[mabbo]

What I find interesting when comparing the US the Canada on topics like these is that in Canada, there is self-interest in demanding workers be protected. Like beyond the fact that it's a good thing you do.

Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

There's incentives for our government to protect workers from risks that will cost a fortune to fix.

In America, there's only the "because it's the right thing to do" reason, which is never enough for anyone to actually do anything.

[dang]

Please don't take HN threads on generic nationalistic flamewar tangents. I'm sure you didn't intend it, but that's what this leads to, in the statistical case.

https://news.ycombinator.com/newsguidelines.html

Edit: we've had to ask you not to do this on HN more than once before. Please avoid it in the future.

https://news.ycombinator.com/item?id=34492512 (Jan 2023)

https://news.ycombinator.com/item?id=34073107 (Dec 2022)

[mabbo]

Sorry Dang. I hadn't realized it was coming off that way, but I'll be my best to check myself in the future.

I can see how what I said would be construed that way.

[dang]

Appreciated!

[slumpt_]

He was drawing a pretty reasonable comparison between economic incentives in the respective countries and how it has downstream affects for regulatory response. Don't make it something it isn't.

[dang]

You make a good point, enough for me to realize that I misunderstood the comment. Still, the last sentence of the GP comment veered into nationalistic putdown.

Flamebait in a comment has to do with the most inflammatory thing it contains, not the most interesting thing. When a house is on fire, people don't admire the décor.

[haldujai]

Canadian data is relatively poor quality (mostly from the 90s) outside of Alberta (I expect QC and BC probably have the highest rates) but historically and estimates are that we have slightly higher incidence than the US.

https://onlinelibrary.wiley.com/doi/full/10.1111/resp.14242

> There’s incentives for our government to protect workers from risks that will cost a fortune to fix.

There are many examples where this is inaccurate but let’s keep it simple and delve a little deeper into the silicosis problem presented in this specific study.

From the JAMA article:

Although a substantial number of the patients, including some of those who were uninsured or with restricted-scope Medi-Cal, likely had an undocumented immigration status, we did not directly collect information about whether individuals were undocumented immigrants.

Note that public health system in Canada is not “free”. Legal immigrants, documented workers, citizens and refugees have access to provincial or federal health insurance which pays for care.

Undocumented or illegal immigrants have neither (and also would not get WSIB which would be the payer for most silicosis cases) and actually have better coverage in California.

Additionally:

Ten patients (19%) were uninsured, 20 (38%) had restricted-scope Medi-Cal, 7 (13%) had Medi-Cal, 8 (15%) had private insurance, and 7 (13%) had workers’ compensation.

So 34/52 had some form of government provided or mandated insurance.

As an aside while restricted-scope Medi-Cal and uninsured rates are the surrogates for undocumented immigrants in this study, those over the age of 50 (or 19-25) are also eligible for full scope Medi-Cal but were not identified in this study. Medi-Cal will also be expanding in January 2024 to cover undocumented immigrants aged 26-49.

Even if we assume Canada’s silicosis incidence is lower, all of the above strongly suggests your public health system cost-savings incentive hypothesis is incorrect.

[PaulDavisThe1st]

> Note that public health system in Canada is not “free”.

I'm enough of a pedant to annoy the fuck out of most anybody who knows me, but really? Look, there is no "free" health care anywhere, but it's a term that has (perhaps unfortunately) become widely used as a synonym for, depending on your sensibilities "no charge at the point of service" and/or "socialized health insurance and health care coverage".

And Canada is certainly one or both of those.

The metric "well, they don't provide it for undocumented persons" is a weird one, as is the use of California as a counter-example.

[haldujai]

I think you may be “annoying the fuck” out of yourself here. Your reply is full of strawman arguments.

The comment I replied to asserts that the government incentive to reduce healthcare expenditures improves workplace safety, and consequently in the context of this article would have prevented silicosis/PMF in these patients.

I highly doubt most HN commenters are aware of whether undocumented migrants are covered in the Canadian system as they are in California, certainly the person I replied to was not, so I explain differences in coverage.

Consequently, the argument doesn’t hold water as the financial incentive for the government is stronger in California than in Canada as it relates to this study population.

> The metric "well, they don't provide it for undocumented persons" is a weird one, as is the use of California as a counter-example.

I'm not providing any counter examples, undocumented workers in California are the subjects in the article we are commenting on. Where in fact there happens to be socialized healthcare that you seem to think I'm arguing against.

[PaulDavisThe1st]

All good, but you still had to get in the jibe about '"free" healthcare' for reasons that have nothing to do with either TFA or the GP's point.

[haldujai]

It's not a gibe. I used scare quotes around free because it's obvious that a socialized system is funded by taxes, what's not obvious a bill is always generated during healthcare delivery in the Canadian system.

You yourself seem to not understand this distinction with your comment: "no charge at the point of service".

There is always a charge at the point of service and a bill is generated. The difference with the US is that the Canadian healthcare system, which also functions mostly privatized, uses a single payer model so the government is the only one legally permitted to pay for insured services. In other words, each province runs a large insurance company and there is a law that states that no one is allowed to charge any person or company other than the government insurance plan for anything the government has deemed reimbursable for any person covered by the plan.

(So you don't misinterpret my statements again: while government run hospitals, but not the physicians working in them, do get capitation payments they also bill for some services. What is billed vs paid through capitation varies by province. Services rendered to uninsured patients are never from capitation funds and are always charged directly to the patient).

If the services rendered or you are uninsured, like the patients in the article study, it functions the same as the US and you will personally receive a bill in the mail with similarly obscene rates much higher than what the government insurance company would have paid.

This distinction has everything to do with the article and GP's point which asserts that the Canadian government will bear some cost for the care of the patients in the California study which is flatly incorrect. If there was no charge at the point of service none of this would matter.

[PaulDavisThe1st]

> There is always a charge at the point of service and a bill is generated.

I was thinking more broadly than just the US or Canada. In Scotland, for example, there is literally no charge at the point of service.

[pupppet]

> Canadian data is relatively poor quality

Sure, no axe to grind here. Do tell us your impartial take.

[haldujai]

Perhaps you are unfamiliar with medical research but stating that available data is poor quality is an objective assessment. I provided a brief explanation in parentheses which you excluded for some reason.

I also provided a reference that is open access but here is the relevant section for you:

In Canada, there are no national data on the incidence or prevalence of silicosis. In the province of Alberta, where silicosis is a notifiable disease, health insurance data revealed 861 cases with at least one reported diagnosis of ‘silicosis’ during a period of 10 years from 2000. These results were based on raw data and not a secondary review of primary imaging and clinical information. Data from 2000 through 2009 showed that only 29 workers' compensation claims were accepted for silicosis in Alberta. Data from Quebec's compensation system revealed 351 compensated cases of silicosis between 1988 and 1998. Of note, workers who participated in regular surveillance had milder disease at the time of compensation.

The JAMA study is from 2019-2022. Data that is 20-30 years old is relatively poor quality.

Changes in medicine, workplace safety rules and occupational trends makes it hard to compare to silicosis rates in Canada to the US in order to assess the claims of the comment I replied to therefore I think the relative incidence described in this review article (from 2022) is inaccurate.

If you want to disregard my quality assessment, the discussion ends with the review article showing silicosis rates are 3x higher in Canada.

Can you elaborate on how any of this shows I have an axe to grind or that I’m biased?

[retrac]

Canadian here who believes our labour safety standards are generally better than the USA (based on anecdote and experience, not data).

Canadian data is poor quality. On any issue you might care to pick, the topic is better studied in the United States. I run into this all the time. For example, we make allocation decisions at a charity I volunteer at with, about what health problems unemployed LGBT people tend to have. We use data for American urban populations. The data doesn't exist for Canada, AFAIK. It's a smaller country! There's simply less research and statistic-taking done! It's a reasonable statement.

Besides -- commenting on the lack of good data usually implies the exact opposite of what you seem to think -- it is an admission by the poster that their argument is based on weak evidence.

[haldujai]

> it is an admission by the poster that their argument is based on weak evidence.

Which is exactly why I limited my reply to a discussion about the California study and healthcare systems rather than reiterating the claims in the 2022 article I referenced which states silicosis incidence is 3x higher in Canada, based on 20-30 year old data.

Although I live in the US now I’m a dual citizen and practiced medicine in both countries, the only axe I have to grind with Canada is the harsh winters which are incompatible with my fragile desert descent body.

[dghughes]

Then again my Dad who died of a lung disease said the government agency (Coast Guard) he worked for turned a blind eye to what he and his co-workers had to do. Dad would tell me even as the late 1990s his job was to take a powder, wet it, form it into big mats. They were filters for the boiler water. The powder used was or maybe just contained asbestos. He said the workers on the dock were covered in it he said the place looked like it had snowed.

Dad knew but he was stuck in the past of "It had to be done" mentality. And really as a high school drop out he really may not have understood the danger. For years he and my grandfather had a painting business with the paint at that time containing lead.

[Anon1096]

Perhaps unexpectedly, people dying are usually _cheaper_ for a healthcare system than healthy people. This has been studied a lot with smokers, basically people in old age cost far more than young people and thus a true cost-minimizing system would not be how you expect. Of course, we aren't trying to minimize cost so the premise is flawed.

[Sharlin]

Smokers specifically are very much a net cost to society, because smoking kills slowly and in a very expensive manner.

In any case, anything that makes people die young, or more generally reduces people’s capacity to work (like many diseases of affluence) is incredibly expensive to society once you factor in indirect and opportunity costs.

[lazide]

Eh, depends. COPD, or like the article is about, Silicosis, is a long slow drawn out illness.

[DoughnutHole]

This is very dependent on the illness.

From a cost perspective it’s best that people die suddenly. If I live a fairly healthy life into my 80s and die of a heart attack, I might not necessarily have cost my insurer that much, as opposed to if I suffer from a chronic illness for 10, 20, 30 years.

Cancer is now usually not a sudden death sentence - treatment is good enough now that most cancers caught early can be treated and patients often go through multiple remissions before it or a complication from treatment finally gets them.

Insurers very much do not want their customers getting cancer, because it is invariable an extraordinarily expensive condition to treat and treatment can go on for years.

[haldujai]

> Cancer is now usually not a sudden death sentence - treatment is good enough now that most cancers caught early can be treated and patients often go through multiple remissions before it or a complication from treatment finally gets them.

Small clarification - early detection is most often curative and cheap.

The really expensive part is that several advanced stage cancers (even IV with widely disseminated metastatic disease) now survive for many years on treatments costing low to mid 6 figures/year.

It actually provides a pretty good incentive for insurers to cover screening and early detection beyond what is mandated by law.

[CrazyStat]

> Small clarification - early detection is most often curative and cheap.

> It actually provides a pretty good incentive for insurers to cover screening and early detection beyond what is mandated by law.

The evidence in favor of mass screening programs in the hope of early detection is actually weak to non-existent [1].

> In total, 2 111 958 individuals enrolled in randomized clinical trials comparing screening with no screening using 6 different tests were eligible. Median follow-up was 10 years for computed tomography, prostate-specific antigen testing, and colonoscopy; 13 years for mammography; and 15 years for sigmoidoscopy and FOBT. The only screening test with a significant lifetime gain was sigmoidoscopy (110 days; 95% CI, 0-274 days). There was no significant difference following mammography (0 days: 95% CI, −190 to 237 days), prostate cancer screening (37 days; 95% CI, −37 to 73 days), colonoscopy (37 days; 95% CI, −146 to 146 days), FOBT screening every year or every other year (0 days; 95% CI, −70.7 to 70.7 days), and lung cancer screening (107 days; 95% CI, −286 days to 430 days).

There are large institutions, both nonprofit and commercial, which stand to gain by convincing people that mass screening is useful and important. The available scientific evidence does not support their position.

[1] https://jamanetwork.com/journals/jamainternalmedicine/fullar...

[haldujai]

You’re looking at the wrong metric and misinterpreting the stats, not only is overall survival not a good metric for cancer screening none of the studies are sufficiently powered for OS.

What you want to do is look at stage at presentation, treatment costs by stage, and screening costs. These were done for nearly every recommended screening program.

The available evidence behind currently recommended screening programs unequivocally shows improved cancer-specific survival and earlier stage at diagnosis.

[CrazyStat]

I'm going to strongly push back on both (1) the notion that overall survival is the wrong metric and (2) that I'm misinterpreting something, given that I didn't really offer any interpretation at all. I just cited a paper.

> What you want to do is

No, what I want to do is assess whether broad screening programs actually make people live longer. Overall survival is the correct metric. Evidence in favor of the claim is lacking.

> none of the studies are sufficiently powered for OS.

"Sufficiently powered" is relative to what size of effect you want to detect--which you haven't specified, so I'm not sure how you can make the assertion that none of the studies are sufficiently powered.

> The available evidence behind currently recommended screening programs unequivocally shows improved cancer-specific survival and earlier stage at diagnosis.

These outcomes ignore negative effects of screening on people who don't have cancer, which is why I'm not interested in them. And yes, there are negative effects, and no, they are not negligible.

[sershe]

Do you have a reference for this? This was a weak hunch for me before but I always assumed I was wrong based on e.g. insurance rates. If insurance prices it higher, it must be more expensive to cover?

[DoreenMichele]

Last I checked, Canada doesn't share a border with Mexico and some portion of these Latino "day workers" are illegal immigrants. Day workers are often paid under the table and when I have read other stories about them, they tend to include medical horror stories like "So, this guy cut 3 of his fingers off and they didn't even take him to the ER. They just returned him to the place where they had picked him up."

This is not exactly the best use case for arguing about Canada versus US healthcare policies.

[mitthrowaway2]

Canada doesn't have a border with Mexico, but it does have its share of undocumented and under-protected workers.

> While there are no accurate figures representing the number or composition of undocumented migrant population in Canada, estimates range between 20,000 and 500,000 persons

> Research suggests most undocumented individuals live in large urban centres and typically work in seasonal and informal sectors, such as construction, agriculture, caregiving and housekeeping.

> Undocumented migrants are a vulnerable group due to their lack of immigration status, as was seen during the COVID-19 pandemic. They have limited access to health care, social services or employment protections.

Source: https://www.canada.ca/en/immigration-refugees-citizenship/co...

Until this year, asylum-seekers could transit through the United States into Canada under the Safe Third Country Agreement, by crossing the border at an irregular crossing like Roxham Road.

Sources: https://www.cbc.ca/news/politics/deal-roxham-road-migrants-b...

https://www.cbc.ca/news/canada/canada-asylum-seeker-increase...

https://web.archive.org/web/20230601135133/https://www.nytim...

[LegitShady]

Canadas temporary foreign worker program means you don't need to illegally hire day workers, you just keep the wages low enough that nobody will take the job and then tell the government you need to bring in foreign workers - not for professional or technical work, not for picking in the fields, but for working at McDonald's and tim Hortons.

They also allow international students at diploma mills to work 40 hrs a week, above the table.

It's a sham.

[DoreenMichele]

A quick search suggests there are 10.5 million in the US.

https://www.pewresearch.org/short-reads/2021/04/13/key-facts...

[mitthrowaway2]

On a per-capita basis that's not hugely different, but one of the reasons may be that Canada provides a somewhat easier path, relative to the United States, to becoming a legal immigrant rather than remaining undocumented.

[lazide]

Really? I’ve had relatives try to immigrate to Canada (from the US), and it was quite a horror story. Any specifics?

[nemo]

Relative to Canada the United States is even more difficult to legally immigrate to, consider that the US system has been constantly adding ever increasing hurdles to legal immigration for ages.

[spanktheuser]

A quick search suggests there are 335 million Americans but only 37 million Canadians.

https://www.indexmundi.com/factbook/compare/canada.united-st...

[prepend]

So Canada has 1/10 the population of the US and 1/20 the population of undocumented immigrants.

So seems like Canada has many fewer immigrants of this type than the US.

[Tao3300]

More policy preaching from ultra-white northern countries that don't let anyone in. It's such a tired trope...

[kamilner]

Canada doesn't let anyone in? Over a fifth of their population was born outside of Canada.

Edit: Actually over a quarter.

[sologoub]

26.4% of Canada’s population are first generation immigrants (foreign born): https://www12.statcan.gc.ca/census-recensement/2021/as-sa/fo...

[guraf]

Canada will have imported over 1M immigrants in 2023 (for their population of only 40M!). Newsflash: most aren't white.

[swagempire]

Canada is pretty heavy on immigration I hear-- its how they partially make up for a declining birthrate.

[chiefalchemist]

It's not only Canada that uses immigration - legal or turning a blind eye to illegal - to make up for falling birthrate.

Look at Germany. Look at France. Look at what's happen to Japan because such an option isn't as viable.

It's simply not politically feasable to say, "Without immigrants, our economy is f'ed."

[pgeorgi]

> It's simply not politically feasable to say, "Without immigrants, our economy is f'ed."

And yet, that's what politicians in Germany are saying: "Denn Deutschland braucht sie dringend: Durch die seit Jahrzehnten sinkende Geburtenrate gibt es auch weniger Arbeitskräfte. Diese Lücke konnte lange über Zuwanderung aus dem EU-Ausland gefüllt werden. Doch inzwischen reicht das nicht mehr aus." (https://www.spdfraktion.de/themen/neustart-migrationspolitik, the social-democrat representatives in Parliament)

"Because Germany needs them urgently: Due to the declining birth rate for decades, there are also fewer workers. For a long time, this gap could be filled by immigration from other EU countries. But this is no longer enough."

[arcticbull]

American too, birth rate is 1.6, well below a replacement rate of 2.1

[pgeorgi]

> its how they partially make up for a declining birthrate.

To the detriment of their origin countries who suffer from losing their best and brightest. How "Northern countries exploit the South again" is a (rather quiet) talking point that I believe will become louder in the future.

[ChumpGPT]

>What I find interesting when comparing the US the Canada on topics like these is that in Canada, there is self-interest in demanding workers be protected. Like beyond the fact that it's a good thing you do.

Is there any evidence of this? That the Canadian Gov cares more about workers than the US Gov?

>Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

What evidence do you have that this is the case?

>In America, there's only the "because it's the right thing to do" reason, which is never enough for anyone to actually do anything.

Is this your opinion or is this the reality. I don't know if you have ever walked by a construction site in Toronto to see guys cutting cement or stone. None of them have masks. Sometimes they will have a wet saw when cutting cement on the street but that is to reduce dust for traffic and pedestrians and not so much for their health. The Canadian Postal Union fought the Federal Gov for years to provide an environment where paper dust was considered a health hazard and workers need to be protected. Many postal workers suffered from COPD because paper dust was too fine for the Lungs to filter. What about farmers and dust? I'm sure they suffer just as much as American farmers.

I've come to realize Canadians suffer from an inferiority complex and have to constantly try and make comparisons to make themselves feel better, it's a strange phenomena.

- Expat....

[Aeolun]

I don’t think cutting in the open air and cutting in tiny sweatshops are at all comparable.

[ceejayoz]

Exposure won’t be anywhere near zero outdoors unless there’s a serious breeze. Over decades that’ll add up.

[ChumpGPT]

Then you have never seen someone cut stone in open air. Because it creates such a cloud of stone dust you could hide a house in it.

[bushbaba]

America offers Medicare so we still bear the cost. Just only if they live long enough to receive the retirement benefits.

Yeah one heck of a perverse incentive.

[cj]

Medicare for the elderly, but we also have Medicaid for people in poverty (< $15k/yr income for a single person w/o a family) which covers most basic medical/dental/ vision needs and is taxpayer funded.

Someone taken out of the workforce may qualify for that if they don’t already qualify for disability insurance or similar payments (although I’m not 100% clear if those are funded via private disability insurance or public programs)

[lotsofpulp]

Medicaid is not at all comparable to Medicare.

First, Medicare pays a lot more to healthcare providers than Medicaid. Medicare pays more for more medications than Medicaid, and has fewer prior authorization requirements for those medicines. Fewer providers will accept Medicaid, and people using Medicaid will receive less or worse healthcare than those in Medicare.

Second, Medicaid is administered by each state, and there is a lot of variability on how easy the state makes it so people can actually get healthcare. Lots of states straight up refuse money simply to punish people of a certain socioeconomic class because it happens to win votes.

Bottom line, Medicaid is so leaders can claim they are helping poor people get healthcare AND keep taxes low. Medicare is for actually delivering healthcare to people because that contingent makes up a huge proportion of votes.

And yes, even Medicare is not delivering all healthcare, as it has multiple tiers to deliver differing amounts of healthcare to different socioeconomic classes.

[thomastjeffery]

The most obvious point: if they were equivalent programs, we would just include people under the poverty line with Medicare. Instead, we have a completely different program, managed by different people with different goals. Down to its very core, Medicaid is a political football.

[lotsofpulp]

Exactly, I guess my comment could have been much shorter.

I love how there is even an Additional Medicare Tax. The political lines in the US are very much old v young, but some of the young, especially politically active ones, vote with the old since they are among the wealthy young, and the rest do not participate enough, or do not have sufficient knowledge about how resources are being meted out and how they will be affected now and in the future.

[cma]

Not in all states if you have no dependents.

[sologoub]

Since the examples are in CA, there is Medi-Cal for those who are too poor to buy subsidized insurance and it’s not age-related unlike Medicare. It’s an expanded form of Medicaid. I’d bet CA taxpayers do shoulder the costs if the victims know to apply.

[paulddraper]

> Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

That is true with or without publicly funded healthcare.

[grecy]

You could argue that more sick people is good for the US economy, and it helps rich people get richer.

[paulddraper]

Also, broken windows

[grecy]

To the tune of billions of dollars, yes.

[AnthonyMouse]

> Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

The US healthcare system uses private insurance, implying that more use of the healthcare system raises everyone's premiums. And people without insurance then go to emergency rooms which are in turn still passing the cost onto private insurers. So voters already have the same incentive in order to avoid their premiums going up.

[thomastjeffery]

That incentive is obfuscated, though. Every insurer exists as an invisible boundary where cost is not passed to others.

On top of that, insurance is optional. There is no guarantee a person will get affordable care. That's the entire point of the system! If there were a guarantee, it would be indistinguishable from Canada (and practically every other country's) single payer healthcare system.

[AnthonyMouse]

> Every insurer exists as an invisible boundary where cost is not passed to others.

How does that affect issues like this where an increase in overall costs would reasonably be expected to apply to all insurers?

> On top of that, insurance is optional.

More than 90% of the population has health insurance, which is well over the majority required to bring about legislation.

> If there were a guarantee, it would be indistinguishable from Canada (and practically every other country's) single payer healthcare system.

That certainly isn't true. Serious problems with the US healthcare system include AMA lobbying to maintain a doctor shortage, various patent laws and FDA rules that limit competition and increase costs and a malicious lack of cost transparency. None of that would be improved merely by routing the premiums through the government.

[yjftsjthsd-h]

> Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.

The taxes part is the same; only the healthcare half is different.

[galangalalgol]

Incidentally this is also why everyone working in a nation has to receive these benefits (and any others guaranteed to citizens), otherwise you get migrant workers who suck up this, quite literally in this case, but don't receive healthcare.

[lm28469]

Only illegal migrants aren't covered, legal ones are. If you make it available to everyone regardless of their legality to be on the soil you open up a whole bunch of other issues

[sandworm101]

Canada largely avoids this problem by not allowing a subset of illegal people to exist in the country. Canadians are polite, but working in canada without some sort of legal status is far harder than in the US. They have lots of immigrants, but vanishingly few illegal ones in comparison to the US.

[morelisp]

Like what?

[lm28469]

Like giving people an incentive to illegally come to your country ? If there are no difference between coming legally or illegally the choice is easy.

Like I could just book a one way flight to LA and become a US citizen because reasons ?

[duped]

Like how most of our ancestors got here, you mean?

[AnthonyMouse]

You can either provide social benefits to your country's poor or you can have open borders. If you try to do both at once, you're providing social benefits to the world's poor, and the amount of benefits you can provide from a given tax base falls through the floor.

[lazide]

Well, not since ~1882.

https://www.uscis.gov/about-us/our-history/overview-of-ins-h...

That said, overstaying tourist visas (aka just hopping on a plane and then not going back) is a very popular form of illegal immigration into the US.

[Shaanie]

How was the wellfare at that point? :-)

[lm28469]

Your ancestors genocided the whole continent, if anything that argument is against what you advocate. We're not in the 1700s, people can travel more easily, information travels instantly, what worked 300 years ago doesn't necessarily works now.

I'm all for helping people but you cannot import the world's misery and expect it to be smooth, first because it doesn't solve anything, second because it just doesn't work from a simple demographic point of view.

[LordShredda]

That could also be resolved by having tight border security and heavily penalizing anyone involved with their entry

[cjbgkagh]

I have ME/CFS and the fact that we're expensive to the general public seems to be the only reason there is any public money spent on treatments and cures at all. However, Canada and others are finding that medically assisted suicide offers an even cheaper alternative solution. So instead of money spent on treatments and cures we get subtle and not so subtle encouragements to kill ourselves, and I expect the problem to keep getting worse. I.e. I don't think the actual emergent behaviour for shared healthcare costs is as altruistic as you appear to except.

[mhb]

We already have the government involved - OSHA. Why would having it more involved be better if its current involvement is not solving the problem? It's pretty to think that the government has some sort of self-interest and if it can save money in the long run by spending money in the short run, it will do that. But that's not how things work, is it?

A more plausible conclusion from observing the results of an entity's involvement in something is that if it is incompetent with the thing you gave it to do, don't give it more stuff to do.

[bastawhiz]

> if it is incompetent with the thing you gave it to do, don't give it more stuff to do.

When my code doesn't work, I don't sunset the code, I fix it. Why would the best course of action be to stop trying instead of fixing the root of the problem?

[zdragnar]

If your code doesn't work, it could be anything from a minor typo to a bad abstraction based on bad assumptions that requires a full refactor to get correctness and / or minimum acceptable performance.

About 90% of that scale requires sunsetting at least some of your code and doing something differently.

[mhb]

When your Maytag dishwasher breaks after a month, do you think the best thing to do is to buy a Maytag washing machine?

[bastawhiz]

I don't say "I'm not using a dishwasher anymore" I figure out how to get the dishwasher that's in my kitchen fixed.

[mhb]

Fine. So advocate for fixing OSHA instead of revamping the entire health care system.

[bastawhiz]

It's almost as if we should do both!

[rafaelmn]

Not agreeing/disagreeing with this you but I wonder how you feel about obesity tax ? Low physical fitness tax ? There's plenty of evidence that exercise and diet significantly impact health (especially on population level) - like you said there's an incentive to keep those people healthy contributors instead of chronic burdens on the system. Sounds like a logical extension but doesn't seem popular/implemented widely.

[moomoo3000]

Public transit and walkable streets are also incentivized. People naturally end up walking more outside of US.

[morelisp]

If you take this view, any tax on current state is like a "cancer tax" - you're just doubly punishing the person.

Sugar tax, coal tax, corn syrup tax, worked-your-employees-90h/week tax? Sure.

[pydry]

I feel great about slapping a tax on the profits of companies that sell highly processed, sugary, addictive foods so that the market selects for healthier alternatives.

Maybe subsidies for selling fresh fruit and veg also.

I guess you could tax their victims instead though... they don't have a lobby so theyre probably easier to take advantage of.

[plagiarist]

We are Calvinists down here, so bad people were always predestined to be bad and they deserve to be punished. Corporations making money must have be good because they are succeeding, so why would we hurt them?

I will never be punished for being over- or underweight since I am good. The universe would have to be broken for me to be taxed.

[echelon]

> I guess you could tax their victims instead though... they don't have a lobby so theyre probably easier to take advantage of.

Nobody is the victim of choosing to eat a cake.

[jmvoodoo]

We aren't talking about cake though. We are talking about inexpensive highly processed foods made predominantly from ingredients that are subsidized specifically because of their caloric density. I.e. corn.

High caloric density is what you want if you need to be able to feed your country in war, so we subsidize these foods.

No one wants to eat just plain corn though, so companies process it into other foods that are then sold cheaply because they are receiving these large subsidies.

People end up consuming large quantities of these foods because they are cheap, and our brain reward centers a pre-wired to love lots of cheap easy calories.

Knowing all of this, it makes perfect sense to tax the living crap out of highly processed foods that are made from subsidized ingredients. You're just taking back the subsidy you put there in the first place, and shaping consumer behavior for the greater good (which is a common use case for taxation).

[AnthonyMouse]

> Knowing all of this, it makes perfect sense to tax the living crap out of highly processed foods that are made from subsidized ingredients.

The consequence of this would be that the subsidized food gets exported to a country that doesn't tax it, at which point you're subsidizing some other country's food.

The US is also a large net exporter of food, implying there is more than enough domestic production for wartime needs. Also, the US hasn't been in that kind of a war in almost a hundred years and MAD makes it unlikely that it ever would be again. The obvious conclusion is to eliminate the subsidies.

[pydry]

>The consequence of this would be that the subsidized food gets exported to a country that doesn't tax it, at which point you're subsidizing some other country's food.

If theyre smart they won't take this shit either.

Nice of you to let Americans sacrifice their health on $othercountry's behalf though.

[jmvoodoo]

Don't disagree, but eliminating the subsidy is much more challenging politically than taxing junk food.

[ImHereToVote]

When you live in poverty and have no prospects for the future. Some mass produced cake from the supermarket might be the only thing keeping you together. As soon as the work of the laptop class is automated by next generation agentic LLM's, you will probably understand.

[filoleg]

> As soon as the work of the laptop class is automated by next generation agentic LLM's, you will probably understand

Coming any second now, right behind robotaxis, with the only difference being that robotaxis will probably actually happen within the lifetimes of the current “laptop class”.

[mitthrowaway2]

Tax on sugar, sure. But having an obesity tax would be like having a silicosis tax.

[rafaelmn]

This is based on the assumption that sugar causes obesity - I don't think there's any strong evidence for that, or that low carb diets work better for fat loss than low fat, from what I've seen both have same effect (calories equated) and both have equally terrible long term adherence/outcomes. Sugar seems like a nice villain but it's more likely that you'd have to tax any high calorie food that tastes good.

And what about physical activity ?

[mitthrowaway2]

If not sugar, then other causes should be taxed if the evidence supports that such taxes would have an impact. I'm not a policy expert myself.

The best public investment to promote physical activity is designing cities to enable "the gym of life"!

https://youtu.be/KPUlgSRn6e0?si=GDmrYq-XQtn9SaKx

[rafaelmn]

Fair enough, guess my problem would be that since these things would be implemented by politicians it would end up being driven by fads/popular opinion, and without strong evidence (of which there's very little) you'd essentially be conducting population level experiments even if you wanted to be scientific (eg. food pyramid to the extreme)

[throwaway8378]

What about all the other harmful activities? Recent studies about alcohol usage shows that even small amounts can be much more harmful than previous estimates. In addition to the health issues, we also need to consider all the accidents and violence that is connected to drunkeness.

[guraf]

Alcohol is not only heavily taxed in Canada, but most provinces also have a monopoly on selling spirits. That's right, the gov is selling the booze, pocketing both the tax and the profits.

[mantas]

Alcohol is usually taxed. Just like tobacco. Although sugar and other harmful substances should join the former.

[ilyt]

The problem is that you generally have to force people to keep their own safety. Else the el cheapo company shitting on any work safety will be cheaper and quicker, coz workers don't know any better, and thus more competitive, at worst killing the companies trying to do it properly.

[frozenport]

Does Canada have a different policy on engineered stone?

[lazide]

How do you explain the massive push to ban/stop Smoking?

The US is pretty much the only country to successfully reduce it, near as I can tell (perhaps Canada has had success too?).

[mitthrowaway2]

I'm curious about how you got that impression. In Canada, smoking is down from 26% in 2001[1] to 15% in 2019[2]. (Cannabis consumption is probably trending upward though). I have no reason to believe that this decline is particular to the US and Canada. Japan has been trending down from 33% in 2000 to 20% in 2020[3]. I expect this will have accelerated since the government made a strong anti-smoking push during the Tokyo Olympics. In fact, this seems to be a trend across the entire developed world, see this chart[4] showing that cigarette sales per adult per day peaked by the 1980s in every developed country surveyed, and all have been trending downward for decades. The US shows up as exceptional mainly in how extremely high its cigarette consumption habits were in the '60s and '70s.

[1] https://www150.statcan.gc.ca/n1/pub/82-624-x/2012001/article...

[2] https://www150.statcan.gc.ca/n1/pub/82-625-x/2020001/article...

[3] https://www.macrotrends.net/countries/JPN/japan/smoking-rate...

[4] https://ourworldindata.org/grapher/sales-of-cigarettes-per-a...

[lazide]

Ah, it was just a much larger shift in the US, especially demographically. It went from 44% of adults (stats not gathered on younger folks, but anecdotally it was ‘cool’ and a lot of highschool age kids smoked) to 13.8% for adults (anecdotally many quite old) and only 8.8% for younger folks.

Traveling outside the US to Europe or Asia (eastern/southern Europe or China in particular) it’s very visible, where in the US outside of a few locations it’s almost invisible now and notably uncommon.

Especially for educated or higher income folks, too.

[steve_adams_86]

Canada worked to discourage and regulate smoking more aggressively around 20-30 years ago, and in 20 years we’ve gone from around 1 in 4 people smoking to more like 1 in 10. It steadily trends down.

https://uwaterloo.ca/tobacco-use-canada/adult-tobacco-use/sm...

[Shaanie]

What's with Americans and their strange view that the US is somehow managing to do something nobody else has? Just as an example I checked my country: https://www.researchgate.net/figure/Prevalence-of-daily-smok...

I'm pretty sure the figures will look somewhat similar in most western countries.

[lazide]

What is it with non-Americans and their strange view that the US as a whole does anything?

[was_a_dev]

The majority of Western countries have implemented and successfully reduced smoking rates.