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I am no expert on the public health system and so I'm more than willing to be educated/corrected here, but I have the following impression: There is more money

I am no expert on the public health system and so I'm more than willing to be educated/corrected here, but I have the following impression: There is more money to be made by stakeholders treating health problems than there is in preventing them. And so there is a lot more money and effort invested in developing pharmaceutical and treatment solutions than there is in preventing the problems they treat – even though that would be far, far better for society as a whole. Alternatively/additionally, the stakeholders that make money treating things (insurance companies, hospitals, etc.) are simply larger and better capitalized than those that make money preventing health problems (gyms, health food stores, etc.) The biggest gym or fitness company in the world is probably minuscule in comparison to the average medical company. The only wrinkle in my understanding here is that as far as I know, insurance rates are lower for healthy people, and thus doctors(?) are somewhat incentivized to have healthier patients. Is there a market-based solution to this? And if so, what would it look like? Tax breaks for gyms? More lobbying from Big Gym?

throwawaysleep 2y ago
The barrier to exercise isn’t money in most cases. It is that exercise is misery. Exercise sucks. I am overweight. I much prefer Ozempic (and pay a substantial premium for it) vs lifestyle change. So do millions of other Americans who are shelling out for it. You would basically need to economically torture fat people to the point that exercise is less horrible than your incentives. I’m paying 8K a year to avoid exercise.
- danielbln 2y ago
  It's a shame that exercise is linked to misery for so many people, because it doesn't have to be miserable. Hell, it's so so much easier to stick with it if it isn't miserable. I always tell new runners to slow down, like ridiculously slow, laughably slow. If it feels like the lung is burning and you want to vomit, oh that is wayyyyy too fast. Keep it slow and steady and maybe only ever so slightly uncomfortable, then allow your body to adapt and ride that feeling until you're all of the sudden exercising much harder but without feeling like you do. I posit that exercise does not have to feel terrible to work, and that it can be turned into something that feels maybe a little bit uncomfortable during, but really nice after.
- Ma8ee 2y ago
  Exercise doesn't have to suck. For it not to suck, it has to be on the right level for you (if you think you'll about to puke or die, it's not on the right level), and it has to stimulating in one way or another. If you can't find anything of all the possibilities, from Karate to soccer to windsurfing, stimulating in itself, maybe just reward yourself watching your favourite series on Netflix from a stationary bike.
- keiferski 2y ago
  I think you probably just need to find a form of exercise that you enjoy. For me, I really don't like going to the gym, but I do enjoy biking. That aside, exercise is just one aspect of prevention. In most places that have lower obesity rates, people probably exercise less than they do in America, which is ironic. My broader point is more that the system is set up in such a way that it's easier for you to get overweight and then pay $8K a year to buy a treatment drug, than to just help you avoid getting overweight in the first place. Probably because the cost to do that is much less than $8K, so the stakeholders are much less incentivized to do it.
- matco11 2y ago
  Lots of people love exercise. It can even be a lot of fun to play a game of basketball, soccer, or to dance… We are all different, and one just has to find a type of exercise that one likes. Also, being low in fat is great, but it’s not the same as also having a developed muscle structure, strong bones, and performant cardiovascular system.
- RandomLensman 2y ago
  Then the benefits of exercise are broadly inaccessible to you - which is a fair choice. That said, maybe it is useful not to think about excerise as exercise?
- tromp 2y ago
  Not all exercise sucks. When the weather is good and I ride my recumbent through the beautiful Dutch landscape, I'm getting both exercise and joy.
- 082349872349872 2y ago
  [There are three types of fun (I, II, III) described in https://www.rei.com/blog/climb/fun-scale https://www.rei.com/blog/climb/fun-scale ] That's odd, I'd think even for people who barely exercise there'd be plenty of Type I fun, available much more cheaply than USD 8K/yr. Distance is what matters; people who actually like jogging get their distance in much more quickly than the rest of us, but long slow distances can also be covered much more pleasantly. (Type II fun is probably indistinguishable from type III fun at the start, but should you ever get more involved in sport you'll discover that there are many, many things that are type II but not type III) > We condition the masses to hate the country, but simultaneously we condition them to love all country sports. At the same time, we see to it that all country sports shall entail the use of elaborate apparatus. So that they consume manufactured articles as well as transport. —DHC for Central London
- hatefulmoron 2y ago
  The truth however is that to choose the pill is to choose uncertainty. There is no certainty that the drug you choose for your symptoms will work, less certainty that it will work for years into the future, and no certainty that it won't cause you further issues that will be remedied by a different pill, and on it goes. Some things can't be fixed by exercise, so take the pills. Some things can, it's probably best to take the exercise. If it doesn't work, the pills are still waiting for you. I guess what I'm saying is: exercise is misery, but not preventing damage is delayed misery of uncertain magnitude.
- fifticon 2y ago
  As countless others have replied, those of us that enjoy exercise feel like something is off here :-). I may be wrong, but my impression is that it is like driving a car with flat tires. Yes, that feels wrong, but once you inflate those tires, driving the car no longer feels wrong. At times when I have been out of shape, it has felt taxing to start up. But as soon as my shape starts to tighten up, it no longer feels like misery at all, instead it feels like the privilege getting to drive around in a cool machine - your very own body. It may be this is fundamentally different between types of people. For example, I have heard many women claim that running never felt good to them, even when they were in shape (this might there be related to how hips may be differently shaped for running).
- globular-toast 2y ago
  That's good because exercise wouldn't solve your problem anyway. You'd just be a fat guy who exercises. Exercise isn't a misery when you aren't fat. To lose weight you eat less. Unfortunately we've decided treating food addiction with pills and removing organs is the way to go rather than targeting the addictive stuff itself. Kinda like treating heroin addiction by removing arms.
  - mnw21cam 2y ago
    Yeah, there are studies that show that eating less is much more effective than exercising more for losing weight. There are other studies that show quite often the most effective way to eat less is to fast every now and again. And that's because if you're trying to diet by eating a small meal, your stomach/brain is going to be yelling at you all the time that you're hungry and you should eat some more, but if you fast, after 16 hours or so that urgency goes away and you stop feeling as hungry. Fasting sounds a lot more scary than it actually is. The record fast length is 382 days [0]. [0] https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast
- branko_d 2y ago
  I’ll hazard a guess: you never liked exercise, even as a kid? If that’s the case, I’ll hazard another guess: you lived in an environment where you couldn’t just go out and play whenever you wanted? I might be completely wrong in my guesses, and I apologize if I am. But I strongly believe that all kids are naturally predisposed for physical activity, and it’s the duty of the society to let them do that in an easy and safe way.
  - VBprogrammer 2y ago
    Interesting thesis - however I was one of those kids. I had plenty of access to exercise we lived in a quiet housing estate where we could easily play hockey or football in the streets. The only exercise I enjoyed was cycling and that wasn't really the done thing in late high-school. Weirdly enough, I now go to the gym 3 times a week. I don't love it like some people do but I've made it enough of a habit that I do it anyway. The main motivation for me was wanting to be active enough to keep up with my kids and a string of minor ailments (mostly not relating to lack of exercise) which gave me a bit of a shove to do something.
  - CalRobert 2y ago
    Hard to let your kids play outside when there's 2500kg Dodge Rams going 80kph in the streets.
  - pandaman 2y ago
    As somebody who had been outside all the time during childhood and hated exercise starting with the PE in school, I don't think your guess is well founded in reality. None of my childhood friends had been keen on exercise either and PE was not the most popular class in my school... For me there is a huge difference of doing something that requires physical exertion in order to complete and doing pointless physical exertion for exertion's sake. I can skate on a board or skates, or ride a bike for hours because it's about skill and technique for me, I feel frustrated after running for a minute. Similarly I can free-dive whole day but swimming laps feels like a massive chore. I believe some people can enjoy exercise but, judging by how many fit people are there - they are in small minority.
- gwd 2y ago
  > Exercise sucks. Lots of people, including myself, love exercising. If nothing else, endorphins are a great natural "high". And I can tell that the rest of my system just works better when I'm working out regularly: I have fewer hunger attacks, I sleep better, I feel better. And, I just really like the feeling of picking up really heavy things (that being my current exercise of choice). From what I can tell, the "exercise sucks" barriers most people face are 1) not everybody likes everything, and 2) it takes at least 2 months of training to get to the point where you can get the taste for the endorphins without being overly sore afterwards. Now maybe you've spent 2 months trying all kinds of different activities (swimming, walking, hiking, weight lifting, cycling, wrestling, football) and none of them have worked, in which case fair enough. But if you haven't, I'd recommend trying it. I can see why if you're overweight that running wouldn't be very fun. If you haven't tried weight lifting, definitely give that a go. If you're overweight, you've got a head start lifting heavy things (you), so it shouldn't be as hard to get into. People who've never lifted weights have this idea that it's mind-numbingly boring; but the mental focus you need to lift heavy things is actually a bit more like meditation. And being able to confidently lift really heavy things is an amazing feeling, not to mention having pumped-up muscles.
  - red-iron-pine 2y ago
    > Lots of people, including myself, love exercising. great, good for you and those people. but clearly most people don't. plus you cannot out-exercise a poor diet. doesn't matter how hard you go in the gym or on a hike if you slam donuts and pepsi all day.
    - gwd 2y ago
      > great, good for you and those people. but clearly most people don't. If throwawaysleep had said, "Some people seem to like exercise, but I've tried all kinds of things and never found anything that wasn't a misery", I probably wouldn't have replied. But rather, they said, "Exercise is a misery" -- no exceptions or qualifications. They have acknowledged the importance of exercise, and seemed to indicate that they would be willing to do it for their own health if it were just boring or mildly annoying; but they believe exercise is always unpleasant. They seem to believe that everyone who does exercise regularly does so by just powering through the misery; but that this is realistically not an option for them. So there's something they don't know, something they need to know -- exercise doesn't always suck. Lots of people exercise without having to "power through" any misery, because they've found routines they actually enjoy. And so, maybe there's a routine that they will enjoy as well. You're not going to look for something unless you know that it might exist. > plus you cannot out-exercise a poor diet. doesn't matter how hard you go in the gym or on a hike if you slam donuts and pepsi all day. I'm not sure where the donuts and pepsi are coming from. I don't know what happens if you take Ozempic while only eating donuts and pepsi; it's possible you could stay thin, but you definitely won't be healthy. But since you raised it: Slim != healthy, and healthy eating !=> slim. It's possible to gain weight eating healthy most days and only eating really unhealthy once a month. And it's possible to have healthy muscles / cardiovascular system and still be overweight, or to have poor cardio and be slim. I'm pretty sure it's healthier to be overweight and cycle 20 minutes every day than to be slim and a couch potato. If throwawaysleep is slamming donuts and pepsi all day, they should stop that for their health and well-being. But although it might slow the rate at which they gain weight, it probably won't make them slim. Similarly, if they're overweight, while a normal, sustainable exercise routine will probably slow the rate at which they gain weight, or help them lose a bit, it probably will never make them slim. But they will be a lot healthier nonetheless.
- coldtea 2y ago
  >The barrier to exercise isn’t money in most cases. It is that exercise is misery Only if you haven't been doing it. When you follow through and get the hang of it, it can be ecstasy. >I’m paying 8K a year to avoid exercise. And paying a lot more in cognitive and health decline long term, both in monetary terms (treatment) and in non-measurable quality of life terms. Ozempic is just weight loss (and the potential side-effects of longer term use with it, we'll find out in the future). Weight loss is table stakes for optimal performance.
- thefz 2y ago
  > Exercise sucks. I am overweight. I much prefer Ozempic There is zero need for exercise if one wants to lose weight.
- Moldoteck 2y ago
  "Exercise sucks. I am overweight." - to beat the weight problem exercise will do little. It's mostly what you eat. Exercise is for muscles, shape, health, blood pressure and many other great stuff and sometimes for weight loss, but generally exercise is not a good way to lose weight, in fact it can boost the hunger feeling and you could eat more calories without noticing. Ozempic is good for weight loss (with some risks but it's a great tool) and if combined with shaping good food habits - eventually you can drop the ozempic and keep the weight, and when weight is good, exercise is much easier (but still sucks for many). Some do prefer to bike as a form of exercise that's both healthy and greatly improves leg muscles which can help if joints were destroyed when the person was overweight. But ozempic will not help with health problems related to lack of exercise and sedentary life, it'll help just for weight(and sometimes addiction) loss. Use the right tools for right puroses to reach your goals
- fire_lake 2y ago
  There are fun ways to exercise. You should give more things a try! Ozempic may help with weight loss but there are other health reasons to exercise.
- badpun 2y ago
  Have you tried walking? Just by walking one or two hours every day, you should burn enough calories to steadily lose weight. The health benefits of just walking are numerous: staving off musculosceletal degeneration (it will get to you quite quickly if you don't exercise at all - just look at astronauts), better sleep, improved mood and mental clarity. If you can walk in nature or at least peaceful and green urban environment, your mental health will benefit as well. There's a reason so many great thinkers in history were proponents of long walks in nature.
  - bregma 2y ago
    A couple of hours every day? I spend 8 hours a day sleeping and 8 hours a day at work. Anther 4 hours in meal prep and consumption, personal hygiene, commuting, and mandatory household chores. That leaves 4 hours a day in elective time. Now you suggest I dedicate 50% of that time in non-productive exercise where I'm stuck with my own thoughts and no other mental stimulation while being physically uncomfortable? Or once a month I could go to the doctor and get a shot. I can see the appeal of Ozempic. Now mind, I'm not overweight, but I do have diabetes and mild hypertension controlled through diet and, until my old dog "went to sleep" recently, regular exercise. I don't like the diet and often resented the twice daily long walks in all kinds of weather but still prefer that over chronic medication, especially one delivered through a means the gods did not give you an orifice for. My choice, but I respect other people's choices.
- Unbefleckt 2y ago
  Whenever I think about the exercise I'm doing being unpleasant, I remember how unpleasant existing was as an unfit out of shape person day to day.
- CalRobert 2y ago
  I used to be 280 pounds (127kg). My BMI was 38 and I was in horrible shape. People told me I needed to go to the gym, take up running, etc. - and that advice, while well-meaning, was mostly bad. For me, what I needed was to swim and bike more. I loved those things. Running hurt and was miserable. Weight lifting was horrible. Team sports were a misery. But I could happily bike (on a recumbent in particular) for ages, at my own pace. When I sold my car, started riding a bike everywhere, and started a volumetric diet (don't eat tiny meals, eat big ones of low-calorie-density foods) I dropped to about 200 pounds. And I stayed there for a long time (over a decade) until I moved somewhere I could do this even better - the Netherlands - and I've lost another 20 pounds. And I just ride my bike around. I don't go to a gym (I do get a swim in a couple times a month though). Riding my bike in suburban California was, indeed, torture, but only because it's a horribly-designed place. In nice places it's a delight.
oldpersonintx 2y ago
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gniv 2y ago
Here in France there seem to be a lot of subsidies for physical activity. For example, each town has a swimming pool, used by kids and adults alike, with very cheap membership. Then there are the associations, each focused on an activity -- tennis, badminton, pilates, etc. If you pay in September for the year, it's again quite cheap. There are of course typical gyms, but the associations are much more popular afaict.
- gwervc 2y ago
  It's cheap only for a few sports. The martial art I'd like to do is at least 200€/year in the few clubs of my town, plus additional fees for administrative stuff like license and "passport". And then membership is often based on somewhat calendar years starting in September, so if you don't register exactly at this moment the cost per month is even higher.
  - hahajk 2y ago
    The September issue aside, 20€/mo seems pretty reasonable depending on how often you can go. Especially if there is a coach involved. Typical gyms in my area are about $20/mo just to access the machines and weights. Specialized gyms like Crossfit are all >$100/mo.
  - hnhg 2y ago
    What is expensive to you? 200EUR works out to a few euros a week. That is fantastic value compared to anything I have experienced in other EU countries in this decade.
globular-toast 2y ago
Gyms aren't the solution. Gyms also make most of their money treating the problem. They are massively oversubscribed because they know most of their members don't actually go. Most of their members are on the "forever diet". You know, the one where you're always trying to "lose weight" but never actually do (usually the opposite). The actual problems are things like food addiction and forced sedentary lifestyles. The solutions to these are things like taking food addiction seriously and treating junk food the way we treated cigarettes (ban all advertising for a start) and getting rid of cars in towns.
- nicopappl 2y ago
  To go in your direction, a few countries in South American did ban advertising for junk food. In addition to education in schools, it dramatically helped reduce overweight-related sickness.
graemep 2y ago
Treating long term is a lot more profitable than curing too. One of the worst things that ever happened to pharmaceutical industry profits was the the discovery that most ulcers can be cheaply cured with antibiotics (which won the discovers a well deserved Nobel prize). Even after this ulcer drugs were hugely profitable. I cannot remember the numbers from when I was an analyst covering them (more than 20 years ago!), but at one point a very big proportion (maybe even most) of Astrazeneca's profits came from their blockbuster ulcer treatment. Imagine how much more profitable that would be without a cheap cure around! Gyms are not the solution, nor are health food stores. Far more people join gyms than make use of them. You can keep fit going for walks or running or a multitude of cheap things. IMO the problems are lack of time for exercise and money for a healthy diet. Poor people have a far worse diet than rich people because they have to fill up with cheap junk. Junk food takes less time to prepare. I have ready meals sometimes because I am tired. Some people have to do it all the time, and they do not have the money to be fussy about how healthy the meals are.
- johnnyanmac 2y ago
  >the problems are lack of time for exercise and money for a healthy diet. pretty much. You go to some circles that will keep swearing by "Calories in, Calories out", and blaming any detteral of this as laziness. It's basically the equivalent of saying "stop smoking" to a smoker. Yes, they are objectiely right, but also miss all the subtlety of the steps needed to "stop smoking". Time is definitely the biggest factor, and modern society feels like it's demanding more time than ever of workers for less spending power than ever. Of course people don't have time to work on their diet/exercise when some are working 2+ jobs at barely above minimum wage.
  - georgeplusplus 2y ago
    Where exactly is the nuance in this? I pity the smoker more because they don’t have to smoke but feel compelled to smoke through addiction. You have direct control over how many calories you consume and it’s a basic human instinct to eat. Saying there’s nuanced steps inbetween is just a way to hand wave away someone’s laziness to not tackle the problem.
noufalibrahim 2y ago
Reminds me of something similar I read. > Large companies will tell you that you need to eat different. Never to eat less.
082349872349872 2y ago
We have many (about 1 per 20'000 people) short circuits consisting of exercise stations scattered about a forest with a jogging/walking path connecting them. As far as I know, the insurance companies sponsor these, and presumably they find the upkeep costs (under $1'500/year?) pay back in reduced overall payouts?
vmfunction 2y ago
>There is more money to be made by stakeholders treating health problems than there is in preventing them. And so there is a lot more money and effort invested in developing pharmaceutical and treatment solutions than there is in preventing them – even though that would be far, far better for society as a whole. The health care system in US is very broken. This paper [1] really outlines. It not just more money made in treating health problems than prevention. Due to the health insurance is structured in US, there is also an incentive for doctors to prescribe the more expensive treatment instead of the cheaper more effective treatment. https://pubmedinfo.org/wp-content/uploads/2017/11/Is-US-Health-Really-the-Best-in-the-World-Barbara-Starfield-MD-MPH.pdf https://pubmedinfo.org/wp-content/uploads/2017/11/Is-US-Heal...
- dTal 2y ago
  Neatly skewered 3 decades ago in the Sunday funnies: https://www.gocomics.com/outland/2023/01/16 https://www.gocomics.com/outland/2023/01/16 It is depressing how many of those comic strips are still relevant today.
thefz 2y ago
In the US. Anywhere the healthcare system is public, there is more pressure in lowering its cost / raising its efficiency.
mahdi7d1 2y ago
There is no solution. The problem is not in the lack of funding or interest from investors. The public itself is not interested in preventing. They think the probability of something bad happening for them is low (for example heart attack) thus they are not willing to put in the effort and proactively try to prevent it (for example by exercising). This can be either from a lack of accurate data or even when the data is accurate and available someone might still interpret it differently. For me a 3 percent chance might be insignificant for someone else 1 percent is still high.
- alwillis 2y ago
  > The public itself is not interested in preventing. They think the probability of something bad happening for them is low Which is ironic because we all know someone who’s had a heart attack, cancer or a stroke. And if someone decides to make lifestyle changes, they’re often going against society and the medical establishment. A friend recently was able to stop taking her diabetes and hypertension meds after she did things her doctors discouraged her from doing, like intermittent fasting, which I told her about. Now she distrusts doctors because they told her she’d have take these meds for the rest of her life.
fire_lake 2y ago
The issue is simple really. We evolved in an environment where resources are scarce and energy conservation is critical. These instincts applied to the industrialized society lead to overeating and inactivity. Very few possess the willpower to overcome this on their own.
- keiferski 2y ago
  But there are plenty of industrialized societies where obesity is less of a problem. https://en.wikipedia.org/wiki/List_of_countries_by_obesity_rate https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
- guerrilla 2y ago
  This fact is being used as an excuse that to ignore two other enormous problems: people refuse to grow up and take responsability on the one hand and on the other hand they are completly drowned in a sea of manipulation that does everything it can to make sure they consume as much as possible. Ban all advertising and foster a culture of maturity.
TheRoque 2y ago
Maybe, just maybe, sometimes a free market is not the solution ? The US people have the lowest life expectancy and the most money spent amongst rich countries [1]. I am not 100% sure, but it seems to me that all the other rich countries have a more government-controlled healthcare ? [1]: https://www.kff.org/other/slide/the-u-s-has-the-lowest-life-expectancy-among-large-wealthy-countries-while-far-outspending-them-on-health-care/ https://www.kff.org/other/slide/the-u-s-has-the-lowest-life-...
- keiferski 2y ago
  I don't think the situation in the US is as market-based as these kinds of comments imply. There are a ton of regulations in the US healthcare market and quite a lot of anti-competitive corporate influence, probably even more than in some other countries.
  - TheRoque 2y ago
    Regulations don't imply that the healthcare is backed by the government, it's a different thing
    - keiferski 2y ago
      I’m just saying that the idea of “the healthcare system in the US is extremely market based” is not really accurate. If anything it seems less affected by market dynamics than healthcare in other places.
CalRobert 2y ago
Well, one clear market-based solution would be pricing transportation appropriately. If people were allowed to not pay for car infrastructure (via parking minimums, restrictive zoning, taxpayer-funded highways, etc. et.) and take their bike and train instead there would be a strong price signal to encourage the healthier activity. I moved to the Netherlands a year ago and have already lost 9kg (about 20 pounds) without really even trying that hard. I just don't have a car. It's even more baffling we don't do this because this is cheaper AND healthier. If the same organisation is paying for health care and transport (like a national government) than it should be a blindingly obvious solution.
- jiriknesl 2y ago
  This policy would be too unrelated to health. You can have a sedentary person who works from home and orders takeaways. You can have a person who has a car who goes to gym 4 times per week, hikes during weekends and plays tennis 2 times per week and eats healthy food. There is no reason to tax the second person more than the first one.
  - sufehmi 2y ago
    Public policies are designed to work on populations, massive number of people - not anecdotal evidences like these. And taxing private transportation / providing incentives for public transportation does not only benefit our health, it also bring other benefits; global warming issues, dependency on fossil fuels, etc
  - superhuzza 2y ago
    From the health perspective I agree, but there's a pretty clear reason to tax the second person more, since they have a car: more emissions, road use, infrastructure costs etc.
  - CalRobert 2y ago
    Well, we're talking about population-level health here, not individuals. And, in general, places where it's easier to get around using your own body have healthier people. Our current tax policy actively disincentivizes this - literally collecting _less_ tax could result in better health outcomes if it meant narrower, safer streets (which are cheaper to build and maintain), less parking (parking spots can cost tens of thousands of USD/EUR depending on where they are, and more insidiously, often displace housing), etc.
richardw 2y ago
Insurance/banking company I worked for has made billions from incentives. Exercise, getting preventative tests, driving slower, reducing dangerous credit behaviour. Works in their market (might not in yours) and the clientele has self selected, so now they have a huge client base who largely follow incentives, which reduces their risks massively. If you drive fast you go elsewhere. That’s half the secret. It’s harder to replicate without the client base.
- azmodeus 2y ago
  Did they operate in Germany? If you can name them, I would like to check them out? Reminds me of Vitality health insurance in the UK
  - richardw 2y ago
    Yup related. I messaged you on LinkedIn.
arghwhat 2y ago
While it is true that pharma does not earn money if you do not need drugs, I would not blame them for not forcing people into gyms. Unlike the food industry which directly causes the issue by pushing addictive and unhealthy food, I suspect the underlying problem with treatment vs. prevention is in culture and mentally. You need to convince people to spend a significant portion of time exercising and eating healthy when they do not yet have issues in order to prevent future issues, taking time away from other, more entertaining things. Even with a goal, exercise is hard work. Treatment on the other hand rarely requires significant effort, and once it is needed it is no longer something you can ignore and postpone like you could with prevention. At the same time, many conditions which pharma develops treatment for are not fixed with exercise.
georgeplusplus 2y ago
>>>>Is there a market-based solution to this? And if so, what would it look like? Tax breaks for gyms? More lobbying from Big gym? Using your point, how would lobbying from big gym be able to compete with the dominate interests of pharm and medical. The desire to work out comes down to the self determination of the person and I don’t think there is any product that is a substitute or replacement for that. You don’t need a fancy gym to get rigorous exercise. You can do everything in your home. Walking, running, Push ups, sit ups, squats, dips, are free and easily accessible to do anywhere. biking, swimming, and pull-ups are less accesible but are also relatively easy and cheap, these also are the best exercises one can do to avoid injury. I would say building more bike roads, walkable spaces, outdoor exercise areas, and emphasize these things early in schooling are the best and most effective. I’m sure it is emphasized highly in Europe where people are generally more in shape.
nonameiguess 2y ago
It's unfortunate that the one answer to this from a person actually being prescribed "diet and exercise" is saying they don't want to and that comment is currently greyed out. Because my less than expert observation is this comment is the kind that gets trotted out consistently by cynical systems thinkers who think they've uncovered sinister forces making the population sick on purpose. This seems to ignore that tremendous effort does go into trying to convince people to eat better and exercise more. Money put into youth sports, mandatory gym classes, amateur athletics as their own carveout for nonprofit activity. Lyndon Johnson launched the presidential fitness challenge in 1966. Michelle Obama tried to make this her entire pet project for 8 years while her husband was in office. Other parts of the Internet are full of people like the greyed out comment making the exact opposite observation to yours. They complain that doctors don't take them seriously or give them medicine, refuse surgeries if you're overweight, and are always prescribing diet and exercise. For what it's worth, and I guess it doesn't have to be worth much, my personal hobbies outside of work have always consisted of sports and fitness. I was into these things well before I ever discovered my first computer. One consequence is most of the informational/entertainment content I consume is sports and fitness focused, including a few podcasts hosted by both coaches and medical doctors, who also make the same counterarguments to your own observation here. Every major medical association out there, national and international standards bodies, primary care physicians themselves, do in fact prescribe preventive measures like diet and exercise, but either the patients and general population ignore these and don't do it anyway, or they don't seek any sort of remedy until they're too far gone in the first place. There are clearly plenty of environmental factors causing higher levels of diseases of civilization, ranging from the accessibility of sports and recreation facilities in particular places to a poor walking environment to food abundance, but it certainly isn't just this. Plenty of nobility of old got fat eating minimally processed, locally grown foods that their ancestors ate, before cars and concrete existed. We can see the same thing happening to our own pets. They're seeing elevated rates of obesity and hypertension and stuff you'd never see in the wild, and this happens even when they're fed great food and allowed every opportunity to exercise. The unfortunate reality is evolution equipped mammals with an incredible propensity to conserve energy and overeat when the opportunity to do so is available, presumably because such an environment would have largely been seasonal and not permanent in the distant past. We've made it permanent. I'm not at all trying to say that we can't do anything society-wide. There are obvious differences between nations and regions. There have to be reasons some places do better than others, but I doubt that market forces are one of those things because those are largely the same everywhere, and the entire world has seen diseases of civilization pop up as soon as people have the chance to overeat and live sedentary lives. Hacker News really hates this for some reason, but things like GLP-1 agonists are going to be necessary if you really want to hit everyone that is affected by this. A whole lot of people simply are not going to eat less and move more no matter what incentives you give them.
belZaah 2y ago
> There is more money to be made by stakeholders treating health problems than there is in preventing them This is not in line with economic theory. According to it, actors would simply price the treatment and an npv of the potential future cash flow. It would actually be more beneficial to treat people completely, as it reduces the risk of the cash-cow suddenly being hit by a car, for example.

throwawaysleep 2y ago

The barrier to exercise isn’t money in most cases. It is that exercise is misery. Exercise sucks. I am overweight. I much prefer Ozempic (and pay a substantial premium for it) vs lifestyle change. So do millions of other Americans who are shelling out for it. You would basically need to economically torture fat people to the point that exercise is less horrible than your incentives. I’m paying 8K a year to avoid exercise.

danielbln 2y ago
It's a shame that exercise is linked to misery for so many people, because it doesn't have to be miserable. Hell, it's so so much easier to stick with it if it isn't miserable. I always tell new runners to slow down, like ridiculously slow, laughably slow. If it feels like the lung is burning and you want to vomit, oh that is wayyyyy too fast. Keep it slow and steady and maybe only ever so slightly uncomfortable, then allow your body to adapt and ride that feeling until you're all of the sudden exercising much harder but without feeling like you do. I posit that exercise does not have to feel terrible to work, and that it can be turned into something that feels maybe a little bit uncomfortable during, but really nice after.
Ma8ee 2y ago
Exercise doesn't have to suck. For it not to suck, it has to be on the right level for you (if you think you'll about to puke or die, it's not on the right level), and it has to stimulating in one way or another. If you can't find anything of all the possibilities, from Karate to soccer to windsurfing, stimulating in itself, maybe just reward yourself watching your favourite series on Netflix from a stationary bike.
keiferski 2y ago
I think you probably just need to find a form of exercise that you enjoy. For me, I really don't like going to the gym, but I do enjoy biking. That aside, exercise is just one aspect of prevention. In most places that have lower obesity rates, people probably exercise less than they do in America, which is ironic. My broader point is more that the system is set up in such a way that it's easier for you to get overweight and then pay $8K a year to buy a treatment drug, than to just help you avoid getting overweight in the first place. Probably because the cost to do that is much less than $8K, so the stakeholders are much less incentivized to do it.
matco11 2y ago
Lots of people love exercise. It can even be a lot of fun to play a game of basketball, soccer, or to dance… We are all different, and one just has to find a type of exercise that one likes. Also, being low in fat is great, but it’s not the same as also having a developed muscle structure, strong bones, and performant cardiovascular system.
RandomLensman 2y ago
Then the benefits of exercise are broadly inaccessible to you - which is a fair choice. That said, maybe it is useful not to think about excerise as exercise?
tromp 2y ago
Not all exercise sucks. When the weather is good and I ride my recumbent through the beautiful Dutch landscape, I'm getting both exercise and joy.
082349872349872 2y ago
[There are three types of fun (I, II, III) described in https://www.rei.com/blog/climb/fun-scale https://www.rei.com/blog/climb/fun-scale ] That's odd, I'd think even for people who barely exercise there'd be plenty of Type I fun, available much more cheaply than USD 8K/yr. Distance is what matters; people who actually like jogging get their distance in much more quickly than the rest of us, but long slow distances can also be covered much more pleasantly. (Type II fun is probably indistinguishable from type III fun at the start, but should you ever get more involved in sport you'll discover that there are many, many things that are type II but not type III) > We condition the masses to hate the country, but simultaneously we condition them to love all country sports. At the same time, we see to it that all country sports shall entail the use of elaborate apparatus. So that they consume manufactured articles as well as transport. —DHC for Central London
hatefulmoron 2y ago
The truth however is that to choose the pill is to choose uncertainty. There is no certainty that the drug you choose for your symptoms will work, less certainty that it will work for years into the future, and no certainty that it won't cause you further issues that will be remedied by a different pill, and on it goes. Some things can't be fixed by exercise, so take the pills. Some things can, it's probably best to take the exercise. If it doesn't work, the pills are still waiting for you. I guess what I'm saying is: exercise is misery, but not preventing damage is delayed misery of uncertain magnitude.
fifticon 2y ago
As countless others have replied, those of us that enjoy exercise feel like something is off here :-). I may be wrong, but my impression is that it is like driving a car with flat tires. Yes, that feels wrong, but once you inflate those tires, driving the car no longer feels wrong. At times when I have been out of shape, it has felt taxing to start up. But as soon as my shape starts to tighten up, it no longer feels like misery at all, instead it feels like the privilege getting to drive around in a cool machine - your very own body. It may be this is fundamentally different between types of people. For example, I have heard many women claim that running never felt good to them, even when they were in shape (this might there be related to how hips may be differently shaped for running).
globular-toast 2y ago
That's good because exercise wouldn't solve your problem anyway. You'd just be a fat guy who exercises. Exercise isn't a misery when you aren't fat. To lose weight you eat less. Unfortunately we've decided treating food addiction with pills and removing organs is the way to go rather than targeting the addictive stuff itself. Kinda like treating heroin addiction by removing arms.
- mnw21cam 2y ago
  Yeah, there are studies that show that eating less is much more effective than exercising more for losing weight. There are other studies that show quite often the most effective way to eat less is to fast every now and again. And that's because if you're trying to diet by eating a small meal, your stomach/brain is going to be yelling at you all the time that you're hungry and you should eat some more, but if you fast, after 16 hours or so that urgency goes away and you stop feeling as hungry. Fasting sounds a lot more scary than it actually is. The record fast length is 382 days [0]. [0] https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast
branko_d 2y ago
I’ll hazard a guess: you never liked exercise, even as a kid? If that’s the case, I’ll hazard another guess: you lived in an environment where you couldn’t just go out and play whenever you wanted? I might be completely wrong in my guesses, and I apologize if I am. But I strongly believe that all kids are naturally predisposed for physical activity, and it’s the duty of the society to let them do that in an easy and safe way.
- VBprogrammer 2y ago
  Interesting thesis - however I was one of those kids. I had plenty of access to exercise we lived in a quiet housing estate where we could easily play hockey or football in the streets. The only exercise I enjoyed was cycling and that wasn't really the done thing in late high-school. Weirdly enough, I now go to the gym 3 times a week. I don't love it like some people do but I've made it enough of a habit that I do it anyway. The main motivation for me was wanting to be active enough to keep up with my kids and a string of minor ailments (mostly not relating to lack of exercise) which gave me a bit of a shove to do something.
- CalRobert 2y ago
  Hard to let your kids play outside when there's 2500kg Dodge Rams going 80kph in the streets.
- pandaman 2y ago
  As somebody who had been outside all the time during childhood and hated exercise starting with the PE in school, I don't think your guess is well founded in reality. None of my childhood friends had been keen on exercise either and PE was not the most popular class in my school... For me there is a huge difference of doing something that requires physical exertion in order to complete and doing pointless physical exertion for exertion's sake. I can skate on a board or skates, or ride a bike for hours because it's about skill and technique for me, I feel frustrated after running for a minute. Similarly I can free-dive whole day but swimming laps feels like a massive chore. I believe some people can enjoy exercise but, judging by how many fit people are there - they are in small minority.
gwd 2y ago
> Exercise sucks. Lots of people, including myself, love exercising. If nothing else, endorphins are a great natural "high". And I can tell that the rest of my system just works better when I'm working out regularly: I have fewer hunger attacks, I sleep better, I feel better. And, I just really like the feeling of picking up really heavy things (that being my current exercise of choice). From what I can tell, the "exercise sucks" barriers most people face are 1) not everybody likes everything, and 2) it takes at least 2 months of training to get to the point where you can get the taste for the endorphins without being overly sore afterwards. Now maybe you've spent 2 months trying all kinds of different activities (swimming, walking, hiking, weight lifting, cycling, wrestling, football) and none of them have worked, in which case fair enough. But if you haven't, I'd recommend trying it. I can see why if you're overweight that running wouldn't be very fun. If you haven't tried weight lifting, definitely give that a go. If you're overweight, you've got a head start lifting heavy things (you), so it shouldn't be as hard to get into. People who've never lifted weights have this idea that it's mind-numbingly boring; but the mental focus you need to lift heavy things is actually a bit more like meditation. And being able to confidently lift really heavy things is an amazing feeling, not to mention having pumped-up muscles.
- red-iron-pine 2y ago
  > Lots of people, including myself, love exercising. great, good for you and those people. but clearly most people don't. plus you cannot out-exercise a poor diet. doesn't matter how hard you go in the gym or on a hike if you slam donuts and pepsi all day.
  - gwd 2y ago
    > great, good for you and those people. but clearly most people don't. If throwawaysleep had said, "Some people seem to like exercise, but I've tried all kinds of things and never found anything that wasn't a misery", I probably wouldn't have replied. But rather, they said, "Exercise is a misery" -- no exceptions or qualifications. They have acknowledged the importance of exercise, and seemed to indicate that they would be willing to do it for their own health if it were just boring or mildly annoying; but they believe exercise is always unpleasant. They seem to believe that everyone who does exercise regularly does so by just powering through the misery; but that this is realistically not an option for them. So there's something they don't know, something they need to know -- exercise doesn't always suck. Lots of people exercise without having to "power through" any misery, because they've found routines they actually enjoy. And so, maybe there's a routine that they will enjoy as well. You're not going to look for something unless you know that it might exist. > plus you cannot out-exercise a poor diet. doesn't matter how hard you go in the gym or on a hike if you slam donuts and pepsi all day. I'm not sure where the donuts and pepsi are coming from. I don't know what happens if you take Ozempic while only eating donuts and pepsi; it's possible you could stay thin, but you definitely won't be healthy. But since you raised it: Slim != healthy, and healthy eating !=> slim. It's possible to gain weight eating healthy most days and only eating really unhealthy once a month. And it's possible to have healthy muscles / cardiovascular system and still be overweight, or to have poor cardio and be slim. I'm pretty sure it's healthier to be overweight and cycle 20 minutes every day than to be slim and a couch potato. If throwawaysleep is slamming donuts and pepsi all day, they should stop that for their health and well-being. But although it might slow the rate at which they gain weight, it probably won't make them slim. Similarly, if they're overweight, while a normal, sustainable exercise routine will probably slow the rate at which they gain weight, or help them lose a bit, it probably will never make them slim. But they will be a lot healthier nonetheless.
coldtea 2y ago
>The barrier to exercise isn’t money in most cases. It is that exercise is misery Only if you haven't been doing it. When you follow through and get the hang of it, it can be ecstasy. >I’m paying 8K a year to avoid exercise. And paying a lot more in cognitive and health decline long term, both in monetary terms (treatment) and in non-measurable quality of life terms. Ozempic is just weight loss (and the potential side-effects of longer term use with it, we'll find out in the future). Weight loss is table stakes for optimal performance.
thefz 2y ago
> Exercise sucks. I am overweight. I much prefer Ozempic There is zero need for exercise if one wants to lose weight.
Moldoteck 2y ago
"Exercise sucks. I am overweight." - to beat the weight problem exercise will do little. It's mostly what you eat. Exercise is for muscles, shape, health, blood pressure and many other great stuff and sometimes for weight loss, but generally exercise is not a good way to lose weight, in fact it can boost the hunger feeling and you could eat more calories without noticing. Ozempic is good for weight loss (with some risks but it's a great tool) and if combined with shaping good food habits - eventually you can drop the ozempic and keep the weight, and when weight is good, exercise is much easier (but still sucks for many). Some do prefer to bike as a form of exercise that's both healthy and greatly improves leg muscles which can help if joints were destroyed when the person was overweight. But ozempic will not help with health problems related to lack of exercise and sedentary life, it'll help just for weight(and sometimes addiction) loss. Use the right tools for right puroses to reach your goals
fire_lake 2y ago
There are fun ways to exercise. You should give more things a try! Ozempic may help with weight loss but there are other health reasons to exercise.
badpun 2y ago
Have you tried walking? Just by walking one or two hours every day, you should burn enough calories to steadily lose weight. The health benefits of just walking are numerous: staving off musculosceletal degeneration (it will get to you quite quickly if you don't exercise at all - just look at astronauts), better sleep, improved mood and mental clarity. If you can walk in nature or at least peaceful and green urban environment, your mental health will benefit as well. There's a reason so many great thinkers in history were proponents of long walks in nature.
- bregma 2y ago
  A couple of hours every day? I spend 8 hours a day sleeping and 8 hours a day at work. Anther 4 hours in meal prep and consumption, personal hygiene, commuting, and mandatory household chores. That leaves 4 hours a day in elective time. Now you suggest I dedicate 50% of that time in non-productive exercise where I'm stuck with my own thoughts and no other mental stimulation while being physically uncomfortable? Or once a month I could go to the doctor and get a shot. I can see the appeal of Ozempic. Now mind, I'm not overweight, but I do have diabetes and mild hypertension controlled through diet and, until my old dog "went to sleep" recently, regular exercise. I don't like the diet and often resented the twice daily long walks in all kinds of weather but still prefer that over chronic medication, especially one delivered through a means the gods did not give you an orifice for. My choice, but I respect other people's choices.
Unbefleckt 2y ago
Whenever I think about the exercise I'm doing being unpleasant, I remember how unpleasant existing was as an unfit out of shape person day to day.
CalRobert 2y ago
I used to be 280 pounds (127kg). My BMI was 38 and I was in horrible shape. People told me I needed to go to the gym, take up running, etc. - and that advice, while well-meaning, was mostly bad. For me, what I needed was to swim and bike more. I loved those things. Running hurt and was miserable. Weight lifting was horrible. Team sports were a misery. But I could happily bike (on a recumbent in particular) for ages, at my own pace. When I sold my car, started riding a bike everywhere, and started a volumetric diet (don't eat tiny meals, eat big ones of low-calorie-density foods) I dropped to about 200 pounds. And I stayed there for a long time (over a decade) until I moved somewhere I could do this even better - the Netherlands - and I've lost another 20 pounds. And I just ride my bike around. I don't go to a gym (I do get a swim in a couple times a month though). Riding my bike in suburban California was, indeed, torture, but only because it's a horribly-designed place. In nice places it's a delight.

oldpersonintx 2y ago

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gniv 2y ago

Here in France there seem to be a lot of subsidies for physical activity. For example, each town has a swimming pool, used by kids and adults alike, with very cheap membership. Then there are the associations, each focused on an activity -- tennis, badminton, pilates, etc. If you pay in September for the year, it's again quite cheap. There are of course typical gyms, but the associations are much more popular afaict.

gwervc 2y ago
It's cheap only for a few sports. The martial art I'd like to do is at least 200€/year in the few clubs of my town, plus additional fees for administrative stuff like license and "passport". And then membership is often based on somewhat calendar years starting in September, so if you don't register exactly at this moment the cost per month is even higher.
- hahajk 2y ago
  The September issue aside, 20€/mo seems pretty reasonable depending on how often you can go. Especially if there is a coach involved. Typical gyms in my area are about $20/mo just to access the machines and weights. Specialized gyms like Crossfit are all >$100/mo.
- hnhg 2y ago
  What is expensive to you? 200EUR works out to a few euros a week. That is fantastic value compared to anything I have experienced in other EU countries in this decade.

globular-toast 2y ago

Gyms aren't the solution. Gyms also make most of their money treating the problem. They are massively oversubscribed because they know most of their members don't actually go. Most of their members are on the "forever diet". You know, the one where you're always trying to "lose weight" but never actually do (usually the opposite). The actual problems are things like food addiction and forced sedentary lifestyles. The solutions to these are things like taking food addiction seriously and treating junk food the way we treated cigarettes (ban all advertising for a start) and getting rid of cars in towns.

nicopappl 2y ago
To go in your direction, a few countries in South American did ban advertising for junk food. In addition to education in schools, it dramatically helped reduce overweight-related sickness.

graemep 2y ago

Treating long term is a lot more profitable than curing too. One of the worst things that ever happened to pharmaceutical industry profits was the the discovery that most ulcers can be cheaply cured with antibiotics (which won the discovers a well deserved Nobel prize). Even after this ulcer drugs were hugely profitable. I cannot remember the numbers from when I was an analyst covering them (more than 20 years ago!), but at one point a very big proportion (maybe even most) of Astrazeneca's profits came from their blockbuster ulcer treatment. Imagine how much more profitable that would be without a cheap cure around! Gyms are not the solution, nor are health food stores. Far more people join gyms than make use of them. You can keep fit going for walks or running or a multitude of cheap things. IMO the problems are lack of time for exercise and money for a healthy diet. Poor people have a far worse diet than rich people because they have to fill up with cheap junk. Junk food takes less time to prepare. I have ready meals sometimes because I am tired. Some people have to do it all the time, and they do not have the money to be fussy about how healthy the meals are.

johnnyanmac 2y ago
>the problems are lack of time for exercise and money for a healthy diet. pretty much. You go to some circles that will keep swearing by "Calories in, Calories out", and blaming any detteral of this as laziness. It's basically the equivalent of saying "stop smoking" to a smoker. Yes, they are objectiely right, but also miss all the subtlety of the steps needed to "stop smoking". Time is definitely the biggest factor, and modern society feels like it's demanding more time than ever of workers for less spending power than ever. Of course people don't have time to work on their diet/exercise when some are working 2+ jobs at barely above minimum wage.
- georgeplusplus 2y ago
  Where exactly is the nuance in this? I pity the smoker more because they don’t have to smoke but feel compelled to smoke through addiction. You have direct control over how many calories you consume and it’s a basic human instinct to eat. Saying there’s nuanced steps inbetween is just a way to hand wave away someone’s laziness to not tackle the problem.

noufalibrahim 2y ago

Reminds me of something similar I read. > Large companies will tell you that you need to eat different. Never to eat less.

082349872349872 2y ago

We have many (about 1 per 20'000 people) short circuits consisting of exercise stations scattered about a forest with a jogging/walking path connecting them. As far as I know, the insurance companies sponsor these, and presumably they find the upkeep costs (under $1'500/year?) pay back in reduced overall payouts?

vmfunction 2y ago

>There is more money to be made by stakeholders treating health problems than there is in preventing them. And so there is a lot more money and effort invested in developing pharmaceutical and treatment solutions than there is in preventing them – even though that would be far, far better for society as a whole. The health care system in US is very broken. This paper [1] really outlines. It not just more money made in treating health problems than prevention. Due to the health insurance is structured in US, there is also an incentive for doctors to prescribe the more expensive treatment instead of the cheaper more effective treatment. https://pubmedinfo.org/wp-content/uploads/2017/11/Is-US-Health-Really-the-Best-in-the-World-Barbara-Starfield-MD-MPH.pdf https://pubmedinfo.org/wp-content/uploads/2017/11/Is-US-Heal...

dTal 2y ago
Neatly skewered 3 decades ago in the Sunday funnies: https://www.gocomics.com/outland/2023/01/16 https://www.gocomics.com/outland/2023/01/16 It is depressing how many of those comic strips are still relevant today.

thefz 2y ago

In the US. Anywhere the healthcare system is public, there is more pressure in lowering its cost / raising its efficiency.

mahdi7d1 2y ago

There is no solution. The problem is not in the lack of funding or interest from investors. The public itself is not interested in preventing. They think the probability of something bad happening for them is low (for example heart attack) thus they are not willing to put in the effort and proactively try to prevent it (for example by exercising). This can be either from a lack of accurate data or even when the data is accurate and available someone might still interpret it differently. For me a 3 percent chance might be insignificant for someone else 1 percent is still high.

alwillis 2y ago
> The public itself is not interested in preventing. They think the probability of something bad happening for them is low Which is ironic because we all know someone who’s had a heart attack, cancer or a stroke. And if someone decides to make lifestyle changes, they’re often going against society and the medical establishment. A friend recently was able to stop taking her diabetes and hypertension meds after she did things her doctors discouraged her from doing, like intermittent fasting, which I told her about. Now she distrusts doctors because they told her she’d have take these meds for the rest of her life.

fire_lake 2y ago

The issue is simple really. We evolved in an environment where resources are scarce and energy conservation is critical. These instincts applied to the industrialized society lead to overeating and inactivity. Very few possess the willpower to overcome this on their own.

keiferski 2y ago
But there are plenty of industrialized societies where obesity is less of a problem. https://en.wikipedia.org/wiki/List_of_countries_by_obesity_rate https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
guerrilla 2y ago
This fact is being used as an excuse that to ignore two other enormous problems: people refuse to grow up and take responsability on the one hand and on the other hand they are completly drowned in a sea of manipulation that does everything it can to make sure they consume as much as possible. Ban all advertising and foster a culture of maturity.

TheRoque 2y ago

Maybe, just maybe, sometimes a free market is not the solution ? The US people have the lowest life expectancy and the most money spent amongst rich countries [1]. I am not 100% sure, but it seems to me that all the other rich countries have a more government-controlled healthcare ? [1]: https://www.kff.org/other/slide/the-u-s-has-the-lowest-life-expectancy-among-large-wealthy-countries-while-far-outspending-them-on-health-care/ https://www.kff.org/other/slide/the-u-s-has-the-lowest-life-...

keiferski 2y ago
I don't think the situation in the US is as market-based as these kinds of comments imply. There are a ton of regulations in the US healthcare market and quite a lot of anti-competitive corporate influence, probably even more than in some other countries.
- TheRoque 2y ago
  Regulations don't imply that the healthcare is backed by the government, it's a different thing
  - keiferski 2y ago
    I’m just saying that the idea of “the healthcare system in the US is extremely market based” is not really accurate. If anything it seems less affected by market dynamics than healthcare in other places.

CalRobert 2y ago

Well, one clear market-based solution would be pricing transportation appropriately. If people were allowed to not pay for car infrastructure (via parking minimums, restrictive zoning, taxpayer-funded highways, etc. et.) and take their bike and train instead there would be a strong price signal to encourage the healthier activity. I moved to the Netherlands a year ago and have already lost 9kg (about 20 pounds) without really even trying that hard. I just don't have a car. It's even more baffling we don't do this because this is cheaper AND healthier. If the same organisation is paying for health care and transport (like a national government) than it should be a blindingly obvious solution.

jiriknesl 2y ago
This policy would be too unrelated to health. You can have a sedentary person who works from home and orders takeaways. You can have a person who has a car who goes to gym 4 times per week, hikes during weekends and plays tennis 2 times per week and eats healthy food. There is no reason to tax the second person more than the first one.
- sufehmi 2y ago
  Public policies are designed to work on populations, massive number of people - not anecdotal evidences like these. And taxing private transportation / providing incentives for public transportation does not only benefit our health, it also bring other benefits; global warming issues, dependency on fossil fuels, etc
- superhuzza 2y ago
  From the health perspective I agree, but there's a pretty clear reason to tax the second person more, since they have a car: more emissions, road use, infrastructure costs etc.
- CalRobert 2y ago
  Well, we're talking about population-level health here, not individuals. And, in general, places where it's easier to get around using your own body have healthier people. Our current tax policy actively disincentivizes this - literally collecting _less_ tax could result in better health outcomes if it meant narrower, safer streets (which are cheaper to build and maintain), less parking (parking spots can cost tens of thousands of USD/EUR depending on where they are, and more insidiously, often displace housing), etc.

richardw 2y ago

Insurance/banking company I worked for has made billions from incentives. Exercise, getting preventative tests, driving slower, reducing dangerous credit behaviour. Works in their market (might not in yours) and the clientele has self selected, so now they have a huge client base who largely follow incentives, which reduces their risks massively. If you drive fast you go elsewhere. That’s half the secret. It’s harder to replicate without the client base.

azmodeus 2y ago
Did they operate in Germany? If you can name them, I would like to check them out? Reminds me of Vitality health insurance in the UK
- richardw 2y ago
  Yup related. I messaged you on LinkedIn.

arghwhat 2y ago

While it is true that pharma does not earn money if you do not need drugs, I would not blame them for not forcing people into gyms. Unlike the food industry which directly causes the issue by pushing addictive and unhealthy food, I suspect the underlying problem with treatment vs. prevention is in culture and mentally. You need to convince people to spend a significant portion of time exercising and eating healthy when they do not yet have issues in order to prevent future issues, taking time away from other, more entertaining things. Even with a goal, exercise is hard work. Treatment on the other hand rarely requires significant effort, and once it is needed it is no longer something you can ignore and postpone like you could with prevention. At the same time, many conditions which pharma develops treatment for are not fixed with exercise.

georgeplusplus 2y ago

>>>>Is there a market-based solution to this? And if so, what would it look like? Tax breaks for gyms? More lobbying from Big gym? Using your point, how would lobbying from big gym be able to compete with the dominate interests of pharm and medical. The desire to work out comes down to the self determination of the person and I don’t think there is any product that is a substitute or replacement for that. You don’t need a fancy gym to get rigorous exercise. You can do everything in your home. Walking, running, Push ups, sit ups, squats, dips, are free and easily accessible to do anywhere. biking, swimming, and pull-ups are less accesible but are also relatively easy and cheap, these also are the best exercises one can do to avoid injury. I would say building more bike roads, walkable spaces, outdoor exercise areas, and emphasize these things early in schooling are the best and most effective. I’m sure it is emphasized highly in Europe where people are generally more in shape.

nonameiguess 2y ago

It's unfortunate that the one answer to this from a person actually being prescribed "diet and exercise" is saying they don't want to and that comment is currently greyed out. Because my less than expert observation is this comment is the kind that gets trotted out consistently by cynical systems thinkers who think they've uncovered sinister forces making the population sick on purpose. This seems to ignore that tremendous effort does go into trying to convince people to eat better and exercise more. Money put into youth sports, mandatory gym classes, amateur athletics as their own carveout for nonprofit activity. Lyndon Johnson launched the presidential fitness challenge in 1966. Michelle Obama tried to make this her entire pet project for 8 years while her husband was in office. Other parts of the Internet are full of people like the greyed out comment making the exact opposite observation to yours. They complain that doctors don't take them seriously or give them medicine, refuse surgeries if you're overweight, and are always prescribing diet and exercise. For what it's worth, and I guess it doesn't have to be worth much, my personal hobbies outside of work have always consisted of sports and fitness. I was into these things well before I ever discovered my first computer. One consequence is most of the informational/entertainment content I consume is sports and fitness focused, including a few podcasts hosted by both coaches and medical doctors, who also make the same counterarguments to your own observation here. Every major medical association out there, national and international standards bodies, primary care physicians themselves, do in fact prescribe preventive measures like diet and exercise, but either the patients and general population ignore these and don't do it anyway, or they don't seek any sort of remedy until they're too far gone in the first place. There are clearly plenty of environmental factors causing higher levels of diseases of civilization, ranging from the accessibility of sports and recreation facilities in particular places to a poor walking environment to food abundance, but it certainly isn't just this. Plenty of nobility of old got fat eating minimally processed, locally grown foods that their ancestors ate, before cars and concrete existed. We can see the same thing happening to our own pets. They're seeing elevated rates of obesity and hypertension and stuff you'd never see in the wild, and this happens even when they're fed great food and allowed every opportunity to exercise. The unfortunate reality is evolution equipped mammals with an incredible propensity to conserve energy and overeat when the opportunity to do so is available, presumably because such an environment would have largely been seasonal and not permanent in the distant past. We've made it permanent. I'm not at all trying to say that we can't do anything society-wide. There are obvious differences between nations and regions. There have to be reasons some places do better than others, but I doubt that market forces are one of those things because those are largely the same everywhere, and the entire world has seen diseases of civilization pop up as soon as people have the chance to overeat and live sedentary lives. Hacker News really hates this for some reason, but things like GLP-1 agonists are going to be necessary if you really want to hit everyone that is affected by this. A whole lot of people simply are not going to eat less and move more no matter what incentives you give them.

belZaah 2y ago

> There is more money to be made by stakeholders treating health problems than there is in preventing them This is not in line with economic theory. According to it, actors would simply price the treatment and an npv of the potential future cash flow. It would actually be more beneficial to treat people completely, as it reduces the risk of the cash-cow suddenly being hit by a car, for example.