How to be a Dirtbag

Dankasaurus wrote:
Dental:  Everyone but Americans have fucked up teeth AFAICT.  If anything America should slow down on the perfect dental outcomes and focus on other, more substantive and less vain, outcomes.

My climbing buddy flies from the USA to Germany for dental treatment.

Ricky Harline wrote:

Don't think he did "blame America first." I think he pointed out that our healthcare system is shitty, which in terms of overall health outcomes, price, or efficiency it objectively is.

Respectfully:  It’s not shitty for lots of folks.  It’s a miracle for lots of folks, and shitty for some folks.  The media’s philosophy is “if it bleeds it leads”...so we’re not gonna get real data from them about what is actually good about America  healthcare.  Maybe somebody can point to how I can connect the dots between the subjective (“shitty” and “better”) and the idea that Canadian healthcare is objectively better than the American one.

For example I don’t know what you mean by “efficiency”.

All I know is that in my experience Inhave had positive outcomes, so has my young family.  My father was a physician and what he will point to is more like the data shown above regarding administrative overhead and top-heaviness.  He will point to the shortage of primary care as a driver of other costs. 

Anyways, I’m sure you all have your reasons, your experiences, your anecdotes, too.

I just am tired of hearing “America sucks” as though it was perfectly obvious truth...without hard supporting data.

Jim Titt wrote:

My climbing buddy flies from the USA to Germany for dental treatment.

Because of cost?  Or because of some other reason?  Anyway this is an anecdote, your friend’s experience.  

I have a lot of respect for you, Jim, by the way.  Your technical contributions to this site are peerless.

Here’s an anecdote: My Japanese wife had to have huge amounts of dental work after coming to the US to avoid losing teeth and gum disease due to (incompetence or indifference or cost control or random chance in her) prior care in Japan.

Lee Green wrote:

Despite outspending them all, the US health care system ranks dead last among the most developed nations ( commonwealthfund.org/chart/…).

If you'd like detailed data, what bibliographic software do you use? I'll export a few thousand articles' worth of original research, reviews, and analyses in the format of your choice. I'm a doctor, and I do practice (including being a wilderness medicine instructor), but mainly I'm a professor - of health management and policy. 26 years practicing and teaching in the US, and now 7 in Canada. And at my age I've been a patient in both systems more than enough too. I know the data, and I've lived it first hand both as a doctor and a patient. The Commonwealth Fund is right.

The person who recommended "move to Canada and pay nothing for health care" has it half right. Living in Canada now, I don't pay at point of care. But being of high income, in a country that believes in progressive taxation, I do indeed pay a lot for health care. (Still less than in the US, though.) Much of that goes to pay for health care for those less fortunate in life circumstances than I am. And that's OK.

The biggest difference I see in Canada is the effect on small entrepreneurs. In the US, if you don't have a job with a big company that provides generous health benefits, you're living one illness or injury from bankruptcy. In Canada it's much easier to run your own small business, or to work for yourself. Say, as a mountain guide.

Thanks.  Your link shows America ranked last in every category.  But I’d like to dig much, much deeper there.  And again, those “first world” countries have a different structural political economics.  

I don’t use bibliographic software, I would use Python to operate with raw data. I’m not a social science research person.  
Do you have recommendations for access to raw health data?  
Or is that too difficult to get due to HIPA and other obstacles, hence the reliance on prefiltered stuff which has assumptions and possibly bias?

Dankasaurus wrote:

Show me some data to support the absolutist assertion in your two first sentences.  Nothing anecdotal, please.   Show me the data.  Who ranks us 30th vs. Canada 23rd?  On what metrics?  How are those metrics computed?  Quality of coverage...what does that mean?  

Dental:  Everyone but Americans have fucked up teeth AFAICT.  If anything America should slow down on the perfect dental outcomes and focus on other, more substantive and less vain, outcomes.

I find it somewhat hard to believe that these two paragraphs were written by the same person...

Dankasaurus

The butt hurt is strong with this one...

Nick Goldsmith wrote: TRAdiban you are a fcking asshole.   Mod if you delete this post but let tradiban give me shit for  losing my oh so wonderful bronze plan that MY taxes payed for then join the club.....  

I'd wager the amount of taxes you were contributing was negligible, might be time to calm yourself a bit.

Nick Goldsmith wrote: Canada has way better health care than we do. end of story.  we rank 30th for quality of care Canada 23rd. when it comes to quality of coverage we rank dead last. when you add dental into the mix it gets really bad...  I have several friends who go to the Azors for dental care. their dentist is a member of the American dental association. he claims that the ADA confrences are all about how to do more procedures so that you can generate more revenue.  Not about best patient care.. They get their crown done with the 10day ocean side vacation and airfare for the same price as just the crown in USA... 

If you have a problem with capitalism you are more than welcome to leave the country. End of story. BYEEEEEEE

First the Buddha holds post, now this? Are politics the new black totem?

Dankasaurus wrote:

Respectfully:  It’s not shitty for lots of folks.  It’s a miracle for lots of folks, and shitty for some folks.  The media’s philosophy is “if it bleeds it leads”...so we’re not gonna get real data from them about what is actually good about America  healthcare.  Maybe somebody can point to how I can connect the dots between the subjective (“shitty” and “better”) and the idea that Canadian healthcare is objectively better than the American one.

For example I don’t know what you mean by “efficiency”.

All I know is that in my experience Inhave had positive outcomes, so has my young family.  My father was a physician and what he will point to is more like the data shown above regarding administrative overhead and top-heaviness.  He will point to the shortage of primary care as a driver of other costs. 

Anyways, I’m sure you all have your reasons, your experiences, your anecdotes, too.

I just am tired of hearing “America sucks” as though it was perfectly obvious truth...without hard supporting data.

I didn't argue it was shitty for everyone. If you have very good insurance through your employer or are rich then it's the best healthcare system in the world. The problem is how many people get fucked over by the system by having a shitty insurance plan that guarantees poor care, by being underinsured (meaning they can afford their insurance premiums but not to actually receive any healthcare), or by not being able to afford to get any care at all. 

In order for one healthcare system to be objectively better you need to qualify which parameters you're selecting for, as I did in my post. If you were to only look at quality of care from those who receive insurance through their employers you would probably find that the US is in the top 5 or maybe even the best in the world. However:

•  27 million Americans don't have health insurance, and 44 million are underinsured, so a fifth of the population aren't even in the game of receiving needed care. 
• Two third of Americans filing for bankruptcy do so due to healthcare costs. 
• If you simply look at the health outcomes of the population (which presumably is what a nation's healthcare system is for) the United States definitively lags other countries. This one should be of significant interest to you. To my understanding this isn't caused by the percentage of Americans receiving excellent healthcare through their employers, but rather by the startlingly large percentage of people getting left out of affordable, high-quality care.  
• Efficiency means to weigh the health outcomes of the populace against the price of the system (measured in a % of GDP or per capita). The United States performs poorly in overall health outcomes but if our spending was low it could still be efficient. What is so amazing about our system of course is that we spend double that of normal countries to achieve worse outcomes.
• The United States spends over $10,000 per capita, the comparable country average is almost half that. Remember that about a fifth of our population isn't even really being served by our system, meanwhile other nations have affordable universal healthcare.
• To further drive home the point: public health spending in my home state of California (medicare and medicaid, ACA subsidies, things like that) was $260 billion, with a population of 40 million. That gives you a per capita public healthcare expense of $6,500. We spent more servicing the needs of a minority of the population than Canada or Germany or you name it would spend to serve their entire population. This is what I mean by inefficiency.

"Half penny, two penny, back of the queue
Yes mister poor man this means you
Justice for money what can you say
We all know it's the american way "
-Styx, 1981

There are a lot of affordable dental/eye rates in the US if you shop around.

Don’t see how people are complaining about the better of the healthcare options we have.

All on board with regular healthcare is ridiculous, but I also think Obamacare was shit. The government does a poor job and regulation and fixing issues. 

Matt N wrote: Weird, not one mention of health/healthcare or medical in there. (I didn't read it all, just ctrl+F)

Rule #1 to live off $3k a year - don't get sick. Ever.

We agree with ColinW - save now, weekend/vacation warrior during working years, have a nicely funded retirement. Won't start until our early 50s, likely, though. But there are plenty of 50+ years olds who crush harder than we'd ever dream of - so I think we'll do just fine.

I have healthcare now (living off of more like 7 to 8 thousand dollars a year) but I find it interesting that the same people who are terrified of medical debt often times have 80,000 dollars in student loans. 

People, stop arguing about stupid politics and go on a climbing road trip. Its amazing how chill and civilized people are around campfires. ( I wrote a chapter about it in the book)

master gumby wrote:

If you have a problem with capitalism you are more than welcome to leave the country. End of story. BYEEEEEEE

This is ridiculous

FWIW, I thought the book was pretty good.  I liked how it interspersed tips/pragmatic ideas and story.  

It needs some copyediting, but I've already got one book project for another climber that I'm supposed to be working on.

Kevin DB wrote: People, stop arguing about stupid politics and go on a climbing road trip. Its amazing how chill and civilized people are around campfires. ( I wrote a chapter about it in the book)

Lets all sing songs together!

Kevin DB wrote:

I have healthcare now (living off of more like 7 to 8 thousand dollars a year) but I find it interesting that the same people who are terrified of medical debt often times have 80,000 dollars in student loans. 

You don’t see a difference in the 2?

This is a joke right? You’re a 36 year old single male and we’re supposed to woo because you’ve figured out how to live on 7-8 thousand dollars a year? 
Fuck me

Car Lo wrote: First the Buddha holds post, now this? Are politics the new black totem?

That’s racist.  But do you have one for sale?

Dan Cooksey wrote:

That’s racist.  But do you have one for sale?

Nah...currently using mine to protect 9" cracks as it auto-bumps. But this person might have one for sale still

https://www.mountainproject.com/forum/topic/117560903/black-totem-for-sale-brand-new

Kevin,

I read it front to back a few weeks ago. Great job man, it was a really fun read. I like how you broke up the chapters with different stories in between the trip to Patagonia. Thanks a lot for releasing it for free! You are the man.

-Jake