Car and Driver magazine’s pick of the most beautiful car ever built, but what good is it if there’s nothing under the hood?

The biggest issue plaguing the U.S.

Imagine an automotive industry that sold cars and trucks with no recommendations as to oil changes or other servicing, so that motor vehicles would start breaking down after 20,000 or 30,000 miles and dealers could make big bucks on repairs.

This approach would pretty well describe how the American health-care industry functions today. But don’t take my word for it. Take it from semi-retired, health economists Len Nichols and Paul Hughes-Cromwick, who recently penned a commentary for MedPage Today on “How to Contain Health Care Costs.”

Their commentary summed the national problem well.

“Economist worries about healthcare cost growth began when national health spending topped 6% of gross domestic product (GDP) in 1970,” the two men wrote. “We spent 18 percent of our GDP on healthcare in 2024.”

But what followed was nothing more than a treatise on the need to lower the costs of drugs, hospitalization, insurance, etc. Wholly missing from the article were the words”physical activity,” and those two words are important because they define the biggest health problem in the U.S. today.

Americans now largely ignore the regular servicing their bodies need to function properly over the long haul..

Covid’s message

The SARS-CoV-2 pandemic of the unfit and unhealthy should have made everyone in the country acutely aware of this, even if they’d somehow managed to miss the fact that cardiovascular diseases have long been, and still are, the nation’s biggest killer. And this despite decades of doctors and drug companies attacking the problem with ever more and better drugs.

But what the pandemic told us, in the simple words of a team of research doctors from California, who published in the peer-reviewed American Journal of Preventive Medicine in 2023 was this:

Americans “who were consistently inactive were 191 percent more likely to be hospitalized and 391 percent more likely to die than those who were consistently active.”

These aren’t just big numbers; these are huge numbers to which were attached billions of dollars in health spending, because the greatest costs associated with Covid-19, the disease caused by the SARS-CoV-2 virus, were linked to those who died in the country’s intensive care units (ICUs).

A study of the medical costs of Covid-19 from March 2020 to October 2021 pegged the direct cost at about $22 billion.

The study, published in the peer-reviewed MDPI Economies in 2024, noted hospital costs ballooning from $3,552 “for deaths that occurred upon arrival” to $10,065 “as the cost associated with the death that occurred at an emergency room.

“For inpatients with more severe symptoms and complications who need to be admitted to a hospital, the cost of inpatient treatment is estimated at $20,920. However, around 10 percent of Covid-19 inpatients might require more intensive care, which costs $63,060 on average.”

This was a good investment when patients survived, but many patients did not survive intensive care, especially early in the pandemic.

A peer-reviewed study in the Annals of the American Thoracic Society reported that “among 1,966 mechanically ventilated patients” treated in a New York hospital during the first wave of Covid-19 “61 percent died within 28 days after intubation.”

Survival rates for patients in intensive care units (ICUs) did improve as the pandemic progressed, but many of them were left suffering with what would come to be called long Covid.

One peer-reviewed study published in the Journal of Intensive Care in 2024 reported that “73 percent of patients had not completely recovered from Covid 19” with ICU-treated patients tending “to show slower recovery in neurocognitive symptoms, mental health outcomes, and resuming work than non-ICU-treated patients.”

Tip of the iceberg

Were all of this national-wealth-draining sickness limited to Covid-19, it would be one thing. But it’s not.

Study after study has documented Americans getting ever fatter, ever less fit and thus needing ever more medical treatment. A January study published by JAMA, formerly the Journal of the American Medical Association, reported that this is now a country where, “in 1990, 19.3 percent of the…adult population were living with obesity; by 2022, this had increased to 42.5 percent.

“By 2035, this was forecasted to increase to 46.9 percent.”

This is simply not healthy, as former body influencer Gabriella Lascano pointed out in a New York Times “confession” last month. Lascano decided she was too big when it became difficult for her to wipe her ass.

 “I don’t care how trendy or cute or fun it seems to be fat,” she wrote in the commentary that described all the fat friends she’d known who died early because of complications linked to obesity “You got to really think about your health. Love yourself at any size, but don’t forget that your heart has to beat, babes.

“Not everyone can control their weight, and no one should be mistreated for it. But what’s not fatphobic is this: Being fat does increase your risk of health problems. Studies show obese people are about six times more likely to develop Type 2 diabetes. We have a 28 percent greater risk of heart disease. We have higher risk for 13 types of cancer. Up to seven times the risk for endometrial cancer, up to five times the risk for esophageal cancer. Colon, rectal, pancreatic, kidney. Higher risk of strokes.”

Needless to say, her commentary – not to mention her weight loss – was not well received by many in a country where obesity has become a norm and is closing in on defining the majority of Americans.

The medical community’s answer to this is a variety of so-called GLP-1 drugs that help people lose weight but come with their own medical issues, not to mention high costs and the apparent need for most people to commit to taking the drugs for the rest of their lives to avoid reverting to their previous obese state.

And GLP-1s  do nothing to get people fitter in a society where many now spend little time using their muscles for anything. The drugs only make the once fat and unfit look better.

They remain as unfit as before they started taking the drugs, and possibly more unfit in that one of the problems with GLP-1s is muscle wasting. The drugs are the automotive equivalent of getting that car or truck detailed to look great while ignoring the engine that is quickly falling apart under the hood.

But here’s the scariest thing about the big fat, national problem of declining fitness.

Among the doctors and nurses and other health professionals scurrying to voice their opinions in the comments on that MedPage commentary on “How to Contain Health Care Costs,” not a one mentioned the fundamental thing that needs to be done, which is to somehow get Americans moving again.

And this is not an isolated occurrence. Consider Dr. Steven H. Woolf, a public health expert, pontificating in JAMA Perspectives:

“For decades, U.S. disease and mortality rates (have) exceeded those in other high-income countries, a gap that widened over time. When U.S. life expectancy flatlined after 2010, experts recommended policies to address the leading causes of death and structural factors that systematically put the health of the U.S. population at risk. They called for widening access to health care, alleviating economic stresses on low-income and middle-class households, reducing income inequality, strengthening the social safety net, and tightening regulations to protect public health.

“Few of these recommendations were implemented. Such policies are politically unpopular in the U.S. and are opposed by powerful special interests. Although the nation made some progress in addressing the drug and obesity epidemics, too little was done to address structural issues or slow the trajectory. Between 2010 and 2019, all-cause mortality at ages 25 to 64 years increased by 19.6 percent.”

Certainly socioeconomic factors play a role in American health, but physical activity, or the lack thereof, is a massive confounder when it comes to assessing how social status and income influence health. As English researchers who studied activity levels in the U.S. reported in the peer-reviewed BMC Public Health in 2018, “levels of active participation in moderate-to-vigorous intensity physical activity across all domains were highest amongst highly-educated adults.”

Or, put another way, a lack of physical activity was highest among the less educated, who disproportionally suffer the health consequences of inactivity.

It would be nice to believe that the American medical community is so focused on examining the trees that it simply misses the forest here, but it is impossible to avoid wondering if the whole public health problem isn’t more about economics than health.

The possibility that the now massive American health-care industry is more interested in making money by treating unhealthy Americans than in trying to get America healthy again is hard to ignore. This is, after all, a capitalist society, and there is no reason to believe the people in the health-care industry should be any less interested in the rewards of capitalism – ie. money – than those involved in any other industry.