Who Wins and Who Loses in the Latest G.O.P. Health Care Bill | Hacker News Reader

Who Wins and Who Loses in the Latest G.O.P. Health Care Bill

mobile.nytimes.com

73 pointsmcguire103 comments

I think the cynical and only correct interpretation of this bill is that Republicans ultimate priority is to cut health provisions for largely sicker, older, and poorer Americans in order is to cut taxes for households with incomes above $200k via a budget reconciliation process that requires less than 60 votes in the senate.

The Republican public campaign against ACA/Obamacare is a fraud masquerading as a campaign against all of the things people don't like about the ACA, which is its high premiums and deductibles, and incomplete networks. In fact this bill will literately deliver even higher premiums, higher deductibles, and more restrictive networks all to allow Paul Ryan to cut taxes without getting the Senate to press the nuclear button on the last vestiges of the filibuster.

Considering everyone knew this was coming and had time to prepare, can you point out how many blue states had legislation for single payer health systems ready to go?

Either democrats don't seem to want it or they just want a nice wedge issue without actually doing anything.

Won't that encourage red state inhabitants to not buy insurance, then when they get sick move to blue states and drain their systems?

Limit it to people that have been residents for a certain period, say 2 years. Maybe even limit it against prior conditions for even longer.

And verify it's a real problem. How many poor, sick people in red states have the economic mobility to move to a blue states?

I have no pre-existing health problems (that I know of) and I get no government subsidies. The scorecard lists people like me as winners in the GOP health care bill.

However, I think, most of us will lose from this bill, because we'll live in a country that is less fair

* less fair (if you believe that a market-based approach to healthcare is unfair to people who are born with - or acquire - serious health problems, aka pre-existing conditions ...... and if you believe that poor people should get subsidies to let them get affordable healthcare)

> most of us will lose from this bill, because we'll live in a country that is less fair

Most of us will lose, even financially. Uncertainty is a huge drag on business. Insurance is all about reducing uncertainty, and universal insurance is even more potent in that regard. Millions of Americans will now be less likely to change jobs or take other risks that might leave them exposed to a greater risk of catastrophic medical expenses. Lenders and businesses will have to adjust for an increased number of people defaulting on loans because medical expenses forced them into bankruptcy. In these and a dozen other ways, this regression on insurance is going to hobble the economy and end up hurting us all.

BTW, I'm not at all trying to imply that it's only bad because it's bad economics. Far from it; I think the moral objections are even stronger. I'm just trying to explain how this change is wrong even according to the one criterion its proponents still (arguably) care about.

Worth noting that the winners are mostly the people that are subject to the 3.8% medicare tax, which you don't see until after your first 250k of income, and is only subject to investment income. So, your average high-paid software engineer is still not going to be a "winner" in this case.

I'm "rich" (I make way over 250k) and even I feel this is completely wrong and unjust. I pay hundreds of thousands in taxes each year and am still thankful and grateful just to be in this country because I understand historically what it took to get us here. These people are truly heartless and self-interested in the most un-American of ways. I'm no Democrat by any measure but my party, the Libertarians, need to stand for more, stand in numbers, and replace the Republicans once and for all as the new face of conservatism in the 21th century.

What these people are doing to our underclasses and disenfranchised groups is wrong.

I look forward to going back to the days where I couldn't buy insurance at any price because of pre-existing mental health conditions.

Because you know what makes me a productive member of our glorious workforce? Not being able to get care.

This legislation is a complete mess. That said, I'm bleakly optimistic that if it succeeds in breaking healthcare for enough people badly enough, the pushback may give us an actual shot at a single-payer healthcare system in the US in my lifetime.

Thousands of people will die in the process, it's a high price to pay for a political win.

Single payer is not a political goal, it objectively saves and improves lives.

Saving and improving lives IS a political goal.

Then everything is a political goal, and there's no point on you classifying anything as a political goal as to measure its value.

"Too high price for a political goal" and "everything is a political goal" are not compatible.

So, tell me, what's your point really?

the point is, one party values not redistributing money over saving peoples lives.

the other does not.

one of them got elected by poor rural people who really need the ACA.

i dont think that political goals have value. theyre about the last thing to have "value". "Exterminate all jews" was a relatively popular political goal just a couple decades ago. As far as "valuable things" go, political goals range relatively low on that totem pole.

Hah! I tried hard to avoid bringing the Holocaust reference as a political goal, but I guess it clearly shows that saying something is a "political goal" is a moot point, which you seem to agree with anyway :-)

why try so hard?

Godwin's

It is a political goal. It maybe shouldn't be a divisive, partisan political goal for the reasons you describe, but in fact it is that, too.

Then the argument of "too high for a political goal" is moot, because everything is a political goal.

But according to Nancy Pelosi, single-payer healthcare isn't on the Democratic Party platform, either:

> Vice News Correspondent Evan McMorris-Santoro noted that Pelosi told him that single payer health care should be designated as a solution for states to provide on their own and that the political reality is that Congress isn’t ready for single payer health care.

http://observer.com/2017/05/nancy-pelosi-rejects-single-paye...

This is why I hoped Trump would win over Clinton. Look - even a lot of Republicans are repulsed by this administration. I knew (because of how large the Bernie or Bust movement was) that Clinton would lose if she won the nomination.

I myself wrote Bernie in, simply because I wanted to see how things played out, and I dislike the Clinton's w/ a venomous hatred, and feel back-stabbed by DNC.

But I also felt that perhaps we need the Republicans to take power with the WORST leader imaginable for 4 years -- nobody can ruin the republican party brand better than Trump can. After 4 years, democrats might just start looking like the party of conservatism, and values that help more people. If anything more people will be hurting after a Trump presidency and be open to progressivism...

Here's a good article that shows though that Neoliberalism as an ideology is over, and the winds of change are pushing for Nationalism or Egalitarianism to come in and take over...

https://benjaminstudebaker.com/2016/02/10/why-bernie-sanders...

Trump is a short-term win for GOP, but a long term win for dems, because he will ruin their image/brand.

The biggest deal here is that it removes the "individual mandate". Without the mandate, costs on the exchanges will got through the roof, so basically no one who doesn't qualify for a subsidy will be able to afford them. That said, catastrophic plans will once again be a viable option for many people.

In short - it changed a flaws nationalized healthcare program into an expensive entitlement program for low-income earners.

It depends on what you expect the catastrophic plans to cover.

In a lot of ways, the expensive, high deductible ACA plans are catastrophic plans. It just happens to be the case that they will actually cover a medical catastrophe, so they are expensive. A catastrophic plan that leaves the patient dead or declaring bankruptcy didn't really provide enough insurance.

Also, it depends a lot on what you mean by low income earners, but a family of 4 on $65,000 is getting a bigger subsidy than a very low income single adult in a state that didn't expand Medicaid (http://kff.org/uninsured/issue-brief/the-coverage-gap-uninsu... ).

Can someone explain to me how this can be passed off as anything but pure evil?

The comedy in this is that the Republicans will continue to scream about "the shrinking middle class" but when every policy is designed to benefit the wealthy elite at the expense of the center the middle class will not magically re-appear.

Very much looking forward to see which Republicans in swing states get the boot next year.

I find your confidence in the stupid American voting population strange.

In other words, I don't believe that they'll do anything like what you're implying they will.

This bill is going to end up killing people (through the removal of health insurance for the poor and those with "pre existing conditions"); even your most uninformed voter will come around once this starts being put into place.

I'm hoping for riots, but will accept replacing representatives through the voting process.

Our health care story in the United States has been killing people for decades, yet here we are.

> This bill is going to end up killing people

I'm pessimistic that this will ever be known by those in swing states, let alone cared about. I've traveled to those places and met people there. They have normalized death due to medical complications and drug addiction. Why should more people dying make a difference there?

Roughly half the people in a swing state would tend to be people that agree with you (because that's what a swing state is...).

Edgy though, you hit that mark.

> the stupid American voting population

That seems a little unfair. I'd say they're more insulated than stupid. But when people inside their bubble start losing subsidies and getting hammered with the true cost of coverage, that might be enough to break through to some of them.

The thousands I've paid because of the individual mandate sure didn't help my middle class status.

So were you expecting free health insurance or were you expecting no health insurance?

The internet is full of people who seem to believe (at least for rhetorical purposes) that their insurances rates never went up before the ACA and were never going to go up, and they were never going to be dropped from their catastrophic deductible plan halfway through medical treatment for reaching a lifetime limit.

Well, the 2% Medicare tax is, from their perspective, something that should never have passed in the first place. So repealing it is going back to a previous form of status quo.

Beyond that, I think it's the basic philosophy that government should not be involved in funding health care for citizens (I think those high-risk pools are basically being set up to fail/abandon). I don't really understand it, because I don't see how the normal arguments of self-reliance and accountability translate to sickness, which is by definition out of our control no matter how self-reliant and accountable we are.

If these people demanding taxpayer-funded healthcare were responsible enough to get real jobs before getting cancer, then we wouldn't be having this discussion.

Is this satire? Are you serious? Do you know people get all kinds of illnesses at all ages and do you know that hospital bills are so high that even gainfully employed people in "real jobs" would have trouble paying for them with all their life savings? How much do you think a stay in the hospital is? How much do you think insurance will cost you if you have a medical condition? What if your insurance drops you or you lose it somehow and now you can't afford new insurance because you got sick?

I know sarcasm doesn't always translate, but dude... come on.

https://en.wikipedia.org/wiki/Poe%27s_law

Here's a different perspective: if the government is involved in paying for your healthcare, that gives voters a say in how you live your life. Taking too many risks? Like wine or soft drinks a bit too much? Maybe you enjoy rock climbing, or horse riding, or skiing, or some other dangerous activity? Well, maybe I don't want to pay for your risks, and I get to call you a drunk, fat and lazy, or foolhardy and reckless, needing more regulation and laws to keep you in your place - and your health costs low. We'll ban tasty food, nice drinks, and any activities that are more than a standard deviation or two out of the normal risk profile. We'll have a nice gentle bland life mapped out for you with low health costs.

IMO the biggest elephant in the room is rationing. We can't give infinite healthcare to everybody for all their lives, particularly in very old age. We need to make hard trade-offs. In a free market system, the rationing is done by affordability and price levels: we choose who's more worthy of living longer by how much capital they've accumulated. In a more centralized system, we might choose to pay for interventions based on how much extra "life" they give, and ration by selecting a threshold for how much we pay for extra life year - this is how the UK NHS works, where life year is a QALY, quality-adjusted life year. But anything that doesn't address this elephant in the room, and appeals to emotions about the poor, sick, elderly, dying because they can't afford the treatment they need without considering who exactly we're going to leave to die and why, because we can't all be each other's caregivers for life, is intellectually bankrupt.

This law literally tells you how to live your life, especially if you're a woman: No kids, no reporting sexual assault, ...

As per your claim on the NHS I'm not sure what are you trying to imply. Do you think the NHS or other similar systems choose to let people die based on economic reasons? Because that'll be a surprise. Disclosure: I live in the UK and grew up in Spain, where last night my grandmother passed at the age of 99 after A LOT of healthcare was poured into her (despite the fact she never had "a job"), of course paid by taxes.

The NHS does have a guidelines published by NICE. Doctors would follow those when deciding care. It's not about your contribution to the economy, but about the patients quality of life and future life expectancy. Being 99 means she could have had another decade if an acute illness was corrected.

Things get difficult when patients have longer term chronic illnesses. If she had kidney failure and heart desease the doctors who probably discuss a different care plan.

It's a lot more likely that your insurance company will come down on your rock climbing, horse riding, vodka drinking, etc. than that government will do so. Rationing will happen by bankruptcy and/or death.

The "supply" of medical care does seem quite tight to me, but increasing spending doesn't necessarily lead to rationing, it depends on whether there is existing underutilized supply and how difficult it is to increase the supply.

Like for existing drugs that are profitable but expensive to produce. Our industrial capacity is such that producing those drugs doesn't really impose any medical opportunity cost.

One thing I appreciated about Obamacare is how its structure flowed pretty logically from the value, or moral axiom, that people should not be able to go bankrupt from health care costs alone.

That's also the kind of value that people can disagree on, though. For as much as we might believe that it's unfair for someone to do all the right things and then still end up with the wrong illness and go bankrupt, for others that is the natural order of things.

Although it's worth pointing out that it was still possible (pre-ACA) to go bankrupt from health care costs even if you had done well at amassing capital.

Altogether I think that's why so many people see this as deeply distorted and unfair, the sort of thing that government should smooth out.

> the basic philosophy that government should not be involved in funding health care for citizens

Why not just privatize the police, the fire department, the military, the national highway system, everything? Why is helping sick people so different from helping pay people to put out fires for homes that don't belong to you?

> I don't see how the normal arguments of self-reliance and accountability translate to sickness, which is by definition out of our control no matter how self-reliant and accountable we are.

The "Just World Hypothesis". Many supporters, either overtly or subconsciously, believe that people get sick because they "deserve" to in some moral way. The universe is punishing for their sins, so why should taxpayers pay them off?

You can see an example of this worldview in this thread in fact, with the comment: "People who drive their cars recklessly and who speed pay higher auto insurance premiums. People who choose poor lifestyle behaviors (smoking, drinking daily Cokes, not exercising, drug use) were subsidized by those who 'drove safely.'"

Now, I'm in favor of single-payer healthcare. I can also understand the point of view of the "free market" health care solution. But calling a repeal of Obamacare "evil" is hyperbolic at best.

Taking away health insurance from 24M people isn't evil?

Might need to recalibrate the evilometer.

That's quite the loaded question. If you're framing it as simply thus giveth, thus taketh then sure in a vacuum just taking healthcare away from people is evil (assuming a certain moral framework).

But that's now what is happening here. There are some who believe that the government should stay out of healthcare (not me) and that prices will be lower, and care will be of higher quality. For them, repealing this act will move toward that outcome, which they believe to be good. There's certainly a philosophical argument to be made here.

On the other hand, people such as myself believe that a nation should just provide healthcare for all citizens because we can afford to, and if managed properly (questionable at best considering the US government) could be cheaper and result in better care and will help make the United States more fair.

So yes, I think it's quite hyperbolic to call the repeal of the ACA evil, and it's disingenuous to say that the repeal is simply "taking away health insurance from 24m people" as if that action is happening in a vacuum.

>But calling a repeal of Obamacare "evil" is hyperbolic at best.

How about "profoundly amoral and uncaring"?

As I mentioned to another poster, it depends on your point of view. On one hand, I sympathize with people who believe in a minimal state, are are fearful of our (mostly shitty) government getting involved in the health care industry. It's uncaring if you believe that all people should have healthcare provided by the government and through taxation of other people whether they want it or not. It's not uncaring if you believe that people should provide for themselves.

I am in favor of government run healthcare for a variety of reasons, but I don't consider the opposite point of view to be profoundly uncaring or amoral. In fact, I'd say that if you ignore that the intent of the ACA was to continue to entrench the government into the healthcare industry, it seems quite immoral to essentially guarantee corporate profits for health insurers.

Neither the democrats or republicans in charge really want single-payer. I think at least the republicans are more honest about it.

> It's not uncaring if you believe that people should provide for themselves.

Yeah, that pretty much is what "uncaring" is.

You can care about people and think they should provide for themselves.

And if they can't take care of themselves, and you leave them to rot, then no—you don't actually care about them.

You leave people to rot every day. Why aren't you paying for healthcare in Africa or paying for healthcare for people in rural West Virginia?

So are you a hypocrite or callous?

There is a far larger philosophical discussion to be had. Summarizing healthcare as "if you don't pay for it you don't care about people who die" is either a political talking point of no value, or a lack of philosophical training and understanding.

> So are you a hypocrite or callous?

...or merely not omnipotent?

I don't do anything for healthcare in Africa, true, because I can only do so much, and so donate money to more local organizations. However, I don't think that they should be left to fend for themselves, and do want help to be provided—and so am supportive of organizations that help.

That's a far cry from "I think people should fend for themselves", which conveniently ignores those that can't.

Why not donate to Africans instead of those local to you?

There are no words more appropriate than "evil" that are also polite enough to be used in a forum like this.

No. More appropriate words would be like "difference of opinion" or "I own my labor" or "I don't agree with this action because I think it's solved better in another way".

Painting people who disagree with you, especially if they have sound philosophical backing, as evil discredits my cause to bring healthcare to all people. If you want to bring healthcare to people, you have to find a way to get them to agree with you or change their mind. Calling them evil does harm.

It really isn't, when you take into consideration what will happen to people because of it's removal.

The healthcare bill was a lipstic on a bulldog to begin with and now it is more like a crayon on bulldog. Everyone is a loser here.

I can assure you a lot of people who don't need to worry about paying health insurance will make some very handsome bonuses out of this.

I don't think there is anything wrong in people making handsome bonuses out of this. In fact apriori I would love to invest in those companies. It is mostly the law firms I suppose.

Don't you think it's fundamentally wrong to cause thousands of deaths every year for profit?

> Don't you think it's fundamentally wrong to cause thousands of deaths every year for profit?

Depends on the alternatives.

It's a GOP Bill? I don't even need to read the article.

Winners: Rich people Losers: Everyone else

I'm torn about this legislation. Since obamacare passed I've had continually higher premiums which is pushing me to the breaking point. I support insurance for preexisting conditions, I don't believe insurers should be able to turn anyone away, for any reason. That said, I don't want the government running my healthcare, I don't want to have to buy insurance from the government, and I don't want to pay for the bad mistakes of others - that's difficult to do but that's my opinion. That all said, I think the media is still in the "fuck Trump" mode and no matter what the republicans or trump comes up with, the media is going to take a shit on it.

All that being said, I don't think the issue is republicans, democrats, or trump. I think the issue with our healthcare is the insurance companies themselves, doctors, medical device companies, pharmaceutical companies, and everyone else who takes a cut, adds a surcharge, and has generally done all they could to squeeze every last dime for their shareholders. Like the big banks, I want to see reform of the health care INDUSTRY, and strict limits placed on what they can charge, whom they can charge, and the whole pile on, surcharge habit.

You can't have your cake and eat it too, though.

Not covering preexisting conditions makes good business sense, as does not covering high risk or elderly people, as do many of the objections I've read about this. Maximizing profit and minimizing loss is exactly what businesses are supposed to do, and in the US, healthcare is a business in which anything but collecting premiums from the healthy and well off is an unnecessary risk.

I don't think the healthcare industry is going to reform in the ways you want without the government forcing them to work against their self-interest, which likely requires some form of "the government running your healthcare."

>and I don't want to pay for the bad mistakes of others

When some moron nail guns a board to his head and goes to the ER you are still paying for that.

What you are now not paying for is people fighting cancer, MS, AIDs, and other long term and terminal diseases.

What made you believe that this legislation would enable you to avoid 'paying for the bad mistakes of others'?

Technically, since you apparently missed my point by writing a post on pure emotion, If I don't have to buy insurance then I'm not forced to pay for insurance and thus my money does not go towards someone who drinks to excess, smokes cigarettes, or engages in deliberate behavior that will likely increase their chances of going to the hospital.

> my money does not go towards someone who drinks to excess

except that you absolutely will be paying for them not seeing a doctor and waiting until they have to go to the emergency room.

People who drink in excess go to the ER and get their stomachs pumped - thats paid for by the taxpayers if the person doesnt have insurance. My point was exactly that - you cannot avoid paying for these emergency rooms visits by changing how insurance works, the way to pay less for these emergency room visits is to decrease them by promoting more holistic care - and how does the government promote things? by providing economic incentives in the form of tax breaks, subsidies, etc.

I guess you missed my point by responding with pure emotion...

Again slow down, think carefully and try to stay rational. You'll never have universal health care or coverage. Someone had to pay for it. You can't force people at the end of a bayonet to pay for the mistakes of others. Well, perhaps in your socialist dream world. Keep voting for Bernie and maybe someday you'll grow up.

People who drive their cars recklessly and who speed pay higher auto insurance premiums. People who choose poor lifestyle behaviors (smoking, drinking daily Cokes, not exercising, drug use) were subsidized by those who "drove safely." Only with smoking were plans permitted to charge more (50%), but it was unverified and many plans did not offer different rates for smokers.

And to those born sick? Are we going to make our society a double jeopardy where not only do they have to contend with illness for their entire lives but also crushing medical debt?

I wrote: > "People who choose poor lifestyle behaviors"

Most of the healthcare costs are from behavior, a much smaller proportion is from genetics. Insurance should be for insurance not to cover the negative externalities from choice.

Do you really think that people who don't smoker, don't do drugs, don't abuse alcohol, don't drink Coke every day, etc should subsidize those that do? If that's the case, then we should be subsidizing people who speed and drive recklessly.

If our options (as they are in this bill) are between people who live extremely healthily subsidizing those who don't live healthily AND those who were born sick vs. people who live extremely healthily helping neither then I'll take the first one any day of the week.

> "between people who live extremely healthily"

I didn't say anything about "extremely healthily". I said people who don't smoke, who don't drink Cokes daily, who don't abuse drugs, who engage is some form of exercise.

I also don't understand your sentence. It was wrong for the Democrats to put the financial burden of unhealthy lifestyle choices on others. Healthcare needs to be changed to fix that problem.

You seem to have missed the forest for a pedantic tree. You're avoiding the fact that there are lots of sick people who never smoked, don't drink lots of soda, don't abuse drugs and exercised who didn't have to face crushing medical debt because of the Democrats. This bill is throwing all those people straight under a bus and why? Because you're upset you might also subsidize a smoker? Talk about throwing the baby out with the bathwater.

The Democrats chose to burden taxpayers, the young, as well as people who are not employed by firms that pay for insurance with excessively high rates instead of taxing tobacco as other countries that offer universal care. Our Federal tax is about $1. Canada, UK, France all around $5-6 per pack. With 13 billion packs smoked in the US, there could have been a huge amount of revenues. The fair ratio for young:old which would reflect healthcare costs is 1:6. Congress mandated 1:3 which means that Congress desired that the young subsidize the high smoking and obesity of the elderly -- those diseases caused by their lifestyle. The Republicans made it more fair so that the ratio is 1:5. If you bothered to ask the young if they feel they should subsidize the smoking and Coke drinking obesity habits of the elderly they would say no.

Moreover, and very importantly, the higher costs of Medicaid have to be paid 50/50 fed/state which means that states have additional tax burdens. This additional tax burden means that higher education, state universities, gets less funding which means students have to pay even higher tuitions.

The Democrats created a problem instead of doing the right thing. Can't blame the Republicans for trying to fix the problem as best they can.

You'll note that neither NYT, WaPo, and any other MSM speaks of raising tobacco taxes. No, these elites don't care about others who can't afford the additional burden that the ACA put on people. If they truly cared, they would ask for the tobacco tax increase like other developed nations that offer universal care.

>The Democrats created a problem instead of doing the right thing. Can't blame the Republicans for trying to fix the problem as best they can.

Surely you don't imagine this to be fixing it as well as they can?

And why are you unable to address people who were born with genetic diseases/birth defects or who have contracted disease through no fault of their own?

In a case like healthcare I think it's important we put ourselves behind the veil of ignorance. If you did not know who you were going to be born as but you knew that there was a 3% chance you would be born with a birth defect[0] and a 51% chance you would meet the criteria for pre-existing condition[1] which society would you choose, one with ACA or one with AHCA?

Even if you contest the numbers think of it like this, you have x% chance to suffer from a chronic disease and you will also be buried by medical debt and y% that you will be healthy (for most of your life) and pay a small percent each month to hedge your risk.

Or you could choose a society where you have a x% chance to suffer from a chronic disease and you pay a moderate amount each month for insurance and y% that you will be healthy (for most of your life) and pay a moderate amount each month to hedge your risk. Now if you did not know whether you would be a person to suffer from chronic disease or birth defects which would you pick? Seems obvious to me.

[0] https://www.cdc.gov/ncbddd/birthdefects/index.html

[1] https://aspe.hhs.gov/pdf-report/health-insurance-coverage-am...

I'm sorry, but I can't make this any more clear. I have repeatedly said that the insurance should cover those who have genetic issues or issues not caused by their own lifestyle choices. I can't make it any more clear. If you don't understand that, I'm sorry.

I have also repeatedly stated that we should not be paying for the healthcare costs of lifestyle choices of smoking, drinking alcohol, sugar sweetened beverages such as Coke, lack of exercise, etc.

Instead of doing the right thing and increase the tobacco taxes to pay for the programs (as other countries such as Canada, UK, France, Ireland, ...) have done, the Democrats chose to burden others and have chosen to dramatically increased Medicaid costs to the states which means that public universities (or course not the universities of the elites that run the Democratic Party) will get less and less funding and the students will have to go more and more into debt.

The Republicans fixed the problem caused by the Democrats. Instead of blaming the Republicans for fixing these harms, blame the Democrats for folding to the tobacco lobby.

Now, either you understand this that I am not saying that people with genetic issues or issues caused by those others by lifestyle or you don't. But don't blame the Republicans for fixing the harms caused by the Democrats. If you were to actually speak with people as I have you fill find that most agree that they shouldn't have to subsidize the healthcare costs caused by lifestyle choice.

If people really cared, they would lobby for increasing the tobacco tax to levels comparable to Canada, UK, France, Ireland, .... to pay for the programs. Neither NYT, WaPo, or any other MSM or their columnists have advocated following the example of these other countries in order to pay for the care.

BTW, the states can increase their own tobacco taxes, and put the money into Medicaid as NY State has done. Louisiana has a tobacco tax of $1.08 and NYS $4.35. If it raised its tobacco taxes to about $3.00 for the 200 million annual packs smoked and then put the money into Medicaid (matched 2:1 by feds) they would have $600 million to take care of uninsured while lowering the rate of smokers which, at 24%, is one of the highest in the nation.

People claim to care, but if they truly cared, they'd lobby to raise the tobacco taxes using those funds to pay for people who need healthcare.

I split the difference: Those who indulge in risky, generally recognized unhealthy behaviors, should pay more. Those born sick, no, absolutely not. We should do more to incentivize people to lead healthier lives. Since when has health insurance ever gone DOWN?! I lose fifty pounds my insurance rates won't go down, while some guy that doubles the amount he smokes and drinks won't necessarily see any increase.

I guess high deductible plans should provide people incentive to lower their healthcare costs.

It'd be interesting to see if shifting to higher deductible plans leads people to make different health choices or not.

I only stated that people who indulge in unhealthy lifestyles should not have their healthcare costs subsidized by those who choose to not indulge in those unhealthy lifestyles, just as those who drive unsafely should not have their costs subsidized by safe drivers.

Issues of genetics should be covered by insurance, but by far most healthcare costs are from chronic diseases caused by smoking, obesity/lack of exercise, alcohol abuse, etc. and air pollution.

Reply on news.ycombinator.com