[csomar]

Sure. Because the response of a failure in governance is more government? What you are proposing is "unfair". You are essentially suggesting that the rest of the country subsidize a subset who wants to live near high-risk areas. Me too want to live in a dense forest and also have my house by the edge of the river.

You could make the argument for this for healthcare, since no one can choose which illness he is born with. But choosing your housing location is a "choice". And you can/should move somewhere else where it is less risky.

[PaulDavisThe1st]

> Because the response of a failure in governance is more government?

Are you this incredulous when the response to a failure in "the market" is more "market" ? Or when companies fail, and the response is "more companies", do you question that in the same way?

I'm not taking a position on the meat of your point, but this particular angle strikes me as very strange.

[macinjosh]

People choose to smoke, overeat, engage in risky activities that can cause injury near and long term (Rock climbing, riding motorcycles, football, MMA). Why should society pay for these choices?

[throw0101a]

> Why should society pay for these choices?

Because it's the only way to get universal coverage, which if you don't have, means a portion of the population gets really sick, jams the ER, can't afford to pay the resulting bill (maybe declaring bankrupcy), and someone then has to eat/cover the cost. Often by hiking prices for those that do have coverage.

Do a search for "ACA three legged stool":

> It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.

> So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.

> But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.

* https://archive.is/https://www.nytimes.com/2017/07/10/opinio...

This 'architecture' was developed by Jonathan Gruber:

* https://cdn.americanprogress.org/wp-content/uploads/issues/2...

* https://en.wikipedia.org/wiki/Jonathan_Gruber_(economist)

It is a form of social safety net.

[mgh95]

> Because it's the only way to get universal coverage, which if you don't have, means a portion of the population gets really sick, jams the ER, can't afford to pay the resulting bill (maybe declaring bankrupcy), and someone then has to eat/cover the cost. Often by hiking prices for those that do have coverage.

The alternative that is always there is to repeal EMTALA.

> It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.

This misses the problem: [the ACA causes a moral hazard for lower classes likely to use it.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8567089/)

The issue is a policy designed for a highly uniform, high social class, high status state (Massachusetts) was applied to the USA as a whole.

[PaulDavisThe1st]

> The alternative that is always there is to repeal EMTALA.

I suspect you think it's not great having homeless people on the street.

Wait till you see what it looks like when they actually start dying in the street because emergency health care is no longer available to them, nor to many of their housed neighbors, family and friends.

[mgh95]

I don't see what EMTALA has to deal with homelessness in this context. It largely comes down to uninsured, even post-ACA. If we can't afford the current system, it's not a matter of if, but when, either hospitals or providers leave medicare. To put it in perspective, the AMA reports (https://www.ama-assn.org/practice-management/medicare-medica...) that physician medicare compensation has declined 29% since 2001. At a certain point, it will simply be financially unsustainable. Whataboutism to distract from the fact that medicare alone is 3.7% of gdp and is forecast to grow to 5.1% by 2033 (https://www.cato.org/blog/fast-facts-about-medicare-social-s...) doesn't fix anything.

And FWIW, US Medicare spending alone is shaping up to grow to almost as much as some EU nations on a % of GDP basis (https://ec.europa.eu/eurostat/statistics-explained/index.php...).). Medicare isn't the solution. It's the problem.

[inferiorhuman]

  And FWIW, US Medicare spending alone is shaping up to grow to almost
  as much as some EU nations on a % of GDP basis

Your source puts Austria, France, and Germany at the top, or roughly 11–13% of GDP.

https://www.bea.gov/news/2023/gross-domestic-product-fourth-...

https://crsreports.congress.gov/product/pdf/IF/IF10830

The U.S. Bureau of Economic Analysis puts the 2022 GDP at $25.46 trillion ($25,460 billion). Congress puts 2022 spending on private health insurance at $1,290 billion (5%) and Medicare at $944 billion (3.7% of GDP).

[PaulDavisThe1st]

> If we can't afford the current system,

What we can and cannot afford is a choice, not some immutable fact of nature.

A cynical, if realist, version of this would be: if we choose to not spend any more ...

But that's still better since it acknowledges that we, as a nation, have agency in this.

[Panzer04]

Because from a moral standpoint most people agree that we shouldn't allow people to go without treatment, regardless of their poor choices. From a national standpoint it also doesn't make sense to allow people to become cripples for lack of money, reducing their economic value.

Injuries also hurt, so it's not like people don't have other disincentives to avoid injury aside from the price. This isn't the case in other areas, where it's purely a monetary penalty and thus removing that penalty results in way more of that thing taking place.

[Sabinus]

After a society brings in universal healthcare coverage, more rules discouraging smoking, overeating, and engaging in risky activities often follow. Which is either a nice way to get the people of the country caring about each other's health, or an awful government overreach depending on your political bent.

[csomar]

> People choose to smoke

Cigarettes can be taxed with proceeds going to care with those with lung cancer. Dangerous activities can have a separate insurance. For a popular sport, it means most people are engaging in this activity. Houses on the top of a mountain are for a very tiny minority (and a very rich one too). They should finance their lifestyles themselves.

[mgiampapa]

I'm not saying everyone pays the same, I'm saying you take away the for excessive profit nature of insurance. If you live in a tinderbox you are going to have more risk and more costs. Yeah somebody has to model the risk and set a price, but I'm saying it shouldn't be someone who has an incentive to make as much profit as possible.

[Panzer04]

Your seem to be under the misapprehension the problem is insurers charging usurious prices. The reality is Paul in the forest got used to paying whatever 5kpa to insure against a 100 year fire, not 50kpa to insure against a 10 year fire.

It sounds like a lot, but if the risk is actually that high then the prices will be too. Houses aren't cheap. Insurance is a very competitive market, it's easy to comparison shop. The root problem is the high risk, not "unfair" private profit.

(Numbers picked out of thin air to make a point)

[mgiampapa]

Yes, I'm advocating people pay appropriately for risk. The issue is with high risk, insurers pad profits to compensate for excessive risk or leave the market with no option other than some last resort insurers. Having government step in with regulation around profits over time keeps the rates in check. You can have a Lloyd's of London, but they need to have open audited books. Otherwise you can have a not for profit, ie government entity run the book.