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Comment by sonthonax | Hacker News Reader

You know very well that healthy people live differently and end up subsidising the habits of others.

Don’t be so lazy as to argue that a marathon runner makes comparable choices to an overweight layabout. It’s just not true that people’s lifestyles are in aggregate equal. Health insurance companies know this and are legally forbidden to charge obese people more under the ACA. It’s cold hard actuarial fact.

Rather than trying to falsify reality to fit your moral viewpoint, try to argue why he should subsidise.

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> Don’t be so lazy as to argue that a marathon runner makes comparable choices to an overweight layabout.

Marathon running is quite hard on joints, with an increased incidence of osteoarthritis. (There are also overweight marathoners, smoking marathoners, etc.)

> It’s just not true that people’s lifestyles are in aggregate equal.

Certainly, but there's an infinite number of combinations, and there's a serious risk to over-dividing the risk group. Pre-ACA, some folks found themselves shoved off into "high risk pools", which often made them functionally unable to access healthcare. Making folks uninsurable pushes them into more expensive (back to subsidizing!) emergency care, and causes them to delay treatment in ways that often exacerbate a treatable condition.

I suspect the folks here would riot if "sitting in a chair all day" wound up with a massive insurance penalty. Should eating meat come with an insurance penalty? Living in a smoggy city? Overindulging in beer?

> Marathon running is quite hard on joints, with an increased incidence of osteoarthritis.

Most marathon runners are terrible athletes who have terrible training goals and usually stop running due to self-inflicted soft tissue injury. This isn't expensive to treat since normally it's only rest is required to heal from ITB-syndrome or even shin splints. So they're rarely able to turn it into a lifestyle. Those who are able to continue probably are at a higher risk of osteoarthritis. I still stand by these people just cost less to provide healthcare for in old age (and I don't think there's selection bias at play here).

> Pre-ACA, some folks found themselves shoved off into "high risk pools", which often made them functionally unable to access healthcare.

Like I completely agree with this, that it solves this problem.

I was more so trying to raise the moral point about socialised healthcare (and I mean socialised in that loose sense) demanding a sacrifice from those who do take care of themselves. People are willing to suspend notions of natural inequalities to a point because most people still feel they live in a society. But there is a limit to this where people feel their burden is so disproportionate that they seek to emancipate themselves from it. The bonds of society are only so strong.

> I was more so trying to raise the moral point about socialised healthcare (and I mean socialised in that loose sense) demanding a sacrifice from those who do take care of themselves.

Except the "socialized" healthcare systems of Europe have half our total per-capita healthcare costs; the US is and has been abberantly expensive for decades. It's hard to argue this point when we've got a whole bunch of counter-examples disproving the theory.

> Health insurance companies know this and are legally forbidden to charge obese people more under the ACA.

You make it sound like there is a specific provision in the ACA that says, “thou shalt not charge the obese higher premiums.” There is not. Insurance companies are allowed to adjust premiums based on the insured’s age and whether or not they smoke, end of list.

The situation you’re advocating for (charge people based on their known risk at the time of policy issuance) is basically how insurance used to work, and it was dystopian. I literally had a doctor advise me to never get a certain test performed because I might become uninsurable. This state of affairs did not lead to ideal health outcomes.

you can always count on death, taxes, and a discussion on HN about health insurance to run down the “but the obese” path.

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