4 ms·

> But if they choose to exercise their freedom in ways that limit my freedom (via resulting lockdowns, mandatory masking, banned social gatherings, preventing b

> But if they choose to exercise their freedom in ways that limit my freedom (via resulting lockdowns, mandatory masking, banned social gatherings, preventing businesses from operating normally, etc.), then that doesn't feel very fair. You can easily make that argument for plenty of things though. Didn't care for education and wanted to party instead? No welfare for you! Overweight? Sorry, you're limiting my freedom via increased healthcare costs. Broke your leg while skiing? Sorry, you knew the risk, now live with it, insurance is for real accidents only.

ethbr0 5y ago
All of those other examples have additional characteristics that cast the argument differently. Education and obesity both have income and access issues. In that, if you are poor, you don't have access to the same options as those who are wealthy. Skiing is actually the best example (Alaska aside!), given that it's a purely personal decision to engage in or not. So hypothetical... If hospital ICUs were filling with ski accident victims, to the extent they were unable to provide normal care to non-ski patients, and the economy was being impacted (businesses unable to operate, jobs lost, etc.) due to this ski pandemic, then you would say "Skiing is a personal choice that everyone deserves to make, and I have no problem with my tax and insurance dollars paying for skiers"?
- luckylion 5y ago
  > Education and obesity both have income and access issues. Some, but not primarily, so it still stands. I'm sure you can find similar reasons with vaccine-anxiety. People aren't choosing to be afraid of vaccines "just because", there's something going on that terrifies them. > then you would say "Skiing is a personal choice that everyone deserves to make, and I have no problem with my tax and insurance dollars paying for skiers"? Yes, because that's the principle the system is built on. I mean, I think lots of people somewhat consciously make lots of terrible decisions all the time, and the consequences of their decisions do cost giant sums of money that I have to pay lots of taxes for and that cannot be used for people who face truly accidental hardship (think extreme skiing vs walking and a suitcase dropping from a plane). But we've generally decided that that's totally fine, and I've accepted that and I pay taxes to make sure they don't have to face the consequences of their decisions. We cannot say "that's fine for everything, but not here" if we operate on a principle. It's either "you're on your own" or it's not, but it has to be consistent.
  - ethbr0 5y ago
    > We cannot say "that's fine for everything, but not here" if we operate on a principle We already say that, for smoking. And through mandatory school vaccinations (DTaP, varicella, polio, MMR, meningococcal). Which is a big part of my point. What we claim our system to be (Freedom! With guaranteed care! With equal rights to opt out!) and reality (We won't pay for certain dumb things you do. And we'll give you basic guaranteed care and probably not let you die) are two different things. Which is the main thing that's shredding our health care efficiency in terms of per capita GDP spending.
    - luckylion 5y ago
      > We already say that, for smoking. "We" don't, but maybe you do. I'm from Germany, the only time smoking/alcoholism/substance abuse comes up in a relevant way is when you need a transplant and there are multiple recipients and too few donors. And it's not a punishment for what you previously did, it's because of a prediction of what you're going to do, e.g. an alcoholic who has shown no sign of compliance will probably not get the liver if there's a non-alcoholic who also needs it and does what it takes to get/stay healthy. Deaf people whose condition could be cured/massively improved with implants are free to choose not to, and won't lose their disability status, it doesn't turn into a choice/hobby just because there's a choice in fixing it. I'm not sure that's what makes healthcare in the US so expensive. Again, we do it and we spend significantly less than the US. The country is much more densely populated though, university is free and physicians' income is much closer to the average than in the US.
      - ethbr0 5y ago
        We (US) do in that national law allows a surcharge for smokers. States may (and some do) override and decrease this, but it's allowed as the default. Notably, that and age are some of the few factors allowed to influence insurance pricing. Regarding transplant, my understanding is people are transplanted on (1) current health state (worse = higher priority) & (2) ability to comply with post-transplant protocols. So someone who burned their liver out with alcolism and is very sick, but makes a good case that they'll be able to stay sober post-transplant, gets an organ over a less-ill, sober victim of circumstance (e.g. dehydration/heat injury or something). One of the key features I've heard that allow other countries to drive down health care costs is a regulatory requirement that approved treatments (pharmaceutical, surgical, etc) demonstrate greater efficacy and/or lower cost. In the US, the FDA approves on efficacy only. End result being that in the US you can reformulate a medicine, try your best to sell it for $1,000 a pill, even when a cheaper alternative that produces the same results is available.

ethbr0 5y ago

All of those other examples have additional characteristics that cast the argument differently. Education and obesity both have income and access issues. In that, if you are poor, you don't have access to the same options as those who are wealthy. Skiing is actually the best example (Alaska aside!), given that it's a purely personal decision to engage in or not. So hypothetical... If hospital ICUs were filling with ski accident victims, to the extent they were unable to provide normal care to non-ski patients, and the economy was being impacted (businesses unable to operate, jobs lost, etc.) due to this ski pandemic, then you would say "Skiing is a personal choice that everyone deserves to make, and I have no problem with my tax and insurance dollars paying for skiers"?

luckylion 5y ago
> Education and obesity both have income and access issues. Some, but not primarily, so it still stands. I'm sure you can find similar reasons with vaccine-anxiety. People aren't choosing to be afraid of vaccines "just because", there's something going on that terrifies them. > then you would say "Skiing is a personal choice that everyone deserves to make, and I have no problem with my tax and insurance dollars paying for skiers"? Yes, because that's the principle the system is built on. I mean, I think lots of people somewhat consciously make lots of terrible decisions all the time, and the consequences of their decisions do cost giant sums of money that I have to pay lots of taxes for and that cannot be used for people who face truly accidental hardship (think extreme skiing vs walking and a suitcase dropping from a plane). But we've generally decided that that's totally fine, and I've accepted that and I pay taxes to make sure they don't have to face the consequences of their decisions. We cannot say "that's fine for everything, but not here" if we operate on a principle. It's either "you're on your own" or it's not, but it has to be consistent.
- ethbr0 5y ago
  > We cannot say "that's fine for everything, but not here" if we operate on a principle We already say that, for smoking. And through mandatory school vaccinations (DTaP, varicella, polio, MMR, meningococcal). Which is a big part of my point. What we claim our system to be (Freedom! With guaranteed care! With equal rights to opt out!) and reality (We won't pay for certain dumb things you do. And we'll give you basic guaranteed care and probably not let you die) are two different things. Which is the main thing that's shredding our health care efficiency in terms of per capita GDP spending.
  - luckylion 5y ago
    > We already say that, for smoking. "We" don't, but maybe you do. I'm from Germany, the only time smoking/alcoholism/substance abuse comes up in a relevant way is when you need a transplant and there are multiple recipients and too few donors. And it's not a punishment for what you previously did, it's because of a prediction of what you're going to do, e.g. an alcoholic who has shown no sign of compliance will probably not get the liver if there's a non-alcoholic who also needs it and does what it takes to get/stay healthy. Deaf people whose condition could be cured/massively improved with implants are free to choose not to, and won't lose their disability status, it doesn't turn into a choice/hobby just because there's a choice in fixing it. I'm not sure that's what makes healthcare in the US so expensive. Again, we do it and we spend significantly less than the US. The country is much more densely populated though, university is free and physicians' income is much closer to the average than in the US.
    - ethbr0 5y ago
      We (US) do in that national law allows a surcharge for smokers. States may (and some do) override and decrease this, but it's allowed as the default. Notably, that and age are some of the few factors allowed to influence insurance pricing. Regarding transplant, my understanding is people are transplanted on (1) current health state (worse = higher priority) & (2) ability to comply with post-transplant protocols. So someone who burned their liver out with alcolism and is very sick, but makes a good case that they'll be able to stay sober post-transplant, gets an organ over a less-ill, sober victim of circumstance (e.g. dehydration/heat injury or something). One of the key features I've heard that allow other countries to drive down health care costs is a regulatory requirement that approved treatments (pharmaceutical, surgical, etc) demonstrate greater efficacy and/or lower cost. In the US, the FDA approves on efficacy only. End result being that in the US you can reformulate a medicine, try your best to sell it for $1,000 a pill, even when a cheaper alternative that produces the same results is available.