[throwaway010718]

On our current trajectory, "who pays" isn't the most pressing issue. Suppose Medicare for All does save 10% as the article claims, if the cost just keeps rising then it only buys a little more time before no entity can foot the bill.

100 million people in the US have diabetes or pre-diabetes according to the CDC.[1] Diabetes costs $14,000/yr(?) and people are getting it at an earlier age and living longer. Of all the threats to the US, this one is particularly insidious.

There is also the concern that big pharma (along with big-sugar/corn) has too much influence over congress. The U.S. is the only country besides NZ to allow direct to consumer drug advertisement. That fact alone makes me lose faith in the government. Is it prudent to give more power and money to our government when they appear to be complicit and bereft of root cause solutions to address the rising cost ? Bloomberg, as NYC's mayor, seemed like the only politician who was willing to pass unpopular and extreme legislation by way of banning or limiting certain foods.

[1] https://www.cdc.gov/media/releases/2017/p0718-diabetes-repor...

[lhl]

As a tangent, I do think it's increasingly obvious that T2D (and metabolic syndrome) is a disease that's specific to the modern western diet and that lifestyle interventions are very effective at stopping or reversing T2D entirely.

Here's a recent publication on a controlled study being done by Virta Health et al. Of especial interest will be Fig 3 showing just how effective carbohydrate restriction was vs "usual care": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194375/

IDF has also recently published case studies on the effectiveness of intermittent fasting as T2D treatment for those that can't/won't carb restrict: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194375/

To expand on the costs a bit, the ADA has similar estimates, and in their 2018 report [1] estimates $16.75K/ppy costs (also cited by the CDC [2]), with direct+indirect costs estimated at $327B/yr, and that 1/7th of every health-care dollar is spent on diabetes-related costs. The Milken Institute [3] recently published a report on American Obesity [4] that gives even bigger numbers: "chronic diseases driven by the risk factor of obesity and overweight accounted for $480.7 billion in direct health care costs in the U.S., with an additional $1.24 trillion in indirect costs due to lost economic productivity."

[1] http://www.diabetes.org/advocacy/news-events/cost-of-diabete...

[2] https://www.cdc.gov/diabetes/diabetesatwork/plan/costs.html

[3] https://en.wikipedia.org/wiki/Milken_Institute

[4] https://www.milkeninstitute.org/publications/view/944

[martinald]

But the US current system has afiak by far the highest rate of healthcare cost inflation. Single payer systems tend to inflate at less cost than the US one, so it is a win win.