6 ms·

I will generalize but by my experience most Americans I have met just can't fathom to pay (= taxed) for some common good. Why should I pay for someone's healthc

I will generalize but by my experience most Americans I have met just can't fathom to pay (= taxed) for some common good. Why should I pay for someone's healthcare when I live healthy and all I see that others are smoking? Why should I pay for someone's free train ticket when I only travel by car? This I saw across all genders, age groups, and political affiliation. Americans have this hyper individualist mindset that no other country does in the planet. It's good for some things like innovation (see the HN crowd) but not necessarily a benefit for the society.

msgodel 1y ago
Historically these "tax for the common good" policies have only been abused. Most of us are suspicious of/frustrated with them. If you want to improve the common good kill the income tax.
logicchains 1y ago
>Why should I pay for someone's healthcare when I live healthy and all I see that others are smoking? This is a common bad, not a common good. Fundamentally people follow incentives, and when you financially punish good behaviour and reward bad behaviour (make someone with healthy habits pay for someone else's unhealthy habits), you disincentivise the good behaviour and incentivise the bad behaviour. At a society-wide scale, that leads to more of the bad behaviour.
- IAmBroom 1y ago
  Trust me, we live this. And it's always someone else's unhealthy habits; I remember a chainsmoking manager expounding at lunch about the awful burden drug users put on the economy.
- TFYS 1y ago
  I think the incentive of not getting a life altering or threatening disease is much stronger than having to pay for the treatment yourself. If the cost has any effect on choices, it must be very small because it does not show in statistics.
  - lotsofpulp 1y ago
    Then explain the trend in overweight/obesity/diabetes/heart disease statistics? It has long been known that over consuming carbs and sat fats leads to long term health issues, easily measured by excess weight. And yet, the vast majority of people over consume.
    - TFYS 1y ago
      Sure, but making people pay for those treatments themselves does not change anything. For many the quick satisfaction of good food is simply a stronger incentive than a healthy body or a fatter wallet 10 years later.
    - bsder 1y ago
      1) Excess calorie consumption has only been true since about 1990. Up until that point, average heights were still increasing, so that meant that a significant chunk of the population were still undernourished. We are only about one generation from that mark, so people's social habits still haven't moved on from scarcity. 2) Nicotine, in particular, is quite good for appetite suppression. Unfortunately, the delivery system most people choose (smoking) causes more problems that the obesity it suppresses. 3) How easily people lose weight on GLP-1 agonists shows that obesity isn't just lack of willpower. The human body has a lot of systems encouraging you to hoard calories metabolically and very few systems telling you to stop. It is quite impressive that a single drug can somehow flip those metabolic systems completely in the other direction.
      - phil21 1y ago
        > 3) How easily people lose weight on GLP-1 agonists shows that obesity isn't just lack of willpower What? I’m about as pro-GLP1 as it gets - see past comments on the subject. But if anything it absolutely slams the door shut on obesity about being anything but overeating when the environment made it so damn easy to do so. The method of action is you are less hungry and eat less. Full stop. Secondary effects are a rounding error. Sure, there are societal reasons people are fat now. I don’t actually believe willpower is a real thing when surrounded by unhealthy addictive choices. But being able to turn off the hunger switch and turn to easy mode is absolutely the reason these drugs work and are life changing. I’m not ashamed to admit my being fat was due to lack of willpower to not eat excessively. Having a way to make it so I didn’t need to engage said willpower even half as much was the reason I’m now down to 12% body fat and am in shape from working out heavily. It’s not like you take the drug and you magically get thin - you still need to work at it and make healthy choices. They simply become easier to do. Pretending it’s otherwise for the vast majority of people is a disservice. The best most honest way I’ve come up with to describe these drugs is a performance enhancing drug for your diet. Changing society at a root cause level would of course be far better, but that’s not realistic on any human lifetime sort of scale. This is the best we have for people alive today.
rayiner 1y ago
Americans are literally socially selected for that mindset. Around the world, the vast majority of people don’t want to leave their home countries: https://news.gallup.com/poll/652748/desire-migrate-remains-record-high.aspx https://news.gallup.com/poll/652748/desire-migrate-remains-r.... Even in sub-saharan africa, only 37% would emigrate if they had the choice. In asia it’s single digits. So a large share of America’s population is literally made up of the most antisocial 10-20% of the population that would leave, along with their descendants.
- nine_k 1y ago
  But this does have some upsides, it appears.
  - ii41 1y ago
    Hard to say. Americas have been far less dense in population than the old world, and colonizers brought old world tech with which they immediately could start to make use of the land, so they face far less scarcity. For any group of people this is hugely beneficial to their development and helpful in solving their conflicts. Yet we still see some of world's the worst slavey and genocides there. Also today's Latin American isn't world famous for high living standards.
- simonask 1y ago
  I want to question the assumption here that "pioneer mindset" is an inherited trait, and generally whether we can say anything useful about people living today based on the choices of their ancestors several generations back. People emigrated from Europe to America because they were out of options. It was not a case of throwing away all of your possessions to go on an adventure. Rather, the vast majority emigrated because it was literally the only way to move up in a world where land ownership was the key to wealth, and your older brother already inherited the farm, or your family did not own any land in the first place. Or perhaps you couldn't even find an apprenticeship. Keep in mind that all of Europe existed in an extremely rigid social hierarchy with practically zero mobility. Most people in Europe lived in abject poverty. America offered some social mobility, at least to those who came there by choice.
dkiebd 1y ago
>Why should I pay for someone's healthcare when I live healthy and all I see that others are smoking? In the EU (I have no idea about America) tobacco is heavily (and I mean heavily in some countries) taxed because of this.
- pkaye 1y ago
  There are tobacco taxes in the US but it varies by state. Also it seems US is in the lower range on smoking rate compared to many other OECD countries. https://www.oecd.org/en/publications/society-at-a-glance-2024_918d8db3-en/full-report/tobacco-and-alcohol-consumption_b1061362.html https://www.oecd.org/en/publications/society-at-a-glance-202...
- AngryData 1y ago
  Also tobacco users cost less in healthcare because they far more often die right around retirement age, never incurring the far more expensive age related healthcare. Being a smoker also disqualifies them from many common procedures, and also the sin taxes smokers pay on tobacco often exceeds their entire lifetime medical costs. People who blame smokers for healthcare costs are just looking for someone to blame because they either don't want to admit, or don't realize, that their 90 year old granny taking 30 medications a day, having hip replacements, and 3rd round of cancer costs as much in healthcare per year as most people do over 2 or 3 decades.
- whimsicalism 1y ago
  we don’t smoke nearly as much as europeans
lotsofpulp 1y ago
One reason is that it's unsustainable with a top heavy population age histogram, and leads to lower and lower quality of life for younger people.
keybored 1y ago
We are too well-programmed to be individualistic, the crowd said in unison.
- keybored 1y ago
  And that was a typo: too well-programmed to not be individualistic or something. But I guess it works both ways?
sublimefire 1y ago
Taxes as various European states and US states are sometimes on par. Everyone pays for somebody’s health problems, Americans as well, through insurance, it is just health insurance is mandatory in Europe. The other stuff boils down to effective use of tax money, it is easier to do it in a smaller state compared to US or Canada or similar. Individualism has an effect but at this day and age it is about lobby groups politicising any topic they do not like. FYI nobody likes to pay taxes.
- vidarh 1y ago
  Americans pay first through taxes, and then again through insurance, so it's even worse. Medicare+Medicaid cost about as much per capita as the UK's NHS, in part because they have intentionally been barred from being as efficient as possible, with e.g. limitations on using their negotiating power. As for ease of doing it: At least several European systems does delivery via private actors, at least one has decentralised the insurance (Germany), several has segmented the public delivery in regional or local trusts or similar (UK, Norway). In other words: Universal coverage doesn't mean a single top down healthcare system, not is that necessarily desirable. E.g. the UK model uses trusts that prevents failure of leadership in one organisation from causing the whole to fail, and let's trusts get put under alternative management if they underperform. If anything, the EU is a demonstration of how it is possible to do in a heterogeneous way across a much larger population than the US.
  - whimsicalism 1y ago
    the NHS is not a shining model to emulate
    - vidarh 1y ago
      It's underfunded, but it remains one of the top healthcare systems despite that, and provides universal care. It's however relevant here to illustrate how insane the US healthcare situation is, in that Americans pay enough in taxes towards healthcare to provide universal healthcare if structured better, but chooses not to. As an example of how to provide cost effective universal care, the NHS is a shining beacon. If the UK spent comparable amounts per capita to comparably wealthy countries to upgrade it, it'd be 20-30% more expensive, and a lot better, and still vastly cheaper than US healthcare overall.
refurb 1y ago
Meh... that's not uniquely American. I lived in Asia and the country had a very capable public healthcare system with universal coverage. Generally a very socially harmonious society that heavily balances personal status with that of society. But cover the cost of drug for orphan diseases? "Why should my costs go up because of some child that costs half a million a year?" It was quite shocking.
wolvesechoes 1y ago
> Americans have this hyper individualist mindset that no other country does in the planet Come to Poland. This kind of egoism becomes more and more rampant.

msgodel 1y ago

Historically these "tax for the common good" policies have only been abused. Most of us are suspicious of/frustrated with them. If you want to improve the common good kill the income tax.

logicchains 1y ago

>Why should I pay for someone's healthcare when I live healthy and all I see that others are smoking? This is a common bad, not a common good. Fundamentally people follow incentives, and when you financially punish good behaviour and reward bad behaviour (make someone with healthy habits pay for someone else's unhealthy habits), you disincentivise the good behaviour and incentivise the bad behaviour. At a society-wide scale, that leads to more of the bad behaviour.

IAmBroom 1y ago
Trust me, we live this. And it's always someone else's unhealthy habits; I remember a chainsmoking manager expounding at lunch about the awful burden drug users put on the economy.
TFYS 1y ago
I think the incentive of not getting a life altering or threatening disease is much stronger than having to pay for the treatment yourself. If the cost has any effect on choices, it must be very small because it does not show in statistics.
- lotsofpulp 1y ago
  Then explain the trend in overweight/obesity/diabetes/heart disease statistics? It has long been known that over consuming carbs and sat fats leads to long term health issues, easily measured by excess weight. And yet, the vast majority of people over consume.
  - TFYS 1y ago
    Sure, but making people pay for those treatments themselves does not change anything. For many the quick satisfaction of good food is simply a stronger incentive than a healthy body or a fatter wallet 10 years later.
  - bsder 1y ago
    1) Excess calorie consumption has only been true since about 1990. Up until that point, average heights were still increasing, so that meant that a significant chunk of the population were still undernourished. We are only about one generation from that mark, so people's social habits still haven't moved on from scarcity. 2) Nicotine, in particular, is quite good for appetite suppression. Unfortunately, the delivery system most people choose (smoking) causes more problems that the obesity it suppresses. 3) How easily people lose weight on GLP-1 agonists shows that obesity isn't just lack of willpower. The human body has a lot of systems encouraging you to hoard calories metabolically and very few systems telling you to stop. It is quite impressive that a single drug can somehow flip those metabolic systems completely in the other direction.
    - phil21 1y ago
      > 3) How easily people lose weight on GLP-1 agonists shows that obesity isn't just lack of willpower What? I’m about as pro-GLP1 as it gets - see past comments on the subject. But if anything it absolutely slams the door shut on obesity about being anything but overeating when the environment made it so damn easy to do so. The method of action is you are less hungry and eat less. Full stop. Secondary effects are a rounding error. Sure, there are societal reasons people are fat now. I don’t actually believe willpower is a real thing when surrounded by unhealthy addictive choices. But being able to turn off the hunger switch and turn to easy mode is absolutely the reason these drugs work and are life changing. I’m not ashamed to admit my being fat was due to lack of willpower to not eat excessively. Having a way to make it so I didn’t need to engage said willpower even half as much was the reason I’m now down to 12% body fat and am in shape from working out heavily. It’s not like you take the drug and you magically get thin - you still need to work at it and make healthy choices. They simply become easier to do. Pretending it’s otherwise for the vast majority of people is a disservice. The best most honest way I’ve come up with to describe these drugs is a performance enhancing drug for your diet. Changing society at a root cause level would of course be far better, but that’s not realistic on any human lifetime sort of scale. This is the best we have for people alive today.

rayiner 1y ago

Americans are literally socially selected for that mindset. Around the world, the vast majority of people don’t want to leave their home countries: https://news.gallup.com/poll/652748/desire-migrate-remains-record-high.aspx https://news.gallup.com/poll/652748/desire-migrate-remains-r.... Even in sub-saharan africa, only 37% would emigrate if they had the choice. In asia it’s single digits. So a large share of America’s population is literally made up of the most antisocial 10-20% of the population that would leave, along with their descendants.

nine_k 1y ago
But this does have some upsides, it appears.
- ii41 1y ago
  Hard to say. Americas have been far less dense in population than the old world, and colonizers brought old world tech with which they immediately could start to make use of the land, so they face far less scarcity. For any group of people this is hugely beneficial to their development and helpful in solving their conflicts. Yet we still see some of world's the worst slavey and genocides there. Also today's Latin American isn't world famous for high living standards.
simonask 1y ago
I want to question the assumption here that "pioneer mindset" is an inherited trait, and generally whether we can say anything useful about people living today based on the choices of their ancestors several generations back. People emigrated from Europe to America because they were out of options. It was not a case of throwing away all of your possessions to go on an adventure. Rather, the vast majority emigrated because it was literally the only way to move up in a world where land ownership was the key to wealth, and your older brother already inherited the farm, or your family did not own any land in the first place. Or perhaps you couldn't even find an apprenticeship. Keep in mind that all of Europe existed in an extremely rigid social hierarchy with practically zero mobility. Most people in Europe lived in abject poverty. America offered some social mobility, at least to those who came there by choice.

dkiebd 1y ago

>Why should I pay for someone's healthcare when I live healthy and all I see that others are smoking? In the EU (I have no idea about America) tobacco is heavily (and I mean heavily in some countries) taxed because of this.

pkaye 1y ago
There are tobacco taxes in the US but it varies by state. Also it seems US is in the lower range on smoking rate compared to many other OECD countries. https://www.oecd.org/en/publications/society-at-a-glance-2024_918d8db3-en/full-report/tobacco-and-alcohol-consumption_b1061362.html https://www.oecd.org/en/publications/society-at-a-glance-202...
AngryData 1y ago
Also tobacco users cost less in healthcare because they far more often die right around retirement age, never incurring the far more expensive age related healthcare. Being a smoker also disqualifies them from many common procedures, and also the sin taxes smokers pay on tobacco often exceeds their entire lifetime medical costs. People who blame smokers for healthcare costs are just looking for someone to blame because they either don't want to admit, or don't realize, that their 90 year old granny taking 30 medications a day, having hip replacements, and 3rd round of cancer costs as much in healthcare per year as most people do over 2 or 3 decades.
whimsicalism 1y ago
we don’t smoke nearly as much as europeans

lotsofpulp 1y ago

One reason is that it's unsustainable with a top heavy population age histogram, and leads to lower and lower quality of life for younger people.

keybored 1y ago

We are too well-programmed to be individualistic, the crowd said in unison.

keybored 1y ago
And that was a typo: too well-programmed to not be individualistic or something. But I guess it works both ways?

sublimefire 1y ago

Taxes as various European states and US states are sometimes on par. Everyone pays for somebody’s health problems, Americans as well, through insurance, it is just health insurance is mandatory in Europe. The other stuff boils down to effective use of tax money, it is easier to do it in a smaller state compared to US or Canada or similar. Individualism has an effect but at this day and age it is about lobby groups politicising any topic they do not like. FYI nobody likes to pay taxes.

vidarh 1y ago
Americans pay first through taxes, and then again through insurance, so it's even worse. Medicare+Medicaid cost about as much per capita as the UK's NHS, in part because they have intentionally been barred from being as efficient as possible, with e.g. limitations on using their negotiating power. As for ease of doing it: At least several European systems does delivery via private actors, at least one has decentralised the insurance (Germany), several has segmented the public delivery in regional or local trusts or similar (UK, Norway). In other words: Universal coverage doesn't mean a single top down healthcare system, not is that necessarily desirable. E.g. the UK model uses trusts that prevents failure of leadership in one organisation from causing the whole to fail, and let's trusts get put under alternative management if they underperform. If anything, the EU is a demonstration of how it is possible to do in a heterogeneous way across a much larger population than the US.
- whimsicalism 1y ago
  the NHS is not a shining model to emulate
  - vidarh 1y ago
    It's underfunded, but it remains one of the top healthcare systems despite that, and provides universal care. It's however relevant here to illustrate how insane the US healthcare situation is, in that Americans pay enough in taxes towards healthcare to provide universal healthcare if structured better, but chooses not to. As an example of how to provide cost effective universal care, the NHS is a shining beacon. If the UK spent comparable amounts per capita to comparably wealthy countries to upgrade it, it'd be 20-30% more expensive, and a lot better, and still vastly cheaper than US healthcare overall.

refurb 1y ago

Meh... that's not uniquely American. I lived in Asia and the country had a very capable public healthcare system with universal coverage. Generally a very socially harmonious society that heavily balances personal status with that of society. But cover the cost of drug for orphan diseases? "Why should my costs go up because of some child that costs half a million a year?" It was quite shocking.

wolvesechoes 1y ago

> Americans have this hyper individualist mindset that no other country does in the planet Come to Poland. This kind of egoism becomes more and more rampant.