gimme-five | The blog of a busy guy.

CAT | Health

One of the most important things I have learned is that every choice we make in life has costs and benefits. If I use my only $5 to purchase a latte, I give up the ability to purchase something else with the $5. It’s an elementary principle, but somehow we forget it when we talk about big-picture things.

The Affordable Care Act is an example of this basic lesson. A simplified version of the argument for the ACA is that the President and his supporters wanted to ensure that everyone was covered by health insurance, and that being old or sick would not cause one’s putative insurance rates to be so high that he could not afford to purchase insurance. The ACA also redistributes money to the poor and lower middle class so that they can purchase health insurance for free or at a discounted rate.

By itself, this idea sounds great. No one, except the most partisan, could argue that it would be a good thing if, all else equal, all those who currently don’t have the opportunity to purchase affordable health insurance magically had the opportunity to purchase affordable coverage that they desired.

Unfortunately, it’s not that simple, because things cost money. To pay for the benefit of expanding coverage, which costs money, we have to find a source of revenue. The ACA’s proponents have claimed that this revenue will come from people buying into the health insurance system who otherwise would not have done so, and the money from those individuals being redistributed to benefit the poor, old, and sick. The ideal situation, according to the ACA’s proponents, is that lots of young, healthy individuals will buy in to the system. The unspoken logic is that such individuals will effectively pay the way for others have affordable healthcare coverage. The ACA’s proponents also believe that the new law will result in some limited efficiency gains, such as lowering dependence on emergency room visits by substituting preventative care, though no one seriously contends that these efficiency gains pay for the bulk of the cost (and it’s up for debate whether the law actually makes insurance less efficient). That’s why the ACA includes the individual mandate, which requires individuals to purchase insurance or pay a penalty. And that’s also why the ACA makes illegal insurance policies that provide “sufficient” coverage. The point is to require the young and healthy to buy in, and to pay not only for insurance coverage they think they’ll use, but intentionally to get them to pay for insurance coverage they almost certainly won’t use, so that this coverage will be cheaper for the law’s beneficiaries.

To put it another way, because the bulk of the cost must be paid for the young and healthy, they, as a group, are the “losers” of the ACA, whereas the old, poor, and sick are the “winners.” The cost that can’t be paid for by the young and healthy will be paid for through increased premiums, so to the extent one’s insurance premiums go up, one is also a “loser” whose costs are distributed to the law’s “winners.” (Additionally, to the extent the law leads to increased taxes, those paying the taxes are also “losers.”)

Moreover, for the reasons discussed above, no one can seriously contend that the ACA is “free.” That is, if we’re going to expand health insurance coverage, it’s going to cost a positive dollar amount. Given the number of uninsured and seniors (e.g. baby boomers) in this country, this will be a substantial dollar amount.

Therefore, in arguing over whether the ACA is good policy, the question is not simply whether you believe that it is good that everyone has health insurance, or whether you believe that we should spend less. This is not the question because for every story about a family who is able to buy health insurance at a lower rate, there is a story about a family that must cut back because they have to pay a higher rate. The question instead is whether the expansion is worth the cost and redistribution of wealth. For a number of reasons, I have my doubts that it is. For example:

  • Why are we redistributing even more wealth from the young to the old? The old in the US consume so many resources, have the benefit of social security (which may not be around for the young), and have passed the buck of the nation’s crippling debt onto the young. Moreover, a huge percentage of the old in the country have not saved for retirement and will likely need to be “bailed out” using the resources of the young.
  • Why won’t the ACA’s proponents frame the issue of the ACA as the trade off that I have labeled it here? They speak as if the law will cause no one to pay a single penny more. But as we’ve learned from the President’s embarrassing about-face instructing insurers that he won’t enforce the part of the ACA that required them to cancel plans that were not deemed sufficient by the law (which is plainly unconstitutional and practically a disaster), the law clearly is a trade off.
  • So far, we’ve heard far more about “losers” than “winners” in the news; that is, we haven’t heard many stories about people or families saving money, but we’ve heard lots about insurance rates going through the roof. Particularly embarrassing for the President was using an anecdote of a woman who thought she had saved money under the ACA, but then learned the rate that she was originally offered was a computer error and her true price was far higher.
  • Many of the uninsured who have pre-existing conditions today were once young and healthy, and chose not to purchase insurance when they were younger. They took the benefit of not buying insurance (saving money) when they were young, and bore the risk that they might be unable to purchase affordable coverage if they developed a health condition while uninsured. Under the ACA, however, they are bailed out of the consequences of their risk, on the backs of the present young and healthy who no longer get to make the same choice. This is simply a wealth transfer from young to old.

This doesn’t mean that the concept of expanding health insurance coverage is a bad thing. Perhaps to you, you believe that the concept of universal health insurance is so valuable that it is priceless, which justifies your belief that the benefit is worth the cost. (Though I would disagree that anything is “priceless,” and would ask why the burden should be on the young and healthy to fund your belief.)

What is to be done about this? I don’t agree with the tactics of the Tea Party to threaten the apocalypse if the ACA is not repealed. But I do think that the President needs to be more flexible in discussing substantial modifications to the ACA. The law is not a panacea, and should never have been marketed that way. I would be interested in seeing amendments that, for example, place heavier burdens on well-to-do seniors, or focus more heavily on actual efficiency improvements as opposed to wealth redistribution.

 

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Bloomberg.com reports that while economists have overwhelmingly ridiculed the idea of suspending the gas tax over the summer, Hillary Clinton has continued to stick to her guns. Clinton, after hearing that the economists thought the idea was ridiculous, stated:

I’m not going to put my lot in with economists

Ya know, it’s perfectly fine to say that you’re not going to listen to a consensus of football players giving you advice on filling out your taxes. Or a large group of lawyers giving you advice on how to paint your house. But generally, if you’re untrained in a subject, and practically an entire professional field gives you advice on the subject they specialize in, you should probably listen. And if you’re not going to listen, you’d better have a darned good explanation beyond “I know where you’re coming from, small folk,” for why you’re deviating from trained professionals. So Hillary (and Mr. McCain): if it makes sense to suspend gas taxes, please come forward and explain why rather than giving the same old pandering political speeches about how you’re trying to help “the little guy.” Call me an elitist, but I would rather that economic decisions follow the advice of trained professionals than “the little guy,” who hasn’t learned a thing about economics in his entire life.

But this isn’t even about elitists versus “the common folk.” This is about whether we want to help the country or hurt it. If I had a choice between having a mechanic fix my car or a random neighbor, why the heck would I pick the neighbor? And if I have a choice between having Hillary Clinton or John McCain making economic policy based on hunches or someone who is going to defer to a trained professional, I’m surely going to pick the person who defers to the trained professional.

This proposal to suspend the gas tax sickens me. This is why I hate politics so much.

Please note that this is not an endorsement of Barack Obama. He’s got plenty of problems, too, the gas tax is just an area where he pseudo-shines.

Update 5/6/2008: Greg Mankiw writes:

Why, then, are candidates proposing the holiday? I can think of three hypotheses:

Ignorance: They don’t know that the consensus of experts is opposed.

Hubris: They know the experts are opposed, but they think they know better.

Mendacity with a dash of condescension: They know the experts are opposed, and they secretly agree, but they think they can win some votes by pulling the wool over the eyes of an ill-informed electorate.

So which of these three hypotheses is right? I don’t know, but whichever it is, it says a lot about the character of the candidates.

Update 5/7/2008: From The Wall Street Journal

John McCain and Hillary Clinton want to send cash-strapped consumers on holidays from the federal gasoline tax. But the law they can’t rewrite — the law of supply and demand — suggests it would backfire. Lower taxes would encourage people to drive more, meaning more demand that would push prices higher again.

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My Story:

Three years ago, I noticed my left middle fingernail began turning white instead of its normal healthy pink. I did not know what was going on, but after a few weeks, the entire nail became white and flaky. At first I did not think much of it, but then I started getting regular questions along the lines of “what the heck is wrong with your nail, you freak?” Subsequently, I decided to go to the doctor.

After a short appointment, the doctor told me I had “onychomycosis,” which means nail fungus in regular-person language. He said that I needed to take a medication called Lamisil for two months. That sounded easy enough. But there was a catch: I needed to get a blood test to make sure that my liver could handle the medication.

At that point, since I like my liver, I asked the doctor if I had any other options. I told him I understood the medication was probably more convenient than the other options, but that I would much rather see if I could try a solution that didn’t involve damaging my liver. He told me this was my only option, and that if I did not take the Lamisil, my nail would grow thick and I would get frequent fingernail infections and live with constant fingernail pain. He then wrote me a prescription for Lamisil, using a pen with the Lamisil logo, and I walked out of his office dreading what might happen to my finger if I did not take the drug.

After I picked up the medication, I drove home and googled Lamisil. According to Lamisil’s own website, the pill has a number of side effects. Besides the fact that the drug is tough on your liver, the side effects of Lamisil include:

Headache, which occurred in 12.9% of patients, gastrointestinal symptoms, including diarrhea (5.6%), upset stomach (4.3%), taste disturbances (2.8%), nausea (2.6%), abdominal pain (2.4%), flatulence (2.2%), rash (5.6%), itching (2.8%), hives (1.1%), and abnormalities in laboratory tests of liver enzymes (3.3%).

People who have taken Lamisil have reported a number of other side effects as well. Personally, my life was pretty hellish during my two months on Lamisil. Why? Because I didn’t sleep hardly at all during those two months. The entire time I was on Lamisil my heart was racing. When I tried to lay down in bed I could feel the bed shake because my heart was beating so hard. But nevertheless, I finished my two month medication, in hopes that my fingernail would look better. Alas, even six months after finishing the medication, it looked like this:

My fungus fingernail
My fingernail six months after Lamisil and before vinegar treatment

The medication did me no good. When I finished taking it, I noticed a tiny sliver of pink, healthy nail growing in to my fingernail. However, within a year my entire nail was white again. Thus, I decided to seek out alternatives to Lamisil. It turns out, the doctor who prescribed the medication to me was not entirely honest. There are alternatives to Lamisil, and I found out that at least one of them works extremely well, as long as you’re willing to commit to doing it every day until the fungus is gone.

What This Article is About:

I am writing this article because there is very little information on the internet about how to cure fingernail fungus without resorting to Lamisil. After lots of research, and personal experience, I discovered one solution and have found some other solutions that look promising.

Solution #1: Vinegar. Put vinegar (or Nonyx Gel) on the base of your infected nail (where the nail begins) in the morning, after you shower, and at night until the entire nail is pink and healthy.

I am convinced that I cured my fingernail fungus with this remedy. This remedy consists of applying vinegar or Nonyx gel to the base of your infected nail in the morning, after you shower, and at night, every day until your nail is completely clear. The rationale behind this remedy is that fungus cells can’t stand acidic environments, and vinegar is acidic, so it can stop the fungus from spreading on your nail. Technically, you’re not killing the fungus, you’re just preventing it from growing, and as the nail grows out, the fungus gets clipped off. Here is how my nail looks right now:

IMG_1545
My fingernail, almost completely healed after vinegar treatment

I discovered this remedy via a website called Ask Dr Stoll. Basically, Dr. Stoll recommends that people buy distilled white vinegar and use an eye dropper to drop two drops on the base of the nail (where the nail begins), every morning and night. I recommend putting vinegar on your nail every morning, after you shower or get the nail wet in any way, and at night.

The only problem with using simple vinegar is that it easily rolls off your nail and does not soak in very well. Thus, I bought this stuff at the pharmacy called Nonyx. It is essentially vinegar and xanthan gum. I like it because it makes the vinegar into a paste, so you can apply it to your nail, and as long as you don’t rub your nail against stuff, it will dry and the vinegar will have more time to soak in to the nail. After using Nonyx for several months, my nail is almost entirely clear and pink. Instead of dropping vinegar on my finger, I just squeeze out a bit of the Nonyx gel, rub it onto the nail using the tip of the bottle, and go on my way. The only downside of the Nonyx is the bottle is $20, which is a lot for vinegar paste.

Nonyx
Nonyx

If you have toenail fungus (I have that, too), you can put Nonyx on even if you are going to wear socks. After you put the Nonyx on your nails, roll your socks before you put them on so your toes don’t touch any part of the sock except for the part they will touch while you are wearing the sock, then unroll the sock up your foot so the vinegar doesn’t rub against the rest of the sock.

Some people say you need to use an emery board every night to file down your nails and a hair dryer to dry them off to discourage fungal growth. I never did this, although I am sure it helps speed up the process.

Until you have cured the fungus, do your best to keep the nail dry as much as possible. It’s a pain sometimes, but you’ve gotta do what you’ve gotta do. The fungus likes moisture, so the less moisture you give it, the better. I get it wet in the shower, but try to keep it dry elsewhere.

The one problem with this remedy is that it takes quite a long time to completely cure the fungus. I have spent about five months applying Nonyx to my nail every single day. Based on what I have read online, you need to do this until the nail is completely healed, and you need to do it every day. But if you’re willing to stick to the plan, the results are fantastic.

Solution #2: Soaking in Vinegar/Hydrogen Peroxide, Followed by Soaking in Bleach, Followed by Using a Topical Antifungal Creme, Followed by Filing with an Emery Board.

I discovered this remedy via the Earth Clinic website. Basically, every night, you soak your nails for 20 min in a 50/50 vinegar and 3% hydrogen peroxide solution, then afterward, soak your nail for a minute in a 3/2 bleach and water solution. After that, you apply a topical antifungal creme, and every once in a while, use an emery board to file down the nail. I tried this remedy, and I was having some success, but it was extremely time consuming and uncomfortable. Plus, I was starting to get bleach burns on my finger from the bleach. If you do this, make sure you do a couple of things. First, don’t soak your finger in bleach for too long – it can really burn. Secondly, always soak in vinegar first… if you soak in bleach first the vinegar burns a lot. Finally, make sure you have a paper towel nearby, because you don’t want to spill vinegar or bleach on the carpet or wipe it on your clothes.

Failed Attempts:

The following are things I tried to do that yielded no results or I gave up on, but might be worth a shot:

  • Tea Tree Oil
  • Rubbing Alcohol
  • Vick’s Vapor Rub
  • And check out some of the other Earth Clinic remedies.

If you have personally had any success with fingernail or toenail fungus remedies, please share in the comments.

Disclaimer:

Please try these remedies at your own risk. I believe that using vinegar to get rid of fungus is safer than using Lamisil, but I am not a doctor. I am only a moderately proficient googler who cares about his liver.

Also, some people tell me there are different kinds of nail fungus, and apparently vinegar might not work on all types of fungus. Therefore, I cannot guarantee any one of these solutions will work.

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Mar/08

14

A Better Blood Drive?

The American Red Cross needs to do two things to attract more people to give blood.

First, give money instead of coupons/shwag/etcetera.  Everyone loves money.  Not everyone loves specific goods.

Secondly, and most importantly, market giving blood as a weight loss tool.  Apparently you burn something like 2,000 calories on average by giving blood.  For a lot of people, that is a day’s worth of food.  Since Americans will do all sorts of crazy things except eating right and exercising to lose weight, such as the cabbage soup diet, you’d think they would also try giving blood every now and then.  I think 2,000 calories is close to one pound of fat (I think one pound is 2,500).  So the American Red Cross should be saying: “Donate Blood – Lose a Pound!”

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Food Prices

Check out this graph. I haven’t checked out the underlying data, but based on everyday experience, I would say this graph is accurate. Not only is it more convenient to eat unhealthy food such as pre-packaged sweets, but it is less expensive as well. So, a rational person has two factors telling him to choose unhealthy food over healthy food. The question is, why is unhealthy food cheaper?

I do not have a personal underlying theory as to why unhealthy food is cheaper. The cynical person in me says this is because of lobbyists in the unhealthy food industries. The uncynical person says maybe it’s economies of scale of producing packaged foods, since they are more produced than grown and those costs are easier to bring down.

Regardless, this is interesting.

Hat Tip: Photo Basement

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