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PaperclipPerfector  10mo ago (text post)   26209 thread views

Culture War Roundup for the week of January 1, 2024

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I’ve always been blown away by the obsession with health care. Does the average person spend more than a few days interacting with health care pa?

In addition to the comments below, it's also worth noting that there is a massive disparity in how much people interact with medical institutions. Some people do have the misfortune of either personally having been struck by chronic conditions or having a close family member that has, but the more common situations are people that just eat themselves into it or medical their neuroses. About 15% of adults have diabetes, about 6% have sleep apnea, about 20% take some sort of psych meds, and so on. Sure, many of these things could be cured with diet and fitness changes, but for many people there is a culture of medicalization and it seems entirely normal to them that they are permanently dependent on medical institutions to remain alive and physiologically regulated. They can't control blood sugar, they can't sleep, they can't even focus on basic tasks without repeated visits to medical professionals and prescriptions for daily drugs.

If one’s a parent of small children or very aged, certainly.

I’m a parent of small kids. So we go to the pediatrician and it is very easy. No fuss. Don’t know why anyone would complain about that.

The people I know who are the loudest about health care all have Type 1 diabetes. That Wikipedia article says

Within the United States the number of people affected is estimated at one to three million.

so around 0.3-1% of the population. One I know says they very intentionally went the route of working for a big company to have a stable corporate job with health care because they've known since childhood that their choices were stable employment or death. The ones I know who didn't luck into such a stable career are pretty angry about it.

Women with significant period symptoms (which are fairly common, albeit not universal) also tend to care about health care to get access to the medication to manage their periods (aka birth control).

But also, catastrophic events resulting in high medical bills don't have to be all that common before a lot of people have a friend or acquaintance who had trouble with such a situation.

I know no one in the final category. My recollection from the literature is that bankruptcy due primarily to healthcare is very small (as opposed to bankruptcy that includes health care but where health care is not the primary factor).

With respect to the second category, I guess (maybe?). That’s putting aside that birth control per se is pretty shitty for women but also relatively cheap and affordable. I wouldn’t think again that birth control is a primary factor but who knows.

First one, yeah that seems legit (insulin is expensive).

That’s putting aside that birth control per se is pretty shitty for women but also relatively cheap and affordable.

You're probably thinking of birth control pills. Long-lasting birth control is both more effective and less shitty. And possibly actually cheaper, but the cost has to be paid up-front. An IUD is about $1000+ (but can last 7+ years), which isn't huge but can be a large expense for a young woman.

Per annum? Yes.

Schedule an appointment. Attend it only to get a referral for the thing you already knew you needed. Get a test ordered which has to be done across the county because reasons. Pay for all of these when you receive a bill months later, because the whole time, the provider and insurance are volleying back and forth on what will be covered and in what amount. If, during any step, you run into a bureaucratic hurdle, expect to spend an hour or two on the phone, because for some reason these companies all use voice-activated robot dialogue instead of a keypad or, God forbid, a website.

You can avoid most of this stuff if you’re young and healthy. America is not really either of those things, on average. Even the simplest brush with this system turns into a bureaucratic hassle. I understand the processes which led to this perverse setup. Wouldn’t it be nice if we could design it better?

Per annum. I get that it can sometimes be a hassle but that seems weird for relatively young people to base their seeming life or identity around, no?

How do you mean?

I think the normal level of engagement with the issue is something like “that guy says American healthcare sucks; my one experience with a chest x-ray concurs, so I guess I’ll vote for him.” If you want to get really spicy, share a meme or two about it on Twitter.

It's about a fifth of the US economy, if you're insured it involves monthly payments that will make up a significant portion of your paycheck or be significant deductions from it, if you're uninsured and poor you get regular paperwork from Medicaid that you have to fill or correctly or can end up in deep shit, and the reimbursement and deduction system drives a lot of other (often dumber) behaviors.

And if you have a pregnancy, or a serious illness, or a chronic illness, it gets a lot more in-your-face.

Yeah I guess the monthly payments are a pain in the ass. But so is FICA or Fed Income Tax, etc.

My wife and I have kids. Her heath care during pregnancy was fine. Wasn’t enough to orient our life around health care as a topic.

But assuming you fit the demographics of the average Motte reader, you likely have good to very good insurance no? That puts you in the upper bracket. How much did you end up paying for your wife's pregnancy care? How long did it take you to pay that off? Had she had to have been rushed to an out of network hospital, how would that have impacted your finances? What if her doctor was in network but the lab her doctor used was not?

I moved from the UK to the US so I have experienced both healthcare systems as an adult, and they both have their advantages and disadvantages, but the US one definitely requires more engagement, which isn't necessarily bad, but the more issues you have with executive function and planning the worse it gets. I can get a good chunk off my premiums by getting a yearly physical and then a yearly biometrics test, and by getting a prostate exam and by getting a dental exam and so on and so forth. For a planner like me with experience working through bureaucracies that works pretty well (though even for me the inability to know if a recent colonoscopy was going to be coded as routine or diagnostic in advance and therefore not knowing if was going to be out of pocket for around 600 dollars or 6,000 was literally a pain in the ass).

Treatment in the US is usually good and quicker than the NHS (though in rural or urban areas it can be comparable, it took me 6 months to get in with my PCP when I moved to a small town in the US, and it looks close to that now I have moved back to the city), but it does require much more engagement and does give you much more uncertainty about what is exactly going to be paid for or not. On balance I would say it is probably better, but it is also more stressful. It took 3 months before I knew for sure my bill was going to be 700 bucks, not 6,000.

We have an HSA. Just set up payment plan and used that. It didn’t impact our finances in any noticeable way.

Which goes to the point I think, only somewhere between 1 in 6 and 1 in 10 Americans have an HSA in the first place. And presumably you must have made the choice to set up/pay into one at some point, thus spending more time thinking about and planning for health spending.

Hypochondria was already widespread in progressive circles in 2019, but Covid practically made it into a heavenly virtue, to the point that many of the people reporting "long Covid" symptoms never actually contracted Covid in the first place. Progressives are also the faction most likely to endorse the idea that literally everyone in the world should be in therapy, which implies that anyone who isn't currently in therapy should interact with a healthcare professional anywhere from 12-52 days of the year more than they do at present.

That’s fair. I wasn’t thinking of therapy. I am literally anti therapy (generally think it does more harm than good).

A recent study demonstrated that getting vaccine boosters is correlated with Long Covid.

I was not surprised at all. In fact, this result is obvious once you have an accurate model of Long Covid. Boosters don't make it more likely for Covid to occur. However, people whose anxiety disorder masquerades as "Long Covid" are also more like to seek boosters.

A recent study demonstrated that getting vaccine boosters is correlated with Long Covid.

Can you cite the study you're referencing?

I won't pretend to be anywhere close to up-to-date on COVID literature, but the top pubmed result was this review:

the odds ratio of developing long covid with one dose of vaccine ranged from 0.22 to 1.03; with two doses, odds ratios were 0.25-1; with three doses, 0.16; and with any dose, 0.48-1.01...The high heterogeneity between studies precluded any meaningful meta-analysis.

Here you go: https://pubmed.ncbi.nlm.nih.gov/36538532/

My original synopsis was wrong. It was having 2 doses at all which was associated with Long Covid, although the much bigger risk was obviously having a severe case of the disease.

Note that this was only among people who tested positive for Covid and presumably sought medical treatment so it wouldn't capture the anxiety cases who may have never even contracted the illness.

I'll retract my original statement.

Does the average person spend more than a few days interacting with health care pa?

Not sure, but access to reasonable healthcare without bankruptcy or other life-destroying stuff is nice. In this case importance is not well measured by how much time is spend on interaction with them.

It is kind like I spend about 5h in total in my life interacting with military and consider armed forces to be quite important for my country to have (and large part is that I prefer to avoid interacting with military too much, especially Russian one).

Yes black swan events etc. But most people don’t orient their life around that (and for most people catastrophic coverage is feasible).

I guess I just don’t understand the extreme fixation on health care for people who frankly don’t use a lot of it.

"what happens if I break leg / get run over by bus / get cancer" is not some very unlikely black swan but something that happens to basically anyone.

You think a lot of people get run over by buses? Or for that matter you think a lot of healthy young people get cancer or even break a leg?

  1. I think that having accident severe enough that hospitalization / doctor help is highly useful are relatively common to the point that I would care about it

  2. yes, I think that broken leg is not something unusual - and if I would break leg it would not be some black swan event

It seem even even more frequent than I expected from looking at https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=5732068_nihms896931f1.jpg

See also

Over the 3-year study period, 2009–11, 2,482 Olmsted County residents age 18–49 years experienced one or more fractures, for an overall age- and sex-adjusted incidence of any fracture of 1,291 per 100,000 p-y (95% CI, 1,240–1,342). There were 1,447 men and 1,035 women, and 91% were white by self-report, in keeping with the racial composition of the community in this age-group (84% white in 2010). The age-adjusted annual incidence for women was 1,007 per 100,000 (95% CI, 945–1,069) compared to 1,567 per 100,000 (95% CI, 1,486–1,648) for men

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732068/

(note: not verified this study at all)

"You think a lot of people get run over by buses?" in USA alone about 40 000 - 50 000 people die in traffic accidents each year. (not checked injuries statistics as it is more likely to be creatively inflated and would require more effort to process it)

That’s like what 0.01%ish of the population? And of those, how many people die on the spot? It can’t explain the presence of “healthcare is super important”

As for broken bones, 1%ish every three years isn’t that much either. Also probably isn’t that bad of an experience from a medical perspective either.

For start, it is 1% annual incidence, right? Which is 46% over 60 years assuming flat 1% chance per year.

And even 0.3% annual is 16% chance over 60 years.

(and if you are unsure why people care about reverse lottery where they have say 0.1% chance of losing 50 000$ each year - then I am just confused)

(number very roughly estimated, I guess that you could pull real numbers but I expect them in this kind of area - how much USA people in the top 0.1% of medical payments in given year pay typically? how much in say Germany or Poland?)

That’s like what 0.01%ish of the population? And of those, how many people die on the spot? It can’t explain the presence of “healthcare is super important”

many more are seriously injured. That is 40-50k dead outright.

So is "what if I get struck by lightning".

Now obviously it's more reasonable to worry about getting injured in the workplace/a bad car crash/whatever than by a lightning strike, but a lot of this runs afoul of "a huge increase over a trivial base...." and anyways most people don't know that the sticker price on the bill you get for medical treatment is not the final price.

So is "what if I get struck by lightning".

  1. not really, this is really unusual - unlike medical issues requiring hospitalization that happen to nearly everyone (except people who never had serious injury/illness and then died on spot or lived so long that prognosis of medical intervention is pointless)

  2. I am still going to prefer spend some funds on lightning rods and would support building codes requiring them (and would avoid fencing on castle tower during storm or sitting on metal viewpoint platforms on top of mountain when I see flashes of storm on horizon. Or standing next to huge metal cross on mountaintop during thunderstorm.)

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