Last week, during the U.S. Senate and House recess and back-to-school rush, media attention to healthcare was negligible. Healthcare trade media noted impressive earnings for Moderna and Bon Secours and the WSJ Journal announced a Medicare Advantage partnership between Costco and SCAN. No major Executive Orders from the White House or CMS rule changes. No major clinical breakthroughs, vaccine policy changes or lawsuits. But a couple of new reports frame the existential risk facing the industry: spending.
- AON forecast for employer health spending: AON forecasts employers will see a 9.5% increase in 2027–the same as this year after increases of 9% in 2025 and 8.5% in 2024.
- U.S. National Debt: The national debt officially passed the $40 trillion mark Wednesday, which includes $2 trillion this year. Note: Healthcare spending is a major contributor representing 27% of total federal spending.
The common theme in both is the steady growth of healthcare spending—faster than wages, higher than inflation and GDP growth and increasingly the result of higher prices for drugs, specialty services, facility modernization, technology and administrative overhead.
The industry’s aversion to transparency, protection of its business-to-business economics and dependence on private investment perpetuate four myths that justify its proclivity for uncontested spending:
- Myth One: Healthcare utilization is the result of verifiable (true) demand despite evidence that induced demand from financial incentives is significant and unnecessary care widespread.
- Myth Two: Healthcare spending above overall economic growth is necessary because demand is increasing though unit price increases for drugs, specialty care and hospital outpatient services exceed demand routinely.
- Myth Three: Healthcare spending growth is unavoidable as the population ages, medical problems become more complex and clinical breakthroughs (like GLP-1 obesity drugs) are integrated in the system though the industry enjoys legal protections to insiders that limit competition.
- Myth Four: Healthcare spending in the U.S. system is necessary to our performance as the world’s global leader for quality though at least 15 other systems outperform the U.S. in key measures of mortality, morbidity, life expectancy and satisfaction while spending 30-50% less per capita on healthcare.
As the midterm election November 3 nears, affordability and costs of living will be prominent in campaign rhetoric. Polling indicates healthcare costs, especially insurance premiums, prescription drug costs and hospital care, factor heavily in how voters assess promises on the campaign trail. Both parties espouse the need for systemic change in healthcare citing affordability for their reasoning. Three general solutions have found their way into this election cycle:
- Price controls imposed selectively by state/federal government applied to hospitals, insurance premiums, physician services and prescription drugs.
- Increased competition enacted through mandatory price transparency, constraints on consolidation and incentives based on value (price + outcome) instead of volume.
- Government control of healthcare payments (single payer) to providers to align spending with budgets while lowering administrative costs for participation.
The reality is none of these is without risk, and voters are wildly misinformed about all. But there’s no doubt they’ll be on the table as a majority consensus forms around a better system. They’re sick of the status quo. They see little difference between not-for-profit and for-profit operators and want something better. They see healthcare spending increases as the product of an industry that cares about its profit first and everything else second.
Healthcare spending—contributing factors and mitigation– is a topic every organization in healthcare must address candidly and holistically. There should be no delusion that interest will subside anytime soon. Just as consumers are rewarding organizations in financial services, retail, higher education and organized religion that offer “newer, better” alternatives, the healthcare landscape will be re-defined by those that do more than opine about affordability and conduct business as usual.
Paul
Sections in today’s report
- Quotables
- Economy
- Hospitals
- Insurers
- Physicians
- Population Health
Quotables
WSJ’ Matthews on Costco-SCAN Partnership: “Costco sells its dedicated members everything from travel packages to gasoline. Now the retail giant is gearing up to enter a huge new market: Medicare.
The warehouse chain plans a limited rollout of Costco-branded Medicare plans, working with SCAN Group, a nonprofit insurer. Nationally, Medicare is a more than $600 billion business for insurers, but the two companies said they would start by selling their jointly named Medicare Advantage products in two states, and a Medicare supplement in a third…
SCAN is based in Long Beach, Calif., and Southern California is a core market for the nonprofit, which focuses on Medicare and has about 460,000 members. SCAN also offers Medicare Advantage plans in Arizona, Nevada, New Mexico, Texas and Washington state.
The effort will let Costco dip a toe in the water of the Medicare business.”
Exclusive | Costco Sells Vacations, Gas and, Soon, Medicare Plans – WSJ
Corporate Board Member on Board strategic preparedness: “Board expertise, information flows and oversight structures need to evolve as the sources of competitive advantage—and the risks surrounding them—change.
- Interrogate how expertise reaches the boardroom.Directors do not necessarily need to replicate management’s technical depth, but they do need direct access to the people, evidence and outside perspectives required to challenge it.
- Look harder at the assumptions behind M&A. When an acquisition’s value depends on a technology, an ingredient, a biological mechanism or clinical evidence, directors are making capital-allocation decisions that rest partly on scientific judgments they may not be equipped to evaluate.
- Don’t assume adding an expert solves the problem.The stronger test is whether directors get the right information, hear directly from relevant executives, use outside advisers when needed and ask informed questions about the risks underlying strategic decisions. “
Corporate Board Member August 23, 2026
Aggarwal on rationing: “The quest for a healthcare system devoid of rationing is, in economic terms, the pursuit of a mirage. While the moral imperative of medicine suggests that care should be a universal right provided without limit, the reality of governance is dictated by the laws of scarcity…
At the heart of the need to ration lies the conflict between finite resources and effectively infinite demand. As medical technology advances, we are not solving health or overcoming the need to ration; instead, we are expanding the horizon of what is possible while inevitably expanding healthcare expenditure…
A healthcare system without rationing is an impossibility because rationing is simply the name we give to the distribution of a finite good. The true evolution of healthcare in the 21st century is not the elimination of rationing but the shift from implicit rationing (the waitlist or the quiet bankruptcy and facility closures) to explicit rationing: transparent, data-driven decisions about what a society can afford and what it is willing to defend.
Whether a nation chooses to ration by the clock, the wallet, or the robot, the Iron Triangle remains unyielding. The goal of a modern state is not to find a way out of the triangle. It is to decide, honestly and transparently, which of its corners it is most willing to defend.”
No Nation Has Escaped Healthcare Rationing. Some Just Hide It Better. | MedPage Today
NYT on National Debt: “America’s gross national debt topped $40 trillion for the first time on Wednesday, an ominous milestone for an economy that sits on a shaky fiscal foundation after decades of borrowing to pay for the rising costs of the military, social safety net programs and President Trump’s tax cuts.
This year alone, the United States is on track to borrow more than $2 trillion to help pay for its obligations, including spending on the war in Iran and the sweeping tax cuts that Republicans enacted in 2025. Soaring interest payments to investors who have purchased America’s debt now make up about half of that red ink, pushing the United States into a deeper financial hole….
“Our federal programs spend much more than the government takes in, and the biggest-ticket items in the federal budget are all running on autopilot,” said Margaret Spellings, president of the Bipartisan Policy Center, a think tank. “Even in the rosiest scenarios, we’re speeding toward a cliff and refusing to turn the wheel.”
U.S. Debt Hits $40 Trillion as America’s Borrowing Binge Continues – The New York Times
JAMA on AI in physician decision-making: “The prevailing view of artificial intelligence (AI) in medicine is that it will support physician-led care. The American Medical Association regularly calls AI augmented intelligence to focus on AI’s assistive role. Similarly, the American College of Physicians argues that AI “should be limited to a supportive role in clinical decision-making” and “should not replace physician decision-making.” In A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future, Wachter argues that the highest tier of care will be AI-aided physicians, whereas AI-only care will be medicine’s “economy class.”
Will Autonomous AI Exceed AI-Aided Physicians as the Best Medical Care? Ezekiel J. Emanuel, MD, PhD1; Abe Baker-Butler, BA1; Neal Khosla, MS2 JAMA August 17, 2026
Atlantic on value of college education: “If you were to judge by public-opinion polling, you might reasonably conclude that Americans have broadly given up on the idea of going to college. In 2013, 70% of adults surveyed by Pew said that a college education was “very important.” This year, only 35% did. Over the same time period, the share of Americans who believe that college is “not worth the cost” rose from 40 to 63%, according to NBC.
If you were to judge, instead, by the choices that Americans are actually making, you might draw a different conclusion. Despite the reported skepticism of higher education, enrollment in four-year colleges and universities is growing. These institutions awarded 2 million bachelor’s degrees in 2023, compared with 1.6 million in 2010, and the fraction of 25-year-olds with a bachelor’s degree has steadily increased for the past 15 years. Even as Americans tell pollsters that college isn’t worth it, their behavior suggests that they still recognize the value of a degree for themselves and their children. And they’re correct to do so.”
The College Backlash Is a Mirage – The Atlantic
Organoids in clinical research:” Since 2009, when Hans Clevers, MD, PhD, and colleagues in the Netherlands created the first organoid, a “minigut,” these laboratory-grown structures no bigger than the tip of a ballpoint pen have captured the imagination of scientists across academia, industry, and government. With major advancements over the past decade, researchers can now use these tiny models of tumors, brains, hearts, lungs, skin, and practically every organ in between to better understand human health, development, and disease. Aside from alleviating the ethical concerns around animal testing, proponents say organoids created from human tumors or stem cells are often better representations of people and the illnesses they acquire than mice, rats, monkeys, and other laboratory animals that have long served as proxies in drug discovery and development.”
A Seismic Shift from Animal to “Human-Based” Research Is Underway—Here’s What to Know About Organoids JAMA Network August 21, 2026 https://jamanetwork.com/journals/jama/fullarticle/2853277
Barnes on AI activity: “We are witnessing a lot of activity where beginnings and endings aren’t really a thing. For instance, while so many AI-enabled medical devices are being used by doctors and so many AI-enabled wearables and chatbots are being used by consumers, the discussion is just beginning about how to handle this serious societal shift in our health care system. This week, the FDA Digital Health Center of Excellence (DHCoE) released a 30-page discussion paper about generative AI-enabled medical devices to solicit feedback on regulatory approaches. Also, this week, the American Medical Association and the Digital Medicine Society released a five principle-framework about the physician’s role in the tech-enabled care world. Also, this week, Epic (our country’s dominant electronic health record company) made several AI-related announcements – including “Ergo” – a tool that blends human clinical judgment with AI to help doctors prep for patients that is reportedly already being used by several big hospital systems. “
Julie Barnes Maverick Health Policy August 20, 2026 www.maverickhealthpolicy.com
Economist on health reform and ACA: “The Affordable Care Act, passed in 2010, tried to keep America’s system more or less intact, but expand insurance for the poor and make it easier for individuals to buy coverage, through new “exchanges” where they could compare and buy plans. Obamacare was never enough for the likes of Bernie Sanders, a leftist senator who preferred universal coverage. Those calls are now being amplified by a new generation of Democrats such as Abdul El-Sayed, Michigan’s Senate nominee, who has made Medicare-for-all a central part of his campaign. Back in 2010 even Obamacare’s most fervent advocates acknowledged, in private, that it was an imperfect bandage, particularly for those on the individual market. New data show how that bandage is unravelling.”
Obamacare is becoming even more frail
Peck on Medicare for All: “In effect, America’s hospitals are financed by a combination of public underpayment and private overpayment. The arrangement may not be elegant or even rational, but it keeps hospitals operating. Medicare for All would destroy that balance.
Supporters respond that hospitals could simply become more efficient. Greater efficiency is desirable, but it can’t bridge a reimbursement gap of this magnitude. Hospitals aren’t ordinary businesses. They can’t close the emergency department on a slow day or staff an intensive-care unit only when demand is high. They must maintain nurses, physicians, technicians, operating rooms, diagnostic equipment and emergency readiness around the clock.
If Congress imposed a regime that paid Medicare rates for every patient, hospitals would first freeze hiring, delay capital projects and postpone equipment purchases. Then would come staffing reductions and closing of money-losing services such as obstetrics and behavioral health. Rural hospitals, many already operating on razor-thin margins, would be especially vulnerable. Eventually, many hospitals wouldn’t generate enough revenue to meet payroll and keep the lights on.
A healthcare system can’t endure if the institutions providing care consistently lose money treating their patients. Medicare for All may promise universal coverage, but its payment rates couldn’t support a sustainable hospital system.”
The ‘Medicare for All’ Math Doesn’t Add Up – WSJ
Economy
Economist on U.S. economic outlook: “With little sign the Strait of Hormuz will reopen soon, bond traders are pricing in continued inflation. And a surfeit of companies issuing bonds, many to fund AI infrastructure, gives buyers new investment-grade options. But the biggest reason is government deficits. Investors increasingly see little prospect of politicians slashing spending or raising taxes. Governments could sell more short-dated bonds, but that raises the risk of refinancing when rates are rising. Or they could buy more of their own debt, but central banks want to shrink their balance-sheets. That leaves few good options to tame yields. “
The Economist August 20 2026 www.economist.com
AON: Employer health costs in 2027: An increase of 9.5% next year would be the same as this year and follow increases of 9% in 2025 and 8.5% in 2024. A larger patient population, chronic conditions and costlier claims are contributing to higher employer benefit expenses. Prescription drugs, particularly glucagon-like peptide-1 medications, also have driven up costs. Highlights:
- For 2027, the increase would equate to employers paying an average of more than $19,000 per employee and $5297 for employees.
- Average plan costs rose 8.3% this year. However, there is a wide variance, and cost increases range from 5.5% to 11.5% for the middle 50% of employers.
- Employers’ share of healthcare costs increased from 3.7% in 2022 to 8.8% in 2026. Employees in 2026 are expected to pay an average of $5,297 for healthcare coverage. This overall annual cost includes both payroll contributions at an average of $3,130 and an average of $2,167 for out-of-pocket expenses.
Yale study: Medicare for All: Researchers estimate that national health expenditure, $5.3 trillion in 2024, would fall to $4.2 trillion under Medicare for All– a reduction of $1.04 trillion, or 19.7%. The largest sources of savings were:
- Lower prescription drug prices benchmarked to those paid in other high-income countries ($377.5 billion)
- Paying all providers at Medicare rates rather than higher commercial rates ($295.6 billion)
- Reduced administrative overhead from consolidating billing into a single payer ($286.3 billion)
- Reduced fraudulent billing ($285.7 billion)
- Better access to primary care would prevent emergency that would avoid emergency and inpatient care ($100 billion)
Along with financial costs, the study projected that universal coverage would prevent 62,863 deaths a year relative to the current system:
- 33,232 among the 27.5 million Americans who were uninsured in 2024.
- 29,631 among adults who hold insurance but are considered underinsured because high deductibles and cost-sharing put necessary care out of reach.
“Projected economic gains and lives saved under universal healthcare in the United States,”
HHS Report: State Directed Payments: Per the report, “State-directed payments to Medicaid managed care organizations rose from $43 billion in 2021 to $144 billion in 2025. By 2025, the average service covered by such a payment was reimbursed at 186% of the Medicare rate.
The Working Families Tax Cut Act, actually the same legislation as the One Big Beautiful Bill Act, caps those Medicaid payments closer to Medicare rates and limits new provider taxes. Once those rules are phased in, the ASPE researchers projected the changes would cut prices paid by non-Medicaid payers by up to 3.5%, generating savings from $100 billion to $175 billion a year, or $502 billion to $875 billion in savings from 2025 through 2034.
Federal health spending overall would fall by $419 billion to $748 billion over the same period. That could also mean lower commercial insurance premiums and greater enrollment in employer and marketplace coverage.”
Housing market slowdown: “Brace for one of the worst years the US housing market has seen in over a decade.
This year, annual home sales could slump to around 4.7 million by 2026-end — the slowest pace of home sales since 2011, the firm wrote in its latest housing-market outlook.
After eking out a small recovery in 2025, homebuying activity has been subdued this year, largely due to a rebound in borrowing costs. Markets are growing more concerned about inflation and are anticipating higher interest rates from the Fed, a factor that has pushed up mortgage rates.
High mortgage rates have been a major constraint on the housing market, keeping many existing homeowners locked into mortgages financed at lower rates. Prospective buyers, meanwhile, have also been pushed to the sidelines.”
Capital Economics www.capitaleconomics.com
Altarum’s Health Sector Economic Indicators August 2026: Highlights:
GDP growth continues to outpace health spending growth, but they have begun to converge in June 2026
- In June 2026, national health spending grew by 5.8%, year over year, down from the May 2026 growth rate of 6.1% and significantly lower than its June 2025 rate of 7.1%.
- Growth among major spending categories was highest for dental services, at 8.2%, year over year, while spending for prescription drugs grew the slowest, at 1.9%. Drug spending growth has slowed significantly this year; it stood at 8.6% in June 2025.
Growth in economy-wide inflation outpaces health care prices for ninth consecutive month
- In July 2026, the overall Health Care Price Index (HCPI) stood at 2.6%, down from its June value of 2.9%.
- Economy-wide inflation declined in July, with year-over-year change in the overall Consumer Price Index (CPI) decreasing by 0.1% from June’s value of 3.5% to 3.4%; the Producer Price Index (PPI) decreased by 0.8% to 4.7%.
- Among the major health care categories, prices for dental care in July were the fastest-growing at 5.1% year over year. This is an increase from a growth of 4.8% in July of 2025. At the other extreme, prescription drug prices fell by 3.1%—their seventh straight month of lower year-over-year prices.
- For major payers, year-over-year Medicare prices growth for services (3.3%) exceeded private insurance (2.8%) and Medicaid (1.7%).
- The implicit measure of health care utilization growth was 2.6% year over year in June, down from the May value of 3.1% (July data are not yet available).
- Among major spending categories, home health care utilization increased the fastest, at 5.6%, followed by prescription drugs at 4.3%. Utilization of dental services grew the slowest, at 1.2%.
August 2026 Health Sector Economic Indicators Briefs | Altarum
Hospitals
Gist on rating agency views of NFP hospitals: “U.S. not-for-profit hospitals entered 2026 in much better shape than in 2022-2023, new medians reports from the three major ratings agencies released this summer found. Performance softened after the 2024 recovery, according to Moody’s, but Fitch Ratings noted that 2026 medians mark the third consecutive year of improvement. Meanwhile, S&P Global Ratings found improved balance sheets supported by strong demand and revenue growth, despite softened operating gains, as most outlooks remained stable with negative outlooks declining. Yet, expense growth and modest improvement in operating margin—with significant geographic variability—slowed performance, according to Moody’s and S&P. Looking ahead, Fitch cautioned that tighter Medicaid eligibility and funding rules may weaken payer mix and create more financial pressure in 2027. This could place renewed weight on margins and test the cushion that not-for-profit health organizations have rebuilt since the Covid-19 pandemic.”
Bon Secours’ non-operating income:” Nonprofit health system raked in $1.1 billion this year from stake in medical billing firm.”
The payouts from Ensemble far exceed Bon Secours Mercy’s operating income so far this year August 18, 2026 https://www.statnews.com/2026/08/18/bon-secours-mercy-revenue-cycle-firm-ensemble-2026-payouts/
Kaufman Hall: Hospital performance in June 2026: “While performance has remained relatively stable on the surface, there is considerable variation across hospitals, and those with the thinnest margins are often the ones caring for our most vulnerable populations. While operating margins trended upward in June, hospitals’ overall performance still lags 2025 and is seeing “intensifying” uncompensated care pressures and faster-than-inflation expense growth. Highlights:
- Calendar year-to-date operating margin index of 2.5% and a single-month operating margin index of 4.5% (both including health system allocations for shared services costs). The former is a 6% lag compared to the first half of 2025, while the latter reflects a 6% bump over this May’s median operating margin.
- 2% month-over-month increase in daily bad debt and charity logged by hospitals, which, year-to-date, is 17% higher than the same cutoff in 2025. As a percentage of hospitals’ gross operating revenue, year-to-date, uncompensated care is 8% higher than in 2025.
- Comparing hospitals’ year-to-date data between this year and last, daily net operating revenue was 6% higher, gross operating revenue 7%, inpatient revenue 5% higher and outpatient revenue 8% higher. Net patient service revenue rose 5% both per adjusted discharge and per adjusted patient day.
Kaufman Hall Outpatient Care Hospital Impact
Insurers
On Medicare Advantage Star Ratings methodology changes: “The third, final and best option is to do the hard thing and rebuild. Not another increment bolted onto a contested base, but a deliberately smaller program—a compact set of measures anchored in clinical outcomes and patient experience, grounded squarely in the agency’s statutory authority, adopted through the rulemaking the law demands, and then left stable long enough for plans to invest against it. Robustness here means common sense metrics and durability: a score that a plan can reproduce, a beneficiary can trust, and a court cannot unwind. CMS has begun to move this way; its 2027 rule trims the measure set and refocuses on clinical care and member experience That instinct is right and should be pursued as a wholesale effort as opposed to a piecemeal one.
CMS cannot keep getting this wrong because the cost is not paid in legal fees. It is paid in benefits withheld, in trust spent, and in the integrity of the government’s promise to tell an older American something true about the care she is about to choose. The stars were built to guide. Right now, they flicker. The task is not to defend them, and not to extinguish them, but to make them worth steering by again.”
Stars On the Docket: Medicare Advantage Quality Ratings on Trial | Health Affairs
Physicians
Kaufman Hall Q2 2026 Report: Highlights:
- The median investment/subsidy per physician FTE was $314,231 in the second quarter of 2026, up less than half a percent from $313,330 in the second quarter of 2025 — essentially flat. Subsidy per provider FTE, a broader measure that includes APPs, was similarly steady at $235,908, compared with $235,417 a year earlier.
- Support staff expense is shrinking as a share of total spending. Support staff labor fell from 13.6% of total expense in the second quarter of 2025 to 13.4% in the second quarter of 2026, continuing a decline from 14.1% just two years earlier. Support staff FTEs per 10,000 providers work relative value units dropped too, from 3.09 in the second quarter of 2024 to 2.94 in the second quarter of 2026.
- Non-labor spending is falling even faster. Non-labor expense as a percentage of total expense dropped from 15.9% to 15.3% year over year — a 4% relative decline, and down from 16.2% two years ago.
- Provider expense, meanwhile, is claiming a growing share of the pie. Provider labor rose from 70.5% to 71.3% of total expense over the same period, continuing a climb from 69.7% in the second quarter of 2024
Physician Flash Report: Q2 2026 Metrics August 18, 2026 https://www.vizient.com/insights/reports/physician-flash-report
Trilliant on physician shortage: “It is axiomatic that healthcare is local, but the well-documented national projections of inadequate physician supply are rarely discussed at the local level. Without an understanding of age-weighted physician supply by specialty at the market level, it is not possible to build a coherent plan to address gaps in care access at the CBSA or county level. This gap has long shaped policy initiatives that fall short in serving the rural and lower-income populations they were meant to reach, reflecting a persistent disconnect between Federal policy and local need…Because the training pipeline takes years to build, the supply available today was locked in decades ago by policy decisions grounded in projections that proved to be egregiously wrong.”
Healthcare Is Local, and So Is Physician Supply
Burda on AMI proposal to supervise AI: “Axios also published this story on the American Medical Association (AMA) coming out with a new framework that positions doctors as AI’s supervisors. 4sH POV: Trade associations’ role is to protect the economic interests of members. The AMA is no different. This is about protecting doctors from the economic threat posed by AI, not the threat AI poses to care.”
Population Health
WSJ on higher education future: “Higher education is hitting a demographic cliff. After years of growth, the pipeline of 18-year-olds is dwindling—a result of lower birthrates.
The largest number of Americans born in a single year arrived on campus in the autumn of 2025, and now a falloff is looming. College enrollments are forecast to drop 13% by 2041…
Part of the reason is rising skepticism about the value of a college degree. More families reason that if they are going to spend tens of thousands of dollars, the diploma better pay off with a good job—otherwise why bother?
Teens are hedging their bets by applying to more schools. On average, students now submit nearly seven applications each on the Common App, a rise of 46% since 2015-16, according to a 2024-25 report from the provider.”
America’s Colleges Are Hurtling Toward an Enrollment Cliff – WSJ
Business Insider on costs of living for seniors: “Skyrocketing bills for people in their twilight years are wreaking havoc on unprepared families. It’s created an eldercare crisis that’s upending retirement plans, decimating finances, and blowing up careers…
The dozens of families that spoke to BI estimated long-term care for a loved one can cost up to six figures over a lifetime. One expert suggests 70% of adults over 65 will need some form of eldercare in their life, meaning it’s an expense the majority of us should account for.
The costs are on track to keep rising. Nursing homes and adult day services prices are up 212% since 1997, far outpacing inflation during that time. And a shortage of caregiver workers, either due to immigration crackdowns or general industry attrition, further complicates things. “
The cost of getting old August 17, 2026 l.businessinsider.com/s/vb/j_o5RcRH0_TAKFXncXY-IntIRRrHIKrZv4QLSRQtxIjkijuFn3gU5DCdNYdQinAmNcU-
GLP-1 use and women’s health: “Some 22% of American women and 14% of men have taken GLP-1s for weight loss or for chronic conditions such as diabetes. Among women who had been out of work, employment rates increased by 27% for those taking GLP-1s. That change is bigger than the employment gap between American women with a high-school diploma and those with a university degree. A similar penalty is found in the dating market. The chances of a single woman marrying or moving in with a partner increased by 29% relative to one who had not lost weight. Weight loss had no effect on existing careers and relationships: women taking GLP-1s who already had a job did not go on to achieve promotions or earn more. Excess weight appeared to prevent women only from getting hired.
Little wonder, then, that girls as young as three say they worry about their size. GLP-1s not only help people become healthier. They may also help them escape social censure.”
How big is America’s “obesity penalty”?
UNICEF on global childhood obesity: “A report by UNICEF, the United Nations’ children’s agency, published on September 10th, found that the number of school-aged children who are obese is, for the first time, higher than those who are severely undernourished. One-fifth of children aged 5-19 are overweight; of them, half is obese. The reason is simple: cheap, heavily processed foods are now a daily part of children’s diets across the world, crowding out fresh fruits, vegetables and proteins. In a survey of 20 poor and middle-income countries, UNICEF found that in 13 more than half of infants aged 6-23 months had consumed sweet drinks or sugary foods the previous day. Even in Britain many ready-to-eat baby pouches marketed as healthy are far from it. In countries with lax regulation, the fare is worse. A study of hundreds of infant and toddler foods sold in seven South-East Asian countries found that half were ultra-processed, meaning they are laden with sugar, salt and ingredients not typically found in a home kitchen. A third contained additives that are not permitted under the Codex Alimentarius, the UN’s food-standards code.
But changing diets is hard. Ultra-processed foods are, on average, about 50% cheaper than fresh or minimally processed foods, according to the UN’s flagship report on food systems. A global survey of large-scale school-meal programs in 2024 found that 25% served processed meats, 21% served sweets, 19% served deep-fried food and 14% provided sugar-sweetened drinks. With many adults eating poorly, meals at home also pack lots of calories but lack healthy nutrients such as fibre, protein and vitamins.
Stronger rules that restrict the advertising and sales of unhealthy foods could help. So could subsidies to make good food cheaper. What children eat early shapes their tastes for life. Adult diets are habits fixed in childhood. Once formed, those tastes are hard to shift
