That 90% number is plain not true. Please cite any source for that.

The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/)

Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesi...

I was using obesity as a standin for metabolic syndrome to compare populations. Not sure if measure how many ppl have 'metabolic syndrome.

https://www.nhlbi.nih.gov/health/metabolic-syndrome

metabolic disease = all things that can be fixed by lifestyle modifications ( unless you are too far gone, ie).

see my reply here: https://news.ycombinator.com/item?id=32744868

Metabolic syndrome is often a side effect of medication or symptom of other diseases that can't be fixed with lifestyle modifications alone.

For example, there are a lot of people on psychiatric medications that can cause metabolic syndrome as a primary side effect.

> is often

Would be interesting to know how often.

Tens of millions of people in the US take atypical antipsychotics and antidepressants that cause metabolic syndrome as a very common side effect.

I wonder though how much this drives up the cost.

Because obesity also drives down lifespan, and age has a huge impact on healthcare expenditures.

Obesity, like smoking, is one of those morbidities that lower lifetime healthcare costs significantly, as most costs are incurred in old age, as you saisd. Obesity, smoking, etc can kill before reaching an age where people start incurring high costs.

There is a lovely tale from Czech Republic in 2001 where Philip Morris was distributing analysis showing the economic benefits of smoking to their shared healthcare pool.

https://www.wsj.com/articles/SB995230746855683470

Don’t get so hung up on precise numbers. We all know Americans are obese and that greatly adds to healthcare costs.

I can’t imagine any downside of trying to prioritize lowering obesity.

"Don't get so hung up on precise numbers", uh, 90% isn't just imprecise, it's so catastrophically wrong that it undermines your entire argument

This is a topic that’s always going to have wildly different numbers. Who cares? It doesn’t change what we all know to be true. Nothing has been undermined whatsoever

What we all know to be true is your troll status.

Do you know the right number by any chance?

Thank god we aren't discussing your imagination, then.

My state has a "stupid motorist" law that requires people who negligently put their vehicles in danger and then use state resources to get bailed out, to pay for the rescue themselves. Perhaps we could create a "stupid eater law" for medicare/medicaid, forcing obese people etc to pay for their own private health insurance or healthcare which would free up money for others to buy more healthcare privately (via lower tax burden). My families healthcare would definitely be more affordable if I weren't burdened paying for the negligent actions of others.

Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? This is one of the moral hazards of a socialized medical system. When the rest of society is paying for your medical care it becomes tempting to save money be dictating exactly how you're allowed to live your life.

Obesity is a serious public health problem but we won't fix it by calling people stupid or charging them extra.

Yes I think that makes sense, to an extent. Maybe not specifically those because they are too hard to measure. But it would be a great way to have people put skin in the game. As a taxpayer paying for others’ healthcare I’d love if they were incentivized to live healthier lives to reduce costs

There are people genetically predisposed to gain weight or have heart disease. Cancer can be Russian roulette, as is your immune system picking up random autoimmune disorders. Accidents happen.

There are too many stakeholders with too many backgrounds and conditions for anything like your proposed system to work. Everyone would be angry.

> There are people genetically predisposed to gain weight

And this genetic mutation somehow happened in the last 50-100 years or so? Obese people have always existed. Obese poor people are fairly new. The root cause is diet, not genetics.

It's "common knowledge!"

Read "a contamination theory of the obesity epidemic" to see how incorrect your assumptions are.

Human HLA / MHC have a significant role in gut microbiota composition.

Gut flora, in turn, play a significant role in hormone and appetite.

The interactions are complex, but genetics contributes to obesity.

>Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby?

Yes, precisely. Keep chopping down at these factors until all that's practically left is private healthcare -- that's a feature not a bug. It's enough that I have to pay the bill to scrape the blood off the street when a motorcycle is crashed, not interested in paying someone elses motorcycle related health premiums on top of that (I've gotten enough motorcycle injuries while carrying my own private healthcare :) )

>This is one of the moral hazards of a socialized medical system.

As you say with public healthcare the effect (you say temptation) is to socialize your health related losses while privatizing the gains you reap.

Yes, I'm getting sick of paying for people who drive cars, go to restaurants and concerts, and have children.

> socialize your health related losses while privatizing the gains you reap.

Those famous health care gains.

I'm not sure how the heck you jumped from "drive motorcycles" to "drive cars".

Driving cars would be minor and apply to almost everyone, so it would mostly cancel out and be negligible. Really it would be a slight discount for taking transit, and that seems... fine to me.

And those other ones aren't even notable risk factors.

Not people who live in dense cities with good subway systems and a walkable infrastructure. Driving is one of the most dangerous things humans do. The argument that all health care should be private– the perspective this comment addressed– would not make such a consolation simply because it's common.

> Not people who live in dense cities with good subway systems and a walkable infrastructure.

Yeah, so almost everyone.

> Driving is one of the most dangerous things humans do. The argument that all health care should be private– the perspective this comment addressed– would not make such a consolation simply because it's common.

Car deaths are about 1% of deaths. Heart disease and cancer are each around 15x as likely.

Even if it's high on the danger scale, I don't think it would be a very big factor in health care costs.

The US is a big place but most people live in cities. Few car accidents are fatal.

CDC: Motor vehicle crashes are a leading cause of death in the U.S.1, with over 100 people dying every day. 2 More than 2.5 million drivers and passengers were treated in emergency departments as the result of being injured in motor vehicle traffic crashes in 2015.1 The economic impact is also notable: for crashes that occurred in 2017, the cost of medical care and productivity losses associated with occupant injuries and deaths from motor vehicle traffic crashes exceeded $75 Billion."

American Society of Civil Engineers infrastructure report card says only 45% of the US population has no access to public transit.

> Motor vehicle crashes are a leading cause of death in the U.S.1, with over 100 people dying every day.

Motor vehicle crashes are slightly outside the top ten causes of death. Those 100+ deaths are coming out of about 9300 total deaths.

> The economic impact is also notable: for crashes that occurred in 2017, the cost of medical care and productivity losses associated with occupant injuries and deaths from motor vehicle traffic crashes exceeded $75 Billion.

Productivity losses are outside the scope of medical costs, but even if we include those dollars that's $75B out of $4100B in health care spending.

So I stand by my statement that it's a pretty small impact.

> American Society of Civil Engineers infrastructure report card says only 45% of the US population has no access to public transit.

And most of the other 55% still need cars.

You said "good subway systems and a walkable infrastructure" and that's what I responded to. We can go ahead and remove the word "subway", but the fraction of people with access to good public transit systems is pretty small.

Sure. As long as we tighten up on other externalities.

You use a lot of energy? You pay for the damage to the world.

> Perhaps we could create a "stupid eater law" for medicare/medicaid, forcing obese people etc to pay for their own private health insurance

That might be a good idea after we make sure that every single person has equal access to healthy foods and equal ability to afford healthier options. Maybe we could also ban companies from adding HFCS to everything, ban advertising of any unhealthy foods, fine people for not wearing masks or vaccinating their babies, and police what people are allowed to have in their refrigerators so we can punish anyone who has too many unhealthy foods in their home!

Or... maybe we can let doctors and scientists figure out what the best ways to combat the obesity problem are and try to find ways to help people instead of punishing them while in the meantime making sure everyone has access to the care that they need. If we had universal healthcare the costs for your family would the same as everyone else no matter if you or the next person drinks, or smokes, or likes rock climbing, or plays sports, or drives more than x number of miles in a year, or has more than x number of sexual partners, or doesn't exercise at least x number of hours a day and nobody would have to go around spying on everybody to make sure they aren't doing anything that might raise someone else's costs "or else".

>yea because they have healthy population, its not because of some smart govt policy

yes it is, because the health population itself is supported by strong intervention. Singapore banned the advertisements of sugary drinks years ago, Singapore strictly regulates the number of vehicle licenses in the country encouraging public transport and walking, it forces citizens to allocate money for healthcare to private savings funds which incentives reducing your own healthcare costs, and so on.

The reason American's are obese isn't a miracle or because Americans are stupider, it's because Americans refuse to take collective action when it comes to the health of the nation.