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Comment by lionhearted | Hacker News Reader

> The U.S. pays 2x the (nationally) for health care for comparable (and usually a more poorly ranked) level of care.

The United States also has only 5% of the world's population (304M/6,700M), but produces a heck of a lot more than 5% of the world's medical innovation. Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down.

> The U.S. ranks relatively poorly -- near the bottom of the industrialized countries -- on almost every measure of performance.

With an incredibly unhealthy lifestyle, it's pretty incredible how long American longevity is. A fine on obesity would probably do more to increase American health than a fine on being uninsured, but that's unlikely to happen.

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> Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down.

There was an article in The Economist recently (unable to find the link - read a hard copy) which dispelled this myth. Research was done in some European countries (including the UK) which showed that introducing the NHS has not slowed down innovation. They also suggested some incentive plans to make sure innovation did not take a hit.

In either case, I think it's a long stretch to say that this bill, among other things, will lead to a reduced drug innovation. The money in the Drug business in the US and around the world will ensure that does not happen.

I pretty sure it's possible to find examplars in other industrialized countries with modern healthcare systems where their lifestyles are unhealthy.

I can't speak for the UK (but I believe I've seen a study that claims obesity rates in the UK are in fact higher than in the US), but Germans aren't exactly the pinnacle of healthy living, majority smoke, drink and eat outrageously bad (thought incredible delicious) food. Koreans likewise engage in lots of walking about, but the air quality in the major cities is very poor, they have remarkably sedentary lifestyles until college, and then as "salarymen", they probably compete drink for drink with the Russians and Korean food is full of high protein and high fat food sources -- ever sit down and eat 2 kg of Sam Gyeop Sal (Pork Belly) at a sitting? My friends in Japan report a similar lifestyle in Japan.

What's remarkable is that Americans, who generally like to stake claim at being the best in everything, tolerate a system that ranks them down with 2nd and 3rd world countries fighting for what, 40th place between Colombia and Brunei?

Over the next 20 years, one side effect of this sort of bill might be to slow that innovation down.

Is that definitely true? There are no exceptions etc... in the bill for newly discovered drugs?

Even if it is, there is the argument that the American people are paying the price for new drug invention that the rest of the world (eventually) gets the benefit of.

Note: I'm not making a pro-American argument here, just looking at what I think are some important consequences.

A fine on obesity would probably do more to increase American health than a fine on being uninsured, but that's unlikely to happen.

At some point I think they were considering a reward for preventive measures. If that includes eating healthy and regular exercise, it would be great!

I agree everyone should eat a healthy diet and exercise regularly, but that is impossible to verify.

How would the government (or a private insurer for that matter) attempt to verify whether I ate Kashi cereal for breakfast instead of an egg mcmuffin and coke at the nearest mcd's drive-thru? Random blood draws and expensive blood analysis?

How would the government attempt to verify whether I exercised getting my heart rate above 120 for 20 minutes at least 4 times a week? Mandatory wifi-enabled heart-rate monitors for everyone, to be worn 24/7?

In either case, there would be massive fraud, and efforts to combat fraud would lead to wholesale violation of personal privacy in contravention of established 4th amendment constitutional law.

Tax on unhealthy food would encourage healthy eating.

It's a good tax too because eating such food increases healthcare costs on the public.

See http://gregmankiw.blogspot.com/2006/10/pigou-club-manifesto....

This idea has been floated before. I think it's actually a good one, though defining "healthy" and "unhealthy" foods can be a bit nebulous.

One could start with a few well known food items and move from there I suppose.

I.e. milk goes from 4% fat --> 0% fat (skim).

For meat, there are well known measures of how lean the meat is.

For bread, the more grains it has makes it more healthy (I think).

You would only be able to tax the extremes though. For different people, different amount fat, etc... are correct depending on their body types, exercise habits, family history, etc...

For eating... your right, I can't think of a good system.

For exercise, some insurance companies give benefits for going to a gym some number of times a week/month/year. Its not perfect, but I would suspect it probably has few false positives.

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