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Comment by bastawhiz | Hacker News Reader

That's an outrageous take. Should they be disqualified for screening and treatment for glaucoma, cataracts, or macular degeneration as they age? What about diabetic retinopathy? There's plenty of conditions that are obviously unrelated to such a procedure where the obvious cause is age. We don't deny breast cancer screening or treatment to women who have had silicone implants, or testicular cancer treatment to men who have had vasectomies. Or treatment for throat and lung conditions to smokers, or diabetes treatment to people who have eaten shit food their whole adult life. Or skin cancer treatment to people with tattoos

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If they are willing to pay for this kind of eye surgery out of pocket, then I suppose it is not too much asked that they pay a treatment for glaucoma, cataract or macular degeneration out of pocket.

Yes, to all of those things. It’s not even controversial.

I'm pretty sure the idea that older people should be denied treatment for conditions that are common at their age [1] because years or decades earlier they did something that has no relation whatsoever to that condition is in fact controversial.

[1] Nearly a quarter of people have cataracts before 70 and 10% of people have some form of age-related macular degeneration by 50.

Denying people welfare benefits for antisocial behavior is not controversial.

Say a 68 year old veteran went to a VA doctor for a facial skin cancer, and was denied treatment because when he enlisted 50 years earlier he got a tattoo of his unit on his buttocks.

Do you really believe that denial would not be controversial?

No, but only because he made up for it by being a veteran.

What if he was a retired farmer, the 50 year old tattoo was to commemorate the year he led his high school football team to the state championship, and it was Medicare denying coverage for a facial skin cancer because of that old buttocks tattoo?

Probably not controversial.

I don't see how you can come to that conclusion.

About 1/3 of Americans have a tattoo [1]. Of the people without tattoos 66% say seeing a tattoo on someone gives them neither a negative or positive opinion of the person.

A tattoo on the buttocks will not cause skin cancer on the face. (There is a small association between tattoos and skin cancer but that is skin cancers at the tattoo sight, and it is not so much that they cause the cancer but rather make it harder to notice the cancer so it tends to be farther along before detected).

So I don't see how it could not be controversial to cut of Medicare to someone over something that a solid majority don't care about and that almost certainly has nothing whatsoever to do with their skin cancer.

[1] https://www.pewresearch.org/short-reads/2023/08/15/32-of-ame...

He's saying he doesn't personally approve of tattoos. I don't think there's any further place you can productively take this conversation.

Medicare isn't "welfare", it's the standard American health system for people over the age of 65. Moreover, there's no good-faith way to call it "welfare". Please stop doing this here; you have other venues for this kind of rhetoric.

Medicare is obviously welfare! It’s a socialized system that involves society paying for medical care for old people, instead of leaving old people or their families to pay for it themselves.

Medicare is obviously welfare! It’s a socialized system where society pays for medical care for old people, instead of leaving old people or their families to pay for it themselves.

Of course whenever you have taxpayers paying for something for individuals, those taxpayers may properly decide to exclude undeserving individuals from receiving benefits.

Excluding undeserving individuals from government benefits is not controversial.

What would be controversial is classifying people as undeserving for past actions that

(1) were and are completely legal,

(2) are not even considered to be bad by a large fraction of the country, and

(3) have nothing whatsoever to do with what they are being excluded from.

Well over 90% of Americans aged over 65 are Medicare beneficiaries, most of them having paid into the program throughout their whole lives. I think this argument is probably better suited to your twitter TL.

> Moreover, there's no good-faith way to call [Medicare] "welfare".

For some context, Wikipedia says:

> In the United States, depending on the context, the term "welfare" ... can also include social insurance programs such as unemployment insurance, Social Security, and Medicare.

https://en.wikipedia.org/wiki/Welfare_spending#United_States

No. Not in the context Rayiner meant it, where there's policy discretion about who gets it, the way you might apply work requirements to SNAP.

I don't think "policy discretion to deny" is what the word "welfare" means.

But in any case, Medicare is literally denied to prisoners, which is an example of ... denying welfare benefits for antisocial behavior?

The entire thread is about the discretion to deny services.

So your point is that we don't hold people responsible for the consequences of their actions.

I don't think a contrarian opinion to that should be considered outrageous.

How are age-related conditions the consequences of their actions? And how is someone collecting disability because they can't work because they have a condition that could be (or could have been) treated better than someone being able to work and pay taxes? What you're defending benefits nobody, it's just punishing people for doing something you find distasteful.

The fact you call that opinion outrageous is outrageous itself. Here you have people getting cosmetic surgery which sets them up for risk and yet it’s shocking to you that someone has a different opinion than you? That they’d prefer the money they are forced to contribute NOT go to people who intentionally do risky surgeries? The fact you can’t even see the reasonable difference is insane to me.

It's outrageous because the government pays for medical care so that people don't suffer. It's an inherently compassionate reason. I can't imagine a justifiable position where you think someone should suffer because they can't afford care that the government would otherwise pay for, regardless of the reason for their ailment and regardless if it's a stupid reason. And doubly so if the reason you're denying them care is because they had an elective or cosmetic procedure that almost certainly didn't contribute to their risk factor for the condition they're suffering from. Triply so if it's something debilitating, like blindness.

Even from a common sense perspective, someone who is blind and on disability because they had a risky procedure is unquestionably worse for the country and society than someone who is able to return to work and pay taxes.

What you're advocating for is literally just pettiness. It doesn't benefit anyone. It's not saving the taxpayers money. It's not reasonable in any way.

>It's outrageous because the government pays for medical care so that people don't suffer. It's an inherently compassionate reason.

I don't see why universal or government provided healthcare has to be for "compassionate" reasons. It's perfectly consistent to interpret it as an insurance program, where you pay a premium to avoid catastrophic costs. Indeed in many countries that's how healthcare is structured (eg. [1]).

[1] https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

Is avoiding catastrophic costs not a compassionate reason? Why should someone not be eligible/worthy to avoid catastrophic costs? If someone is paying their premium (be it from a Medicare/Medicaid plan or from their tax dollars), why should they not be covered?

Should we also refuse to rescue people who went hiking in deep wilderness or boating in unsafe waters? Or negotiate the release of citizens taken prisoner by hostile foreign regimes or gotten seriously ill while vacationing against government advice? Since when is it good policy to refuse help to people who have made poor choices or taken risks?

>Is avoiding catastrophic costs not a compassionate reason?

Different people can have different reasons for supporting a program. The fact that you think government provided healthcare is "compassionate" doesn't mean that other people can't think that it's a purely transactional arrangement similar to home or car insurance. A grocery store providing food is arguably "compassionate", in the sense that it stops you from starving, but no one would claim "grocery stores are inherently compassionate".

>Why should someone not be eligible/worthy to avoid catastrophic costs? If someone is paying their premium (be it from a Medicare/Medicaid plan or from their tax dollars), why should they not be covered?

Most other forms of insurance often contain a clause saying that it doesn't cover intentional or negligent damage. If you're doing doughnuts in a parking lot and crash into a pole, that won't be covered by your car insurance.

>Should we also refuse to rescue people who went hiking in deep wilderness or boating in unsafe waters?

AFAIK in some circumstances people get billed for those rescues, so it's not as good as an example as you think it is.

> Or negotiate the release of citizens taken prisoner by hostile foreign regimes or gotten seriously ill while vacationing against government advice? Since when is it good policy to refuse help to people who have made poor choices or taken risks?

At some point.. yes? These sorts of scenarios exist on a spectrum. The state department is probably not going to send in Seal Team Six to extract some kid who traveled to Syria to join ISIS but got cold feet. On the other end of the spectrum are stuff like "preventable" car accidents: most car accidents are arguably preventable (eg. rear ending a car because you were following too close), however such accidents are nonetheless covered by car insurance. Drawing the line at "elective cosmetic surgery" isn't "outrageous".

Everyone takes risks. It's as outrageous as saying that if an elderly person gets in a car accident they should have Medicare coverage dropped. It's impossible to live a risk-free life and that stance comes from a punishment mindset.

The suggestion was that if they get cosmetic eye surgery that should be cut off from screening and treatment for all future eye conditions, not just eye conditions that might have been caused or exacerbated by that cosmetic surgery.

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