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Many people living in the 'Diabetes Belt' are plagued with medical debt

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Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#71

Post by [deleted] »

WalterBright wrote: post #48
burkaman wrote: post #7

Related: ProPublica investigation on doctors performing unnecessary amputations on poor black diabetes patients, because they don't pay enough attention to the patients and also get paid more to amputate. https://features.propublica.org/diabetes-amputations/black-a... Another link if you are skeptical there is a racial issue: page 12 of https://data.dartmouthatlas.org/downloads/reports/Diabetes_r... . Among Medicare…

Frontline did an episode a while back were dentists were performing unnecessary major dental work on poor people when the government had a program to pay the dentists for such work. Frontline was outraged at the dentists, but did not seem to recognize that this is the inevitable result of incentives the government set up.

[deleted]

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#72

Post by burkaman »

standardUser wrote: post #2

"Seventy-nine out of the 100 counties with the highest levels of medical debt are in states that have not expanded Medicaid under the ACA" Who benefits in these 10 states that have still failed to expand Medicaid? What is the upside, to either the populations of these states or the politicians who run these states and make those decisions? Because the downsides are obvious and seem to directly harm a lot of people.

I mean, medical debt collectors benefit, and they do have lobbyists.

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#73

Post by nradov »

SilasX wrote: post #58
WalterBright wrote: post #48

Earlier quoted context omitted.

Frontline did an episode a while back were dentists were performing unnecessary major dental work on poor people when the government had a program to pay the dentists for such work. Frontline was outraged at the dentists, but did not seem to recognize that this is the inevitable result of incentives the government set up.

Whoa whoa whoa, I'm the first one to call out perverse incentives in government programs, but even I would assume that dentists had meaningful ethics codes and enforcement that would largely mitigate this kind of abuse. OTOH, if the "unnecessary" there just means "not satisfying the platonically correct cost/benefit analysis", and there's still some net benefit to the patient, and the government program didn't ask th…

Dentists do have an ethical code, government payers do look for patterns of abuse, and state licensing boards do investigate complaints of unnecessary procedures (to some extent). But many of these cases really fall into gray areas. Dentistry is still more an art than a science, and different dentists treating the same patient in good faith will often come up with completely different treatment plans. It's tough to really prove abuse. Financial incentives absolutely do encourage healthcare providers to err on the side of doing more procedures.

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#74

Post by burkaman »

rayiner wrote: post #59
areoform wrote: post #30

Earlier quoted context omitted.

I don't think it helps to call them "degenerate." They're human beings. Some of them, more clever than you. Who are trapped in lives of quiet desperation. We think we are civilized, but we are just as barbarous as the world of Hugo's Les Misérables. We live in a world filled with Inspector Javert's spending their lives chasing their Valjeans.

Changing labels doesn’t change the underlying reality. Spend some time talking to some old stock Yankees. Their attitude towards food is different. A phrase you’ll often hear is “eat to live.” It’s not a wonder that Alabama has an obesity rate that’s over 60% higher than Massachusetts.

This is a very extreme claim that requires a lot of evidence. If we're just throwing out ideas, I'll make a claim that "attitude" is a lot less of a factor than having only dollar stores and no grocery stores within an hour's drive.

Also, I've lived in Massachusetts my entire life and I've never heard anyone say "eat to live".

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#75

Post by nradov »

yibg wrote: post #45
EatingWithForks wrote: post #31

Earlier quoted context omitted.

If you're that fat you're statistically unlikely to lose weight without medical intervention of some sort, even something as basic as talking to a fucking nutritionist about portion sizes.

I sympathize with how hard it is to lose weight, but at some point personal responsibility kicks in right?

Personal responsibility is great, but we're all paying for patients with type-2 diabetes (and other lifestyle related chronic conditions). We pay in terms of higher taxes for Medicare/Medicaid, higher premiums for private commercial insurance, and higher charges from providers trying to cover losses from indigent patients who default on medical debt. People are unlikely to suddenly become more responsible so what is your solution?

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#76

Post by somescarygirl »

hello_computer wrote: post #70
standardUser wrote: post #66

Earlier quoted context omitted.

That's not a policy. That's indulging in a fantasy world. A policy might be ending subsidies for sugar, or creating subsidies for healthier foods, etc.

[flagged]

Things are not that black and white. There are many places in both urban and rural America where access to healthy food is much further away and more expensive. If you're relying on food stamps unhealthy foods will often make your dollar go further. This is especially important when you're trying to feed a whole family. The corner mcdonalds or bodega is easier to access food when you don't have a car and work double shifts. Food preferences are also learned early in life and harder to break as you get older. This is a far more nuanced problem than people choosing unhealthy foods because that's what they want.

To combat this NY state, for example, has a whole program around getting additional benefits on top of SNAP for produce at local farmers markets which has been very successful. So yes, while no one is holding a gun to their head your hyperbole is not really adding anything useful to the discussion.

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#77

Post by mrguyorama »

w1nst0nsm1th wrote: post #38
burkaman wrote: post #7

Related: ProPublica investigation on doctors performing unnecessary amputations on poor black diabetes patients, because they don't pay enough attention to the patients and also get paid more to amputate. https://features.propublica.org/diabetes-amputations/black-a... Another link if you are skeptical there is a racial issue: page 12 of https://data.dartmouthatlas.org/downloads/reports/Diabetes_r... . Among Medicare…

Man.. It's Nazi Germany level of evil.

Hitler claimed to have taken inspiration from how America treats its undesireables.

A doctor who grew up in the heyday of eugenics could still be practicing medicine into the 70s. We literally gave black people syphilis behind their backs, and now we wonder why they are vaccine shy. We spent over two centuries with at least half the country openly espousing as policy that black people were a lesser race and the south screamed from the hills that it was God's intention that white people control black people.

The children of these people were still politically relevant recently.

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#78

Post by xyzzyz »

burkaman wrote: post #74
rayiner wrote: post #59

Earlier quoted context omitted.

Changing labels doesn’t change the underlying reality. Spend some time talking to some old stock Yankees. Their attitude towards food is different. A phrase you’ll often hear is “eat to live.” It’s not a wonder that Alabama has an obesity rate that’s over 60% higher than Massachusetts.

This is a very extreme claim that requires a lot of evidence. If we're just throwing out ideas, I'll make a claim that "attitude" is a lot less of a factor than having only dollar stores and no grocery stores within an hour's drive. Also, I've lived in Massachusetts my entire life and I've never heard anyone say "eat to live".

I seriously doubt that in Alabama there are many people who don’t have a grocery store within an hour drive. Almost certainly less than 10% of population. Even if you said 20 minutes instead of an hour, it wouldn’t be a lot of people either. The thing with areas this remote is that few people live there.

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#79

Post by mrguyorama »

specialist wrote: post #39
standardUser wrote: post #2

"Seventy-nine out of the 100 counties with the highest levels of medical debt are in states that have not expanded Medicaid under the ACA" Who benefits in these 10 states that have still failed to expand Medicaid? What is the upside, to either the populations of these states or the politicians who run these states and make those decisions? Because the downsides are obvious and seem to directly harm a lot of people.

Spite. Segregationists closed public pools and defunded public schools, rather than share with black people. Hurting poor whites as much as poor blacks. Of course they'd also gut the social safety net.

Some Americans would gladly eat shit if a black person had to smell their breath after.

Re: Many people living in the 'Diabetes Belt' are plagued with medical debt

#80

Post by nradov »

yoyohello13 wrote: post #13
prottog wrote: post #8

Earlier quoted context omitted.

> This is as much a cultural problem as a financial one. I live in one of these Diabetes Belt counties. I'd like to add another aspect to the "cultural problem", which is that the median person here eats absolutely horrendously and doesn't exercise at all. > we'd rather give you bad food I'd like to believe that people have the agency of choosing what they eat.

> I'd like to believe that people have the agency of choosing what they eat. They do, but they need to know how to eat a healthy diet. I don't know about you, but I've never once seen a commercial about eating whole foods with vegetables. I am however bombarded on a daily basis with adds for fried chicken and burgers. Some people just don't have the access and education.

Fried chicken and burgers really aren't that bad from a diabetes standpoint. You will sustain more metabolic damage from drinking a regular Coca Cola with that fried chicken than from the fried chicken itself.
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