This is why health insurance and healthcare in general are so expensive

We have a community fitness center a few blocks from my house. It has a very good weight room and a room with treadmills and ellipticals as well. A family membership is just 15 dollars a month. No showers or lockers or anything like that, but you do get use of a first class weight room and a cardio equipment for just 15 dollars a month. The cost for an individual is just 10 dollars a month. Yet despite its inexpensive costs, I often have the weight room to myself as you can see from the picture I took this morning. There is seldom more than another person or two in there.

Regular strength training and cardio will reduce the rate of death by all causes by over 23% a year. It reduces the odds of cancer by 31% a year. It reduces the odds of heart disease by 33% a year. Combined with a good diet, and the reduction is over 50%. Regular exercise combined with a good diet, practically eliminates the odds of developing type 2 diabetes. This does not even get into the reduction of joint and mobility issues, reductions in rates of dementia, increased health span and so on.

So for 15 dollars a month, the health benefits of strength training, running (I do that outside), and a good diet reduces health costs by over half. For just 15 dollars a month. That is better results than any drug on the market no matter the costs of the drug. Yet the place is almost always empty. We would literally reduce healthcare costs in this country by over half a trillion dollars a year if people just watched their diet and used their local community center gym.

How many people right now bitch about the ACA, or bitch about Republican healthcare plans, and so on, but don't even take these simple inexpensive steps in their lives that would reduce their personal healthcare costs by tens of thousands if not hundreds of thousands of dollars? You want to know why health insurance is so expensive? Don't blame politicians, its because these places are empty.

There are a LOT of other ways to reduce health care costs through people taking more responsibility for themselves, too.

SouthernDemocrat said:

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We have a community fitness center a few blocks from my house. It has a very good weight room and a room with treadmills and ellipticals as well. A family membership is just 15 dollars a month. No showers or lockers or anything like that, but you do get use of a first class weight room and a cardio equipment for just 15 dollars a month. The cost for an individual is just 10 dollars a month. Yet despite its inexpensive costs, I often have the weight room to myself as you can see from the picture I took this morning. There is seldom more than another person or two in there.

Regular strength training and cardio will reduce the rate of death by all causes by over 23% a year. It reduces the odds of cancer by 31% a year. It reduces the odds of heart disease by 33% a year. Combined with a good diet, and the reduction is over 50%. Regular exercise combined with a good diet, practically eliminates the odds of developing type 2 diabetes. This does not even get into the reduction of joint and mobility issues, reductions in rates of dementia, increased health span and so on.

So for 15 dollars a month, the health benefits of strength training, running (I do that outside), and a good diet reduces health costs by over half. For just 15 dollars a month. That is better results than any drug on the market no matter the costs of the drug. Yet the place is almost always empty. We would literally reduce healthcare costs in this country by over half a trillion dollars a year if people just watched their diet and used their local community center gym.

How many people right now bitch about the ACA, or bitch about Republican healthcare plans, and so on, but don't even take these simple inexpensive steps in their lives that would reduce their personal healthcare costs by tens of thousands if not hundreds of thousands of dollars? You want to know why health insurance is so expensive? Don't blame politicians, its because these places are empty.

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How do you propose we attack this problem? If we are simply going to say the people did it to themselves the problem will remain.

I belong to an LA Fitness facility (2 floors) that has free weights, resistance machines, large cardio section, a basketball court, cycling room, yoga/zuma/pilate room, Olympic size swimming pool, large spa, sauna room, 12 shower cubicles for each gender, and large locker rooms with about a dozen individual wash basins. Open from 5am-midnight. Most of the time it's quite busy. I'd estimate 50% 18-35, 30% from 35-55, and 20% are 55 and over. I pay $25 a month and use it ~3-4 times per week.

But this particular workout facility may be an anomaly as far as usage. I'd like to hear from others.

Rogue Valley said:

I belong to an LA Fitness facility (2 floors) that has free weights, resistance machines, large cardio section, a basketball court, cycling room, yoga/zuma/pilate room, Olympic size swimming pool, large spa, sauna room, 12 shower cubicles for each gender, and large locker rooms with about a dozen individual wash basins. Open from 5am-midnight. Most of the time it's quite busy. I'd estimate 50% 18-35, 30% from 35-55, and 20% are 55 and over. I pay $25 a month and use it ~3-4 times per week.

But this particular workout facility may be an anomaly as far as usage. I'd like to hear from others.

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Well yes, there are other fitness centers that are lots busier. However, that is a bit misleading, because unfortunately most people sign up for a fitness center, go a lot for the first month or so, and then hardly ever go after that. The business model for most gyms revolves around that - sign people up, get them paying a monthly fee, and know that most of them will only go for the first month or so.

SouthernDemocrat said:

Well yes, there are other fitness centers that are lots busier. However, that is a bit misleading, because unfortunately most people sign up for a fitness center, go a lot for the first month or so, and then hardly ever go after that. The business model for most gyms revolves around that - sign people up, get them paying a monthly fee, and know that most of them will only go for the first month or so.

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You're probably right about longevity. I'd say only ~30% are still there from when I signed up. Used to go to a Gold's Gym. Much smaller with fewer amenities.

MrPeanut said:

How do you propose we attack this problem? If we are simply going to say the people did it to themselves the problem will remain.

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I would suggest that it takes with a revamping of our school physical education programs.

For one. In many cases.. we have decreased physical education training in our youngsters.

Two.. physical education has become paired too much with competitive athletics. The focus of money has not been on creating a healthy student body.. but on creating a competitive sports program that benefits a few participants.

jaeger19 said:

I would suggest that it takes with a revamping of our school physical education programs.

For one. In many cases.. we have decreased physical education training in our youngsters.

Two.. physical education has become paired too much with competitive athletics. The focus of money has not been on creating a healthy student body.. but on creating a competitive sports program that benefits a few participants.

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I think that is a good start. I would couple physical education with healthier food at schools. A lot of modern schools have soda and ice cream machines that kids can basically use however much they want. I think that if we really decide as a nation that the health of our population begins in school we could change a lot for the better. I would bet that if all of that sugar was removed we may see some increases in test scores as well.

SouthernDemocrat said:

We have a community fitness center a few blocks from my house. It has a very good weight room and a room with treadmills and ellipticals as well. A family membership is just 15 dollars a month. No showers or lockers or anything like that, but you do get use of a first class weight room and a cardio equipment for just 15 dollars a month. The cost for an individual is just 10 dollars a month. Yet despite its inexpensive costs, I often have the weight room to myself as you can see from the picture I took this morning. There is seldom more than another person or two in there.

Regular strength training and cardio will reduce the rate of death by all causes by over 23% a year. It reduces the odds of cancer by 31% a year. It reduces the odds of heart disease by 33% a year. Combined with a good diet, and the reduction is over 50%. Regular exercise combined with a good diet, practically eliminates the odds of developing type 2 diabetes. This does not even get into the reduction of joint and mobility issues, reductions in rates of dementia, increased health span and so on.

So for 15 dollars a month, the health benefits of strength training, running (I do that outside), and a good diet reduces health costs by over half. For just 15 dollars a month. That is better results than any drug on the market no matter the costs of the drug. Yet the place is almost always empty. We would literally reduce healthcare costs in this country by over half a trillion dollars a year if people just watched their diet and used their local community center gym.

How many people right now bitch about the ACA, or bitch about Republican healthcare plans, and so on, but don't even take these simple inexpensive steps in their lives that would reduce their personal healthcare costs by tens of thousands if not hundreds of thousands of dollars? You want to know why health insurance is so expensive? Don't blame politicians, its because these places are empty.

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You pay $15 per month of your own money to have access to the gym and not only does it (statistically speaking) reduce your own long-term health care costs relative to what they would be if you took bad care of your body, it indirectly reduces costs collectively given your health costs are paid by a pool of dollars collected from many others. Yet the only differential factor in the pricing of those premiums is age and whether you smoke or not. Does that really make sense, that an obese binge drinker your age would pay the exact same premium amount as you for the same health insurance coverage?

I pay a hell of a lot more for car insurance if I choose to drive a Bentley. It seems it would be good if we made people pay more for coverage when their behavior increases their risk factors. You can't align financial and health incentives without charging voluntarily unhealthy people more and voluntarily healthier people less.

Neomalthusian said:

You pay $15 per month of your own money to have access to the gym and not only does it (statistically speaking) reduce your own long-term health care costs relative to what they would be if you took bad care of your body, it indirectly reduces costs collectively given your health costs are paid by a pool of dollars collected from many others. Yet the only differential factor in the pricing of those premiums is age and whether you smoke or not. Does that really make sense, that an obese binge drinker your age would pay the exact same premium amount as you for the same health insurance coverage?

I pay a hell of a lot more for car insurance if I choose to drive a Bentley. It seems it would be good if we made people pay more for coverage when their behavior increases their risk factors. You can't align financial and health incentives without charging voluntarily unhealthy people more and voluntarily healthier people less.

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I have made the same argument for years.

MrPeanut said:

I think that is a good start. I would couple physical education with healthier food at schools. A lot of modern schools have soda and ice cream machines that kids can basically use however much they want. I think that if we really decide as a nation that the health of our population begins in school we could change a lot for the better. I would bet that if all of that sugar was removed we may see some increases in test scores as well.

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Oh without a doubt. There are modern schools where there are MCDONALDS in the school. As usual the issue really comes down to lobbying and money. We need a place to get rid of all that cheap high fructose corn syrup. And the school systems have become a great place to do that. Large companies like Cisco make millions providing already processed and prepared foods to school districts. And Agriculture and companies like Cisco lobby for these meal programs.

There are great examples of schools that hire cooks and provide excellent tasting AND nutritious foods from "scratch". . And ironically... these schools have been found to produce these meals CHEAPER than providing pre packaged meals. AND have much less waste as students will eat it.

But it will require a major shift in school philosophy which for the most part is "cheap and easy" is best.

Neomalthusian said:

You pay $15 per month of your own money to have access to the gym and not only does it (statistically speaking) reduce your own long-term health care costs relative to what they would be if you took bad care of your body, it indirectly reduces costs collectively given your health costs are paid by a pool of dollars collected from many others. Yet the only differential factor in the pricing of those premiums is age and whether you smoke or not. Does that really make sense, that an obese binge drinker your age would pay the exact same premium amount as you for the same health insurance coverage?

I pay a hell of a lot more for car insurance if I choose to drive a Bentley. It seems it would be good if we made people pay more for coverage when their behavior increases their risk factors. You can't align financial and health incentives without charging voluntarily unhealthy people more and voluntarily healthier people less.

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Won't work.

the problem with punishment schemes.. like what you describe (you pay more if you x).. is that they don't work.

Look at how much the price of cigarettes has been increased with taxes, and yet.. people still go out and blow hundreds of dollars on cigarettes AND pay more in insurance to boot.

Heck../ look at what happens to your car insurance premiums if you get speeding tickets... then go take a drive and drive the speed limit and see how many cars pass you.

You cannot legislate health anymore than you can legislate morality.

We have to change a culture. And that starts with our kids...

jaeger19 said:

Won't work.

the problem with punishment schemes.. like what you describe (you pay more if you x).. is that they don't work.

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It works with car insurance. People keep buying nice cars despite insurance costing more.

Look at how much the price of cigarettes has been increased with taxes, and yet.. people still go out and blow hundreds of dollars on cigarettes AND pay more in insurance to boot.

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The intent of charging them more is not merely punitive. It’s simply pricing insurance according to risk. Insurance companies have to do this to some degree to avoid adverse selection.

You cannot legislate health anymore than you can legislate morality.

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You can to a degree. A lot of immoral things are also illegal.

Neomalthusian said:

It works with car insurance. People keep buying nice cars despite insurance costing more.

.

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Right.. so despite the increase cost of car insurance.. they keep doing an expensive behavior.

You just supported my premise.

The intent of charging them more is not merely punitive. It’s simply pricing insurance according to risk. Insurance companies have to do this to some degree to avoid adverse selection.

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No they don't. The nature of insurance is spreading the risk out.. that's how it works.. with an extremely large portion.. including obese people.. who aren;t using that insurance.

For the most part, the whole.. "we have to charge you more because so and so smokes etc.. .. its a big fat lie by insurance companies to make you feel better about paying through the nose. "Its not us making a profit.. its THEM".

I am in the health field and own healthcare businesses. When I purchase healthcare for my employees, the rates are way higher than they are for other industries.. (industries that have high utilization no less). Of course the insurance company states "well its because healthcare workers use more healthcare... they are more likely to go to the doctor".

HA.. BS.. we tend to be less likely to go to the doctor because we don't freak out about little things..and we are more likely to get preventative medicine done or do it ourselves. The real reason that healthcare gets charged more? Because 1. The healthcare business has the money to pay for costly insurance.. 2. Our workers understand and value healthcare insurance so they have a higher demand for healthcare insurance (even though utilization is lower than other industries). Which means the insurance company knows they can gouge me more.

Studies have shown that the price of healthcare insurance goes up and down with the increase or decrease in the financials of industries. regardless of utilization.

You can to a degree. A lot of immoral things are also illegal.

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Yep and people still do them. I would submit that the people that don't do those activities do so because they already have a moral objection to doing them.. and not because of the law.

Is the reason that you don't murder your neighbor because of the law.. or because you think murdering your neighbor is wrong?

jaeger19 said:

Right.. so despite the increase cost of car insurance.. they keep doing an expensive behavior.

You just supported my premise.

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No, you're assuming the goal is to make everyone healthy by charging them differential rates for insurance coverage. I.e. you're assuming the goal of charging differential car insurance premiums between Porsche drivers and Kia drivers is to get people to stop driving Porsches. That's not the goal. The goal is to promote maximum fairness in the cost of insurance coverage between people whose risk of needing payout is significantly higher, which has an even deeper and more fundamentally important goal of preventing adverse selection.

No they don't.

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Yes they do. Why do health insurance companies charge 60-year olds more than 25-year olds?

The nature of insurance is spreading the risk out.. that's how it works..

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Not with zero attention to differential risks. Premiums normally vary relative to the risk of payout.

For the most part, the whole.. "we have to charge you more because so and so smokes etc.. .. its a big fat lie by insurance companies to make you feel better about paying through the nose.

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You're not being consistent. Insurance companies are allowed to charge smokers more than non-smokers, and older people more than younger people. There are completely rational reasons for this, both on the consumer side as well as the insurer side. You wouldn't be able to get low-risk people to buy the coverage if you couldn't vary the rates whatsoever according to risk.

I am in the health field and own healthcare businesses. When I purchase healthcare for my employees, the rates are way higher than they are for other industries.. (industries that have high utilization no less). Of course the insurance company states "well its because healthcare workers use more healthcare... they are more likely to go to the doctor".

HA.. BS.. we tend to be less likely to go to the doctor because we don't freak out about little things..and we are more likely to get preventative medicine done or do it ourselves. The real reason that healthcare gets charged more? Because 1. The healthcare business has the money to pay for costly insurance.. 2. Our workers understand and value healthcare insurance so they have a higher demand for healthcare insurance (even though utilization is lower than other industries). Which means the insurance company knows they can gouge me more.

Studies have shown that the price of healthcare insurance goes up and down with the increase or decrease in the financials of industries. regardless of utilization.

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I can't prove your insurance providers aren't bull****ting you, nor do I have a desire to, but the point of all this was that it's normal in a private insurance model for clearly differential risk profiles to cause differential premium rates, but with health insurance in particular, except for smoking and age, law otherwise forbids insurers from charging different premium despite clear evidence of vastly differential individual risk profiles.

Yep and people still do them.

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But you said morality can't be legislated. Of course it can, at least to the degree that many immoral behaviors are illegal. Therefore those things are legislated. Just because speed limits don't prevent all cases of speeding doesn't mean we can't regulate speed limits. Of course we can, and we do.

I would submit that the people that don't do those activities do so because they already have a moral objection to doing them.. and not because of the law.

Is the reason that you don't murder your neighbor because of the law.. or because you think murdering your neighbor is wrong?

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This diverts the topic significantly down a philosophical bunny trail.

Consider the extremes: insurance that charges the same premiums for all, zero regard to differences in the individual insured's risk profiles. Why doesn't this work in the real world? Because the lowest risk participants can easily see it's a bad deal for them, so they won't buy it. Other extreme, an insurance product covers everyone with 100% variability on individual risk factors, e.g. you get in a car wreck, your premiums are hiked by the amount needed to buy you a new car. Why doesn't this work in the real world? Because it provides no perception of value to customers, they're effectively paying the same amount for the coverage as they would pay if they had no coverage. The notion of insurance that is purchased voluntarily is that people need to perceive a value to the protection. This means they have to see a reasonable potential that they could need payouts far exceeding their premium payments. This means some variability of premiums is required, but not absolute variability. Either extreme results in adverse selection, which causes an insurance death spiral.

SouthernDemocrat said:

We have a community fitness center a few blocks from my house. It has a very good weight room and a room with treadmills and ellipticals as well. A family membership is just 15 dollars a month. No showers or lockers or anything like that, but you do get use of a first class weight room and a cardio equipment for just 15 dollars a month. The cost for an individual is just 10 dollars a month. Yet despite its inexpensive costs, I often have the weight room to myself as you can see from the picture I took this morning. There is seldom more than another person or two in there.

Regular strength training and cardio will reduce the rate of death by all causes by over 23% a year. It reduces the odds of cancer by 31% a year. It reduces the odds of heart disease by 33% a year. Combined with a good diet, and the reduction is over 50%. Regular exercise combined with a good diet, practically eliminates the odds of developing type 2 diabetes. This does not even get into the reduction of joint and mobility issues, reductions in rates of dementia, increased health span and so on.

So for 15 dollars a month, the health benefits of strength training, running (I do that outside), and a good diet reduces health costs by over half. For just 15 dollars a month. That is better results than any drug on the market no matter the costs of the drug. Yet the place is almost always empty. We would literally reduce healthcare costs in this country by over half a trillion dollars a year if people just watched their diet and used their local community center gym.

How many people right now bitch about the ACA, or bitch about Republican healthcare plans, and so on, but don't even take these simple inexpensive steps in their lives that would reduce their personal healthcare costs by tens of thousands if not hundreds of thousands of dollars? You want to know why health insurance is so expensive? Don't blame politicians, its because these places are empty.

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Yes, I'm sure it's primarily because people are all hella buff lifters and tireless aerobics masters in other developed countries that their health care costs per capita are half the US' or less and that your anecdote is evidence as opposed to y'know, a patently ludicrous and absurdly inefficient structuring of the health system riddled with perverse incentives that puts private profit before people?

jaeger19 said:

Won't work.

the problem with punishment schemes.. like what you describe (you pay more if you x).. is that they don't work.

Look at how much the price of cigarettes has been increased with taxes, and yet.. people still go out and blow hundreds of dollars on cigarettes AND pay more in insurance to boot.

Heck../ look at what happens to your car insurance premiums if you get speeding tickets... then go take a drive and drive the speed limit and see how many cars pass you.

You cannot legislate health anymore than you can legislate morality.

We have to change a culture. And that starts with our kids...

Click to expand...

I don't completely disagree with you, but the increase in the price of cigarettes did indeed reduce smoking rates. https://www.npr.org/sections/health...igarette-smoking-in-the-u-s-continues-to-fall

Neomalthusian said:

It works with car insurance. People keep buying nice cars despite insurance costing more.



The intent of charging them more is not merely punitive. It’s simply pricing insurance according to risk. Insurance companies have to do this to some degree to avoid adverse selection.



You can to a degree. A lot of immoral things are also illegal.

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The problem is that health insurance works nothing like car insurance. If health insurance worked like other forms of insurance, then your body would have a value determined by your age and lifetime salary. You would be insured up to that value, and one you exceeded it, the insurer would consider you a total loss. The older you got, the lower the value of your body would be and thus the the less the insurer would pay for your healthcare before considering you a total loss. Example: A thirty year old attorney might be worth 500k before the insurer would consider them a total loss. In contrast, a 55 year old administrative assistant would only be worth a 100k before the insurer would consider them a total loss. By the time you hit your 70s, you would be worth next to nothing.

Surrealistik said:

Yes, I'm sure it's primarily because people are all hella buff lifters and tireless aerobics masters in other developed countries that their health care costs per capita are half the US' or less and that your anecdote is evidence as opposed to y'know, a patently ludicrous and absurdly inefficient structuring of the health system riddled with perverse incentives that puts private profit before people?

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For one, we do actually have the highest obesity rate in the developed world. We also have the highest type 2 diabetes rate in the developed world. Both of those are by quite a margin. We also have the highest rate of heart disease among fully developed nations. So actually, our particularly poor diet in this country, and our particularly sedentary lifestyle in this country (we are the most sedentary of any country in the fully developed world), does increase our healthcare costs considerably. The doesn't mean there are not all sorts of problems with our healthcare and health insurance system, but we can't ignore lifestyle factors as well.

Health and healthcare costs are not something that just happen to you.

SouthernDemocrat said:

The problem is that health insurance works nothing like car insurance. If health insurance worked like other forms of insurance, then your body would have a value determined by your age and lifetime salary. You would be insured up to that value, and one you exceeded it, the insurer would consider you a total loss. The older you got, the lower the value of your body would be and thus the the less the insurer would pay for your healthcare before considering you a total loss. Example: A thirty year old attorney might be worth 500k before the insurer would consider them a total loss. In contrast, a 55 year old administrative assistant would only be worth a 100k before the insurer would consider them a total loss. By the time you hit your 70s, you would be worth next to nothing.

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I acknowledge the differences, the point was to explain why insurance normally would charge different premiums based on different risk profiles.

SouthernDemocrat said:

Well yes, there are other fitness centers that are lots busier. However, that is a bit misleading, because unfortunately most people sign up for a fitness center, go a lot for the first month or so, and then hardly ever go after that. The business model for most gyms revolves around that - sign people up, get them paying a monthly fee, and know that most of them will only go for the first month or so.

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Having spoken to a lot of people who have done that thing where they quit after a month, I'd say there's two big problems.

One is that a lot of people don't know how to start doing exercise. They attack it way too quickly, sometimes wind up injuring themselves, or become discouraged by how little they can do before they're tapped out. Finding a way to reach people about how to go from very low fitness, to better fitness, in a way that is safe and maintainable might help. When I was getting back in shape after some injuries and a terrible sedentary office job, I started with a month of just bodyweight exercises before I went anywhere near anything more intense.

Two is, quite frankly, gym culture is pretty terrible in some places. I got a pass because I'm thin (because obviously skinny = healthy, right? :roll. But I have seen and heard lots of crap aimed at overweight people at the gym. A lot of them get stared at, or hear snickers, or told that they are what the resident gym bro doesn't want to look like. I've seen people take pictures of them.

I'd say one of the worst is when said gym bros tell them they're "not trying hard enough." They have no idea what baseline that person is starting from -- if, on top of being overweight, they have an injury, or some sort of illness, or whatever else, that may impact how hard they can go, or warrant starting out from a conservative position and working their way up. We've had some DP'ers with diabetes share how sick they've gotten from doing what they thought was a normal workout, but turned out to be too much for their health issues. And Gym Bro doesn't know any of that when he's accusing a newbie of "not trying hard enough."

SouthernDemocrat said:

I don't completely disagree with you, but the increase in the price of cigarettes did indeed reduce smoking rates. https://www.npr.org/sections/health...igarette-smoking-in-the-u-s-continues-to-fall

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No, it didn't. Cigarettes cost considerably less in the US than they do in most of Western Europe, and yet their smoking rates are much higher than ours.

It's not cost. It's that America made a much more robust and active effort to prevent youth smoking.

SmokeAndMirrors said:

No, it didn't. Cigarettes cost considerably less in the US than they do in most of Western Europe, and yet their smoking rates are much higher than ours.

It's not cost. It's that America made a much more robust and active effort to prevent youth smoking.

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Behavioral economics 101: It's not the cost of cigarettes that discourages people from smoking, its the cost of cigarettes relative to what they were that discourages people from smoking. In much of Europe, people are used to spending more for consumer goods and so on, thus you have to raise the price of something by more than you would here to get the same impact in terms of behavioral modification.

SmokeAndMirrors said:

Having spoken to a lot of people who have done that thing where they quit after a month, I'd say there's two big problems.

One is that a lot of people don't know how to start doing exercise. They attack it way too quickly, sometimes wind up injuring themselves, or become discouraged by how little they can do before they're tapped out. Finding a way to reach people about how to go from very low fitness, to better fitness, in a way that is safe and maintainable might help. When I was getting back in shape after some injuries and a terrible sedentary office job, I started with a month of just bodyweight exercises before I went anywhere near anything more intense.

Two is, quite frankly, gym culture is pretty terrible in some places. I got a pass because I'm thin (because obviously skinny = healthy, right? :roll. But I have seen and heard lots of crap aimed at overweight people at the gym. A lot of them get stared at, or hear snickers, or told that they are what the resident gym bro doesn't want to look like. I've seen people take pictures of them.

I'd say one of the worst is when said gym bros tell them they're "not trying hard enough." They have no idea what baseline that person is starting from -- if, on top of being overweight, they have an injury, or some sort of illness, or whatever else, that may impact how hard they can go, or warrant starting out from a conservative position and working their way up. We've had some DP'ers with diabetes share how sick they've gotten from doing what they thought was a normal workout, but turned out to be too much for their health issues. And Gym Bro doesn't know any of that when he's accusing a newbie of "not trying hard enough."

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I agree that a lot of people don't really know how to exercise. For example, most people don't know that there is no such thing as "toning", and that everyone should lift heavy (which is relative of course to the abilities of the individual) and focus on compound lifts / functional strength training. Moreover, most people don't know that some machines like an elliptical are basically worthless, that running on a treadmill is typically worse on your joints than running outside, and that if you are not getting your heart rate up, you are not accomplishing that much.

It would be better if everyone were required to take a strength training class in high school rather than just Physical Education.

SouthernDemocrat said:

For one, we do actually have the highest obesity rate in the developed world. We also have the highest type 2 diabetes rate in the developed world. Both of those are by quite a margin. We also have the highest rate of heart disease among fully developed nations. So actually, our particularly poor diet in this country, and our particularly sedentary lifestyle in this country (we are the most sedentary of any country in the fully developed world), does increase our healthcare costs considerably. The doesn't mean there are not all sorts of problems with our healthcare and health insurance system, but we can't ignore lifestyle factors as well.

Health and healthcare costs are not something that just happen to you.

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To nearly the extent that it constitutes the vast majority of the cost differential?

Absolutely impossible.

The US absolutely does have high incidents rates of both, and they do explain _some_ of that differential, but not nearly to the extent it comes anywhere close to accounting for more than a doubling in per capita costs vis a vis other developed countries. For example, obesity and diabetes prevalence in the US are each only about 5% greater as a % of the population than in Australia, and yet the former's per capita spending is more than double; 113% higher. This is clearly and predominantly a matter of systemic issues rather than the fault of individuals. Sure, the state of general fitness in the country could use substantial improvement, but let's put the majority of the blame where it actually lies, rather than assert that it's chiefly because people are lazy and indolent that the American healthcare is by far the most costly and inefficient in the world.

I apologize for the incisive tone, but it legitimately bothers me when people try to imply (or outright state) that majoritarian blame is not with the system but the people victimized by it.