The obesity explanation doesn't pass the sniff test. Canada is 12% less obese than the U.S., but it spends 6% less of its GDP on healthcare. Put differently, if obesity was the reason for excess spending, the U.S. would save $1.1 trillion for every 12% of its population that is cured of obesity. If true, that would peg the marginal cost of obesity at $27,777 per person per year (1.1 trillion/.12*330 million), or 9x the annual salary of a doctor in Cuba. That is beyond the realm of believability, even if I introduce the other population-induced causal factors which you implied but didn't specify.
Additionally, the government would be more invested in the population's health under a single-payer model. It would actively work to reduce the prevalence of obesity and lower its costs. That would include taxing consumable goods with a negative health externality, commensurate with the magnitude of that externality. That would also include incentivizing the consumption and production of goods with positive health externalities and investing in pro-health infrastructure.
Imagine if a city faced the following math: "A network of bike lanes would cost us $40 million and $10 million to maintain over the next 10 years. It would also save around $50 million in health expenditures every 10 years. After one decade, it will cost $10 million and continue to save us $50 million." All the bike lanes you could dream of would be built overnight, assuming there would be subsidies by a M4A healthcare program. I'm more excited at the prospect of converting roads into pedestrian walkways and scooter highways. That wouldn't seem like such an expensive proposition if the government would recoup the cost in healthcare savings.
> The obesity explanation doesn't pass the sniff test. Canada is 12% less obese than the U.S., but it spends 6% less of its GDP on healthcare.
It's my blog (RCA). My argument is that obesity substantially explains US health outcomes in relation to other countries. I never claimed obesity is the cause of high national health spending (as in, "inputs"). To the contrary, I have consistently argued US health spending is well explained by its wealth (technically income levels).
To a first approximation, national health spending is entirely explained by the average house income level in the long run. While time, healthcare technology, and other factors are assocatied with rising spending, these changes are ultimately very well explained by changing income levels.
Amongst high-income countries, a 1% increase in income is robustly associated with a long run increase of about 1.8% (it's highly elastic).
The US spends more than Canada because it's still a much richer country (which isn't to say Canada isn't a nice place!).
> That is beyond the realm of believability, even if I introduce the other population-induced causal factors which you implied but didn't specify.
Again, I never said this, but other population health risk factors such as age structure, disease rates, and the like are of negligible significance when it comes to long run aggregate spending. Such factors may be highly predictive within countries and may have some say in the short run (within budgetary constraints), but in the long run national picture the evidence suggests these factors amount to little more than noise. National household income levels trumps everything.
> Additionally, the government would be more invested in the population's health under a single-payer model.
US government programs, namely Medicare and Medicaid, spend more on healthcare than most other high-income countries do in total (even more so comparing public-to-public). Just how much more incentive do we need before these magical effects kick in? Higher health spending predicts higher obesity rates in time series and cross-sectionally (though this is likely ultimately mediated by long-run income levels and by time).
Where is the evidence that these programs have large, sustained effects and are cost effective? Most data indicate these programs have negligible effects in the long run and they almost always cost more than they save (which isn't to say we shouldn't necessarily do it, but the economic rationale is v. weak).
Additionally, the government would be more invested in the population's health under a single-payer model. It would actively work to reduce the prevalence of obesity and lower its costs. That would include taxing consumable goods with a negative health externality, commensurate with the magnitude of that externality. That would also include incentivizing the consumption and production of goods with positive health externalities and investing in pro-health infrastructure.
Imagine if a city faced the following math: "A network of bike lanes would cost us $40 million and $10 million to maintain over the next 10 years. It would also save around $50 million in health expenditures every 10 years. After one decade, it will cost $10 million and continue to save us $50 million." All the bike lanes you could dream of would be built overnight, assuming there would be subsidies by a M4A healthcare program. I'm more excited at the prospect of converting roads into pedestrian walkways and scooter highways. That wouldn't seem like such an expensive proposition if the government would recoup the cost in healthcare savings.