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Comment by smallnamespace | Hacker News Reader

One persons's 'unsustainable subsidy' is another person's 'showing compassion for those who are less fortunate'. It's not like New Orleans is a particularly affluent area either, and people have lived there for a very long time.

Take health insurance—one view could be that it forces people who are healthier to subsidize those who are less healthy.

While some people are unhealthy due to factors outside of control, others are unhealthy because they do unhealthy things. Would you consider the latter an 'unsustainable subsidy'?

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Wait what? You're comparing healthcare, which is a necessity, to choosing to live in a particular city. People that need healthcare don't have a choice, people _do_ have a choice to relocate to a more sustainable city though.

I agree with you that NOLA isn't just the wealthy. But, that doesn't change the fact that its not a sustainable city to live in.

Don't a large number of people have health problems as a result of poor diet and lack of exercise? I think that would qualify as a choice. I know I could probably lower my cholesterol with more discipline. If I choose not to, it's reasonable for me to pay higher insurance premiums.

I'm reacting to the harsh, judgmental attitude towards people in NOLA and using health care insurance to point out that the world is complicated.

Some people are certainly unhealthy because of choices they made (yet there's still broad support for universal risk sharing), while some people in NOLA certainly aren't there by choice.

The poverty rate there is about twice the US average, and something like 40% of Americans don't have any substantial savings. Many people aren't able to uproot themselves and move even if they wanted to without outside financial assistance, at which point I'm sure someone will be asking 'why should we pay to move people when they made a bad choice of where to live?', forgetting that these people may have lived there for generations.

You can be poor anywhere in the US, it doesn't have to be in a flood zone.

The main argument for rebuilding these areas seems to be "these people have lived there for generations". People move, and catastrophic flooding seems like a better reason than most.

> People that need healthcare don't have a choice, people _do_ have a choice to relocate to a more sustainable city though[...]

People have a choice in relocating from New Orleans for less flood risk, but they don't have a choice to relocate from the US if their main problem with living there is is with the US's health care system?

I'm not going to argue that they should, but this example isn't exactly doing the work for you that you seem to think it's doing. If you're going to say "just move from New Orleans" someone else can say "just move to Canada".

You can argue about the relative difficulty of those things, but they're not inherently different, and there's certainly people for whom it's a lot easier to move countries than say people in abject poverty in New Orleans who can't imagine pulling off a move to another city in the US.

Have you ever actually tried moving to a different country? Its exponentially harder than moving a few miles down the road.

Plus this argument is losing the point that the government is already spending the money trying to temporarily fix the problem instead of using that money to buy up the properties at a price point that would allow the residents to move.

I know not everyone would want to move, so I'm personally a fan of mandatory flood insurance in those flood prone areas. When there inevitably is a flood the resident can rebuild from their own pocket or use the insurance to move.

Yeah, four times now. As noted I'm not saying it's easier than moving down the street, just that if we're talking about people in such poverty that they couldn't move down the street comparing it to the experience of other more well-off people moving countries is hardly unreasonable.

No, he's comparing an unhealthy lifestyle to choosing to live in a particular city. People _do_ have a choice to change their lifestyle.

Yet, the healthcare doesn't discriminate between consequential and circumstantial ailments. I wonder why not?

It should. I believe you should pay more if you have unhealthy life style. First implement a good universal health care, second make people making the wrong choices (smoking is a wrong choice, being old is not) pay more.

It's tricky. For instance: My understanding is that people who smoke tend to die younger, and therefore spend less for healthcare over their lifetime than people who don't. So why should they pay more?

Then there is the whole question of "what is an unhealthy lifestyle?" It seems likely that not getting enough exercise is probably unhealthy, but diet advice is all over the place. You need better science than we have now to make these decisions.

There is substantial research that says that conditional care like what you propose is often used as a cudgel to deny Government assistance to those that need it the most.

In other words, I think the cost of putting in these guardrails, often with good intentions, is that they're misused against minorities and the poor. If that's the case, I would rather a few freeloaders/bad decision makers abuse it rather than the most needy going without the healthcare they desperately want.

If people choose to go rock climbing or ride motorcycles should they also pay more for health care?

Sometimes in history whole cities get moved a few miles. It's expensive, yes, but it does it done. In the 1950s and 60s Ontario and Quebec in Canada moved some smaller villages away from the St. Lawrence river when it was being expanded. Some cities get moved because damns are being built like in China's Three Gorges Dam.

Yes.

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