Nessun Dorma: Insomnia and Sleep Aids

Sleep deprivation side effects -- Wikimedia

Sleep deprivation side effects — Wikimedia

Most people experience less than satisfying sleep at least occasionally, but some sufferers go for years without relief. Not being able to fall asleep at the normal hour in a reasonable length of time is known as “sleep onset insomnia.” Older people especially may suffer from waking too soon or not getting enough deep sleep. Sleep is a complex neurochemical phenomenon, and a wide variety of different causes for poor sleep make it hard to diagnose and relieve.

What’s often called sleep hygiene is a collection of good practices and habits that tend to lead to better sleep. Harvard Medical School’s Division of Sleep Medicine has a good list.

If you’re getting exercise and avoiding caffeine or alcohol late in the evening, you might still have problems. Chemical sleep inducers in the form of drugs and supplements can help get you to sleep or keep you asleep, but prescription medications like Ambien and Lunesta can have side-effects, cost a lot, and can be addictive. Many people have been hooked on them (and the drugs of past eras like tranquilizers and sedatives) for years, unable to stop without going through far worse withdrawal symptoms.

If your problem is getting to sleep, your body and mind may be revved up and out of synch with your natural sleep hours. Not engaging in eating, drinking, or stimulating activities for a few hours before normal bedtime can help. Some natural supplements — chemicals already found in your body or food that promote sleep — work for many people. A list:

Melatonin, one of the body’s primary sleep signalling chemicals, is continuously produced by the pineal gland, but destroyed by light hitting the eyes, so it is a driver of the sleep-wake cycle that lags exposure to light; it’s partly because exposure to light synchronizes your sleep cycle that staying up late with bright lighting can disturb it. Taking natural melatonin a few hours before normal bedtime reinforces the natural cycle somewhat, although there’s little evidence of it crossing the blood-brain barrier after absorption by the digestive system. Try sprinkling a bit of melatonin in powdered form under your tongue, perhaps by opening a commercial capsule like these. Melatonin, like some other drugs and vitamins, can be absorbed somewhat by the blood-vessel-rich skin under the tongue — this is called sublingual administration. Melatonin successfully reduces time-to-sleep and insomnia for most people, though it is less effective at keeping you asleep. If you’re already getting up to go to the bathroom at 3 AM, though, you can do another sublingual dose of melatonin and sleep a few more hours successfully.

5-HTP or its precursor L-Tryptophan. Tryptophan is an amino acid component of the proteins in many meats, eggs, and dairy products, and is commonly believed to create the sleepiness after a big Thanksgiving turkey dinner — though turkey meat has no more L-Tryptophan than most other meats. It is also usually credited for the “glass of milk at bedtime” method for assisting sleep. After a Japanese manufacturer of L-Tryptophan produced contaminated batches in 1989, injuring thousands and killing as many as 37 people, L-Tryptophan was banned by the FDA in the US. These restrictions were loosened and finally lifted completely in 2005. As a result of that incident, though, more people still take 5-HTP, which is a metabolite of L-Tryptophan and his similar effects. A few hundred mg of either does tend to produce faster and deeper sleep in most people, and like melatonin thet are both safe and not habit-forming.

Valerian Root is somewhat less harmless. An old herbal standby, this herb in capsule form is used by millions as a sleep aid. While it does work, it can’t be recommended for any but the shortest-term use because it is a mild liver poison — long-term use damages liver function. Other herbal teas like chamomile also have some sedative effects without any obvious toxicities.

GABA is another amino acid and neurotransmitter which doesn’t seem to cross the blood-brain barrier, yet has some obvious effects, producing calm and deeper sleep and perhaps aiding production of growth hormone in older body builders who take it. I take a gram every night before bed and it seems to deepen sleep. It also has some side-effects reminiscent of the niacin flush for some, so be careful and experiment with small doses before trying more. A reliable low-cost provider of GABA powder which can be mixed into any drink is here. Capsules tend to provide less effective dosages.

Doxylamine succinate is an old standby which works fairly well and is cheap and safe as a sleep aid: as an antihistamine, it is obsolete because its side-effect of drowsiness is intolerable during the day. But while it’s unwise to take any drug regularly unless you really need to, it’s at least not addictive and is easy to buy OTC: as this Kirkland-label product from Costco, for example.

Everyone’s sleep problem is different, and with age staying asleep becomes the most common problem. Natural substances can help but good sleep hygiene should be tried first.

More reading on other topics:

Regulation Strangling Innovation: Planes, Trains, and Hyperloop
Public Schools in Poor Districts: For Control Not Education
Real-Life “Hunger Games”: Soft Oppression Destroys the Poor
The Social Decay of Black Neighborhoods (And Yours!)
Child Welfare Ideas: Every Child Gets a Government Guardian!
“Income Inequality” Propaganda is Just Disguised Materialism

The greatest hits from (Science Fiction topics):

Fear is the Mindkiller
Mirror Neurons and Irene Gallo
YA Dystopias vs Heinlein et al: Social Justice Warriors Strike Again
Selective Outrage
Sons of Liberty vs. National Front
“Tomorrowland”: Tragic Misfire

Accountability, Equality, and Partial Fairness

Seal of the Handicapper General - Harrison Bergeron

Seal of the Handicapper General – Harrison Bergeron

One of the bigger problems with the ACA or any health insurance system which outlaws medical rating is its removal of the financial consequences of bad health habits. Progressives believe heavy taxes on cigarettes will reduce smoking and thereby reduce lung cancer and early death; a financial penalty on a self-destructive habit justified by the social welfare state’s future payment of medical expenses. (One issue is whether this is even true — it turns out most actuarial calculations show those who die early as a result of lung cancer have less spent on their medical care in old age and forego social security payments, so they save the welfare state money.)

But if you equalize the cost of medical insurance regardless of health habits, you are reducing the consequences of unhealthy habits and thus encouraging them. Accountability — having to be responsible for one’s actions — suffers under equalizing systems. Drivers with many accidents and drunk-driving convictions on their record will pay much more for (and find it difficult to even obtain) car insurance, and that’s normally considered a Good Thing because we want there to be financial penalties for habits that endanger others, like driving recklessly or under the influence.

The reasonable objection to charging for health insurance based on health record is that health status is only partly controlled by previous habits and behavior; a big chunk is genetics and chance. So it seems unfair to those who are sick because of bad luck in the genetic lottery — or even by accident, as cancers, for example, are thought in some cases to be created by accidental mutations, and only some cancers are caused by avoidable environmental exposures like smoking.

And many children begin life behind the eight-ball, having inherited problematic genes that make them more likely to suffer from conditions that cost a great deal to treat. Should insurance companies be able to use the results of genetic tests to offer low-cost policies to some, and much higher-cost policies to the unlucky?

In a laissez-faire world, insurance is an adversarial game with customers trying to hide any damaging information from the insurer as the policy is being sought, and the insurer doing their best to deny claims afterward. As a result, governments set up insurance commissions and regulators since it was impractical to adjudicate disputes over every consumer’s insurance policy in an expensive court of law. Arbitration and insurance commissions have done a fairly good job in the past of managing this conflict of interest, with some states being more pro-consumer than others.

One partial workaround for the medical rating problems is the idea of “continuous coverage.” The initial risk pool is assumed equal, and anyone who keeps paying for coverage continuously is allowed to stay in that average-risk category because some small part of their earlier premiums is true insurance — covering the risk that a health issue will turn up which makes them a bad risk in the future. Insurance contracts typically cover one year, and so if there is no requirement to continue coverage beyond that contract, rates could adjust upward or renewal could be denied based on negative events that happened during that year. Requiring renewal at the same rate as the rest of the risk pool makes the contract insurance against the long-term costs of treating any illness acquired during the period, not just that year’s costs.

What happens to people who allow their insurance coverage to lapse because they can’t afford the premiums or simply forget to pay? Most states had a high-risk pool with required must-issue, but rates were very high (of course — since the people seeking insurance under it were far more likely to need expensive care in the short term.) Some hybrids, like exclusions for pre-existing conditions for six months or a year, helped get people coverage at in-between prices.

The PPACA (“Obamacare”) tried to eliminate the problem with must-issue (no one could be refused insurance) combined with narrow time windows for seeking coverage and penalties for going uninsured. These were intended to force everyone to get insurance and to keep them paying for their insurance even if they were being charged much more than they were likely to receive in benefits. Younger, healthy people were expected to pay more to cover the costs of older, sicker people. In practice this did not work — even the subsidized rates were too high to get healthy young people to join up, and the penalties of going without insurance were small compared to the inflated new prices for insurance. So individual insurance coverage pools shrank and were dominated by new customers needing a lot of expensive, deferred care, and rates rose further as doctor networks were narrowed and more healthy people stopped paying.

The Supreme Court’s ruling deeming the ACA constitutional was only partial — the attempt to force states to increase Medicaid enrollments was deemed unconstitutional, so many states did not expand Medicaid. This left a bizarre hole in coverage in those states where a person could make too much to get Medicaid coverage, but too little to get private insurance subsidized through the exchanges. And the expansion greatly increased Medicaid enrollments in those states that participated, accounting for nearly all of the decrease in the uninsured in the US, but Medicaid itself has never been shown to improve medical outcomes or decrease mortality, and many people complained that they were forced to join Medicaid when they would have preferred to buy private insurance.

Also, the Supreme Court’s swing voter on the case, Chief Justice John Roberts, specifically warned that the fine for not having approved insurance was only constitutional if it was viewed as a tax, and an increase to the fine to an amount sufficient to force compliance would make it unconstitutional. This cuts off the ACA proponents’ attempt to raise fines to try to force more enrollment.

Which brings us to the subject of this essay — how do we decide what is fair when consequences of simple bad luck and genetics are mixed with the downside of behavior under a person’s control? Suppose a well-off person (let’s say the son from a wealthy family who left him a trust fund) drinks, smokes, and plays video games all day throughout his life. In his 40s now, he’s obese and unhealthy, with emphysema and cardiac problems imminent. Should his expensive future healthcare be subsidized by middle-class families who have worked hard, exercised, and been careful to avoid bad habits? That is the way ACA policies are now set up. Even unsubsidized, policies for wealthy people in poor health are much cheaper under the ACA than they would be in a free market, and those who have restrained their appetites and sacrificed to maintain their health better pay more than they otherwise would to make up for those costs.

But there’s no easy way to separate those “bad unhealthy” people whose illness is due to their own choices from those “deserving unhealthy” people who are ill because of chance or genetic inheritance.

The ACA plan tried to compel more equality of premiums regardless of actual risk or likely use of medical services, which removed some of the incentive for healthier behavior and burdened those who made the effort and sacrifice to keep themselves healthy. This tried to protect those who were simply unlucky, but many of those people are worse off than they were under previous high risk pool plans provided by the states, and have had their care disrupted or cut off by the high prices and narrow networks.

Every complex system is adaptive, and human systems especially so, with people quite capable of understanding the rules and seeking out every loophole to their advantage. The ACA has failed because people aren’t easily herded by programs designed by committees, and by finding the loopholes (paying for one month and using it for three, staying off until actually ill then signing up under the many loopholes in enrollment windows to get expensive care then dropping out again), the people have ensured the ACA cannot be sustained in its current form.

The ACA, which was promoted as saving everyone money, has ended up being much more costly for most than the old system. It has helped a few, but cost far more tax and premium dollars to help those few than a direct subsidy to the existing high-risk pools would have. The redistributionists have again discovered that unintended consequences will make nonsense of their social engineering schemes.

Philosopher John Rawls is usually cited by progressives intent on redistribution; his thought experiment suggested we view a system as just if we would choose it willingly, not knowing in advance what advantages or disadvantages we would be born with. You can argue that much behavior is also dictated by fate — our example of the obese videogamer may well have been doomed by being born into his particular family with parents who could not guide him toward a better way of living. But under that view, no one is responsible for anything, and we know that people can change to overcome even the worst background and genetic inheritance. Removing rewards for modifying one’s behavior toward the socially-valuable means a society which is less civilized and poorer in every way.

The classic Vonnegut story “Harrison Bergeron” takes equality to the extreme. The government has decreed that all must have equal abilities and outcomes, and so those who are more intelligent or talented are handicapped to bring them down to average. Of course, this becomes a nightmare with tragic outcomes as society grinds to a totalitarian halt.

But suppose we already have a little bit of this deadening effect introduced by the government’s emphasis on hiring by ethnicity or sex rather than ability. Would we even realize that the but-for world where only merit is considered would be wealthier, happier, and more fulfilling for most if not all people? If one has never seen a ballet performed to perfection by the most talented dancers on Earth, would we notice that the dancers are being dragged down by lead weights they have been forced to carry — or selected for political reasons rather than talent — making their performance less satisfying?

Socialists and redistributionists tend to think diversity and choice and product improvement are not as important as providing the poorest an equal quantity of goods, and the central planners of the USSR counted quantities of production, not quality; the stories of great quantities of useless, poor-quality, ugly products available from state stores while people schemed and bribed to get better-quality goods from abroad show how central planners failed to understand what mattered to the people. Even Bernie Sanders, who should know better, suggested there was too much choice in deodorant and shoes, and restricting choice would somehow allow more poor people to be fed, clearly missing a lesson or two of the socialist past.

So if you had never seen a perfect ballet or operatic performance, you might not notice how the ones you have seen have been compromised for the sake of political goals. Similarly, if you’ve never seen a world of free enterprise without identitarian politics or Party corruption, you will never realize how much freer and more productive your society might have been. The US overcame a history of race and sex discrimination to more closely approach the standard of merit alone — then has been backsliding incrementally as race- and sex-conscious employment policies took hold. While it appears the US is now limiting progressive overreach by not electing Hillary Clinton president, there has been a lot of damage already, with government agencies especially dysfunctional. It will take a lot of work battling entrenched special interests to reverse the educational system’s failure to teach children civics, history, and economics.

Death by HR: How Affirmative Action Cripples OrganizationsDeath by HR: How Affirmative Action Cripples Organizations

[From Death by HR: How Affirmative Action Cripples Organizations,  available now in Kindle and trade paperback.]

The first review is in: by Elmer T. Jones, author of The Employment Game. 

Corporate HR Scrambles to Halt Publication of “Death by HR”

Nobody gets a job through HR. The purpose of HR is to protect their parent organization against lawsuits for running afoul of the government’s diversity extortion bureaus. HR kills companies by blanketing industry with onerous gender and race labor compliance rules and forcing companies to hire useless HR staff to process the associated paperwork… a tour de force… carefully explains to CEOs how HR poisons their companies and what steps they may take to marginalize this threat… It is time to turn the tide against this madness, and Death by HR is an important research tool… All CEOs should read this book. If you are a mere worker drone but care about your company, you should forward an anonymous copy to him.


For more reading goodness:

Materialism vs Purposeful Life: Trump, Bannon, and Teilhard de Chardin
Sekrit Reform Agenda: Untangling Government: Medical Deregulation
No More Elections or Campaigns: Liquid Democracy
“Death by HR” – High Tech Threatened by Social Justice Activists

Seal of the Handicapper General - Harrison Bergeron

Seal of the Handicapper General – Harrison Bergeron


Sekrit Reform Agenda: Untangling Government: Medical Deregulation

I have been researching issues of dysfunctional government and over-regulation for the next book, which won’t be done for months. But now is a good time to discuss some of the results that bear on the new administration’s agenda.

Trump rode a popular wave of anger at being lied to and cheated by the DC pols and bureaucrats who have been in the pockets of special interests — oligopolic corporations, unions, and regulated industries — for several decades now. The fog of disinformation funded by government PR and interlocking media conglomerates obscured how regular people were being shafted to fund ever-increasing costs for medical care, education, housing, and cable TV, special interests that had captured their regulators to increase profits at the expense of middle-class families. Proximate causes of voter anger: the lies of Obamacare and the intentional subversion of the law and welfare systems to support a large population of illegal immigrants intended to tip the electoral balance against citizens who were born in the US or entered legally. The government cheerleaders denigrated blue-collar and less degreed workers, while promising and failing to deliver good jobs. “College for everyone” policies meant college degrees came to be required for all good jobs, and meanwhile failed public schools graduated students unprepared for even low-level college work, then stuck the dropouts with nondischargeable student loan debts. College tuitions rose far faster than inflation while an elite class of academics and administrators took home fat paychecks and enjoyed job security and benefits unavailable to most taxpayers — meanwhile abusing nontenured adjuncts to do the actual teaching for poverty-level pay. Lives have been destroyed by the promises of the social engineers, and the people finally stopped buying the propaganda.

Trump is not beholden to the usual billionaire donors and subsidy-seeking industries. His administration is the first opportunity in decades to seriously overhaul the regulatory structure that has crippled US competitiveness. Real structural reform could unleash a wave of growth and new jobs and lower costs of housing, allowing people to move to where the jobs are and start rebuilding families and lives that have stagnated since 2008’s Great Recession began.

I’m going to propose an agenda of radical reform that not only would create a business boom, but a freedom dividend. The elitists have tried micromanaging normal people by regulating the most trivial details of daily life (for example, incandescent bulb and plastic shopping bag bans) and opposing all new housing, pipelines, and industrial development. They should be told to mind their own business.

Radical reform agendas affecting multiple sectors have a problem getting accepted. One can try to build a coalition to get people to accept the parts they don’t like for the sake of others they do, but you run the risk of notifying the entrenched interests that you’re threatening their monopoly profits. Those special interests will join together to fund propaganda to frighten the population into halting the reforms. This was Arnold Schwarzenegger’s downfall in California; he took on the entrenched power of public employee unions — nurses, prison guards, and civil servants — who funded a massive PR campaign against his reforms and halted them at the ballot box. Schwarzenegger gave up, convinced the interests he had challenged were too powerful to curb. So perhaps the reform agenda should be secret — picking off the interests one by one with as little fanfare as possible, so the people wake up one day to discover they are richer and more free than before. Announcing that you intend to fire millions of paper-pushers so they can go to work in real jobs that actually add value might possibly be a bad idea… even those paper-pushers might be better off in the long run working in more dynamic industries, but it is hard to convince someone to voluntarily undergo wrenching change for some long-term good.

So slow and steady change, with due regard for transitional measures to smooth the way. But smash the system, gently, and let people choose freely how to live and create. The status quo is no longer sustainable, and change rolled out before the inevitable collapse of the debt-based economy will perhaps forestall the worst scenarios.

One of the downfalls of the Democratic-Progressive machine was the failure of the Rube Goldberg ACA / Obamacare health insurance scheme they believed would cement their electoral dominance by creating more dependent citizens. Passed in a hurry when they were about to lose their lock on the Senate, the law was a Frankenstein monster of parts assembled by special interest groups and progressive policy wonks, famously cheered on by MIT Prof. Jonathan Gruber, who admitted the proponents had intentionally obscured its true nature: to greatly raise the cost of insurance for healthy middle-class families so that poorer, sicker people could get subsidies without revealing the huge hidden tax increase involved. Repeated lies were used to pass it, including Politifact’s Lie of the Year for 2013, Obama’s “If you like your health care plan, you can keep it,” plus the promise of $2500 per family yearly savings.

But the current death spiral of the ACA individual insurance market is far worse than the planned hidden tax and subsidy scheme. Through its poorly-designed rules of payment for coverage, the scheme allowed and encouraged gaming — clever consumers discovered they could sign up and pay for one month, then get lots of expensive healthcare services for three months before being cut off for nonpayment. And the loopholes allowing enrollment outside normal time windows were so easy to bypass that many people dropped coverage, returning to pay only when they had a major medical expense upcoming. Because of the high prices — which were barely affordable even with subsidies, and many times the cost of similar pre-ACA policies for those who were not subsidized — many or most of those eligible chose not to buy in, leaving the sickest and poorest to drive up average medical spending for the risk pool.

As a result, the trumpeted increase in coverage was entirely due to expanded Medicaid, which is free and worth every penny. The Oregon study which showed that Medicaid coverage did nothing to increase health or decrease death rates for newly-covered people was ignored, and the claims that new Medicaid coverage would save thousands of lives every year and decrease ER usage among the poor turned out to be false — ER usage rose as poor people continued to prefer no-appointments, no-payment access to ERs over Medicaid clinics with long waits for appointments. Meanwhile, the 20 million people who had paid for their own insurance before the ACA have been soaked, and there are now only 10 million people enrolled in the new individual ACA plans. So while proponents continually claim success in that more people are “insured,” the deteriorating quality of the coverage and the reduced participation by the young and healthy who were supposed to pay the bills mean that it is becoming both a financial and a healthcare disaster.

What happens when a significant number of voters have supposed facts drummed into them by political leaders, but discover they were all lies, and many middle-class voters are being soaked for insurance that covers less and costs much more, reduces choice in providers, and limits travel because they can’t get coverage outside their area of residence? They begin to doubt the word of the “experts” of the government propaganda machine on every other subject, and they yearn for honesty.

Passed to satisfy all major special interest groups, the ACA appeared likely to increase profits for health insurance and drug companies, which is why they supported it. It has not worked out that way, with the companies generally losing $billions on individual health insurance plans. Progressives are now calling for a public option which would somehow undercut the pricing of private insurance companies, many of which are nonprofits, while doing the same work the government way — we can see how well that might work by how patients are treated by the VA.

But the failure of the ACA has created a climate for real reform because the old mostly-functional system is now smashed to pieces and there is less to lose from drastic change. The ACA, ruled constitutional by the Supreme Court, established that the Federal government could regulate and interfere with the healthcare markets of every state. Under the expanded Commerce Clause powers now established as precedent, nothing stops Congress from seizing direct control of medical professional licensing. The balkanized 50-state regulation of care is part of the inefficiency of the system — it should go. In practice there is no evidence that doctors licensed by one state become hazards to care in a different state, and the complex schemes that restrict supply and raise costs for medical certifications need to be streamlined and unified. Irish doctors who go through a four-year program are just as good as doctors trained in the US’s standard eight-year program, which costs hundreds of thousands of dollars more. Services which can be provided by technicians in cheap clinics like those popping up in drugstores nationwide should be expanded; for example, checking for suspicious skin growths to screen for cancer can now be done by AI-based optical scanners at very low cost. Standard tests and treatments for colds, flu, STDs, skin fungus, and impacted earwax don’t require a doctor’s knowledge. State laws requiring doctor supervision of even routine care do little to improve care but a lot to restrict availability and raise prices.

Medicaid is both expensive to taxpayers and provides delayed and substandard care. An expanded system of clinics for the poor is a much better way of spending public money on low-income patients. Hospital ERs need to be free of the requirement to treat non-emergency patients, and free to pass them off to public clinics who can more cost-effectively treat the less urgent problems they bring in.

Requiring prescriptions for drugs raises costs and reduces availability for everyone, even wealthy people — having to see your doctor several times a year to renew routine prescriptions for birth control, blood pressure, cholesterol, and other common medications adds to costs with minimal benefits. Doctors have to waste time jumping through insurance company hoops intentionally imposed to reduce drug costs, and vast amounts of time and money are spent needlessly.

There are some medications which need to be controlled to prevent overuse. Antibiotics, for example, gradually lose their effectiveness as organisms build up resistance, and so having some authority limit their use to cases of real need is cost-effective. But most standard medicines should be free for sale over the counter — only antibiotics and highly addictive drugs need to be controlled. This would cut out layers of cost and reduce prices and the cost in time and trouble to patients and doctors. OTC birth control costs the system much, much less than Obamacare’s “free” birth control pills.

Many newly-approved treatments are startlingly expensive. One reason for this is a hidebound FDA, which requires massive double-blind controlled studies for approval. For each drug that is approved, many more fail, so the billions spent have to come from somewhere, and that means very high list prices for patented treatments. The focus on approvals can make or break billion-dollar companies, and so the FDA deciders are subject to influence-peddling campaigns and barely-hidden bribery, making their decisions less transparent and more political than is decent. Meanwhile, foreign countries control prices and reap the benefits of new treatments while not footing much of the development cost. It’s only because the US government enforces this setup that the market works this way; removing bans on imports and equalizing world prices for medications would force the pharmacy companies to price more rationally and fight the price-controlling developed countries that are free-riding on US research costs.

So setting up a commission to investigate modernizing FDA approvals, freeing up provision of most medical services and licensing, and allowing US sales of any drug approved by reputable agencies abroad would be a good start. Drug companies will fight this since it means they have to find another way to charge the costs of research more broadly to the rest of the developed world while selling at marginal cost to poorer patients wherever located, but the current situation is not sustainable — just as the US no longer dominates the world economy and can no longer afford to pay the lion’s share of defense costs for its allies, medical research and drug approval costs have to be more widely shared. And the paternalistic control of what adult citizens choose to eat, drink, smoke, and take as drugs needs to end. It is vastly wasteful and costly to freedom.

All insurance is a bad deal in that it costs more than the services one might expect on average to get in return; the overhead of the insurance company, claims managers, and payment systems has to be built into the price. Thus insurance for small expenses one could easily afford to pay is a bad deal; extended warranties for appliances, phones, and travel insurance are overpriced. Most people who bought their own insurance pre-ACA had catastrophic coverage, which kept premiums down by having high deductibles. But these policies got them access to the insurance company-negotiated prices, which is important because hospital list prices have been set artificially high in response to the Medicare reimbursement system. Bare-bones policies covered the truly unaffordable costs of serious medical treatments, which is the correct use of insurance. Now many people who had catastrophic coverage can’t get it at the formerly reasonable prices since even unsubsidized policies must conform to ACA rules.

So the first relief for ACA problems is to end regulation of policy benefits so individuals can buy what they actually need in coverage. If medical screening is allowed, setting up a national subsidized high-risk pool for poorer people with pre-existing conditions can help solve that problem, or regulations could require anyone with continuous coverage to be accepted, as they did before the ACA in most states — only a few people would find themselves uncovered and needing a subsidized high-risk pool. Most of the damaging gaming of ACA policies comes from those who stop paying in until they have an expensive need, and requiring continuous coverage limits that problem.

Subsidies for lower-income people are problematic in many ways. One is the benefits cliff, which penalizes someone who increases their income many times the increase, punishing efforts to better their lives. Another is the high cost to taxpayers — the costs have been less in total than expected because ACA policies have been much less popular than expected, but higher per covered person. Getting medical costs down overall through deregulation and heightened interstate competition and economies of scale will help, and making any subsidy required be available through income-tax credits eliminates the need for the costly and mostly failed state and national marketplace web sites, easier dreamed of and promised than executed by government contractors. Those have cost $billions but have proven unsustainable even when they work. Let insurance companies sell directly, let any aggregator compete to sell policies, and get the government out of health insurance provision entirely.

The FDA was once focused on policing the marketplace for food and drugs — its predecessor started under the Pure Food and Drug Act of 1906, and the emphasis was on preventing fraud. Focused on dangerously adulterated food and false claims of efficacy for medical treatments, proper manufacturing and labeling were effective at reducing problems, with the Prohibition-like bans on some drugs and detailed regulation of what chemicals a citizen could buy coming later. Most of the damage caused by quacks and adulterated foods and drugs could be prevented by emphasizing consumer information and labeling instead of prohibition — making sure what is sold is what it is labeled as being and preventing unsupported claims of efficacy are really all that is required, and the growth of FDA regulation beyond that is retarding progress and increasing costs to consumers with very little benefit. Patients with their doctor’s guidance ultimately choose what is needed and useful in medical care, and the FDA has forced them to smuggle in lifesaving medications from abroad and set up a system that prices treatments far above affordable costs. No one who is facing a life-threatening illness to should be kept from trying promising treatments the FDA is too slow to approve. And advanced countries like Britain allow pharmacies to sell, for example, codeine (similar to heroin!!) with acetaminophen tablets for the asking — with little additional risk, though they have been criticized for not warning enough against the dangers of overuse of acetaminophen (Tylenol).

And the FDA is legally prevented from halting the advertisement of and wasted money on homeopathic medicines, which do nothing but can harm people by delaying treatment with real medication. They are also barred from halting supplement sales, and liver toxins like valerian root are still sold freely without appropriate warning labels. Consumers are lead to believe authorities have made the world safe for them, and do not investigate and are not sufficiently skeptical of claims made.

The Hoover Institution’s studies of medical reform are in line with what I’m suggesting, though less radical. I’m particularly bored by HSAs and schemes to jigger tax credits when the underlying problem is that costs are just too damn high, but those incremental improvements would be worthwhile.

[next installment: Sekrit Plan for media conglomerates and cable TV companies, now one and the same]


Death by HR: How Affirmative Action Cripples Organizations

[Death by HR: How Affirmative Action Cripples Organizations,  available now in Kindle and trade paperback.]

The first review is in: by Elmer T. Jones, author of The Employment Game. 

Corporate HR Scrambles to Halt Publication of “Death by HR”

Nobody gets a job through HR. The purpose of HR is to protect their parent organization against lawsuits for running afoul of the government’s diversity extortion bureaus. HR kills companies by blanketing industry with onerous gender and race labor compliance rules and forcing companies to hire useless HR staff to process the associated paperwork… a tour de force… carefully explains to CEOs how HR poisons their companies and what steps they may take to marginalize this threat… It is time to turn the tide against this madness, and Death by HR is an important research tool… All CEOs should read this book. If you are a mere worker drone but care about your company, you should forward an anonymous copy to him.


For more reading goodness:

Regulation Strangling Innovation: Planes, Trains, and Hyperloop
Who Killed Prince?: Update – Buprenorphine Implant Approved by FDA
FDA Wants More Lung Cancer
No More Elections or Campaigns: Liquid Democracy
Death by HR Introduction: HR Pushes Damaging Regulations Into the Enterprise
Death by HR: Thiel, Trump, Palantir: Regulation as Partisan Weapon
Update on: Who Killed Prince? Restrictions on Buprenorphine
California Dream Choo-Choo Lives On: Bay Bridge Lessons Ignored
Public Schools in Poor Districts: For Control Not Education
The VA Scandals: Death by Bureaucracy

Flossing: Absence of Proof is Not Proof of Absence

Flossing: Never Like the Photo

Flossing: Never Like the Photo

Dentists and media have been telling us for generations that brushing and daily flossing are absolutely critical for preservation of teeth and gums into old age. A flurry of publicity in the last few days has people wondering if this is another instance of authorities blindly asserting healthy living ideals that are not only wrong, but might actually be harmful, as the USDA’s Food Pyramid and advice to eat low-fat, high-carb diets were.

Let the New York Times story, which was typical, explain:

For decades, the federal government — not to mention your dentist — has insisted that daily flossing is necessary to prevent cavities and gums so diseased that your teeth fall out. Turns out, all that flossing may be overrated.

The latest dietary guidelines for Americans, issued by the Departments of Agriculture and Health and Human Services, quietly dropped any mention of flossing without notice. This week, The Associated Press reported that officials had never researched the effectiveness of regular flossing, as required, before cajoling Americans to do it.

In a statement issued on Tuesday, the American Academy of Periodontology acknowledged that most of the current evidence fell short because researchers had not been able to include enough participants or “examine gum health over a significant amount of time.”

The revelation has caused a stir among guilt-ridden citizens who strive to floss daily but fall short of that lofty goal. Among experts, however, it has been something of an open secret that flossing has not been shown to prevent cavities or severe periodontal disease.

A review of 12 randomized controlled trials published in The Cochrane Database of Systematic Reviews in 2011 found only “very unreliable” evidence that flossing might reduce plaque after one and three months. Researchers could not find any studies on the effectiveness of flossing combined with brushing for cavity prevention.

“It is very surprising that you have two habits, flossing and toothbrushing without fluoride, which are widely believed to prevent cavities and tooth loss, and yet we don’t have the randomized clinical trials to show they are effective,” said Dr. Philippe Hujoel, a professor of oral health sciences at the University of Washington in Seattle.

But this is not unusual. Double-blind scientific studies are very expensive, and impractical for long-term effects on large populations. Because flossing is a procedure done by the study subjects themselves, there is no way of telling whether self-reported flossing is done correctly or at all, and lying about having faithfully flossed to your dentist is one of the most common white lies. “I always floss daily” is right up there with “I never think lustful thoughts about [sexually-attractive person who is not my spouse]!” in the book of self-serving fibs.

“Absence of Proof is Not Proof of Absence” — the lack of evidence of an assertion (“flossing helps prevent gum disease and preserves teeth”) is not evidence that the assertion is false. That would be the fallacy of Argument from Ignorance, often seen in the argument that there is no God because there is no evidence that He/She/It exists. If we have no evidence, we can’t determine anything about truth or falsehood. So all of these clickbait stories hinting everyone has been wasting their time flossing and authorities are full of it are simply wrong.

No studies are really needed because long experience of millions of dentists shows that regular brushing and flossing do tend to prevent gum disease and loss of teeth. While the evidence is not proof as the FDA might require it if it were a newly-proposed drug, my own personal results from periods of less and more dental hygiene efforts demonstrated that flossing helps. My gums improved and I had far fewer problems once I found two excellent time-saving devices for brushing and flossing.

First, electric toothbrushes with high-speed oscillating brush heads make brushing your teeth thoroughly yet gently easy and quick. These are marketed as ultrasonic, though that’s exaggerating bit. Here’s the one I use:

Philips Sonicare Diamond Clean Toothbrush

Flossing is notoriously tedious, with some types of floss shredding between teeth, cutting into fingers trying to hold it, and being almost impossible to get between back molars without stretching your mouth uncomfortably. There are several flossing helpers that ease this by holding a short segment of floss at the end of a long handle you can reach back with, but this is still time-consuming.

I found a great appliance which uses puffs of water or mouthwash instead of floss, and easily reaches back to flush the spaces between back molars:

Philips Sonicare Airfloss Ultra

This does a decent job of flushing out food particles, but is far more practical than the dental irrigators (Waterpiks) which spray far more water and take much more time to use. With the Airfloss, you place the head at the lower end of the junction between two teeth, push the button, and *puff* a tiny amount of high-speed liquid flushes out the crack. The consensus is that while this is not as good as thorough flossing, it is much better than the haphazard and occasional flossing most people do, and by making it easy to add to your routine, far more likely to become a regular habit. My dentist started complimenting me on my gum health shortly after I started using it regularly, and it continues to be excellent. One note: because of the high-tech nature of the machine, it doesn’t last as long as one might like — I went through a warranty replacement, but the company was good about sending me a new one when it stopped working. If you have to buy one every two years, it’s still a great deal better than gum surgery. You also need to practice to avoid spraying your surroundings, but it’s still far less messy than Waterpiks.

More reading on health and diet:

Salt: New Research Says Too Little May Be Unhealthy
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Sugared Soft Drinks: Health Risk? (and What About Diet Soda?)
Almonds: Superfood, Eat Them Daily for Heart Health
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Junk Science: Vitamin Mania
Progressive Neighborhoods: Low Vaccination Rates Create Epidemics
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Why We’re Fat: In-Depth Studies Under Way
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Green Coffee Extract for Weight Loss: “Dr. Oz” Hypesters Fined
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Daily Aspirin Regimen Reduces Cancer Rates
Acidic Soft Drinks and Sodas: Demineralization Damages Teeth
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