How the food industry profits
The river of chronic disease, the author writes, starts not at the hospital but at the supermarket. Korea’s food industry produced 114.8 trillion won in 2024, driven by ultra-processed and convenience food, while type 2 diabetes under 30 quadrupled between 2008 and 2021.
Additives are tested one by one, yet people eat dozens together, and testing the combination is not a legal requirement.
A disease market the size of a tech giant
Of 213 trillion won in current health spending in 2024, 80.3% went to chronic disease: four of every five won spent on health. Circulatory disease cost 14 trillion won, cancer 10.7 trillion, hypertension 4.5 trillion and type 2 diabetes 3.2 trillion.
Five forces keep it growing: ageing, the spread of lifestyle disease, wider early screening, lower diagnostic thresholds and extra prescriptions to manage side effects.
Who benefits: drug makers, hospitals, test providers
The book is explicit that this is not about villains. Most clinicians and researchers work in good faith; the problem is the landscape they work in.
Lifelong medication resembles a subscription, and Korea’s top fifty drug makers passed 24 trillion won in sales in 2024. Fee-for-service pays for every visit, test and prescription but has no line item for prevention counselling. In a 4.5 trillion won screening market, one abnormal finding leads to another test, and another.
Who pays: patients, families, the nation
Patients pay in fees, co-payments, hours in waiting rooms and lost working years. Families carry unpaid care, and its stress can become illness of its own.
The final bill goes to the state: of 213 trillion won in 2024, government and health insurance carried 127.7 trillion, or 59.9%.
Health insurance on the brink
A projection in a Korean health administration journal puts national health spending at 560.9 trillion won by 2033 on current trends, 2.5 times the 2023 level, and still 424.3 trillion under strict price control.
The author names three reasons the cycle persists: a principal and agent problem between providers and patients, information asymmetry, and a time mismatch, since prevention pays off in twenty years while political terms last four or five.
The economics of prevention
A 2020 analysis by the US Centers for Disease Control and Prevention found that every dollar put into prevention programmes saved 5.6 dollars in medical costs.
The book draws a line between screening, which finds disease earlier, and prevention, which stops it arising. Real prevention, it argues, starts at the table and in daily habits.
Why restoring the system makes economic sense
The author sets a treatment economy of symptom control and lifelong management against a prevention and restoration economy. He treats resistance to change as rational, not immoral, and sees new doors for drug makers and hospitals in prevention and health management.
Applying the CDC returns to Korea, his own estimate is that 10 trillion won invested in prevention and system restoration could save 70 trillion won in medical costs. The choice between inertia and a change of course, he concludes, decides the next generation’s finances.
Questions this chapter answers
How much does Korea spend on chronic disease?
By the statistics the book cites, about 171 trillion won in 2024, or 80.3% of 213 trillion won in current health spending.
What is the outlook for Korean health insurance?
One projection has national health spending reaching 560.9 trillion won by 2033 on current trends. The author warns of higher premiums, higher co-payments and a widening gap in access to care.
Is the book saying drug makers and hospitals cause disease on purpose?
No. It says there are no villains in this chapter, only an incentive structure that rewards treatment and prescribing and leaves prevention unpaid.
Does prevention really pay?
A 2020 CDC analysis found each dollar spent on prevention programmes saved 5.6 dollars in medical costs, which the author uses to argue that prevention is an investment.
Read more on the blog
References from the book
- 질병관리청, "2025 만성질환 현황과 이슈", 2025.
- 보건복지부·국민건강보험공단, "2024년 경상의료비 통계", e-나라지표, 2025.
- 한국농수산식품유통공사, "2024 식품산업 생산실적", 2025.
- 질병관리청 국립보건연구원, "30세 미만 2형 당뇨병 유병률 연구", 2025.
- U.S. Centers for Disease Control and Prevention, "Fast Facts: Health and Economic Costs of Chronic Conditions", 2026.
- 정형선 외, "한국 국민의료비 및 구성항목의 미래 추계: 2024-2033의 10년 추이", 한국보건행정학회지, 2025.
- 메디포뉴스, "주요 국내 제약사, 2024년 매출 24조 돌파", 2025.3.18.
- 대한종합건강관리학회, "국내 건강검진 시장 규모 조사", 메디칼타임스, 2024.
- U.S. Centers for Disease Control and Prevention, "Prevention Return on Investment", 2020.
- 로버트 러프킨, 유영훈 옮김, 『내가 의대에서 가르친 거짓말들』, 정말중요한, 2024. (원제: Lies I Taught in Medical School)
