Dying in the Safety Net.

[Escape_Goat]

Preventative care?

It's hard for me to want to help fund the poor's insurance when they're eating McDonalds and taco bell 24/7 for all three meals, smoking crack, shooting up, smoking a pack a day, and sitting at home doing absolutely nothing productive, living off other people. Yeah no wonder they have health problems. You want preventative care? Lets start with what we can prevent ourselves (e.g. what I listed above).

In the words of Lincoln: "You cannot help people permanently by doing for them, what they could and should do for themselves."

Sure, all poor people aren't like this - but a large amount of them are, and I don't feel bad when their health starts to deteriorate. They did it to themselves and they know it.

Do I think lazy people have a "right" to health care at the expense of the hard working? Yeah right.

Wow.

Poor people eat low quality food (fast food, etc) because it's what they can afford. Telling someone who has a few dollars per day to spend on food that they should use it to buy fresh produce and healthier foods is unrealistic; they can either spend their ~$3 on a pound of apples when they can buy a meal at a fast food joint. Yea, the apples are healthier, but for people dealing with food scarcity, it's more important that they consume more calorie dense foods. It comes down to whether they starve now or have health problems later.

The characterization that poor people are inherently lazy is pretty disgusting because that "Just World" view pretends that there are no institutionalized barriers to opportunity that exist in our society and that those people who live in poverty deserve their misfortune as a consequence of their bad decisions.

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[ruralsurg4now]

No, he means that our salaries depends on a system that is catastrophically overregulated. The reason that those of us in healthcare can charge the prices we do (this is true for everything from pharma to physicians salaries) is because a complex web of regulations prevents anyone from providing the service you provide more cheaply than you do.

Um, sorry, but no. You seem to be under the misconception that the government is awesome because it prevents you from being undercut in price. That's hilarious because the government is why you get reimbursed at a fraction of the cost. In other words, it's the opposite. The government is actually forcing you to be undercut.

 

[ruralsurg4now]

Wow.

Poor people eat low quality food (fast food, etc) because it's what they can afford.

That's another falsehood. Eating fresh food is quite inexpensive. That's one of those lies that is circulated to justify the actions of the poor.

 

[KnuxNole]

Remember womb raider, there will be people in your practice daily who aren't the most compliant or who are unaware how to eat healthy. After all, poll 100 people young and old and 70-80 won't have an idea. Education is key, sure some won't care but others might. Same with everything else. It might be easy for me and you to find jobs, but we are the minority. Telling people it's easy won't motivate them. On the flip side, we can't let people know it's impossible to make changes. That's one of the many challenges we are tackling, and you will be too!

 

[Ja3ger]

It's not that I don't want to help people and provide everyone with perfect healthcare. It's that, in our society, providing perfect care to everyone is NOT A REALITY. It's something that many liberals don't understand. We have limited resources and we must distribute them efficiently. To me, that means helping hard working, honest, diligent people who are actively putting in an effort to improve their lives.

By providing healthcare to these "good-for-nothings" I have been alluding to, we are essentially telling them "Oh, please, by all means continue being a worthless sack of ****, not contributing to society. It's ok, we'll pay for you anyway." This mentality is contagious.

What if I told you that providing care to more people IS A REALITY? And not just marginally more but significantly more (i.e. tens of millions).

How many "honest" people in poverty (through structural barriers they have virtually no control over) will it take for you to allow yourself to also cover just one "worthless sack of ****"?

 

[Perrotfish]

Um, sorry, but no. You seem to be under the misconception that the government is awesome because it prevents you from being undercut in price. That's hilarious because the government is why you get reimbursed at a fraction of the cost. In other words, it's the opposite. The government is actually forcing you to be undercut.

Not even kind of true. Maybe this could be true if we were in a single payer system, but we're not. There's a cash market for your services, anyone is free to go buy the best medical care you can offer for cash, and the rich often do exactly that either directly or through premium health insurance plans. The government can't undercut the prices you can charge to those people unless they provided everyone with lower cost alternative healthcare plans, which they don't. Actually it works the other way: the prices set by that cash market is, indirectly, what sets physician billing schedules. The government only insures people that, without government insurance, would have essentially a zero percent pay rate: the very poor and the very old.

The government doesn't set prices for healthcare. However they do limit the supply of healthcare, by artificially limiting who can provide it. Price points are the intersection of supply and demand. The government makes medical care scarce. The wealthy buy up healthcare the way they buy every other scarce resource at high cost. The government, struggling to keep some of the now scarce healthcare for everyone else, chases the fee schedules of the wealthy, offering reimbursements that are lower than physicans can get with a wealthier payer mix, but much better than physicans get in any other country on the planet. Of course, just like with the housing bubble, those who are too rich for government subsidized insurance and too poor to afford to buy a scarce resource for cash get left in the cold, but you as the physican are making a fortune off of the deal.

 

[Womb Raider]

Remember womb raider, there will be people in your practice daily who aren't the most compliant or who are unaware how to eat healthy. After all, poll 100 people young and old and 70-80 won't have an idea. Education is key, sure some won't care but others might. Same with everything else. It might be easy for me and you to find jobs, but we are the minority. Telling people it's easy won't motivate them. On the flip side, we can't let people know it's impossible to make changes. That's one of the many challenges we are tackling, and you will be too!

Very true, I agree that education is paramount. I definitely don't think it is easy, if anything, it's extremely difficult. We are no different than the laws of physics, we want to follow the path of least resistance (i.e. become a couch potato). However, 99% of the time we have the opportunity to do something productive.I also think that the environment we were raised in plays a HUGE role in this dilemma. I am not ignoring the difficulties involved in "breaking free" of poverty - they are very real and serious. However, I DO think that many of these people have no desire to educate themselves and work to get out of the poverty circle. They are perfectly comfortable with living off other people, being lazy and eating Big Macs and voting for Obama. Education is this country isn't exactly hard to come by. The more free things we throw at these people the less likely they'll want to change. Why should they? Hard work is hard.

 

[Womb Raider]

What if I told you that providing care to more people IS A REALITY? And not just marginally more but significantly more (i.e. tens of millions).

How many "honest" people in poverty (through structural barriers they have virtually no control over) will it take for you to allow yourself to also cover just one "worthless sack of ****"?

1) Really? Where is the money coming from?
2) I'd rather focus all my effort into helping the "honest" people in poverty - don't worry, we won't run out of supply.

 

[ruralsurg4now]

Not even kind of true.

Sorry, but you're totally wrong. The government does set prices for reimbursement, since private insurance companies follow the lead of Medicare. Look into it before you talk so authoratitively next time.

 

[DR MOM]

Not paying what? Are you saying all people in this country contribute to funding the healthcare system?
Imagine being in school with 10 other students. Lets say you busted your *** to make an A in this class. However, only two of you made an A. The others partied, had a grand ol' time and failed. Now, to help everyone, the teacher assigns everyone a "C" grade rather than giving individuals the grades they earned. Does this sound fair to you? People aren't equal, deal with it.

Of course this is a premed forum, so dying of cancer and getting a C are basically the same thing.

We don't need to 'deal' with structural inequalities - unless by deal you mean address them with urgency.

 

[NickNaylor]

That's another falsehood. Eating fresh food is quite inexpensive. That's one of those lies that is circulated to justify the actions of the poor.

Yes, but there is also the investment of time required to transform that fresh food into meals, not to mention the skills necessary to do so. Some people don't have the time to fix a minimum of two meals daily from fresh ingredients.

Sent from my SGH-M919 using Tapatalk

 

[Ja3ger]

1) Really? Where is the money coming from?
2) I'd rather focus all my effort into helping the "honest" people in poverty - don't worry, we won't run out of supply.

1) From the savings we'll have after taxpayers no longer have to subsidize even near the same number of people currently forced to go to emergency rooms and/or dying from preventable diseases.
2) Ideally, of course. But how would you go about doing this? The problem is that generally it's difficult to pick the "honest" people from the others without being inefficient or ineffective on a large scale. This problem has only gotten worse over decades. We need single-payer; if you disagree, what do you propose we do specifically? Just concede that this is the way things have to and will always be?

 

[NickNaylor]

Not paying what? Are you saying all people in this country contribute to funding the healthcare system?




First correction - what MIGHT prevent them from getting sick.

If someone is going to partake in habits that they KNOW are bad for them and are directly involved in causing health problems, then yes, I don't think we should be required to help them if they can't afford it. This is my moral philosophy, not so much my views on American healthcare. Why should I be punished for the actions of others when they know they're doing something they know to be harmful?

Imagine being in school with 10 other students. Lets say you busted your *** to make an A in this class. However, only two of you made an A. The others partied, had a grand ol' time and failed. Now, to help everyone, the teacher assigns everyone a "C" grade rather than giving individuals the grades they earned. Does this sound fair to you? People aren't equal, deal with it.

As far as your "preventative" measures. I strongly agree that we this area of medicine looks very promising, and is undoubtedly cheaper. However, you need to remember that many of these "preventative measures" you are so excited about require very proactive involvement by people they hope to affect. The reality of the situation is, if they don't want to help themselves, we can't make them. Sure, illnesses like the flu, HPV, etc.. can be dealt with relatively effectively with vaccines, but for the majority of other illnesses it isn't that simple. Heck, most of the uninsured people I see in that have/get a coronary stent don't actively take their anti-platelet & ASA. Guess what happens? They're repeat customers.

Obesity, for example, is where we should start imo.




Um, yes. Anything but sit on their *** and wallow in their own depression. If you can't find a job, look somewhere else. If you don't have any skills, get a job mowing a law - if you're a hard working, honest man, people will learn this and you'll move up in the world.

What do you suggest? Have them continue living off government benefits? Or perhaps you'd like to fund them yourself and save us all the trouble?



I have been exposed to the clinic setting for a few years now. Sure, my generalizations have limits - not every poor person is a good-for-nothing homeless person.

It's not that I don't want to help people and provide everyone with perfect healthcare. It's that, in our society, providing perfect care to everyone is NOT A REALITY. It's something that many liberals don't understand. We have limited resources and we must distribute them efficiently. To me, that means helping hard working, honest, diligent people who are actively putting in an effort to improve their lives.

By providing healthcare to these "good-for-nothings" I have been alluding to, we are essentially telling them "Oh, please, by all means continue being a worthless sack of ****, not contributing to society. It's ok, we'll pay for you anyway." This mentality is contagious.

I'm not going to respond to every point of your post partially because I'm on my phone and partially because I simply don't feel like it, but I think the main problem with your whole perspective is that your views are predicated on some variation of the Just World theory/fallacy. You seem to believe that if people are unhealthy or poor it's their own fault. In other words, somewhere along the line those individuals made poor decisions or otherwise did something wrong to get themselves in the position they find themselves in. My opinion is that you think this because it is consistent with your life experience. Your life experience is not the universal life experience, and there are plenty of people that DO work hard and make the right decisions and yet find themselves in ****ty positions. I don't think they should be punished for that by not providing them with healthcare and other basic services. You do.

Sent from my SGH-M919 using Tapatalk

 

[ruralsurg4now]

Yes, but there is also the investment of time required to transform that fresh food into meals, not to mention the skills necessary to do so. Some people don't have the time to fix a minimum of two meals daily from fresh ingredients.

Sent from my SGH-M919 using Tapatalk

Everyone has the time to do it. I do it and it takes all of fifteen minutes. Stop trying to make excuses for the poor, like they're sub-human, and start having some expectations for them.

 

[Womb Raider]

1) From the savings we'll have after taxpayers no longer have to subsidize even near the same number of people currently forced to go to emergency rooms and/or dying from preventable diseases.
2) Ideally, of course. But how would you go about doing this? The problem is that generally it's difficult to pick the "honest" people from the others without being inefficient or ineffective on a large scale. This problem has only gotten worse over decades. We need single-payer; if you disagree, what do you propose we do specifically? Just concede that this is the way things have to and will always be?

1. I'll believe it when I see it.
2. Yes, ideally. I've been giving you my opinions as if we were operating under "Womb Raider's Affordable Care Act" - not how I will actually be practicing in real life.

The problem HAS gotten worse over the decades. We're giving out too many free handouts to the poor. Do you have any idea how EASY it is to get food stamps? Disability paychecks are WAY too high, in most cases. What about all the money given to irresponsible single mothers who have 8 kids? I think I remember reading that 47% of Americans are receiving some sort of government aid....

People figure out that they can live off the government doing absolutely nothing. Guess what? They indulge in recreational activities, have lots of kids, and their kids grow up and know no different, perpetuating the cycle. While we're talking about preventative measures... We need to cut back on handing out free things so that they'll stop expecting it.

I'm not going to respond to every point of your post partially because I'm on my phone and partially because I simply don't feel like it, but I think the main problem with your whole perspective is that your views are predicated on some variation of the Just World theory/fallacy. You seem to believe that if people are unhealthy or poor it's their own fault. In other words, somewhere along the line those individuals made poor decisions or otherwise did something wrong to get themselves in the position they find themselves in. My opinion is that you think this because it is consistent with your life experience. Your life experience is not the universal life experience, and there are plenty of people that DO work hard and make the right decisions and yet find themselves in ****ty positions. I don't think they should be punished for that by not providing them with healthcare and other basic services. You do.

You're dang right that isn't my life experience - but it could have been.

Sure, some people work hard and find themselves in bad positions. Usually, these are not the whiners and beggars of society and they are definitely the minority.

What about the lazy glutton dopeheads? They are the majority.

 

[ruralsurg4now]

1) From the savings we'll have after taxpayers no longer have to subsidize even near the same number of people currently forced to go to emergency rooms and/or dying from preventable diseases.

Except taxpayers are currently going to be subsidizing the same peoples' insurance. AND there are still going to be illegals and other uninsured that you'll continue to subsidize. This is another post where people pretend that people get better coverage, more care, and SAVE money, which is hilarious. Even Democrats gave up this game months ago.

 

[SunsFun]

No, I wouldn't. That shows how little you know about our current system. By your logic, the more I work for people who don't pay me, the richer I get. That's like when Nancy Pelosi said that when we pay people unemployment, we stimulate the economy. That's right, the more we pay people who aren't working, the better our economy gets.

I am talking about switching current system to a free market one with a perfect competition. If that happened your job would not pay that much at all. Free market = no isolation. US is flooded with foreign doctors. Free market = minimal barriers to entry. General surgery is split into multiple category and each is done by someone with a certificate from high school. There is an appendix clinic in Canada that operates under a similar model doing what US surgeons do for less money and better outcomes.

The bottom line is that American system has never been free market. The prices of the things you do are highly inflated and do not reflect the true market value of the service you provide.

 

[BlueLabel]

Poor people eat low quality food (fast food, etc) because it's what they can afford. Telling someone who has a few dollars per day to spend on food that they should use it to buy fresh produce and healthier foods is unrealistic; they can either spend their ~$3 on a pound of apples when they can buy a meal at a fast food joint. Yea, the apples are healthier, but for people dealing with food scarcity, it's more important that they consume more calorie dense foods. It comes down to whether they starve now or have health problems later.

I have to disagree with your point here. McDonald's is indeed cheap, but food can be purchased much more cheaply (and of course, be better-prepared and more nutritious) at a supermarket. I think your argument is a little misleading because you characterize supermarket food as "apples", when in fact a tremendous variety of tasty and nutritious options are available - indeed a wider range than you'll find at Wendy's. You're basically saying, "you'd be a dummy wasting your money on the laughable supermarket apples (what kind of a meal is that??); it's a perfectly rational, logical, and correct decision to go feed your babies a square meal over at Burger King". This is ridiculous.

But anyway, let's bring in some facts and figures and carefully analyze your point to explain why it is objectively and verifiably wrong. According to the US Dept. of Agriculture, the absolute minimum cost of feeding a family of 4 a healthy diet is between $146-$289 weekly. For our purposes here, let's call a "healthy diet" a diet of around 2000 Calories daily. Let's take a look at a standard fast food option - let's say a Big Mac meal from McDonalds. According to company data, a meal consisting of the sandwich, medium fries, and a soft drink would come out to 1070 Calories. So 2 Big Mac meals daily would constitute a "healthy diet" by our very loose definition. According to a worldwide pricing data tracker, the average price of a Big Mac meal in the USA is $6.64. Simple math:

$6.64 x 2 meals a day x 4 family members x 7 days a week = $371.84, nearly 255% more expensive than the USDA's minimum. Clearly then, we must agree that the "affordability" of fast food is absolutely not its appeal. Rather, its appeal is likely its convenience. It's my contention that when you pay a premium for something to enjoy its convenience, you are partaking in a luxury. Like first class airline tickets. If one is in a situation of extremely limited resources, one should not be consuming luxuries - particularly when the effects of that luxury are harmful to the long-term health of you and your family. It would be wrong in my view to give folks that feed themselves this way a "pass" because of this poor decision-making.

But, please don't take this to mean I think they should be denied access to healthcare - I certainly don't want anyone to suffer. Actually I kind of agree with a lot of points you and others are making about health care reform. I'm simply arguing that we cannot solve this problem with a strictly "state-based" approach. We can do all the leading money can buy, but sooner or later the horses will have to drink.

The problem here is I think we at times get carried away with the spirit of reform, and fail to appreciate that there is only so much that the state can accomplish. It requires a change in attitude and behavior on a personal level as well to achieve real success here. I see the same kind of issue in discussions about race - there's sort of this assumption that only institutions have to change. Sometimes, people have to change also - and saying so isn't a defense of our flawed institutions, or in this case, flawed health care system. I just think we have to look at some of these problems as both one of "supply" (the health care system) and "demand" (the people it treats).

 

[BlueLabel]

This site has been making me double-post all day. Sorry about that.

 

[SunsFun]

Not paying what? Are you saying all people in this country contribute to funding the healthcare system?




First correction - what MIGHT prevent them from getting sick.

If someone is going to partake in habits that they KNOW are bad for them and are directly involved in causing health problems, then yes, I don't think we should be required to help them if they can't afford it. This is my moral philosophy, not so much my views on American healthcare. Why should I be punished for the actions of others when they know they're doing something they know to be harmful?

Imagine being in school with 10 other students. Lets say you busted your *** to make an A in this class. However, only two of you made an A. The others partied, had a grand ol' time and failed. Now, to help everyone, the teacher assigns everyone a "C" grade rather than giving individuals the grades they earned. Does this sound fair to you? People aren't equal, deal with it.

As far as your "preventative" measures. I strongly agree that we this area of medicine looks very promising, and is undoubtedly cheaper. However, you need to remember that many of these "preventative measures" you are so excited about require very proactive involvement by people they hope to affect. The reality of the situation is, if they don't want to help themselves, we can't make them. Sure, illnesses like the flu, HPV, etc.. can be dealt with relatively effectively with vaccines, but for the majority of other illnesses it isn't that simple. Heck, most of the uninsured people I see in that have/get a coronary stent don't actively take their anti-platelet & ASA. Guess what happens? They're repeat customers.

Obesity, for example, is where we should start imo.




Um, yes. Anything but sit on their *** and wallow in their own depression. If you can't find a job, look somewhere else. If you don't have any skills, get a job mowing a law - if you're a hard working, honest man, people will learn this and you'll move up in the world.

What do you suggest? Have them continue living off government benefits? Or perhaps you'd like to fund them yourself and save us all the trouble?



I have been exposed to the clinic setting for a few years now. Sure, my generalizations have limits - not every poor person is a good-for-nothing homeless person.

It's not that I don't want to help people and provide everyone with perfect healthcare. It's that, in our society, providing perfect care to everyone is NOT A REALITY. It's something that many liberals don't understand. We have limited resources and we must distribute them efficiently. To me, that means helping hard working, honest, diligent people who are actively putting in an effort to improve their lives.

By providing healthcare to these "good-for-nothings" I have been alluding to, we are essentially telling them "Oh, please, by all means continue being a worthless sack of ****, not contributing to society. It's ok, we'll pay for you anyway." This mentality is contagious.

I am just curious, what have you specifically contributed to society? As a middle or upper class kid (assumption) you consume disproportionally larger chunk of environmental resources. What did you do for this society to call others "worthless sack of ****?

 

[SunsFun]

Um, sorry, but no. You seem to be under the misconception that the government is awesome because it prevents you from being undercut in price. That's hilarious because the government is why you get reimbursed at a fraction of the cost. In other words, it's the opposite. The government is actually forcing you to be undercut.

Why are you arguing here? Anybody who understand basic economics knows that physicians are overpaid because of the regulation currently in place. Remove regulation - the salaries will go down. Don't you understand what happens when more competitions enters the market?

 

[NickNaylor]

What about the lazy glutton dopeheads? They are the majority.

I'm assuming that for such a bold assertion you have some - ANY - kind of evidence that suggests that. Of course you don't - it's much easier to just believe whatever you want - but I figured I'd ask. And even if it is true, so what? What are you going to do about it? Is your actual argument that we should somehow filter out the "lazy" (how do you define that, by the way?) and deny them benefits? Or is the argument that we should deny benefits because of the risk that some recipients might be "lazy?"

Either way you have an uphill argument to make. My guess is that it ultimately comes down to greed: "I don't want to spend resources to improve the lives of others because I'd rather have nice things even at the expense of others' livelihood." I would also submit that you failed to address any of the issues I brought up. You just continue to claim that people in need are "lazy" with no explanation for why that means they aren't entitled to things like basic access to healthcare or how you would pragmatically implement a procedure that identifies the lazy.

Like many silly proposals, it sounds great and has a nice populist feel, but the devil is in the details.

 

[Harpsx]

I have to disagree with your point here. McDonald's is indeed cheap, but food can be purchased much more cheaply (and of course, be better-prepared and more nutritious) at a supermarket. I think your argument is a little misleading because you characterize supermarket food as "apples", when in fact a tremendous variety of tasty and nutritious options are available - indeed a wider range than you'll find at Wendy's. You're basically saying, "you'd be a dummy wasting your money on the laughable supermarket apples (what kind of a meal is that??); it's a perfectly rational, logical, and correct decision to go feed your babies a square meal over at Burger King". This is ridiculous.

But anyway, let's bring in some facts and figures and carefully analyze your point to explain why it is objectively and verifiably wrong. According to the US Dept. of Agriculture, the absolute minimum cost of feeding a family of 4 a healthy diet is between $146-$289 weekly. For our purposes here, let's call a "healthy diet" a diet of around 2000 Calories daily. Let's take a look at a standard fast food option - let's say a Big Mac meal from McDonalds. According to company data, a meal consisting of the sandwich, medium fries, and a soft drink would come out to 1070 Calories. So 2 Big Mac meals daily would constitute a "healthy diet" by our very loose definition. According to a worldwide pricing data tracker, the average price of a Big Mac meal in the USA is $6.64. Simple math:

$6.64 x 2 meals a day x 4 family members x 7 days a week = $371.84, nearly 255% more expensive than the USDA's minimum. Clearly then, we must agree that the "affordability" of fast food is absolutely not its appeal. Rather, its appeal is likely its convenience. It's my contention that when you pay a premium for something to enjoy its convenience, you are partaking in a luxury. Like first class airline tickets. If one is in a situation of extremely limited resources, one should not be consuming luxuries - particularly when the effects of that luxury are harmful to the long-term health of you and your family. It would be wrong in my view to give folks that feed themselves this way a "pass" because of this poor decision-making.

But, please don't take this to mean I think they should be denied access to healthcare - I certainly don't want anyone to suffer. Actually I kind of agree with a lot of points you and others are making about health care reform. I'm simply arguing that we cannot solve this problem with a strictly "state-based" approach. We can do all the leading money can buy, but sooner or later the horses will have to drink.

The problem here is I think we at times get carried away with the spirit of reform, and fail to appreciate that there is only so much that the state can accomplish. It requires a change in attitude and behavior on a personal level as well to achieve real success here. I see the same kind of issue in discussions about race - there's sort of this assumption that only institutions have to change. Sometimes, people have to change also - and saying so isn't a defense of our flawed institutions, or in this case, flawed health care system. I just think we have to look at some of these problems as both one of "supply" (the health care system) and "demand" (the people it treats).

I think the point you are missing is unhealthy food does not necessarily refer to McDonalds. There are things like microwaveable dinners, frozen pizza, canned foods, instant noodles, etc (i.e. the "middle isles/frozen food isles"). Fresh foods, if not used quickly, will go rotten. That is where the money sink is and why these foods can be considered "expensive". When you are juggling a labor-intensive job, sometimes multiple as many poor families do, these cheap, nutritiously deficient foods are what they defer to for both convenience and to save time to because these are usually non-parishable and easy to make. Further, you have to consider that many of these families are not as well educated in nutrition as a sciences student who wants to go to medical school is. When your first consideration is to make sure your family can pay the rent and not starve, checking the nutritional content may not be the most important thing on their mind.

 

[Harpsx]

Argh double post.

 

[SunsFun]

That's another falsehood. Eating fresh food is quite inexpensive. That's one of those lies that is circulated to justify the actions of the poor.

Inexpensive by what metric? Junk food is much cheaper than fresh fruits and vegetables taking price per calorie into account.

 

[SunsFun]

Let's not forget about food deserts. Areas in the country where the only food you can buy is junk food. Poor people don't have cars and can't drive thirty minutes regularly to buy fresh food all the time.

I recommend watching a documentary "Place at the Table" on Netflix which highlights the problems discussed here really well.

 

[Reckoner]

I have to disagree with your point here. McDonald's is indeed cheap, but food can be purchased much more cheaply (and of course, be better-prepared and more nutritious) at a supermarket. I think your argument is a little misleading because you characterize supermarket food as "apples", when in fact a tremendous variety of tasty and nutritious options are available - indeed a wider range than you'll find at Wendy's. You're basically saying, "you'd be a dummy wasting your money on the laughable supermarket apples (what kind of a meal is that??); it's a perfectly rational, logical, and correct decision to go feed your babies a square meal over at Burger King". This is ridiculous.

But anyway, let's bring in some facts and figures and carefully analyze your point to explain why it is objectively and verifiably wrong. According to the US Dept. of Agriculture, the absolute minimum cost of feeding a family of 4 a healthy diet is between $146-$289 weekly. For our purposes here, let's call a "healthy diet" a diet of around 2000 Calories daily. Let's take a look at a standard fast food option - let's say a Big Mac meal from McDonalds. According to company data, a meal consisting of the sandwich, medium fries, and a soft drink would come out to 1070 Calories. So 2 Big Mac meals daily would constitute a "healthy diet" by our very loose definition. According to a worldwide pricing data tracker, the average price of a Big Mac meal in the USA is $6.64. Simple math:

$6.64 x 2 meals a day x 4 family members x 7 days a week = $371.84, nearly 255% more expensive than the USDA's minimum. Clearly then, we must agree that the "affordability" of fast food is absolutely not its appeal. Rather, its appeal is likely its convenience. It's my contention that when you pay a premium for something to enjoy its convenience, you are partaking in a luxury. Like first class airline tickets. If one is in a situation of extremely limited resources, one should not be consuming luxuries - particularly when the effects of that luxury are harmful to the long-term health of you and your family. It would be wrong in my view to give folks that feed themselves this way a "pass" because of this poor decision-making.

But, please don't take this to mean I think they should be denied access to healthcare - I certainly don't want anyone to suffer. Actually I kind of agree with a lot of points you and others are making about health care reform. I'm simply arguing that we cannot solve this problem with a strictly "state-based" approach. We can do all the leading money can buy, but sooner or later the horses will have to drink.

The problem here is I think we at times get carried away with the spirit of reform, and fail to appreciate that there is only so much that the state can accomplish. It requires a change in attitude and behavior on a personal level as well to achieve real success here. I see the same kind of issue in discussions about race - there's sort of this assumption that only institutions have to change. Sometimes, people have to change also - and saying so isn't a defense of our flawed institutions, or in this case, flawed health care system. I just think we have to look at some of these problems as both one of "supply" (the health care system) and "demand" (the people it treats).

Not that I disagree with you, but I think it's important to consider another factor driving people's food (and often healthcare) decisions: availability. Food deserts absolutely exist in the US - I grew up in one. Sometimes that "luxury" is the only reasonable option. But you're absolutely right, focusing only on the system and not on individual decision making/motivation is ignoring part of the problem.

Edit: sorry for basically a repeat of SunsFun's post. Didn't see it until after I wrote this.

 

[SunsFun]

1. I'll believe it when I see it.
2. Yes, ideally. I've been giving you my opinions as if we were operating under "Womb Raider's Affordable Care Act" - not how I will actually be practicing in real life.

The problem HAS gotten worse over the decades. We're giving out too many free handouts to the poor. Do you have any idea how EASY it is to get food stamps? Disability paychecks are WAY too high, in most cases. What about all the money given to irresponsible single mothers who have 8 kids? I think I remember reading that 47% of Americans are receiving some sort of government aid....

People figure out that they can live off the government doing absolutely nothing. Guess what? They indulge in recreational activities, have lots of kids, and their kids grow up and know no different, perpetuating the cycle. While we're talking about preventative measures... We need to cut back on handing out free things so that they'll stop expecting it.




You're dang right that isn't my life experience - but it could have been.

Sure, some people work hard and find themselves in bad positions. Usually, these are not the whiners and beggars of society and they are definitely the minority.

What about the lazy glutton dopeheads? They are the majority.

Ironically while you're claiming this, the safety net for Americans in real dollars has actually shrunk.

 

[Harpsx]

Let's not forget about food deserts. Areas in the country where the only food you can buy is junk food. Poor people don't have cars and can't drive thirty minutes regularly to buy fresh food all the time.

I recommend watching a documentary "Place at the Table" on Netflix which highlights the problems discussed here really well.

Good point. Convenience stores are probably an awful lot easier to reach than taking the bus to grocery stores where you will have to lug a bunch of heavy bags home.
Now, everyone consider that in the context of having to juggle a (potentially multiple) labor-intensive job.

 

[BlueLabel]

I think the point you are missing is unhealthy food does not necessarily refer to McDonalds. There are things like microwaveable dinners, frozen pizza, canned foods, instant noodles, etc (i.e. the "middle isles/frozen food isles"). Fresh foods, if not used quickly, will go rotten. That is where the money sink is and why these foods can be considered "expensive". When you are juggling a labor-intensive job, sometimes multiple as many poor families do, these cheap, nutritiously deficient foods are what they defer for both convenience and to save time to because these are usually non-parishable and easy to make. Further, you have to consider that many of these families are not as well educated in nutrition as a sciences student who wants to go to medical school is. When your first consideration is to make sure your family can pay the rent and not starve, checking the nutritional content may not be the most important thing on their mind.

That is true. For what it's worth I was explicitly responding to a binary comparison between supermarket vs. fast food fare. But I don't think you have to be an expert nutrition scientist or fiendish label checker to shop healthy and smart at the supermarket. However you do raise an important point, but I am unconvinced that this absolves people of being accountable for their decisions. Remember that I am not advocating any kind of punishment or restriction for these people, only saying if we want to address this problem and move forward we cannot treat people like totally helpless victims of circumstance incapable of making their own decisions.

Inexpensive by what metric? Junk food is much cheaper than fresh fruits and vegetables taking price per calorie into account.

Are you sure about that? Based on BLS statistics and USDA data, my back of the envelope calculation puts a pound of navel oranges at 160 Calories per dollar. That's a better value than an Arby's Roast Beef sandwich, a Taco Bell doritos locos taco, a KFC double down, a Panera Bread full italian combo sub, a Chipotle burrito, and by the way a McDonald's Big Mac. At least according to this Buzzfeed article. They also have grapes up there at 130 Cal/dollar and bananas at 656 (!!!), but their figure for oranges was overestimated compared to my calculations so take that with a grain of salt.

 

[BlueLabel]

This double post thing is starting to get on my nerves. What's the deal??

 

[BlueLabel]

Let's not forget about food deserts. Areas in the country where the only food you can buy is junk food. Poor people don't have cars and can't drive thirty minutes regularly to buy fresh food all the time.

I recommend watching a documentary "Place at the Table" on Netflix which highlights the problems discussed here really well.

Not that I disagree with you, but I think it's important to consider another factor driving people's food (and often healthcare) decisions: availability. Food deserts absolutely exist in the US - I grew up in one. Sometimes that "luxury" is the only reasonable option. But you're absolutely right, focusing only on the system and not on individual decision making/motivation is ignoring part of the problem.

Edit: sorry for basically a repeat of SunsFun's post. Didn't see it until after I wrote this.

Good point y'all. It wouldn't be fair of me to criticize people for availing themselves of their only option.

 

[SunsFun]

That is true. For what it's worth I was explicitly responding to a binary comparison between supermarket vs. fast food fare. But I don't think you have to be an expert nutrition scientist or fiendish label checker to shop healthy and smart at the supermarket. However you do raise an important point, but I am unconvinced that this absolves people of being accountable for their decisions. Remember that I am not advocating any kind of punishment or restriction for these people, only saying if we want to address this problem and move forward we cannot treat people like totally helpless victims of circumstance incapable of making their own decisions.



Are you sure about that? Based on BLS statistics and USDA data, my back of the envelope calculation puts a pound of navel oranges at 160 Calories per dollar. That's a better value than an Arby's Roast Beef sandwich, a Taco Bell doritos locos taco, a KFC double down, a Panera Bread full italian combo sub, a Chipotle burrito, and by the way a McDonald's Big Mac. At least according to this Buzzfeed article. They also have grapes up there at 130 Cal/dollar and bananas at 656 (!!!), but their figure for oranges was overestimated compared to my calculations so take that with a grain of salt.

I am pretty sure about my assertion. I actually did a project on that in my environmental justice class. The studies I looked at compared prices in various inner-city stores for fruits and vegetable to chips/candies/hot dogs etc. if you are interested in learning more just watch the documentary I suggested earlier. They synthesize a lot of data on this topic.

 

[BlueLabel]

Glitch double post

 

[Womb Raider]

I am just curious, what have you specifically contributed to society? As a middle or upper class kid (assumption) you consume disproportionally larger chunk of environmental resources. What did you do for this society to call others "worthless sack of ****?

A) This is a silly question.
B) I'm not a fan of personal attacks, so I won't return fire or feel the need to prove myself to you. After all, we're on the internet - whatever I say, who knows if its true? What's the point?

I'm assuming that for such a bold assertion you have some - ANY - kind of evidence that suggests that. Of course you don't - it's much easier to just believe whatever you want - but I figured I'd ask. And even if it is true, so what? What are you going to do about it? Is your actual argument that we should somehow filter out the "lazy" (how do you define that, by the way?) and deny them benefits? Or is the argument that we should deny benefits because of the risk that some recipients might be "lazy?"

Either way you have an uphill argument to make. My guess is that it ultimately comes down to greed: "I don't want to spend resources to improve the lives of others because I'd rather have nice things even at the expense of others' livelihood." I would also submit that you failed to address any of the issues I brought up. You just continue to claim that people in need are "lazy" with no explanation for why that means they aren't entitled to things like basic access to healthcare or how you would pragmatically implement a procedure that identifies the lazy.

Like many silly proposals, it sounds great and has a nice populist feel, but the devil is in the details.

So.... Are you disagreeing with me? Are you saying that most poor people are hard working, honest citizens who are making a genuine effort to stay healthy and contribute to society?

What am I going to do about it? Well gee wiz, I wish I could implement Womb Raider's Affordable Care Act, but unfortunately that isn't going to happen. We're having an intellectual discussion. But yes, if you want reality - I think if someone wants free health care, free food, free anything from the government (or from my pocket), they should be able to show that they aren't a slum of society. E.g. take drug tests, show that they're working or trying to work. Educating themselves AND making sure their children are being educated. Oh, but this is a free country you say? Not if you're living on my dime. The opportunities are there people - stop defending the lazy.

My argument doesn't stem so much from greed as it does from supporting leaches. Would you walk around living with a leach attached to your neck? Oh you wouldn't? What if that leach was a human being? I don't like parasitic members of society.

Although you may think that we, as humans, have some "moral obligation" in life to improve the lives of others at our own expense, this is your constructed reality, not everyone's. Assuming you do believe in this logic, where do you draw the line to your charitable donations?

 

[KnuxNole]

Everyone has the time to do it. I do it and it takes all of fifteen minutes. Stop trying to make excuses for the poor, like they're sub-human, and start having some expectations for them.

Then you should teach your patients. 80 percent won't have a clue how to do it in 15 mins by a longshot. They would think you are crazy or unrealistic. You have to remember you might find it easy, but most won't.

Especially in YOUR rural area. Where there aren't fancy resources or free access to everything under the sun.

 

[BillrothI]

Just want to point out that there's nothing inherently unhealthy about microwaved or canned foods. The term "junk food" is highly subjective and often misleading. Food doesn't need to be "fresh" to be healthy. In fact, buying frozen/canned foods in bulk offers a number of advantages in terms of price and convenience. BlueLabel's numbers are pretty spot on.

-Bill

 

[dorian baltar]

[quote="Carl Seitan, post: 14618853, member: 531689

What's hilarious is that deride an appeal to emotion as the least intelligent form of argument and then immediately follow it up with an appeal to authority. Bravo.[/quote]

I was too eager to comment and didn't read the next 3 posts. Disregard the following.

He didn't use appeal to authority, he just pointed out a mistaken assumption. If ruralsurg4now had said something like, "I'm a doctor and you're a medical student or pre-med, so I'm right," that would have been an appeal to authority.

 

[SunsFun]

A) This is a silly question.
B) I'm not a fan of personally attacks, so I won't return fire or feel the need to prove myself to you. After all, we're on the internet - whatever I say, who knows if its true? What's the point?



So.... Are you disagreeing with me? Are you saying that most poor people are hard working, honest citizens who are making a genuine effort to stay healthy and contribute to society?

What am I going to do about it? Well gee wiz, I wish I could implement Womb Raider's Affordable Care Act, but unfortunately that isn't going to happen. We're having an intellectual discussion. But yes, if you want reality - I think if someone wants free health care, free food, free anything from the government (or from my pocket), they should be able to show that they aren't a slum of society. E.g. take drug tests, show that they're working or trying to work. Educating themselves AND making sure their children are being educated. Oh, but this is a free country you say? Not if you're living on my dime. The opportunities are there people - stop defending the lazy.

My argument doesn't stem so much from greed as it does from supporting leaches. Would you walk around living with a leach attached to your neck? Oh you wouldn't? What if that leach was a human being? I don't like parasitic members of society.

Although you may think that we, as humans, have some "moral obligation" in life to improve the lives of others at our own expense, this is your constructed reality, not everyone's. Assuming you do believe in this logic, where do you draw the line to your charitable donations?

You are the one calling majority of poor people leaches. What gives you a moral high ground to do that?

The opportunities are there for YOU because you were lucky to be born in the right family, go to decent school with carrying teachers, and having friends who were a positive influence. Sure you faced adversity, but you have zero understanding of what some people have to go through just to survive. I worked for years with kids who had to sleep at friend's houses and not eat once a day in cafeteria and majority of them did everything to have a better life. I'd much rather work with them than some entitled little brat who has been sucking on his parents' tit for all of his life and thinks that poor people are just lazy since the opportunity is always there.

 

[Harpsx]

That is true. For what it's worth I was explicitly responding to a binary comparison between supermarket vs. fast food fare. But I don't think you have to be an expert nutrition scientist or fiendish label checker to shop healthy and smart at the supermarket. However you do raise an important point, but I am unconvinced that this absolves people of being accountable for their decisions. Remember that I am not advocating any kind of punishment or restriction for these people, only saying if we want to address this problem and move forward we cannot treat people like totally helpless victims of circumstance incapable of making their own decisions.

You are right, we cannot absolve all responsibility as if they are helpless and I do think that ultimately, on an individual level, it is both a complex mix of social factors and personal factors in which weigh in to their food choices.

However we must agree and acknowldge that there is a strong social context for which people make their choices, which can sometimes be much more influential than a persons personal choices. I like to see it as a range of opportunities. Depending on your socioeconomic class, the range of possible choices you can make are larger or smaller. It is up to you to make the "best" choices within your range, however we cannot reasonably expect people to statistically always make/or even know what the best choice within their range is. Even people in higher socioeconomic "classes" do not always do that/know, but when they fail, they have a larger supporting cushion to fall upon. Those at the bottom often do not.

 

[SunsFun]

Just want to point out that there's nothing inherently unhealthy about microwaved or canned foods. The term "junk food" is highly subjective and often misleading. Food doesn't need to be "fresh" to be healthy. In fact, buying frozen/canned foods in bulk offers a number of advantages in terms of price and convenience. BlueLabel's numbers are pretty spot on.

-Bill

How do you suggest someone without a car, an access to a real grocery store, and a maximum of 20 dollars to spend buys the food in bulk?

 

[NickNaylor]

A) This is a silly question.
B) I'm not a fan of personally attacks, so I won't return fire or feel the need to prove myself to you. After all, we're on the internet - whatever I say, who knows if its true? What's the point?



So.... Are you disagreeing with me? Are you saying that most poor people are hard working, honest citizens who are making a genuine effort to stay healthy and contribute to society?

Yes, I am disagreeing with you and agreeing with the multitude of studies that have shown that, in the long run, benefits like preventative healthcare cost less than not paying those benefits. Having a healthy, educated society is also important to economic growth and things like social mobility. I know this is hard for you to understand since it's all about you, but believe it or not, things like this actually benefit you. It is good for everyone if more people have the ability to earn and spend as much money as possible. Removing people from the economy due to poverty, illness, or poor education is bad. Even if you disagree with the moral argument supporting benefits to those who need them, the economic argument is pretty uncontroversial and mainstream.

What am I going to do about it? Well gee wiz, I wish I could implement Womb Raider's Affordable Care Act, but unfortunately that isn't going to happen. We're having an intellectual discussion. But yes, if you want reality - I think if someone wants free health care, free food, free anything from the government (or from my pocket), they should be able to show that they aren't a slum of society. E.g. take drug tests, show that they're working or trying to work. Educating themselves AND making sure their children are being educated. Oh, but this is a free country you say? Not if you're living on my dime. The opportunities are there people - stop defending the lazy.

You do realize that this exact thing - drug testing people receiving state benefits - was done in Florida, right? The result was that 2.6% of recipients tested positive for drug use. You know what happened? The state realized that they were spending more money doing the drug testing than they were on paying benefits to those that who "don't deserve them." Still think these sorts of things are a good idea?

My argument doesn't stem so much from greed as it does from supporting leaches. Would you walk around living with a leach attached to your neck? Oh you wouldn't? What if that leach was a human being? I don't like parasitic members of society.

Please tell me about all the ways in which you are not a parasite of society and actively contribute to the well-being of others. I'm looking forward to hearing them. I'm sure you've done a lot of great things after receiving all of those government-funded/mandated things like universal education, vaccination, and loans for secondary education, and will continue to do great things after you benefit from government-funded residency training and more government loans for your medical training. What have you done to not only make the spending on you net-neutral, but net-positive? Dis gun b gud.

Although you may think that we, as humans, have some "moral obligation" in life to improve the lives of others at our own expense, this is your constructed reality, not everyone's. Assuming you do believe in this logic, where do you draw the line to your charitable donations?

This isn't really relevant to the discussion, but I'm of the opinion that given that we all have one life to live, we should all strive to live the most fulfilling lives possible that results in the happiest life possible. For example, I support using the income of the wealthy - who have the ability to continue doing what I mentioned in the last sentence - to support the poor, who may not have access to things like food and shelter. However my own opinion is irrelevant in the context of policy discussions.

See above.

 

[dorian baltar]

Further, you have to consider that many of these families are not as well educated in nutrition as a sciences student who wants to go to medical school is. When your first consideration is to make sure your family can pay the rent and not starve, checking the nutritional content may not be the most important thing on their mind.

As far as I know, nutritional education in medical school is very minimal. This is one of the problems in curricula in my opinion. A lot of nutrition is common sense, at least for a doctor, but conveying that information in a way that a patient can use isn't common sense.
I think a good change would be to emphasize education of patients, not only about nutrition, but about whatever their current affliction(s) is/are. While I don't think medical students need devoted nutrition classes for their own knowledge, I think it would be good to spend a little time in rotations getting tips on how to quickly disseminate key tips on better nutrition to patients. I'm sure a lot of people think they're better off getting fast food for themselves and their kids than buying a sack of potatoes, but as we all know, that's not true. I bought red potatoes for $1/pound this week. That's 1816kcal per dollar (1lb*454g/lb*4cal/g), much better than ~1000kcal/$6.
Patient education is one of the main issues I'm passionate about. I think it's worth the extra 5 minutes with each patient to tell them why something happened to them (if you can, cancer and other things are too complicated, but kidney stones are pretty easy to explain). Then explain how they can avoid the problem (cue quick nutrition tips, exercise ideas, etc.).
I am purposefully avoiding how care should be paid for. I just think doctors should be proactive about preventative care and provide easy to remember and execute ideas about how to be healthier on a daily basis. Really, the patient is ultimately much more effective at keeping him or herself healthy than we are. Most of what we are/will be capable of is dealing with the consequences of patients' behavior, which is not the ideal position to be in.

 

[KnuxNole]

Med students need nutrition ed too. After all not everyone in med school eats a healthy diet, knows basic nutrition, etc.

 

[Harpsx]

As far as I know, nutritional education in medical school is very minimal. This is one of the problems in curricula in my opinion. A lot of nutrition is common sense, at least for a doctor, but conveying that information in a way that a patient can use isn't common sense.
I think a good change would be to emphasize education of patients, not only about nutrition, but about whatever their current affliction(s) is/are. While I don't think medical students need devoted nutrition classes for their own knowledge, I think it would be good to spend a little time in rotations getting tips on how to quickly disseminate key tips on better nutrition to patients. I'm sure a lot of people think they're better off getting fast food for themselves and their kids than buying a sack of potatoes, but as we all know, that's not true. I bought red potatoes for $1/pound this week. That's 1816kcal per dollar (1lb*454g/lb*4cal/g), much better than ~1000kcal/$6.
Patient education is one of the main issues I'm passionate about. I think it's worth the extra 5 minutes with each patient to tell them why something happened to them (if you can, cancer and other things are too complicated, but kidney stones are pretty easy to explain). Then explain how they can avoid the problem (cue quick nutrition tips, exercise ideas, etc.).

Haha, I was less so referring to nutritional education in medical school and more so that a student in higher education, and especially one educated with the intention of going to medical school, is probably going to know a thing or two more about nutrition than the lay population, and particularly more than those who are not as well educated and have less access to nutritional education.

But for the most part I agree

 

[dorian baltar]

Med students need nutrition ed too. After all not everyone in med school eats a healthy diet, knows basic nutrition, etc.

I don't doubt this, but it's still hard to believe. Well, I completely believe few med school students eat well, it's just hard to imaging they don't know what good choices are. Nutrition just seems like common sense. Eat minimally processed whole foods as much as possible and don't go overboard with oils, salt, and sugar. Following that would improve most people's health considerably. There's too much noise in research findings to get any more specific than that anyway.

 

[ruralsurg4now]

Then you should teach your patients.

I'm not a life coach. If you want to, then YOU teach them. I'm just pointing out that what you guys are saying isn't true.

 

[ruralsurg4now]

Let's not forget about food deserts.

There's no such thing as a food desert. That's just another myth made by liberals to excuse the behavior of poor people. They just randomly make up lies like "people are dying in the streets due to lack of healthcare." Nobody has ever seen even one person dead in the street for pretty much any reason, but you're supposed to go "wow, that sounds plausible!!"

 

[NickNaylor]

There's no such thing as a food desert. That's just another myth made by liberals to excuse the behavior of poor people. They just randomly make up lies like "people are dying in the streets due to lack of healthcare." Nobody has ever seen even one person dead in the street for pretty much any reason, but you're supposed to go "wow, that sounds plausible!!"

Lol.

 

[KnuxNole]

Rural surg should be a life coach. It's not like it's that bad haha. Ill do it without hesitation.