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Comment by navane | Hacker News Reader

Sure everyone is entitled to their vice, but should we provide healthcare to people that are consciously, actively destroying their own health? Should we treat lung cancer in smokers? Should we treat diseases in anti-vaccers?

Taxing vices makes them proportionally more expensive for the have-nots, without solving any issue. No one gives up smoking or drinking because they don't have the money for it.

I say don't forbid, don't tax, but let there be consequences. It must be very frustrating for medical personal to deal with anti-vaccers and heavy smokers. You buy sigarets? Just sign this waiver. Don't get vaccinated? Don't get a check in the system for future treatment.

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The obsession people have with “consequences” is really weird. The point of civilization is protecting people from negative actions that can hurt them, letting people die of easily preventable outcomes is 1. heartless, and 2. very bad for society.

It almost seems like risk-averse people resent those who take risks for having more fun sometimes. Smoking, drinking, and drugs making you not able to get healthcare at all is next level Puritan shit

This is just a simplistic model of human behaviour. People assume that the guilty are making these choices independently and the prudent are doing the same. In each case wider societal factors are at play.

I was raised christian and was therefore deeply scared of drugs until age 21, luckily for me by the time I was mature enough to enjoy drugs at around 25 my brain had developed fully and I was able to try MDMA & LSD with positive life-altering consequences. Some of my friends who didnt have the same fear ended up trying hard drugs at far too early an age and became addicted. Not all of them, but at least those who had self-control issues and mild ADHD.

Things often come down to a genetical and circumstantial lottery, the more we do to minimise negative consequences of bad luck and level the playing field the more we will benefit from everyones talent collectively

> next level Puritan shit

yups. and besides that: where to draw the line and how to enforce it? "sugar" for instance...

The problem with the idea (for me) of letting people live with the consequences is that in the UK, I'm forced to pay a good chunk of tax (I think it's about 1/5th) on a failing health system.

Rough "napkin" math on this is massively over simplified but the NHS spent roughly £134 billion in 2019/20 (before covid). We have around 67 million people in the UK. That works out at roughly £2000 (~$2500) a year. I ended up spending 4 hours in A&E a few weeks ago trying to get some some antibiotics for a suspected infection because my GP just wouldn't call me back to prescribe them.

I would love to go private (and likely still will), but since I'm forced to pay into our NHS system, I feel like I have already paid for healthcare. I was quoted around £45 a month for private healthcare, which doesn't include the first stage GP visit, but some companies are adding on a handful of video call GP visits as part of the private plan. Bupa charge something like £80 for a 30 min GP visit.

Obviously I'm young and that cost will increase, but at this point I feel like the NHS is just enforced social healthcare thats no better than what can clearly be provided by the private sector. I've only started looking into this recently after my awful experience here in the UK and I'm sure I've missed a ton of factors.

My point is, if I'm forced to pay for healthcare from my tax then I expect healthcare for any issue I have in a reasonable time and to a reasonable quality. Opting out is not really a realistic option.

https://fullfact.org/health/spending-english-nhs/ https://www.ons.gov.uk/peoplepopulationandcommunity/populati...

The GP system is failing, but the Americans will tell you that a £2k bill for an A&E visit is quite cheap. Mind you, the American system has three sets of numbers which are mostly fictional and completely different: the hospital bill, the amount paid by the insurer, and the out-of-pocket "excess" that you actually have to pay.

Don't forget that in both countries public healthcare has to do a lot for the over-65s who don't have spare money for spiralling costs.

But the choices are not the American system vs NHS. The dutch do a good job of an insurance based system, Singapore is totally different still (though obviously not applicable as its a fairly small country.

A great counter example is Signapore where each individual has a mandatory savings account which can only be used for healthcare. However, catastrophic illnesses and insufficient funds are covered by the gov. Another element of the scheme is that the savings accounts can be used for family members. This incentives people to seek the cheapest care, and keep family members healthy. While the poor, retired etc are still taken care of.

The problem I have with the NHS is that I dont see what my care costs at any point. I dont think that leads to good decision making.

> I dont see what my care costs at any point. I dont think that leads to good decision making.

How much extra do you want them to spend on computing this? To what extent do you actually want cost factored into your care?

In the context of a Singaporean system what you spend matters, as it reduces your ability to gain benefits in the future. It will discourage people from getting scans and tests that are only of marginal benefit.

That's a horrifying, dystopian future I'd rather not be a part of.

Everybody should be entitled to health-care no matter what their life choices.

If you drive a motorcycle and get in an accident, you should expect the same level of healthcare as someone who drives a car and gets into an accident, despite the vastly different level of injury.

If the system you're living in allows you to buy and consume cigarettes, sugar, marijuana, and you need medical assistance for your diabetes, lung problems, cancer - I'd expect the same level of care as someone who'd abstained from these vices their whole life.

To limit medical care to people based on what they choose to do to their bodies is the exact same as limiting medical care to people based on what they can afford.

It's "Just pull yourself up by the bootstraps and work harder to afford your chemotherapy, you non-smoker!" vs. "Sorry you work 16-hour days to provide for your family so you have a stress outlet of stress-eating, smoking/vaping, etc. - but you made that choice, should have 'pulled yourself up by your bootstraps' and kicked the habit!"

On the other hand, why other people would have to pay for your poor life choices? Why another 16h/day worker who does lead healthy lifestyle have to subsidise his mate who goes by „live fast, die young“?

>Sure everyone is entitled to their vice, but should we provide healthcare to people that are consciously, actively destroying their own health? Should we treat lung cancer in smokers? Should we treat diseases in anti-vaccers?

I think you are right that some people do take it too far. But from what I've seen a lot of people who do end up chain smoking or overeating processed foods daily have other underlying health-conditions. For example with smoking a lot of ADHD sufferers who are undiagnosed might self medicate with nicotine as it is a stimulant. Some might also have working memory issues and struggle with self control.

Ultimately most individual choices have a societal aspect to them, a lot can be tackled by education, early diagnosis and choice architecture

Don't forget those joggers who damage their knees and hips with their dangerous practices: jogging waiver. And don't get me started on the rock-climbers ...

Nordic walkers! Tai chi grandma's!

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