[miley_cyrus]

No that is a huge failure. That is perhaps the biggest failure of Obamacare.

That means I, as someone with healthy lifestyle habits, has to pay largely the same premium as someone who smokes, is obese, and doesn't exercise. And sure enough, life expectancy in the US immediately stalled after the law's implementation: https://www.macrotrends.net/global-metrics/countries/usa/uni.... Exactly what economics would predict would happen.

[orionsbelt]

And what if you, despite being healthy, get diagnosed with cancer right one your employer fails, thus becoming uninsurable? This type of thing happened to people.

It’s nice the above can no longer happen. You could, at the same time, still allow insurers to charge a premium to smokers and obese and for other lifestyle risks within one’s control. They are not mutually exclusive.

[JuniperMesos]

The entire system of linking health insurance to one's current employer is bad. I should just be able to buy it with money I earn from doing anything that pays me, just like I do with my car insurance or any other type of insurance.

[ZuLuuuuuu]

That decline is mostly because of Covid pandemic, no? And it looks like the life expectancy picked back up after 2022.

Similar laws existed in EU countries long before US, and EU countries also saw a decline in life expectancy during those years: https://www.macrotrends.net/global-metrics/countries/deu/ger...

[idiotsecant]

Look at this Ubermensch that will never have a stroke, develop cancer, or any number of debilitating conditions. Must be nice!

It is the basic duty of every human to do their best to make sure every other living human is afforded a life of simple human dignity. Full stop. We have the resources. Let's just do it.

[thereitgoes456]

Sadly we do not have, and will never have, the resources to help everyone, even to a baseline of human dignity. Surely we can't give people unlimited talk therapy, MRIs, and cancer treatment for free. But some people sorely need these things.

Preventative/propylactic care is orders of magnitude cheaper than treatment once a disease has manifested. It makes sense to me to punish people for not doing this care, thereby choosing to impose more strain on an already overburdened system.

Note that GP only mentioned things we have control over -- exercise, weight, not smoking. Of course I agree that it would be cruel to disadvantage pre-existing conditions.

[johnnyanmac]

That's the point of insurance. It's the idea that everyone pools together money and when something bad happens to one person, its finances are mitigated by the input of others. Some will benefit more and others benefit not at all. But no one can predict who is on what end.

Yes, if everyone gets cancer at the same time then Health Care is boned. But then again, so is society. So why worry about that worst case scenario?

>Note that GP only mentioned things we have control over -- exercise, weight, not smoking.

We couldn't pass laws to help control what companies put in food, and failed to subsidize healthier food options. I wish you the best of luck with healthcare trying to pull off that endeavor with punishments for obesity. I'm guessing it wouldn't be poolitically popular.

[clcaev]

> Sadly we do not have, and will never have, the resources to help everyone, even to a baseline of human dignity.

This is really a matter of choice. There is a level of treatment that most people could have with far less friction. We just have decided to organize our economy otherwise.

Broadly, we need to stop seeing our economy as a zero sum game. It's dehumanizing. So what if there are a few bad actors that abuse the situation? Most don't. If everyone is doing something harmful, eg smoking, then we need strong public education, etc.

[idiotsecant]

Since when do we not have the resources? Nearly every developed country on earth manages it ok.

[mlrtime]

Does every other country have a boarder that "allows" millions of people in every year? These EU countries are tightening hard on immigration as they have found that it crushes their social nets. Not to mention keeping defense spending adequate relative to allies.

If this was so easy, what is the plan?

[array_key_first]

Immigrants are easily exploitable labor. They aren't sucking up our resources. If anything, we're sucking up their resources.

I live in Texas. Look around me. Who's building these 500,000 dollar homes? Not fatass white people. And who is buying them? Not the people building them.

[foldr]

Several million people migrate to EU countries from outside the EU every year, yes. The number will be lower than a million for most individual EU countries, but then the individual countries also have smaller populations than the US.

[idiotsecant]

Oh boy, here we go.

[lovich]

> That means I, as someone with healthy lifestyle habits, has to pay largely the same premium as someone who smokes, is obese, and doesn't exercise.

Do you live a healthier lifestyle than every single other person in your insurance plan or are you just a hypocrite who’s decided the line is acceptable when it includes you, but not one inch beyond that?

[randycupertino]

The obese and smokers actually cost less because they die early vs healthy people who live a long life and need a lot of care when they're aged.

"Smoking was associated with a moderate decrease in healthcare costs, and a marked decrease in pension costs due to increased mortality." https://bmjopen.bmj.com/content/2/6/e001678

The UK did a study and they found that from the three biggest healthcare risks; obesity, smoking, and alcohol, they realize a net savings of £22.8 billion (£342/$474 per person) per year. This is due primarily to people with health risks not living as long (healthcare for the elderly is exceptionally expensive), as well as reduced spending on pensions, etc..

[d1sxeyes]

US policies wouldn’t affect the life expectancy in the UK, which has broadly the same trend: https://www.macrotrends.net/global-metrics/countries/gbr/uni...

This is despite no-one paying (directly) for health care.

Would you be willing to submit to invasive investigations into how you live to identify any risk factors you have (both under your control, like choosing to drive, international travel, and not under your control, like genetic predisposition to heart disease) to ensure your premium can be accurately calculated?

Blaming people for their illnesses is something we have historically gotten wrong a lot, and regardless, it’s pretty inhuman as a society to leave people to suffer and die because they can’t afford healthcare.

[zimpenfish]

> Would you be willing to submit to invasive investigations into how you live to identify any risk factors you have

To be fair, there are insurance policies (at least in the UK) which give you discounts if you drive "safely"[0] or health insurance that rewards you for "being active"[1].

[0] https://www.which.co.uk/money/insurance/car-insurance/how-bl...

[1] https://www.vitality.co.uk/rewards/ "you earn Vitality points by getting active or attending your health check-ups [...] rewards, including a reduced excess and lower renewal premiums"

[d1sxeyes]

Example 1 is car insurance, not health insurance, so not really apples to apples. Being able to drive is not the same as being able to access healthcare.

Example 2 is private healthcare insurance, which does exist in the UK, but only about 10-15% of the population have it, and it's mostly about getting access to healthcare provision faster. These private providers can of course do what they like, same as in the US, with the caveat that everybody is entitled to free, comprehensive healthcare through the NHS if they don't have private healthcare insurance.

However, folks that can afford to sometimes like to skip the queue.

It's worth noting I suppose that the UK has significantly more in the way of 'sin taxes' than the US. For example, tax on cigarettes is 16.5% of the retail price plus £6.69 ($8.73) on a packet of 20, meaning on average cigarettes retail for around £15 (~$20). This compares to the US average of somewhere around $3 tax and retail of around $10 (varying based on state).

It's more complicated to calculate for alcohol, but again, the UK taxes alcohol more heavily than the US.

This additional tax revenue helps to fund the treatment of those who use those substances (although to be clear, it doesn't cover it fully).

[benmmurphy]

I would be very surprised if taxes on tobacco did not cover the increased costs to the State from tobacco users. When I last looked at it tobacco users were dying early before they imposed huge costs on the State during their old age years and this produced an enormous saving to the State. This was ~20 years ago and we might be much better at keeping people alive and this has changed the calculus.

[d1sxeyes]

So it seems that the literal cost of treating smoking related illnesses is indeed fully covered (multiple times) by the tax revenue generated.

https://fullfact.org/health/farage-smoking-revenue-nhs/

However, net cost to the state when you factor in inability to work, etc is estimated at twice the tax revenue.

Your point that smokers die younger and so cost the state less is a contentious topic with lots of debate. One thing that is clear is that tobacco firms are actively pushing that narrative, which, given the industry’s history with regards to data and studies like this makes me instantly suspicious: https://www.wsj.com/articles/SB995230746855683470

[benmmurphy]

> it’s pretty inhuman as a society to leave people to suffer and die because they can’t afford healthcare.

this is mostly about drawing a line between the tradeoffs of costs and the benefits of increased lifespan and better quality of life. almost no-one actually believes all of societies resources should be committed to healthcare to achieve some small marginal health gain. claiming people are inhuman because they want to draw the line differently is messed up.

[d1sxeyes]

That’s a fair point. But whether a person lives or dies should not be a function of their income.

The NHS for example today doesn’t spend infinite resources on any individual. In some cases, the decision is that the cost of treatment is not justified by the benefit.

Whether someone is a smoker is a factor in that decision: how much longer they may live, their expected quality of life. Also their lifestyle is taken into consideration when determining the order of a transplant list, etc.

But the decision is never made based on their ability to pay.

[pdntspa]

I remember being denied coverage after aging out of my parent's healthcare plan. The cited reason was "pre-existing conditions", which were allergies and a congenital cleft lip and palate (I had a number of corrective procedures as a kid). I was a healthy and relatively normal young adult.

Life expectancy flatlining could be any number of things. Correlation != causation

[tartoran]

How about if that is diabetes, or something else that does not depend on lifestyle choices?

[mlrtime]

You're kidding right? Look up how many people have type 2 diabetes, greater than 90%

[croon]

Assuming they mean type 1 yields a better dialogue.

[abenga]

That's the point of insurance.

[grahar64]

Yes, everyone on insurance should be young and healthy. Fuck those sick people /s