And? Do you deny that Dems feel strongly about this issue? Every single action is endlessly accused of "political posturing" by opponents, and that takes the plac of actual debate. See Kimmel's monologue, or Milo's trolling, or any of the marches/protests, etc.... BTW, sitting in segregated coffee shops was political posturing also, does that make you reject arguments against segregation. Your complaint that it is distasteful is duly noted, but surely you can scratch down one millimeter to see the profound anger and strong beliefs under that? Larger and larger statements are made in a vain chasing for the tiny sliver of Americans (<5%) are open at all to any argument.


When you say "both" you really mean the GOP, right? The Dems are completely frozen out. The parties are in ideologically different galaxies on this issue.

You're ignoring how difficult it is for many to change lifestyles because of lack of knowledge and other barriers in particular among low SES folks and minorities. Also kids are extremely affected with no control and the outcomes are a lot worse because that's all they've known.

So yes if we could just zap people's brains into walking and eating well in theory we'd all do better at least for non genetic chronic conditions. But no we just can't do that. And most interventions work well. For 3 months. Then outcomes get negative again. But then you still have a lot of chronic conditions that don't respond to lifestyle changes (T1D, asthma, several autoimmune conditions etc). And then there is cancer. So no it's nowhere near as simple as you think it is.

And I'm not the only one to say that. The entire research community working on interventions for chronic conditions (of which I belong) says that.

I think this goes back to the fallacy that everyone can pull themselves up by their own bootstraps. The idea that everyone has the same abilities and desires but only some choose to use them.

---

_____
TEAM HD
Each day is what you make of it so make it the best day possible.

Imagine you are living around the poverty level. Your monthly income just about reaches the end of the month before you have to choose between bus fare and food for your kids. You can choose to buy a healthy salad (if you can find it in your food desert) for $5.99 that gives you 400kCal, or you can choose to buy a $2.99 fast food meal that gives you 2,000kCal.

---

----------------------------------
"Go yell at an M&M"

So long as medicine continues to offer an "easy" way out of lifestyle problems, there's not really much motivation undertake those difficult lifestyle changes. We will continue to throw medical solutions at lifestyle problems until it bankrupts the country. People are lazy more than they are stupid.

I fully disagree that people don't know at least the very basics of a healthy lifestyle. I can drive a couple of miles down the road and be in a nice pocket of the 3rd world. Among the severe alcoholism, oppressive poverty, and a culture completely socialized in terms of healthcare and education the kids and adults can at least outline the very basics of living a healthy lifestyle. I can personally name hundreds of people, from my own files, who have problems largely of their own creation who know full and well how to help themselves, yet they don't do it.

I don't think many people think of T1D, asthma, autoimmune conditions (I have one) or cancer as primarily lifestyle generated problems. So that's why we have smart people like you searching for medical solutions to those issues. But we, as a culture, have to do a little bit of the work. Diet improvements and a basic level of activity/exercise are only going to reduce a tremendous amount of the burden from the healthcare system so that doctors and researchers can actually get to work helping people who need it, instead of those unwilling to help themselves in the most basic way.

Me, personally? I'm having the salad, or likely food I brought, since I have Celiac disease and either option would likely cause major problems for my health.

Personal responsibility for the win? Modern medicine doesn't have a rescue for me. It's on me.

Sorry, I didn't realize you are living around the poverty level, and so are intimately familiar with that status. I'd have thought you'd have a slightly different opinion on the subject, though. Go figure. Best of luck.

---

----------------------------------
"Go yell at an M&M"

You're not that stupid, are you?

I asked you to imagine you are living around the poverty level, and gave you a choice that you seem to think is presented to those in that SES ("eat a vegetable"). You answered as if it were you, personally, as you are now. I guess I'm too stupid to present the scenario to you.

---

----------------------------------
"Go yell at an M&M"

I tend to agree with you, but Francois makes some good points as well.

What if we take the lower SES folks out of this, and consider how much money is spent on average to well-to-do folks who have the issues of low/no activity, overeating, smoking, and they are not in a food desert and have access to care/education?
I can think of a cohort here in my urban city.
So, maybe we still bear the burden for some of the healthcare for people who don't have access to a healthier lifestyle, but I don't want to shoulder that burden for people of means who would rather take pills for their hypertension or get repeating imaging and treatment for knee/back pain than go take some lbs off and get a little bit active.
We could save *some* amount of money this way, it seems.

Yeah, but our only major medical bills came when my wife and I began triathlon. Who knew an emergency ambulance could be so expensive? Can hardly wait for my knee replacement surgery....;).

Who knew an emergency ambulance could be so expensive?

I was hit by a pick-up truck while bicycling in Oregon and was transported by a Medi-vac helicopter the 30 miles to Bend. I had travel insurance but the cost, which turned out to be fortunate as the flight alone was $25,000.

If we take the low SES folks out, yes, I can agree with you and Trout to a large extent. The issue is that the low SES folks represent a very large proportion of the folks affected by this. Also, what do you make of the kids born in families 'not taken out' with bad lifestyle habits. If a woman is obese and with T2D during pregnancy, the risks of obesity and T2D increase drastically for the child, regardless of their own habits... We have an entire group here working on such longitudinal follow up, for such populations. And this has been the case for 2 generations already at least. What do we do then? Tell them 'tough luck mate?' Also, no matter how good our interventions are, we end up fighting the multi billion dollar food industry, with cute little ads about how this and that foods are healthy. It's an uphill battle, and it's very very shortsighted to think it's entirely on people.

We're back to the do I take a test that I would do something about or not because the risk of the diagnosis on your record may be worse than the problem.

I have a friend (who is not obese and works out) that is thinking of backing out of sleep study because Apnea is a preexisting condidtion. If this person has apnea are they healthier knowing and treating- well they are in the short run, but if they can't get insurance and something worse comes up maybe not. I'm curious what slowtwitchers would do right now in that situation?

I think we agree far more than we disagree. I get that there are lots of influences on people's decision making and that those decisions are nearly 100% made through emotion, but I disagree that it's not ultimately the responsibility of the individual what they put into their bodies or do/don't do with their bodies.

I understand your perspective as you work with big ideas over populations rather than individuals.

I do find it disheartening that the research community views personal responsibility as a non viable option. That is discouraging, though not surprising based on my observation of patients over the last decade plus.

I personally feel that we need to go towards either end of the spectrum, but not in the middle. Either a free market, liberty driven system where your decisions are not my problem/cost, or socialized medicine with transparent rationing and strings attached to each dollar spent to reduce the overall costs in healthcare. Right now we seem to have the worst of both.

The research community does not discard personal responsibility at all. It's trying to address some of the barriers.
From your comments, I'm guessing you're a healthcare provider, possibly a physician. I work primarily with clinical colleagues in primary care (from peds to adults as well as endocrinologists), but they're also researchers. And when you look at the population at large rather than the typically very biased view that a typical physician has (local population, of a specific neighborhood etc. then you realize that many face hurdles in achieving a healthy lifestyle. And contrary to what you've asserted, a LOT of folks really don't know what is a healthy lifestyle. We've run nationwide surveys and the results are really poor. People underestimate how much they eat (particularly between meals) and overestimate how much they move.
Also among several minority groups, being bigger is deemed healthy, and there is a clear distrust of physicians.
These results have been replicated over several populations, with a variety of surveys.

So, we are definitely not discarding the role of personal responsibility. We are addressing that first step to realize that this needs to happen. Usually referred to as 'pre-contemplation phase' in one of the models of behavior change.

I have no doubt though that in several neighborhoods of 'middle America' there are folks who have no excuse.

I think we need a two tier system. Basic needs and emergency covered by a public system with some rationing on non time sensitive care. With a private paid tier for more comforts and quicker turn around for non time sensitive procedures.

I lived in Ireland and that is their set up. It was fascinating to see the statistics of private vs public from the boom and then through the recession.

Two tier system with social security and employer provided insurances is exactly what France has. And it works very well.

The public option keeps the private insurers in check.

I hope every bit of the bill will become law.
Then I will get a tax break, keep my really good insurance and many that voted for this administration will get what they want - crappy healthcare.

When it come to personal responsibility. Maybe he is right, the USA does not have a structural problem - Americans are just lazy. It was said by an American so it must be true......

Asshole comments are what make you a target. Some of the other smug stuff, so what, but then you just make jackass comments like this.

---

_____
TEAM HD
Each day is what you make of it so make it the best day possible.

Exactly! Moreover, this approach is hopelessly muddled between charging more for lifestyle choices vs. charging more for higher medical risk, assuming there was a reasonable way to properly judge those. Way too many extraordinarily healthy friends have been diagnosed with cancer, and a whole set of friends have completely different body types, based far more on genetics than diet. Are you trying to achieve social engineering through taxation/penalties? It can possibly be effective for some discreet behaviors (i.e. cigarette/alcohol), but the issue becomes very muddled very quickly.