"A Useful Idiot"

This is worth a read, if you like bending your head around big numbers.  The takeaway - the people in this country are spending an absurd amount of money on "healthcare".  The questions:  What does "healthcare" mean in this context?  Where is the money coming from and why do we spend so much?  

My answer:  "Healthcare" means keeping sick people alive a long time by the use of drugs, without having any idea how to prevent or cure disease.  Nor are there any studies planned which would provide the answer for how to prevent/cure disease - even though nearly everyone agrees these diseases are "lifestyle related."  

The money comes from you, and we spend so much because we're stinking rich, and secondarily, because the government's interventions have created mal-incentives which have, in the words of Michael Porter, broken the value stream between the provision of health care and the consumers/purchasers of health care.

The author of the piece displays the normal confusion about what science is, and about how to understand what could make us healthy, and about the value of the opinions of experts (he loves to appeal to authority whenever convenient).  He shows a naive trust in government to come up with solutions - and completely ignores all the ways the government caused the problems that he points to.  He writes as if he believes he's smart and well enough informed on these topics to offer important insight.  "Not so much."  He is, literally, a useful idiot.

His analysis of economics is to real economics what most football predictions are to truth, and this one comment - "Dean Ornish, the San Francisco-based doctor who probably knows more about diet and heart disease than anyone" - proves he's utterly uninformed as regards health, diet and science.  Or, perhaps it proves he's writing to an audience that is not interested in genuine inquiry.  In short, he's an editorialist not a person to be taken seriously for analysis.

But aside from my temptation to hold him in "contempt of knowledge" for those and other sins of ignorance, he makes one very important point - we divert an immense amount of human effort into keeping sick Americans alive.  The dollar value on that effort is in the trillions.   Here are the stakes: 

For the first time in history, lifestyle diseases like diabetes, heart disease, some cancers and others kill more people than communicable ones.  Treating these diseases - and futile attempts to "cure" them - costs a fortune, more than one-seventh of our GDP.

Those are potent facts.  The author links to this article, for these numbers:

In 2008, the country spent $2.3 trillion on medical care, or 16.2 percent of gross domestic product and $7,681 per person.

His story is riddled with the ridiculous, like this appeal to an authority which is as responsible for the growth of lifestyle disease as any:

This isn't just me talking. In a recent issue of the magazine Circulation, the American Heart Association editorial board stated flatly that costs in the U.S. from cardiovascular disease - the leading cause of death here and in much of the rest of the world - will triple by 2030, to more than $800 billion annually. 

Well, it's not him just talking, it's a editorial board - of an organization with a track record of ignoring the holes in their advocacy of health solutions, and for making many dollars for endorsements of the food industry.  Heck, opinions from editorial boards, that's scary and convincing wouldn't you say?  Perhaps I'd be more convinced if the AHA had been funding a true test of what diet is best for prevention of the diseases of civilization. Instead the AHA put both feet into the "fat makes you sick" non-science.  The AHA is a joke, and gives every appearance of being an industry mouthpiece, existing primarily to raise funds through the licensing of their logo, with little evidence they are helping a single living soul.

The author employs results from epidemiological studies to represent things they can't possibly represent:

The INTERHEART study of 30,000 men and women in 52 countries showed that at least 90 percent of heart disease is lifestyle related; a European study of more than 23,000 Germans showed that people with healthier lifestyles had an 81 percent lower risk.

Those "studies" didn't show any such thing - they can't since the science has not even determined what "healthier lifestyles" are.  If science HAD made that determination, epidemiological studies still couldn't show what causes what.  That's not to say that I doubt the results, the larger point to me is this is an author who cites faux science and then says "let's just give this problem to the US government to solve."  Seems to me that since the US government is a top purveyor of faux science that solution could be problematic.

The crux of the article:

But the trillion-dollar question is, "How do we get people to eat that way?"

I don't have an easy answer; no one does. But it for sure will take an investment: it's a situation in which you must spend money to make or save money. (Yes, taxes will go up, but whose taxes?) Some number of billions of dollars - something in the rounding error area - should be spent on research to figure out exactly how to turn this ship around. (The NIH, which pegs obesity-related costs at about $150 billion, just announced a new billion-dollar investment. Good, but not enough.)

I'm amazed anyone lets anyone get away with saying "investment" as regards the government taking your money and spending to burnish the credentials of one politician or another.  It's black humor of the higher order.  Picture a highwayman holding you up saying "Look, this is an investment, I'm going to use this money to make me look good in the eyes of others, you can feel good about giving me your money!"   

As to the NIH (to their credit, the NIH did refuse to lie and say that there was proof of the "fat will kill you" conjecture) has proved to be incompetent in even determining what a healthy diet is; they spent a billion and came away with nothing in 30 years of trying.  Now they are supposed to skip that step and dive into figuring out how to get us to eat according to this author's strongly held belief about diet and health?  Before the NIH could viewed with credulity, how about they get their business into one sock and fund legitimate tests to determine what factors result in the diseases of civilization?

Again the author appeals to authority (count me skeptical about the "experts"):  Experts without vested interests in the status quo come to much the same conclusion: Only a massive public health effort can save both our health and our budget.

Perhaps these are the experts that have us eating 11 servings of grains per day, low fat milk, and advising the use of industrially produced polyunsaturated oils - none of which has been tested via intervention study to prove they are "healthy", or even tolerable.  But lets say for a moment they are what he portends them to be - if I have ten experts and you have 11 and they disagree about exactly how the government should take your money and "invest" it to save the world - what do you think will be done?  Correct.  Whatever the politicians think has the best chance of making them look good.  

Recap to this point:  the government which encouraged us to stop eating fat based on faux-science, and encouraged us to eat sugar and fructose, and who's agriculture wing makes it expensive and sometimes criminal to eat grass fed animals but pays union "inspectors" to watch while animals are mass slaughtered, is the only possible agent to fix the world wide problem of metabolic syndrome which leads to virtually all "lifestyle diseases."  These people live in Reversoworld.  The bad stuff that inevitably results from governments messing about in things that governments have no business messing in, creates all the justification needed for more messing about.  Perversely, after the government made us sick peddling agricultural products which have no proven "healthy" quality, they now spend our money - waste our money? - to pay for our "health care."  This is painting oneself into a spending corner on a scale only a government could accomplish.  

One last bone to pick - the author counts each "lifestyle disease" separately - cost of treating high blood pressure, cardiovascular disease, diabetes, gout, diverticulitis, many cancers, etc.  But even though he sees, and the experts he believes so faithfully in see, the nutrition-as-one-cause-of-lifestyle disease, they can't seem to put two and two together to think of these disease states as a spectrum of results caused by one problem.  They see them as discrete disease states caused by discrete lifestyle factors.  Hypertension - oh that's exercise, salt intake and obesity related.  Diabetes - results from obesity and eating too much fat.  Cardiovascular disease - too much saturated fat and inactivity.  Short version - people eat too much and move too little, resulting in obesity, which causes diabetes and other stuff.  They believe this wholeheartedly, seemingly unquestioningly, despite what should be a glaring fault - it is not proved.  And given that, it would seem that step one would be to fund the tests which would convincingly yield causality in this chain of conjecture.  

Here's what I think and this is what I see - when you treat people for glycemic control by restricting the type and quantity of carbohydrates - with specific attention to industrially produced polyunsaturated oils and all highly dense carbohydrates - all of the other outcomes are affected.  Obesity and abdominal circumference is affected.  Fasting lipids (best markers for CVD available) change for the better.  High blood pressure resolves for most.  Gout treatment is not required.  All of the short term markers for health can be manipulated with one intervention - carbohydrate restriction.  Intervention experiments out to one year support these observations, and these tests have been repeated and the results confirmed.  The author and his experts ignore this significant science.  It would be just fine with me if they keep their hands off of government efforts to make people "eat better."

Side note for econ geeks:

I don't know if he means to do it or not, but he also points out how meaningless it can be to say "private sector spending" versus "public sector spending."  

Of this $2.3 trillion, the federal government spent $817 billion, while state and local governments spent $290 billion. The tax exclusion for employer-provided health insurance amounted to about $250 billion in lost federal revenue — which is, effectively, a government subsidy for health care. Add up all of these sources, and you get about $1.35 trillion of health spending done by the public sector and slightly less than $1 trillion done by the private sector.

In other words, some health care spending results after government takes it away from taxpayers at gun point, and spends the money on someone.  Other health care spending results due to government incentives to avoid taxes by accepting very expensive "insurance" (pre-paid service plans which are call insurance) in lieu of taxable benefits.  The other half of health care spending comes out of the pocket of the customers who get the benefit of a doctor's care at the time of payment.  Where does all the money come from?  You and me, either via the government's coercive extraction via taxation, or via insurance we choose based on distortions in the "insurance" markets.  What would this system look like without the influence of a government which is influencing nearly every part of the US health care process?  It's hard to say but it wouldn't look anything like the one we have.  Given that government's influence is pervasive in this process, I'm at a loss why anyone would assume that more government is the cure.  But the author is in that camp of the naive few who seem to think the problem with US health care is that there's not enough government coercion being thrown around.  

Economics can show how wealth is created - when human energy is expended transforming copper into electrical power lines, or plastic and other raw materials into coffee makers, or bricks, or shingles, or automobiles, the result can be a product which has more value than the raw materials that were put into the end product.  Generally, a successful product is one which allows human being more free time to do as they choose, while spending less time on food, water and shelter.  Wealth is, in this model, the ability to spend time on something aside from satisfying your basic needs for continued life.  

What this means for "health care" is it creates value in a variety of ways; illness prevented, minimized and/or cured, allows a person to produce wealth.  Money poured into "health care" can produce more wealth by creating new technology (drugs, diagnostic machines, knowledge, application of knowledge via delivery process, training of medical staff), as well as by making sick folks well or preventing illness.  In other words, there is spending on outcomes and spending on capacity which eventually improves outcomes.  You can buy as much healthcare today for $100 as you could in 1970.  The difference now is that there is more health care you can buy, because the system has created a lot of "wealth".  Arguably, it's been the wrong kind of wealth.  The wealth we needed was to know how to avoid the diseases of civilization - determining why aboriginals exposed to civilization degenerate in health until they are as unwell as we are - and instead, we've been sorting out how to survive (but not how to avoid or thrive through these diseases).  Perversely, much evidence suggests the "knowledge" advocated by the government has compounded the diseases of civilization.  

In short, as the author suggests, most of the money spent on "health care" needn't have been spent, and need not be spent in the future.  The stakes are momentous - and that's understatement.  The military points out that the biggest national security threat the US faces is the insolvency of the government via medicaid.  The President has stated, more or less, that medicare is the sum total of our budgetary problems.  The math as of a few years ago was pretty telling - barring some massive increase in US economic growth, by 2042 the government will have enough to pay for medicare and the national debt payments only - no defense, no salaries for government employees, no nuttin' but health care for old folks and the payments on our debt.  Long before then, we enter the death spiral of scared investors needing higher interest rates to make giving us their money seem smart - how long do you think we could survive that.  

US government has, by intruding into healthcare and diet, created the possibility of it's own demise.  Our government has become a black hole of productivity.

For now, I'll restrain myself from addressing all the mal-incentives created by subsidizing and enabling patients to pay for meds that sustain their lives to some degree while allowing them to ignore the root cause of their disease.