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Comment by aeternum | Hacker News Reader

If you exclude obese individuals US life expectancy is quite high. Health is the ultimate marginal good so exorbitant expenditure is relatively logical. You can't take the money with you so it often makes sense to spend on health even assuming extreme diminishing returns.

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US obesity rates are around 40% of population. Australia, Canada, UK, it is around 30% of population. Canadian life expectancy is 3-4 years higher on average. UK around 3 years higher on average. Australia around 4-5 years higher

Does the gap in obesity rates fully explain the difference in life expectancy? Or are there other factors at play?

I don't think it actually does, because UK has lower obesity rates than Australia (26-29% versus 32%), yet also lower life expectancy (Australia is 81.1 male, 85.1 female; UK is 78.8 male, 82.8 female)

I don't know how well this is represented in your stats, but qualitatively US obesity is incomparable to anything you see in Europe. I don't think 40% vs 30% does it justice.

Yes, if you exclude about half of the U.S. population (40% of Americans are obese) [1] then the U.S. has life expectancy that is on par with the rest of the developed world.

[1] https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

What role does access to health care have I wonder. Canada and Australia (well, ALL other developed nations) have universal healthcare. I know that in the states past 65 they do, but not getting proper health care before then surely puts people at risk of dying earlier. Also, what is the venn diagram of people who are obese and don't have affordable access to healthcare - double whammy.

The American demographic with the highest rate of being uninsured, Hispanics, have life expectancies comparable to the UK average. So access to healthcare probably plays some role, but it seems like there are lots of other confounding factors.

It also doesn’t seem to vary that much by state level healthcare differences. States vary quite a bit by geography, but states that didn’t do Medicaid expansion, like Wisconsin and Wyoming, seem to have similar rates to neighboring states that did.

>If you exclude obese individuals

The obesity rate in the US is 40%. The just-overweight rate is 33%. So unless we really ramp up on tackling obesity, the life expectancy is going be dragged down.

Universal access to GLP1s would almost certainly effectively end the obesity problem.

SubQ pen injections are something even most people afraid of needles can get used to quite quickly, so even if the pill forms never get to the same efficacy there's really no reason that they couldn't solve it for most everyone once they go generic and become affordable, or become otherwise subsidized. China already produces the APIs in huge quantities for insanely cheap for sale on the black market, so we know that they can be produced for extremely low costs.

And the US has no plans to do it, probably because the cost doesn't even out until 15+ years, outside the timeframe for congressional budget estimates.

The tragedy of short term thinking.

The US doesn't have to. Rybelsus already costs less than a thousand dollars per month, some of which is offset by reduced spending on groceries/restaurants/coffee/alcohol.

This is the even more effective pill that is about to hit the market:

https://www.lilly.com/news/stories/what-to-know-about-orforg...

>11. How much will orforglipron cost?

>LLilly recently announced an agreement with the U.S. government to expand access to its obesity medicines and reduce patient costs. Upon FDA approval, self-pay patients living with obesity will be able to access orforglipron through LillyDirect's self-pay pharmacy channel with the lowest dose starting at $149 with additional doses up to $399.

Those numbers are extremely expensive for people on a fixed income (Medicare patients) and the people who are must vulnerable to the shitty US food system (Medicaid). It needs to be free.

$149 to $399 per month is affordable to many, many people, especially considering grocery and other spend should go down.

For those on Medicare, the cost will be $50/month.

Maybe it should be free but it's quite affordable at 50, that is relatively easy to make up in saved junk-food/snack costs.

Only if you’re rich. While the non-rich can’t afford health care.

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