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In the 1900s infectious diseases were rampant in New York City because New Jersey, just across the Hudson River, was basically a swamp that bred mosquitos. Every summer, the mosquitos would just fly across the river and start infecting people with malaria and yellow fever. Everyone but the rich people, of course. They would just pack up their stuff and move somewhere colder.

Now, it’s 2023 and being poor is still hazardous to your health. People in poverty have poorer health outcomes and more unhealthy habits than more affluent people. They are twice as likely to develop Type II Diabetes for example, and with it everything from heart attacks and strokes to kidney failure, adult blindness and limb amputations. Prevent diabetes, and you prevent just about everything.

New York didn’t solve its infectious disease problem by giving poor people a bunch of expensive pharmaceutical drugs but by draining the swamp – literally! Clean drinking water, access to nutritious food, improvements in workplace safety, sanitary living conditions, being able to get a job, and having a supportive social network have all been shown to have a bigger effect on health outcomes than access to healthcare.

In 2008, the state of Oregon inadvertently ran a randomized experiment measuring the effect of government spending on health insurance. The state government decided they had just enough money left over in their annual budget to give Medicaid coverage to 10,000 citizens, randomly assigned via a lottery. There was no improvement in their health outcomes, but they did increase hospital admissions by 30%, outpatient and ER visits by 40%, and wasted a lot of money for no tangible benefit. 36% more, in fact.[1]

Oh, and that’s not all. Individuals on Medicaid are almost twice as likely to die after surgery as privately insured patients, and about one-eighth more likely to die than the completely uninsured, according to a study published in the Annals of Surgery by The University of Virginia in (2010).[2]

A meta-analysis of fourteen randomized studies by the British Medical Journal in 2021 concluded that “general health checks did not reduce morbidity or mortality, neither overall, nor for cardiovascular or cancer causes.”[3] Patients randomized into receiving general checkups received up to 20% more diagnosis over the next six years, despite no improvements in their health whatever – just misdiagnoses, extra costs, extra treatments, and extra distress for nothing!

The data is very clear: Under the current system, you should only go for a checkup if you have a specific health complaint. I’m not saying that’s how it should be… I’m only saying that’s how it is. Despite being the most treated population in history, we just get sicker and sicker for longer and longer and shell out more and more for the privilege. All that happens when you offer people more access to more “free” doctors and checkups is they find things to treat – whether it would be helpful to treat them or not.

This reminds me of the Ivan Illich quote…

“Many students, especially those who are poor, intuitively know what the schools do for them. confuse process and substance. Once these become blurred, a new logic is assumed: the more treatment there is, the better are the results; or, escalation leads to success. The pupil is thereby “schooled” to confuse teaching with learning, grade advancement with education, a diploma with competence, and fluency with the ability to say something new. His imagination is “schooled” to accept service in place of value. Medical treatment is mistaken for health care, social work for the improvement of community life, police protection for safety, military poise for national security, the rat race for productive work.”

  • Deschooling Society

I don’t advocate government programs, for the same reason I don’t recommend more Medicaid. They tend to do more harm than good. But if you were really going to spend public money on improving people’s health – it wouldn’t be on healthcare – that’s for sure! If only a small percentage of what is currently spent on Medicaid in the USA was reallocated to making sure those most in need have access to good nutrition, clean drinking water and food, housing with ventilation that is free of mold, indoor heating, regular garbage collection, sanitary sewage systems, and so on, the number of expensive diseases would fall. Singapore’s Housing Development Board builds high-quality housing for the poor instead of wasting money on treatments which to do not increase the length or quality of life; they also place publicly funded gyms in every neighborhood. The fact that this is never even discussed as an alternative indicates that public spending on healthcare is more about lining the pockets of campaign contributors than health. We won’t house a homeless person, but we will throw endless amounts of money on treatment for them if they roll into hospital.

A huge propaganda campaign has been waged to convince people that more healthcare means better health and that the government must provide it. However, the facts simply do not support this. We would save more money providing social care for the elderly so they didn’t have to stay in hospital. We are going to have to confront the issue one way or another because this system cannot go on indefinitely – Medicare is bankrupt! It will be better if we plan a soft landing. The cost of care for people with diabetes can easily run over $15,000 a year. Since people on low incomes don’t have the means to pay for their own treatment they tend to be cared for out of the public purse. This means the affluent cannot afford (pardon the pun) to turn a blind eye to the plight of the less-well-off because they are ultimately going to pay the price (sorry, I can’t stop) for doing so.

My stipulation for any intervention would be that $1.50 must be cut from Medicaid for every $1 spent on the public health program. Each term a set amount of money is to be reallocated and specifically earmarked for the precise purpose of ill-health prevention: improving moldy homes or paying farmers to add minerals to the soil. This must then be approved by a 2/3rds majority. This would be to prevent the program from going on indefinitely with people just “finding” things to spend the money on that are no more effective than wasting it on Medicaid. Left to their own devices, government programs tend to grow arms and legs and before long serve no one except the ever-growing legion of bureaucrats that work in them. In fact – if a government department is created to solve a problem and does so successfully then everyone in that department has done themselves out of a job! Perhaps it would be better to find nonprofits that are already demonstrating success in solving these problems and fund them to expand their operations on a fees-for-results basis.

Remember, the major causes of death are destructive of the quality of life as well as the length of life of sufferers, so a little rethinking of our priorities would save untold amounts of suffering as well as money.

If you are sane in an insane world and want help transcending the matrix of control to reach your life goals Check Out My Freedom Warrior Program.


[1] Flynn, S. M. (2019) “The Cure That Works: How to Have the World’s Best Healthcare – At a Quarter of the Price”, Regnery Publishing, p179-181

[2] Damien J. LaPar et al., (2010) “Primary Payer Status Affects Mortality for Major Surgical Operations,” Annals of Surgery 252 no.3: 544-51

[3] LT Krogsboll et al. (2012) “General health checks in adults for reducting morbidity and mortality from disease: Cochrane systematic review and meta-analysis,” British Medical Journal 345 e7191.

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