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There’s pretty solid evidence that lifetime healthcare spending is actually lower for obese people, even in European countries with better allocation towards yo

by paulmd 2y ago

There’s pretty solid evidence that lifetime healthcare spending is actually lower for obese people, even in European countries with better allocation towards younger populations. In the US, it’s definitely cheaper to have people dying young before they get that third hip replacement and two rounds of chemo. > one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832. https://pubmed.ncbi.nlm.nih.gov/37222003/ https://pubmed.ncbi.nlm.nih.gov/37222003/ You should at least consider the possibility that you’ve unfairly jumped to assertions about “cost” out of another layer of paternalism that is not warranted by the facts. Like the whole “muh tax/healthcare dollars” may actually be backwards and having them live longer might well end up costing you more. That is the essence of the CBO paper that was discussed yesterday too: curing the obese doesn’t really reduce lifetime healthcare spending, because the US healthcare system barely spends anything on anyone who isn’t an AARP member anyway, and reducing obesity is going to lead to a lot more AARP members in 10-20 years. Which is a good thing, but also not going to be a net financial benefit, especially when you only are paying for seniors to begin with and don’t see any of the healthy-population benefits. This is the problem with all these discussions around obesity, everyone treats it as a moral failing and automatically assumes every other factor falls into line backing their ideal moral stance etc. And money doesn’t really care about morality, it’s quite cheap to have people die early before they get the third knee replacement and the second round of chemo. People have been doing the “ugly people = worse/morally inferior/less deserving” since the dawn of time and people today have somehow convinced themselves they’re immune. But morality doesn’t necessarily line up with practical reality, in this case finances.

HDThoreaun 2y ago
Thank you, I have thought a bit about the tradeoff of more heart attacks vs. longer lifespan in terms of lifetime spending. Good to see the literature on it.
- paulmd 2y ago
  In fairness, it's also a longer lifetime with more socially-productive time etc - obesity has a somewhat higher cost-intensity-per-year than a comparable fit citizen, probably. But we already live in the society where very little is spent on earlier care - because the US spends very little on early care of anyone who's not an AARP voter. So is that a meaningful reduction in total spending? That is my interpretation of why the semaglutide budget effects are dire etc - well, Medicare doesn't spend anything on the fatty who dies at 50, and if they live to 80 and get cancer it's a lot more expensive for Medicare in the long-run actually. The proximal cost of the drug almost doesn't matter itself ($700/mo is w/e in terms of what we spend on seniors, and obesity is expensive both short-term and long, right?) it's more the long-run budget effects. It's already generally a shift upwards in Euro societies with more egalitarian age distribution of spending. Then you consider the US's favoritism for seniors... and the fact that ultimately Medicare foots a lot of it (minus the substantial amounts they can claw back ofc). They are the ultimate "sick pool"/adverse selection, right? Yeah, the USG's budget numbers probably look really bad if we cure obesity actually, even if it wasn't expensive. Thanks for your disarming attitude.

by paulmd 2y ago

HDThoreaun 2y ago

Thank you, I have thought a bit about the tradeoff of more heart attacks vs. longer lifespan in terms of lifetime spending. Good to see the literature on it.

paulmd 2y ago
In fairness, it's also a longer lifetime with more socially-productive time etc - obesity has a somewhat higher cost-intensity-per-year than a comparable fit citizen, probably. But we already live in the society where very little is spent on earlier care - because the US spends very little on early care of anyone who's not an AARP voter. So is that a meaningful reduction in total spending? That is my interpretation of why the semaglutide budget effects are dire etc - well, Medicare doesn't spend anything on the fatty who dies at 50, and if they live to 80 and get cancer it's a lot more expensive for Medicare in the long-run actually. The proximal cost of the drug almost doesn't matter itself ($700/mo is w/e in terms of what we spend on seniors, and obesity is expensive both short-term and long, right?) it's more the long-run budget effects. It's already generally a shift upwards in Euro societies with more egalitarian age distribution of spending. Then you consider the US's favoritism for seniors... and the fact that ultimately Medicare foots a lot of it (minus the substantial amounts they can claw back ofc). They are the ultimate "sick pool"/adverse selection, right? Yeah, the USG's budget numbers probably look really bad if we cure obesity actually, even if it wasn't expensive. Thanks for your disarming attitude.