I agree with you 100%. You just earned a sub!

I remember taking a health care policy course that gave credible evidence that health care, and particularly health insurance, has only an indirect effect on health outcomes.

The key factors are:

1) Genes

2) Basic public health like sanitation and immunization.

3) Lifestyle choices.

4) Basic preventive medicine

All four of those cost very little money, but we pay trillions on health care on curing illness and insurance. I think that it a serious misallocation of societal resources.

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It's so clear what you need to do to live long, healthy lives: eat real food, engage in resistance training, build your aerobic capacity, sleep regularly and enough, don't drink or smoke or do drugs, and have good relationships.

I find it fascinating and baffling why the vast majority of people don't do these things, as you feel so much better and are able to pursue all of your values more if you do.

Re: health coverage and behaviors: What if there were more direct financial incentives to engage in healthy behaviors? What if, say, insurers were motivated and able to incentivize these known positive health behaviors--because they had a long-term stake in their insureds health?

Today, insurance companies have any given insured on their books for only a year, before coverage is re-written at annual re-enrollment. So their incentive is to minimize this year's expenditures on the insured, even if that makes the long-term costs higher.

What if we found a way to have insurers be "stuck" with their insureds for many years, maybe even for life? That's what happens in the private part of Germany's health insurance system.

I wrote a post on this a while back, curious what you think about that idea.


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"I find it fascinating and baffling why the vast majority of people don't do these things, as you feel so much better and are able to pursue all of your values more if you do."

I think the answer to that question is fairly simple: drugs and fatty, sugary foods are addictive, both physically and psychologically. People don't generally abuse those things unless they are already unhappy to some degree, which then makes it even harder to break the cycle of addiction. I think the most important question is why are people so unhappy that they want to escape with drugs, alcohol, and binge eating?

Early interventions like real exercise programs in elementary school, mindfulness training, good nutrition habits, and others during childhood would definitely help instill healthy coping mechanisms that may prevent them turning to substances later in life, but I think there's still something bigger going on.

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Coverage of useless care doesn't help. Theoretical coverage does not either.

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I have a feeling that GLP-1 agents are going to upend a lot of nutrition in the next few years. They seem to curb appetite markedly, in addition to cutting the cravings for tobacco, alcohol and drugs.

Accessing these agents will be vital though. I suspect that they will get much, much cheaper, and I suspect that this, in combination with much more widespread coverage, will lead to better health outcomes.

There are second order effects. Healthier people are cheaper to insure, and this will go a long way as well to improving health

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