--- title: Why should there be universal access for HOTs? description: The case for universal access to HOTs is compelling on moral, economic, and strategic grounds. --- [FAQ & Mythbusting ](https://www.rethinkx.com/faq-and-mythbusting) # [Why should there be universal access for HOTs?](https://www.rethinkx.com/faq-and-mythbusting/why-should-there-be-universal-access-for-hots) Written by [RethinkX](https://www.rethinkx.com/faq-and-mythbusting/author/admin) | Jun 2, 2026 3:03:06 PM The case for universal access to HOTs is compelling on moral, economic, and strategic grounds. An estimated 10% of all global deaths are now attributable to obesity, and that burden is not evenly distributed. Lower-income populations have been subjected to decades of targeted marketing of cheap, calorie-dense foods, limited access to nutritious alternatives, higher stress loads, and less nutritional education. These are structural conditions that individuals cannot easily overcome through willpower, and a class of drugs that effectively addresses the underlying biology now exists at a manufacturing cost of under $5 per dose. The argument for restricting access to those who can afford $1,000 per month, thereby concentrating the health benefits of this disruption among those already advantaged, is difficult to defend on any ethical framework. On the economic side, the US alone loses at least $573 billion per year to obesity, with $172 billion in direct medical costs and $401 billion in lost productivity. The return on public investment in universal HOT access would exceed the cost by a wide margin. If generic HOTs cost $10 per month and are used by all 107 million obese American adults, the total annual cost would be roughly $13 billion, against a potential economic benefit of $573 billion per year, not counting the downstream savings in healthcare, disability, criminal justice, and social services. And this is just considering obese Americans, a much larger portion of the population could benefit from optimization. If universal HOT access meaningfully reduces the prevalence and severity of alcohol and drug addiction, and the emerging evidence suggests it would, the criminal justice and social services savings could also be enormous. As much as $110 billion of the US criminal justice budget is directly associated with drug and alcohol abuse, and reducing this would benefit not just government finances but the individuals, families, and communities most harmed by addiction. Strategically, nations that ensure universal HOT access will have a competitive advantage in workforce productivity, healthcare costs, and long-term economic growth over those that leave access entirely to market forces. A healthier population is a more productive, more resilient, and more capable one. The WHO's 2025 addition of GLP-1 drugs to its Essential Medicines List signals the direction of emerging international consensus. ##### **Explore the evidence...** - The moral case for universal access is straightforward. Obesity disproportionately affects lower-income populations who have been subjected to decades of targeted marketing of cheap, calorie-dense foods, limited access to nutritious alternatives, higher stress loads, and less nutritional education. These are structural conditions that individuals cannot easily overcome through willpower. - [Read about the equality and equity implications of the HOT disruption in our Rethinking Health report.](https://www.rethinkx.com/health/social-implications)   - The economic case is perhaps even stronger. The US alone loses at least $573 billion per year to obesity in direct medical costs and lost productivity. If generic HOTs cost $10 per month and were used by all 107 million obese American adults, the total annual cost would be roughly $13 billion, against a potential economic benefit of $573 billion per year, not counting downstream savings in healthcare, disability, criminal justice, and social services.  - [Understand the full economic cost of obesity and what universal HOT access could mean for public finances in our Rethinking Health report.](https://www.rethinkx.com/health/industry-implications) - [Read the Yale, King's College, and Doctors Without Borders study confirming that semaglutide can be produced for under $5 per month.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816824) ## Obesity Reduction Savings Calculator Estimated 15-year savings from reducing U.S. adult obesity (2026–2040) Target Obesity Rate by 2040 20% 15-Year Cumulative Savings $2.1T vs. maintaining 40% obesity rate Annual Savings by Year $573B $287B $0     Based on $6,472 annual cost per obese adult (medical + lost productivity). All figures in 2023 USD. This calculator is for illustrative purposes only and is not an economic model or financial advice. - If universal HOT access meaningfully reduces the prevalence and severity of alcohol and drug addiction, the criminal justice and social services savings alone could be enormous. As much as $110 billion of the US criminal justice budget is directly associated with drug and alcohol abuse, and the human cost to individuals, families, and communities is incalculable. - [Read about how GLP-1s are cracking the biological code of addiction.](https://www.rethinkx.com/blog/glp-1s-are-cracking-the-biological-code-of-addiction) - [Explore the latest AI-powered research on GLP-1s and alcohol use.](https://www.rethinkx.com/health/alcohol-ai) ## U.S. Potentially Addictive Products & Services Industries Projected 20-Year Market Impact from HOT Adoption Conservative Aggressive Speed of Adoption: Slow How quickly market change occurs. Adoption Rate: Low Percentage of adults that adopt HOTs. How much does addictive product demand drop? 20% Decline in alcohol, tobacco, gambling, drugs, gaming, porn, and treatment per adopter. Social Media Direction Impact on social media platforms from reduced compulsive use vs. AI-driven growth. Decline Stable Growth Years to Ignition Point: 10 When the most rapid phase of change begins. Projected 20-Year Change -4.5% -$35.7B annually ### Total Market Size (USD) ### Segment Breakdown (USD)   Addictive Products & Treatment ($715B)   Social Media ($85B) **Addictive Products & Treatment** ($715B) includes alcoholic beverages ($260B), illicit drugs ($150B), tobacco/nicotine ($115B), gambling ($70B), digital gaming ($55B), addiction treatment ($55B), and pornography ($10B). **Social Media** ($85B) faces uncertain impact—compulsive "doom scrolling" may decrease, but AI advancements could drive continued growth. GLP-1s modulate dopamine signaling in the brain's reward pathways, appearing to moderate addictive and compulsive behaviors across categories. - The strategic case mirrors the argument for universal vaccination. Nations that ensure universal HOT access will have healthier, more productive, longer-lived populations within a decade. - [Understand why the World Health Organization added GLP-1s to its list of essential medicines](https://www.who.int/news/item/01-12-2025-who-issues-global-guideline-on-the-use-of-glp-1-medicines-in-treating-obesity) - [Read about the geopolitical implications of differential HOT adoption and why nations that act early will pull ahead in our Rethinking Health report.](https://www.rethinkx.com/health/geopolitical-implications)   - Universal access requires not just affordable drugs but the policy tools to deliver them. Compulsory licensing, public patent pools, investment in generic production, domestic manufacturing capacity, and telehealth-based prescribing at scale are all available instruments. Will decision-makers will act with the urgency the situation demands? - [Discover the policy choices available to nations seeking to accelerate HOT access in our Rethinking Health report.](https://www.rethinkx.com/health/choices) - [Read about how the University of Liverpool analysis shows generic semaglutide could reach 160 countries by end of 2026.](https://www.medrxiv.org/content/10.64898/2026.03.04.26347508v1) ### **Witness the transformation** We are entering a new era of healthcare based on a categorically different kind of medicine whose purpose is not just to save us from illness, but to help us be the best version of ourselves. The next generation of HOTs will trigger a multi-trillion-dollar global disruption, affecting dozens of industries across multiple sectors, driving a radical global improvement in health and wellness encompassing at least 1 billion people worldwide before 2040. Optimizing well with advanced HOTs will soon become as important as eating well with nutritious foods. Nations, industries, and individuals that recognize this early and act decisively will be best positioned to capture the extraordinary benefits of this transformation. [Learn more about the HOT disruption and its implications for health, society, and the economy.](https://www.rethinkx.com/health/homepage)   **Disclaimer** The information provided in this FAQ is for general informational and educational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. This content does not establish a doctor-patient relationship. The content regarding GLP-1 receptor agonists (or any other medical treatments) should not be used as a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read here. The authors and publishers of this FAQ and related report make no representation or warranty, express or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any information presented. Reliance on any information provided here is solely at your own risk. 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