On 9/16/2015 2:16 AM, Don Y wrote:
On 9/15/2015 9:39 PM, Tony Hwang wrote:
Don Y wrote:
On 9/15/2015 3:38 PM, bob haller wrote:

Watching someone smoke themselves to death is, to me, a big shrug.

As stupid as smoking seems to me, I agree. Obviously there are
benefits
to smoking - it calms, energizes, suppresses appetite. Maybe
more. And
who is anyone to say a informed adult cannot make the choice to add
some
enjoyment to his good years at the expense of reducing the number
of his
bad years?

Helps the finances of the Social Security and Medicare programs, too.

the costs to try and save smokers lives is astronmical///////

anyone who smokes shouldnt be covered by health insurance for smoking
releated illnesses.....

What about folks who drink? Are overweight? Don't exercise? Don't
eat right? Don't get the proper amount of sleep? Use recreational
drugs? Consume too much caffeine? Work long hours? etc. Each of
these have associated costs. Where do you draw the line?

require the tobacco companies to pay for their ill health..

In *theory*, the individual pays the cost for their "bad habits"
(along with genetic issues). In *reality*, we subsidize bad behaviors
(just like we subsidize bad policies).

Should insurers rate folks *individually*? I.e., assess *your*
particular
"expected costs" and set the premium based on that? Stop grouping
folks into broad classes to distribute the risk?

and smoking around any child should be proscuted as what it really is,
child
abuse

What about folks with "tempers"? Alcoholics? Addicts (of any sort)?
People who are psychologically "unfit"?

It's relatively easy to come up with a list that just grows -- each
addition
"making sense" (to someone).

N.B. I am not taking a stand on any of these issues. Rather, pointing
out how easily this sort of thinking can get out of hand.

I have a buddy who believes healthcare should be "free". Of course,
that
means we all pay for each other. Should I, then, be able to *prevent*
him from indulging in the habits that he has (smoking, poor sleeping
habits, diet, etc.) on the grounds that *I* am paying for *his*
healthcare?

I always wonder why healthcare should be provided to people who don't
care of
themselves. Our system should pay more attention to preventive
medicine than treatment oriented medicine.

One of the goals of the ACA was to incentivize providers to shift resources
to preventative measures: free physicals, free health maintenance tests,
free flu shots, etc.

It should start from training medical student.

I think the problem lies with the *consumer* more than the supplier.
People expect to be able to "get fixed" without being "inconvenienced"
(by lifestyle changes, etc.). The consumers end up "training" the
providers to adopt *their* preferences.

SWMBO had a cholesterol problem some years back. MD was ready to
Rx a statin to bring it under control. Instead, she opted to
tackle it with diet and exercise. THAT NIGHT we changed her diet.
Four weeks later, the doctor was *flabbergasted* at the change in
her blood chemistry! No meds, no side-effects from those meds, etc.
And, a healthier lifestyle as an inherent part of the bargain.

How many folks will discipline themselves thusly? Esp if the
other option is "take one of these each day"?

How many times does an MD need to see patients NOT doing the right
things -- and, having to resort to drugs -- before he stops even
*offering* that suggestion as a remedy?

Also note, N. American doctors prescribe more drugs than any other in
the world.

I suspect you'll find that Americans *want* "pills" over other, less
expensive (but more *committed*) treatments. E.g., you don't need a pill
to lose weight -- you just have to *burn* more calories than you
*consume*! Ah, but that means you can't have second helpings of that
meal that tastes *so* good (because it has lots of sugar and fat!).

You can bring modest hyperlipidemia under control with diet and
exercise -- instead of resorting to drugs.

You can control much type 2 diabetes (esp "pre-diabetes") with exercise,
weight loss and diet -- instead of resorting to drugs.

I just had a check up this morning and my Dr. told me that while my A1C
was great that my bs was slightly elevated and that I was definitely
diabetic (type 2) and he wanted me to take the metformin even though my
bs is doing good just by diet and exercise. I was told years ago that I
didn't have a choice about becoming a diabetic because of family history
of type 1 diabetes. They said eventually that my pancreas would stop
functioning properly because of that family history. I'm just on the
this side |-- of being a diabetic. Prior to that I was hypoglycemic
for probably 20 years. I used to have low blood sugar episodes where
I'd be just short of blacking out, but now that I've crossed over to the
diabetic side that rarely ever happens.

My grandmother was insulin dependent and her bs would get between
300-400 at times.

Not sure why Dr.s want people to take meds when they can control the
type 2 with diet and exercise.

You can bring moderate hypertension under control with diet, exercise
and stress reduction techniques -- instead of resorting to drugs.

But, no one wants to "do the heavy lifting" to bring about these
changes. "Can't you just GIVE ME A PILL?"

The other problem with many of these maladies is that their *real*
consequences (heart attack, stroke, blindness, etc.) happen down
the road. In essence, you're dealing with a control system that
has enormous *lag* -- the patient's "control actions" (or lack
thereof!) don't manifest in the "output" for DECADES!!

[People have a tough time losing weight because weight control is
also a system with lots of lag; yet that lag is on the order of
days or weeks (before you see results from your changed diet),
not *years*!]



--
Maggie