health care crisis

Health care spending and health insurance are favorite topics for presidential elections and this year is no different. Once again the spotlight is on spending, insurance, and insurance coverage. Suffice it to say that the US is doing very poorly in this sector compared other civilized countries. Here we are on par with the Third World except when it comes to spending. We spend more than any other country on the planet but our return on investment is decidedly poor. Life expectancy in the US is ranked 27th in the world, just ahead of Cuba, a country that spends just $186 per person per year. We need $4,800, the most of any nation. The second biggest spender, Switzerland at $3,300 per person, can at least boast of a much better life expectancy, where it ranks 4th.

We are constantly told that our health care system is the best in the world, and while some may disagree, it is for sure the one that is the most out of reach. US healthcare is virtually off-limits to most citizens. I am sure that is not much of a concern to many as they seem to believe that they have access and that is what matters. Access to the best of the best. Surely, the US healthcare system is big on tech wizardry and stitching skills. We excel at procedures nobody else will do. To go where no man has gone before. Unfortunately, anyone with a bit of clinical know-how and experience will tell you that such flashy stuff often amounts to nothing much in the scheme of things. While the record shattering twenty bypass operation is front page news, the same patient dying a few days later in the ICU from a nosocomial infection goes largely unnoticed.

Furthermore, as any centenarian will tell you, the key to longevity is to stay away from hospitals and medical practitioners. Iatrogenic deaths run close to a million per year according to some studies. Iatrogenic morbidity is many times higher. Clearly prevention is better than cure. And the best prevention is the one where you don't see a doctor. Prevention of the type advertised by doctors, hospitals, and drug companies only serves to provide these do-gooders with another source of income.

It may sound far fetched but preventive healthcare is closely linked to global warming. Suburban living with its huge, isolated mansions and perpetual need for driving not only causes excess greenhouse gas production, it also leads to social isolation, and lack of exercise. Hence our epidemic of obesity, a key factor in many illnesses. Obesity rates are much higher in suburbia than in urban populations.

Many of the "diseases" that consume our health care budget and make our citizens ill are easily preventable. That is not to say that all cases can be prevented, as genetics surely plays a role. However, the vast majority of cases are. Heart disease, stroke, cancer and other ills will always be with us but they need not affect so many people or strike so early in life.

Lack of exercise, endless hours spent in traffic jams or watching TV, social isolation, fast food, ubiquitous sodas, sugar-rich diets, are but some of the factors that are making people sick. Some studies have argued that whatever savings we as a society made against infectious disease have been nullified by our new illnesses due to lack of exercise.

It appears our life-style is unsustainable in more ways than one. Our key problems are intimately connected. Before the subprime crisis, 25% of housing loss and foreclosure were linked to lack of health insurance and soaring health care bills. We have just added another factor to that list. The housing problems caused by the lending crisis are added on top of those due to inadequate health care coverage.

Recent studies have shown that for the first time since world war two, life-expectancy is dropping in some areas of the country. The finding was isolated and it could be a fluke, but it is also possible that we have another canary in the coal mine situation. Rather than blame the health care industry -which is already more bloated than healthy- we should look in the mirror and face the problem. We are getting fatter, we are exercising less, we are isolated in our mansions and our cars, and despite our "enhanced connectivity" promised by cell phones and the internet, we are more often alone and lonely. To fill the void we do our patriotic duty and go shopping. We are busily consuming our way out of existence.

meet junior, the gas-guzzler

In the 1950's when there were only 150 million Americans, most kids walked or biked to school. After school they played in with their friends in the neighborhood. When dinner was ready, mom stepped outside and yelled for the little ones to wash their hands and come to dinner. Now that there are 300 million of us, kids are driven to school, and to an ever increasing number of "after school activities," birthday parties, and play-dates. Like a highly paid limo service, parents or nannies are waiting at every step to drive junior to his or her many engagements.

Clearly, this is not a good trend. It should surprise nobody that childhood obesity is rampant. But the trend is not just destructive to our kids. It also results in a disproportionate amount of greenhouse gas production. And it isn't limited to the daily driving.

Children are the most important force behind the move to suburbia, a decidedly unhealthy and environmentally destructive choice. Most adults it seems, become fearful of the city when they are about to have children. Neighborhoods that looked inviting and stimulating before, suddenly turn frightening and dark. The daily barrage of "news" only adds oil to the fire. Expectant parents feel a strong urge to go hide in suburbia, lest something happens to their precious newborns.

With the move to suburbia comes a bigger house, more items to put in that house, and a lot more driving. The driving starts right away as mom and dad need to go to work, to pregnancy class, and to regular checkups. It only gets worse from here. Junior needs a nanny who has to drive in and out. A bit later he or she needs to be driven to day care and later to pre-school. Many families now add a third car to drive junior around. They also switch to heavier and bulkier cars that get worse gas mileage. Kids are the main justification for the mini-van revolution. The same applies to the SUV and the newer cross-over car. Nothing like 5,000 pounds of metal to shield the little tyke. And lots of room to drive the soccer team around.

Anxiety is the key driver in child rearing. And it seems the older baby boomers are a lot more anxious than previous generations of - generally younger- parents were. For one, these younger parents did not have the luxury of worrying about everything from good schools to brain-stimulation activities. They often also lacked the resources to over-pamper their offspring. And believe it or not, that was a whole lot better. There was no epidemic of childhood obesity back then. Kids did not get stuffed with food supplements, forced into intellectual and cultural activities at age 2, and driven all over the universe. They had time to be kids. They walked, ran, and played. And that was better for their bodies AND their brains.

Running and walking are no longer acceptable. They are seen as a waste of time. Or worse, dangerous. These could be signs of hyperactivity or ADHD. Sitting still is no good either. Maybe the little one is autistic. There is no more time to wait for normal development to happen. Junior needs to sit upright at 6 months, walk at 11 and talk at 2 years. It is all on the clock. Any delay needs swift medical attention. To be followed by psychotherapy and tutoring if necessary. And don't forget the drugs. Junior is good for the services economy.

According to research, K-12 schools use 7% of all commercial building's energy use. Got to keep those youngsters warm and hooked to the computer all day long. Got to get those brains prepared for the real world. Outside, 82 million moms stand at the ready to drive the kids to a myriad of after-school activities, all of these happening at different locations. Junior needs chess, piano lessons, karate, soccer, ballet, etc. All of it starting as soon as he or she utters a few sounds and is stable enough to stand on two feet. There is no time to lose. If we want to score Harvard or Yale, we better get on the waiting list for that super pre-school that charges $20,000 in tuition and has a five year waiting list. Better get another job too and some more driving and flying around.

Unfortunately, all this activity will do more than its fair share to destroy junior's world. But oh, get in the car ! We are late for chess.

saving the environment one step at a time

Minimizing one's environmental impact is quite easy to do. Especially in a country like America where the average person's impact is enormously out of proportion compared to the rest of the world. Americans easily consume and waste double of what their European and Japanese counterparts do. And since those countries have an equally high standard of living, and one that translates into a state of well-being and happiness that is similar if not better than ours, the facts confirm that our excesses are unnecessary and counterproductive. So what is keeping us from doing the right thing?

Many set out with good intentions only to be frustrated and disillusioned by a myriad of obstacles, rules, and practical considerations. Unfortunately, there is also a fair amount of peer pressure. Peer pressure that is not just limited to teenagers and young adults. In many cases, adult peer pressure is embedded in neighborhood rules and home owner association prescriptions. Peer pressure pushes us to buy bigger cars than we need, and maintain unnecessarily manicured lawns. It may force us to use dryers instead of hanging up our laundry. It may also compel us to leave our porch lights on all night.

Americans have a busy life-style. They are more on edge than Europeans or Asians. Many are so busy putting out fires left and right that they truly believe there is no other way. It is an excuse that is often heard, and one that the sufferer experiences as real even though there is little reality to it. In many cases people enslave themselves to become taxi drivers for their kids or friends. Many also feel a constant need to drive to shopping malls to take advantage of ever present sales. A great many drive to workouts and other leisure activities.

Here are some things to consider if you feel too busy. One, turn off your TV and your radio. The constant barrage of ads has a detrimental effect on you, urging you to spend more and eating up your valuable time. The whole rhythm of TV and radio shows is also meant to keep you on edge. The constant flashing and high speed music are not good for you.

Turning off your TV will save you money and carbon emissions. Especially if you turn off that TiVo box or HD cable/satellite receiver too. Be aware that these devices may need to be unplugged to achieve success.

Two, stop driving your kids to their "activities." Let your kids play. They will be happier and so will you. They will also learn more. Humans learn by playing and our brains are wired to learn. There is no need for extra stimulation here. It is bad enough that you drive your kids to school. Kids should walk to school or ride their bike. If they did, we would not have a childhood obesity epidemic.

Three, stop driving to the mall to take advantage of savings. They are taking advantage of you. You cannot save by spending. If you turn off your TV and radio, and dump your junk mail, you won't know about all the great savings and you won't be tempted to waste your time. If you have less stuff you will need less time to clean up and organize. Don't become a slave to your gadgets. They are wasting your time.

Walk, jog, or run around the neighborhood instead of driving to the gym. Ride your bike. This will save you gas, reduce air pollution, and keep you in shape. If everyone drove less there wouldn't be an asthma epidemic either.

Turn off your lights and throw away your nightlights. Darkness is good for you. It promotes restful sleep and you will be less tired the next day.

scary stuff

ExxonMobil is running ads entitled Energy Security. These ads are meant to convince us that we should be open minded when it comes to energy. Open minded in this context means we need to "keep our doors open." We need to get energy from more places. Places like Iraq. We also need to "Increase access to energy resources in our own backyard." That is corporate lingo for drilling in the Alaska Wilderness, if you didn't know. And no matter how you feel about that, it is not the really scary part. Sooner or later we will do it in any case.

The evil government -the government is always evil as you know, even though we voted it in place- is preventing access to 31 billion barrels of recoverable oil and 105 trillion cubic feet of natural gas. All of it in our backyard. And why would our government do such evil deeds ? It must be infiltrated by left-wing environmental terrorists. Or maybe aliens from outer space who are engineering our demise. Or maybe the U.N.? Or maybe they are all in it together?

Because according to ExxonMobil, with "the advanced technologies of today," we could recover all this oil and gas without damaging the environment. If you believe that you also believe in Santa Claus. But even if we managed to recover it without damage to the environment, we couldn't really use it, read burn it, without damaging the environment. But then again, regardless how you feel about that, it is not all that scary. Because that too will eventually happen.

No, it is the reassuring part of the ad that is scary. The part where ExxonMobil tries to convince us of the value of its approach. The part that reads, "Put another way, that much oil equates to over 8 years of current US crude oil imports." If eight years impresses you -as no doubt it is meant to do - think of it this way. If your doctor told you you have only eight more years to live, how would you feel ? Eight years is peanuts really. It is a blip. If eight years is all we have, we may as well forget it.

But wait, the ad is an ad, and so it engages in some subtle massaging and distortion of the facts. That is only 8 years of imports, not 8 years of use. We import only half of what we use. So four years is more like it, give or take a few months. And at present rates too, never mind the inevitable growth that ExxonMobil is preparing to "serve."

It is truly scary that we have less than five years worth of oil in our backyard. And that we feel the urgent need to exploit it now to fuel over oversized vehicles, and heat our oversized homes and otherwise waste it in excess.

It would be rather trivial for America to cut its energy use in half. And we wouldn't even have to take drastic measures. We would not even have to buy anything new or develop new "cutting-edge" technologies. All that is needed is for us to drive less, heat and cool less, and in general be sensible about life. And that doesn't mean we couldn't splurge every once in a while. But right now we are splurging each and every minute of every day. And it doesn't even bring us any enjoyment. Quite the opposite really. All we get is endless traffic delays, road rage, obesity, high blood pressure and the like.

We are this grossly overweight giant, who keeps eating and eating for no reason other than to consume more. And we all know what happens to such giants: their life-expectancy is dramatically reduced. Here is to your health, America !

mckinsey and greenhouse gases

Today, McKinsey issued a report showing how the US could reduce greenhouse emissions in 2030 by 3.0 to 4.5 gigatons of CO2-equivalent using "tested approaches and high-potential emerging technologies." What that research-speak really means is that we could easily reduce our emissions significantly by just applying what we already know. Furthermore, the extensive research shows that the country would incur minimal costs to do so and in the long run it would save money too. I wonder how much people paid to get to these mostly common sense conclusions. I offer you my free advice.

Before I delve into the conclusions let me cite some rather frightening facts that were also in the report. The US government projects that annual greenhouse gases would rise from 7.2 gigatons in 2005 to 9.7 gigatons in 2030, an increase of 35%. And this would be due to three factors: a continued expansion of the US economy, a rapid growth in buildings, appliances, and transportation, driven by a population increase of 70 million and rising consumption; and finally an increased use of carbon-based power in electricity generation (read dirty coal).

And to add icing to the cake, the growth in emissions would be accompanied by a decrease in the carbon absorption by forests and agricultural lands. It would decline from 1.1 gigatons in 2005 to 1.0 gigatons in 2030. This is what the government thinks. The current government that is, one that isn't shy of adjusting a few numbers here and there if it suits their purpose. They don't have to worry about re-election. It seems they don't worry about what comes after them in any case.

Here is what we can do:

1. We can improve the energy efficiency in buildings and appliances for 710 to 870 megatons. This includes such no-brainers as lighting, heating, ventilation, air conditioning, insulation, etc.

2. Increase the fuel efficiency of transportation for 340 to 660 megatons. It includes lightweighting, diesel use, turbocharging, etc.

3. Various options in the energy-intensive portions of industry for 620 to 770 megatons. These too are efficiency in heating, cooling, power, etc.

4. Expanding and enhancing carbon sinks, for 440 to 590 megatons. Here we increase forest stock, improve soil management, etc.

5. Reducing the carbon efficiency of electric power generation for 800 to 1,570 megatons. Here we can switch to nuclear, wind and solar generation, and clean up our coal plants.

I just want to add some free advice here. No need to pay me high "research costs." These will help immediately and will save you money. Not only that, they make sense and they will improve your health as well. Think of the billions we will spend "curing" heart disease, cancer, diabetes, and obesity. Plus you will feel better. It is all related really.

1. Turn off your lights. You don't really need to buy CFLs. You can just turn off your lights when you don't need them and leave all other lights off too. You can turn down your thermostat and wear a sweater. You can stop heating and cooling your entire house. You definitely want to stop heating and cooling it when you aren't there. You can buy a smaller house when you are in the market. It may also help your credit rating.

2. Stop buying bulky, impractical and oversized cars. Stop driving unless you have to. Buy a bike and cycle. Walk. Have your kids walk to school. Walk with them. Remove all the unnecessary weight from your car. Empty the trunk, throw out the "entertainment system," etc. You don't need to turn your car into a living room. If you do, you are spending too much time there. Walking maybe faster. Also buy local. Don't buy cheap imports and don't buy food that was grown elsewhere. Then you can save even more. You won't need vitamins, supplements, and other pharma junk.

3. Turn off the lights and your computer at work. Turn off all the stuff you don't need when you leave. Stop printing and copying unless you have to. Save paper.

4. Plant a tree. Remove your lawn. Throw out your lawn mower. Forget the fertilizer. Stop wasting water. It needs to pumped to your house. It is heavy. It uses tons of energy and produces tons of greenhouse gases. If you want to grow anything, grow vegetables and fruits. They taste better than the ones you can buy, they are healthier, and you get a workout taking care of them.

5. Electricity is very dirty. Especially in the South, where coal dominates. Use less of it. Throw out your power tools and get a workout. It will help your heart. You will feel better. You will be healthier. Remove all chargers from outlets unless you need them. Stop buying electric gadgets.

In essence, it is time to downsize. Downsize your girth, your house, your car. And don't think of it as stepping back. Because it isn't. You will be better off. You won't have to work two jobs to keep up on all your payments. You won't have to worry about saving enough for retirement. You will be healthier, feel better, and live longer.

the day after

With Thanksgiving out of the way, it is time to think about burning some calories before the next big eating binge. And what better way to do so than to go shopping? This is black Friday start of the retail season. Or maybe you prefer a trip to the gym to work off those extra calories? Given that the average American over-eats by about 2,000 calories on Thanksgiving Day, there is plenty of burning to do. And no shortage of good intentions it seems.

The US leads the world in the number of "health clubs." According to the International Health, Racquet and Sportsclub Association (IHRSA), the US health industry had $17.6 billion in revenues in 2006. That compares to just over $10 billion in Western Europe, where the population is at least 1/3 higher than in the US. As of January 0f 2007, there were an estimated 29,357 clubs and 43.7 million health club members in the country. 

Just over half the members belong to commercial clubs. The next biggest category is the YMCA and YWCA memberships at 19%. 2/3 of the members are in the 18-54 age category, nearly equally divided between 18-34 and 35-54. Women make up 57%. Half of the membership has incomes over $75,000 a year, and 1/3 make over $100,000.

Gyms it seems are a great place to socialize. And socializing is what most people do when they get there. When it comes to calories however, gyms don't do so well. You'd be better of walking or jogging there. Burning calories requires prolonged and steady exercise and that is the type of exercise gyms are particularly unsuited for. Even though the places are stacked with treadmills, stairsteppers, stationary bicycles, ellipticals, rowing machines, and other aerobics equipment, few if any, use them correctly. And don't expect any help from the club either.

In order to satisfy everyone, clubs limit aerobic exercise equipment use to 30 minutes or less. Given that it takes about 15 to 25 minutes to become fully aerobic, hardly anyone can get to a workout within the time limit. But no sweat, experience has shown that most people give up after a mere 20 minutes of watching TV while jogging or walking. And sweat is the right word. Most people would dread to sweat hard in public.

Most gyms keep up a cozy temperature. You would not want anyone to catch a cold now would you? And that is why most restrict the use of fans too. But it is hardly possible to get a good workout on a stationary machine without adequate cooling. And that would mean a frigid sub-60 degree room with plenty of fans moving air around. And a decent size puddle of sweat under each machine. Yuk, where is the fun in that?

In the end this may not be so bad. Because research has shown that stationary exercise puts a lot of (heat) stress on one's system. Some have even argued that indoor exercise may not be all that good for you. Keep that in mind when you walk on the treadmill. Oh, and don't forget a coke and a snack on the way out. You can always go on a diet later.

bloated

No matter how rich you are you can only sit in one sofa at a time. You can only read one book at a time, and you can only watch one movie at a time. You can build houses all over the planet and stuff them to the gills with art work, furniture, and other fine items, but you can only be in one room at a time. You can heat and cool, illuminate and ventilate, but it will do you little good unless the light shines on you and the fan blows your hair. 

You can collect cars, boats, airplanes, and helicopters, but you can only drive one car, sail one boat, or fly one plane at any given moment. You can having enough swimming pools for a pod of blue whales but you can only swim in one at a time. You can collect so many toys you won't have enough hours in your life time to try them all at least once.

You can drink fancy waters from exotic bottles but tap water is likely of better quality. You can sip expensive wines from rare vintages, but distinguished experts may not be able to tell them apart from a $10 supermarket bottle in a blind tasting. You can drive your Ferrari but chances are your average speed won't exceed 30 mph. And the revving engine is likely to damage your hearing.

It should come as no surprise then, if your only friend in life is poor dog. Or a very rich dog for that matter.

But rejoice, there is one thing where you do excel. You are leaving a huge footprint of destruction. A scar on the planet that will be there for generations to come. A scar that you won't be able to offset by setting up foundations to help the poor and the needy or prevent and cure illnesses on continents far away. If you'd really wanted to save humanity or solve problems why not look around you? How about that $40 million mansion and all its useless gadgets?

Why not shed some excess weight? Losing weight is a much needed prescription for the world today.

pressure cooker

A five year study by the US Dept. of Veterans Affairs and reported to the American Heart Association found a seasonal effect on blood pressure. The most likely hypothesis is that an active "summer" lifestyle is key. There is also a correlation with weight gain as it is known that people tend to gain weight in winter and lose it in summer. 

Other researchers think the hypertension link may be with salt intake. More salt means more water -and would mean more weight- and for many people higher fluid volume means higher pressure. It is unclear why people would eat more salty food in winter but salt losses due to sweat are much higher in summer. And the more active you are the more you sweat.

Hypertension is estimated at over 50 million cases in the US, about a third of which are undiagnosed. That is one out five to six people. While that may seem high, the number pales in comparison with the number of overweight people. 60% of adults in the US are overweight according to the CDC, and up to a quarter are obese. These data are a few years old and given the strong up trend, todays numbers may be even higher.

Being overweight is strongly linked to diabetes and the number of new diabetes cases has tripled since 1980. The incidence is now 1.44 million per year for a total of nearly 16 million cases. In 1980 the incidence was below 500,000 and the total at 5.6 million.

All of these diseases are strongly linked to life-style. The NIH further estimates that up a third of cancer cases are linked to life-style as well. And life-style means driving around all the time and sitting on the couch watching TV while munching on chips and drinking soda. And while you are watching those shows all your life-style choices are constantly reinforced by a barrage of advertising. Much of that advertising is done by car companies.

A recent study found that teens are less likely to drink if it is explained to them that companies are trying to manipulate them into drinking by suggestive advertising. Some schools are now teaching programs deconstructing ads that appear clearly aimed at teens. Whether that is true or not, the key lesson here is that people do not like to be manipulated.  Unless they are unaware of it of course.

Alcohol ads feature iPods, Play Stations, jewelry, hip clothing and other items teens can identify with. If you agree with this premise, and most parents apparently do, take a look at car ads. Take a look at the imagery used to sell oversized cars and ask yourself if you are being manipulated. Compare the rugged outdoor feel of an SUV ad with the famous Marlboro man ad. Both are trying to sell you items that you don't need and that are bad for your health.

Don't fault your teen for giving in to peer pressure, or think about suing alcohol companies for attempting to manipulate their minds. Look in your driveway before you cast the first stone.