Universal Health Care - Still Not Possible in US

[golodhendil]

Hydrogen, from reading your posts it almost seems as if scientists know nothing about anything.

Again, your suggestion indicates that there is no standard or clear attributes for fitness, and as a result, no definition. You are presuming that any set of assumptions of what fitness is are natural. That is incorrect.

Additionally, are there set standards of fitness for every single ethnicity, gender, age group and lifestyle? No. None. Besides, how would you go about calculating the fitness of a woman of one mixed ethnicity and a certain lifestyle and a man of another mixed ethnicity and race, and his own specific lifestyle? Do you have clear and complete health knowledge concerning differences between all genders, ethnicities and age groups? Do have similar knowledge that pertains to every known 'lifestyle' that people engage in? You don't; no one has such knowledge.

As for incentive to change, change to what? You still have not defined what fitness is.

On the contrary, in medicine fitness is generally defined by cardiorespiratory fitness (CRF), which is measured at clinics with treadmills and walking tests and other controlled exercises. Research in the past 4 decades in different countries, across all ethnicities and age groups and for both gender has consistently shown that CRF is inversely associated with coronary heart diseases, other cardiovascular diseases and mortality from all causes, independent of and in addition to risks from smoking and drinking, etc. If we ever need an objective standard, CRF will come as close as we can get. (but see below)

Your point is not clear here. If you are suggesting that fitness be related to the appearance of disease in a person, then you should know all the possible root causes of these diseases first. Smoking increases the risk for lung cancer, but there are still a very large number of people who get lung cancer who never smoked. There are also smokers who never get lung cancer (the majority). People can lead what is presumed to be very healthy lives and still suffer from any one of the above afflictions.

To say we need to know all the root causes of diseases before we can decide on preventative or diagnostic criteria means we can basically throw out all of medicine, because we are never going to know every cause of any disease. All we can do is know with a certain confidence level that a certain number of factors will have whatever probability of causing the disease, and base our decisions on that.

By the way, the bolded part is misinformation. Among causing other cancers, smoking has been most strongly linked with lung cancer, and has been attributed as the cause of nearly 90% of all cases, especially the more deadly non-small cell lung carcinoma and further especially the cases that have worse prognosis. As far as there is certainty in science and medicine, the link between smoking and lung cancer is probably among the most certain.

Another piece of misinformation/mis-reasoning further up: while blood cholesterol level (more strongly, the levels of HDL and LDL) has been definitively linked to increased risk for heart diseases, of course there are other risk factors and markers that are also involved and monitored. And you asked what if someone with a healthy diet has increased cholesterol level? Then he should be screened for familial hypercholesterolaemia or other genetic or acquired defects in cholesterol metabolism.

More confused thinking on your part. Remember, I was the one who informed you that everything is toxic in large enough quantities. That's literally the first rule of ecotoxicology.

That is correct (the original quote by von Holhenheim was "All things are poison and nothing is without poison; only the dose makes a thing not a poison"), but it's not just the first rule of ecotoxicology, it's the first rule of all of pharmacology-toxicology.

You still have failed to define what fitness is, and you also have neglected to state who you would see doing all this policing over the bodies of people. Rather than to presume to answer for others, try describe how you would regulate and police the bodies of the entire population.

I have less of a problem with Keithz' original suggestion of setting athletic exit requirements for high school, because to some extent it can serve as another (arbitrary) benchmark that, like academic performance (and "discipline scores" and mandatory arts instructions in certain Asian education systems), correlates with commonly perceived notion of a "well-rounded" education. But I disagree with a punitive "fitness tax", not because "fitness" cannot be defined objectively (it can), but because of the myriad socioeconomic factors that are hard to control, and especially the genetic components of diseases that are not yet fully worked out. Perhaps it might be more acceptable if one day personal genomics is routine, and "all" (though absolutes are not generally accepted in science) the genetic associations are understood well enough such that exemptions or exemption percentages can be set for every predisposing genes with their respective contribution (eg, if you have genes A, B and C which have x%, y% and z% association with obesity then you get an N% deduction from the fitness tax). But this would be a rather pointless logistic nightmare for which the effort and investment is probably better spent on other social programs or health measures, and is also unjust because it awards/penalizes people for their genetic makeup.

 

[afransen]

^ That is a much better counterargument. The logistical difficulty of managing a tax credit that is sufficiently fair would probably put the idea to bed, at least for the foreseeable future. However, if we accept that a degree of physical fitness is desirable as a requirement for graduation from high school, it follows that it's not unreasonable to at least encourage or reward if not mandate levels of physical fitness at other stages of life.

 

[kEiThZ]

^ It's not an unreasonable expectation but we just don't do it. We don't allow minors to consume cigarettes and alcohol either, although you could argue that most pre-teens are fully aware of their dangers and are capable of making an informed decision on their use these days. So does that mean we should completely ban alcohol and ciagarettes for adults too?

I can understand the premise of your suggestion. It's a worthwhile goal, but ultimately not very feasible. A test for high school students, however, is easily implementable, would not rankle too many folks and could be administered without significant difficulties. Imposing a standard like this could make significant gains in the fight against obesity. Indeed, it might well make childhood obesity negligible in a few years if parents start to take the test seriously (and they would if graduation was at stake).

 

[Hydrogen]

On the contrary, in medicine fitness is generally defined by cardiorespiratory fitness (CRF), which is measured at clinics with treadmills and walking tests and other controlled exercises. Research in the past 4 decades in different countries, across all ethnicities and age groups and for both gender has consistently shown that CRF is inversely associated with coronary heart diseases, other cardiovascular diseases and mortality from all causes, independent of and in addition to risks from smoking and drinking, etc. If we ever need an objective standard, CRF will come as close as we can get. (but see below)

This does not change the fact that this type of measurement is still arbitrary - and a rather small element of what is popularly invoked or identified with the vague notion of "fitness." Rather baldly stated, all the CRF tells you is what portion of a population can pass a certain type of test. It does not tell you with any certainty that those individuals who pass will automatically avoid disease, or those who fail will all die an early death (but for afransen, they're a big potential source of tax revenue).

The problem with the word "fitness" is that anyone can come up with their own test for it, can choose whatever parameters, and adjust them as they may see fit (pardon the pun). Insurance companies have had a love affair with the BMI. More recent adjustments to that measure have increased the number of people defined as obese. This often includes people deemed to be physically "fit."

In other words, change the measure, get a new result. Change your measure of what fitness is supposed to be, get a new result. Otherwise the term is not particularly useful.

To say we need to know all the root causes of diseases before we can decide on preventative or diagnostic criteria means we can basically throw out all of medicine, because we are never going to know every cause of any disease. All we can do is know with a certain confidence level that a certain number of factors will have whatever probability of causing the disease, and base our decisions on that.

Not at all. To put it simply, epidemiology cannot eliminate all the variability among humans. Applying probability to a group leaves a lot of room for the role of noise from other variables.

By the way, the bolded part is misinformation.

I said that smoking increased the risk for lung cancer. What's factually wrong about that? The majority of smokers never get lung cancer. Check the statistics. Lung cancer is a relatively rare disease, that's also can be checked. There are people who don't smoke who get lung cancer. Is that factually incorrect? No.

Before you go off assuming, I don't smoke, never have, never will, don't see the point, hate butts littering the city, and believe that it is an addiction for some people.

That is correct (the original quote by von Holhenheim was "All things are poison and nothing is without poison; only the dose makes a thing not a poison"), but it's not just the first rule of ecotoxicology, it's the first rule of all of pharmacology-toxicology.

And always a good rule to know.

But I disagree with a punitive "fitness tax", not because "fitness" cannot be defined objectively (it can)

So what is a fitness? What is a "fit" person?

but because of the myriad socioeconomic factors that are hard to control, and especially the genetic components of diseases that are not yet fully worked out.

Which is also part of my point. I don't see you suggesting that, on the basis of your own admission, that requires that "we can basically throw out all of medicine" as you implied I was suggesting.

Perhaps it might be more acceptable if one day personal genomics is routine, and "all" (though absolutes are not generally accepted in science) the genetic associations are understood well enough such that exemptions or exemption percentages can be set for every predisposing genes with their respective contribution

In other words, when push comes to shove, "fitness" is still an arbitrary term. There is really no such thing as fitness; there presently are assumptions, constructs, beliefs and prejudices about what fitness people think fitness is.

 

[afransen]

I think I should point out something, since Hydrogen seems intent to mischaracterize what I said: I was not advocating a 'fitness tax' as a revenue source. I suggested a tax credit, which could be balanced by a small increase in income taxes. Characterizing my position otherwise is a strawman.

 

[Epi]

It's kind of silly to pretend to think that we can figure out a way to 'define' fitness.

1) Medically, there's no way you can properly do this. Are you going to use blood levels as a cutoff? All studies relating blood levels of anything to overall health are based on population studies of risk and have little bearing on the risk of any individual person. And even then, they are just measures of risk, not actual fitness. As hydrogen has stated, you can be perfectly 'healthy' and have bad numbers or have a really crappy lifestyle but have 'good' numbers.

Similarly BMI measurements are not a good way to measure things. Someone with lots of muscle mass can have a higher BMI. Some people with lighter bones can have lower BMIs. Sure there will be 'obvious' people who are obese, but you can't so easily quantify everyone inbetween. When doctors make recommendations based upon physical body measurements, they understand that these numbers, much like blood tests are only a guide and not 'diagnostic' of anything in particular.

Furthermore, there are many a 'fat' person that don't have health problems, while lots of thin appearing people do.

Then there's the obvious problems with defining fitness as by using say military fitness tests, or by using some sort of marker. How can such a thing actually be responsible? There are HUGE discrepancies between what sorts of 'ability' people can physically do and their personal medical issues. While there are some obvious trends, at the individual level you cannot accurately predict such things.

It's perfectly possible for someone to be 'weak' (i.e. not strong) but be healthy. It's perfectly possible for someone to be 'thin' and be unhealthy (i.e. bulimics, type 1 diabetes, etc). It's perfectly possible for someone not to be able to run far or fast and be healthy from the point of view of not getting any major medical problems.

2) Practically there's no way you can do this without using a lot of resources. Who will do the testing? You think doctors will? Who will pay for that? Who's going to pay for all these exercise testers? Why are we diverting healthcare workers to something like this, when we're short of doctors, nurses, and all types of healthcare? There would be a HUGE expendature to run a national program like this without tons of problems, and really, is this a good way to use money? If we're using specific machines to test people (i.e. treadmills), then who pays for them? What treadmill company benefits? Will there be corruption? If we do bloodtests and measurements, why are we using nurses for this?

3) Then there's the law angle. Imagine the huge number of exceptions to this entire silly thing. How about all those millions of people with physical disorders, genetic disorders, congenital disorders, accident victims and so on who will obviously need exemptions? How about people who end up getting HURT because of this testing (imagine causing heart attacks in old people running on your treadmills while testing). How about people who are religiously against it? (i.e. women who can't let men examine them, but in their community the government hires a guy). How about all the people who don't neatly fit into any profile for whatever reason? How about all the inevitable people who 'pass' this test, but still cost the system a ton of money vs those who 'fail' the test but don't have any health problems?

There will be so many lawsuits and exceptions it will become stupid. It won't be long before the supreme court strikes it down as unconstitutional against the Charter of Rights and Freedoms.

4) If you look at population level trends, the most 'unhealthy' people tend to be the poor and immigrants. Immigrants because people who come from other parts of the world who are suddenly exposed to the 'western diet' are really badly off, and cause immigrants generally are poorer anyway. Witness all those Indians (aka Asian subcontinent) with diabetes in Canada because genetics screws them over. As well, the poor already have great barriers to being healthy. This includes jobs with crappier hours, no money for gym memberships/exercise classes, unhealthy food being cheaper than healthy food and so on. So in the end, it just becomes an extra burden on the poor which won't win many friends in the left.

5) Lastly, there will be so many exceptions, that the rules will be made so completely general, that in the end... will it even become effective?



All in all, while it may sound like a great idea at first, if you really look at it closely, the idea of adding some kind of tax for being 'unfit' will definitely not work in real life.

(For the record, a tax credit for being healthy, is in effect a tax for being unhealthy. It's just semantics)

 

[jade_lee]

It's draconian. We live in a world of diversity. It's difficult to access the qualities that make for the better person, the desired fittest ones. The fact that we live longer causes health care costs to rise significantly. Lifestyle choices certainly can prolong our lives and we should encourage good choices but when individuals suggest that it would be easy to enforce fitness on high school kids all I can think about is how easy it was to put children in the mines or factories now in the third world and it's so wrong.

 

[afransen]

Makes one wonder about car insurance rates. How is it fair that car insurance rates be boiled down to such arbitrary factors as age, location, and gender? Surely the risk a given driver poses is determined by many other factors...

 

[theman23]

Great post Epi. Lets not forgot that many markers used to measure disease states have a large degree of overlap between diseased and healthy populations. Medical science is not really down to a "science", so to speak.

I'm also sympathetic to jade lee's perspective on this issue. A person's health is a separate issue from his or her education, and I don't see the reasoning in denying someone their diploma and education simply because they do not meet our society's (arbitrary) standard of fitness. Even if we are to ignore those who are intrinsically susceptible to poor health, almost all the external factors that lead to poor health-bad diet, lack of exercise, etc.- are the result of lifestyle choices that we (ie the people, government, etc.) really have no business controlling. I know its cliche, but whats being suggested here is that "slippery slope" that many opponents of universal health care have warned about. Lets not go down that slope.

 

[kEiThZ]

...Lifestyle choices certainly can prolong our lives and we should encourage good choices but when individuals suggest that it would be easy to enforce fitness on high school kids all I can think about is how easy it was to put children in the mines or factories now in the third world and it's so wrong.

That's a ridiculous assertion. How is a fitness test any more draconian than any other test we give kids in school? Or even the fact that we insist that they go to school until they are 18? Please explain that. Are you seriously suggesting that a little more gym time would be more draconian than the 4-5 English credits we make them read books they don't really like? How is it any different than passing gym class today? Kids come to school with varying academic abilities but we still insist on one bar at test time. Is that draconian? We also insist on higher academic standards for university bound kids? Is that draconian? If you are one of those parents that insist that we should place no standards or expectations on kids, then I guess we can agree to disagree. Just don’t feel to down when kids in China and India start taking your kids jobs….and yes, they have PT standards there on top of higher standards for math, reading, writing, science, etc.

Nobody is suggesting that we have olympic qualifying standards... just enough to get the kids off the couch. It's hardly devious to insist that kids have a level of athleticism that would enhance their quality of level, make them less prone to injury and reduce health care costs in the long run. I think that's a noble goal.

I have even spoken to various provincial politicians about it and many of them do agree. Given the McGuinty government's penchant for nanny-state laws, this is one that I think would be a no-brainer for them. Very little public opposition would be there to an idea like this. The payoff would be huge in the long run. And it would cheap to implement.

Ps. Another alternative I have proposed is raising the number of gym credits required from 1 to 4…gym class every year….for those who don't like the idea of testing.

 

[jade_lee]

You are a wee bit out of touch with reality with respect to the current credit system in Ontario firstly, kids with failing marks are often granted credits for said courses and you don't sound like you have much experience in the realm of parenting being somewhat authoritarian when you become one I suspect. As for myself I have a teen aged son. His fitness goals have always been self driven and he enjoys the athletic programs offered both inside the educational venue and beyond, most of his buddies are like that too, fitness clubs have really taken off in most communities when affordable.
Today high school students have extremely active social lives both in the community and online, the standards are much higher for them in Ontario since
grade 13 was abolished, the tools they have at their disposal to learn, research projects, find solutions is incredible, fabulous well educated teachers with the help of parents who want their kids to experience the feeling of success sounds like sounds like a formula for well educated kids to me. We could do better but we are doing a good job. Paranoid threats about brainiac kids from other countries being better suited for jobs they will take from our kids are hilarious.
Provide the means of success to a group of poor (incert your cause here) kids and they will come is my community motto.

 

[kEiThZ]

You are a wee bit out of touch with reality with respect to the current credit system in Ontario firstly...

As somone who regularly tutors students, and is within a decade of the end of high school I am fully aware of how the system works.

... kids with failing marks are often granted credits for said courses.

It's lovely that we have academic standards that don't reflect real life. What happens when you don't pass your exams in university or you don't finish your reports at work?

..and you don't sound like you have much experience in the realm of parenting being somewhat authoritarian when you become one I suspect.

Why the gratuitous personal attack? You don't know me and you don't know what my parenting style would be. Then again, this kind of low-brow behaviour is to be expected given the various bigoted attitudes you have expressed in the past.

As for myself I have a teen aged son. His fitness goals have always been self driven and he enjoys the athletic programs offered both inside the educational venue and beyond, most of his buddies are like that too, fitness clubs have really taken off in most communities when affordable.

It's great that your son is fit and self-motivated. The statistics show that is not the norm. We make policies for the average person, not for the exceptional. Under a fitness testing policy, your son would not incur any additional burden. He would also get recognition for his efforts by getting an easy pass on the test. This is a far cry from today where fitness is not something we test at present. The test is aimed at improving the fitness of all kids. It's obviously not meant to target those who are already physically active.

Today high school students have extremely active social lives both in the community and online...

Has there been a time period when high schoolers did not have active social lives? However, that does not mean that they are more fit or acadmically disciplined. In fact statistics show this is not the case.

...the standards are much higher for them in Ontario since grade 13 was abolished....

You should talk to a few university profs about that. Failure rates in first year university have soared. It's becoming obvious that students have not been adequately prepared in high school for what's coming ahead. When it comes to first year science and engineering programs, student performance has been outright atrocious.

...the tools they have at their disposal to learn, research projects, find solutions is incredible, fabulous well educated teachers

Again, we have always been blessed with reasonably well funed and equipped schools. Even the Mike Harris cuts (although deplorable) were nothing compared to schools in other parts of the country. Ever seen the schooling conditions on some Native reserves? My issue is not with the lack of resources but in how they are deployed. And when it comes to fitness, we do deploy plenty of resources, but that has not yet effected a reversal in some very negative health trends for young people.

...with the help of parents who want their kids to experience the feeling of success sounds like sounds like a formula for well educated kids to me.

A good parent prepares their kids for the failures of life too, not just the successes. Passing them on from grade to grade when they don't deserve it gives them a false feeling of success and sets them up for significant failure later. Ditto when it comes to fitness. The statistics bear it out. And the consequences could be severe in the future, for the kids of today and the health system tomorrow. Parents are not having much success at getting their kids of the couch. At least if there's a test to aim towards, most parents will have a tool to encourage their kids to get more exercise.

We could do better but we are doing a good job. Paranoid threats about brainiac kids from other countries being better suited for jobs they will take from our kids are hilarious.

They are not paranoid threats. It is a reality that kids work harder in other jurisdictions. I studied in the Indian, Cambridge and Canadian school systems. And I can tell you there are marked differences in the standards, workload and expectations for students. And our system fairs on the bottom. When I have kids, I will spend the cash to put them in IB programs. I don't trust our system as presently constituted to provide a rigorous and well-balanced education, and the lack of a serious fitness/athletic requirement is but one among many indicators.

Provide the means of success to a group of poor (incert your cause here) kids and they will come is my community motto.

We provide plenty of parks, gyms, after-school and during school sports programs. Why then are obesity rates so high?

And you still have not answered the question I posed earlier. How is a fitness requirement any more draconian than an English or Maths test?

 

[Hydrogen]

That's a ridiculous assertion. How is a fitness test any more draconian than any other test we give kids in school? Or even the fact that we insist that they go to school until they are 18? Please explain that. Are you seriously suggesting that a little more gym time would be more draconian than the 4-5 English credits we make them read books they don't really like? How is it any different than passing gym class today?

Ps. Another alternative I have proposed is raising the number of gym credits required from 1 to 4…gym class every year….for those who don't like the idea of testing.

It's not gym class that is the problem, it's what is being done with it. If the purpose of gym class is to successfully complete a final test, then it's as banal as all other approaches to education that revolve around test-passing as the sole purpose and end. Such an approach may end up imbuing PE with the same hoop-jumping quality that is so often misinterpreted as being education.

Students won't really be learning anything from a test-passing approach (except that the purpose of PE is to pass the test). Such an approach hardly points to any value for being physically active. For learning to contribute to education it must entail learning things of value. Educative learning must be self-conscious: one has to know what is happening, and why, and to be able to take hold of control of it in order to turn it toward one's own purpose. This points to PE being something more than an exercise regimen geared toward passing the largest number of students as possible.

If the purpose of PE is to pass a fitness test with arbitrary measurements, then some students may come to see the course (and its content) as irrelevant, something to get though and then forget about. That's not exactly a good outcome if you are trying to transmit something considered to be worthwhile.

 

[kEiThZ]

^ That's why I have suggested the other alternative be upping the Phys Ed credit requirement from the current 1 credit to 4 credits. That means students would be doing PE every year. No test, just a lot more gym class.

I would argue that this might bother parents and students more since the increase in mandatory credits takes away the opportunity to take classes that the student likes. Whereas, if we could test for whatever our goals are (they are not going to be defined on a blog), then students could take whatever they wanted and still work towards the fitness test on their time.

There's more than one way of skinning a cat. My problem with the current system is that being healthy and fit is simply not emphasized in the current curriculum. Most students take PE in grade 9 and that's it. And the stats bear out the results of that kind of curriculum.

 

[Hydrogen]

Regardless of whether it's one or four credits, PE does not automatically result in "fit" people. Not to belabour the point, there has to be a definition for that first. If there is no such definition other than an assumed set of physical benchmarks, then the educative content ends up being rather hollow.

Don't get me wrong here, I'm not suggesting no type of physical activity in school. Far from it. What I am going to suggest is that PE become more educationally valuable, better linked to other portions of the curriculum, and connected in action to other "practical" values and skills that you have mentioned.

The point I'm trying to make is that there has to be more to PE than just fulfilling an exercise regimen in order for the courses to have any educative value. Just telling people they have to exercise to be "fit" is banal. If anything, the development of PE course materials have suffered from a lack of creativity.

I don't like to invoke false dualities, but why not create course content that requires more mind/body activities? As a military man, I think you could easily see the value of something like orienteering as being the basis of a PE course that brings a whole set of skills-sets, and a range of physical activities together. It's actually not a new idea, but certainly one worth reexamining and updating for schools.

Any approach such as this would provide considerable educational potential for creating connections between various types of physical activity, many practical and intellectual skills and intellectual content. Possible links could span across such things as physical activity necessary to explore different environments, local and global history, biology, navigation, exploring the natural world, city exploring, observational skills, creativity, team-building skills, individual and group problem-solving, dealing with physical emergencies and a host of possible references to related artistic and cultural movements. I think that such a basis for curriculum development would weave physical activity into education, rather than leaving it as merely a discrete portion.

Would some sort of exercise regimen be part of such course content? Yes, of course. But it would be situated in a larger context of activities. It would be much easier to see the value of such exercises because their benefit would have clear practical value that would be part of a continuum.