Convenience

Everyone is selling convenience. That’s the most valuable commodity around. If you can find a way to make someone’s life easier, then you can sell them anything.

I’ve decided to start feeding my dog real food. I almost slip every time and say human food. As if chicken, beef, rice, sweet potatoes, and vegetables (the main items of his diet now) are only made for us. He’s getting older, he’s 13, and I think real food might expand his horizon and longevity. If it works for me, why wouldn’t it work for him?

The impetus for this decision came as I observed him devouring a frozen beef femur the other night. For hours he laid outside on his blanket with it and sucked everyone ounce of bone marrow and life force he could out of that bone. Watching him gave me the sense that he needed real food. And that’s when my decision was made.

But it made me question why I even give him kibble to begin with. Why do I feed my dog pellets of processed food? What am I actually buying? Because I can buy and cook food for my dog if I want to. So it’s not actually food that I’m buying. It’s not some special formula like they want you to believe. When has fortified processed food every proven to be better for your health than actual food? Never.

I’m really just buying convenience. I’m paying someone else for the convenience of not having to shop, cook, clean, and plan for my dog. I’ve outsourced that responsibility.

The company wins. They get paid. I win. All I have to do is remember to order food, and scoop a few cups of kibble into his bowl each day. The only loser is my dog who’s left to eat what my fiancee calls “food with no life force.”

Looking at it from the view of dog owner to dog, the decision to give my dog processed food seems straight forward. The juice, giving him real food, is not worth the squeeze, shopping, cooking, cleaning, planning. Despite how much we love our animals we can’t deny the fact that we view them as lesser, even if by a tiny margin. Which is why they don’t get all the perks and luxuries new give ourselves. Whether that’s real food, or that big expensive procedure. It’s just easier and understandable not to.

But I wonder if that’s why we, humans in modern civilization, eat so much processed food. Convenience, cost, time, energy, yes. But is that the only reason? Or is it also because we don’t think highly enough of ourselves to warrant taking the time to plan, shop, and cook our meals? Do we think we’re not worth the extra cost, time, and effort? We know the benefits of eating real food, and the consequences of eating processed food, so why is 70 percent of the American diet made up of processed food?

I don’t actually know if that’s the case or not, clearly. And I know that for many people in this world that it is way more complicated than I’ve made it seem. But for many of us, it’s probably not that complicated, and we could feed ourselves better with very little impact to our lives, and I’m fascinated by why we don’t.

A Word on Optimization

At what point does the cost of pursuing optimization begin to outweigh the benefits? At what point do we consider optimization achieved?

There’s such a push to try and optimize every aspect of our lives. Whole industries have been built on it. Careers made on it. But no one can really tell you where the curve starts to level off, and your efforts become futile, or even start to erode the progress you’ve made. But I have to believe that a life focused on optimization misses the point of life. 

It’s my opinion that if you exercise regularly, 3 - 5 times per week, and you eat a good diet, one that is rich in fruits, vegetables, lean meats and proteins, and devoid of added sugars and artificial ingredients (nothing processed) then you are at least 90 percent of the way there. If you’re sleeping well, which you likely are because you’re exercising and eating right, you’re even closer. Working a job you love, closer still. Maintaining close relationships with loved ones. You’re nearly at 100 percent.

So how much more of a role could vitamins play? Supplements? Hot and cold therapy? High intensity training? How much more is it going to add to your life? How many days, weeks, years will it add? How much better are you going to feel? One percent better? Two percent better? I take vitamins, supplements, and do different “health” modalities, and the difference between when I do them or not is negligible.

I’ve heard countless people say “when I stopped eating sugar I felt amazing.” “When I stopped eating bread, pasta, and processed food I felt amazing.” “Stopping drinking was the best thing I ever did.” “When I started exercising I felt amazing.” Whether that was walking, hiking, running, yoga, or strength training was irrelevant. And that’s been my experience as well.

But I’ve never heard anyone say “When I started taking my vitamins, I started to feel amazing.” “When I started waking up to view morning sunlight is when everything changed.” “Creatine changed my life.” It’s just not something I’ve ever heard.

Conversely, if you’re not eating right and exercising, then there is nothing you could ever do to feel amazing. No vitamins, supplements, medication, contrast therapy, or any other life hack that people and companies promote will give you that feeling that exercise and diet provides. And anything that does provide that benefit only lasts a short time and then wears off.

So I guess there’s two things I think about.

The first is personal. Why am I spending so much time and money on this dream of being “optimized” when I’m already as close to the pin as I can get. It’s like that old Jim Gaffigan joke. He goes to the gym, sees a bunch of really in shape people and say, “What are you doing here? You’re done.”

Second is societal. If careers and industry were built on getting people to eat right and exercise, instead of focusing on a small percentage of the population that are “optimizing,” how much better off would we be? I know it doesn’t work like that. Doing good was never the intention of capitalism, and the former is way harder than the latter. It’s way easier to say “take this pill,” then it is to educate people and give them resources to improve themselves. But it’s still the thing I think about and wonder.

We’re focused on optimizing a few while the masses could use a hand with the basics.

Another Reason for Universal Healthcare

And just like that UnitedHealth Group reduced the work required for patients to receive their medication. It’s as if there was no real reason for anyone to jump through these hoops to begin with. It’s as if all the requirements for reauthorizations were made up. As if they were only in place to make it difficult for people to receive their medication and deny or delay peoples prescriptions and save UnitedHealth Group money.

It seems that way, because it is.

Once you see the truth you can’t unsee it, and that’s how I feel here. After learning about universal healthcare systems in other developed countries around the world my views of healthcare in this country have totally changed. Perhaps the most eye-opening fact I learned was that in developed nations with universal healthcare insurers, whether they are private or public, are not allowed to deny or delay claims. I can’t help but see this situation through that lens.

The problem is that UHG, a for profit health insurer, is allowed to implement their own set of made up requirements that do nothing but make it more difficult for patients to receive medical services and medication. And the arbitrary nature of these requirements is confirmed by the fact that, after receiving some “pressure,” at a moments notice they can change those requirements. So much so that they anticipate a 25 percent reduction in paper work associated with reauthorizations for the 80 drugs they selected.

When you see that you have to ask the question: If they can so easily and quickly eliminate those requirements, then why were they there in the first place? And, what other “requirements” could just as easily and quickly be eliminated? How could insurance make it easier for doctors and patients to receive the care they need and are entitled to instead of making it more difficult?

It’s a big game to them. The prize is money. The consequence is suffering.

I know because I saw it firsthand after the company I worked for was acquired by UnitedHealth Group. The focus was never on patient outcomes or the level of care patients received. Not when it got in the way of profits. UHG executives didn’t fly in for meetings to discuss how patients were doing. They flew in to ask: why we weren’t making more money, how could we make more money, and when we would make more money.

I was never a proponent of universal healthcare, especially when I was working. It took me a long time to come around to it. Reading The Healing of America was the last piece for me. I realized I wasn’t a proponent of it because I didn’t understand it and because I had succumbed to the propaganda that opposed to. TR Reid’s book gave me the information I needed to understand how it could work, and why it was so important.

Healthcare is not something to mess around with, that suits in a board room should be pontificating on. Healthcare should be easily obtainable, accessible, and affordable for everyone. And people who actually study medicine should be making the decisions. Decisions shouldn’t be made based on their impact on a stock price.

From my time working under UnitedHealth Group I still own some shares of their stock. When their CEO was murdered, the stock took a dive. When the DOJ opened up an investigation into improper billing of Medicare it dove further, and it hasn’t recovered. I told my brother I’m stuck between a rock and a hard place.

“On the one hand, my stock is down 30 percent. On the other hand, UHG is finally getting what it deserves, and even though it hurts my wallet, I’m happy that they’re facing a reckoning.”

Ignoring the root cause in healthcare

Every book or long form podcast contains at least one gem of information, new perspective, or piece of context that shines new light on an old topic. That’s the opening sentence from my last post: War Good. Trump Bad. But the theme continued when listening to another Joe Rogan podcast (I’m on a Rogan roll). This one was with Chris Williamson.

They were discussing a wide range of topics when Chris dropped this piece of knowledge on me. He said that patients who undergo bariatric surgery have higher rates of suicide post surgery. The reason, he explained, was because obese patients get that way by using food as a coping mechanism for whatever trauma they are trying to deal with. No different than the way an alcoholic drinks, or a drug addict drugs. They are all dealing with the same thing, unaddressed trauma, their substance of choice just differs.

But when patients come out of bariatric surgery, and the size of their stomachs have been greatly reduced, they can no longer eat enough to sedate those depressed or anxious feelings. They can’t eat themselves into a “food coma” and feel ok. So, they turn to self harm. And it turns out, it’s true.

It’s another one of those things that after hearing makes so much sense, but not something I ever thought about before. Bariatric surgery is addressing the symptom of the disease. It’s addressing the weight gain, not the reason the patient gained so much weight in the first place. But the root cause of why they got that way is ignored.

I feel sad when I hear things like this. Because people turn to doctors, hospitals, and clinicians to help them with whatever ailments they face. And it’s the job of the practitioner to figure out what’s really going on, but most of the time they don’t. An obese patient needs to lose weight to save their life and improve their quality of life, but excess weight is not the underlying issue.

And while there are probably bariatric surgeons out there who address the whole problem, or try to by referring their patients to psychotherapy in addition to surgery, most physicians probably don’t. I worked in the system long enough to know how most physicians operate. And it’s not totally their fault.

Incentives are woefully mis-aligned. Surgery makes money, so hospitals and surgeons are incentivized to perform surgery. Spending time with a patient and coaching them to lose weight is not a money maker in the short term, so very few physicians put any real effort into it. 

It’s just another example of the failure of our healthcare system. It’s just another example of how we don’t address the root cause of issues in this country. We just try to cover them up or cut them out. Meanwhile the issue continues to lurk in the darkness waiting to rear its ugly head again.

A system that works for everybody is very badly needed in this country. A total realignment of healthcare’s incentive structures is very badly needed. So many people are suffering and not getting the help they need. Imagine if we had a system that actually worked for everyone.