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Comment by HDThoreaun | Hacker News Reader

Id be happy to see a tax on fat people due to the externalities they place on the healthcare system. Im not happy to see policy that uses peer pressure though. I dont think the government should be shaming people for questionable activities that arent illegal. I really dont think the government should be in the business of shame at all.

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> Id be happy to see a tax on fat people due to the externalities they place on the healthcare system.

What about dumb people? Or people with Down syndrome? Or people who use a wheelchair? Or people who were born with a missing limb? Or spina bifida?

Why limit it to “fat people,” other than because society says it’s simply okay to shame them more than others?

And before you say it’s a choice: it isn’t always. Kids don’t get to pick what their parents feed them, and while you can make changes in adulthood, if you don’t have the tools or skills, good parents (or any at all), and so on, you’re in for a rough time.

I'd argue the way American culture is constructed (drive everywhere, less opportunities to walk, folks are socially isolated) in a way that actually puts people in a situation where they are much more likely to be overweight.

So the costs are ones we as a society are putting on individuals are coming back to bite everyone in the ass.

Of course there are tons of other ways that Japanese society makes it easier to be skinny than American society does. Im just saying that some portion is the shame culture, not sure how much and not sure if its possible to figure that out, but I do know that Im not interested in trying that method.

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/

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.

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.

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.

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