Whoa Nelly!

"Whoa Nelly" is an exclamation often used as a "say what?" "Hold on," or "back the truck up" expression. It is of unknown origin, but was apparently made famous by some fellow who announced football games for several decades. Pick your exclamation, there is some potential approaching for reigning in.

But, the "whoa" is a command to stop. The word has found new protagonists in the financial field. Blue Cross Blue Shield of Massachusetts announced in April that it will no longer "cover GLP-1s for weight loss." The price of medications, according to CBS News "have skyrocketed" and are "crippling budgets in the public and private sector."

California's "revised budget" predicts a $12-billion deficit, according to Family Doctors. One solution being discussed is to "end ... coverage for GLP-1 medications used for weight loss starting January 1, 2026." That would reportedly include Medicaid patients, according to Becker's Payer Issues.

Nonetheless, we have some significant challenges.

1. Too many people are overweight or obese.
2. Too many of us like our comfort foods (to the point of being uncomfortable)
3. We Americans like simple solutions that do not involve personal sacrifice (eating less, exercising).

The upshot is worthy of discussion.

The National Library of Medicine republished a Washington Post article in 2020. It concluded:

"74% of adults in the U.S. are overweight."

"43% who are considered obese."

10% of them "don't perceive themselves to be overweight."

There are many obese Americans. What would it cost to treat them all for Diabetes? The question is posed that way because GLP-1s are approved by the Food and Drug Administration to treat Diabetes. "Diabetes is a disease." And, there are those who think obesity is a disease also. Nonetheless, the Centers for Disease Control (CDC) reminds that:

"Obesity is influenced by many factors, including health behaviors, stress, and medical conditions."

Before one puts too much emphasis on that, the same might be said of Cancer, heart disease, and a raft of other conditions.

Nonetheless, what is the cost?

The Peterson KFF Health System Tracker reports that the costs of one month's prescription of the popular GLP-1s, annualized, are:

For some reason, the cost here is about five to ten times more expensive "than in other large, wealthy countries." That comparison seems troubling. Why are these medications so much more expensive in the United States, and how could that be ameliorated?

That GLP-1 cost is comparable to the average people pay for health insurance, which is "$8,951 for single coverage and $25,572 for family coverage," according to Kaiser Family Foundation.

The adult population of the United States is 347,045,613 (74%). The "overweight" is therefore likely about 256,813,755 and the "obese" is 149,229,614 (43%). To treat the "obese" with these drugs would cost:

Yes, that is $1.6 trillion to $2.4 trillion to treat all of the "obese" with GLP-1 medication for their obesity. The U.S. federal budget in 2024 was $6.9 trillion total. To treat all the "obese" with GLP-1 at retail price would require 24% to 35% of the total federal budget.

What would it take to treat the "overweight" population with these medications? That would be between $2.8 trillion (42% of the budget) to $4.2 trillion (60% of the budget).

These figures are, of course, at retail. The great myth is that someone is paying retail. They are not, well, not very often. Nonetheless, the cost of this solution to obesity seems significant, and likely explains the current proposals to cease providing these Diabetes medications for obesity.

Nonetheless, there are applications in the works for FDA approval of various GLP-1 for the specific purpose of obesity. Novo Nordisk has submitted an oral form, and Eli Lilly is similarly on track for an application.

It seems likely that debate will persist regarding the treatment of obesity. There will be questions of comparing the cost of treating obesity with "one pill," or preventing it with another (White Rabbit, Jefferson Airplane, RCA, 1967):

"One pill makes you larger

And one pill makes you small

And the ones that mother gives you

Don't do anything at all

Go ask Alice

When she's ten feet tall"

What, though, is the cost of treating all the ailments that are complicated by obesity? The CDC says these include:

"Coronary heart disease.Type 2 diabetes.

Cancers (endometrial, breast, and colon).

High blood pressure.

Lipid disorders (for example, high total cholesterol or high levels of triglycerides).

Stroke.

Liver and gallbladder disease.

Sleep apnea and respiratory problems.

Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint).

Gynecological problems (abnormal periods, infertility)"

In other words, having made the decision to socialize medicine and abandon personal responsibility, which cost is more palatable? Do we pay to treat obesity, or do we pay to treat implicated diseases? Is one a better solution, generally, a more economic decision overall, or a more logical choice?

There seems to be some potential that we are at a point of inflection. Decisions of great import may lie ahead regarding the persistence and perniciousness of "obesity," the societal inclination away from diet and exercise, and all that the implications and tangents that entail. 

The truly socialist medical systems have aptly demonstrated that supply and demand cannot be eradicated. Market forces persist. An editorial from Britain reminds that socialism means rationing care. The decisions are not made economically, but politically, and yet are supply/demand decisions nonetheless. There, the obese are being denied surgery, relief, and remediation. 

Scarcity is an economic fact. 

Or, again, perhaps we just redefine obesity? See What's in a Name (August 2020). That might make decisions for us, but will it make anyone healthier? Or, is it just rearranging the deck chairs? 

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