Comment by hayst4ck | Hacker News Reader

Comment by hayst4ck | Hacker News Reader

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Disclaimer: I am in favor of health care for all.

The best faith argument against health care for all is that it creates a strong incentive to limit freedom.

If the government were responsible for everyone's healthcare, then it would want to reduce healthcare costs. If it were to reduce healthcare costs, it would have to understand and regulate or tax things that hurt health. Things that hurt health are things like sugar, tobacco, alcohol, advertising unhealthy stuff to children, sports, especially adventure sports, driving, etc.

If the government can draw a direct correlation between sugar consumption and health costs, there is now a strong incentive to tax and regulate sugar.

If people go skiing and that becomes a significant health cost (broken bones) you now have a strong incentive to tax skiing.

For adventure sports, it's easy to imagine what is currently the balance between safety and excitement could end up being regulated past a point you would personally be happy with.

This increases government size, increases government intervention, and limits both business "freedom" and individual freedom. The catch phrase for this line of thinking is "nanny state."

Personally, I don't like being obese, and I don't like looking at obese people and "just don't eat sugar" is harder than it sounds. I am quite in favor of government intervention for the benefit of society as a whole in the form of things like sugar tax or sugar regulation, but I find the argument that this kind of intervention harms freedom compelling (just not more compelling than the benefits of giving up that freedom).

This is the exact argument that was used in some states regarding mandatory motorcycle helmet laws. It’s also possible to hold both views at the same time (paternalistic laws should be avoided and also society would be better off if everyone did exactly what the law intends)

I am also in favor of health care for all, but I'm not necessarily in favor of subsidizing all kinds of reckless behaviors by having the public pick up the hospital bills either.

Like, if you want to go, say, base jumping (just picking a risky recreational activity here), I'd be OK with saying "you need a separate insurance for that, if you hurt yourself the government isn't picking up your tab." That seems like a more straightforward way of handling the problem than to try to somehow tax base jumping.

The trouble is, of course, where to draw the line. It's possible that the cost of these voluntary risks is just negligible compared to general health care.

Why is a passion for base jumping more/less of a condition/affliction than doing heroin or getting cancer? What about people who take dangerous jobs, what if the job isn't so much dangerous, but the person did something stupid/against regulation on the job? What about teenagers doing reckless shit because they are too inexperienced to know better? What about STD's, those are more or less a choice to get. Kids are elective, why don't we tax pregnancy? Should we have drug insurance you need for doing illegal drugs?

How would you feel if you had kids and one of your kids took up base jumping? What if they took up high school football?

Once you've carved out exceptions, you've now changed the frame to something horrible. Systemic problems (obesity, drug use, mental health) probably deserve government meddling, but your first sentence is exactly the problem with conservative points of view. Conservatives can't put themselves in the position of doing something reckless and therefore feel they deserve to be better off (more money in their pocket) than the other person, until something bad happens to them. "Fuck you I got mine" is the liberal characterization of this attitude.

"cost of these voluntary risks is just negligible"

I was hospitalised for a few days because my cat bit me - is keeping a cat reckless behaviour?

I think it would be supremely silly, and more importantly hugely expensive, to try and monitor behaviour and track down what people were doing that caused an injury in order to decide whether their health care costs should be covered.

The solution in the case of risky activities (sport) in New Zealand is the compulsory ACC system which is insurance against accidental injury.

Every business has to pay ACC premiums depending on how risky their business is (in terms of health outcomes). If you are injured, everyone involved is indemnified (you can't sue them) but ACC pays for all your healthcare.

Eh, I don't find this argument compelling. Insurance companies already have significant influence in the government, and the line from sugar consumption to health care costs has already been established. So if this is the concern, well... guess what... it's already the case.

Also, while there are examples of behavioral engineering taxes (tobacco, etc.), this can't really be applied so easily to a basic food item like sugar, which is in practically everything in varying degrees. People have revolted over taxes on tea, mind you. A coffee tax, sugar tax, etc. is nearly unthinkable.

Furthermore, this type of taxation is not correlated with already existing examples of socialized medical systems, and this concern over pleasure taxes is not typically expressed by opponents to socialized medicine. Rather, the issue I hear expressed is that people who have good insurance already are scared they will wind up with something worse, and will have no other options at that point. This belief seems to be related and magnified by the xenophobic tendencies of the American political right (the more vocal opponents of socialized medicine; though so-called moderate liberals don't really entertain it either). They believe that if we let marginalized groups have equal access to good medical care, it will dilute their own access, creating scarcity and resulting in longer wait times to get treatment. These people also generally fear 'big government', and characterize anything run by the government as inefficient and costly. Therefore, they essentially believe they will pay more in taxes than the cost of their existing insurance; that they will be subsidizing the cost of care for peoples they generally contempt (HIV meds for homosexuals; abortions for women); and will have worse care for themselves. That's pretty much the argument in a nutshell. It's extremely petty and self-serving.

But, it's not so much that their belief is fully incorrect. While it is likely that health care would cost much much less overall for everyone, it could reduce their presently-VIP access to essential medical treatment in some instances. They believe their money entitles them to better access to medical treatment.

In conclusion, the more realistic (and actual) good faith argument is that insurance companies already do lobby the government to prevent any legislation that would pose an existential threat to their industry, which has vast wealth and power. Socializing medicine is good for medicine, and bad for medical insurers. So, they pay politicians who perpetuate the beliefs I described above and resist meaningful regulation and reform of the medical industry.

This is simply a fact. No need to construct unrealistically contrived stories about pleasure taxes. Ask these people in private what they believe. They will certainly tell you!

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