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Comment by treeman79 | Hacker News Reader

Good insight.

Coming together is tricky when there is no common grounds.

One side wants wealth to be fairly Evenly distributed to help the poor.

The other side helps the poor by creating so much wealth that that most poor people have a lot of wealth.

These days you can be considered poor and have housing, ac, heat, tv, video games, maybe a car, and weight problems because food is so cheap.

This only leaves those who truly can not or will not work. Severe physical or mental illness, etc.

Some can’t stand that inequality exists. Others “know” that destroying inequality means we create more poor people.

That’s not even touching right to own body vs right to life crowd. There is almost no middle ground in that battle. Either it’s removing a sac of cells or killing a baby. Maybe some wiggle room at the start, but none by end

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More likely that you'll have weight problems because healthy food and lifestyles are much more difficult to acquire and maintain without sufficient wealth.

It’s such a reversal. Historically Chunky woman were often considered more ideal since that meant wealth and status.

Skinny woman meant poverty.

Difficult to carry fat on a diet of turnips.

No shortage of healthy, yet poor people. Then again we go back to the problem of defining "healthy". Not even the ultra-wealthy are completely illness-free.

Healthy is a BMI in the normal range and following something close to the Harvard nutrition plate (USDA one is bought by big agriculture).

Being able to afford a meal service or go to Whole Foods is also much harder when you live in a food desert. Yes we do give people EBT or something but then it is spent on junk food/soda.

So how do you fix that? Maybe if you’re overweight medically speaking pay more in insurance/taxes? That would never fly tho so we are in the current national predicament.

Really? Walking is free but driving isn't. More food costs more than less food. And lots of boring difficult healthy food (eg. veges) is cheaper than more pleasurable easy food (eg. fast food). Being unemployed provides more time to do healthy things than having a busy job.

I'd say the reason poor people are unhealthy is the same as the reason they're poor - unwillingness to work.

> Walking is free but driving isn't.

Living in safe neighborhood to walk in isn't cheap, nor is a gym membership, nor is having time to drive to a nice neighborhood or trailhead to hike.

> Being unemployed provides more time to do healthy things than having a busy job.

People who are chronically unemployed but physically able often have a serious mental health issue that prevents them from holding down a job.

> I'd say the reason poor people are unhealthy is the same as the reason they're poor - unwillingness to work.

The working poor usually have little time in their day to exercise for health, especially when they are working multiple low wage jobs to make ends meet. Many of them work physically demanding jobs that are bad for their health, and are exhausted by the end of their work day - and not a "good" kind of exhaustion at that.

They are poor because they live on a knife's edge, one accident away from financial insolvency or lack of sufficient access to necessities like health care and education opportunities.

Also having to work multiple jobs to break even. The problem isn't "inequality" it is that the floor in the US is so low compared to other wealthy nations.

Lots of people who make decent money live paycheck to paycheck because of poor decisions

This is a great example of having the right ideas but not understanding workable systems with real people. Let's take just one industry and I can show you how it's not as simple as you make it out to be: socialized/single-payer medicine. This is a system which reduces incentives (profits) in exchange for some equity. This is a great idea because we don't like it when people suffer. But what are the costs? Basic economics/psychology informs us that when incentives affect behavior. When the profits in healthcare are reduced there is less incentive to create new products/treatments/services. This is the tradeoff we're making. What happens down the road? Of course no one knows exactly, but we do know what will tend to happen. A new drug that might've been created in 5 years takes 7 instead. And then the next advancement that builds off that one takes even longer still. The whiz-kid who might've invented the new surgical technique which saves hundreds of lives per year might go into finance instead. What does this mean? It means we've slowed the velocity/acceleration of advancement. So people who live 50 years in the future will not have as good of healthcare as they could've if we'd left the greater incentives in place. And the people who live 100 years in the future are relatively even worse off to where they would've been because we've had 100 year at the slower pace. Since the future is functionally infinite, we are causing infinite harm to people in the future (all the advancements they won't get) at the cost of providing some comfort for some people today. And this applies to every industry, every redistribution program, every set of regulations. It's not just politics/law either, we make these decisions in our own lives every day. Are you going to buy that Apple Watch, or are you going to put that extra $ into your 401k?

Stoicism teaches us that all negative emotion is rooted in a lack of understanding. So when someone says they don't want to raise the minimum wage, or doesn't want universal healthcare, or whatever... it's helpful not to have that knee jerk reaction of "This person is bad and wants people to suffer." That's almost never the case.

First of all, "Basic economics/psychology informs" does not constitute empirical proof that UHC leads to decreased "innovation" (which is a weasel word in itself).

Second, even if we granted the premise that UHC leads to less healthcare innovation, this doesn't mean that there's "infinite harm" in to people in the future. Unless you're claiming you have a crystal ball, there is absolute 0 epistemic basis on which to make this claim. For all we know, not having UHC leads to nuclear war and we all die. Or, having UHC leads to the singularity. Etc.

Third, even if we grant that there's an innovation advantage to for-profit medicine AND we grant that you can predict the future, that still doesn't mean that there's "infinite harm", precisely because "harm" is comparative. I would argue that we've picked most of the low-hanging fruit of human medicine and that the marginal utility produced by new treatments is far outweighed by the human suffering of our for-profit system.

>First of all, "Basic economics/psychology informs" does not constitute empirical proof that UHC leads to decreased "innovation" (which is a weasel word in itself).

Either you believe humans respond to incentives or you don't. It's that simple.

> Second, even if we granted the premise that UHC leads to less healthcare innovation, this doesn't mean that there's "infinite harm" in to people in the future. Unless you're claiming you have a crystal ball, there is absolute 0 epistemic basis on which to make this claim. For all we know, not having UHC leads to nuclear war and we all die. Or, having UHC leads to the singularity. Etc.

I'm not making a "butterfly effect" argument where there's no obvious direct line between choice A and impact B. The only axiom I need is that humans respond to incentives, and then what happens when you reduce or remove incentives is obvious. You tend to get less of that thing.

>I would argue that we've picked most of the low-hanging fruit of human medicine and that the marginal utility produced by new treatments is far outweighed by the human suffering of our for-profit system.

If you believe we're basically near the end of potential for human medicine, would you support cutting subsidies and funding for research in the healthcare field?

"Either you believe humans respond to incentives or you don't. It's that simple."

Fine. I don't, at least in the simple model you present. And I hae 40 years of behavioral economics to point to.

It seems that your claim of infinite harm is based on the idea that the future is infinite. If the current subpar healthcare situation continues indefinitely, is the harm that it inflicts on its victims not also infinite? Is the benefit provided from removing this source of harm not also infinite? Then by your own reasoning, the question is not nearly as simple as infinite > finite.

Being in favour of single-payer, I can still appreciate arguments against it I guess. But this particular one isn't very effective.

Cheap healthcare advances at the same rate as expensive healthcare, it just lags some years. That's why Walmart famously has dozens of prescriptions it can offer at a price of only $4/mo. Those drugs were once very expensive and were only available to the relatively wealthy.

Once upon a time, I bought my expensive asthma inhalers from Walmart because it's the most convenient pharmacy. Then they stopped carrying it. In fact, every one did. The manufacturer's patent ran out and they stopped making it. It was several years before the drug came back on the market by which time I had moved on to another expensive inhaler.

I too was affected by this. The root cause was the CFC bans [1] to save the ozone layer. The old inhalers used CFCs and therefore could not be used anymore. New technology had to be created that used a different delivery mechanism. Profit incentive is what caused that new delivery mechanism to be created.

[1]: https://en.wikipedia.org/wiki/Chlorofluorocarbon#Regulation

Regardless, even if you can find some legitimate counter-examples it doesn't negate my premise in the same way that anecdotes are not data.

I think you'll find that the price just changed. People are reporting absurd price drops on a wide variety of different medications. You can thank Trump for it.

It's sort of price controls, but not the usual sort. Trump decided to enforce most-favored-nation pricing. Any price can be charged, except that the USA always gets the cheapest price. The drug manufacturers are understandably livid, so they are now funding attack ads.

Yes, we always have to think about perverse incentives and the resulting unintended consequences. But some of these problems can be remedied with more government involvement. E.g., instead of allowing BigPharma to reap windfall profits (via artificial IP monopolies) to finance R&D (which they spend less on than they do on advertising), why not treat drug development as a public good and finance it accordingly? (We might see less investment in Viagra and more in anti-malaria drugs.)

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