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Re:America’s Looming Primary-Care Crisis by pengaru on Saturday July 25, 2020 @09:35PM (#23953728)
My understanding is that a major cause of America's burgeoning healthcare burden is the food environment.

The argument I've heard smarter, better informed people than me make is: If healthcare were nationalized, it would incentivize the government to help fight the battle against itself in the context of unhealthy agricultural subsidies and policies.

When the government subsidizes farming corn on a massive scale, and all these corn-derived products make people obese and give them diabetes, it becomes counter to the government's own goals if its charter includes providing affordable healthcare to all.

If we don't stop subsidizing liquid sugar, it'll continue finding its way into everything possible.

What kills me is people proposing taxing products w/added sugar... talk about the American way; spend people's tax dollars on subsidies producing the sugar, then tax them again for consuming the thing you made cheap with their taxes! smh

Re:America’s Looming Primary-Care Crisis by cortesoft on Saturday July 25, 2020 @09:42PM (#23953755)
I think you are misunderstanding the incentives that drive politicians if you think extra health care costs would make them change their subsidy policy. They subsidize because the recipients are powerful donors who want them. It isn’t because it is sound fiscal policy.
Re:America’s Looming Primary-Care Crisis by roenxi on Saturday July 25, 2020 @11:05PM (#23954097)
Adding to this; there is also no evidence that the US's politicians care about financial incentives as applied to the US government.

If it affects them personally then they'd jump like a cat on a stove; but if it only affects the budget they aren't going to respond to any incentive.

If the US was being influenced by financial incentives it wouldn't be doing many of the things it does. Like tax cuts or spending more money.

Re:America’s Looming Primary-Care Crisis by neutronman on Sunday July 26, 2020 @01:02AM (#23954563)
The monetary policy of the USA is insane these days. Tax cut and spend is here for the moment. Taxes will go up but so will spending...
Re:America’s Looming Primary-Care Crisis by reducesuffering on Sunday July 26, 2020 @01:52AM (#23954753)
Food subsidies poll extremely well and the US votes for them. They are one of the least controversial public policies and not because of "powerful donors." Almost all countries subsidize food production and there are strong reasons why this is so. Primarily, countries want a robust domestic food surplus for social stability. High food prices or lack of food leading to famine are one of the highest causes of social unrest.
Re:America’s Looming Primary-Care Crisis by cortesoft on Sunday July 26, 2020 @12:28PM (#23958186)
Ok, even if you are right, they still aren’t concerned with the fiscal impact of the policy.
Re:America’s Looming Primary-Care Crisis by MattGaiser on Saturday July 25, 2020 @11:43PM (#23954259)
Yes, because cheap food is not something that would otherwise interest lots of people...

Increasing corn production also does not play to a crucial constituency in the Presidential elections...

This obsession with “rich donors” ignores that voters will also get mad at politicians for the consequences of eliminating those subsidies.

Re:America’s Looming Primary-Care Crisis by jyounker on Sunday July 26, 2020 @12:22AM (#23954418)
The smaller your donor base, the fewer people you have to make happy. My personal belief is that this is why income inequality is inversely correlated with democratic representation.
Re:America’s Looming Primary-Care Crisis by Aeolun on Saturday July 25, 2020 @11:37PM (#23954228)
Then fix that?

Powerful donors should not exist.

Re:America’s Looming Primary-Care Crisis by DoreenMichele on Saturday July 25, 2020 @10:10PM (#23953868)
My understanding is that a major cause of America's burgeoning healthcare burden is the food environment.

That's only one factor. Another is car dependence and lack of pedestrian-friendly built environments.

There is a lot of research on just how much harm it does us to sit all day, every day. We sit in a car to make a long commute to work. We sit our desks. We sit in the car again.

And hitting the gym occasionally doesn't fully compensate for living like that.

Urban planners used to configure cities to help promote physical health and we don't do enough of that anymore. It's nigh impossible to escape a sick outcome when trapped in a sick system that makes healthy choices largely out of reach for most people.

Re:America’s Looming Primary-Care Crisis by qserasera on Sunday July 26, 2020 @01:01AM (#23954562)
Our metabolism increase from walking 5-15 minutes every day is significant. With individual car transportation there is little want or little ability to do so. Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car.

Every day US citizens waste hours life with transportation. I do believe in cars but I also believe we need to reshape how we live. If the US government allows our time to be wasted repeatedly by a variety of lobbies building infrastructure for a variety of interests it shows how little our leadership values the time of our citizens. I almost find it more egregious that government wants to waste the time of our citizens than wanting to eventually kill ourselves with emissions.

The US currently has an oversupply of labour and I suggest the US does something with it to reshape infrastructure to be less energy reliant.

The world should look into outfit and create houses with manditory natural cooling/heating, increase density in cities and towns to reduce habitat distruction and sprawl, reduce emissions of high GWP chemicals, and create a global political situation to reduce reliance on a failing economic system that incentivizes people to hide pandemics.

Re:America’s Looming Primary-Care Crisis by u801e on Sunday July 26, 2020 @11:14AM (#23957620)
> Many schedules do not allow for daily 60 minute exercise routines at the gym which take 10-15 min to get there by car.

You can get that 60 minutes of exercise/physical activity if the transportation to various destinations is changed into a form of exercise for all or some part of it. In the case of a bicycle, it does require that destinations are less than 10 miles (16 kilometers) away, otherwise it would take too much time.

Re:America’s Looming Primary-Care Crisis by pm90 on Saturday July 25, 2020 @10:33PM (#23953958)
Growing food and subsidizing farmers that produce food is more for the National Security angle: without enough food, there will be rapid social instability and riots and a complete breakdown of society. It’s absolutely essential to produce much more food than can be possibly required by the populace.
Re:America’s Looming Primary-Care Crisis by frank2 on Sunday July 26, 2020 @01:40PM (#23958695)
True in general (well, except your final sentence), but the topic is the US, which has never failed to produce enough food to feed its population and is unlikely to to start failing now.
Re:America’s Looming Primary-Care Crisis by pm90 on Sunday July 26, 2020 @02:39PM (#23959119)
It doesn’t produce that food magically. A certain section of society needs to be dedicated to growing food and supported with subsidies if they can’t grow food economically.
Re:America’s Looming Primary-Care Crisis by frank2 on Sunday July 26, 2020 @02:42PM (#23959154)
Even in the absence of government subsidies, the US probably would'nt've experienced a shortage of food.

I'm not saying that it is impossible for the US to experience a food shortage or even that smart people in and out of government shouldn't worry about that eventuality. I am saying that current and past US programs to subsidize farmers probably do not do / have not done much to reduce that risk and that most of the group collectively deciding to continue the subsidies probably know or strongly suspect that.

In my experience, the elected representatives and other influencers arguing for the subsidies don't even use food security as an argument. (Again, like others in the thread, I am restricting myself to US food policy.) Instead, they argue that the family farm is a producer of particularly virtuous individuals, and it would be a shame if all the family farms were to be driven out of business by large corporations.

The US Midwest has the largest tract of arable land in the world and twice as large as the second largest. If the people of the world were redistributed among the countries so as to equalize the probability of famine among the countries, the US would probably end up with a population over a billion.

Re:America’s Looming Primary-Care Crisis by jjk166 on Monday July 27, 2020 @11:14AM (#23965868)
The farm subsidies started after the great depression when food shortage was a serious possibility and national security was forefront. While the rhetoric has shifted, the real purpose has not. Yes, the US has the geography to produce vast quantities of food, but that's all useless if no one is farming it. Even with subsidies agriculture is neither lucrative nor appealing for the vast majority of individuals. If the few remaining farmers go off and get better jobs, a huge amount of implicit knowledge will be lost and a lot of infrastructure would be left derelict. This might not be a problem in the short term, America is wealthy enough to import food, but should its suppliers ever try to leverage that position then America would not be able to instantly resume producing the food it needs. Every major power heavily subsidizes domestic agriculture for the same reason.
Re:America’s Looming Primary-Care Crisis by JoeAltmaier on Monday July 27, 2020 @11:23AM (#23965955)
I've heard it said the US could feed the entire world!
Re:America’s Looming Primary-Care Crisis by baix777 on Saturday July 25, 2020 @10:38PM (#23953973)
Canada is similar to the US in terms of food consumption, and yet Canada has much better health care outcomes and lower health care expenditures. I'm not saying food isn't a factor, I'm just wondering how big a factor it is compared to universal access to health care.
Re:America’s Looming Primary-Care Crisis by bluedino on Saturday July 25, 2020 @11:15PM (#23954150)
It’s the food. The USA has 40% obesity rate vs 15% of Canada. We just eat more here, and we eat more garbage.

Funny enough, if you chopped off the fattest 5-6 states, the USA would compare more favorably.

Re:America’s Looming Primary-Care Crisis by nolangerner on Saturday July 25, 2020 @11:43PM (#23954260)
Re:America’s Looming Primary-Care Crisis by knubie on Sunday July 26, 2020 @10:41PM (#23961831)
That's interesting, the CDC lists 42.4% for the US. https://www.cdc.gov/obesity/data/adult.html
Re:America’s Looming Primary-Care Crisis by Aeolun on Saturday July 25, 2020 @11:39PM (#23954237)
Anecdotally, coming to the US from Europe/Japan. The food there is ridiculously fat/large. At least as long as you want to spend less than $30/meal.
Re:America’s Looming Primary-Care Crisis by kevin_thibedeau on Sunday July 26, 2020 @01:22AM (#23954639)
Or it's not the food and people have just adopted a lifestyle where all energy expenditure is minimized.

That is self evident in social behavior. Your theory is just an easily trotted out bogeyman.

Re:America’s Looming Primary-Care Crisis by shados on Sunday July 26, 2020 @10:30AM (#23957285)
Anecdotally, it's at least partially the food. I was a little overweight when I moved to the US, and now I'm full blown fat. My lifestyle (aside for food), didn't change.

The main difference is availability and price, especially the latter. A decent lunch near my office in my home country was 20-30 bucks (converted in USD), and I made X/year. Now I make 3-4+ times X, and you can get more food than I can eat at shit like Panda Express for 6-8 bucks. So vs my income, it's almost 10 times cheaper.

If it wasn't for health concerns, it no longer made sense for me to cook. So I just had delivery/takeout almost every day after I moved (switching country is stressful, so I was happy to get all the time back I could get). Then the health issues cropped up. Now I'm trying to dial it back, but its tough.

I know a _lot_ of people who had similar things happened to them after they moved here, and anecdotally again, one of them moved back and started losing weight super fast, without really trying.

Re:America’s Looming Primary-Care Crisis by ArkVark on Saturday July 25, 2020 @09:50PM (#23953796)
Cut out the middleman - fund national healthcare directly with a tax on air pollution and sugar.

The idea that nationalized healthcare (paid for by the middle class) will encourage politicians to tax the unhealthy food of the lower classes is fantasy - this has not manifest itself in other Western countries which do have nationalized healthcare systems.

Re:America’s Looming Primary-Care Crisis by mensetmanusman on Sunday July 26, 2020 @09:54AM (#23957063)
It doesn’t matter what you eat if you don’t move your body.

People have to realize that the wealth America gained post WW2 was poured into making life comfortable and easy (institutionally and economically).

This had the unintended consequence of making Americans (on average) some of the unhealthiest humans in the world.

Re:America’s Looming Primary-Care Crisis by evan_ on Saturday July 25, 2020 @09:52PM (#23953797)
What if the money collected for the theoretical tax on sugar-containing products went directly to subsidize the sugar producers?

Then again just ditching the subsidies would get the same thing done with less paperwork...

Re:America’s Looming Primary-Care Crisis by wisty on Saturday July 25, 2020 @11:46PM (#23954278)
The US government already spends an absolutely incredible amount of healthcare, comparable to Canada or the UK (per capita). Medicare (old people), Medicaid (poor people) and VA, funds for people who don't pay emergency rooms. It's actually a huge amount of total spending, and while the government gets discounts (like health insurers) it's not radically more efficient.

The problem is, I think, often one of over-treatment. If hospitals are paid per procedure (as they are in the US) they are encouraged to do procedures that are actually bad for patients. Insurers can try to reign in over-treatment (to the horror of people who think that more healthcare is always a good thing), but regulators and customers (and activists) fear they do so targeting costs, not patient outcomes. It's all just a mess.

Here's a few issues:

* Over-testing is the most innocuous problem, but even tests aren't "free". At best, it's annoying and makes you not want to go back to see the doctor unless you know it's urgent (especially if it's costing you money or time). Tests might also the emphasis away from immediate treatments (both things that the doctor can do, and things the patient needs to do) as it becomes more of a "wait and see" game.

* Drugs. Obviously they cost money, and they can have side effects. Over-prescription is widely recognised as a major issue.

* Cesareans when they're a bad idea.

* Heart surgery when it's a bad idea.

* Aggressive treatment (especially of cancer) that statistically decreases the quality-adjusted life years a patient has, but hey you have to do something right?

I could go on, but there's really a ton of things where a hospital should do nothing, but has a lot of pressure (from patients and profit motives) to act. While insurers can try to control this, I think it goes without saying that they're also not entirely the good guys, and giving them too much power to reject treatments is also a bit worrying. Confrontational systems might work in the legal system, but it's too slow and expensive to work in healthcare.

Let's look at the special interests the US has (it's not just corn syrup!):

* Caps on doctor training spots. Obviously this is not unique to the US, but a free market solution is hardly going to work when you cap supply.

* Existing players (insurers, hospitals) want high overhead (regulations, admin) to create a moat.

* Drug companies in the US want high drug prices. Australia will subsidise drugs, but only if the drugs are priced right (which creates an incentive for companies to offer deep discounts in Australia). In the US, this kind of bargaining doesn't happen to the same degree. People online keep telling me that the spending on drugs is good though, because it's driving research (it's fine with me if Americans want to spend all their money subsidising the rest of the world).

[dead]
Re:America’s Looming Primary-Care Crisis by katbyte on Saturday July 25, 2020 @11:18PM (#23954160)
> And “liquid sugar” isn’t a problem. People choosing to consume too much of it is. I am perfectly healthy, normal weight, plenty of exercise and I like to drink Coke. Should I have to pay a tax or higher prices because some fat-ass makes the choice to drink it like water?

yes. we tax darts and alcohol - the medical cost of sugar probably well exceeds all risky outdoor activities by orders of magnitude. ~200 climbing accidents a year vs https://www.forbes.com/sites/danmunro/2013/10/27/sugar-linke...

Re:America’s Looming Primary-Care Crisis by mensetmanusman on Sunday July 26, 2020 @09:26AM (#23956903)
‘Should I have to pay for other people’s unhealthy behavior’ is the main debate about healthcare...
Re:America’s Looming Primary-Care Crisis by sintax2 on Saturday July 25, 2020 @10:05PM (#23953848)
Surely you could afford an extra $0.10 here and there if it means millions of people would make better choices, yeah? Taxes don't work like you think they do. If you have a Coke now and then, it doesn't really affect you. If you drink three a day, it starts to add up.

If this is unpalatable, we could always just tax Coca Cola directly so they can pay for their sugar-induced health crisis.

Re:America’s Looming Primary-Care Crisis by gruez on Saturday July 25, 2020 @10:34PM (#23953959)
>It would also incentivize the government to restrict all manor of activities in the name of “health.” Want to go rock climbing? Pay a tax. Want to ride a motorcycle? Pay a tax.

Okay I'll bite. Why shouldn't we do that? If you're going to 28x your death risk[1] by participating in a purely non-essential activity, why should you be able to externalize the costs to others?

>Perhaps instead of taxing food, we instead tax obesity. Put the responsibility on the individual.

That's actually not a bad idea. We kinda already have that for smoking, in the form of higher insurance premiums for smokers.

[1] https://en.wikipedia.org/wiki/Motorcycle_safety#Crash_rates_...

Re:America’s Looming Primary-Care Crisis by mandelbrotwurst on Saturday July 25, 2020 @11:04PM (#23954089)
Who is going to decide which activities are "non-essential" ? How will they go about determining whether there are more benefits or costs associated with a particular activity?

Rock climbers can fall - they also build physical and mental fitness as well as learn to work together with and trust others in a high pressure environment.

Motorcyclists can crash, but they're choosing a form of transport that is far more efficient than a single passenger vehicle in many ways (fuel consumption, parking requirements, traffic impact).

People are already incentivized by nature to sort out on their own what sorts of activities will allow them and their communities to flourish. Let them. We will all be better for it.

Re:America’s Looming Primary-Care Crisis by creato on Sunday July 26, 2020 @01:05AM (#23954577)
Why does anyone even need to decide? Just look at the amortized costs for any activity, whether it is "essential" or not. Essential things still cost money. The only thing you might want to do is provide a rebate for taxes on "essential" activities. This still provides the market pressure for people to minimize costly activities (but doesn't ban it), while being net zero impact to revenue.

Someone mentioned there are 200 climbing accidents a year. Figure out how much that costs, and bake it into the cost of some climbing specific requirement (climbing permits? equipment? gym memberships?). I doubt the cost will be significant. And if it is, maybe we should rethink climbing as an activity.

Same with sugar. Figure out how much added sugar actually costs in terms of health impacts, and tax sugar appropriately. A key point of this strategy is that if you aren't consuming a large amount of e.g. soda, as a parent post claimed, then the tax is negligible anyways.

> Motorcyclists can crash, but they're choosing a form of transport that is far more efficient than a single passenger vehicle in many ways (fuel consumption, parking requirements, traffic impact).

Motorcycles aren't actually that efficient. A prius gets better gas milage than many (most?) motorcycles: https://www.latimes.com/news/la-hy-throttle2apr02-story.html

At least a prius has a chance of carrying more than one person.

Re:America’s Looming Primary-Care Crisis by gruez on Saturday July 25, 2020 @11:25PM (#23954191)
>Who is going to decide which activities are "non-essential" ?

A nonpartisan government panel of scientists. I realize with the current political climate in the us, that might be a tall order, but that doesn't immediately mean the idea should be dismissed.

>How will they go about determining whether there are more benefits or costs associated with a particular activity?

Cost benefit analysis based on empirical evidence?

>People are already incentivized by nature to sort out on their own what sorts of activities will allow them and their communities to flourish. Let them. We will all be better for it.

The examples you've listed lie on a spectrum. Indoor rock climbing probably isn't too negative, all things considered. OTOH motorcycles is much harder to defend. You're really going to risk your life to save a few grand a year on gas and parking?

Like I said before none of this is new. The government has already deemed tobacco to be more harmful than good. As such, it's heavily taxed. I don't find it outrageous to tax things that are similarly obviously more harmful than good.

Re:America’s Looming Primary-Care Crisis by Reelin on Sunday July 26, 2020 @12:19AM (#23954408)
What you describe is the polar opposite of freedom. It should be immediately dismissed not due to the current political climate but instead because it would establish the ultimate nanny state full of red tape and bureaucracy.

No one should be arbitrating personal activities unless they directly and immediately impact those around you.

(And for the record, I vehemently disagree with sin taxes such as those for alcohol and tobacco. Legally requiring health warnings on the packaging, on the other hand, makes a lot of sense to me. Also note that alcohol and tobacco have much more consistent and severe health impacts than, say, refined sugar.)

Re:America’s Looming Primary-Care Crisis by NicoJuicy on Saturday July 25, 2020 @10:07PM (#23953856)
> Perhaps instead of taxing food, we instead tax obesity. Put the responsibility on the individual.

You probably have better genes than my family. Lookup endomorph body type or reasons of reduced metabolism.

Evolution has inversed survival of the fattest, so it seems ;)

Re:America’s Looming Primary-Care Crisis by mlavin on Saturday July 25, 2020 @10:35PM (#23953965)
>endomorph body type

Somatypes are an ancient pseudoscience, while caloric intake relative to TDEE doesn't lie.

Re:America’s Looming Primary-Care Crisis by msla on Sunday July 26, 2020 @12:08AM (#23954362)
Think it through a bit more:

If obesity were taxed, there would be pressure to put loopholes in those taxes. Somatypes and "thrifty genome" and so on would be perfect hooks to hang those loopholes on. Result? Questioning that science becomes politically untenable, at least in some universities and research labs. After all, "the grants just follow the illiction returns", as the poet once said:

https://www.thecrimson.com/article/1987/9/29/borking-up-the-...

Re:America’s Looming Primary-Care Crisis by NicoJuicy on Sunday July 26, 2020 @06:35PM (#23960686)
Completely ignoring some persons that can eat everything they want and don't gain weight.

I lost 25 kg. In 6 months, with counting calories and all. But the amount of effort I had to deliver for a normal weight is almost exponentially more

1 hour strength training per day

1 hour cardio in the morning

No alcohol

6 * eating small portions

8 hours of sleep

1 cheat meal per week

Every day, no exceptions.

Re:America’s Looming Primary-Care Crisis by dialamac on Saturday July 25, 2020 @10:55PM (#23954046)
That’s pseudoscience.

Regardless of any minor variability in metabolism, you literally cannot get fat from things you don’t put in. This is like high school or middle school physics. This is by far the biggest factor in obesity (consumption).. such that everything else is essentially irrelevant. People with actual metabolism disorders either die or require replacement of enzymes, whether that’s type 1 diabetes or the rarer metabolism disorders.

If you eat high volume foods with calories at or below what you’re expending, you will not get fat, full stop. Starving people aren’t fat.

There are of course behavioral differences that dictate consumption, some of which are genetically influenced, but metabolism has not much to do with it.

Re:America’s Looming Primary-Care Crisis by fomine3 on Tuesday July 28, 2020 @08:39PM (#23982262)
Yes, What people eat is most important but Is metabolism not influenced from genes?