Of Nike Sneakers and Healthcare reform

Great Debates
121

  1. We need to stop thinking of all healthcare as “healthcare.” There are really two different things at issue: Basic healthcare and extraordinary measures.

  2. Basic healthcare we can think of as the care we give to our pets at a vet. This is all the basic easy stuff and will take care of the vast majority of everybody’s needs. It needs to be cheap enough to be reasonably available to everybody without insurance. It needs to be available and easy, like taking your pet to the vet.

example: My neighbor’s dog got run over. It had severe injuries to the head, a broken leg and internal injuries and acquired emergency surgery and a week at the vets. Total cost was about $1,500. If I had the same injuries it would probably cost 100 times that. Why? I know it’s going to cost more because I won’t sleep in a cage, but why should the same treatment cost me 100 times that?

We need to lower the cost. To do that we need to cut people out of the bureacracy of insurance. If you are insured, anything in this category that you need, you get. If you’re not insured the cost should be a reasonable out of pocket expense. Limit liability. Limit malpractice. Limit everything, but this basic care to bring the cost down.

Some of us like to go to the Doctor quite a bit, and want lots of tests, and Doctors are loathe to refuse. We don’t care about cost if we’re insured, because it’s a third party. If we are paying out of pocket, we care.

Insurance companies will need an out for abusive overuse. Have arbitration panels, that the insurance companies can appeal to, to drop your coverage or deny claims for a pattern of frivolous use of basic healthcare.

Just like today, you should not be denied treatment at an emergency room based on ability to pay. But, they can go after you to recover costs. Only the costs shouldn’t be crippling.

  1. Extraordinary Measures need to be covered for children. If you can afford insurance for them, that’s fine. If you can’t, a medicare/medicaid sort of coverage should apply from the government.

If you live to age 18 without a preexisting condition that would stop you from getting coverage you are now completely on your own in terms of choosing to get coverage or not. You can be denied extraordinary measures based on ability to pay. If you have a preexisting condition by age 18 that would prevent this your existing coverage if you have it, or medicare/medicaid would continue for life.

  1. Extraordinary Measures include self-inflicted/lifestyle illnesses, on a scale based on severity of illness versus degree of personal responsiblity. If one chooses to abuse or not take care of oneself, the burden of the additional costs incurred increasingly becomes yours.
122

If you had read the cite you would see that during the 2000s the number of fatal accidents dropped 65% from the decade before. So even though there was one anomalous decade in a 50 year time period in terms of *percent * of accidents atrributed to mechanical failure, there were in fact less fatal accidents that occurred due to mechanical failure. The exact opposite of what you asserted.

No I do not concede that. Even if there were some accidents that occurred from safety equipment, that is not enough data in itself to indicate that the safety equipment was a net loss. It reminds me of people that say seat belts are dangerous because they may trap you in a burning car, yet ignore that they save a tremendous number of lives overall because being trapped in a burning car is so rare compared to other sorts of accidents. So if safety equipment eliminates 100 accidents, but induces 10, the net effect is positive.

Again, I know of no engineers who think they can eliminate all accidents. Your argument is a straw man.

There have been 17 fatal mountain climbing accidents in Oregon since 1994. Of those, 3 occurred in a single incident with a scenario like you describe (and note, there was no case where 5 died so unless it happened prior to 1994 you are just making up numbers). We do not know how many climbers were saved by roping together, so we do not know if roping people together is a net positive or not.

123

The Tarahumara do not have foot problems. Because my foot problems went away when I took away these measures. To anecdotal?

Try this:

http://www.livingbarefoot.info/2009/09/why-barefoot/
"In 2007, researchers at the University of Witwatersrand in Johannesburg, South Africa, published a study titled “Shod Versus Unshod” The Emergence of Forefoot Pathology in Modern Humans? in the podiatry journal The Foot. The study examined 180 modern humans from three different population groups (Sotho, Zulu, and European) comparing their feet to one another’s as well as to the feet of 2,000-year-old skeletons. The researchers concluded that, prior to the invention of shoes, people had healthier feet. Among the modern subjects, the Zulu population, which often goes barefoot, had the healthiest feet while the Europeans—i.e., the habitual shoe-wearers—had the unhealthiest. One of the lead researchers, Dr. Bernhard Zipfel, when commenting on his findings, lamented that the American Podiatric Medical Association does not “actively encourage outdoor barefoot walking for healthy individuals. This flies in the face of the increasing scientific evidence, including our study, that most of the commercially available footwear is not good for the feet.”
“A paper titled “Athletic Footwear: Unsafe Due to Perceptual Illusions,” published in a 1991 issue of Medicine and Science in Sports and Exercise. “Wearers of expensive running shoes that are promoted as having additional features that protect (e.g., more cushioning, ‘pronation correction’) are injured significantly more frequently than runners wearing inexpensive shoes (costing less than $40).” According to another study, people in expensive cushioned running shoes were twice as likely to suffer an injury—31.9 injuries per 1,000 kilometers, as compared with 14.3—than were people who went running in hard-soled shoes.”

http://www.livingbarefoot.info/2009/01/you-walk-wrong/

“Natural gait is biomechanically impossible for any shoe-wearing person,” wrote Dr. William A. Rossi in a 1999 article in Podiatry Management. “It took 4 million years to develop our unique human foot and our consequent distinctive form of gait, a remarkable feat of bioengineering. Yet, in only a few thousand years, and with one carelessly designed instrument, our shoes, we have warped the pure anatomical form of human gait, obstructing its engineering efficiency, afflicting it with strains and stresses and denying it its natural grace of form and ease of movement head to foot.” In other words: Feet good. Shoes bad.

Perhaps this sounds to you like scientific gobbledygook or the ravings of some radical back-to-nature nuts. In that case, you should listen to Galahad Clark. Clark is 32 years old, lives in London, and is about as unlikely an advocate for getting rid of your shoes as you could find. For one, he’s a scion of the Clark family, as in the English shoe company C&J Clark, a.k.a. Clarks, founded in 1825. Two, he currently runs his own shoe company. So it’s a bit surprising when he says, “Shoes are the problem. No matter what type of shoe. Shoes are bad for you."

Also good examples of shoes that you can buy that approximate the natural gait on that cite.

124

This is false. I hope it’s not deliberate. I said nothing about total accidents. I only said “percentage of accidents caused by mechanical failure.” That has, as I stated gone up in the last decade, rather dramatically.

If what I am saying reminds you of something else, that is immaterial to what I actually said. I gave you examples, and I gave you a cite for a book where you could read about more.

Moreover, your stance is unreasonable. A reasonable person would expect that not all safety systems are effective, and that some could be counterproductive. If you wish to be so obstinate and unreasonable as to deny this, I don’t feel compelled to spend the effort correcting it. My experience suggests people with such viewpoints tend to be intractable to reason.

I was making up the 5 people. I thought that was apparent when I said: “Let’s say for purposes of example…”

Upon looking in my book now, the actual incident I was basing this on occured in 2002 and consisted of 4 people roped together.

Again, you are being obstinate, and completely missing the point. The number of people roped together is immaterial, the math works out the same. Roping together on Mount Hood tends to save everybody unless the top man falls in which case everybody falls. If it’s four people than it saves 3 out 4 incidents of falling individuals (persons 4,3, and 2) can fall and be arrested by the man above. But if person one falls he takes out 2,3,4 (and creates a landslide for everybody below.)

There is no net gain. Roping together 4 people stops 3 out of four falling scenarios, but the fourth scenario has four times the consequence. Roping 5 stops 4 out of 5 but has five times the consequence.

It’s a matter of simple math.

The number is immaterial. You’re missing the point.

When Bill Ward fell in 2002 he took all four of his team with him. They took another five with them on their way down. The incident resulted in death or severe injuries for all but 2 of those 9 people.

125

I get 4 scenarios as I’ve described resulting fatalities on Mount Hood since 1975, not sure how many more nonfatal accidents.

Don’t care. You’re missing the point.

126

Bricbacon:

One of your corrections is accurate. They didn’t finish 1,2,3,4,5. They finished 1,2,3,5.
I misremembered.

Congratulations. It doesn’t really change things, or my larger point. Frankly, I’m kind of fed up with arguing the minutiae to the exclusion of the larger idea.

Tarahumara, amazingly good runners, yes?

127

Do you have any evidence that this is true?

According to this cite, two climbers fell, causing the other two to fall.

As Mr. Rollins noted, there is a risk of a domino effect, but he said nothing about the the technique being ineffective. Do you have any evidence that this is the case?

128

Actually, I believe it was 1st, 2nd, and 5th. The problem is you don’t have a larger point. Your larger idea is based on faulty premises, and unsubstantiated claims.

129

Scylla, none of that supports your actual claims.

That shoes can lead to foot problems seems self evident. Corns, blisters and so forth are almost entirley due to shoes. That damage of the sort you describe caused by the mechanism you ascribe is totally without any evidential support at this juncture.

And I am still waiting for evidence that these Indians have a 0% incidence of lung cancer and diabetes, and that 100% of octogenarians run ultramarathons. Because those claims sound like classical child-of-nature bullshit.

130

In the shoes/no shoes controversy another thing which must be considered is ankle support. I have been seriously injured twice in my life because I wasn’t wearing footwear with adequate ankle support. In both cases I was wearing lowcut shoes which allowed my ankle to twist. Both times injury would definitely have been prevented had I been wearing boots high enough to cover the ankle, with sufficient stiffness to prevent extreme ankle twisting.

131

Let’s use some OP logic:

We have three scenarios for seat belt use:

a) There is an accident and the seat belt keeps the occupant from hitting the dashboard and dying.

b) The car bursts into flames and the seat belt traps the occupant who burns to death.

c) The car rolls into the water and the seat belt traps the occupant who drowns.

In 2 of the 3 scenarios the seatbelt does more harm than good, therefore seat belts make you less safe.

132

Also, if the accident rate is going down, and goes down more in one area than another, the percentages shift even if there is nothing worsening about the area that now has worse numbers.

133

One thing I think you forgot, Scylla, is that our current health state and healthcare system evolved over time and in cahoots with the rest of Modern American Life.

Nobody woke up one day and said “Gee, wouldn’t it be great if we all got fat and paid our insurance companies a ton of money so we could see our physicians, who’d tell us to lose weight.”

Our American health problems are a multi-faceted system. We sit at computers in offices all day, we’re not running around the Grand Canyon looking for berries. We watch television where advertisers tempt us to purchase food we don’t need (but can afford, because we sat in the office all day). Our delightful automobiles give us even more reason to sit for long periods of time and pollute our air, but they let us go buy more of that food we don’t need.

We’re hardwired to solve the problem of feeding ourselves. We’d rather do it with less effort, rather than more. This is not a moral issue. It’s making us fat and being fat and sedentary is generally unhealthy (though not always, as my 65-yr-old skinny-runner-father-with-the-heart-attacks vs. 65-yr-old fat-sedentary-mom-with-no-physical-ailments illustrates).

But still, wanting to eat more than you actually need to and doing it with the least effort necessary is not a moral failing.

I do agree with your central thesis that healthcare reform will not make most of us healthier - that IS largely a matter of personal choice. But there ARE a significant number of people whose access to necessary medical treatment is stymied by insurance companies’ profit margins.

Greed is endemic, too.

134

That’s an obviously faithless misrepresentation of my argument. In my five climbers scenario there is no reason to think that any one climber in line is likelier to fall than any other, so it can be assumed that each scenario is equally likely.

Your faithless restatement presents three nonequivalent scenarios. Scenario “a” would have a much higher expected frequency than b or c.

I take the fact that you have to alter my argument in order to create fault with it as evidence that you find my actual argument sound.

In your false restatement of my argument you do not present 3 equally likely possibilities. Scenario “a” would have a much higher expect

135

Not that I disagree with overall point but don’t forget T-bones! Belts can hold you in place while car bends in in and crushes you.
So 3 out 4 scenarios, or 75%!

136

And you seem to misunderstand that without information on how many times roping together saves lives vs causing death, your made up scenarios are utterly worthless. Plus you have zero data behind your claim that if the first climber falls the rest of the climbers will fall with him/her. But this is totally in line with the rest of your reasoning in this thread. In each case you look at the possible downside of a safety measure and not at the upside. Without both you have absolutely no way of knowing if it is a net positive or net negative.

So I ask you:

What is the percentage of times that the leader falling will take out the rest of the group, rather than them being able to arrest his fall by planting their crampons and ice axes?

137

I thought the answer to this question was obvious: The leader falling will pull down the group nearly 100 percent of the time due to the basic physics of the forces involved.

Following from my scenario, if 90 kg of leader and eqipment attached by 10 feet of rope with two feet of slack falls, he will fall 18 feet before the rope is tight against the second climber. If the rope can distribute that force according to the work energy principle by stretching one foot than average impact force is…

15,876 kg or 35,000 pounds hanging on the rope.

No chance at all.

This pure physics example assumes free fall in a vacuum.

The climber is on a slope, might partially self arrest, bounce off a rock or what have you which would decrease the impact force maybe even by a very large degree, but since the lead travels twice the distance of the safety rope minus slack before the possibilty of an arrest, the amount of kinetic energy involved is for illustrative puropses 100 percent unrecoverable.

138

Except that in reality, it is a non-100% probability:

For every explanation of why this does not contradict your silly claim, I can find two more instances that prove you wrong.

I accept that sometimes, climbers die because they are roped together. But, more often than not, they avert disaster. Your certitude about the 100% fatal consequence of a fall with roped-together climbers is categorically false.

139

Your cite bears little resemblance to the scenario I’ve presented, presenting a totally different physics picture, one note quite so unrecoverable. Where it is applicable, it supports my argument.

We appear to be dealing with less kinetic energy than what I’ve described. Nonetheless, your article calls this belay a “miracle.”

But, if you believe a good safety system depends on miracles to make it work than I guess you have a point.

Fortunately, that’s not I’ve argued. My scenario is specific: Mount Hood, roped together in a vertical line. There are situations where this could be a good safety measure, Mount Hood is not one of them.

Nor, apparently is K2. Notice that the the two falling climbers in your article collided with the line strung between climbers below them. This suggests that those climbers were not in a vertical line, but a horizontal one. If you’ll recall, this was one of the possible solutions I’d suggested to the line of vertical climbers problem. K2 being a more challenging and exclusive mountain, it attracts more expert climbers. Doubtless, they are aware of the climbing in a vertical line problem (it’s not exactly a revelation to the climbing community) and were ascending in a safer formation.

So again, far from detracting from my arguments, this supports them.

140

Why? Have you grown tired of ignoring and not addressing all the evidence I’ve already presented? Would you like me to go look for a term paper?