Health

Seven Reasons Why Americans Pay So Much for Health Care

Scott Buchanan5 Comments

Ken Alltucker at USA Today recently published a piece titled Seven reasons why Americans pay more for health care than any other nation. It starts off:

Americans spend far more on health care than anywhere else in the world but we have the lowest life expectancy among large, wealthy countries.

A lot of that can be explained by the unique aspects of our health care system. Among other things, we reward doctors more for medical procedures than for keeping people healthy, keep costs hidden from customers and spend money on tasks that have nothing to do making patients feel better.

“We spend more on administrative costs than we do on caring for heart disease and caring for cancer,” said Harvard University economist David Cutler. “It’s just an absurd amount.”

The article notes that the whole system is skewed towards high costs. It is not just profiteering insurance companies. Seven factors are listed. I will excerpt them in italics below, and close with a few of my comments.

Reason 1: Lack of price limits

U.S. hospitals have more specialists than do medical facilities in other nations. Having access to 24/7 specialty care, particularly for hospitals in major metro areas, drives up costs… Patients have more elbow room and privacy here. U.S. hospitals typically have either one or two patients per room, unlike facilities abroad that tend to have open wards with rows of beds, Chernew said. He said differences in labor markets and regulatory requirements also can pack on costs.

Of the $4.5 trillion spent on U.S. health care in 2022, hospitals collected 30% of that total health spending, according to data from the Centers for Medicare & Medicaid Services. Doctors rank second at 20%. Prescription drugs accounted for 9% and health insurance − both private health insurance and government programs such as Medicare and Medicaid − collect 7% in administrative costs.

Reason 2: Hospitals and doctors get paid for services, not outcomes

Doctors, hospitals and other providers are paid based on the number of tests and procedures they order, not necessarily whether patients get better.  The insurer pays the doctor, hospital or lab based on negotiated, in-network rates between the two parties.

Critics of this fee-for-service payment method says it rewards quantity over quality. Health providers who order more tests or procedures get more lucrative payments whether the patients improve or not.

Reason 3: Specialists get paid much more ‒ and want to keep it that way

Doctors who provide specialty care such as cardiologists or cancer doctors get much higher payments from Medicare and private insurers than primary care doctors.

Some see that as a system that rewards doctors who specialize in caring for patients with complex medical conditions while skimping on pay for primary care doctors who try to prevent or limit disease.

[My comment: There is a saying in management science that your system is perfectly designed for the results you are getting. In other nations with a fixed pot of money, doled out by the government, to mainly non-profit health providers, there is (in theory, at least) an incentive system that would work towards minimizing overall health expenses. In the U.S., though, we have a mainly for-profit system, that collects more moolah the more health problems we have, and the more expensive are the treatments. Most healthcare providers try to be noble-minded and work for the good of their patients, but still the overall financial incentives are what they are.  The health insurance companies are one of the few forces working against endless upward spiraling of healthcare costs. ]

Under the current system, doctors are chosen or approved by the American Medical Association to a 32-member committee which recommends values for medical services that Medicare then considers when deciding how much to pay doctors. Some have compared the idea of doctors setting their own payscale to the proverbial fox guarding the henhouse.

Reason 4: Administrative costs inflate health spending

One of the biggest sources of wasted medical spending is on administrative costs, several experts told USA TODAY….Harvard’s Cutler estimates that up to 25% of medical spending is due to administrative costs.

Health insurers often require doctors and hospitals to get authorization before performing procedures or operations. Or they mandate “step therapy,” which makes patients try comparable lower-cost prescription drugs before coverage for a doctor-recommended drug kicks in.  These mandates trigger a flurry of communication and tasks for both health insurers and doctors.

Reason 5: Health care pricing is a mystery

Patients often have no idea how much a test or a procedure will cost before they go to a clinic or a hospital. Health care prices are hidden from the public. …An MRI can cost $300 or $3,000, depending on where you get it. A colonoscopy can run you $1,000 to $10,000.

Economists cited these examples of wide-ranging health care prices in a request that Congress pass the Health Care Price Transparency Act 2.0, which would require hospitals and health providers to disclose their prices.

Reason 6: Americans pay far more for prescription drugs than people in other wealthy nations

There are no price limits on prescription drugs, and Americans pay more for these life-saving medications than residents of other wealthy nations.

U.S prescription drug prices run more than 2.5 times those in 32 comparable countries, according to a 2023 HHS report…. Novo Nordisk charged $969 a month for Ozempic in the U.S. ‒ while the same drug costs $155 in Canada, $122 in Denmark, and $59 in Germany, according to a document submitted by Sanders.

[My comment: Yes, this disparity irks me greatly].

Reason 7: Private Equity

Wall Street investors who control private equity firms have taken over hospitals and large doctors practices, with the primary goal of making a profit. The role of these private equity investors has drawn increased scrutiny from government regulators and elected officials.

One example is the high-profile bankruptcy of Steward Health Care, which formed in 2010 when a private equity firm, acquired a financially struggling nonprofit hospital chain from the Archdiocese of Boston.

… Private equity investors also have targeted specialty practices in certain states and metro regions.

Last year, the Federal Trade Commission sued U.S. Anesthesia Partners over its serial acquisition of practices in Texas, alleging these deals violated antitrust laws and inflated prices for patients. …FTC Chair Lina Khan has argued such rapid acquisitions allowed the doctors and private equity investors to raise prices for anesthesia services and collect “tens of millions of extra dollars for these executives at the expense of Texas patients and businesses.”

[ This also concerns me. That anesthesia monopoly should never have been allowed, in my opinion. The reason the PE firm paid to acquire all those individual practices was so that they could raise prices while minimizing services. Duh. That is the PE gamebook. When they do a corporate takeover, they nearly always fire employees and raise prices on products, to goose profits. This would not be a problem if the business were, say, selling pet rocks, but healthcare is different.

In many metro areas now, nearly all healthcare providers (even if they seem to retain their private practices) have become part of one or two mega conglomerates that cover the area. I feel fortunate because at least on of the mega conglomerates in my area is a high-quality non-profit, but I pity those whose only choice is between two for-profits.]

Final comments: I think another factor here is in our private enterprise system, it is so costly to become a doctor that they have to charge relatively high fees to compensate. This leads to a system where there are layers and layers of admins and nurses to shield you from actually seeing the doctor. As an example, I sliced my finger a couple of years ago, and went to an urgent care facility. There was an admin at the desk who took down my insurance info and relayed my condition to the back. Some time later, an aide took me back and weighed me and took my blood pressure. I think a nurse swung by as well. Finally, The Doctor Himself sailed in, to actually patch me up. And of course there were layers of administrative paperwork between me, the care facility, and my insurance company, to settle all the charges.

In contrast, a friend told me that when he broke his arm in the UK, he went to the local clinic, which was staffed by a doctor, and no one else. The doc set his arm, charged him some nominal fee, and sent him on his way.

There are other factors, I’m sure, such as the unhealthy lifestyle choices of many Americans. Think: obesity and opioids, among others.  I suspect that is to blame for the poorer health outcomes in this country, more than the healthcare system.

In favor of the current U.S. system, although we pay much more, I think we do get something in return. It seems that with a good health plan, the availability of procedures is better in the U.S. than in many other countries, though I am open to correction on that.

The Mythology of Rice and Beans

Zachary Bartsch3 Comments

I’ve written about proteins twice before. Once concerning protein content generally and then another concerning amino acid content of animal proteins. The reason that I stuck to animal proteins initially was because I held a common and false belief: Singular vegetarian foods aren’t complete proteins. The meat-eaters gotchya claim is that meats contain complete proteins. After all, we’ve heard a million times that beans and grains are often eaten together because they form a complete protein. The native North Americans? Corn and beans. Subcontinent Indians? Rice and Lentils or chickpeas. Japan? Rice and soy. Choose your poor or vegetarian population in the world, and they combine beans and grains. We’ve always been told that it’s because the combination constitutes a ‘complete protein’.

But you know what else constitutes a complete protein? Any of those foods all by themselves. What the heck. I haven’t been lied to. But I’ve certainly been misled. Let me briefly tell you my research journey. My recommended daily intake (RDI) are from the World Health Organization and the amino acid data is from the US Department of Agriculture. Prices are harder to pin down in a representative way, but I cite those too.  

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The Price of a Complete [Animal] Protein

Zachary Bartsch2 Comments

I wrote about the protein content of different foods previously. I summarized how much beef versus pea and wheat flour one would need to eat in order to consume the recommended daily intake (RDI) of ‘complete proteins’ – foods that contain all of the essential amino acids that compose protein. These amino acids are called ‘essential’ because, unlike the conditionally essential or non-essential amino acids, your body can’t produce them from other inputs. Here, I want to expand more on complete proteins when eating on a budget.

Step 1: What We Need

To start, there are nine essential amino acids with hard to remember names for non-specialists, so I’ll just use the abbreviations (H, I, L, K, M, F, T, W, V). The presence of all nine essential amino acids is what makes a protein complete. But, having some of each protein is not the same as having enough of each protein. Here, I’ll use the World Health Organization’s (WHO) guidelines for essential amino acid RDI for a 70kg person. See the table below.

Step 2: What We Need to Eat

What foods are considered ‘complete proteins’? There are many, but I will focus on a few animal sources: Eggs, Pork Chops, Ground Beef, Chicken, & Tuna. Non-animal proteins will have to wait for another time. Below are the essential amino acid content per 100 grams expressed as a percent of the RDI for each amino acid. What does that mean? That means, for example, that eating 100 grams of egg provides 85% of the RDI for M, but only 37% of the RDI for H.

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We’ve Got You Covered

James Bailey1 Comment

That’s the title of a recent book by Liran Einav and Amy Finkelstein, subtitled “Rebooting American Health Care”. I reviewed the book for Independent Review; the short version of my review is that while I don’t agree with all of their policy proposals, the book makes for an engaging, accurate, and easily readable introduction to the current US health care system. Here’s the start of the review:

Liran Einav and Amy Finkelstein are easily two of the best health economists of their generation. They have each spent twenty years churning out insightful papers published in the top economics journals. As a young health economist, I would read their papers and admire how well they addressed the technical issues at hand, but I was always left wondering what they thought about the big picture of health care in the United States….

The book’s prologue describes how Finkelstein’s father-in-law finally bullied her into writing on the topic, using almost the exact words I always wanted to: “I know these are hard issues. But come on … You’ve been studying them for twenty years. You must be one of the best placed people to help us understand the options. Do you really have nothing to say on this topic?”

The conclusion:

I learned a lot reading the book, despite having already studied U.S. health financing for over a decade—for instance, that the first compulsory health insurance program in the U.S. was a 1798 law pushed by Alexander Hamilton to cover foreign sailors. While the authors are more used to writing math-heavy academic papers, We’ve Got You Covered reads like the popular press book it is. Perhaps the highest endorsement comes from a non-academic family member of mine who picked up the book and noted, “These are not dry writers … this doesn’t sound like a book written by economists, no offense.”

The full review is free here, the book is for sale here.

Weight Lifting is for You

Joy Buchanan1 Comment

This is a guest post by Mary Buchanan, a Board Certified Behavior Analyst. Here she explores the intersection of behavioral economics with her own health and fitness behavior change.

My childhood dentist often said, “Take care of your teeth, or they’ll go away.” As I approach my 40th birthday, I’m learning the same is true of my muscle mass. I can use it or lose it. And I can lose it faster or slower based on my lifestyle choices. 

As a behavior analyst, I have spent many years practicing the science of behavior, specifically teaching others how to master new, meaningful skills. I see myself as my own client now as I work to replace my old aimless approach to fitness with evidence-based eating and exercise interventions. 

I wish I could say I embraced strength training as soon as I heard about its benefits. Instead, as I noticed more and more recommendations for women to “lift heavy”, I kept filing that information away for someday in the future. When I joined a gym last January, I returned to what I used to do in years past: Pilates classes or cardio machines. After 9 months of that approach with no benefits to show for my efforts, it was time to change my behavior.

Behavioral economics has a term for what causes people to resist changing their behaviors without a significant incentive for doing so: status quo bias. 

Another behavioral economics term, loss aversion, helps to explain what moved me into action. Loss aversion refers to how people are often more motivated not to lose something they have than they are motivated to gain something similar. All humans start to lose muscle mass around age 30, but that fact was not on my radar until recently. I wasn’t interested in building muscles when I thought mine were adequate to my daily tasks. Now that I realize my muscle loss has been underway for years and the liabilities of that loss are clear to me, I’m motivated to rebuild and mitigate future muscle loss. How? By doing heavy lifting 2-3x per week and eating enough protein for my body to keep the muscle it makes. 

There are many great resources that provide advice in this area, but I’ve decided to begin
with learning from Dr. Stacy Sims since she specializes in what works for women. Based on what I’ve learned, here are my target behaviors for increase:

  • Practice strength training for at least 30 minutes, 2x per week.
    Dr. Sims says 3x per week is better, but 2x is an acceptable minimum that I can commit to either through classes at a gym or YouTube videos. As a behavior analyst, I know that I’m more likely to maintain a new behavior pattern when it is easy to feel successful early and often.
  • Continue to challenge myself throughout strength training by adding weight as I get stronger.
    To stimulate muscle growth you must challenge your muscles so they break down and repair stronger. How heavy is enough? If you lift a weight 10x and it’s difficult to lift on the last two reps, but still possible for you to maintain good form, that is an appropriate weight for you to train with. When that weight gets easy to lift, it’s no longer heavy enough for your training purposes.
  • Increase my healthy protein intake.
    In Roar, Dr. Sims suggests that women aim for .75-0.8 grams of protein per lb. on a light or non-training day, and increase to 1-1.2 grams of protein per lb. on strength training days. 

Working on these goals together creates synergy. I am more motivated to make healthier eating choices because my eating is connected to my strength training goal. Strength training has also become more exciting for me the more I’ve learned about its benefits, including:

  • Increased metabolic rate
  • Improved posture and stability
  • Stronger bones
  • Better blood pressure control
  • Improved immunity
  • Maintenance of healthy body composition (lifting heavy helps maintain lean muscle and reduce fat gain)

As if that weren’t enough, I have another reason to keep going. As soon as I started resistance training, my sleep improved! I’ve had difficulty sleeping for many years already, both with falling asleep and staying asleep, and honestly, if sleeping through the night was the only benefit available to me from resistance-based workouts, I would still be all in.

While none of this constitutes professional medical advice, it is worth looking into, especially if you, like me, never saw role models strength training as a young person. Once you understand how it works in your favor now and as you age, the benefits are too good to pass up.

RESOURCES

Stacy Sims, MSC, PHD is an exercise physiologist and nutrition scientist. She specializes in teaching women what works for their bodies based on their body type, stage of life, and fitness goals. 

My first introduction to her work and recommendations was this 26-minute interview: https://www.youtube.com/watch?v=APwKKUtjINo

Her book, Roar, is helpful for those who want to learn about general women’s health, though it is especially geared towards female athletes. https://www.amazon.com/ROAR-Revised-Fitness-Physiology-Performance/dp/059358192X/

Next Level focuses on the physical changes women experience with the natural aging process. It clearly presents how we can use the latest research to work with what is happening in the body instead of against it. https://www.amazon.com/Next-Level-Kicking-Crushing-Menopause-ebook/dp/B091JVW6QR/

Pistol Squats Complete the Home Workout from James

National Survey of Drug Use and Health State-Level Data: Now Cleaned in Excel and Stata

James Bailey1 Comment

I offer a cleaned version of the state-level NSDUH in Stata .dta and Excel .xlsx formats here.

The NSDUH is mostly quite good as government datasets go- they share individual-level data in many formats and with the option to get most years together in a single file. But due to privacy concerns, the individual-level data doesn’t tell you what state people live in, which means it can’t be used to study things like state policy. SAMHSA does offer a state-level version of their data, but it is messy and only available in SAS format. So I offer the 1999-2019 state-level NSDUH Small Area Estimation Dataset in Stata .dta and Excel .xlsx formats here.

If you have Stata I recommend using that version, since the variables are labelled, making it much easier to understand what they represent.

This is the latest addition to my data page, where you can find cleaned/improved versions of other government datasets.

Protein, Protein Everywhere

Zachary Bartsch8 Comments

If you’ve ever been vegetarian or if you have ever spoken to a vegetarian about their diet, then you have probably heard or asked “How do you get enough protein?”.  While it’s important for health and economic achievement to get adequate protein, not too long after comes the questions about types and sources of protein. This question is relevant for vegetarians and vegans, but also people with meat allergies and people with religious dietary guidelines that prohibit meat always or seasonally. Let’s break it down.

Some omnivores are incredulous that vegetarianism can provide adequate protein or protein quality. But protein itself is relatively easy to get and any judgmental attitudes on both sides are mostly just vibes. Legumes and nuts tend to have a lot of protein. But relative to what?

The World Health Organization recommends that an 80-kilogram (176 lb) adult should get 66.4 grams of protein per day (0.83g per kg). That’s the protein content of about a 9oz of peanuts. Protein is super important and it’s luckily not that hard to get if you eat a variety of foods. Even if you’re trying to consume double the WHO recommended daily intake (RDI), it’s an easy feat.

Below is a table of some popular protein sources. The table includes the grams of protein per 100 grams of food, which makes the protein content a percent. The table also includes the number of grams needed in order to achieve the WHO protein RDI of 66.4 grams. The last column is for our American readers who need the serving to be in ounces.

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The Dietary Salt Wars

Scott BuchananLeave a comment

For many years, it has been stated as settled science that Americans need to cut back their sodium intake from the current averages of about 3400 mg/day to less than  2400 mg sodium (about 1 teaspoon of table salt). The 2400 mg figure is endorsed by the National Academies, as described in the 164-page (we’re from the government and we’re here to help) booklet Dietary Guidelines for Americans published by USDA and HHS. The reason given is that supposedly there is a roughly linear relationship between salt intake and blood pressure, with higher blood pressure correlating to heart disease. The World Health Organization (WHO) recommends less than 2000 mg.

The dietary salt boat has been rocked in the past several years by studies claiming that cutting sodium below about 3400 mg does not help with heart disease (except for patients who already incline toward hypertension), and that cutting it much below 2400 mg is actually harmful.

The medical establishment has come out swinging to attack these newer studies. A 2018 article (Salt and heart disease: a second round of “bad science”? ) in the premier British medical journal The Lancet acknowledged this controversy:

2 years ago, Andrew Mente and colleagues, after studying more than 130000 people from 49 different countries, concluded that salt restriction reduced the risk of heart disease, stroke, or death only in patients who had high blood pressure, and that salt restriction could be harmful if salt intake became too low. The reaction of the scientific community was swift. “Disbelief” was voiced that “such bad science” should be published by The Lancet.  The American Heart Association (AHA) refuted the findings of the study, stating that they were not valid, despite the AHA for many years endorsing products that contain markedly more salt than it recommends as being “heart healthy”.

This article went on to note that, “with an average lifespan of 87·3 years, women in Hong Kong top life expectancy worldwide despite consuming on average 8–9 g of salt per day, more than twice the amount recommended by the AHA recommendation. A cursory look at 24 h urinary sodium excretion in 2010 and the 2012 UN healthy life expectancy at birth in 182 countries, ignoring potential confounders, such as gross domestic product, does not seem to indicate that salt intake, except possibly when very high, curtails lifespan.”

A more recent (2020) article by salt libertarians, Salt and cardiovascular disease: insufficient evidence to recommend low sodium intake, stated in its introduction:

In 2013, an independent review of the evidence by the National Academy of Medicine (NAM) concluded there to be insufficient evidence to support a recommendation of low sodium intake for cardiovascular prevention. However, in 2019, a re-constituted panel provided a strong recommendation for low sodium intake, despite the absence of any new evidence to support low sodium intake for cardiovascular prevention, and substantially more data, e.g. on 100 000 people from Prospective Urban Rural Epidemiology (PURE) study and 300 000 people from the UK-Biobank study, suggesting that the range of sodium intake between 2.3 and 4.6 g/day is more likely to be optimal.

… In this review, we examine whether the recommendation for low sodium intake, reached by current guideline panels, is supported by robust evidence. Our review provides a counterpoint to the current recommendation for low sodium intake. We suggest that a specific low sodium intake target (e.g. <2.3 g/day) for individuals may be unfeasible, have uncertain consequences for other dietary factors, and have unproven effectiveness in reducing cardiovascular disease. We contend that current evidence, despite methodological limitations, suggests that most of the world’s population consume a moderate range of dietary sodium (1–2 teaspoons of salt) that is not associated with increased cardiovascular risk, and that the risk of cardiovascular disease increases when sodium intakes exceed 5 g/day.

The keepers of orthodoxy fired back the following year in an article with an ugly title Sodium and Health: Old Myths and a Controversy Based on Denial  and making ugly accusations:

Some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections.

Ouch.

I don’t have the expertise to dig down and make a ruling on who is right here. But I do feel better about eating my tasty salty chips, knowing I have at least some scholarly support for my habit.

Herd Mentality Among Pediatricians Caused Current Peanut Allergy Epidemic

Scott Buchanan1 Comment

A headline, “How Pediatricians Caused the Peanut Allergy Epidemic” got me to click the other day. The article makes some important points, I think.

Having a peanut allergy is a serious health concern, both as an adult and for one’s child. For a sensitized person, exposure to peanut-containing products can be fatal if an Epi-pen or emergency room is not available for an epinephrin injection. Since this is an economics blog, I’ll note that a 2012 survey estimated the economic cost of any food allergy in US children at $24.8 billion annually, or $4184 per child. This includes direct medical costs, and the indirect costs, including opportunity costs, for children and their caregivers.

Out of an abundance of caution, pediatricians in the 1990s started recommending that parents keep peanuts from their infants and children. Instead of protecting children, however, this policy has done just the opposite. The incidence of peanut allergies has soared, with now some 2.5% of the pediatric population showing peanut allergies:

Around the year 2000 peanut allergies began to skyrocket. Sales of EpiPens, used in cases of peanut-induced anaphylactic shock, became a major expense for parents and a growing profit center for the manufacturer. … So, what changed? How did peanuts go from cheap, nutritious food source to become the little death pills that we think of them today? The answer is not what you would expect: pediatricians created the peanut allergy epidemic.

Meanwhile, the more that health officials implored parents to follow the recommendation, the worse peanut allergies got. From 2005 to 2014, the number of children going to the emergency department because of peanut allergies tripled in the U.S. By 2019, a report estimated that 1 in every 18 American children had a peanut allergy. 

It did not have to go like this.  I poked about the web and found another article, titled The Medical Establishment Closes Ranks, and Patients Feel the Effects, which framed matters in terms of physician behaviors:

 Peanut allergies in American children more than tripled between 1997 and 2008, after doctors told pregnant and lactating women to avoid eating peanuts and parents to avoid feeding them to children under 3. This was based on guidance issued by the American Academy of Pediatrics in 2000.

You probably also know that this guidance, following similar guidance in Britain, turned out to be entirely wrong and, in fact, avoiding peanuts caused many of those allergies in the first place.

That should not have been surprising, because the advice violated a basic principle of immunology: Early exposure to foreign molecules builds resistance. In Israel, where babies are regularly fed peanuts, peanut allergies are rare. Moreover, at least one of the studies on which the British advice was based showed the opposite of what the guidance specified.

As early as 1998, Gideon Lack, a British pediatric allergist and immunologist, challenged the guidelines, saying they were “not evidence-based.” But for years, many doctors dismissed Dr. Lack’s findings, even calling his studies that introduced peanut butter early to babies unethical.

When I first reported on peanut allergies in 2006, doctors expressed a wide range of theories, at the same time that the “hygiene hypothesis,” which holds that overly sterile environments can trigger allergic responses, was gaining traction. Still, the guidance I got from my pediatrician when my second child was born that same year was firmly “no peanuts.”

It wasn’t until 2008, when Lack and his colleagues published a study showing that babies who ate peanuts were less likely to have allergies, that the A.A.P. issued a report, acknowledging there was a “lack of evidence” for its advice regarding pregnant women. But it stopped short of telling parents to feed babies peanuts as a means of prevention. Finally, in 2017, following yet another definitive study by Lack, the A.A.P. fully reversed its early position, now telling parents to feed their children peanuts early.

But by then, thousands of parents who conscientiously did what medical authorities told them to do had effectively given their children peanut allergies.

This avoidable tragedy is one of several episodes of medical authorities sticking to erroneous positions despite countervailing evidence that Marty Makary, a surgeon and professor at Johns Hopkins School of Medicine, examines in his new book, “Blind Spots: When Medicine Gets It Wrong, and What It Means for our Health.”

Rather than remaining open to dissent, Makary writes, the medical profession frequently closes ranks, leaning toward established practice, consensus and groupthink.

This article describes further instances of poorly-founded medical advice. Women were scared away from helpful estrogen hormone replacement therapy for many years because of unfounded fears of breast cancer. Blood donor institutions suppressed concerns about AIDS in donated blood, in order to not rock the boat:

In 1983, near the beginning of the AIDS crisis, the American Red Cross, the American Association of Blood Banks and the Council of Community Blood Centers rejected a recommendation by a high-ranking C.D.C. expert to restrict donations from people at high risk for AIDS. Instead, they issued a joint statement insisting that “there is no absolute evidence that AIDS is transmitted by blood or blood products.” The overriding concern was that Americans would not trust the blood supply, or donate blood, if people questioned its safety.

As with the advice on peanuts, a reversal came about far later than it should have. It took years for the blood banking industry to begin screening donors and it wasn’t until 1988 that the F.D.A. required all blood banks to test for H.I.V. antibodies. In the interim, half of American hemophiliacs, and many others, were infected with H.I.V. by blood transfusions, leading to more than 4,000 deaths.

That is poignant for me, since a good friend of mine died from AIDS that he contracted through a blood transfusion in that timeframe.

Well, what to do now about peanuts? It seems an obvious action is to expose infants to peanuts, at 4-6 months, along with other solid foods – – perhaps with the caveat to start with small doses and preferably stay within driving distance of an emergency room should that be needed. As for children who now manifest peanut allergies, there is some hope of desensitizing them if you start young enough, preferably no more than three years old.

What is vision insurance good for?

James Bailey5 Comments

The answer sure seems to be “nothing”. I just went for an eye exam for the first time since Covid and realized that I’ve been wasting my money by paying for vision insurance.

The problem isn’t the eye exam- that went fine, and was covered fine with a $35 copay. But it was covered by my health insurance, not my vision insurance. So what is the vision insurance good for, if it doesn’t cover eye exams?

The answer is supposed to be “glasses”. It is supposed to cover frames up to $150 with a $0 copay, and basic lenses with a $25 copay, from in-network providers. That sounds ok- but there are two problems.

One is that almost none of the in-network providers (like Glasses dot com or Target optical) appear to actually offer lenses where the $25 copay applies; instead the minimum lens price is at least $85.

The second problem is that the premiums are high enough that even if I use them to get $25 glasses (which I eventually found I could through LensCrafters), it wouldn’t be worth it. They don’t sound high at first, which is how I got suckered into signing up for this scam in the first place. It’s just $5/month for single coverage; that sounds like nothing, especially for an employer benefit. It is a rounding error compared to health insurance premiums, and it comes out of pre-tax money. A small waste, but still a waste. Why?

Glasses are just so cheap if you can avoid the monopoly retailers and get them somewhere like Zenni. Zenni will sell you perfectly functional (and IMHO good-looking) prescription eyeglasses for $16. Their frames start at $6.95, lenses at $3.95, and shipping at $4.95. Catch a sale, or order enough to get free shipping, and you could actually get glasses for well under $16.

Or you can do what I did- order glasses from Zenni with premium options that pushed them up to $50- and find it is still cheaper than using the insurance I already paid for to get the cheapest pair available at most of their in-network retailers. The cheapest possible deal with insurance would be to pay $60/year in premiums, get glasses as often as the insurance allows so as not to waste the benefit (every 12 months- much more often than I find necessary), find frames listed under $150 to get for $0 copay, and find an in-network provider that actually offers lenses for the $25 copay. In this best-case scenario you are still paying $85 per pair of glasses. Given that the $60 in premiums came from pre-tax money, perhaps you can argue that it was really more like $40 in real money; but you can also buy glasses from a competitive retailer like Zenni using pre-tax money from an HSA or FSA.

So as far as I can tell, vision insurance really is useless. I certainly decided not to use it for my latest pair of glasses even though I had already paid years of premiums; Zenni was still much cheaper for a comparable product. I’m dropping vision insurance now that open enrollment is here. My take-home pay will be going up, and EyeMed will stop getting my money for nothing.

Is there anyone vision insurance makes sense for? I think it could makes sense for someone who really wants brand name glasses, or for someone who really wants to get their glasses in-person at the optometrist, and wants new glasses every year. For everyone else, run the numbers for your own plan, but I suspect you would also be better off just buying glasses directly.

Disclaimer: This post is not sponsored & doesn’t use affiliate links; Zenni is the best option I currently know of, but I’d be happy to hear of other competitive retailers you think are better, or an argument for when vision insurance is actually useful.