Monday, November 21, 2016

Dependence vs. Freedom

What if I told you that having "health insurance" does not increase your lifespan when compared to large groups of Americans that forego "health insurance"? If "health insurance" does not increase lifespan, which is very measurable, or healthspan (the time of life without chronic conditions), which is less measurable, what purpose does it serve?

If you are able to get past the idea that "health insurance" does not increase lifespan or healthspan you might argue that "health insurance" protects people from a medical bill that would "bankrupt" an unfortunate individual. But what if it is the existence of "health insurance" that inflates those medical bills? Of course, it is all much more complicated than that - but only at the margins (chronic and disabling conditions) and at the end of life. And those complications exist because of structural issues within our society. More on that soon.

There are over 500,000 Americans that do not have health insurance, do not want health insurance, and have an exemption from and do not have to participate in "Obamacare", Medicare, and Social Security. These are America's Amish, Mennonite, and Hutterite communities; the Plain People. Despite having no "health insurance" these groups have the same or better life expectancy as other Americans of Northwestern European heritage.


Their "healthspan" simply blows ours away, but that has to do with their active lifestyle and the absence of TV's influence on diet, family, and political beliefs.

Let's get back to the critical comparison. These people DO NOT participate in insurance of any fashion - no homeowners insurance, no life insurance, no health insurance, no disability insurance. If you really think about it, the average American labors under an oppressive burden in the form of the costs of "insurance". Oh, you might think you have it better than these people because in addition to those burdens you also have the benefit of air conditioning, refrigeration, etc... but this cost/benefit difference is not translating into discernibly different lifespans. The lifestyle differences are personal and subjective. The average wealth accumulation comparison is not.

While the average denizen of the rural American landscape is overweight, has few children, is medicated, uses tobacco, alcohol, and illicit drugs (and as far as I am concerned they have every right to live this way) and has essentially no savings and little net worth; the average Plain Person is fit, has many children, is not medicated, some use tobacco, most do not use alcohol or illicit drugs, and by 50 have accumulated enough assets to get them through their old age without eating dog food and get their many children started in this manner of living. While many are now starting to work "off farm", and I think that will create challenges for these communities in the future, the previous generation worked "on farm" in various capacities (there is not much farming to do in Winter and Summer) accumulating land, livestock, timberland, and productive capital goods (farming equipment, implements, and trade tools). While the average American facing retirement has $106,000 saved the average family in these Plain People communities have significantly greater assets/net worth and far fewer bills. They also remain relatively productive until they become infirm, at which point their strong families see to the needs of the elderly.  During their old age they typically move out of their home and the youngest son and his family take it over and buy out the other siblings, some of whom are a generation older than the youngest son is. A small cottage - often called a "dowdy house" - is built on the family land for the old folks. Heroic end of life treatments are not sought out. These people die at home, in the company of their family. Their funeral, complete with casket and burial, costs $500 or so.

Americans participating in the industrial/information/governmental economy must place their elderly, and their children, in the care of the State because they must spend 50, 60, even 70 hours per week commuting and working in order to pay for all of the insurance products that our system demands that we buy.

And despite the "lack of access" from being "uninsured" and living far from healthcare facilities and without a motor vehicles to drive back and forth to "medical care" and "medical treatment" there is no discernible difference in lifespan.

Why? How can that possibly be?

Simple. "Diagnostic services" are not necessarily curative and most do not improve health or increase lifespan. In fact, there is plenty of evidence that the belief in the value of those services removes incentive to engage in healthy and productive behaviors. Knowing what it is that is going to end your life or destroy your quality of life does not seem to change the outcome or our  lifespan. In fact, there is no "seem" about it. There is no evidence that these incredible interventions do anything to extend lifespan across the entire American population. The tremendous gains in lifespan during the 20th and 21st centuries are almost entirely attributable to vaccines, antibiotics, nutrition, sanitation/hygiene, and improved surgical techniques. And most of that does not cost very much. Yes, we are much better at treating trauma, and it is a good thing, too, because our industrial goods - particularly automobiles - inflict an enormous amount of trauma injuries onto the population and roughly 2% of us will meet our destiny in an automobile crash.

Is there some other conclusion that can be drawn from the fact that life expectancies are the same for the 500,000 Plain People that eschew health insurance and the typical American who has health insurance? Isn't 500,000 people a large enough sample? The amount of unnecessary "treatment" or "care" generated in order to consume 18% of American GDP, twice the level of the rest of the industrial world's GDP/healthcare spending, to wind up at the exact same place must simply be seen for what it is - a never ending series of human experiments that enrich people working in one industry at the expense of the health, wellbeing, and financial security of everybody else.

The answer is not "health insurance". The answer is to let The People operate in a Free Market of liberty and enlightened self-interest. People will make intelligent decisions and calculations regarding the cost/benefit of personal healthcare spending. The result will be less oppressive healthcare costs and a population that is rewarded with greater freedom and autonomy. And maybe a longer "healthspan" even if there is no material improvement in lifespan.

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