“Rich people get Ozempic. Poor people get body positivity.”
That was one of the iconic lines from a “South Park” special in May dubbed “The End of Obesity.”
The show focused its trademark satire on semaglutide, a class of type-2 diabetes drugs that have become popular in the last few years, particularly among wealthier Americans, for weight loss.
But why the class dichotomy?
America’s obesity problem is expensive, in ways we don’t even think about.
We should rethink the idea that semaglutide — and its name brands such as Ozempic and Wegovy ���should be available only to the rich who can afford them.
What if we could actually save money in the long run by making such drugs accessible to those who can’t pay out-of-pocket?
America’s pudge means more people miss work and incur huge medical bills.
More people struggle conceiving babies.
And fewer qualify for military service.
The economic toll in medical costs alone is $173 billion annually, according to the Centers for Disease Control and Prevention.
What’s more, these costs stem disproportionately from poorer Americans, since, as we already know, poverty and obesity are linked.
It may seem counterintuitive to “body-positive” advocates on the left, and to anti-spending advocates on the right who scoff at drugs in favor of discipline, but mandating coverage of weight-loss medications, and in particular ensuring their coverage by state Medicaid plans, would actually reduce long-term health costs, bolster the nation’s birth rate, and enhance military readiness.
Medicaid recipients tend to be young — precisely the population we need to join the armed services, raise the next generation and build the next great American age.
The disproportionate prevalence of obesity among Medicaid recipients — markedly higher than that among their privately insured counterparts — calls for a comprehensive strategy including GLP-1 medications.
Amongst older Medicaid recipients, presence on Medicaid rolls tends to be sticky, with eligibility often lasting a lifetime.
Investment in preventative health now will save Medicaid (and ultimately Medicare) significant costs later.
Meanwhile, one of the immediate payoffs could be more babies.
After all, America’s current baby bust is intertwined with its obesity problem.
GLP-1’s would help mitigate this. Just search “Ozempic babies” on TikTok.
Semaglutide is already helping women conceive, whether by improving sperm quality in men or reversing impaired fertility in women, with happy moms showing off surprise infants they previously believed they were incapable of conceiving.
We’re living in a sad era in which native-born Americans have drifted away from marriage and baby-making.
In addition to fixing the mechanical and hormonal impediments that prevent conception, perhaps the wide availability of GLP-1 medications could also help young Americans regain their mojo and abandon screens in favor of real, embodied lives.
Speaking of embodied lives, fat Americans are ill-prepared to defend their country.
While Americans diverge on issues of military proactiveness abroad, we generally agree on the importance of defense and preparedness.
Yet unfortunately, as Americans have expanded, our military has shrunk.
The Department of Defense reports that obesity is one of the top reasons recruits fail to qualify for military service, with nearly one-quarter of applicants disqualified for this reason.
By improving the health of potential recruits, mandatory coverage of GLP-1 medications could enhance the pool of eligible individuals, improving national security.
The inclusion of GLP-1 medication coverage across both private and public insurance sectors taps into the economic principle of scale — greater adoption leading to lower costs over time.
For Medicaid, the immediate cost implications of coverage are balanced against the substantial long-term savings from reduced treatment of obesity-related illnesses.
For private insurers, coverage means long-term cost minimization and health-outcome optimization for insured populations.
The stark reality that obese individuals incur medical costs approximately $1,429 higher than their normal-weight counterparts annually underscores the urgency.
By limiting access to GLP-1 medications, we are being penny-wise but pound-foolish, condemning Americans to unhealthier, unhappier presents and sicker, shorter futures.
Of course, when progressives have wanted to increase access to expensive medications, they’ve gotten their way. PrEP, the drug that reduces the risk of contracting HIV, is broadly available, affordable, and covered by Medicaid.
Plan B, the drug taken to prevent pregnancy, is available over the counter.
GLP-1s, by contrast, require a doctor visit and pre-authorization — and even then, often go uncovered.
The process of accessing the medication seems designed to frustrate those seeking it.
Access through conventional channels is so restricted that it has fueled a booming business in direct-to-consumer, cash-pay, compounded versions.
Safe, legitimate, versions of these drugs should be widely accessible.
As my colleague, Chris Pope, has shown, the current price of name brand GLP-1s is too high for government programs.
But the opportunity to bulk sell vast quantities to Medicaid plans should incentivize drug companies to negotiate lower per-unit prices.
Alternatively, states should purchase compounded versions from trusted partners.
We know that GLP-1 medications significantly reduce body weight.
One study showed an average weight loss of 14.9% among participants.
Such success rates can’t come soon enough.
In the wake of COVID-19, Americans ballooned.
The rate of body-mass-index (BMI) increase approximately doubled for children and adolescents during the pandemic compared to pre-pandemic years.
The sedentary lifestyle enforced by ill-conceived lockdowns, coupled with increased screen time and disrupted physical activity through school sports and playground access, exacerbated the problem.
Additionally, pandemic-induced stress and anxiety pushed consumers towards increased consumption of high-caloric, processed foods.
Something must change.
America is past the point of “eat less, move more,” an approach many doctors secretly understand doesn’t actually work.
Particularly post-lockdowns, we face a crisis, one which falls particularly on communities in real America — places like South Park.
It’s crushing the young and the poor. It’s shrinking our population, hobbling our military, and impoverishing our futures.
Providing broad coverage of GLP-1s will be a heavy lift in the short term, but it’s a key piece of any realistic pathway to national health.
Tim Rosenberger is a legal fellow at the Manhattan Institute.
