“The rich have Ozempic. The poor have body positivity.” That was one of the signature lines from a “South Park” special in May called “The End of Obesity.” The show focused its iconic satire on semaglutide, a class of type 2 diabetes drugs that have become popular in recent years, particularly among wealthier Americans, as a way to lose weight.
But why the class divide? The obesity problem in the United States is costly, at levels we haven’t even thought about. We should reconsider the idea that semaglutide—and its brands like Ozempic and Wegovy—should be available only to the wealthy who can afford it. What if we could actually save money in the long run by making these drugs available to those who can’t afford them out of pocket?
American obesity means more people are missing work and facing exorbitant medical bills. More people are having trouble conceiving. And fewer people are eligible for military service. According to the Centers for Disease Control and Prevention, the economic cost of medical bills alone is $173 billion a year. And these costs are disproportionately borne by the poorest Americans, because, as we already know, poverty and obesity are linked.
It may seem counterintuitive to body-positive advocates on the left and anti-spending advocates on the right who deride drugs in favor of discipline, but mandating coverage of weight-loss drugs, and especially ensuring their coverage under state Medicaid plans, would actually reduce long-term health care costs, boost the nation’s birth rate, and improve military readiness.
Medicaid beneficiaries are typically young—the population we need to join the military, raise the next generation, and build the next great American generation. The disproportionate prevalence of obesity among Medicaid beneficiaries, significantly higher than their privately insured counterparts, requires a comprehensive strategy that includes GLP-1 drugs. Among older Medicaid beneficiaries, Medicaid rolls tend to be persistent, with eligibility often maintained for life. Investing in preventive health today will save Medicaid (and eventually Medicare) significant costs later.
In the meantime, one immediate benefit could be more babies. After all, the current baby bust in the United States is closely linked to its obesity problem. GLP-1s could help alleviate that problem. 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 mothers showing off surprise babies they previously thought couldn’t conceive.
We live in a sad time in which native-born Americans have abandoned marriage and procreation. In addition to addressing the mechanical and hormonal barriers that prevent conception, the widespread availability of GLP-1 drugs could also help young Americans regain their enthusiasm and abandon screens in favor of real, embodied lives.
Speaking of real life, obese Americans are ill-prepared to defend their country. While Americans differ on issues of military proactivity abroad, we generally agree on the importance of defense and preparedness. Yet, unfortunately, as Americans have grown, our military has shrunk.
The Department of Defense reports that obesity is one of the leading reasons recruits are ineligible for military service, with nearly a quarter of applicants disqualified for this reason. By improving the health of potential recruits, mandatory coverage of GLP-1 drugs could expand the pool of eligible individuals, thereby improving national security.
The inclusion of GLP-1 coverage in both the private and public insurance sectors is based on the economic principle of scale: wider adoption leads to cost reductions over time. For Medicaid, the immediate financial implications of coverage are weighed against the substantial long-term savings from reduced treatment of obesity-related diseases. For private insurers, coverage means minimizing long-term costs and optimizing health outcomes for insured populations.
The stark reality that obese people face medical costs that are about $1,429 more than their normal-weight counterparts underscores the urgency of the situation. By limiting access to GLP-1 drugs, we are cutting corners, condemning Americans to a healthier, unhappier present and a more difficult, shorter future.
Of course, when progressives wanted to expand access to expensive drugs, they won. PrEP, the drug that reduces the risk of contracting HIV, is widely available, affordable, and covered by Medicaid. Plan B, the drug used to prevent pregnancy, is available without a prescription.
GLP-1s, on the other hand, require a doctor’s visit and prior authorization, and even then they are often not covered. The process of accessing the drug seems designed to frustrate those who seek it. Access through conventional channels is so restricted that it has fueled a thriving trade in compounded versions, paid for in cash and sold directly to the consumer.
Safe, legal versions of these drugs should be widely available. As my colleague Chris Pope has shown, the current price of branded GLP-1s is too high for government programs. But the ability to sell large quantities in bulk to Medicaid plans should provide incentives for drug companies to negotiate lower unit prices. States should also purchase compounded versions from trusted partners.
We know that GLP-1 drugs significantly reduce body weight. One study showed an average weight loss of 14.9% in participants. Success rates like these can’t come soon enough. In the wake of COVID-19, Americans have exploded. The rate of increase in body mass index (BMI) has nearly doubled in children and adolescents during the pandemic compared to pre-pandemic years.
The sedentary lifestyle imposed by poorly designed lockdown measures, combined with increased screen time and physical activity disrupted by school sports and access to playgrounds, has exacerbated the problem. In addition, pandemic-induced stress and anxiety have pushed consumers to consume more high-calorie processed foods. This needs to change.
America is past the point of “eat less and move more,” an approach that many doctors secretly understand doesn’t work. Especially after the lockdown, we face a crisis, one that is hitting hardest in real American communities, like places like South Park. It’s crushing the young and the poor. It’s shrinking our population, hampering our military, and impoverishing our future.
Ensuring broad coverage of GLP-1 will be a daunting task in the short term, but it is a key part of any realistic path to national health.
Tim Rosenberger is a lawyer at the Manhattan Institute.
