A few years ago an old friend from high school came to visit us. He collapsed from congestive heart failure while he was here (we live at 5000 feet). He is well to do and was taken to the hospital where they treated him for a week. Then his insurance company decided it would be cheaper to have him near home so they chartered a jet air ambulance to fly him 800 miles home. He recovered when he was back at sea level. We went to visit him and I suggested that he could become a lot healthier if he got a modicum of exercise (he was a total couch potato). He replied that he had no time to, for instance, walk a couple of miles a day. I believe that he will cost the system upwards of at least a million dollars in his lifetime. His wife is a doctor, but all she, and his other doctors do, is prescribe drugs. Every one of his problems would be solved by modest hour-a-day lifestyle changes. He won't do it.

He is well to do and smart. The dumb poor folks are even worse. They, like him, will acquire type 2 diabetes, with all its hideous effects, and expect the medical system to prescribe some treatment that requires no effort from them.

Type 2 diabetics cost Medicare $18,000 a year each. For almost all it is totally curable by voluntary life style changes. Profit or non-profit, these people require the services of high paid professionals. How do we induce these people to take responsibility for their illness?

I deeply resent paying huge amounts of money to pay for the care of idiots, whether it's single payer or whatever.

Any health care system will have to ration if it is to control costs. There are three methods: price, queuing, and some form of selection. Single payer will inevitably end up queuing. Except that the well to do will go for price by opting out.

As I pointed out in a previous post the Feds have low administrative costs and high fraud rates, and the insurance companies have high administrative costs and low fraud rates. It probably ends up costing the same either way. Hospitals, doctors, and pharmaceutical companies are standing by ready and willing to commit fraud at the slightest opportunity. A single payer system where the care deliverers are not salaried will by subject to lots of fraud. Where they are salaried you will get the dregs of society becoming care deliverers. Of course fraud includes unnecessary treatments. How will a single payer system prevent doctors from prescribing unneeded treatments and drugs as they do now? I have friends who are Docs. They rely on the chronically ill for most of their income, for whom they can prescribe all kinds of drugs for which they get sizable kickbacks.

Since I am on Medicare I opted for the Blue Cross Medicare Advantage plan they offered, because in a modest way it reduces my subsidy of the sickies, and eliminates my need to buy supplemental insurance. I have a $5000 out of pocket maximum, but since I am saving about $1500 a year by not requiring supplemental insurance I'll be ahead in three years. Since I cost the system almost nothing, we are all winners. As soon as they offer the Medicare HSA I will take that, and further reduce my subsidies. Sickies should be covered by the general fund or a new value added tax, not by forcing the healthy to subsidize them with a highly regressive tax (falsely named compulsory insurance). Subsidizing sickies out of the general fund or a VAT would make the tax somewhat progressive, as opposed to Hillary's compulsory insurance .

Perhaps the reason the whole planet gets fat as the American diet is adopted is the same reason that brains have shrunk. A little known fact is that our late 20th and 21st century brains are 10% smaller than 19th century brains. Stupidity and fatness go together. Not because stupid people eat more (maybe they do) but our diets don't contain brain food, mainly omega-3 fatty acids. Beef use to contain lots of omega-3 when cattle were grass fed. So maybe the cause is that we are all lacking nutrients and overeat to compensate. In any event fish oil contains lots of omega-3 and since most of it goes to make paint, there is plenty for supplementing diets. Who knows what other shit our modern lifestyle has perpetrated.

Do a little research. There are reasons for our fatness besides self-indulgence and ignorance. I'm old enough to remember the 1950's when fatness was extremely unusual. We have not changed genetically, but our diet sure has.

I was in Wellesley, Massachusetts, a while ago. There were almost no fat people. I saw the same thing in Restoration Hardware in Dallas. Certain areas of the country seem to have great social pressure against fatness. Or do those smarter, upper middle class, people have more of needed nutrients in their diets?

As Jared Diamond pointed out in his book, Guns, Germs, and Steel, he considered the New Guinea Highlanders to be more intelligent than the average American. They obviously ate no processed food, which only contains what the USDA considers nutrients.

One of the key aspects of low intelligence due to nutritional deprivation is the inability to see beyond the obvious, and the loss of the ability see deep connections. I recommend that you eat a little more brain food.

Black men in America who are on the Down Low also vociferously deny that they are homosexual. Since women are not very available in the Middle East, "heterosexual" men who indulge in homosexuality might not consider themselves "homosexual". Hell, Ahmadinejad himself might have messed around a bit and would not consider himself queer. I suspect that once most Middle Eastern men finally get a little pussy they give up the homosex.