Who hurts the US Healthcare system worse?

Well, maybe some data will shed light.It's not so much that we're a nation of fatty-fats; its that we pay doctors too much and have socialized medicine formed out of a risk pool solely composed of those who have the highest health care expenditures, which also happens to be an increasing portion of society:Increasing obesity of Americans doesn't help, but the vast majority of our health care dollars are spent to doctors on behalf of seniors.

Fair enough. As an aside, though, it sounds like she's overworked, and dangerously so; we know that judgement becomes impaired after about 6-7 hours of the kind of attention one needs to practice medicine. But instead of reflecting that, we allow doctors to work insane 20-hour shifts - we demand it, in fact - and that's largely the result of there not being enough doctors.Why aren't there enough doctors? There aren't enough medical schools. Incidentally, that's also the reason your doctor friend graduated with 200k in loans; the cartelized medical school system can afford to demand that kind of tuition. Doctors in other countries don't graduate with that kind of debt and as a result, don't need to work themselves to death (making potentially fatal mistakes after the 10th hour of their shift) and don't need to be paid an exorbitant 200k a year.The result of the conditions you describe your friend working under are exactly what I would expect - our doctors are the highest-paid of any nation, but they make the most mistakes.

That may be, but since medical schools require medical students to do real medical work at "teaching" hospitals in addition to their coursework, work for which they pay rather than are paid for, and since the requirement to do this negative-wage work is so enormous that medical students aren't able to have a second job by which to cover living expenses, the fact that loans are primarily composed of a student's living expenses is still the medical school's fault.Again, our doctors are being overworked in part because hospitals and medical schools can get away with overworking them, and in part because there's actually too much work to go around for the number of doctors and medical students we have. An increase in the number of medical students would solve these problems.

Well, no. Medicare and Medicaid cover both seniors older than 65, eligible disabled persons, and eligible low-income persons like the tennis-shoe-wearing patient in your doctor's letter. They're in the same pool but categorized differently. The crisis he's referring to is that the government's bill for Medicare and Medicaid is enormous and getting larger, to the point where it threatens to crowd out all other spending. That's the "health care spending crisis", or sometimes the "entitlements crisis", that people are talking about. And it's not driven by poor people with Type 2 diabetes, its driven entirely by the expensive care afforded to an increasingly aged population.

It doesn't follow that a person who can afford a handful of inexpensive consumer goods could, by not owning those goods, afford health insurance. Unless this doctor guy has reason to believe that his patient is spending $1000 a month or more on cell phones, shoes, and spinning rims or what-the-fuck-ever, his inference that his patient could exercise "personal responsibility" in a market where the monthly premium can be several thousand dollars if you have a pre-existing condition (you know - like one that might require you to see a doctor!) if insurers will even consider enrolling you.Given the stigma that accrues to the poor in our society, it doesn't strike me as inherently reasonable that someone with a limited income would purchase those goods that best connote the appearance of wealth and affluence, and therefore would lead our doctor-writer to the erroneous conclusion that someone with no ability to afford health insurance was actually rolling in it, and just too lazy to sign up with Blue Cross.

Well, look, you can blame today's kids and adults for the dramatic rise in obesity, or you can claim that yesterday's adults were fatty-fats and that's why senior care is so expensive, but I don't really see how both can be true. And I don't really see how saying that it's possible to be a healthy person in your adult years so that you don't drag a bunch of health problems into your senior years solves the problem we have now, which is that those seniors weren't healthy adults and did drag a bunch of health care problems into their senior years.All of which ignores the fact that there's at least a couple of studies that indicate that poor health choices in your adult years - like smoking, especially - actually save the government money because they're associated with high early-60's mortality. The jury's still out, I think - I've read arguments for both directions on that - but it's not immediately clear that good health in your working years strongly correlates with cheaper health care in your senior years. It's actually quite expensive to be a senior no matter how healthy you are.

For someone with Type 2 diabetes and a couple of related co-morbidities on the individual private insurance market, with no employer to subsidize a group plan? Probably $1500 is the average. I've read as high as $3000. That's for a single person; extending the plan to cover a family is likely to triple the cost. Agreed, and even if it is I'm unsure why I should give a fuck. It's not like anyone makes mad bank off of welfare and food stamps, and if they're spending those things on consumption, that's basically economic stimulus. I read somewhere that the stimulus tax multiplier at those low income levels is something like 1.3 to 1; for every dollar transferred to the poor that they then spend, it generates $1.30 in tax revenue.

Type 2 diabetes isn't actually caused by obesity. No, of course not. Even if you make a major lifestyle change and improve your health, your conditions are all still pre-existing. Whatever health issues you had in the past don't get expunged from your medical records, and they represent a continuing actuarial likelihood that you'll make expensive medical claims in the future. Plus, the individual-insured risk pool has more unhealthy people in it than the pools in your average group insurance plan (because the group plans select against those people too unhealthy to work), so the premiums are higher regardless of your actuarial situation.Seriously, Oni, talk to an insurer about this stuff.

There's no medically-coherent definition of "overweight" or "obese." For instance, look at this BMI-defined-obese fat fatty:Being obese doesn't mean being unhealthy; body fat isn't a proxy for health. I thought we covered this already.

You got paid to go to graduate school, either by an assistantship or the GI Bill. Yes, a lot of people don't "do that" anymore because a lot of people have to pay to go to graduate school, now. An MFA or a PhD in the humanities costs money, they don't give you money.

No, it's not. Eating poorly is risky health behavior. Being inactive is risky health behavior. But it's possible to eat heathily and have a healthy active lifestyle and still be obese.Obesity is not a proxy for health.

Short of dissection, how do you check someone's body fat, Oni? No, look, you're just flat-out wrong about this. Obesity is associated with a number of co-morbidities but that's just a word that means "fat people frequently have these other conditions, too." It doesn't mean that they're caused by obesity. Being obese doesn't inherently make you unhealthy. A number of unhealthy lifestyle and eating habits tend to cause obesity, but it's possible to have very healthy eating habits, a healthy active lifestyle, and still be obese due to differences in metabolism, how efficiently the body uses calories and extracts them from food, and so on. And under those conditions there's little to no association with health effects at all.Weight isn't a proxy for health; you can't just look at someone and know how healthy they are. For that matter, you can't just look at someone and know their body fat content.

Well, wait. No, they don't have their own healthcare system.They have their own health insurance system, but for the most part relatively few doctors work Medicare/Medicaid cases exclusively; Medicare and Medicaid pay doctors and hospitals like an insurer would. They're basically the "insurer of last resort". But those over 65 and low-income people served by Medicare and Medicaid go to your doctor and hospital, they're not in a separate system. The health care infrastructure they're a drain on is the one you use, too. For the most part, healthy people don't go to doctors. The question is, what's primarily making American users of health care unhealthy, and the answer is overwhelmingly their age, not their weight.

A BMI? Of course. But, again, the BMI isn't a very coherent determination of your actual body fat content because it assumes that what bulks out your body is always fat. Someone with a lot of bulky muscle registers as "obese" on the BMI. That was my point about Shane Carwin. Well, yes. Because as usual you're insensate to new information.

I don't see where it does that, since it's nothing but a comparison of your weight to your waist size.