I am too lazy to respond to each of you individually, so I'll just ramble until I get bored (yay insomnia!).
First let me say that it's gratifying to see that many of you actually know what libertarians are. For years, I've had to endure being dismissed as a conservative by you bleeding heart hippie socialist dirtbags Reminds me of all the times I've been called the N-word or r**head. Now at least when you insult me, you use the right terminology. Also, billy, I am so thankful I had the foresight to install my spitguard on my keyboard before seeing your atlas shrugged comment. Note: Never read any Rand. have no plans to.
Onto healthcare. Let me start by saying I think the whole problem with the healthcare debate is that we're approaching it as if healthcare is the sum total of health. At the risk of sounding like a hippy myself, health is a much more holistic thing than healthcare. Everything from environmental contaminants (cough bisphenol A, phthalates cough) to how food is grown (higher yield-->poorer nutrition) what food we eat (no further comments) to lifestyle (video games, sedentary lifestyle) to healthy living and prevention research (useless, largely) to medical education with regard to health maintenance (WORSE than useless).
As i've already said in this thread, the best way to reduce healthcare expenditure is to reduce demand for healthcare. Until we take a look at all the societal phenomena behind the rise in healthcare utilization, it is just plain stupid to even think about addressing healthcare itself.
Heinlein once remarked that a people who forget their history have no future. Bioanthropologists (those who study human evolution) have been aware for several decades now that the rise of agriculture, while paving the way for civilization, longer average life expectancies, etc, also began a vicious cycle of trading quantity for quality. Only recently (last couple hundred years) have we re-achieved the stature and brain size that our pre-agricultural ancestors had. That's right, the agricultural period actually heralded shrinking brains and bodies. Things like vitamin deficiencies, tooth decay (not wear) in young adults, etc, are virtually unheard of in the pre-agricultural archaeological record, but commonplace afterward.
And this correlates to today where (leaving aside organic vs. not), modern varieties of fruits and vegetables husbanded specifically for increased yield per acre are actually less nutritious than their less-cultivated counterparts. Grain-fed meat, farmed fish, and caged chicken have high levels of omega-6 fatty acid and low levels of omega-3 fatty acids (causes inflammation=bad).
Moving on to this past century, we have this wonderful experiment with an n of billions on the effects of modern methods of food production and patterns of consumption and their effects on health. It's called Asia. Age-adjusted incidences of obesity, diabetes, dementia, cancer, and almost every chronic, expensive disease we can think of have skyrocketed in the past few generations as they've adopted a more western lifestyle. While obesity is easily explained by sedentary lifestyle and calories, we learn that there is an outrageously strong connection between all these chronic diseases and the change in n-6/n-3 fatty acid ratio (increased) over time. No surprise since almost all of them are linked to generalized inflammation.
Funnily enough, in Asia, the poor and the rural have a lower age-adjusted incidence of chronic disease. Because their food is more likely to be traditionally grown/fed/caught, rather than 'industrialized'.
Much is made of the 'genetics' of health issues like obesity and diabetes. I've never understood this. Lets take a basic evolutionary population genetics model, assuming mendelian inheritance with complete penetrance and apply it to what we know about trends in obesity in the past two generations in the US. Based on this simple model, we can determine that obese people have had twice as many children as non-obese people. Applying it to asia, the obese have had on average 5-10 times as many children as the non-obese each generation. Extrapolating backwards, we can then estimate that a single person onthe mayflower carried the obesity gene. In India and China, the obesity gene popped into being in the 1800s, and then spread like wildfire, as these fatties did the nasty, repeatedly, with absurd reproductive success.
If you assume incomplete penetrance, partial heredity, and multiple gene loci involved (all true), the model actually produces MORE ridiculous figures, as these attenuate the 'strength' of the obesity signal in the genome, thus requiring more absurd reproductive differentials between the obese and non-obese. Not less.
Looking at DM2 specifically, which populations are the most 'at risk' for the disease? Funnily enough, it's the populations in which this disease was almost unheard of 50 or 100 years ago. Strange, that.
Vg +Ve = Vtot Maybe that's the answer???
The NIH spends how much money finding new genes 'for' obesity, how much money studying the intracellular signalling mechanisms and tissue-level pathogenic processes? God knows.
Why? When genetics and cellular-level processes really are quite obviously the smallest part of the obesity epidemic? As made obvious by the basic evolutionary population genetics and the Great Asian Experiment?
As for nutrition, I see studies involving omega-3 acid supplementation with ridiculously puny amounts ranging from 300mg to 1000mg. It's been known for decades that the optimal n-6/n-3 ratio is 2-1 or less, compared to the 8-1 ratio we average. And we also know that seeing health outcome differences require getting under 4-1 at a minimum. With an average daily intake of about 18grams of n-6 fatty acids, and 2-3 n-3 fatty acids from dietary sources, supplementation studies should be using 6g a day at a minimum to see a benefit.
http://www.informaworld.com/smpp/content~content=a713479734~db=all~jumptype=rss
More wasted money.
And exercise. Less than 1 in 10 doctors I've polled informally are aware of the best method for increasing BMR, and losing weight (it's not 'cardio', and it's not weight training). Even fewer understand the basics of how to manipulate macronutrient ratios during a dieting phase to prevent bottoming out of BMR and lean mass loss. I didn't even bother with trying to figure out who knew how to spot anterior and posterior pelvic tilt, forward head posture, quad dominance, hip tightness, (all of which can be assessed with nothing more than a hard look) and the numerous other MSK imbalances caused by our sedentary lifestyles and occasionally by our ******ed exercise methods (treadmill *cough*) that are the precursors to cervical and lumbar discopathies, and knee and hip arthritis.
I haven't even touched the huge problem of chemoestrogens because quite frankly I'm tired and I doubt much of this will be read anyway. But if they're strong enough to create intersex fish and frogs, they're probably strong enough to affect us as, even if we're not seeing a huge rise in intersex children.
So why are we wasting sooooo much money in labs studying minutiae and coming up with more pharmaceuticals when we can't even approach optimality with regard to basic lifestyle and health. Why are we so concerned with 'healthcare' when we don't even really concern ourselves with health in the first place.
Before we even think of talking about healthcare reform, I want to see us make progress on health. No more farm subsidies for high-yield crops with poor nutrient density. Direct them at decent produce instead. Tax breaks for grass-fed meats, free range chickens, and non-grain-fed fish. Sales tax on unhealthy foods (including the poorly-raised meats and crops). No sales tax on the healthy stuff. Redirection of NIH money into sensible nutrition and exercise studies. More studies on improving dietary and exercise compliance. A change in medical education. Etc, etc, etc.
Ok I'm done for now.