entire week(with sides, of course).

Also, I don't eat breakfast, snacks, desserts or drink anything other than water(but I would eat desserts if I kept them in the house).

I just looked at the Wikipedia list of countries by obesity. Mexico is 36% of adults with obesity, Hungary (hah) is a slightly higher 36, Ireland is 30, El Salvador is 29, Germany is 24, Colombia is 23. It is possible this data is wrong or misleading though?

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Hmm, well, I guess I consider this good counter-evidence against my theory.

What you're describing I totally understand. I call them "fat thoughts" and I live my day-to-day life suppressing them. I imagine that "fat thoughts" and "gay thoughts" are distinct categories of intrusive thoughts but I feel like I could understand one from having experienced the other.

I hear that the GLP-1 Agonist drugs make the fat thoughts go away, it would be super funny if they turned out to also make gay thoughts go away too, someone should test that.

I think this is pretty true across most domains of enjoyment. I know people who weep at the sound of beautiful music or a great piece of art. Your thing is food. I don’t see that as a reason why you can’t try to keep things within reasonable limits.

Agreed, I think I can diet and lose weight, I just imagine it takes more of an effort of willpower for me (or someone like me) than for some other people.

the vast majority of obesity is caused by neglecting fork-put-downs and overeating. You, unless you have a severe medical condition, are capable of simply not eating at every opportunity

This seems more interested in figuring out where to allocate blame, or castigating people for not being virtuous enough, than concrete results. If you’re a government charged with increasing citizen health then you will get results by doing things like limiting the amount of hunger-inducing additives, sugar, empty carbs in mass market food products, removing junk food vending machines from school hallways and other public spaces, etc. Also, culture and behaviour doesn’t generate spontaneously. Policy choices in the past shaped human behaviours of today. There’s a conspiracy run by corporations focused on manipulating people into being degenerate hedonists.

I mean sure there’s a bit of blaming in that. But I think until the issues are actually understood, I don’t think you can make much headway. Yes corporations especially food corporations are trying to get people to eat more and eat worse food, and I think it certainly needs to be addressed. But tge interventions would rarely be medical. They’d be perhaps regulations on ingredients (all surprising amount of our food ingredients are illegal in Europe), or not allowing vending machines in schools. I think it might be well past time to get cooking taught in schools so people know how to people know how to cook healthy meals. I’d like to see recreational sports make a big comeback as I think it would help both the loneliness epidemic and the sedentary lifestyle problems we have.

We also have to essentially renormalize the concepts of portion control and self control. You simply cannot remove all temptations from the environment. You can’t make grocery stores not have candy and sodas at tge checkout. You can’t ban video games when everyone has the internet. At some point, the same issues come up and it’s something the rest of society cannot do for you. You have to learn self control. We can’t have it for you. We can possibly shame people for having an entire pizza to themselves, but it runs counter to what most people have been taught so it’s uphill.

The thing is that very little of that is medical. And blaming the medical system for an entire culture eating slop and not exercising is not only not going to help, but will probably drive people out of those jobs. Your doctor can’t undo decades of gluttony and a sedentary lifestyle in a couple of visits. Nobody can. And I don’t think blaming the medical system for social problems is a reasonable way to get good results. Fix the cultural problems.

We’re the people looking for ways around having to do work.

"We're" looking for ways to have the people who did the work to do the work for others, or at least pay them so they don't have to.

US life expectancy is reduced by factors like cultural issues: gun violence, car accidents, etc.

You can't mention this without mentioning obesity rates & dietary habits.

Americans, the fit ones too, have culturally poor diets. Vegetables & simply prepared meats (poaching, raw fish, sautee) are shunned in favor of unhealthy cooking methods (frying), fat based sauces (ranch) and simple carbs (potatoes). India has a similar problem with culturally poor diets.

Maybe those extra ten years of life are when you're stroked out and have a pretty terrible quality of life and it would've actually been great to meet a health care system with a death panel

That's my anecdotal observation. The US is excellent at helping you stay alive in misery. Aging is one example. But, disability, drug use, depression, chronic pain get the same treatment. No one cares to fix you. They want to get you back to your base level of misery until you come back again.

Potatoes isn't "simple carbs", it's starch. French fries are made with large quantities of oil so that more than half calories comes from added oil, vs. less than 5% in potatoes. Literally no one gets fat from eating potatoes.

In the US, even if you love fruits and vegetables, in my experience it is hard to find actually good ones. Even locally sourced farmer's market ones that I have had generally tasted flat and empty compared to some stuff I've had in other countries. I don't know how much the taste correlates with the nutritional value, but I'm sure that it at least somewhat does.

From my understanding a lot of this has to do with farming practices, mono cropping, and generally poor soil quality.

Definitely a difficult problem to solve unless you grow your own food. Which is a luxury not available to many.

Yeah, the produce at national chains on the east-coast is especially bad. Sad result of national supermarket chains monopolizing. When star market is your only option in a 15 minute range, you go to star market. Some boutique organic stores have great produce, but folks ain't affording that unless they're in the top 5 income percentile.

In my experience, Trader Joe's (value), Costco (bulk), Whole foods (premium) & Aldi (budget) have the most consistent quality across all national locations. The other chains are hit or miss.

I've always liked ranting about how produce at the market is higher-quality in Texas than in other places.

I’m always impressed walking around the produce section of French and Italian supermarkets at how you can smell the tomatoes from 20ft away.

Another and often ignored factor is how sedentary american culture is. Driving is ubiquitous with more people commuting by bicycle in Copenhagen than in all of the US. American grocery stores are surrounded by a sea of parking while in the rest of the world most people would walk to their local store. One thing that struck me in the US was how common escalators are. Lawn mowers nearly always have an engine in the US and are often ones the user sits on. In other places a person mowing grass is more likely to walk. Even fit Americans don't move that much. Fit Americans tend to be sedentary nearly all the time except for four hours a week of vigorous fitness. Gym culture is bigger in the US than in much of Europe. What is missing is movement in every day life.

I don’t see how you fix that when the best way to keep thieves away from your property is to keep it unwalkable and keep public transportation out. In dense parts of the urban landscape, walking is marginal during the day and probably unwise at night unless you’re in a group. That doesn’t get fixed unless you can keep the drugs and crime out by a method other than building the environment such that you need a personal vehicle to get around that area. I live in the county surrounding St. Louis, and the neighborhoods near m3 that would be considered “walkable” also are poor areas that have bars on their windows. No one with the means to afford something better wants to live in a place like that, and so while nobody says so out loud, those with the means want to have to drive around because that means that you don’t have the low income housing and issues that come with it.

It's why I am adamant on living in the few dense pockets of American cities. I've started step tracking and the difference is stark. If I take public transit to work & do groceries on foot, it's trivial to pass 10k steps. If I am in-and-out of a car all day, then it's hard to crack even half that. Have you tried to make up for a 5k step deficit ? It takes a whole hour of walking on the treadmill !

It shouldn't be too hard. All a family needs is -

  1. Good public schools
  2. Walkable
  3. Safe
  4. Dense (So groceries & amenities exist nearby)
  5. Purchasable (for upper middle class)

There are practically zero places in the US that satisfy all these requirements.

Some parts of Greater-Boston & NYC are the only 2 that semi-satisfy this requirement, and they're definitely borderline for #5. I'm also cheating on public schools for NYC/Boston proper because all the good public schools are competitive exam-schools which your child may not get into. I'm lucky. Bellevue WA is the worst I have had to deal with. Can't imagine how bad it is in proper suburbia.

if you don't get murdered, or into a car wreck, or overdose, or kill yourself, or your mom didn't attempt a home birth at age 16, you actually have good survival odds. The best in the world.

Is this after making those adjustments for the other countries as well?

I don't know if the full computation has been done, but if you thumb through this fairly large report (free, but email required for guest download link) it's pretty clear that the US has a worse showing in a lot of these causes of death versus a basket of comparable countries. So, the claim doesn't seem easily disposed, at least.

There might be a much simpler explanation: demographics.

It’s not that the US medical system is doing great work (sorry Peter) it’s that the US has a large underclass which drags it down.

Once the underclass starts dying off, the demographics of the surviving people are going to look a lot more like Sweden’s. The results will be similar.

Many disparities between the US and Europe can be explained by demographics. Swedish-Americans do just as well as Swedes, etc… Sometimes there will be legit cultural differences (car culture for example) but demographics tend to have the greatest explanatory power in any social science realm.

Once the underclass starts dying off, the demographics of the surviving people...

Wait, what? How?

How?

Adding poison to intercepted shipments of fentanyl and selling it.

Opioids, murder, suicide, car accidents, obesity, smoking, unchecked diabetes, alcohol abuse, untreated disease, etc...

The demographics of people who reach age 70 are quite different than the same cohort at birth. Asian Americans live something like 15 years longer on average than African Americans for example. And people with high IQs live far longer than those with low IQs.

Oh, you were just talking about age cohorts, not society as a whole. Never mind.

I have heard this but I don't really know how to tease this out. Also isn't it unfair to only let the US filter out its underclass? Why can't Sweden do that too in this conjecture and really break some records?

Because in truth the means are a justificatication for the end.

Sure, but once we remove the bottom 20% from both countries, I think they will look much more similar.

Notably, Sweden doesn't have a large population of people of sub-Saharan African descent. (Although they are busy working on that apparently).

I am not saying that 100% of the difference can be explained by demographics, only a majority of it. The US will still have more car deaths because our cities were built after cars were invented.

It's kind of hilarious watching people bend themselves into knots trying to figure out why Vermont and Hawaii have such high life expectancies, and Mississippi does not.

Here's a fun fact. The lifespan of Chinese-American women is 91.3 years.
https://asamnews.com/2021/12/23/immigrants-asians-live-healthier-lives-than-those-asians-in-the-country-longer/

run the numbers and find out. My understanding is that Sweden's underclass is (or was, before mass immigration) much, much smaller per-capita, so filtering it out wouldn't change the outcome much. By contrast, the US underclass is very large, and so it swings the numbers. This matters because the standard claim is that Swedish policies would fix things, but there's no reason to believe that Swedish policies made the underclass small rather than not having an underclass being what allowed Sweden to adopt its policies.

By that rubric, the Christmas carol Baby, it’s Cold Outside is the most corrosive and deadly work of pro-terrorism propaganda in human history, since it stochasticly inspired all modern Islamic terrorism. It’s directly responsible for 9/11. Bing Crosby should have been imprisoned for life!

So his argument proves too much? (Note that I myself have Views on that particular composition....)

Are those views that it's great and sweet and opposition to it is Everything Wrong With The World These Days? Because if not you should start a new op so we can discuss it.

Are those views that it's great and sweet and opposition to it is Everything Wrong With The World These Days?

More complicated than that.

Because if not you should start a new op so we can discuss it.

Will do; where should I post it?

I mean, is every revolution in history actually just based on vibes? Can otherwise reasonably well off people just flip their shit and start cutting heads off in the streets?

I mean, is every revolution in history actually just based on vibes?

The Boston Tea Party started after the British lowered taxes on tea (and eliminated taxes on several other goods), but kept a small tax to make the point that 'we have the right to impose taxation without representation'.

Yes? For instance, your entire country could lose its mind over an uncommon cold, and then there’s rioting in the streets for one political faction while the other normies kill each other over toilet paper.

You think humanity has changed much in the 4 years since that happened?

Sure yes, I guess I'm still just shocked at murder possibly caused by a sub-culture's overzealous interpretation of an Our World in Data graph.

People kill over all sorts of things, as long as the victim is an outgroup member.

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