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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):
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
#assassinbaestory 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.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
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
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
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?
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.
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
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 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 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
Likewise, there's cheese and there's cheese. Cheese can be minimally processed or intensively processed.
It all depends in what's in those corn tortilla chips. I reckon it would be processed, even ultra-processed depending on ingredients.
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.
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.
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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.
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? 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).
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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.
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