Maggie's Farm

That's a good analysis. I agree.

Unfortunately, we're past fixing that kind of misuse of language. The political term is what it is. It's like saying "Liberal". "Liberal" used to me free-market, free minds, freedom in general.

Today, it's been combined with "Progressive" while "freedom" is more aligned with "Conservative" (which I hardly see as promoting "freedom"). Progressive is more totalitarian, while Conservative is more culturally stringent. Different sides of the same coin in my view.

Words and language are difficult buggers. Most of the time, misunderstandings and disagreements aren't related to a fundamental opposition, but just using a word or phrase that someone can't wrap their head around the same way you do.

But you make a great point.

I recently went in for back problems and a Nurse Practitioner dealt with me. Physician's Assistants are far more common.

Doctors are on short order. Mainly due to the administrative requirements, from what I can tell. They do a lot of paperwork now.

All great points. You're right that it's not always poverty that is a deciding factor - that's why I mentioned cultural differences. Comparing different poverty-stricken regions won't always result in high levels of overlap for main cause of mortality. Some will have extremely high infant mortality, others not. Some will have high levels of drug abuse, other not. Some will have higher levels of cancer/smoking related mortality, others not.

Culture is a differentiator. Community is a differentiator. Too often we make it about one thing, since that's easier. Race. Poverty. Makes it easy to say "yeah it's all different, but if they weren't poor or black, it wouldn't have happened."

I don't know that's true. In fact I know it's not. It's just easy to say.

Agreed. I mention it below, along with a few other items.

One overlap in both spending and death could be opioids. The few people I know who have struggled with this addiction all started because of prescriptions due to pain from athletic endeavor. Opioids were somewhat expensive, but are now very affordable - meaning more easily bought and OD'd on.

Another is obesity. With 2 overweight people in my family, I know their spending on healthcare is probably 2-4X mine. It was a major reason for me to cut weight 15 years ago, and stay active.

If both these were addressed, I would submit we'd see the US lower its health costs while improving its life expectancy.

One thing unlooked at. Infant mortality. I don't know the numbers, but I remember not 30 years ago the US was very high among industrialized nations with regard to infant mortality, and this drags the life expectancy down significantly. Most of this is due to drug use and inner city poverty. I don't consider either of these truly addressable items. Some would say "the rest of the world" has "fixed" those issues - I'd say they've only kicked the can down the road. Their deficits are going to come due, and most of those deficits are related to spending to make healthcare 'affordable to all' - which only means eventually someone has to go without (scarce resources are always scarce over time, and cannot be made eternally abundant).

In addition, other nations have less diversity than we do here in the US. That kind of cultural homogeneity plays a HUGE role in making managing lifestyle and poverty 'easier'. It doesn't solve anything, really, but when you consider the nature of, and differentiation between poverty in Appalachia, inner cities, and border towns, you can understand that it's not just a "poverty" issue but it's also a cultural issue. Some things are prioritized over others simply because they are assumed they have to be. My father, a doctor, took me to see patients during some of his time doing pro bono work to show me how culture plays into how we make health decisions. Yes, wealth is important...but I just came from a conference where there were a lof of very wealthy (and very unhealthy) people. Obesity and drug use were common among this crowd. Definitely a wealth problem, rather than a "privilege" or poverty problem. They have the cash, they spend it on things they DESIRE strongly.

I'm not sure that's a common thing in other nations. It could be - but I doubt it. We are a wealthier nation than most, after all, and we are incredibly indulgent.

If you don't follow the Manhattan Contrarian, I'd suggest seeking him out.

I am fairly certain the Germans, at least NOW, would fail and fail miserably.

The hurdles are high, the efficiencies low. Even a Manhattan Project wouldn't likely lead to much benefit. Technically, the US has been in the midst of one - albeit a muddled one - for years. Billions of investment dollars and subsidies are spent on concerted efforts in this realm, and have yielded us....The Tesla and home battery packs and....home generators running on LNG.

Most of the EV/sustainable grid work is still "subsidized" and supported by fossil fuels. That's undeniable.

I still think work on Stirling Engines (which Dean Kamen did a lot for in the early 2000s) is underdone and there are opportunities there, particularly when mixed with geothermal as opportunities present. Geothermal actually is very efficient and affordable (after amortizatoin) right now. But it's a heavy upfront payment cost.

All that said, I doubt anyone is going to solve this fast, even the Germans with a concerted effort. Nuclear is underappreciated and shunned for no good reason.

Also, I think the key point you make is "the individual level"

Grids are designed for scaling down. We need to develop individual results that scale up. Original electric development was meant to be highly local (DC) but Tesla made it heavily centralized and able to cover long distances with AC - that was a massive benefit.

But the reality is local development scaling up is the future. Decentralized benefits. You can still do scaled down central productization for larger, industrial needs. The two need to work in tandem, whereas right now they do not do that very well (for what it's worth, blockchain and crypto can be utilized to solve for a lot of this).

But doing something on your own is always the main way to invoke change. Policy and Manhattan Projects are usually too little, too late, and often misplaced. You sometimes get lucky, like we did with the Manhattan Project, and solve for something in a moderately timely fashion....though many would argue today the Manhattan Project only ended WWII a little bit earlier, and many would argue it probably wasn't even necessary. I won't argue either point - I'm just saying there are views which support this. So you may be able to say even that, technically, provided less good than we'd have hoped for more money than it was worth (again - I am NOT saying this, but many could and do).