[hiAndrewQuinn]

I doubt you can free healthcare your way out of obesity. You can't even healthcare your way out of obesity when you make it really, really personally expensive to be obese. And obesity is almost certainly the mortality bottleneck these days.

Obesity is primarily caused by the 1-2000 micro-decisions we make each year about what to eat, when, and how much. A free visit to the doctor now and then is just not going to move the needle much on that one way or another for most people, most of the time. Even if it could we have to ask why a $0 doctor visit would be so much more effective than a $100 doctor visit.

No, the effects you're seeing what Europeans are more fit than Americans on average is coming from somewhere else. I think the real answer is the obvious one: Food here in Europe is simply worse tasting than in the US in general. I've been here for 5 years across twice as many countries; I've never had a pizza here that even matches Little Caesar's back at home, in terms of lighting up my little monkey neurons, to say nothing of Costco. If I ever go back home I will break and get one of the two within a week of reaching the airport.

Capitalism is an optimization process that has optimized the heck out of food reward signal. Your only real options are either to be poor enough that capitalism doesn't care about getting you the 'good stuff' - easier said than done when being poor sucks, and when the good stuff is constantly getting cheaper over time anyway - or you fight back with even harder optimization in the reverse direction. You could argue Europe is some mixture of both compared to the US.

[throwaway290]

I think free healthcare means government must want ppl to be healthy. Unhealthy people literally take money from government's pocket, so gov uses various regulation against unhealthy stuff and does healthy lifestyle promotion

[hiAndrewQuinn]

I don't see why that would work better than having the unhealthy people literally take the money out of their own pocket.

[throwaway290]

Can you explain how you disagree. You mean people have as much money as the government to waste on their health issues? Or you mean people without free healthcare can self regulate habits and be totally not influenced by corporate advertisement and cheap unhealthy stuff dominating food markets? I think that's maybe too rosy

Imagine the government pays for healthcare. The government can pass laws. What is cheaper for gov, to pass laws or to pay for healthcare. Of course they prefer to pass laws which regulate unhealthy stuff and run promotions to get people be healthy. Regular people cannot do this.

[hiAndrewQuinn]

Alright, now imagine the government doesn't pay for healthcare. This is the literal cheapest thing for them, as it now costs $0, and they don't have to spend time worrying about law.

If the government isn't paying for your healthcare, then you have to pay it yourself. If you are fat, statistically, you will probably end up paying a lot more over time. This is not "wasted" money - no money you spend on your health is totally wasted. The good news is, you personally benefit from this money more than anyone else who could possibly spend it on your behalf - you reap the health benefits, the extra Christmases with the family, the bigger smiles from strangers.

Now how much does being fat cost over a lifetime? Frequently in the range of tens or even hundreds of thousands of dollars. That's pure medical costs, before we even consider how much the intangibles are worth.

The thing is: Most people understand this. If you understand this, and are still fat, then on some level you are indeed saying that the money isn't worth the trade-off of changing your whole lifestyle to (a) fix this and then (b) ensure you don't end up there again.

To me that's proof that being fat is a very hard thing to change just by throwing money at it. The literal best, most incentivized person, the fat person themselves, can't even figure out how to change it, not even with at minimum tens of thousands of dollars on the line. There are probably government interventions that probably could move the needle at scale, but they are probably not "let's subsidize spinach farmers" or whatever, because an extra $2 per week for spinach is just not that much money compared to even a single $50,000 gastric bypass. They probably look more like "If your BMI drifts above 27 we send you to weight loss prison and you can come out when you're below 22 again", which sounds insane, because it is. It is simply a very hard problem to solve by throwing money at it.

[throwaway290]

> Alright, now imagine the government doesn't pay for healthcare. This is the literal cheapest thing for them, as it now costs $0, and they don't have to spend time worrying about law.

I mean a government that already chose to implement free healthcare. THEN it is cheaper for them to keep people healthy.

Of course it would be cheapest to not care at all. But if you already locked into caring then it is cheaper to prevent than to treat

[hiAndrewQuinn]

That isn't actually the argument I'm making, but for what it's worth that's both false and begging the question. A government can choose to stop implementing universal healthcare, just like it can choose to implement it.