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0 pointsarethuza20d ago0 comments

"Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.”

Aneurin Bevan

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nradov19d ago

That's true to an extent, but the majority of US healthcare spending goes to treating chronic conditions caused more by lifestyle choices than misfortune. There's a fundamental issue in public health policy about individual responsibility and whether to charge people more (or potentially even deny care) over factors at least partially under their control. For example, the Affordable Care Act (Obamacare) allows health plans to charge tobacco users higher premiums. Is that fair? Should we also charge higher premiums to alcohol users or those with sedentary lifestyles? There are no clear right or wrong answers here.

tremon19d ago

That topic should be a non-starter as long as US government policy is to keep shitting in the food bowl. There's way too many communities living under the toxic spill or waste of some unregulated industrial process -- and the country seems perfectly ok with that kind of "lifestyle". I really don't see why we should villify individual lifestyle choices when the entire country is happy with intentionally harmful policy choices.

So, if health insurers want to start charging premiums I suggest they send their bills to Superfund sites first, then to regular toxic cities like Flint, Camden, Hinkley or Picher, then to producers of known-carcinogenic substances (like Chrome-6 or Roundup), and then to advertisers of known-harmful products like alcohol or tobacco. Only when they run out of those targets can we have a discussion on individual lifestyle choices.

nradov19d ago

OK cute rant but do you have a realistic proposal? I absolutely agree that we should do more to reduce exposure to toxins but there's no legal mechanism for health plans to shift costs that way. Ultimately some of the money spent caring for others with lifestyle-related chronic conditions is going to come out of your pocket through insurance premiums and taxes. This is inevitable. Are you willing to pay more for people who choose to smoke and get lung cancer / emphysema / heart failure / etc? Yes or no?

There's very little tobacco advertising anymore so we're not going to squeeze many dollars out there.

https://www.fda.gov/tobacco-products/products-guidance-regul...

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magicalist19d ago

> There are no clear right or wrong answers here.

Absolutely, but there are lots of working, existing models that are better than ours in practice, so this isn't much of an excuse.

nradov19d ago

That's a meaningless statement. You can find many examples of "working" national healthcare systems (for various definitions of working) and they're all different in how they allocate costs to consumers.

For one example there are some positive aspects to the Japanese system in that they achieve good outcomes (on average) at lower costs. But that's partly due to the "Metabo Law" aka "fat tax" which voters in other countries might see as punitive or discriminatory. I'm not necessarily arguing for any particular approach to lifestyle-related health conditions but any choice involves trade-offs.

https://www.telegraph.co.uk/news/2023/12/07/japan-solved-obe...

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groundzeros201519d ago

In practice everyone has vastly different preferences, expectations, and desires different levels of care then.

For example Some people want to see a specific doctor they know in a private session to discuss life and family stresses. Others only go to urgent clinics if they need an immediate medication.

j / k navigate · click thread line to collapse

0 comments

nradov19d ago

tremon19d ago

nradov19d ago

There's very little tobacco advertising anymore so we're not going to squeeze many dollars out there.

https://www.fda.gov/tobacco-products/products-guidance-regul...

4 more replies

magicalist19d ago

> There are no clear right or wrong answers here.

Absolutely, but there are lots of working, existing models that are better than ours in practice, so this isn't much of an excuse.

nradov19d ago

https://www.telegraph.co.uk/news/2023/12/07/japan-solved-obe...

1 more reply

groundzeros201519d ago

In practice everyone has vastly different preferences, expectations, and desires different levels of care then.

For example Some people want to see a specific doctor they know in a private session to discuss life and family stresses. Others only go to urgent clinics if they need an immediate medication.

j / k navigate · click thread line to collapse