Why Nutrition is So Important to Health

From the Price-Pottenger Nutrition Foundation:

Dr. Francis M. Pottenger, Jr., MD
Dr. Pottenger was an original thinker and keen observer whose imagination, integrity and common sense gave him the courage to question official dogma. Dedicated to the cause of preventing chronic illness, he made significant contributions to the understanding of the role of nutrition in maintaining good health.

In his classical experiments in cat feeding, more than 900 cats were studied over 10 years. Dr. Pottenger found that only diets containing raw milk and raw meat produced optimal health: good bone structure and density, wide palates with plenty of space for teeth, shiny fur, no parasites or disease, reproductive ease and gentleness.

Cooking the meat or substituting heat processed milk for raw resulted in heterogeneous reproduction and physical degeneration, increasing with each generation. Vermin and parasites abounded. Skin diseases and allergies increased from 5% to over 90%. Bones became soft and pliable. Cats suffered from adverse personality changes, hypothyroidism and most of the degenerative diseases encountered in human medicine. They died out completely by the fourth generation.

The changes Pottenger observed in cats on the deficient diets paralleled the human degeneration that Dr. Price found in tribes that had abandoned traditional diets.

More to follow ...

On Music, Heart & Brain Health, and Michael Jackson

(Above: A visualization of music; a tribute to Michael Jackson. Notice the visual pattern: high-variability that has self-similar segments throughout, giving rise to multiple long-range correlations that make the song coherent and enjoyable for listening.)

(Above: Lebron James comments on the important role that music plays in his life; especially, in regards to his energy levels and emotional states--note that he diversifies and listens to various types of music.)

(Above: Bernie Williams, the athlete & now the artist, who integrates sports and music so brilliantly. He led the Yankees in center field for many years; now, he's making professional strides as a musician.)

Aside: My previous essay in this domain = An Argument from Physiology

Primer: My posts on MyHealthInnovation.com (thanks to Carlos Rizo)

Prelude: Rough Fractals

A FRACTAL IS GENERALLY "A ROUGH OR FRAGMENTED GEOMETRIC SHAPE THAT CAN BE SPLIT INTO PARTS, EACH OF WHICH IS (AT LEAST APPROXIMATELY) A REDUCED-SIZE COPY OF THE WHOLE," A PROPERTY CALLED SELF-SIMILARITY." BECAUSE THEY APPEAR SIMILAR AT ALL LEVELS OF MAGNIFICATION, FRACTALS ARE OFTEN CONSIDERED TO BE INFINITELY COMPLEX. NATURAL OBJECTS THAT APPROXIMATE FRACTALS TO A DEGREE INCLUDE CLOUDS, MOUNTAIN RANGES, LIGHTNING BOLTS, COASTLINES, AND SNOW FLAKES.

... AND, as this post shows, MUSIC!

Why Music is So Important to Health

It's a heart-brain thing. Actually, more accurately, it may be a HeartBrain thing.

The intricate signaling patterns that drive our physiologies depend upon epigentic mechanisms, leaving our open-loop neurological systems intimately linked to our environmental conditions and stimuli. External energy radiates constantly, bombarding us from all directions, in various forms, and our bodies detect, process, and respond to these energy sources throughout the day in important ways. Music is one such energy source that our minds, bodies, and souls perceive (via sensory receptors, interneurons, and other neurological pathways, including those in the brain). Every day, our bodies absorb and react to energy from sound waves. Consequently, the patterns of these sound waves can have 'pacesetting' effects on our physiologies. By influencing and shaping the electrical signaling patterns in our hearts and brains, music plays an intriguing role in determining our health states. As Lebron James describes above, music can change our moods and energy levels in profound ways. At the cellular level, these responses occur because our neurons 'play along with the music', firing in synch with the beats and rhythms of the songs we hear. This synchronization phenomenon is important because it turns out that the music we love and enjoy looks, when visualized, just like healthy heart beat patterns do: they both display non-linear, self-similar, multifractal complexity with power-law long-range correlations and scale-invariance. Now for the 'chicken or the egg' question: Do we create fractal music as a manifestation of how our bodies are naturally built to operate (an ancestral default); or, do we compose fractal music because we hear it, like it, and respond by developing more of it? In practice, it is probably an inseparable positive, reinforcing feedback process.

Either way, fractal dynamics are very important to understanding diseases, aging, and health, and Ary Goldberger et al. study these intricacies diligently at the Rey Institute for Nonlinear Dynamics in Medicine at Harvard University. This abstract from one of their magnificent papers says it all, dispelling misinformed views of homeostasis:

According to classical concepts of physiologic control, healthy systems are self-regulated to reduce variability and maintain physiologic constancy. Contrary to the predictions of homeostasis, however, the output of a wide variety of systems, such as the normal human heartbeat, fluctuates in a complex manner, even under resting conditions. Scaling techniques adapted from statistical physics reveal the presence of long-range, power-law correlations, as part of multifractal cascades operating over a wide range of time scales. These scaling properties suggest that the nonlinear regulatory systems are operating far from equilibrium, and that maintaining constancy is not the goal of physiologic control. In contrast, for subjects at high risk of sudden death (including those with heart failure), fractal organization, along with certain nonlinear interactions, breaks down. Application of fractal analysis may provide new approaches to assessing cardiac risk and forecasting sudden cardiac death, as well as to monitoring the aging process. Similar approaches show promise in assessing other regulatory systems, such as human gait control in health and disease. Elucidating the fractal and nonlinear mechanisms involved in physiologic control and complex signaling networks is emerging as a major challenge in the postgenomic era.

Consider a musical piece that featured a repetitive beat, without much variability. This piece would annoy us and bore us to death. Well, if visualized, this repetition would resemble the sinusoidal and simplistic heart beat pattern of a person with Congestive Heart Failure, someone near death:

Conversely, a musical song that displays high multifractal variability, as Michael Jackson's song does in the visualization above, elicits positive responses from us; we love listening to his music. It's no surprise then that a healthy human heart beat pattern resembles Michael Jackson's music:

Sure, on the surface, this graph looks messy; but, that's life--life is messy and involves interpreting what seems like intractable uncertainty. Yet, just like in the visualization of Michael Jackson's song, this picture captures beautifully the striking similarity between the patterns found in MJ's recording and in the heart rate recording from a healthy person.

Unfortunately, Michael Jackson, a person who primed his 'pump' (heart) on healthy fractal signals for so many years, producing music that permeated the globe and crossed generations and cultures (music is a universal language), misused powerful drugs that degraded the multifractal complexity of his heart beat, breathing, and neuronal signaling patterns, resulting in sudden cardiac death. In essence, the many drugs that Michael Jackson was taking made his heart beat look like the dangerous Congestive Heart Failure graph above, making him susceptible to cardiac arrest. Drugs dampened out and muffled the vibrant 'music' of Michael Jackson's heart.

So, what do we do to improve our own health states in the wake of Michael Jackson's passing? We honor his musical legacy by engaging music advantageously in our daily lives. Although, this is not a passive activity. Psychological research shows the tremendous effects that our cognitive processes have on how much 'bang for the buck' we get out of our activities. For instance, a study of housekeepers showed that those workers who were told that performing their cleaning and organizing tasks met the recommendations for daily exercise experienced marked health improvements when compared to control group members who did not receive such information. Psychology matters. It changes our physiologies; it's psychophysiology. Thus, when listening to music, whether it is Bernie Williams playing the guitar, Sophia Melon playing the bass for KSM, Jay-Z doing what Jay-Z does best, or Cold Play performing Viva la Vida (a very fractal-friendly song, by the way. See below.), we should remind ourselves from time to time that listening to music enhances our health. Bernie Williams describes this musical psychophysiology perspective well:

“Music gives you rhythm, makes things flow, a lot of things you can utilize in baseball having a musical mind,” he says. “You have coordination, the rhythm, timing. There’s nothing better than having everything flowing in the game, and musically speaking, you can compare it to being in the zone, everything flowing, like it’s effortless. And it happens in both fields.”
In fact, when he’s on the field, he’s often got a tune in his head.

I am not a musician (unless you count tapping/banging/playing my fingers against/on the steering wheel in my car; I am pretty good at that, lol), but I have a lot of respect for those with musical prowess. I am an athlete who values music as Lebron James does, and my instruments are golf clubs and tennis racquets, two very fractal sports, as well as soccer boots and balls and basketballs (I spent my childhood on courses, courts, and fields, not in garages, at piano seats, or on stage). A musical note for me is a well-struck seven-iron to a back right pin; a step-over and upper-V shot from just outside the 18-yard box; a cross-over drive followed by a behind-the-back pass for a score; or, a winning backhand passing shot down the line. It's kinetic energy. Powerful multifractal musical patterns that resonate to our bones also appear in the movement and energy expenditure patterns (see Levy flights; well-designed golf courses and well-played golf rounds display Levy flight patterns) in many aspects of athletics and training (sprinting = yes; fractal, variable, and intermittent with high-intensity, low-duration; but, marathon running = no; simple, sinusoidal, and repetitive). Admirably, Bernie Williams integrated music and athletics authentically, creating flow throughout his mind, body, and spirit, beating to a fractal drum, creating synergy that propelled him to achieve his goals and perform amazing feats in both disciplines.

Be like Bernie: Embrace healthy multifractal living patterns, from music to athletics, and engage and tap into the additional power of perceptive psychology by reminding yourself regularly that these wise activities and choices will improve your well-being--mentally, physically, and emotionally (and perhaps, spiritually) in profound ways.

From reducing stress responses before, during, and after cardiac surgery to improving the health of patients with heart disease, music is (energy) medicine that can supplement other healing modalities in cost-effective ways (iTunes away!). Music is, after all, a FRACTICAL (fractal + practical) 'cheap health option' that carries little downside risk with potential for worthwhile upside benefit. The deep emotional reach is there; just consider how so many people bonded to Michael Jackson through his music: over the years, our minds associated positive feelings, thoughts, and physiological responses with his fractal dancing, singing, and performing productions. His music served a public health function; a fractal 'pacesetting' public health function. In the wake of his passing, his legacy allows us to learn by grace, rather than by hard knocks, the importance of caring for our hearts and brains in respectful ways. Harnessing music is one such graceful way.

It's a HeartBrain thing.

Let music reign.

Why De-Leverage? Black Swans Lurk

Why de-leverage?

Premise: Leverage creates future obligations based on historical trends, current circumstances, and projected scenarios; it establishes bets on how the future will unfold.

Example -- You enter a mortgage repayment agreement with terms and conditions that project your ability to pay back your loan over the next 30 years based upon your current employment and wealth status, among other things.

Argument: Black Swan hits, both positive and negative, will determine, primarily, how our lives unfold and progress in the future. Black Swans are unpredictable a priori.

Example -- Insert your own example here; instances abound.

Conclusion: Ergo, leverage restricts our abilities to act on options that emerge in the future.

Art DeVany's point (from months ago):

Options give you the ability to act on events after they occur, thus you retain your freedom of choice. Obligations, such as a mortgage, give you no choice.

More importantly, leverage 'pressurizes' our lives, from cash flow pressure (in monetary terms) to interpersonal relationship pressure (in energy, emotional, and mental terms), because we must continue to service our 'debts' regardless of our constantly updating and evolving circumstances. This pressure stifles innovation, creativity, happiness, and serendipitous exploration by confining the options that we can pursue; leverage reduces our freedom of choice. Unexpected and unpredictable options exist in the future, but leverage makes pursuit of some of these emergent options impossible because we must continue to operate in accordance with the future (or possible futures) we expected to occur when we entered our leverage contracts. De-leveraging positions us to be 'long on options' and 'short on obligations', allowing us to act on unexpected positive Black Swan hits while preventing collapse when negative Black Swan hits strike and rear their ugly heads.

However, leverage will not go away. Since leverage is a bet on the future, folks will continue to leverage themselves out to pursue these bets, and, inevitably, some of them will succeed (by chance, luck, hard work, or for whatever reason), and this success will spur further leverage moves, and the spiraling pattern of leveraged operations and living will ensue once more.

De-leveraging is one way to prevent spreading yourself too thin.

(+ / - ) Black Swans lurk in the shadows of the future; de-leveraging empowers us to act in accordance with the old adage that 'chance favors the prepared (and minimally-leveraged) mind'.

Stretched too Thin: Why Dunbar's Number and a Return to Localism are So Important to Improving the Human Condition in the Information Age

We've lost our way.

Don't get me wrong; there have no doubt been many benefits along the way.

But, we've moved too far away; far too far away. Like talented students heading off to college, we have "gone away" (and, perhaps, gone astray?).

The computing and internet revolution has transformed what it means to be human in so many ways, but human beings have interacted with each other under the real (gravitational) constraints of space and time for centuries and centuries; Facebook, Twitter, GMail, et al. are only brief glimmers along the human history timeline of social behaviors. Profoundly, the digitization of social interactions has warped space and time, pulling our relationships into realms we have never experienced before (chat boxes, Facebook wall posts, etc.). And, just because it exists, does not mean it is (entirely) good for us.

A return to localism, placeism (see Bill Kauffman; thanks to Dave Lull), and authentic social relationships is in order. In the blink of an eye, on an evolutionary time scale, we have changed the social textures of our world dramatically, moving us further and further into foreign territories for interpersonal relationships. On one hand, technology connects us with others and improves communication; yet, on the other hand, we have interacted with each other using these tools for so little time that, like the foods we eat, our minds and bodies do not know how to process them.

From a nation state (an arbitrary / historical line drawn in the sand that carries no validity in a globalized economic world) and government complexes that have grown to astronomical sizes to banks and automakers that are also far too big to succeed, we have endangered our health levels and relationships by stretching ourselves too thin; we have leveraged our energy levels, resources, and time far too far, and we pay the direct price as a result (obesity, chronic disease, exhaustion, unbalanced lives, etc. -- all which carry tremendous $ price tags that offset the economic value they create).

So, what do we do?

We need to de-leverage in every sense of the word: one, reduce personal, corporate, and government debt; two, balance our lifestyle choices with limits; and, three, localize our social spheres (some modern-day tech tools can assist in this way too). In an increasing global world, our minds, bodies, and spirits suffer when we pull ourselves in so many directions; at some point, we must stop and ask ourselves a simple question: "Why are we doing all of this again?"

It's a question that demands that we reflect.

The American government started as a self-limiting social contract, but somewhere along the way, we stretched the limits of that contract to the point where it no longer carried much weight, unleashing an unrelenting spiral of spending, empire-building, and police-state-enforced interventions. We've lost our way; the founding American way. It's the way of localism, placeism, and tribalism; of setting limits and boundaries; of recognizing human nature and constructing minimal yet effective social and cultural rules and expectations that 'protect us from ourselves'. United, Aetna, GM, JP Morgan, Medicare, and the US Department of Education, et al. represent monstrosities that are, quite simply, far, far too big for anyone to operate authentically and humanly within (we can't 'wrap our heads around them'). We need to return to our ancestral roots (respectfully); and, anthropologists, like Margaret Mead, represent one group of people who study these roots and try to deconstruct their implications for how we socialize today. It's a scientific inquiry.

Dunbar's number (thanks to Navanit Arakeri) is an anthropology concept that rises to the surface as constructive in understanding how best to respond to the 'stretched too thin' phenomenon through a return to localism. Other scholars have integrated this notion as well (such as Malcolm Gladwell and Robert Putnam), and Wikipedia provides this introduction:

Dunbar's number is a theoretical cognitive limit to the number of people with whom one can maintain stable social relationships. These are relationships in which an individual knows who each person is, and how each person relates to every other person.[1] Proponents assert that numbers larger than this generally require more restricted rules, laws, and enforced norms to maintain a stable, cohesive group.

Dunbar's number is not a concrete reality; it's an effort to capture the real social limitations that we face as humans: remember, we are (only) human beings. Each of us only has so much energy, so many talents, and so much cognitive and emotional bandwidth to pursue our jobs, maintain our living conditions, and enjoy our family members and friends. Amidst the current economic conditions, embracing the humility that Dunbar's number suggests seems more than reasonable (and could be quite helpful in pulling us out of this mess by restoring and enhancing social cohesion, stability, and innovation).

Just as the entropy of the universe is always increasing and we, as biological organisms, must work constantly to maintain and keep our body systems in check, we must respond to our increasingly global world with diligent local searching and acting patterns in order to achieve stable social relationships with the people we interact with, cherishing our times together along the way. As the big and global giants continue to fall, I suspect, those who embrace localism will be in prime positions to emerge from the ashes and flourish.

Bloom where you are planted.

Important Empirical Result: Safeway's Self-Insured (Cooperative) Health Experiment

Steve Burd, CEO of Safeway, discusses his healthcare experiment.

Read Steve Burd's recent piece in The Wall Street Journal here:

"How Safeway is Cutting Healthcare Costs: Market-based solutions can reduce the national healthcare bill by 40%"

Clearly, as his article and interview show, Steve Burd understands healthcare dynamics quite well.

A brilliant reader, Ahmed Fasih, responded insightfully to my previous post; here are his perceptive and valuable comments:

Epistemocrat, how big would a firm or cooperative have to be to spin off its own true health insurance (catastrophe insurance) company for its employees/members?

Is it feasible for such a company to exist side-by-side with the existing conventional healthcare and insurance industries? That is, could an entrepreneur start such a catastrophic health insurance company at once (after the research into the critical mass required)?

I see tremendous value in an entrepreneur working to expand on the Safeway experiment; in fact, I hope people do it. As far as numbers go, I always default (thanks to Navanit) to Dunbar's Number and then scale from there. As Safeway's experiment shows, it is feasible for innovative health coverage models to exist side-by-side with the existing conventional plans and players. Policies should then be adopted to support, rather than inhibit, the successes that these 'social labs' yield.

This is exactly what we need: more empirical results tested through small-scale, local experimentation. The social challenges we face in healthcare are far too complex to tackle any other way: do the best in your niche of the world and let the good news permeate.

Pricing Health Services and Risks

Sly answer.

There I sat, in one of the largest cities in the world, atop one of the tallest buildings in the city, across the table from the top executives of one of the largest health insurance companies in the world. It was quite a view, let me tell you.

"So, this is where my health premium dollars go; this is expensive real-estate," I quipped to myself.

I sat staring at a slide--a very important PowerPoint slide--that detailed the prices of the different health insurance packages that this insurer offers. From top to bottom, the prices decreased, as the list moved from the gold-plated prepaid healthcare plans (HMO's and the like; these are not 'insurance' products, by any means) at the top, down to the high-deductible, catastrophic and HSA (Health Savings Account)-compatible plans at the bottom. A previous slide had graphed the rapid rise in premiums that this health insurer charged over the past ten years, so I thought to myself, "Clearly, we simply cannot price health risk very well if this health insurer has raised its premiums each year at such an exponential rate. I wonder if this pricing challenge applies to all the products this insurer offers?"

I raised my hand: "Have you had differential success in pricing your insurance products? Do you find it is more difficult to price your 'rich', comprehensive packages than it is to price your catastrophic, high-deductible options?"

A pause proceeded.

The motivation behind my question was simple: most of what we call 'health insurance' in today's marketplace is nothing more than (overly priced) prepaid healthcare--it's the only type of 'insurance' where the incentive is to consume it (file a claim). 'Use it or lose it' is the name of the game when it comes to health insurance, especially if your employer purchases your health benefits (defined benefits) for you instead of compensating you with higher wages (or defined contributions). Under the model, many non-insurable health services and events get included in and priced into health 'insurance' products. But, there exists a spectrum of health services marked by non-insurable, often chronic care events on one end, and insurable, primarily acute care events on the other. In this light, I suspect it is much more difficult to price the primary care services for an obese, diabetic patient who will move into and out of the healthcare system in a number of ways throughout the year. This is the 'car maintenance' (tires, oil changes) world of healthcare. In stark contrast, the price of an ankle surgery in the emergency room is much more concrete and acute (and perhaps involves less pricing variability; more predictability?); the 'car accident' health domain. Surely, we underwrite some health events more effectively than we do others.

That was my basic thought process that preceded my question.

The sly answer: "We prefer that people purchase comprehensive packages."

"Of course you do," I thought to myself, "You want as much of my money as you can get your hands on, and up front, no less."

I left this enlightening meeting with the Chief Medical Officer, Chief Legal Counsel, and a few other C____ folks without a direct answer to my question, but pretty sure I received the answer indirectly.

The real answer: Health insurers are operating on a 'free-option' right now. They have simply raised their prices every year as healthcare costs have escalated--they must do so in order to cover their overhead obligations and return profits. Meanwhile, through consolidation and growth, the distribution of health insurance companies in America looks disastrously power-law (and fragile), with a small number of insurers (WellPoint, Aetna, United, etc.) dominating the financial landscape (analogous to JP Morgan, et al. in the banking realm), reaching overwhelming sizes that make these organizations far 'too big to fail'. The problem is, they are going to fail, and, when they do, their 'too big to fail' statuses will result in socialized costs through government bailouts. It's the free-option that privatizes profits and socializes costs.

The real answer, I suspect, is that we cannot price all health services and risks well. Our current 'health insurance' system incentivizes people to consume health services, lacks incentives for healthy lifestyle choices, and fails to hold people accountable (where appropriate and financially reasonable) for their poor health decisions. We lack individual accountability where it makes sense, and we bankrupt people for healthcare events where catastrophic protection makes sense. The opposite should be the case. Health insurance should insure against bankruptcy (you should not have to worry about losing your house because a brain tumor strikes randomly/unfortunately despite your lifelong conscientiousness), but it should not pay for your visit to see a physician when you have the flu (if your brain tumor were truly caused by really poor health choices, you would have paid the individual costs individually over the years through all the health problems that preceded this unfortunate event). We can't pay for everything in healthcare, so what we do elect to pay for lies at the core of our current health reform debates. If, inevitably, we are going to socialize the costs of medical care, it seems apt that we discuss which costs these are going to be, cutting back 'health insurance' to actual insurance by increasing defined contributions (scaled according to income) and reducing the size of our defined benefits in order to remove the abundance of third-party parasites in the system while reconnecting patients and providers directly as much as possible (a la, Hello Health).

Remember: 'Health insurance' does not ensure access to health care. Health care does not ensure health. Ergo, take all steps possible, for your own sake (if you are lucky enough to be healthy), to enhance, maintain, and preserve your health so that you access health care as little as possible and avoid health insurance claims as much as possible. Our current state of affairs pays for and provides far too much care to people who act irresponsibly, reducing our ability to serve those who truly need and deserve medical services. I wouldn't want a physician spending time and energy caring for my sinus infection if it were caused by my lack of sleep, my carb or beer binges, and my failure to exercise (personally, I elect for Ancestral Fitness, instead). I don't want to clog up our limited resources that could better be used to care for more valuable care, such as life-saving surgery for a baby with a birth defect. Call it social responsibility; call it individual responsibility; call it whatever you like; but, we must figure out how to build a health reform bridge to get us out of this mess and move toward a healthcare system that performs a defined role in society and holds individuals appropriately accountable for their health choices while protecting those deserving of health services from fearing bankruptcy should fate strike their health states in unfortunate and devastating ways.

I don't know what this 'bridge' looks like, although I have implied one above and in previous posts, so I invite you to chime in here or join the following discussions and serve as a healthcare reform bridge-building architect / engineer:

Theory to Practice - Where to Begin with Healthcare Reform (Hint: Look in the Mirror)

http://theorytopractice.wordpress.com/2009/06/17/where-to-begin-with-healthcare-reform-hint-look-in-the-mirror

Y-Combinator - Milton Freedman: How to Cure Healthcare
http://news.ycombinator.com/item?id=667411

To good health.

The Illusion of Individual Responsibility

All the rhetoric right now, from all directions, proclaims that our healthcare system is broken. Fine. But, in reality, our bodies are broken, not our healthcare system. Fix our bodies and you fix our healthcare system. Period. It's that simple. The goal of a health care system, anyways, is to improve, maintain, and preserve people's health. But, that is not happening, and it is not happening because most of our personal health decisions occur outside of the healthcare system: in our homes, at our places of work, in our local restaurants, and within other local ecologies. These are the places where our bodies mend, break, and, hopefully, flourish--not, for the most part, in hospitals, clinics, and other medical buildings. 

With this prelude, I want to highlight a comment made to my previous post; it illustrates the Illusion of Individual Responsibility well:

I think a free market health care system would be best as it would shift most of the burden of paying costs to the unhealthy (although some people are unhealthy because of genetic diseases, most unhealthy people are so from choices). Whereas universal health care is basically just a big subsidization of unhealthy behavior that transfers wealth from the healthy to the unhealthy. It will eventually break down and cost controlling measures like sin taxes and mandatory this and that where people are being controlled like puppets will take place.

Ultimately, I don't think poor health is a societal problem, per say, just so long as the unhealthy are paying for their own treatments. It's your own body, do what you will with it.

I agree that attacking wealth and income inequality via healthcare is not effective--this social challenge needs a more holistic approach--but the reality remains that we will, inevitably, bail out the healthcare system in a manner analogous to how we just bailed out our financial system. As Nassim Taleb says, "If you have to bail out, nationalize." Thus, nationalizing health insurance--but it must truly be insurance, not prepaid healthcare--would allow for catastrophic coverage to be a socialized cost (as would occur during a health system collapse anyway). If nationalized health insurance were purely catastrophic, with high deductibles scaled according to income, then people would bear the risk and burden of their daily lifestyle choices because they would have to pay out-of-pocket for most (>80%) of their health services throughout their lives. In this system, there would be an incentive to stay healthy. If you have a cold, pay the doctor cash, credit card, etc. Don't file an insurance claim. A cold is a non-insurable event. 

Total top-down control suffers from the illusion of control, but the illusion of individual responsibility is important as well. The illusion of individual responsibility emerges when we construct social systems that purport to hold people accountable for their actions, but, when things collapse, they end up bailing people out, thus nullifying their claims about individual responsibility because the costs are ultimately socialized. We all, in the end, bear the costs. The illusion of individual responsibility tempers certain ideological perspectives. It sounds good on paper, just as top-down reforms from on high (Obama's magic wand, for instance) sound good on paper as well. However, in reality, we must simply find ways to heal our bodies, not our healthcare system. Our healthcare system is stretched too thin, unable to provide the resources necessary to care for people's health problems, because our bodies, collectively, are too broken. 

Fix our bodies and you fix our healthcare system.

That's the goal, right, to achieve health?

The Patient of One: Protecting Us from Ourselves

Nassim Taleb mentioned recently the need to reduce or remove debt from our culture to 'protect us from ourselves'. Complex systems--those that drive our modern environments--don't like debt (leverage), Nassim points out, because debt represents a bet on the future; a bet that things will turn out a certain, envisioned way, thus allowing the debt to be repaid, and with interest no less. When the unexpected Black Swan strikes--as many have found with their mortgages/car payments/credit cards recently--the terms of the debt agreement suddenly appear foreign and stretched, and the burden of these obligations grows. (Aside: If anyone has more information about Islamic and Christian cultural views of debt, please contact me; of note, the Parable of the Talents.) The possibility exists, then, had we eliminated debt from our financial practices (just because it exists, doesn't mean it is good for us), that we could have avoided our current downfall by protecting ourselves from ourselves.

Debt and leverage aside, another parallel question prevails: How do we protect ourselves from ourselves in terms of health? Widespread obesity, diabetes, and other chronic diseases show, quite clearly, that we need better mechanisms in health affairs to protect us from ourselves (as Mark Sisson would say, our healthcare system needs to get Primal). I have stated before that the current state of our healthcare system parallels the fragility of our financial system--the health insurance companies and health systems are 'too big to fail'--so determining how best to prevent a similar collapse is key. Just as we have done with banking, we will socialize the losses in healthcare as well. This is important because claims for individual responsibility in health affairs must be balanced with the fact that, like debt contracts, their validity disappears into thin air when the entire system collapses as a result of numerous people being unable to pay for their health services that, in many cases, resulted from poor lifestyle choices for many years.

But, what modalities exist to operationalize this effort to protect us from ourselves and help people achieve health? It's a tough gig; things get quite murky and uncertain quickly. 

Empiricism is needed, but here is a starting list (and a few associated examples):

• 'Sin' taxes (alcohol or sugary drink taxes)
  
• Legislation (mandates for preventive screenings)
• Education (nutrition curriculum)
• Culture (taboos, Ancestral / Primal Fitness)
• Religion ('Ten Commandments')
• Nudges (decision-making architecture)
• Business Models (Hello Health)
• Integrated Delivery Systems (Kaiser Permanente)
• Self-experimentation
• Technology (MyHealthInnovation)

The question is: What really works? Many traditional, mainstream approaches executed from the top down often provide illusions of control while failing to deliver results. Bottom-up modes of action, where innovations often bubble up, struggle to catch hold and reach wide audiences, though.

Ideology aside, this truly is an empirical question that requires answers from experiments--real-world tests (*see Dr. Atul Gawande's latest piece in The New Yorker, thanks to Dave Lull and Navanit Arakeri). Given that, as a whole, we clearly make choices daily that hurt our health states (either out of ignorance, lack of responsibility, lack of resources, or other reasons), what are the most efficient and effective ways to protect us from ourselves (its a humble question to ask, accepting that we don't understand our world as well as we think we might)? For instance, if choice architecture is best--a way to use psychology, behavioral economics, to save you from yourself (read on NPR here and about applications to protecting the environment here, thanks to Dave Lull)--then how do we figure out what the best architectural structures are? Do these frameworks impose upon individual freedom of choice and thought? Are they more 'paternal' than libertarian within their 'paternal libertarianism' school. Undoubtedly, we do know things from experiments about human irrationality while making decisions (see Kahneman, Tversky, and Ariel), and implementing these lessons learned surely could help people and improve their lives. 

It all harkens back to the 'searching versus acting paradox'. As members of the future 'Patient of One' healthcare system, I encourage everyone to participate locally in this searching and acting process.