You do not have to be a bleeding heart to see that paying for a drug up front can be cheaper than paying for a heart attack, a disability check, and a long hospital stay later on. When the Congressional Budget Office guessed this could cost 35 billion, it was looking at government outlays, not the family budget that gets wrecked when a breadwinner cannot work. If Medicare and Medicaid coverage for Wegovy helps people stay in the workforce, keep their small businesses open, and avoid far more expensive care, that is an investment in productivity, not just another program. We should still demand tough negotiations on price and personal responsibility in diet and exercise, but we should not pretend that doing nothing is fiscally conservative. Let us remember that sound policy can be compassionate and cost conscious at the same time. If we insist on paying full price forever, then we really will deserve the bill.