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Notes -
Some quick hits:
A) Cremieux argues that much of the gap in life expectancy between America and Europe is due to obesity. But America is good at one thing at least – spending money on health care. Combine high spending with effective weight loss drugs, and the U.S. is on track to significantly narrow its life expectancy gap with Europe.
Self-driving cars will close the gap further.
B) Drug overdose deaths are down in King County (Seattle area) this year after more the tripling between 2019–2023. This is probably because fentanyl has already killed a significant percentage of the junky population. There has also been some modest progress in cracking down on open air drug markets. In the last 2 years, about 1 in 1000 King County residents died of a drug overdose.
C) Health insurance companies have a terrible reputation. But it's hard to fix. It's a viscious cycle which goes something like this:
Company has bad reputation
Due to bad reputation, the company has trouble getting talent, so they compensate by paying a lot
This selects for people who care more about money than reputation
Money-grubbing behavior leads to bad reputation
If you were next in line at United Health, how would you fix the problem?
Note: Many societies in the past (India, Japan) created special undercastes to do necessary but unsavory work such as working with dead bodies. Should we do likewise and create a special caste of health insurance workers that are not allowed to work in other fields and we can treat like shit with impunity? Reddit probably thinks so.
D) Epistemic status: uncertain.
Many people in the China tariff post said that China is "not expansionist".
But what is today China was, 2500 years ago, just a small collection of states along the Yellow River. Gradually, over the millenia, they absorbed more and more territory into their country.
It's as if the Roman Empire still existed today and controlled all of Europe.
Genetically speaking, the Han people seem to have done much better than Rome. The Romans, the people who lived in the city of Rome circa 500 BC, essentially all died out. For centuries, Rome's population could only be sustained from continual influxes of people from the countryside, and later, far flung areas of the Roman sphere. This doesn't seem to be the case in China. Even today, there are people who can trace direct male lineage to Confucius who lived around 500 BC.
If I'm in a car accident, my auto insurance company pretty much just pays for my accident (or at least that was my limited experience and the experience of others I know). There are occasional disputes about the amounts and autobody companies do have to deal with those disputes, but I am not aware of any auto insurance companies that attempt to just delay approval of repairs until their customers give up or die. In principle, it seems like they could do that - the insured party may decide they can't afford to wait and argue, they just need their car fixed, and then the insurance company can refuse to pay. I'm sure that does happen from time-to-time, but it doesn't really seem like a going concern.
My infinitely naïve solution is to just offer insurance products that you intend to actually make good on rather than deceiving people into believing they're covered in order to create additional profit margins. I'm sure many people would still be bitter about actual facts, but it seems clear that health insurance companies aren't simply dealing with cold actuarial facts and communicating costs clearly, they're lying to people, they're fighting legitimate medical care, and they profit from figuring out ways to legally avoid paying for treatment.
The auto/medical insurance comparison is a good one to think about. Another distinction between the two is that auto insurance is mostly viewed as an individual thing, where the only real public purpose in getting involved is to make sure people internalize the costs that their decisions may have on others (i.e., basically every jurisdiction requires liability insurance). Whereas in the medical industry, the entire apparatus of the industry and relevant government entities (many of which are entirely captured by the same worldview) is so entirely bound by the view that we must subsidize, that we must transfer incomes via regulation of the medical industry, that they descend into such contorted reasoning along the lines of Everything Not Obligatory Is Forbidden. Those are the only two options once we've decided to implement a system that, instead of being oriented toward individuals internalizing the costs of their choices, is oriented specifically for the purpose of externalizing the cost of every single choice you make, no matter how minor, so long as it pushes around some mathematically-computable risk factor in a PubMed article somewhere. This is why such folks literally think that the only option other than strictly making things with some medical risk forbidden (unless you pay someone with a special government license to give you permission) is to literally put a bullet in the heads of anyone who does anything with computable medical risk. This sort of thing would be unthinkable to even express in the automotive world, because the entire mindset is starting from a completely different frame.
Unsurprisingly, this sort of reasoning is incoherent on its own terms. As mentioned in the other topic in the OP, the vastly dominant risk factor driving obscene amounts of medical spending is obesity. Why doesn't the exact same logic work? Why are we not forced to put a bullet in the head of anyone who uses food irresponsibly (perhaps anyone who attempts to purchase some food that hasn't been prescribed by a government-licensed dietitian)? Why wouldn't we have to put a bullet in the head of anyone who works on or drives their own car, rather than having it serviced by a government-licensed mechanic and be chauffeured around by a government-licensed driver? But this is truly the type of reasoning that has infected anyone who is remotely influential in medical policy. Transferring incomes via medical policy is in their bones, like a sacred value. From this core flows most of the ridiculous policy choices we've made, which have built up hack upon hack, ultimately resulting in messed up incentives for insurance companies. Insurance companies are basically not allowed to be honest and provide an honest product at this point, but that's only one of the many effects of a complete error in mindset.
I don't buy this. Everyone dies of something. The efficient way to reduce medical expenses is to die of something that kills you relatively fast. Any claim that people's actions "cause them to have medical expenses" has to be seen in this light. It's by no means clear that some activities cause medical expenses at all just because they lead to early illness and death (I believe cigarette smoking reduces medical expenses for this reason). And even if they do, are they really something we wish to discourage? (do we want to blame people for being nonsmokers because that increases their medical expenses for old age care?)
Why it would even work?
I expect that smokers are more likely to die due to prolonged lung-related diseases rather than something acting quickly. And therefore increase costs.
But they also die much earlier and without elderly care, which is on a totally different level of cost. Also significant savings on social security: the state loves a man who dies on his 65th birthday and covers payments for a lawyer who lives to 98.
the claim was
which seem very unlikely to be true. Pension is surely not a medical expense?
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