To me, this is the strongest argument for a centralised health system, such as the UK NHS.
When you have one organisation responsible for health as a whole rather than just treatment, you can make better decisions. The usual example I give is that it's cheaper to give out the contraceptive pill than deal with pregnancies, but the same thinking applies to broader disease and health.
This holds true for many things. It’s easier to stay in shape and maintain a healthy weight than it is to recover from getting out of shape or overweight. The longer someone spends out of shape or overweight, the harder it becomes to escape the cycle. There’s no better time to start than now.
As for preventative medical treatment: This one is a difficult topic. There’s a popular misconception that getting a lot of different blood tests and imaging scans is a good idea to identify conditions early, but most people don’t understand that these tests (including imagine) are prone to a lot of false positives. Excessive testing has been shown time and time again to lead to unnecessary interventions, leading to worse outcomes on average. A number of previously routine medical tests are now not recommended until later age or until other symptoms appear because routine testing was producing too many unnecessary interventions, producing a net negative benefit.
It’s a hard concept to wrap our heads around when we’re so attached to the idea that more testing means better information. It’s a huge problem in the alternative medicine community where podcast grifters will encourage people to get various tests like organic acid tests or various “levels” testing, then prescribe complex treatment programs with dozens of supplements. The people chasing these tests then throw themselves far out of balance with excess supplements while sinking thousands of dollars into repeat testing
He’s better than most, in that he puts disclaimers on things that aren’t rigorously proven. That said, he talks a lot in that book about things that aren’t actionable, even if they were rigorously proven - such as the coronary calcium scan.
If you get a high score on that test, what are you going to do? Eat better, lose weight and exercise. So skip the test and just do that instead.
A high coronary calcium score factors into the decision about whether to apply more aggressive pharmacologic interventions. Those have risks and side effects so unlike the lifestyle factors you mentioned they aren't appropriate for everyone.
I didn’t say the tests have no use, but trust me: if you’re otherwise well and don’t have symptoms, nobody is making aggressive pharmacological interventions based on the calcium scan.
I am aware that is the current standard clinical practice. Dr. Attia's argument is that we could cut death rates in such patients by starting aggressive pharmacological intervention much earlier in the disease progression. From a physiological perspective that makes some sense, although there haven't been any studies to show whether that cuts all-cause mortality.
This sounds like an example of a fault in how to take action based on results vice a fault in getting too much data. Perhaps the conclusion you state about the better approach being to forego tests is true. For example, if emotional and legal factors prevent patients and providers from acting rationally here. Optimistically, we can do better.
The ACA made this standard. It’s been like this for a long time.
When we were hiring a lot of people out of college, I spent way more time than I expected teaching them about how healthcare works and how to find their own information. We found that a lot of them would build their idea about how health insurance works from years of reading Reddit posts: They thought visiting the doctor was always going to be a $1000 bill or a single accident was going to medically bankrupt them, because those are the stories they saw on Reddit. I would explain things like the free annual physical and many just wouldn’t believe me. It’s really tough to cut through the confusion out there.
I would argue this has severe caveats. I knew a girl in college who was billed over 400$ to test for PCOS, which is one of those diseases that 1) affects just women 2) is underdiagnosed but has severe systemic effects like facial hair growth, diabetes and obesity...
But if they do anything other than extremely basic tests, like blood pressure at the "free annual physical" you will be billed, ridiculous amounts you have no way of knowing in advance.
During these "free" preventative checkups, if your doctor asks if you have any other medical issues to discuss, having an answer other than "no" can change the visit from a free preventative visit into a standard non-free office visit.
These are items you receive along with your insurance.
They are not insurable events and they are not “covered” like an insurable event.
Predictable, regularly occurring events cannot be covered by insurance by definition. You can’t adjust it, you can’t assemble a risk pool, etc.
We use the word “insurance” to mean “nice things that I like” but I think we’d have more enthusiasm for socialized medicine if we knew how much of “insurance” was nothing of the sort.
That's not quite correct. Many patients forgo preventive screening procedures even when they're free (to the patient). Medical insurer actuaries are aware of this and price policies accordingly.
So exercise, eating healthy, fasting, brushing/flossing teeth, consistent sleep schedule, daily sun exposure, good relationships, and stress management all depend on a health insurance plan?
Well, it doesn't have to "depend" on the health insurance plans. But there are definitely ones that reward you in some way for doing some/all of these. Mine literally gives me cash back for doing an annual physical.
You certainly need to "pay" for those yourself, insurance or not (I guess that's probably your point). Going for a run doesn't go on any billing schedule or contribute to GDP, it's all self-funded from your own personal resources of time and energy.
Sam Vimes 'Boots' Theory of Socio-Economic Unfairness
>The reason that the rich were so rich, Vimes reasoned, was because they managed to spend less money.
>Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of OK for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles.
>But the thing was that good boots lasted for years and years. A man who could afford fifty dollars had a pair of boots that’d still be keeping his feet dry in ten years’ time, while the poor man who could only afford cheap boots would have spent a hundred dollars on boots in the same time and would still have wet feet.
What the heck does the price of boots have to do with any of this? All footwear eventually wears out, and if you're talking about athletic shoes the more expensive ones are often less durable (they can improve performance a little).
I think you may be missing the point: preventative treatment is typically much less expensive, for instance behaviour and dietary changes do not require drugs at all and avoiding some conditions can be helped by drugs which have long since come off patents.
But even with your point, all insurance companies I've ever had cover with in the UK have had some element of support for preventing illness (periodic assessments, support material and trackers) and, at least with people covered under company schemes, they clearly have an incentive to offer more if you are at risk of becoming affected by a preventable illness.
When you have one organisation responsible for health as a whole rather than just treatment, you can make better decisions. The usual example I give is that it's cheaper to give out the contraceptive pill than deal with pregnancies, but the same thinking applies to broader disease and health.