Comment by ericmay | Hacker News Reader

Comment by ericmay | Hacker News Reader

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Makes sense and is expected based on how things function in America right now.

  Opioid prescriptions and abuse
  Increased traffic deaths + road rage incidents (https://www.nhtsa.gov/press-releases/early-estimates-first-quarter-2022)
  Deaths of despair + suicides (Many sources and discussions about this) 
  Lack of access to basic health care (lack of access to abortion will contribute here soon)
  Obesity and fast food (self-explanatory) 
  Alcoholism from being bored during the pandemic (https://news.harvard.edu/gazette/story/2022/01/covid-related-drinking-linked-to-rise-in-liver-disease/) 
  (edit) and of course COVID-19 related deaths and illness

I mean there are just so many factors going against us, and either neglect or disagreement on how to solve these problems. On the left you have people who are suggesting that being obese is ok (it's not, it's a health problem, doesn't mean you need to be ashamed or be insulted though) and on the right, well, that speaks for itself.

Similar to global warming, though, the solutions for these problems are technocratic and unlikely to generate any sort of broad public support or acknowledgement in the sense that people vote for candidates based in something like advocating for decreasing traffic fatalities. So long as partisans continue to bicker and worship ridiculous ideological positions we won't have any pragmatic solutions or attempts to mitigate these problems because the technocrats can't function in an environment where ideological purity and populism are the currency instead of facts and solutions.

None of these will cause a downfall of America or anything, we're just going to be a bit more, eh, chaotic?

The biggest underlying issue is the decline of family units. No one talks about it but it’s true. You can’t function as a society when there is no immediate support system left in the form of family and loved ones. We are inherently a social creature.

Citation needed. Does not pass a cursory glance. Meanwhile there are plenty of good stats identifying strong correlates on other factors.

https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...

https://statisticalatlas.com/United-States/Household-Types

In case anyone is curious, the Spearman rank correlation coefficient between these two provided lists is ~0.32.

Family unit decline is a symptom not the underlying cause, it's a small part of the matrix of issues, it's often invoked as a means of blaming something inherently unchangeable, undefinable and unregulateable as a diversion.

And everyone does talk about it, I hear about it 3 times a week and it's because it's a useful distraction and a wedge to force legislation of personal moral choice.

It's like saying all problems individuals are having are caused by the individual. Somehow society, culture, governance and macro economic forces have no effect.

If you think the breakdown of the family unit is the root cause, let me assure you, homeschool familes are facing the same issue in our current environment.

Of course if we want to embrace absurdist reductionism the REAL problem is the dysfunction of churches abandoning their societal role for political power in the 80s, family's DO break down and now we have no "generally apolitical" relational safety net outside of the workplace, so social dysfunction can promulgate with no positive feedback loop of increased social cohesion to stop it. We need religious, areligious and apolitical societies that will facilitate mingling of social classes and are focused on the social good.

From Pew Research (2010), the decline in marriage is offset by rise in new families:

The Resilience of Families. The decline of marriage has not knocked family life off its pedestal. Three-quarters of all adults (76%) say their family is the most important element of their life; 75% say they are “very satisfied” with their family life, and more than eight-in-ten say the family they live in now is as close as (45%) or closer than (40%) the family in which they grew up. However, on all of these questions, married adults give more positive responses than do unmarried adults.

The Definition of Family. By emphatic margins, the public does not see marriage as the only path to family formation. Fully 86% say a single parent and child constitute a family; nearly as many (80%) say an unmarried couple living together with a child is a family; and 63% say a gay or lesbian couple raising a child is a family. The presence of children clearly matters in these definitions. If a cohabiting couple has no children, a majority of the public says they are not a family. Marriage matters, too. If a childless couple is married, 88% consider them to be a family.

The Ties that Bind. In response to a question about whom they would assist with money or caregiving in a time of need, Americans express a greater sense of obligation toward relatives—including relatives by way of fractured marriages– than toward best friends. The ranking of relatives aligns in a predictable hierarchy. More survey respondents express an obligation to help out a parent (83% would feel very obligated) or grown child (77%) than say the same about a stepparent (55%) or a step or half sibling (43%). But when asked about one’s best friend, just 39% say they would feel a similar sense of obligation.

https://www.pewresearch.org/social-trends/2010/11/18/the-dec...

I think there's a really good argument to be made that the marriage rate was previously inflated artificially by cultural expectations and gender inequality.

What kind of life could you expect to make for yourself as an unmarried woman when you didn't even have the right to open a bank account on your own?

https://www.flagshipbanks.com/blog/the-history-of-women-and-...

I think it's 'an issue' but not the major issue, except where it's 'acute'. A lot of couples are not getting married these days, which is 'something' but not like a disaster but in extremely impoverished/violeng ghetto areas you see well over 50% of kids not having any meaningful relationship with their Fathers. Now that is a 'primary' issue but it's also tied to incarceration, violence etc..

Definitely ultra violence (related to universal gun access), lack of healthcare, excessive inequality in some areas, obesity etc. are big factors.

I'm not sure if the most recent post-COVID data is hugely helpful because America did 'not very well' on that one despite having vaccines available. I mean, that's a whole other level of sad. But give it 3 years to see where the data sits without the 'COVID' blip.

At a glance this reads close to "families with no father figure". You probably didn't mean the likes or to induce knee jerk reactions, but would replace "family unit decline" as being an issue of concern with "there's little to no social/gov provided safety net" for folks who need it.

No family is exactly what I meant. More than 1 in every 2 adult are living without a spouse and 15% adult live by themselves alone [1]

[1] https://www.census.gov/newsroom/press-releases/2021/families...

No government can replace the support system a family can provide.

The father becomes the state.

Family as we know it is a historical oddity. Before the industrial revolution the social networks were much broader and involved whole communities, or much more extended families than what we consider normal now. We can introduce other social groups that help people in need and provide support and are not based primarily on family ties. This is orthogonal to “family units”, which is more of a conservative dog whistle. There are not fewer families now than there used to be, it’s just that a family is not necessarily the stereotypical married heterosexual couple with their 6 children.

Cuba, one of the poorest countries in the western hemisphere has a longer life expectancy than the US because they have universal healthcare. They also have a higher divorce rate than the US.

Not disagreeing with you, but a lot of this is due to drastically lower traffic deaths, because there's very little traffic in Cuba.

Cuban healthcare is a joke, ask anyone actually from Cuba. The numbers are mangled to make it look good.

Cuban healthcare is one of the biggest memes ever.

And it's just that, a meme, not a reality.

Straight people should get their act together. Y’all are so stuck on an image of family that has only existed for two generations at most, and it causes you to be lonely and unable to form relationships of meaningful strength outside that image. I feel sorry for straight people.

According to Axios it's mostly COVID and injuries.

https://www.axios.com/2022/08/31/covid-us-life-expectancy

I'd say obesity of by far the worst out of those, since its so widespread and covid certainly didn't help there. That Americans are generally way more overweight than say Europeans is something I keep hearing for multiple decades and became a regular meme source, and I keep seeing it regularly.

I saw a lot of attempts for normalization of this in US media, ie Hollywood family/comedy movies painting it as something to be OK with, and not a disease that will slowly but surely ruin your life and kill you prematurely, all completely preventable. I wonder how much better US healthcare would be if obesity wasn't such an epidemic there, the costs for treating all those comorbidities that eventually come is staggering, all long term treatments.

HFCS must have lion share in this, as overall processed cheap junk food. We don't have it all figured out here in Europe, but at least our approach to food, its quality and quantity is way better here.

The average american is just plain unhealthy. Terrible diet, little daily activity. It's in the stats, which people ignore. You just plain see it with your own eyes as well. It's a genuine problem, not a lifestyle choice.

I agree it's a problem, but how is it not a choice? There are a few exceptions, but most people could choose to be more active and eat better.

Yeah, but the environment does not exactly makes it easier. More like, it usually makes it harder. The way places are build for example - most people have to use car, the option to go by walk. public transport or by bicycle is not there for most people. There are not even sidewalks in quite many places and if you walk somewhere, you are "odd" (I had cops stop at me just because I was walking somewhere. They thought something is wrong.).

The expectation seems to be that you wont just have physical movement normally as part of your daily life, you have to use car to go to special place (gym, park further away) to do things like exercising, jogging etc. And Americans work a lot too, there stereotype of lazy American, but that lazy American works a lot more hours then people in other parts of the world.

I mean, the amount of physical movement I had definitely changed with how easy and pleasant it was to have some low key movements. And the way America is build, it is fairly often neither. Even the way Americans talk about it - low key going by walk or bicycling or whatever is the first to be sacrificed to minor safety improvement or to general "if you want to do it that much, you can go to bike trail, mountains, etc". That however cuts off everyone except most determined.

I wouldn't claim Americans are lazy, in contrary - you guys work way too much and rest from it too little! But if its about physical movement thats another story for many, as is painfully visible.

I completely agree with your description, when I was in US in sort of work&travel program almost 20 years ago on university, I had such huge problems getting by walking to places in ie Hollywood or Maine (2 different universes btw also in obesity). Had to walk on the main road to cut time to work easily by 30 mins one way. I had (good) people sending me to homeless shelters since I looked so odd just trying to walk to places.

The problem is - even if movement and exercise is super healthy, and the more you do the better you feel about yourself, that's not most of the obesity problem. You would have to run 2-3 marathons every day without exception to burn all the excess junkfood energy many people consume.

You can be very healthy by eating well and not being sporty at all. You can't be healthy long term if you are sporty and eat tons of junk (exception may be folks doing sports on professional levels). You may look OK but ie your arteries, heart etc will tell different story.

This is very true. I track my calorie intake for this reason. There is no possible way for me to exercise enough to burn as many calories as I would like to consume. In addition, it helps me make healthier eating choices especially when "bad" food is so inexpensive and readily available.

> You would have to run 2-3 marathons every day without exception to burn all the excess junkfood energy many people consume.

But that is not how it work at all. First the moderate amount of exercise does more for your health then weight loss itself. If the consideration is health and not just aesthetic, moderate movement matters a lot.

Second, it changes how your body works overall - how much energy you spend on daily activities just by existing. As you get into form, you become more active in general, simply because you feel good. It changes your apetite too.

The mechanical recounting of calories does more harm then good, precisedly because it makes people conclude that exercise such as walking around does not matter- but empirically it does.

> You can be very healthy by eating well and not being sporty at all.

You can be healthy and fat too. And the strategy you describe is how you become thin and physically weak - in the long term that is not healthy. Not when you are at 1000 or less steps per day, effectivelly.

I phrased that wrong. Unhealthy habits are often permissively looked at as just a different lifestyle choice ("hey, I just like my burgers and sodas man!"), rather than really being problematic.

I spent a month in Asia, when I was planning the trip I was a little worried about eating out all the time and my health and weight gain. I actually ended up losing weight despite eating every meal in a restaurant.

Everything was so much less sweet, less sugar in everything. Even cookies weren't that sweet

You may have been more active than usual, also? Even just walking to get places each day, instead of spending your entire day sitting at a desk or in a car, makes a huge difference.

There is almost no amount of physical activity that can offset excess consumption. Certainly not walking around on vacation.

https://www.nytimes.com/2018/02/23/sports/olympics/cross-cou...

>A typical elite cross-country skier will burn about 30 calories a minute during training — by comparison, a 155-pound person on an elliptical machine burns about 11 calories a minute.

I believe the units above are supposed to be kilocalories. For comparison, a single pastry easily has 200+ kilocalories, and 350mL of sugary soda has 150 kilocalories.

> "There is almost no amount of physical activity that can offset excess consumption."

This is not consistent with my personal experience. In general I eat what I want, whenever I'm hungry. Sure I try to eat healthy stuff, but sometimes I binge on crap too. I've found that so long as I stay reasonably physically active (nothing crazy, I'd say I average 60 minutes or so of running, cycling, or walking daily), I stay slim. But if I'm not getting that level of exercise for a prolonged period I will start to put on weight.

When I'm on vacation I can easily spend hours walking around a city seeing the sites. I'll often get really tired and hungry by the end of the day - it definitely uses up a lot of energy!

> "For comparison, a single pastry easily has 200+ kilocalories, and 350mL of sugary soda has 150 kilocalories."

But how efficient is your body at actually converting those calories to energy (and subsequently, stored fat)? Surely not anything like 100%! Or to put it another way, there's a lot of calories in your poop ;)

> But how efficient is your body at actually converting those calories to energy (and subsequently, stored fat)? Surely not anything like 100%! Or to put it another way, there's a lot of calories in your poop ;)

Good point! Although, absorption seems pretty high according to this study (75%).

https://pubmed.ncbi.nlm.nih.gov/1091963/

I guess I should revise my statement to say no one can outrun a daily donut/sodas/sugary coffee/bag of chips/cookies/ice cream/beer etc. on a regular basis as a lifestyle, but it could be possible on vacation.

The other saying here is “abs are made in the kitchen”.

>There is almost no amount of physical activity that can offset excess consumption.

Very odd statement to make without quantifying how much "excess" there is in the "excess consumption". If walking a couple extra hours a day on vacation burns (say) 500 calories, that's a pretty large buffer of extra food you can eat - a 20% increase if you're eating 2500 calories per day. But of course a determined glutton can out-eat this.

I was assuming the average person consumes more than 500 extra Calories, but you are correct.

Maybe, but with wfh the last 2 years I've been pretty active. Athletic hobbies keep me busy

There are tons of healthy options in the USA, it's just more difficult when the sweet, calorie dense food is available.

I don't think healthy options were as available as they were where I was traveling to. You also need to be really diligent in the US.

> I saw a lot of attempts for normalization of this in US media, ie Hollywood family/comedy movies painting it as something to be OK with, and not a disease that will slowly but surely ruin your life and kill you prematurely, all completely preventable.

The thing is, looking at OECD ranking I am sitting in country with much lower obesity then USA.

The obesity stigma here is much lower then in USA and was always lower. The stereotype of fat people was that they are friendly and easier to get along with.

Terrible diets lead to obesity and insulin resistance. Doctors do the blood glucose test and if the patient does not figure out eating and nutrition on their own, the Doctors often write prescription for insulin to supposedly control blood glucose. This has the obvious effect of accelerating insulin resistance, though the blood glucose numbers do look better for a while.

> That Americans are generally way more overweight than say Europeans

Indeed, and this is why it's difficult to discuss universal health care with European friends and coworkers.

It's one thing to subsidize basic humanity, some poor soul who got the wrong DNA sequence shattered at the wrong time by the wrong cosmic ray, or who tripped on a sidewalk and wrecked their pelvis. Absolutely laudable goal.

It's another thing entirely to subsidize the stars of My 600lb Life.

And inbefore the inevitable downvotes for being "heartless", I am a former fatass with an abiding hatred for my former self. Fat people largely bring their health problems on themselves. This is a fact. Source: me.

How are you defining worst? Genuinely asking, because as far as I know opioid contributes far more to the falling in life expectancy because it kills people from an early age. Even a fat person's body can keep going into their 50s and 60s.

> Lack of access to basic health care

the number of Americans with health insurance is at a historic high, Biden bragged about it on Twitter last week

it doesn't matter if you go to the doctor...if you don't take the doctor's advice and eat better + exercise...

These health insurances you get in the US are horrible because you can easily pay hundreds of dollars if you go to the doctor depending on your plan. There’s a minimum you need to spend from your own pocket before the insurance starts covering you. For this reason many (most?) people who are insured still do not visit their doctor.

> the number of Americans with health insurance is at a historic high, Biden bragged about it on Twitter last week

I have "good" insurance through my employer. Over the summer I had appendicitis. The cost of the surgery and hospital stay after insurance would have bankrupted my brother and put any of my cousins in substantive medical debt. It would have been nearly a fifth of my retired mother's net worth.

Having insurance is great because it makes lots of care attainable, but it's a vast overstatement to say that having it gives you access to basic care. A majority of Americans have less than $1000 in savings—that's not even an ambulance ride.

FYI, out of pocket maximum in the US is $8,400 for an individual for a calendar year. If the appendicitis happened Dec 31, and treatment was received across 2 calendar years, then two years worth of oop max would apply, so $16,800.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

I used to be me worried until I realized about the out of pocket maximum. But I'm still not sure how it works in practice. Are there ways that hospitals could charge for things that are considered separate from that number, like out of network or not covered things in the insurance plan? There always seem to be extra charges from what the health plans advertise, so I hesitate to trust their out of pocket maximum too.

The big risk used to be getting billed by an out of network provider while you are at an in network facility. Such as getting a surprise bill for $10k from an anesthesiologist that you had no idea was out of network since you thought your hospital was in network and there was no need or ability to check.

But as of Jan 1, 2022 that is no longer a concern:

https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...

The other concern was getting out of network care due to an emergency where you cannot choose in network care, but that is also no longer a concern per above link.

I have had two child births in the past 6 years, and both years we hit our family oop max (~$5k), and after that, we did not have to pay a cent. We took the opportunity to get a whole bunch of healthcare like seeing an ENT, dermatologist, vasectomy, physical therapy to recover from childbirth, etc and all were fully paid for.

I always use the insurer’s website to find in network providers, and I can even get a procedure/diagnosis code and get estimated costs before a visit.

Thank you for posting this! I had no idea that surprise out of network billing and surprise emergency billing were no longer allowed.

Among many, many other things, that was one of my biggest gripes with the US healthcare system. Walking down the street you run the risk of bankruptcy from simply existing, if you have to get emergency care while unconscious.

Can you give some round numbers? I'm curious.

And do you know why insurance didn't cover all but the deductible? Was it the crappy balance billing that's so common now?

Insurance does not pay for copay/coinsurance amounts between deductible and out of pocket maximum. After out of pocket maximum is when insurance pays all of it.

Surprise balance billing is no more since Jan 1, 2022:

https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...

> advice

I was under the impression that doctors were getting sheepish about giving such advice in the US. Patients don't like to hear it.

And overweight patients require more and more expensive treatments over the course of their lives, creating a perverse incentive in a for-profit healthcare system.

>I was under the impression that doctors were getting sheepish about giving such advice in the US. Patients don't like to hear it.

Seems like doctors either tell people to lose weight to cure an ear infection or they don't say anything about weight ever because the outcomes are poor so why bother.

>creating a perverse incentive in a for-profit healthcare system.

Normally private insurers would dump these kinds of people (perhaps leaving them for some government insurer to deal with if such exists). But in a world where insurers' profit margin is regulated to a fixed percentage of the money that flows through insurers they are valuable people to have around.

> Seems like doctors either tell people to lose weight to cure an ear infection or they don't say anything about weight ever because the outcomes are poor so why bother.

Pretty much. But larger thing is that ... doctors are not nutritionists nor lifestyle experts. They do know their own specialization very well, but they are not able to make people loose weight. They do not have evidence based well know strategies of the "we know that this program/advice makes x% of people to make loose weight long term" sort. Usually, what patient gets is general advice of "eating less" followed by some unsustainable diet that is necessary going to fail and just lead to yoyo cycle.

By unsustainable I mean the sort if diet that leads to malnutrition of some sort due to missing stuff your body needs or the one that is too low in calories making the person following it unable to function normally.

Medical staff now get personal satisfaction scores from patients at some hospitals, so now there is also a huge tension about telling patients things they don’t like.

Anecdotally, this was a big reason many of my friends left medicine and nursing.

As (I think) the comedian Jimmy Carr said - "Life is like a box of chocolates. Neither last long if you are obese."

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