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> It's more expensive to not make it accessible. I was under the impression that USA healthcare has out of control costs due chronic diseases[1] . None of whi

> It's more expensive to not make it accessible. I was under the impression that USA healthcare has out of control costs due chronic diseases[1] . None of which have any 'preventative care' that you get at an hospital( cancer maybe an exception) . What can a hospital do about 'physical inactivity' ? We can blame this or that but mind boggling half the population in USA is obese. What can any healthcare system possibly do about that. https://www.cdc.gov/chronicdisease/about/costs/index.htm https://www.cdc.gov/chronicdisease/about/costs/index.htm

DoreenMichele 4y ago
This is true and not really relevant to the point that people who can't afford healthcare get very sick before they go to a doctor and then their care is more expensive and has worse outcomes. One hospital was having so many resources consumed by a relatively small number of very ill homeless people and concluded that housing them would be cheaper and more effective, so it did. Health care really shouldn't be used to mean medical care per se. And that's one of the things that complicates such discussions. https://news.ycombinator.com/item?id=34397790 https://news.ycombinator.com/item?id=34397790
- 908B64B197 4y ago
  > Health care really shouldn't be used to mean medical care per se. And that's one of the things that complicates such discussions. Exactly. Whole hospital floors are completely dedicated to patients with completely preventable diseases with proper lifestyle choices (uncontrolled type-II diabetes, most cardiac and vascular surgeries...). What these people needed a decade or two ago was someone to coach them/engage in a long term discussion about their labs and deteriorating health with them. I can't help to think that defining healthcare exclusively as medical care is an attempt at further gatekeeping from a profession already known for these practices... I mean, what brings in more dollars for the provider, a series of hospitalizations and vascular surgeries or a few hours of consulting and coaching?
PuppyTailWags 4y ago
When I was fat, my insurance wouldn't cover any weight loss procedure (including just visiting my primary physician to discuss my options for weight loss-- a lovely $250 surprise) because I had no obesity-related health problems (heart disease, diabetes, joint issues, etc). So a hospital can actually do a lot for fatties. Being able to talk to a nutritionist, set up a plan, gain access to any applicable medication, addressing out underlying inflammation/hormone/disordered eating...
- hn92726819 4y ago
  How many pounds over a healthy weight were you? 20? 50? 150? Just curious
  - PuppyTailWags 4y ago
    Doesn't matter. I asked how significantly overweight I had to be to have access and the insurance company told me there's no weight-- it's purely obesity related health condition only. Theoretically also I could be 10 lbs overweight and diabetic and get a fast track to ozempic, lol. At one point my family medicine guy suggested he could write down something arguable just to get me to a nutritionist (think making me do some wicked pose while measuring my blood pressure and then writing it down as "high blood pressure") and I told him just don't bother. We did however in future meetings ensure I always had something else to talk about besides my weight progress so I'd never get billed again.
  - dangwhy 4y ago
    They usually consider you for surgery if your bmi is over 40 and you've tried ( and failed) conservative approaches to weightloss.
    - deleted 4y ago
      [deleted]
    - PuppyTailWags 4y ago
      No, that's not the case for many insurance companies. My insurance company only qualified surgery if you had a qualifying health condition. If you were just obese you didn't qualify.
avgcorrection 4y ago
- Let’s go mountain biking! - I’m uninsured. Too risky. You could do something about that.
- dangwhy 4y ago
  lack of insurance is stopping people from taking a walk around the block. It has to be a extreme sport.
  - avgcorrection 4y ago
    I don’t see why not. People who do vigorous sport can turn into complete couch potatoes once they are too old to practice that sport. Difficult concept for you to get, perhaps? Hint: being “healthy” wasn’t the point; it was the excitement, the adrenaline… etc.
  - DoreenMichele 4y ago
    Our built environment makes it difficult to walk anywhere. We should work on that.
tristor 4y ago
I am obese, I have been fighting my weight nearly my entire life. At one point I did manage to get down to a "normal" weight and body fat percentage, but it took more than 7 years of concerted disciplined effort to do so, and it disappeared in less than 6 months by no longer eating as a significant calorie deficit, despite a massive increase in physical activity. For many obese people, for reasons we don't fully understand, our metabolism does not work the same as for people who are not obese. The first time we've had any sort of medical intervention that seems to actually address this is the invention of GLP1 agonists and similar medications. Most insurance providers REFUSE to provide coverage for these medications, even though they are a net positive for the patient and society. Taking a GLP1 agonist while obese can straight-out /prevent/ the development of Type 2 Diabetes, even while you are still obese, and can cure some people of Type 2 Diabetes while they are ungoing further treatment. I am very lucky in that my insurance does cover this treatment. The insurance of several of my friends (who are on ostensibly "better" plans because their premiums are more heavily covered by their employers) does not cover this. If I could make one legal change to the healthcare system in the US, it would be to require insurance providers to cover preventative treatments for obesity. Obesity is the primary cause of chronic health problems in the US, and it's nearly entirely preventable with proper care, but it's almost impossible to get that care /even as a tech worker with employer-provided insurance/. It should be affordable and accessible for nearly anyone in the US to get access to GLP1 agonists and a dietitian. It isn't currently. Lacking this, means that obesity will continue to be a social disease that drives up healthcare costs and drives down productivity, quality of life, and total life outcomes in the US.
- dangwhy 4y ago
  > For many obese people, for reasons we don't fully understand, our metabolism does not work the same as for people who are not obese. My impression was that obese people first get less insulin sensitive over the years and then become obese as a result. They usually measure insulin sensitivity as a proxy to 'metabolism'. > It should be affordable and accessible for nearly anyone in the US to get access to GLP1 agonists and a dietitian. I thought it was only approved for diabetes not obesity.
  - 4y ago
pessimizer 4y ago
> I was under the impression that USA healthcare has out of control costs due chronic diseases. It's an incorrect impression. All health care systems have to deal with chronic diseases. Americans are fat, through they aren't twice as fat as other people, and the UK and Greece are nearly as fat in Europe. US health care costs are out of control because the system is kleptocratic. > What can any healthcare system possibly do about that. Its damned job. The healthcare system doesn't get to complain about the existence of sick people, even if people eugenically think that some illness are less deserving than others.
- dangwhy 4y ago
  > through they aren't twice as fat as other people Did a quick google search. "The Health Survey for England 2021 estimates that 25.9% of adults in England are obese and a further 37.9% are overweight but not obese." 1 "Approximately 70% of American adults have obesity or overweight. " 2 1. https://commonslibrary.parliament.uk/research-briefings/sn03336/ https://commonslibrary.parliament.uk/research-briefings/sn03... 2. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014 https://www.fda.gov/news-events/press-announcements/fda-appr...
  - deleted 4y ago
    [deleted]
  - deleted 4y ago
    [deleted]
- logifail 4y ago
  > Americans are fat, through they aren't twice as fat as other people They are, almost: "US obesity prevalence was 41.9% in 2017 – March 2020"[0] "25.9% of adults in England are obese"[1] [0] https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html [1] https://commonslibrary.parliament.uk/research-briefings/sn03336/ https://commonslibrary.parliament.uk/research-briefings/sn03...
JohnFen 4y ago
> I was under the impression that USA healthcare has out of control costs due chronic diseases That certainly doesn't explain a great deal of it.
kerkeslager 4y ago
For me, my ability to stick to a diet was predicated on my ADHD being properly medicated. I never reached the "obese" category, mostly because ADHD seemingly doesn't prevent me from sticking to an exercise plan, but I was in the "overweight" for most of my 20s because I wasn't able to focus consistently enough to effectively count calories. Many people can't stick to a diet or exercise plan because they haven't been treated for a related problem. For example, many people can't effectively exercise due to joint pain which could be alleviated by physical therapy which is frequently denied by health insurance. Additionally, the "healthcare system" includes stuff like nutritional and exercise education, public gyms, etc., all of which are woefully underfunded in the US. Worse, the programs which do exist have been heavily influenced by lobbyists (lobbyist influence on the Food Pyramid, for example, is well-documented). The corporate right to lie in advertising also means that much education is undermined by straight up lies in ads.

DoreenMichele 4y ago

This is true and not really relevant to the point that people who can't afford healthcare get very sick before they go to a doctor and then their care is more expensive and has worse outcomes. One hospital was having so many resources consumed by a relatively small number of very ill homeless people and concluded that housing them would be cheaper and more effective, so it did. Health care really shouldn't be used to mean medical care per se. And that's one of the things that complicates such discussions. https://news.ycombinator.com/item?id=34397790 https://news.ycombinator.com/item?id=34397790

908B64B197 4y ago
> Health care really shouldn't be used to mean medical care per se. And that's one of the things that complicates such discussions. Exactly. Whole hospital floors are completely dedicated to patients with completely preventable diseases with proper lifestyle choices (uncontrolled type-II diabetes, most cardiac and vascular surgeries...). What these people needed a decade or two ago was someone to coach them/engage in a long term discussion about their labs and deteriorating health with them. I can't help to think that defining healthcare exclusively as medical care is an attempt at further gatekeeping from a profession already known for these practices... I mean, what brings in more dollars for the provider, a series of hospitalizations and vascular surgeries or a few hours of consulting and coaching?

PuppyTailWags 4y ago

When I was fat, my insurance wouldn't cover any weight loss procedure (including just visiting my primary physician to discuss my options for weight loss-- a lovely $250 surprise) because I had no obesity-related health problems (heart disease, diabetes, joint issues, etc). So a hospital can actually do a lot for fatties. Being able to talk to a nutritionist, set up a plan, gain access to any applicable medication, addressing out underlying inflammation/hormone/disordered eating...

hn92726819 4y ago
How many pounds over a healthy weight were you? 20? 50? 150? Just curious
- PuppyTailWags 4y ago
  Doesn't matter. I asked how significantly overweight I had to be to have access and the insurance company told me there's no weight-- it's purely obesity related health condition only. Theoretically also I could be 10 lbs overweight and diabetic and get a fast track to ozempic, lol. At one point my family medicine guy suggested he could write down something arguable just to get me to a nutritionist (think making me do some wicked pose while measuring my blood pressure and then writing it down as "high blood pressure") and I told him just don't bother. We did however in future meetings ensure I always had something else to talk about besides my weight progress so I'd never get billed again.
- dangwhy 4y ago
  They usually consider you for surgery if your bmi is over 40 and you've tried ( and failed) conservative approaches to weightloss.
  - deleted 4y ago
    [deleted]
  - PuppyTailWags 4y ago
    No, that's not the case for many insurance companies. My insurance company only qualified surgery if you had a qualifying health condition. If you were just obese you didn't qualify.

avgcorrection 4y ago

- Let’s go mountain biking! - I’m uninsured. Too risky. You could do something about that.

dangwhy 4y ago
lack of insurance is stopping people from taking a walk around the block. It has to be a extreme sport.
- avgcorrection 4y ago
  I don’t see why not. People who do vigorous sport can turn into complete couch potatoes once they are too old to practice that sport. Difficult concept for you to get, perhaps? Hint: being “healthy” wasn’t the point; it was the excitement, the adrenaline… etc.
- DoreenMichele 4y ago
  Our built environment makes it difficult to walk anywhere. We should work on that.

tristor 4y ago

I am obese, I have been fighting my weight nearly my entire life. At one point I did manage to get down to a "normal" weight and body fat percentage, but it took more than 7 years of concerted disciplined effort to do so, and it disappeared in less than 6 months by no longer eating as a significant calorie deficit, despite a massive increase in physical activity. For many obese people, for reasons we don't fully understand, our metabolism does not work the same as for people who are not obese. The first time we've had any sort of medical intervention that seems to actually address this is the invention of GLP1 agonists and similar medications. Most insurance providers REFUSE to provide coverage for these medications, even though they are a net positive for the patient and society. Taking a GLP1 agonist while obese can straight-out /prevent/ the development of Type 2 Diabetes, even while you are still obese, and can cure some people of Type 2 Diabetes while they are ungoing further treatment. I am very lucky in that my insurance does cover this treatment. The insurance of several of my friends (who are on ostensibly "better" plans because their premiums are more heavily covered by their employers) does not cover this. If I could make one legal change to the healthcare system in the US, it would be to require insurance providers to cover preventative treatments for obesity. Obesity is the primary cause of chronic health problems in the US, and it's nearly entirely preventable with proper care, but it's almost impossible to get that care /even as a tech worker with employer-provided insurance/. It should be affordable and accessible for nearly anyone in the US to get access to GLP1 agonists and a dietitian. It isn't currently. Lacking this, means that obesity will continue to be a social disease that drives up healthcare costs and drives down productivity, quality of life, and total life outcomes in the US.

dangwhy 4y ago
> For many obese people, for reasons we don't fully understand, our metabolism does not work the same as for people who are not obese. My impression was that obese people first get less insulin sensitive over the years and then become obese as a result. They usually measure insulin sensitivity as a proxy to 'metabolism'. > It should be affordable and accessible for nearly anyone in the US to get access to GLP1 agonists and a dietitian. I thought it was only approved for diabetes not obesity.
- 4y ago

pessimizer 4y ago

> I was under the impression that USA healthcare has out of control costs due chronic diseases. It's an incorrect impression. All health care systems have to deal with chronic diseases. Americans are fat, through they aren't twice as fat as other people, and the UK and Greece are nearly as fat in Europe. US health care costs are out of control because the system is kleptocratic. > What can any healthcare system possibly do about that. Its damned job. The healthcare system doesn't get to complain about the existence of sick people, even if people eugenically think that some illness are less deserving than others.

dangwhy 4y ago
> through they aren't twice as fat as other people Did a quick google search. "The Health Survey for England 2021 estimates that 25.9% of adults in England are obese and a further 37.9% are overweight but not obese." 1 "Approximately 70% of American adults have obesity or overweight. " 2 1. https://commonslibrary.parliament.uk/research-briefings/sn03336/ https://commonslibrary.parliament.uk/research-briefings/sn03... 2. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014 https://www.fda.gov/news-events/press-announcements/fda-appr...
- deleted 4y ago
  [deleted]
- deleted 4y ago
  [deleted]
logifail 4y ago
> Americans are fat, through they aren't twice as fat as other people They are, almost: "US obesity prevalence was 41.9% in 2017 – March 2020"[0] "25.9% of adults in England are obese"[1] [0] https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html [1] https://commonslibrary.parliament.uk/research-briefings/sn03336/ https://commonslibrary.parliament.uk/research-briefings/sn03...

JohnFen 4y ago

> I was under the impression that USA healthcare has out of control costs due chronic diseases That certainly doesn't explain a great deal of it.

kerkeslager 4y ago

For me, my ability to stick to a diet was predicated on my ADHD being properly medicated. I never reached the "obese" category, mostly because ADHD seemingly doesn't prevent me from sticking to an exercise plan, but I was in the "overweight" for most of my 20s because I wasn't able to focus consistently enough to effectively count calories. Many people can't stick to a diet or exercise plan because they haven't been treated for a related problem. For example, many people can't effectively exercise due to joint pain which could be alleviated by physical therapy which is frequently denied by health insurance. Additionally, the "healthcare system" includes stuff like nutritional and exercise education, public gyms, etc., all of which are woefully underfunded in the US. Worse, the programs which do exist have been heavily influenced by lobbyists (lobbyist influence on the Food Pyramid, for example, is well-documented). The corporate right to lie in advertising also means that much education is undermined by straight up lies in ads.