[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.