I intend to retire early, and thus one of the challenges my family will face is what to do about health insurance until we’re 65 and can enroll in medicare. We have one kid already, and thus will need care for ourselves as well as children. We’ll have too much money to qualify for a subsidized Affordable Care Act (ACA aka Obamacare) insurance plan, and as of 2020 catastrophic health insurance is at least $1,000 per month for a family, and offers crappy coverage and high deductibles on top of the tens of thousands in premiums we’d pay.
On the plus side, we have been saving a good chunk in an HSA, which I recommend everyone take advantage of while working, so we can at least use that for out-of-pocket expenses.
One of us could work at least part-time to get subsidized insurance benefits.Another intriguing option is Direct Primary Care, where you pay a monthly fee (say, $100 or so) per month for primary care doctor’s visits and basic services (which might cost extra). DPC avoids insurance altogether, making both your life and your doctor’s easier.
While a DCP would cover the basics like labs, check ups, vaccinations, and maybe even bone-setting, what about surgery or other low-probability but extremely expensive hazards? To handle that, take a look at ‘health sharing’, an insurance-like membership plan to will reimburse you for health expenses after a (large-ish) deductible. Think of it as simpler, cheaper catastrophic health insurance, which you get a discount on if you also belong to a DPC.
You can compare the pricing & services providing by this combo of plans to traditional private health insurance by getting a quote at ehealthinsurance.com, and also search healthcare.gov for the health insurance exchange options.
I often wonder how many of our ‘modern’ diseases of obesity, depression, allergies, low back pain, nearsightedness, etc might be linked to things our ancestors did that we don’t, or vice versa. The following are my speculations on this theme.
It’s not ‘genetics’ when health changes across an entire population
Anytime we see a population-wide increase in a certain condition we should assume it’s due to an environmental factor, despite in-group genetic variation. Yes, you might be more likely to have glasses if your parents did, which may be nature or nurture, but if the entire population of Europe has gone from a near-sightedness rate of 15% to 50% in 100 years, you can be 100% sure that’s due to a change in environmental since our genes only change at glacial speed. (In the US, I could only find the change from the early 1970s to early 2000s: 25% – 42%, a huge jump in a single generation!)
Positive changes in environment with respect to health have happened as well thanks to modernity, like improved nutrition for children. This can be seen in the massive increase in human height in developed countries in the last 100 years:
Above: “Over the last two millennia, human height, based off of skeletal remains, has stayed fairly steady, oscillating around 170cm. With the onset of modernity, we see a massive spike in heights in the developed world.”
Examples of living against nature that lead to problems
Sunlight as a necessary nutrient
Getting frequent, incidental sun exposure, tailored to the climate in which your genes developed, is one of those things that I predict will be linked to many positive health outcomes, and the absence of which leads to bad outcomes. This might be the case for those with eczema. (If you suffer from eczema, try getting more sun for a while and tell me if you see any improvements!)
Another example of the benefits of sunlight, in addition to Vitamin D, might turn out to be eyesight: there’s mounting evidence that it’s lack of sunlight, or perhaps lack of being outside and seeing things far away, that has contributed to the epidemic of near-sightedness. Either way, spending a lot more of our time outdoors would surely benefit us on many levels.
One simple solution for children would be teaching certain elementary school classes outdoors (gym would be a natural candidate) or holding lunch outside when weather permits. I read a study that showed that even just 30-60 minutes of extra outdoors exposure per day could dramatically reduce the rate of nearsightedness in children.
The common, baseless wisdom on allergies used to be that children should avoid certain foods, dust, or animals for as long as possible. We now we know we should do the exact opposite: expose kids early on to these benign compounds that become allergens (e.g.: peanuts, dogs & cats.) This early exposure seems to teach our bodies that these things are safe and shouldn’t trigger an immune response. Households with dogs (most beneficial) and cats have children with healthier immune systems.
From an evolutionary perspective this makes sense: things your community ate and had been eating for millennia probably wouldn’t hurt you, and you would probably eat them as soon as you were weaned off breastmilk. (I haven’t googled this yet, but I’d bet that babies ‘learn’ that foods their mother eats while pregnant and during breastfeeding won’t hurt them either, and might prevent allergies that way too. We know that food preferences are passed to in-utero babies, so this speculation seems reasonable.)
The dietary wisdom around avoiding fat, particularly saturated fat, was also unscientific, against human history, and harmful. Gary Taubes and Nina Teicholz have argued this convincingly. This ‘common wisdom’, which really only started in the 1960s and 70s, is being slowly reversed through high-quality randomized controlled trials as well as personal experiences too numerous to ignore, although the medical & ‘nutrition’ fields are very slow to change their prevailing ‘wisdom’ that fat is bad for you.
If you’re trying to lose weight/keep from gaining weight as you age, I strongly recommend cutting out sugar (which includes the malt sugar in beer, sadly) and refined carbs as much as you can, and consider trying Atkins/keto for at least a month or two, and perhaps for life at some tradeoff between fitness and food pleasure that works for you. I have swung too far on the food pleasure side this past year, packing on 10 pounds more than I usually carry… Time to cut the sugar and carbs back down!
Modern cushioned, constrictive, and heeled footwear is another example which is probably at least partly responsible, along with our sedentary lives, for some debilitating physical problems including bunions and knee/lower back problems. This is because modern shoes encourage bad biomechanics and poor posture. Solve this problem early by keeping your kids barefoot/near-barefoot and out of modern shoes for as long as possible, preferably their whole lives!
Above: Can you tell which kid grew up running barefoot? It’s the one who isn’t damaging his knees with each step…
I’ve had knee pain since my late 20s and switched to Xero Shoes a few years ago for both shoes and sandals. Sadly, I didn’t do this until my mid-30s, after the damage was likely done over many years of bad biomechanics while playing basketball and squatting incorrectly… I still have knee pain from time to time, but the better footwear has caused me to be more aware of not heel-striking which helps a lot. The muscles in my feet got noticeably stronger as well during the first 1 – 3 months of wearing zero-drop, low-cushion, wide toe-box shoes, which was exciting.
If you do make the transition, which I highly encourage, take it slow. Start by walking a little bit each day in your barefoot shoes (or just barefoot around the house if you wear shoes or slippers indoors), then add more intense activities over time. I would say it took at least 2 – 3 months before I stopped becoming aware of the fact that I was wearing barefoot shoes, so give yourself time to adapt from a lifetime of poor footwear.
Try to replicate a natural environment for your body and mind by default
My general rule of thumb, which I’ve adopted from Nassim Taleb, is to question the perceived wisdom when it goes against what our bodies were naturally doing for 10s – 100s of thousands of years. Mother nature is an excellent distiller of good ideas on what works from a survival perspective.
[W]hat Mother Nature does is rigorous until proven otherwise; what humans and science do is flawed until proven otherwise. – Nassim Taleb
For me, this means (ideally…)
eating a low-sugar/low-refined carb diet with plenty of fat, and not eating until hungry, sometimes introducing wide gaps between meals (e.g.: intermittent fasting, which is most easily done by skipping breakfast)
avoiding smoking & tobacco, and absolutely no hard drug use (hallucinogenics seem ok generally, but do your homework. I’d bet heavily on edible marijuana being safer than alcohol in the long run, but just my guess.)
minimizing alcohol consumption
wearing flat, flexible minimalistic footwear
lifting heavy things with the right form/putting ‘loads’ on my body regularly. Backpacking, or even just walking, yard work, cooking, carrying your children, and DIY projects are great for building this into your everyday life.
Exposing myself to normal stressors like hunger, heat and cold (turn off the A/C, turn down the heat), sleeping on a firm surface on the ground (try the floor with a camp mat), walking on uneven paths vs flat, paved surfaces, and carrying/lifting heavy things. Try to use your body’s power as much as possible vs that of a machine. Hand tools and DIY are good for this (I love my Fiskars push reel mower; look for them used if you wanna pick one up cheap.) So is carrying your baby or groceries instead of using a stroller, car, or cart. These stressors help our bodies grow stronger and more resilient. I wonder how much of older people’s inability to live comfortably outside of a narrow temperature range, orthopedic footwear, and cushy thermo-foam-ic mattresses is related to a lifetime of coddling our bodies and removing the very stressors that keep us healthy. Movement expert Katy Bowman has many interesting thingsto say on this topic.
exposing my eyes and body to frequent, incidental sunlight by trying to spend more time outside, and aiming for every-other-day sun exposure (while avoiding sunburns!) I live in the Pacific Northwest and have pale, northern European genes, so I’m probably safe in this mostly-cloudy climate, except perhaps in summer. If you are white and live in Texas, that’s not natural, and you probably need to take more precautions when outside. If you’re black and live in northern Sweden, you might need to get more sun exposure than usual.
Speculative advice on kids
I would be especially cautious around introducing modern-unnatural things for kids, partly because brain development doesn’t even finish until we’re in our 20s. For me, that will mean convincing my wife to breastfeed our infant for as long as she can stand, no TV/phones/screens until our kids are at least a few years old (and minimizing it thereafter), no/minimal shoes, plenty of outside time, minimal sugar, lots of whole foods (chewing is good for jaw development), lots of playing, talking, reading, exercising, and socializing, and keeping them off drugs & alcohol at least until they’re into adulthood.
I haven’t really talked about the mental aspect of modern living, but there are plenty of studies linking social media use to depression, and others that show that spending time in nature makes you happier, and maybe even (at least temporarily) smarter. A short walk around my tree-filled neighborhood always leaves me feeling more relaxed & positive.
There’s nothing anti-scientific about living more naturally by default
Nothing I’m suggesting about ‘living in accordance with nature’ is unscientific or meant in any hand-wavy, spiritual way (although if living with nature is comforting to you spiritually, there’s nothing wrong with that!) I’m merely pointing out that our bias should be to assume that many aspects of the environment that human genes have developed in are likely to be important to our health. The absence of these environmental factors (sunlight), or the presence of new modern ones (cigarettes), should be viewed with extreme suspicion when we try to figure out where the diseases of modernity have come from.
If our ancestors didn’t suffer from low back pain, lung cancer, obesity, and nearsightedness like we do, and if we can see all of those diseases rising dramatically over the course of a few generations, it’s obvious that the cause is environmental, and that we should look to alter our environment (or stop altering it so much) as the easiest, cheapest, and most reliable fix. Sometimes that might come from technological ‘nature replacements/enhancements’ (vitamins & vaccines), and sometimes it might come from eschewing certain modern ‘conveniences’ (digital screens & Nike running shoes.)
Closing thoughts and caveats
Some natural things will be harmful, and many unnatural/modern ones are beneficial
‘Found in nature’ doesn’t of course mean ‘beneficial’. Plenty of things can kill you in the wild, and not all practices by prehistoric peoples will be good ones (although they are unlikely to be catastrophic to the species, otherwise those peoples would not have been our ancestors.) We know that there are negative side effects to consuming certain compounds propounded as medicine by primitive peoples (like those who call themselves “naturopaths”), and that it appears to be far safer to isolate the beneficial chemicals as pharmaceuticals in many instances.
Unnatural products can be hugely beneficial when the costs of doing nothing are large, and sometimes they simply mimic nature
Vaccines trigger our natural immunity response to build anti-bodies to fight deadly diseases, and they’ve saved millions of lives from polio, small pox, and the flu. Penicillin is probably the greatest life-saving drug in the history of the world. (Penicillin on Wax is probably the greatest 90s rap album cover in the history of the world.)
Vitamins and the fortification of foods to eliminate nutritional deficits have helped children grow up healthy and strong. Iodine in salt prevents goiters. Vitamin D helps make up for our modern lack of sunshine. Of course, those deficiencies were often the result of us removing the vitamins and nutrients in the first place by, say, replacing nutritious whole wheat and brown rice with the nutrient poor, and more fattening, white, processed versions.
Chlorine in our water prevents deadly pathogens from poisoning us, and fluoride in the trace amounts found in toothpaste protects our teeth from all the sugar & soda we’ve added to our diets. (There’s some controversy on fluoride in the water. I’m speaking here about real medical experts debating the optimal amounts and methods to get fluoride onto our teeth, not the tin-foil hat variety that considers fluoride a government plot akin to chemtrails.)
If I’m about to die young-ish, I want an ‘unnatural’ procedure
Many other modern procedures that extend life in extreme circumstances are highly desirable like heart surgeries or knee replacements. This class of costly modern interventions are probably best used when the downsides of not using them are clear and dramatic (you will die/not walk otherwise), not when the upsides are fuzzy and marginal (you agree to risky back surgery for low back pain, rather than utilize the most natural and safer option of weight loss & physical therapy.)
But modern cures often cover up modern root causes
Many of our modern inventions (contact lenses, say, or orthopedic shoes) may just be band-aids to problems of our own making that could be better solved by getting at the root cause earlier, and avoiding the need for a technical ‘fix’ later.
Some fixes might be worse than doing nothing. Blood-letting is a medieval example. Widespread prescriptions of addictive opioid painkillers is a modern one.
Live it up more naturally!
Get out there into the fresh air and sunshine and use your body like nature intended. Expose yourself to more of life’s useful stressors. Carry and breastfeed your babies if you can (but don’t sweat the breastfeeding too much if you can’t; modern formula is very good!) Change your diet to eat more whole foods and cut back on booze, tobacco, and sugar. Wear minimalist shoes, and spend some time without cushy furniture.