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Comment by gonational | Hacker News Reader

It’s an interesting concept. The primary concern is that most of the costs for catastrophic medical problems will be incurred due to things like obesity, smoking, heavy drinking, dangerous lifestyles, etc. This creates one of two problems (or both?): either I’m left with the bill for others’ bad choices, or individual agency is under state / democratic control (e.g., salty foods banned, dessert banned, drinking banned, etc.).

Neither of those scenarios are ideal.

If the only question was genetic differences, that’s a risk I think a lot of people would be willing to take (e.g., that I might be healthy until 100 and then die in your sleep, theretofore paying constantly for others who have had medical problems for 70 years straight). I myself would be willing to take that risk / pay for that style of universal coverage, if not for the aforementioned choice part (smoking, etc.) playing so heavily into the cost, in practice.

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The costs vs. outcomes analysis across health care systems suggest that your personal lifetime expected return on investment (likelihood * (value/cost)) of a universal health care system with a single large national risk pool will be higher than your lifetime ROI in the current US system.

You are probably underestimating your own unknown non-lifestyle associated risk, along with the risks your offspring represent.

It also costs a lot to detect and judge risk factors, manage individual risk pools, assure compliance, etc. You save a lot of money by simply not bothering to risk-qualify eligibility and this offsets the costs associated with carrying lifestyle risks in a single large pool.

This is a shockingly uncompassionate perspective - is it satire?

Assuming it's genuine, it's also misguided. Almost no-one wants to be obese, alcoholic, etc - accessible healthcare will reduce the incidence of all of these, which in turn will reduce the externalities associated with them.

You also don't need further state control to discourage smoking, drinking, junk food, etc - taxation is the mechanism used globally to discourage undesirable behaviour.

Anarcho-capitalism -- er, "libertarianism" -- at its finest. It's a deeply nihilistic worldview.

Almost all these things are biologically addictive, and furthermore the companies selling them have long known about their addictive qualities and then built marketing campaigns to ensure the public was not aware of the risks.

Taxation is how you recognize the externalities of this behavior while maintaining a free-market system.

We’ve been taxing cigarettes at like 100% or something ridiculous for many years, yet just as many people die from tobacco-related cancers now (if not more) as did when cigarettes were much worse for you (no filters, more chemicals, etc.). Those taxes also did not help to alleviate any of the problems in the medical industry; or if they did, they were obviously offset by something else massive, since cancer healthcare expenditures have risen drastically since their inception.

Also, it’s easy to look at something like cigarettes which pretty much everybody would agree are a terrible idea, and say, “fine, tax em”, but what about when it’s sugar, then butter, then red meat, etc. Let people make their own choices instead, and just don’t put the onus on the rest of us to fix the problems of those choices. Banning smoking in public is acceptable because it’s no longer a choice that only affects yourself; it affects anyone near you in a really terrible way. But taxing cigarettes (or anything else) is no solution.

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