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Comment by Thorentis | Hacker News Reader

What are we going to do now, ban smokers from the health system because they take up more cancer beds? Ban obese people because they didn't stop eating? Ban people who don't exercise because it's easy to do, and provably lowers chance of disease? Don't respond to car accidents due to speeding since it was preventable?

As soon as you start excluding people from the health system because of lifestyle choices, you are deciding who should live and die.

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Actually, smokers and obese actually save Governments money on healthcare and pension costs, because they die earlier:

https://taxfoundation.org/new-study-shows-smokers-and-obese-...

"According to the research, a person of normal weight costs on average £210,000 over their lifetime, a smoker just £165,000 and an obese person £187,000."

"Because they tend to live longer" so ok let's not vaccinate because the unvaccinated will die off faster and cost the healthcare way less

If there was a safe and effective vaccine against lung cancer and obesity do you think your argument would be as strong?

There is a safe and effective vaccine against cervical cancer. Hospitals still care for unvaccinated cervical cancer patients.

https://www.cancer.gov/news-events/cancer-currents-blog/2020...

The HPV vaccine is given to boys and girls for free in Australia, and they’re on their way to eradicating cervical and other cancers associated with HPV. Vaccines are compulsory to receive child care and family tax benefits.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...

you mean the vaccine that isn't universally available for free to all americans?

why would you bother making such a silly comparison?

The HPV vaccine is available for free to all Americans with medical insurance regulated under the Affordable Care Act (Obamacare). That's the vast majority.

https://www.healthcare.gov/preventive-care-adults/

We do still unfortunately have about 8% uninsured but local health departments occasionally offer free vaccination clinics for them.

Y'know, Obamacare mandated coverage of alcoholism and drug addiction in all plans: That is, no one can opt out of paying for other people's problems even when they are caused by a completely optional activity.

I am all for a reforming health care markets and getting third party payers out of the system. Until then ...

That is quite wise and a necessary and basic consideration for a society to get to public healthcare. It will always cost you if you introduce it, but you eliminate severe financial risks in case it hits you. If that is your own doing or not is of secondary importance.

> "you" is doing a lot of work in that sentence.

The vaccine against obesity is a healthy diet. It's cheap, it's easy, it's all about choice.

It’s much easier to spend an hour getting a vaccine than it is to live a healthy life.

if you want to live to 30, sure.

Ahh yes…truly spoken like someone who has never dealt with obesity and weight issues.

For what it’s worth folks, it’s not cheap, it’s not easy, but it is about choice and it will be a battle of will every day of someone’s life. Pretty sure I can speak from experience here— I have spent the last four years taking off 170lbs through diet and exercise.

You don't know what I am. Any fat person who has lost weight will tell you it was simple once they overcome putting the fork down and got used to hunger pains until their stomach gets small enough.

But sure, let's just inject ourselves with experimental drugs instead of working out because it's easier. (it's not, you will die anyway)

Food is cheap, that's the problem, even healthy food is cheap, not the whole food shit, but the boring stuff.

Cook your own food, eat only once or twice until your stomach is small, you get used to it.

Getting a shot is not going to help any fat fuck fight covid.

I am a fat person who has lost weight. Lots and lots of weight—170lbs over 4 years. 460+ to currently 290. So let’s just say I know for a fact that the phrase: “any fat person will tell you it was simple” is complete BS. This fat person would never ever say that. So your comment is false just by my example. I know quite a few people with similar stories to my own. I know for a fact they wouldn’t make that comment either, simply because when folks who have lost large amounts talk about their weight loss journey, we talk specifically about how difficult it is.

But you are right, I don’t know what you are, but I can deduce a few things from your comments with enough certainty that given the opportunity to bet on it, I would. I am certain that you were never obese and never lost a significant amount of weight because you have zero perspective on how easy or hard it is just from the statement you made. Also, the term “fat fuck” you used also gives you away. You see, every fat person I know who has lost significant weight doesn’t make comments like that, because it’s pretty damned offensive. Like nearly n-word offensive to overweight people. See, we tend to be hyper sympathetic to people struggling to lose weight…because we know how truly hard it is—-both being obese and losing weight too.

Additionally, I suspect that you are probably pretty young (also because of the “fat fuck” comment). I suspect likely a teenager and certainly young enough that someone else buys and prepares the food you eat, probably a parent. No one who buys food 2021 would characterize healthy food as “cheap”. It ain’t.

Thank you for your opinion and advice, and I hope should you ever gain weight and need to lose it, I hope it works for you as easily as you claim it to me.

I assume insurers could choose to not cover the treatment costs for a condition if you decided not to get vaccinated. Exposing someone to the full cost of an avoidable expense is a solid method of disincentivizing reckless behavior during a pandemic (smoking and obesity are not comparable).

If you can prove vaccination status, of course, costs should still be covered for hospitalization, as you made the very little effort to derisk.

Your assumption is wrong. Any medical insurance plan regulated under the Affordable Care Act (Obamacare) is not legally allowed to deny coverage or raise premiums based on vaccination status.

According to the CDC, obesity is a significant risk factor for COVID-19.

https://www.healthcare.gov/how-plans-set-your-premiums/

https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e4.htm

Wow, that’s disappointing, but not surprising for American healthcare (don’t cover everyone, but no personal responsibility expectations from those who are covered). We’ll just have to let the fire burn through the forest I suppose and eat the costs from these people until travel and employment vaccination mandates kick in.

Obesity costs the US healthcare system 147 billion per year. We need Health Passports right now if cost is an issue. 5.7 over 3 months is nothing compared to the cost of obesity.

It does, however, apparently allow for employers to charge employees more for insurance under a “wellness” scheme. This is how Delta is charging unvaccinated employees $200/month.

Edit- I am also familiar with wellness incentives/charges around smoking, obesity, and exercise.

Following up, it appears that insurers can use vaccination status in pricing healthcare costs shouldered by the insured. Several insurers have already begun to do this (Aetna and UnitedHealthcare). Coverage isn’t denied, nor are premiums raised, but it’s done through no longer waiving copayments from COVID treatment costs.

https://khn.org/news/article/analysis-dont-want-a-vaccine-be...

https://khn.org/news/article/time-to-say-goodbye-to-some-ins...

If smoking were contagious with an R-factor of 3-6, overflowing hospitals and ICUs, and could be cured by two shots a year, it might not be a bad idea.

A better example, actually, is someone refusing free treatment for lung cancer at stage 1, because they believe that cancer isn't real and Big Onco is trying to kill them, and then barging into the hospital, and demanding treatment when they hit stage 3. I'd have very little sympathy for that person.

Who says we won’t care for these people? This says their choice not to get vaccinated is costing billions.

Re: Cigarettes and seatbelts are bad analogies. Society (via the government) has made moves to reduce smoking and encourage seat belt wearing. Looks like the same is now happening for vaccinations with Biden’s new mandates.

Finally, the US healthcare system already decides who should live or die… either intentionally or structurally.

Very few unhealthy people will ever cost as much as a Methusalem getting pensions and health care. So should we introduce forced euthanasia?

We tax cigarettes. My understanding is the tax is restricted in the budget to only go towards paying for healthcare for smokers. So the smokers can stay, at least.

So that's a job best left to private insurance companies excluding coverage?

Triage exists for a reason, and it seems reasonable to apply that here. If you want to accept the risks of your “lifestyle choice”, you should be the one who faces the consequences by being lower in priority for healthcare. If I exercise and eat right, when I need an ICU bed I should be given priority over someone who accepted the risk of eating fast food three times a day, surely?

Regardless of the moral issue, due to EMTALA hospitals are legally required to care for unstable patients regardless of whether they made unhealthy choices. Changing that would require an Act of Congress.

You can dump covid patients with low odds of a positive outcome off support equipment (vents and ECMOs) when healthier patients come in for treatment and equipment supply is constrained. This is already occurring (crisis standard of care).

Get vaccinated.

This could be a way that systemic pro-vax bias reinforces the statistical outcomes.

Especially in Israel, where their coronavirus spread reaches new heights [1], despite 78% of their population being innoculated! [2]

1. https://www.timesofisrael.com/health-ministry-chief-says-cor...

2. https://www.haaretz.com/israel-news/israel-vaccine-data-how-...

They have to do something because the vaccine just isn't stemming the tide!

They are also giving boosters out. Someone please explain why Israel is struggling with COVID-19?

Because the vaccine helps a lot; but doesn’t solve Covid.

Even at 100% vaccination rate there would still be issues, less issues, but far from Zero.

I'm guessing that's eligible population as the numbers mentioned in the article line up more with around 66% of the total population, which isn't enough to stem the tide.

Triage isn't about making a moral decision. It's a decision of balancing patient medical needs vs resource availability.

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