The American health care system is broken. The reason is not that employer group plans makes insurance more expensive for those who don’t have an employer. No, the reason that the American health care system is broken is because Americans universally tend to believe that

  1. Technology can solve all problems.
  2. If you spend enough, you can get the technology needed for step 1.

This is also the reason why so many people believe that they need a lot of money just to get by. Possibly this attitude comes from the country being one of engineers and businessmen (eggheads and peddlers? :-) ), so lets use this as a model to explain why this combination of thinking fails to solve complex problems.

Technology solves simple problems that usually involve few parts with few degrees of freedom. A pair of scissors has two parts and one degree of freedom. There is roughly one degree of freedom every time on part can move independently of another part. An operating engine has many parts, but most of them are locked together, so effectively there are less than a dozen parts and maybe a handful of degrees of freedom for the different pistons and valves. It is an exceedingly complicated machine that has more than a couple of dozen degrees of freedom on the same level. In more complicated scenarios one builds a hierarchy of solutions if possible. For instance, logical circuits are gathered together on a computer chip, circuit boards are designed with chips with little consideration of the internals of the chips and so on. Compartmentalizing knowledge like this is a great tool but also a great source of weakness (like any great tool is). If humans were sufficiently intelligent, the hierarchy could be leveled and substituted for complexity (like the human brain). The fact that we have not invented artificial intelligence speaks to the fact that we have not mastered complexity.

Complex problems involve many agents with few degrees of freedom or few agents with many degrees of freedom. Examples of the former includes economic bubbles (herd mentality) and the war in Iraq. Examples of the latter includes being healthy and making efficient consumer choices. Assuming the risk of offending 90% of my readers I would say that the American mind(*) is culturally disposed to do worse at these kinds of problems compared to other nations. Conversely other nations do worse at simple problems(**) such as technology and business.

(*) Here I am talking about predispositions (stereotypes) and not the color of one’s passport. Not all Americans act like the stereotypical American just like all Germans do not act like the stereotypical German. Yet if one observes a people over a sufficiently long time there are certain tendencies that one can identify as American, German, Japanese, French, Chinese, …
(**) Make sure to understand the difference between simple problems and complex problems. Simple problems have few parts and few choices or many parts and many choices. Complex problems have few of the one and many of the other. Simple problems can be difficult to solve. Complex problems are often impossible to solve.

I think the recent track records of the economy and the war speak for themselves so lets consider health and consumer choice which is pertinent to this blog. Being a resident alien (and having lived in a few countries) gives me somewhat of an amateurish anthropological advantage in observing the natives. I have frequently seen that whenever Americans need to fix a problem they instinctively turn to Walmart. If you can’t find your hat – go and buy a hat. If that hat is too warm, too big, too red, go buy another one. If the hat example sounds ridiculous just substitute hat for shoes. I bet you have more than 5 pairs of shoes. If you’re hungry, you go and get pizza. And so it goes. Due the innate lack of ability to improvise and find complex solutions, that is, the inability to use fewer things to solve more problems necessitates solving problems by getting many things to solve many problems. Hence the lack of complex skills needs to be compensated by spending a lot of money on a lot of stuff and a lot of service, for instance the US is the first country I’ve been to where it is normal not to do your own taxes. This invisible inability is the main barrier to financial independence for many people. The only solution they know in terms of solving their problems is accumulating a lot of money.

This attitude fares no better when it comes to health care. Many Americans believe that the most important thing they can do remain healthy is to get a good health insurance plan. People cry for affordable health insurance rather than affordable health care or affordable health (clean water, clean air, nontoxic houses, nontoxic food, ..). The belief is that once you get sick or decrepit (and it is widely believed that everybody gets to that point eventually) then you or rather the insurance company throws [their] money at the problem and doctors fix you with technology much like cars are fixed in a garage, the economy is fixed with a stimulus package, or political problems are fixed through the use of superior firepower.

Yet when it comes to health it is always the responsibility of the individual. Health care is mostly about what and how much you eat and how and how much you move. If you eat more than you move, you are unhealthy. This eventually results in all sorts of complex problems (diabetes, clogged arteries, …). If you eat wrongly, the chance of cancer increases. If you are relatively weak (if you can’t do a pull up or a 30 second handstand then you are relatively weak), there will be problems with broken bones, joints, etc. down the line. Problems like strain and overuse also arise from moving wrongly. Thus health care starts with eating and moving correctly. This is common sense but people fail to apply it. Many people are much more likely to pop a pill than to prevent getting sick in first place(*). Forsooth, eating vegetables is widely considered to be more painful than paying several hundred dollars a month in health insurance.

As we get old expensive cancer treatments, joint replacements, etc. are required because of the idea that bodies are to be repaired rather than maintained. This attitude (coupled with a litigation happy public/justice system) causes Americans to pay close to twice as much for their health as the nearest country for the same level of health. I wasn’t surprised when I saw a financial institution predict that Americans needed to save $225,000 to to pay for health care during retirement.

(*) Don’t believe me? What do you do for allergies? Stop eating the food, petting the pet, or staying indoors when the flowers are blooming? Or do you pop a pill? What do people do for bone strength? Lift weights? Or pop a pill?

Now “an ounce of prevention is worth a pound of cure”, so for early retirement/financial independence it becomes crucial to learn how to deal with and think about complex problems. Health issues must be prevented before their appear. This means exercising daily at high intensity. It means cutting back on salt, meat, and dairy products while eating more vegetables and fruits. In terms of problem solving it means learning how to improvise(*) rather than “buying” whenever there is a problem.

(*) We used a cardboard box insulated with aluminum foil to store the ashes of our wood stove and a small garden shovel to rake the [cold!] ashes out until we got a nice set of fire place tools and a metal bucket via freecycle. Similarly the puppy currently used a set of cardboard boxes (which actually hold DVD cases and various other crap) taped together with duct tape and covered with towels for traction as a ramp for the couch. That is, until we find a free or cheap ramp somewhere.