It'll now cost a 65 year old couple $275,000 to cover their medical costs in retirement (in America)

[Grim_Render]

@filmore

But what about diet? The American diet is pretty awful–soda, chips, candy, etc. Lots of foods high in calories but low in nutrition. If one person is getting X calories from things like soda/chips/candy and someone else is getting X calories from cheese/nuts/wine, I would assume the latter person would be healthier.

Also, what about fitness? Many Americans have very low levels of activity. If two people weigh the same but one is sedentary and the other is active, the active person will be healthier.

@asahi

It does explain at least some of the costs, though. Yes, there is a steadily growing population of people who abuse their bodies in other countries, but people elsewhere, on average, are still fitter than we are.

If this was the case, it would be evident beyond America. For example, the UK has a very high obesity rate, smoke more and drink more than Norwegians. But still have far cheaper health care.

If obesity and lifestyle was a heavy driver of healthcare costs, you’d see it in the costs of other nations. But the only real correlations we see is that the US is high in both and Japan is low in both. Beyond that, its all over the map.

[Wesley_Clark]

@filmore

But what about diet? The American diet is pretty awful–soda, chips, candy, etc. Lots of foods high in calories but low in nutrition. If one person is getting X calories from things like soda/chips/candy and someone else is getting X calories from cheese/nuts/wine, I would assume the latter person would be healthier.

Also, what about fitness? Many Americans have very low levels of activity. If two people weigh the same but one is sedentary and the other is active, the active person will be healthier.

@asahi

It does explain at least some of the costs, though. Yes, there is a steadily growing population of people who abuse their bodies in other countries, but people elsewhere, on average, are still fitter than we are. I believe this is less and less the case in Canada and Australia, which are rapidly ‘Americanizing’, if memory serves me correctly, but most other countries still eat less junk and exercise more. I lived in Japan for a few years and while there are still more smokers, they are much, much more active than Americans, and they eat a diet that is far more balanced than ours, both of which probably reduce the risks associated with cancer. When the average American hits retirement age, he is more likely to either have or be at serious risk of devastating chronic illness, which will wipe out his/her retirement.

Intuitively, I agree it makes sense that poor lifestyle results in higher health care costs. Poor lifestyle = more health problems = more health care = higher health care costs.

But that doesn’t seem to be how it works in practice.

Putting aside the issue of foreign nations, just look at the difference between the states.

There are wide variances in the smoking rates and obesity rates by state.

Smoking rates by state.

Map of Cigarette Use Among Adults | STATE System | CDC

In U.S., Smoking Rate Lowest in Utah, Highest in Kentucky

Obesity rates by state

http://calorielab.com/news/wp-images/post-images/fattest-states-2015-big.jpg

Per capita medical spending (in 2014) by state

http://www.kff.org/other/state-indicator/health-spending-per-capita/?currentTimeframe=0&sortModel={"colId":"Location","sort":"asc"}

Per capita medical spending (in 2009 by state.

Per capita medicare spending (in 2014) by state.

http://www.kff.org/medicare/state-indicator/per-enrollee-spending-by-residence/?currentTimeframe=0&sortModel={"colId":"Location","sort":"asc"}

Take a state like Arkansas or Kentucky. Above average obesity rates and above average smoking rates. Health care costs are less than some states with below average obesity and smoking rates like Montana. If there is a correlation between smoking rates, obesity and health care costs I’m not seeing it.

Some states like Vermont or NH with low obesity rates and smoking rates are more expensive in health care costs than other states with higher rates.

I’m not a health care economist, I don’t know what all the factors are. I’m not sure why the new england states are 9-11k per capita.

The closest thing I can find to an argument is that Utah has low medical costs, and low rates of obesity and smoking. But even with that, their medicare spending per beneficiary is about the same as Arkansas, which has far higher rates of obesity and smoking. Colorado has low rates of both smoking and obesity, but their health care costs are only 5% cheaper than Alabama with higher rates of both. Alabama has lower medical costs per capita than new england states which have lower obesity and smoking rates. Some new england states are urban (MA for example) some are rural (VT).

I have no idea what all that data means. But there doesn’t appear on the surface to be a connection between obesity rates and/or smoking with per capita health spending on a state level.

[Grim_Render]

Generally, I suspect unhealthy lifestyle affects healthcare costs in the same way preventive medicine does.

I.e. medically, the most costly years of life are old age years. And unhealthy lifestyle people have significantly fewer of those. While they may be more expensive while alive, that does not necessarily mean more expensive in total. In the case of preventive medicine, I’ve seen studies saying it saves a bit, and studies saying it costs a bit. I’ve ended up feeling it pretty much cancels out.

[Euphonious_Polemic]

@Wesley_Clark

Its really just, like you said, our system is run poorly. But at this point so many powerful interest groups are lined up at the 3.2 trillion dollar a year trough and they aren’t giving it up without a fight. If our health care were as efficient as Europe or Canada, we’d save over a trillion dollars a year. Business interests aren’t going to give up a trillion dollars a year in revenues without a fight.

Exactly this. This is why the system in the US will never be “fixed”. There is a vast amount of cash being syphoned off.

[Wesley_Clark]

@Euphonious_Polemic

Exactly this. This is why the system in the US will never be “fixed”. There is a vast amount of cash being syphoned off.

The best course of action is to hope that blue states and large cities implement meaningful health reform that actually lowers cost. If they do that successfully, it may eventually spread to the national level but there will likely be a 10-30 year delay.

But if CA, IL, NY, etc. pass meaningful health reform and show it can work, it could start the ball rolling.