The Next Step

Jason Kuznicki

Jason Kuznicki is a research fellow at the Cato Institute and contributor of Cato Unbound. He's on twitter as JasonKuznicki. His interests include political theory and history.

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114 Responses

  1. Mike Schilling says:

    Likewise, I want you to obey speed limits, avoid unsafe lane changes, maintain adequate following distance, etc, while I drive as if I were Jeff Gordon. Traffic laws are unworkable.Report

    • Jaybird in reply to Mike Schilling says:

      “Everyone who drives slower than me is a jerk, everyone who drives faster than me is a maniac”?Report

    • Barry in reply to Mike Schilling says:

      And laws against violence – I want to shoot anybody I’m mad at, but I don’t want others to do the same to me.

      And I loooooooooooooooove going into other countries and shooting people, then running back into US territory and laughing, because the other country would have to invade and get me.Report

      • Jason Kuznicki in reply to Barry says:

        I’m talking about what having a collective health care system changes at the margin. There are of course other factors, but let’s set those aside for the moment and ask what this specific change does in isolation. This is hardly an illegitimate move.

        As to proposed counterexamples. Traffic laws aren’t the same at all. If I want to drive like Jeff Gordon, the last thing I want is for everyone else to obey the speed limits. I’d want them to speed as well. (Would Jeff Gordon want someone rounding a NASCAR track at 35mph? Certainly not.)

        As to extraterritorial crime, that’s why we have extradition treaties, which neatly turn “there” into “here” for all practical purposes. Until you can turn “you” into “me” as regards healthcare, the parallel doesn’t remotely hold.

        We may argue that this particular set of incentives not terribly relevant in practice — this is a reasonable criticism — but it does seem to me that one effect of further collectivizing healthcare is to further encourage both paternalism and cheating. (Note that if keeping healthy were valuable enough in itself, we would have no need for any paternalistic health legislation in the first place. But take away one consequence of being unhealthy, and on the margin, some greater number of people will opt to be unhealthy, and laws will be needed to stop them.)Report

        • Mike Schilling in reply to Jason Kuznicki says:

          If I want to drive like Jeff Gordon, the last thing I want is for everyone else to obey the speed limits. I’d want them to speed as well.

          Not really. If I’m going to drive like a maniac, I want the rest of you to drive perfectly predictably.Report

  2. North says:

    It certainly makes sense on the chalkboard but does it stand in practice?

    My own memories of Canadiastan are that the governments there; Federal, Provincial and Local; are no more interested in the dietary or consumptive habits than the US is. My meager googling suggests to me that northern Europe is less regulatory on foodstuffs than the US is. Southern Europe, France and Italy especially, have a lot of food related rules but they seem more focused on agricultural protectionism and on preserving regionally proprietary food types(brands?) than they are on actually dictating to their citizens what they should eat or drink. Both Canada and Europe in general have massively more relaxed drinking laws than the United States and a lot of Europe has the US beat on recreational drugs as well.

    So while the theory sounds good I don’t see much real life evidence of this tendency. I suspect that there are countervailing forces. Ceteris paribus if I have to pay for your health care then I’m going to try and dictate your behavior to you. It seems to me, however, that Ceteris ain’t paribus. Perhaps the impracticality of prohibiting salts or fats is at fault, or the enormous unpopularity that such programs would have is doing it or maybe it’s entirely culturally based. Whatever the reason the behavior of health care providing countries don’t appear to be supporting the theory that health care and intrusive dietary or consumptive laws go hand in hand.

    Also exhibit C: Marmite.Report

    • Mark Thompson in reply to North says:

      In my defense, a large part of my point was to ask the question of how Americans can put the kibosh on this cycle. Other countries seemingly have done precisely that, to be sure. But in the US, it seems that increased costs to government programs serve as a significant justification for nanny-statism. This is, after all, precisely how New York’s anti-sugar proposal is being justified, and it’s also how the proposed higher alcohol taxes are being justified by the likes of Yglesias. We also tend to place a lot of strings on welfare in this country. For that matter, you can probably even throw the Stupak business in here, albeit on substantially different grounds.

      So my post wasn’t an argument against the welfare state or even against social insurance more generally – to the contrary, in fact. Instead, the point was to ask how this country can avoid the pitfalls of using the welfare state as justification for the nanny state.

      Another way of looking at the question, I suppose, is to ask what it is about the US that makes us so willing to engage in this sort of nanny-statism (and for what it’s worth, you can probably include the UK in here as well).Report

      • North in reply to Mark Thompson says:

        Mark, I would never intend for you to feel a need to defend yourself personally on this kind of subject, if my tone was aggressive then I apologize.

        Yes, the US does seem to have a hot/cold tendency on policy doesn’t it? And I’ll join in on throwing an elbow at the idiotic nanny state policies of the UK. I stand in consistent astonishment at how imbecilic it can get there. New York is their own special group of nut bars of course, ever heard about their rent control nonsense?

        I would think (hope) that fiscal concerns might be the inhibiting factor. Does a dollar of government discouragement of unhealthy behavior really yield a dollar or more of government savings in improved health outcomes? I seriously doubt it. Especially when the science of obesity, nutrition etc is still in a considerable flux. Obviously grossly obese people are complete bombs when it comes to health problems but a lot of the research is suggesting that mildly overweight people are actually healthier than underweight or at weight individuals. We just don’t have a full detailed primer down on how the human body works yet.

        Also, if anyone in the US started saying that we needed to take government action to combat obesity I’d throw the national agricultural subsidies book at them. You want healthier foods rolling around? Cut king corn down to size.Report

    • Jaybird in reply to North says:

      I had a “holy cow, is that seriously how they see us?” moment a few months back.

      Maribou and I watch “Rumpole of the Bailey” episodes from the box sets on the occasional date night. Sit down with a glass of claret, put it on, and be whisked away to the world of Stuff White People Like.

      It was Season 1, Episode 3. Rumpole and the Honorable Member.

      There was an MP who was arrested for rape and Rumpole’s son and (American) fiancee went to the trial where they witnessed Rumpole’s cross-examination of the alleged victim (it was a pretty brutal cross-examination, she broke down on the stand). Rumpole’s son’s (American) fiancee went on to chew Rumpole out and make sure that they moved back to America and did *NOT* stay in England.

      At the end of the episode, Rumpole goes on a rant about Americans.

      It is like no anti-American rant I have *EVER* heard before. (Seriously, find the box set and watch it for this rant alone.)

      It’s about Americans and their belief in perfectibility.

      I was blown away. Every anti-American rant I had heard up to that point focused on how rednecky everybody is, how backwards everybody is, how fat everybody is, how the-opposite-of-cosmopolitan everybody is…

      And here is an original document from around 1978 explaining how Americans suck because they are constantly whipping everyone because things aren’t yet perfect.

      I don’t know how representative of Europe this one interpretation of America actually is… but, if it is representative at all, maybe the explanation for the difference between the US and Europe is found, somewhat, in that.

      What works for Europe would not, ever, work here… why? Because the bloody Americans believe in perfectibility.Report

      • Mark Thompson in reply to Jaybird says:

        You have read “The Quiet American,” right?

        Same logic, albeit in a different context. And also completely right.

        Someone can correct me if I’m wrong, but I’m not aware of many politicians in post-WWII Western Europe who have achieved the sort of cult-like status that even a mediocre American President can achieve simply by virtue of winning an election.Report

        • North in reply to Mark Thompson says:

          Well very few politicians in Europe are technically the head of their state. Functionally of course yes they are but the official head of state is typically either a seperate President or a Monarch (a division of power that I heartily approve of).

          All that said, absolutely you’re right. I suppose you have De Gaulle… no he may be technically post WWII but everything about his fame stemmed from the war. Thatcher, who is oddly enough revered here but was never loved in her home country or Europe. No I can’t think of any.Report

        • Jaybird in reply to Mark Thompson says:

          I haven’t… my first experience with the book was knowing that the 2002 movie was based on it and I figured it was a reflexive anti-American movie as part of the initial backlash to the backlash to 9/11.

          I’ll check it out.Report

        • Mike Schilling in reply to Mark Thompson says:

          A wonderful book, by far my favorite of Greene’s “serious” ones. There are many politicians (pundits, thinkers, etc.) of whom it could be said “I never knew a man who had better motives for all the trouble he caused. ”

          But this business about “perfectibility” is nothing new. It was the standard criticism of liberalism by old-line conservatives like WFB and the National Review crowd. By some sleight of hand never fully explained, the desire to improve things via, say, the Voting Rights Act was proclaimed to reveal a belief that society could be made perfect.

          Though the argument that only fools want to remake a society that works quite well enough was, oddly enough, retired during the Reagan Revolution’s attempt to build a shining city on a hill.Report

          • Jaybird in reply to Mike Schilling says:

            For the record, I’ve never considered Buckley’s speeches to fall under the whole, for lack of a better term, “frigging Americans” rants.

            Rumpole’s rant was, I assure you, a “frigging Americans” rant.Report

            • Mike Schilling in reply to Jaybird says:

              No, they were usually “friggin liberal” rants. But if you recall that most Americans subscribed to many of the beliefs that WFB was ranting against [1], the two aren’t that far apart.

              1. Pre-Civil Rights Act, even most conservative white Southerners had no problem with the New Deal. [2]

              2. Which makes sense, as they were among its chief beneficiaries.Report

            • Jaybird in reply to Jaybird says:

              If you were to ask me to recreate an anti-American rant as written by a Brit in 1978, the *LAST* thing that would occur to me would be to take one of Buckley’s, switch out “liberals” for “Americans”, and put it up.

              I guess I always assumed that Europeans were much more… I dunno.


      • Simon K in reply to Jaybird says:

        This is certainly one strain of British anti-Americanism. Most people wouldn’t put it in those terms – rather they’d talk about American earnestness and naivety. But belief in perfectibility, and in particular self-improvability, is what this really means. There’s a close relationship between believing in the possibility of self-improvement and a belief in self-reliance, which of course relates to red-neckness, and lack of cosmopolitanism.Report

  3. Francis says:

    I hereby plead for the proper use of the word “externality”. Activities that increase the cost of implementing a government program are NOT, by definition, externalities. If anything, they are internalities.

    CO2 — externality. So2 — not externality. Reckless conduct — given that most people get their insurance through group policies, wasn’t an externality. But insurers sure tried to make it one through the use of recission.Report

  4. Freddie says:

    Doesn’t this rather seriously underestimate the non-financial impetus to stay healthy? What I mean is, even if your health care is paid by other people, there’s still a huge amount of reasons why you’d want to stay healthy. (The capacity to get laid being one.)Report

    • North in reply to Freddie says:

      I’d say it does Freddie, and wanting to get ones groove on perhaps a reason why the phenomenon doesn’t seem to have leaped from a thought experiment into the general practice in any of the long standing health care providing nations of the west.Report

    • Scott in reply to Freddie says:

      “Doesn’t this rather seriously underestimate the non-financial impetus to stay healthy?”

      Are you really serious? Have you seen some of the obese people out there? They clearly don’t care, which is why they need to suffer the consequences of their behavior instead of mooching off others to take care of them.Report

      • North in reply to Scott says:

        But… they’re already suffering the consequences of their behavior. They can’t climb a couple of stairs without wheezing and puffing like a 1880 steam engine. They suffer considerable physical discomfort from back pain to hemorrhoids. Their clothes are crappy and it’s hard to find anything they can fit into. Their peers try to but sometimes fail to conceal their contempt of their appearance and strangers often don’t bother. There’s a massive quantity of non-governmental disincentive out there against becoming obese.Report

        • Scott in reply to North says:

          Yes, there are disincentives, but clearly there are not enough disincentives for many to change their behavior.Report

          • North in reply to Scott says:

            Many people will do what they wish to do whatever we do. Meth users will literally rot holes in their heads in persuit of their drug of choice and this is in the teeth of the worst kind of penalties we can levy.
            As for the “obesity epidemic” I’m unmoved by much of the panic over it.Report

          • Freddie in reply to Scott says:

            But don’t you think this is an example of a tendency towards a shifting belief in the utility of self-interest among libertarians? I mean if we can’t believe in the power of self-interest in someone’s physical health, jeez….Report

            • Mark Thompson in reply to Freddie says:

              Self-interest can vary substantially from person to person. Quality of life matters quite a bit, and what you or I may view as not a very high quality of life may be perfectly fine for someone else. Certainly, the way I behaved in college probably knocked a year or two off my life. Yet I haven’t the least regret about it.

              Moreover, while it is obviously not possible in the long run for any individual to perfectly gauge his self-interest, he is far more likely to correctly choose the criteria that make up his self-interest than some bureaucrat who has never seen him.Report

              • Freddie in reply to Mark Thompson says:

                I just think that this is all far more deterministic than how people actually live their lives. I don’t think people say, “eating these sticky buns are in my self interest” or “I’m gonna have two more beers because my health care is paid for by the government.” I don’t think human beings operate that way, particularly in regard to the physical urges that lead to eating, drinking, smoking, or other behaviors that impact public health.Report

              • Mark Thompson in reply to Freddie says:

                They may not say “eating these sticky buns are in my self interest,” but surely they think “eating these sticky buns will give me a few seconds of pleasure.” I say that the government should not begrudge the man his few seconds of pleasure if it’s not harming anyone else.

                Now, Jason’s making a different argument than I was, since my argument was for a welfare state with fewer strings attached, with greater liberty for beneficiaries, and with the state making no moral judgments. That said, it strikes me as generally correct that the equation for some people at the margins will shift once they are no longer directly responsible for their health care costs. Again – I see nothing wrong with this, although it is part of why I think voucherized health care is ultimately the way to go. But certainly the long-term economic effects of unhealthy behavior are at least a variable in the equation as to how often someone is going to engage in long-term unhealthy behavior. Lessen those effects, and you will at least marginally increase the person’s willingness to engage in unhealthy behavior.Report

              • Jason Kuznicki in reply to Freddie says:

                Perhaps on the level of the individual you are correct. I’ve seen a study, however, hypothesizing that legalized abortion would cause the syphilis rate to rise, because taking away one negative consequence of sex (unwanted pregnancy) would result in more sex on the margin. And sure enough, the correlation held, state by state, as the various states legalized abortion, and as the federal government did so for the nation. Although I consider myself sort of a squishy pro-choice, it’s a significant finding.

                I will also say — and I admit I might be weird here — that having a high-deductible plan with a health savings account has caused me to think more carefully about my own health, and to make some choices I might not otherwise have made.

                One of them (think hard about this) would probably cause my comment to get caught in the spam filter, so I’m not mentioning it.

                Oh, and it’s for asthma, so get your minds out of the gutter.Report

              • Sam M in reply to Freddie says:

                I don’t think it’s ever as direct as, “government pays for X, so I will have two more Y.” But reducing the price of things is going to increase consumption, at least on the margins.

                I complain to my libertarian friends about their reasoning in theis regard all the time, especially the ones who say legalizing drugs will not lead to more usage. “Look,” they argue. “I have easy access to heroin right now. I can go out on the street and get it, and it doesn’t cost all that much. If it were legal, would I somehow change my mind and become a junky? No. I wouldn’t. So you see, legalization does not lead to more consumption.”

                I think this is wrong.Report

              • Jason Kuznicki in reply to Sam M says:

                Some of us would not consume heroin even if they put it in the water supply. I dare say we’re the large majority, and that the marginal effects of legalization would be tiny. If it’s fair of everyone else to say that the marginal effect I single out in the original post is tiny, then this is surely a permissible answer on my part too.

                But you’re absolutely right — drug consumption would certainly go up by some amount. I would almost certainly use some cannabis if it were legal, but I don’t use any right now and have not done so for years, because I do not consider it worth the risk overall.

                The more sophisticated libertarian argument is that drug consumption would (a) be vastly safer if drugs were legalized, (b) have less associated violence and (c) still follow the same general pattern of lifetime use — the overwhelming majority of people who try a given substance once or twice don’t go on to become addicts, despite popular myths to the contrary. Throw all that in with the tiny marginal increase claim, and the legalizers still have the stronger argument.Report

              • The marginal increase may or may not be tiny if you can get pot at the local convenience store. I smoke and I drink. By sheer coincidence, these are the two drugs that are completely legal and widely available. These are also the drugs most ingrained into our culture. If pot were as widely available and risk-free as cigarettes, there’s a decent chance I would (still) smoke pot. I’ve tried quitting smoking cigarettes various times without much success. Quitting pot was something that I never even set out to do. There are a number of reasons as to why this was different, but I have to think “available on every street corner” and “people doing it all the time around me” are both non-negligible factors.

                I support the decriminalization of pot anyway, but that’s due in part because I’m not hugely worried about an uptick in consumption. I also believe that if we legalize it, we can make procurement harder and less convenient than cigarettes to the point that we can avoid some of the pitfalls. In other words, I would still want to make it more difficult to obtain. I wish we could do that with cigarettes.Report

              • Jaybird in reply to Jason Kuznicki says:

                The argument about reduction of usage has always struck me as willfully ignorant of history.

                After prohibition ended, did alcohol consumption increase? Heck, yeah!!!

                That was, among other things, the freakin’ point.

                What there were reductions in were reductions in smuggling-related crime, gang-related crime, crime related to the revenues that illegal hooch gave, so on and so forth… and the reductions in these things more than made up for the marginal increases in alcohol consumption.Report

              • Mike Schilling in reply to Jason Kuznicki says:

                I would guess there was also a reduction in the unintentional consumption of wood alcohol. Also a good thing.Report

              • I’m aware of prohibition history, Jay. In some cases, black market crime (and loss of liberty through enforcement) are most definitely not worth the reduction that ensues. Prohibition demonstrated that pretty convincingly. It’s the reason that I wouldn’t outright ban tobacco, either (and why the costs of criminalized pot far exceed the benefits). But it doesn’t take an absolute ignorance of history to be wary of putting all drugs on the legal, consumer market.

                Once they’re there and they become ingrained into our culture, they become more beyond our control than they already are. That’s not even to say that I am opposed to mass decriminalization. What we’re doing isn’t working. But I am quite cautious about it and would prefer a different alternative than having cocaine as widely available as tobacco.

                I’d like to see some (cautious) experimentation.

                But for now, I just want to take issue with the notion that criminalization does not reduce use. Even the nascent former libertarian in me considers that a bum argument.Report

              • Jaybird in reply to Jason Kuznicki says:

                For what it’s worth, I agree absolutely that criminalization *DOES* reduce use.

                Of course it does. It takes young men and throws them into prison. There’s a lot less weed in prison, I imagine, than there is outside of it. Moreover, it’s a lot harder to get. There’s a joke I tell about when I knew I was officially middle-aged. I thought about where I might want to buy some if, in theory, I wanted some. As it sunk in that I no longer had “connections”, I knew I was middle aged.

                Even if I wanted some, which I did not, I would not have been able to buy some because I didn’t know anybody and would not have wanted to risk going down to Acacia Park and getting busted by talking to an undercover cop. Any head shops nearby have *HUGE* signs talking about how all this stuff is for TOBACCO USE ONLY, any reference to illegal activity will result in being asked to leave the store.

                I had no connections. I was, officially, old.

                Not that it mattered, of course… but I remember being sort of shocked at the realization.

                If they made it legal tomorrow, would I light up? Nah… but then I ask is my experience unique? Are there people who are similarly square/middle-aged at the margins who, if they made it legal tomorrow, *WOULD* light up?

                No doubt.

                I have no doubt whatsoever that criminalization reduces use… and I honestly question whether people who argue that it does are not being willfully ignorant.Report

              • I have no doubt whatsoever that criminalization reduces use… and I honestly question whether people who argue that it does are not being willfully ignorant.

                You keep confusing me, Jay. You seem to agree that criminalization does cause a reduction, but then you suggest that people who argue that it causes reductions are being ignorant. That’s the vibe I got from the previous comment, too. “I agree with you on this point, but you’re being willfully ignorant.”Report

              • Jaybird in reply to Jason Kuznicki says:

                Not what I am saying, the original post was that decriminalization would increase use (the one at 11:13 am) much in the same way that alcohol use increased after the end of prohibition.

                The second one (the one at 11:53 am) argued that criminalization reduces use and gave a theoretical example how it does.

                People who argue that we will have less use after it becomes legal are being, at best, stupid. More likely, they’re lying to themselves. At worst, they’re lying to you. When you say “I just want to take issue with the notion that criminalization does not reduce use”, know that I had your back.

                I believe that criminalization does reduce use.

                I do not believe that the benefits delivered by this reduction even come within eyeshot of the costs. It’s not even a road-trip to get from here to there.Report

              • Mike Farmer in reply to Sam M says:

                The only clear argument is whether the State should have the power to outlaw drug use.Report

    • Sam M in reply to Freddie says:

      It does appear that significant numbers of people do not react to the current incentive structure. It also appears that significant numbers of nanny-state types agree with the post. That’s (one reason) why people are constantly seeking higher taxes on booze, tobacco, soda pop and all the rest.

      So even if this post is wrong, and its assumptions really do underestimate the existing incentives to stay healthy, that would seem to have little impact on proposals floated by nanny-statists, as THEY seem quite convinced that making people pay more for unhealthy decisions will result in better decisions.Report

      • Francis in reply to Sam M says:

        The link between smoking/drinking and disproportionate societal costs is pretty strong. Everything else gets harder to price. So the public policy basis for sin taxes on alcohol and cigarettes is much stronger than putting a surtax on fries. Not every tax necessarily stands on a slippery slopeReport

      • Trumwill in reply to Sam M says:

        There’s a difference between the effect of long-term and short-term costs. For instance, telling people “If you do this now, somewhere down the line it’s going to cost you. Probably.” is far less effective than saying “You know what, we’re just going to take that money now.”

        Take cars for example. The ebb and flow of higher gasoline prices have less of an impact on consumer choices when it comes to purchasing a car than a lot of people expected. So if you say “Over the next 10 years, you’re going to pay an extra $10,000 in gasoline if you buy this car instead of that one”, that’s not nearly as effective as slapping a $5,000 surcharge on the gas-guzzling vehicle at the outself.Report

  5. Trumwill says:


    Do you suspect that people that are insured act more recklessly than those that are not? I doubt it, not the least of which because of external correlations (those that buy insurance have a job and are more likely to be responsible regardless). However, if it were the case that insulation from the financial consequences of one’s actions always enabled irresponsible behavior that everyone secretly wants to do, it is something that you would expect to see. As Freddie points out, there are all manner of other reasons for people to be healthy having nothing to do with cost. I would go a step further and say that saving money would not be a sufficient incentive to get healthy. It typically works the other way around: diet books, gym memberships, etc.Report

  6. Freddie says:

    There is an empirical question to be asked as to whether people on Medicare, or people in countries with single payer, have less healthy lifestyle choices than the alternative.Report

    • Jaybird in reply to Freddie says:

      How about people in countries with government dietary guidelines?

      There’s an interesting article here:

      Does Canada/Europe have similar guidelines?Report

    • Sam M in reply to Freddie says:

      But it’s a hard question to ask effectively. Swedes are not the same as, say, people from West Virginia. Will they react the same way to the same incentives? For instance, we could also structure the question differently and just compare people in the US who have health insurance versus people who don’t have health insurance. But is that valid? These are two vastly different cohorts of people. (Almost all people who work in good jobs have health insurance, for instance.) I suspect this comparison would yield the answer that people who don’t have health insurance have unhealthy lifestyles.

      I am sure there is a way to get at this data. Perhaps people have tried. But to simply compare people from the US to people from, say, Iceland, doesn’t seem all that useful in terms of isolating lifestyle choices and what leads to them.Report

    • Jason Kuznicki in reply to Freddie says:

      Trumwill and Freddie, you’re both making serious mistakes in your sampling methods.

      Trumwill — You say that people who buy insurance are likely to be more cautious than people who don’t buy insurance, but this doesn’t answer the question — which really is not whether the insured or the uninsured are more cautious, but whether those who would buy insurance become less cautious after they’ve done so. It seems to me that the act of buying insurance could have little other effect, and the insurance companies agree. That’s why deductibles were invented.

      Freddie — The elderly are more cautious than the young, so Medicare isn’t terribly interesting as a sample either. Single-payer systems might be more interesting, of course.Report

      • Freddie in reply to Jason Kuznicki says:

        But it’s the best we have for an American sample with regards to government health coverage and risk behaviors, wouldn’t you say?Report

      • Jason,

        I acknowledged (or at least I thought I did) that external correlation (self-selection) can explain away why insured people are more cautious than uninsured. However, if insulation from financial repercussions were particularly motivating, I still doubt that you would see that difference. YMMV.

        Regarding deductibles, check my comment earlier to Sam about long-term and short-term costs. When we talk about lifestyle choices and the government insulation of consequences from them, we’re thinking particularly long term and we’re thinking in terms of varying likelihood.

        Charging someone $100 to visit the doctor is a good way to convince somebody not to go see the doctor. Telling someone that they may have the pay tens of thousands at some future date if they get lung cancer because of their continued smoking? Less convincing. At that point, they would be more concerned with the fact that they’re dying than that they’re broke. They’ve already decided to take that chance.

        You’re more likely to convince future people not to take that chance by telling them that smoking is going to cost them a thousand or two a year than you are by eventual medical bills they may or may not eventually have to pay.Report

        • Jason Kuznicki in reply to Trumwill says:

          Your comments explain why deductibles for routine medical care should optimally be low, but they do not explain the existence of deductibles in the first place. Deductibles exist to deter risk.Report

          • No, deductibles deter routine medical care and small claims.Report

            • Trumwill in reply to Trumwill says:

              That was an unintentionally curt comment. To elaborate, I really don’t think that, say, the $500 deductible I have on my auto insurance is meant to disincentivize getting into an accident. If it is, it’s a pretty ineffective one. I’m far more concerned with getting injured or injuring someone else than I am with a $500 deductible.

              Secondarily, I am concerned about my insurance rates going up, which I’ll grant is a way that private insurance does encourage good behavior in a way that a national auto insurance plan that doesn’t look at lifestyle choices wouldn’t. However, my point is not that charging smokers higher insurance rates would discourage smoking. I believe it would because it falls under “short term”. But rather that having to potentially pay large sums of money somewhere down the line wouldn’t deter people from smoking.Report

            • Jason Kuznicki in reply to Trumwill says:

              This is certainly one of their effects. But your explanation of why deductibles exist says nothing about the existence of deductibles even against large claims, where, by your reasoning, they would appear superfluous. Deductibles exist as a means of risk sharing, which reduces moral hazard.Report

              • I believe it is the primary effect. Deductibles against higher claims, say $500 on a $2000 surgery, have the effect of saving the insurance company $500 and making the person think twice about having that $2000 surgery if they don’t have $500 laying around. I believe it’s much more about spending reduction than it is about risk reduction.Report

  7. Mike Schilling says:

    Your comments explain why deductibles for routine medical care should optimally be low, but they do not explain the existence of deductibles in the first place. Deductibles exist to deter risk.

    And to lower overall costs, since there will always be more small claims than large ones, and the smaller the claim, the higher the ratio of processing cost to benefit.Report

    • I had a vacuum cleaner disappear from our old house before our recent move. While talking to my insurance rep (auto and renters) I asked if that was covered. She said “Sure, but it’ll all come out of the deductible.” As such, I filed no claim.Report

  8. Josh says:

    The leap from “I have to pay for my own health care, so I don’t smoke or eat bacon” to “Now you pay for my health care, so light ’em up!” seems pretty enormous. I think the biggest difference in my behavior, now that I’m less worried about getting kicked off my privately purchased health plan, will be that I start going to the doctor. Otherwise, I imagine people’s health habits are just that—habits. Certainly there are people out there who pay for their own coverage and still eat to the point of obesity, smoke cigarettes, drink too much.

    I also think there’s a couple orders of magnitude of difference between sugar taxes and trans-fat laws and outright banning bacon or bringing back a form of Prohibition. And I guess when it comes to massive institutions scrutinizing my sex life and other private aspects of my life, I find it hard to believe I’m worse off with the government than with an insurance company. It’s not really like the success rate of getting justice from the corporate sector is so high.

    In regard to people’s health habits, it seems like where we might see serious change would be in government-funded programs like school lunches, which, you know, if you have an objection to forcing kids to eat more vegetables and fruits, it had better be very good for me to take it seriously. Also, though this is admittedly a long shot, maybe we’ll see a rise in the availability and promotion of healthy foods, as citizens in the private sector see an advantage in promoting healthy living.

    Anyway, yes, health care reforms mean that a lot of us will be paying more attention to how other people eat and live. Given that we seem to be a far cry from banning bacon at this point, I’m not convinced that this is a bad thing.Report

    • Jason Kuznicki in reply to Josh says:

      If I have to pay for your health care, then I will want to ban you from eating bacon, smoking cigarettes, having sex, drinking, using drugs, consuming trans fats, or watching TV when you should be engaged in moderate, healthy exercise.

      Honestly, why not? It only makes things cheaper for me.

      Now, we might say that it’s impractical to ban these things, which is undoubtedly true. But I still want to ban you from doing them. As a libertarian, I don’t care for this sudden, newly implanted urge. However, I can’t deny that it has a certain rationality to it.Report

      • Josh in reply to Jason Kuznicki says:

        Yeah, but if I have to pay for your health care—honestly, I don’t care that much what you do. I mean, if I were literally paying for your health care and just yours, then yeah, I would take a more vested interest in your behavior. But the only circumstances in which I see that happening are if you’re my kid, and then I have a vested interest anyway.

        But if I have to contribute, along with everyone else, to paying for everybody’s health care—I mean, for one, the impact is so spread out, it’s basically impossible to care in a meaningful sense. If I see an obese dude eating a Quarter Pounder? I could get outraged, or, you know, it’s possible that he lost ten pounds this month and he’s treating himself. Same with smoking—I don’t know the ins and outs of most people’s lives and habits. (And if you’re driving like an unsafe asshole, I’m already angry, regardless of the health care situation.)

        Also, if I’m paying for your health care and you’re paying for my health care, but we both want the freedom to eat bacon, have sex, and use drugs, we’re really each in the same situation; I’m not going to fret over your life too much because I don’t want you to fret over mine. And I suspect the bulk of Americans are happy with somewhere around the same level of freedoms.

        Finally, there are other empirical examples we can look at: Private employers have paid for health care for employees for a long time now. And while, sure, some employees have been let go because their health coverage became too much of a drag on a business, I don’t think most bosses have peered too deeply into their employees’ lives. Yeah, drug tests, but those are also often for reasons beyond insurance premiums; I don’t see many companies fussing over how much their workers drink or smoke or exercise. At best, they offer incentives to reduce smoking and increase exercise. Which is a good response, I think.Report

  9. Sam M says:

    “health care reforms mean that a lot of us will be paying more attention to how other people eat and live. Given that we seem to be a far cry from banning bacon at this point, I’m not convinced that this is a bad thing.”

    There’s the crux, I suppose. I agree that a lot of us will be paying a lot more attention to how other people eat and live. But I think this is a really terrible thing.Report

    • Josh in reply to Sam M says:

      Why, though? More or less all the worthwhile progress we’ve made as a civilization has been the result of paying more attention to how other people live. I didn’t say, “Watch over how other people eat and live, Big Brother–style.” I just said pay more attention. It has helped us far more than hurt us to examine how we think about race, sex, free enterprise, religion, and a whole gamut of other subjects, so I don’t really know why suddenly having a slightly more vested interest in how we eat and exercise as a society is a bad thing. Maybe I have too much faith in the power of bacon to keep us from going overboard with it, but I don’t think so; rather, I think the immediate leap to “NEXT THEY’LL BE FORCE-FEEDING US TOFU”* is a bit unreasonable.

      I mean, almost no one likes tofu.

      *I realize that is not exactly what you are saying.Report

      • Jaybird in reply to Josh says:

        It’s not like they’re going to force McDonald’s to change from using beef tallow to make french fries to use something else, right?Report

        • Josh in reply to Jaybird says:

          Presumably not, as I don’t believe anyone forced them to do that in 1990. Based on my memory and what this page says, McDonald’s made the change as a response to criticism.Report

          • Scott in reply to Josh says:


            Do you pay any attention to recent news reports about various gov’ts efforts to limit salt, tans fats and sugar? Of course the nanny staters don’t try immediate leaps to tofu as people would rise up. It is much easier to implement the program in small steps and then before you know the nanny state will be here.Report

            • Josh in reply to Scott says:

              Yes, I do pay attention, and even lived in Manhattan when the Awful, Terrible, Very Bad Trans-Fat Ban was passed. All I know is that, as a person who enjoys and ate fast food and other junk food before and after the ban, the quality of my taste experience was unaffected. I didn’t hear anyone else complaining, either. I’m sure there were some complaints, but all of the flak I’ve seen about trans fats has been in the form of blog comments like yours, dude.

              I’ve also met very few “nanny staters” in my time living on both coasts and several places in the middle of this country. I’ve met people who think government should play a larger role in citizens’ health and people who think it should play a smaller one, but never a single person with a long-term plan or desire to get us all eating tofu. Again, I’m sure they’re out there, but I’m not real worried. I think the bulk of Americans are fine with basically invisible alterations to the food they eat in the name of health, but I don’t see them letting bacon get taken away. There are a hell of a lot of small steps between trans-fat bans and that, and I think taking some of those steps is fine.Report

          • Jaybird in reply to Josh says:

            And baby steps and baby steps and more baby steps, when added together, can look like a leap.

            For example, I never thought it would be illegal to smoke at the Waffle House. Now, it’s not only illegal to smoke at the Waffle House but on the deck (which is outside!) at Old Chicago’s. Like, this is the deck next to the bar… and it’s illegal to smoke there.

            Some steps are voluntary, some steps are legislated. Add them up and you’ll see that we’re nothing like we were back in, say, 1980.Report

            • Mike Schilling in reply to Jaybird says:

              1980, hell. Go back to 1880, when no public room would lack a few well-placed spittoons. They were men in those days! (Black-toothed men, of course.)Report

            • Josh in reply to Jaybird says:

              Sure. We’re also nothing like we were in 1970, or 1960, or 1950, or 1900, or 1400, or 300 B.C. Some things have changed for the better; some have changed for the worse. Some people would disagree about which changes are better and which are worse. Personally, as a sometime smoker, it doesn’t bother me that much that I can’t smoke on the deck at Old Chicago.Report

              • Jaybird in reply to Josh says:

                As the owner of an Old Chicago, it distresses me that I can’t let you smoke if you are so inclined.

                (Well, I don’t own one. It doesn’t detract from the point, I hope.)Report

              • Mike Schilling in reply to Jaybird says:

                As a patron of Old Chicago, I’m thrilled that I can go on the deck and breathe air instead of tobacco smoke.

                (Not really a patron. In fact, I’m not sure what an Old Chicago is. Still.)

                And it is true if you switch it to AT&T Park. When I was young, many ball games were part-ruined when the people in the adjoining seats turned out to be chain-smokers. Even outside in the fresh air (and wind, since this was at Candlestick) that was damned unpleasant.Report

              • Jaybird in reply to Mike Schilling says:

                I’m sure you might be. My problem is that I am not allowed to cater to smokers. Come to my bar! Smoke! Drink! Take a cab home! Get a cab to come here in the morning and pick your car up! Order some eggs while you’re here! Smoke while you drink your coffee!!!

                And the people who want to go to church and drink milk and talk about all those other people who are going to hell and how they smell like they’ve been there for a while can do that.

                Let the marketplace decide.Report

              • Mike Schilling in reply to Jaybird says:

                Not the same thing.

                When I see people getting sloshed on eight-dollar beers instead of watching the game, I shudder inwardly, both at their inability to enjoy baseball without being drunk and the economic inefficiency involved, but they haven’t hurt me, so I have no business objecting. When smokers pollute my air, it’s a different story.Report

              • Jaybird in reply to Jaybird says:

                WRT Baseball, well… they have a government-enforce monopoly so the argument could be made that ball parks ought have small designated smoking areas rather than smoke wherever areas, sure.

                But, if you are on my porch at my bar, if you don’t want your air to be smoky, go to the church down the street instead. If there’s an AA meeting in the basement, they will probably have coffee for you to drink and you’ll be able to listen to some nice people tell stories.Report

              • Josh in reply to Jaybird says:

                Well, I don’t think the marketplace was really equipped to decide, in the case of the restaurant smoking bans we’ve seen over the last 20 years or so. Economically, the risk of starting a restaurant is so great that an owner would be a fool to open a place that doesn’t allow smoking when every other place in town does, or even just to go nonsmoking with an existing restaurant if the competitors were still allowing it. Nonetheless, there was clearly a large segment of customers who wanted smoke-free restaurants; there was just no practical way to get there. Sure, they could complain, but even sympathetic owners didn’t want to risk being the first and possibly only one to ban smoking. (And many owners were sympathetic; I managed a family restaurant during the late ’90s, and my bosses would have banned smoking in a flash if they hadn’t known that would just mean losing business to the place next door.) And you can’t really choose not to patronize restaurants that allow smoking when 95 percent of them allow it. Or you can, but it won’t have any impact.

                So, I dunno. What do you do when a bunch of people want to change something but they can’t vote with their dollars to do it? I think you have to vote with your, uh, votes. And for all the doomsaying that precedes every smoking ban, I’ve lived in at least five towns and cities of varying size and region that enacted one, and I can’t say either the hospitality industry or the cigarette industry is suffering.Report

              • Cascadian in reply to Jaybird says:

                I usually associate AA types with heavy chain smokers.Report

              • Trumwill in reply to Jaybird says:

                I share your objection here somewhat. My discomfort with smoking bans is not about the rights of smokers but the right of businesspeople. That being said, gosh these smoking bans are convenient. And in the case of bars, there really weren’t a whole lot of options for non-smokers. I think that there has to be a middle ground here. I’ve suggested in the past that we allow smoking based on licensure. If it’s really important to an venue-keeper to allow smoking, let them. But limit the number of smoking establishments so that non-smokers have a place to go in peace.

                On the other hand, maybe the smoking bans have had their effect and if smoking bans were lifted tomorrow a sufficient number of bars would continue to prohibit smoking. It does seem that it took a law to force action on the issue as few bars seemed to want to be the first to try it.Report

              • Trumwill in reply to Jaybird says:

                I’m not sure I agree as it pertains to restaurants. I think that things were already moving in that direction enough that it would have happened anyway. A large number of establishments were even staying ahead of the curve. Bars, I think, are a different matter. I think some legislation was needed there for that to happen.

                As for people not being able to vote with their dollars, I point to the above solution I mentioned where you basically make businesses buy licenses to allow smoking on the premises and for additional disincentive maybe disallow licensing at establishments that allow people in under 18 or 21.

                I think that there’s a lot of room for compromise, but non-smokers are the majority and in some cases they would cut off their nose to spite their face if it meant letting smokers get away with their filthy habit with any sort of convenience.Report

              • Sam M in reply to Mike Schilling says:

                I agree. The full force of law, and the state’s related monopoly on violence, must be used to ensure things are pleasant for me. Why, the bar down the street features loud music, which is damn unpleasant to me. I called the SWAT team but they did not respond. What gives? It’s almost as if they expect me to shop around to find venues that offer an atmosphere I prefer. What is this, North Korea?Report

              • Josh in reply to Sam M says:

                There are, of course, degrees of things, and smoking is qualitatively different from loud music and atmosphere, in that it actively adversely affects people’s health (including restaurant employees’); and again, shopping around for nonsmoking restaurants was not really an option in many, many places in the pre-ban era. But hey, if equating “using government, an instrument of change, to change something that many people wanted changed” with “TYRANNY!!!” makes sense to you, by all means. I don’t have to live in your brain, dude.Report

              • Sam M in reply to Sam M says:

                Josh says:

                “smoking is qualitatively different from loud music and atmosphere”

                You have a better definition of “air we breathe” than “atmosphere”? OK. Let’s hear it.

                “using government, an instrument of change, to change something that many people wanted changed””

                Oh. Well. As long as a lot of people want it changed, then government ought to change it. I see no potential for abuse. Carry on. Even though finding another venue is well within your capacity to do so. Or ought to be. But lots of people want these things! If only we had a mechanism through which venue providors would supply things people demand. Oh well, someone will dream up something like that in the future. Maybe the best way is for Michael Bloomberg to insist that they be provided.

                As for the health of workers… hooey. The relative risk of working in a smokey bar (one that is always, forever, heavily smokey) is 1.2. Given the low risk that underlies the threat, this means that if 50,000 people work a full career in such a bar (40 hours a week for 40 years) one of them will die from the exposure. But of course, almost nobody works in a bar for that long. The feds acknowledge that it is the MOST transient industry in the economy. So the “deaths” are far fewer than anyone is led to believe. If it really were worker safety in barroms you were after, you would work for non-slip floors and two-drink maximums for large patrons. But nobody is arguing for these things. Weird.Report

            • Trumwill in reply to Jaybird says:

              You’re right that a lot of headway has been made on the anti-smoking front, though I am doubtful that the success can be translated into too many areas. Smoking has two special things that factor in that don’t often apply elsewhere: second-hand smoke and a bright dividing line between those that do it and those that don’t.

              I mean, look at how the anti-smoking legislation got through. A key factor is the utter demonization of smokers. Smoking went from chic to an ugly habit engaged in by obnoxious people. Other than a small subset that smokes here and there, smokers are a different breed. The majority of people do not smoke ever. Tell them that they need to stick it to the non-smokers, well that’s not a tough sell. Bacon? That’s a different story. Most people like bacon. Ban bacon and you’re infringing on your freedom instead of someone else’s. The inconvenience to the 75% of Americans that don’t smoke is not only non-existent, but reversed by the convenience of not smelling someone else’s habit. I doubt that they will be able to get 75% of Americans to turn vegetarian the same way we’ve got 75% of the public abstaining from smoking. Or 51%.Report

              • Jason Kuznicki in reply to Trumwill says:

                I dunno. If I have to pay for their clogged arteries, I have to say that I’d find them pretty disgusting. But I’ll get my bootlegged bacon whenever I can, and not tell the feds or anyone else.

                This is just a way of saying that I wish I could keep up with all of the comments here and respond to all of them thoughtfully, but it’s getting very hard to do, and I have to draw the line somewhere. The 99th comment seems as good a place as any.Report

  10. Mike Schilling says:

    If I have to pay for your health care, I don’t want you to drink, use drugs, smoke, have unsafe sex, or eat bacon.

    This is why, ever since Medicare, we’ve been regulating the behavior of old people?Report

  11. Sam M says:

    “This is why, ever since Medicare, we’ve been regulating the behavior of old people?”

    No, of course not. Which is exactly why old people are exempt from smoking bans, tobacco and alcohol taxes, bans on trans-fats, etc.

    Wait. They’re not exempt? And saving society in terms of health costs were integral parts of rhetoric behind each and every one of these political maneuvers? Oh yeah.

    So we have been steadily increasing the level of “public health” regulations and taxes for decades. On all people. And using heath care costs as a justification.

    Now society is on the hook for a much higher percentage of those health care costs. Which means this is a great time to expect this trend to abate.


  12. Michael Drew says:

    This just all massively undersetimates the people’s abillity to forestall outcomes they don’t want in a democracy. And the pushback here and elsewhere against this trend is already massively outpacing — even preceding — any such actual trend. The alcohol tax increase debate (where this all stems from), after all, stems not from any actual legislative proposal I am aware of, but rather from a paper by a liberal economist that got picked up by a liberal blogger. The fact is that this kind of this would be massively unpopular at any level of popular government (insurance companies on the other hand are dictatorships), and would and will be easily beatn back by the kind of resistance we see here.

    It’s rather hyperbolic to say, “Well, of course what I am describing is prohibitively unlikely [for exactly the reasons I give above], but I just don’t like that I have now had ‘implanted’ in my mind an as-yet-only-imagined impulse on your part to do it.”

    As I pointed out to Mark in the other thread (late – he might not have seen it) — we’ve had this incentive on the books since 1965, as later life is when the actual costs associated with these behaviors (to the extent they present themselves) get incurred. So maybe you’re resultingly against Medicare, great. Let’s note that then and keep it in mind if you also claim to defend social safety nets (as Mark does – Jason, I’m not sure how hard core you are).Report

    • Cascadian in reply to Michael Drew says:

      The absolute worst thing about Canada is the amount of tax on beer.Report

      • Michael Drew in reply to Cascadian says:

        How much?(Reihan Salam proposes quintupling it here without any reference to the health care law)/I’d be interested in the nature of the debates leading to that./We’re not instituting anything like the Canadian public health plan here except where it’s already been on the books for four -and-a-half decades.Report

    • Sam M in reply to Michael Drew says:

      Pitttsburgh recently passed a 10 percent tax on pured drinks at bars. So it’s actually happening. There is now a proposal on the table to extend the tax to “sugary drinks.”Report

      • Michael Drew in reply to Sam M says:

        States and localities are taxing just about anything they can think of period, because they are strapped. Witness:

        Moreover, as I have argued, the rationale for an alcohol tax preexisted the HCR law and debate, and I think has little to do with it — Mark Thompson sees it as supportable so long as not explicitly justified by specific concern for the finances of gov’t health programs. Some things are genuinely harmful – the crankery here about trans fats being a great example. That stuff just genuinely was killing people. It belongs out of food no matter how much of health care is run by the public sector.

        These taxes we don’t like will quite often come to pass regardless of the engagement or lack there of of gov’t into general responsibility for medical care costs. If you want to make the connection of their genesis to such responsibility, you have to make it not just assume it. I have a hard time believing a new law that barely has any provision yet in place is already having this effect. These governments are acting on their own conscience based on revenue needs and certain belief about the health of their citizens, not specific health program cost considerations. You can certainly argue that too is unfounded action, but it’s avery different argument.

        I fear Trumwill is looking better and better about the effect raising the mere point that they are also good for public health program finances would have on the discourse. I still hope that for the non-ideological,a few modest taxes turning out to be the dreaded quote-unquote “government controlling your health” will actually serve as a sound debunking, but likely those people won’t be paying attention until after the law has been in effect a while(what an odd concept), so for now, i tip my hat to you, Mr. Trumwill sir.Report

        • Just to clarify – my position is that such taxes can be justified only if there is an independent public harm caused by an activity that cannot adequately be paid by the perpetrator of the harm because the harm is either untraceable or because the perpetrator will often be unable to adequately compensate his victims. So, carbon taxes are ok by me; a limited tax on alcohol for the purpose of insuring society against the harm caused by drunk driving and drunk college kids on a post-bar rampage is likewise ok. But when a tax or prohibition is implemented to protect the perpetrator or victim from their own freely made decisions, then I immediately have a strong objection. My objection to sin taxes justified by their revenue is that it has the effect of artificially removing behaviors from the latter category into the former.Report

          • You’re right – for an example of your view, the trans fat example was off. This raises another question, however; what is your view of the role of government in controlling harmful substances in food and drug production. If taxation is bad, then prohibition is presumably worse. Are you one who says the necessary effects of the FDA will arise naturally from the market?Report

            • I’m kind of torn on the FDA to be honest. In theory it serves a useful information-sharing function and safeguard against fraud that I tend to view as a legitimate role of government. On the other hand, in practice the drug approval process seems inhumane and too-easily captured by interests such that its reliability isn’t what it should be. But to be honest, the FDA isn’t something that I’ve ever looked at all that closely.

              That said, I can picture a situation in which private companies performed the tasks that the FDA is supposed to provide. But it strikes me as a situation that wouldn’t be all that workable in the context of testing pharmaceuticals given the amount of time and effort necessary to appropriately test drugs and given that the only way these hypothetical companies could ultimately make a profit would be to have the pharmaceutical companies pay them for the right to stamp a product as certified by the company. But that obviously immediately calls into question their independence. True, consumers could make decisions as to which such companies are most independent and trustworthy, but in the context of drugs I’m not sure how they’d be able to do this – the amount of knowledge necessary to assess that reliability is well outside the consumer’s grasp.

              I guess what I’m saying is that pharmaceuticals don’t provide a case where you can have the sort of “meeting of the minds” necessary for a freely entered-into agreement. This logic doesn’t really apply in the case of food products or recreational drugs where everyone pretty much knows that certain foods/drugs are unhealthy in the long run.Report

  13. Rufus F. says:

    I agree with the main point here- once paying for health care becomes a public issue, health becomes a public issue. But I don’t see why the first demands wouldn’t be for price controls. When I go to get an initial diagnosis and referral from my Canadian doctor, it costs the state $30. When my father in Maine goes for the initial assessment and referral, it costs him $110 out of pocket. The difference, as far as I can tell, is that Canadian doctors don’t spend time shooting the shit. So, I’d assume the first thing people will be calling for are price caps on health services. But, the general point- that it’s now seen as the government’s responsibility to fix the system- is probably true.Report

    • Michael Drew in reply to Rufus F. says:

      This is a valid concern, and there is likely some validity to the claims that reforming health care will ultimately involve some amount of government action to influence the practice of medicine toward greater effectiveness and efficiency (whether or not those would ultimately rise to the level of “getting between me and my doctor”). Those claims are, however, I would submit, different and separate from the warnings that the government will now seek to regulate and tax all manner of private behavior that it wouldn’t have before, apart from the practice of medicine, or that we all now have an interest in doing so regardless. They’re not entirely unrelated claims, but they are quite different and separate.Report

      • Rufus F. in reply to Michael Drew says:

        Yeah, I agree they’re different and separate. I just wondered why it didn’t get mentioned in that list of ways the government might try to limit the cost of the program.Report

        • Michael Drew in reply to Rufus F. says:

          The general plan is ultimately to do the lump-sum-payment plan, which would kind of amount to what you are suggesting, but that isn’t in the law in a big way – just some incentives to do that where possible I think. I don’t think even the R’s think the Dems would ever suggest outright price settings (though I suppose it happens in Medicare), so they didn’t make a big show of it. It is a little strange though, you’re right, because that is more or less where we’d end up in a Medicare-for-all world, I think.Report

  14. Scott says:

    Apparently you can’t even pay folks to do the right thing. I hope this convinces folks that doing right has to come from within.

  15. Mike Farmer says:

    I wish the State had a menu of regulations and taxes you could opt out of by signing something that says you will not rely on certain government services, that you will eat drink and smoke what you like and never receive a dime from the government to help pay for the consequences, and you will gladly pay for any harm done to others. You could provide a financial statement to prove you have the funds and income to take care of yourself, thereby reducing your taxes and freeing yourself from certain nanny-type regulations. It could be called the Grownup Opt-out Clause — GOC. Thanks, Mr. State, your plan look wonderful, but I have a private plan I think I’ll stick with.Report

    • 62across in reply to Mike Farmer says:

      Though I doubt this would be possible as a practical matter, in principle I agree this would be a good solution. I doubt I am alone among the center-left as someone who doesn’t care at all for the nanny-state, but still buys the argument that since the government is on the hook for the costs of some behaviors they have a reason to regulate that behavior. If some guy wants to ride his motorcycle without a helmet, yet agrees to cover the costs of his head trauma (including emergency response), that’s okay by me.Report

      • Jaybird in reply to 62across says:

        He’s far less likely to be a head trauma patient and far more likely to be an organ donor.

        (My solution to that problem was to automatically assume positive organ donor status of all helmetless riders. If you want to be buried with both kidneys, wear a helmet. I was surprised by how much pushback I got on that one…)Report

  16. 62across says:

    I’m surprised this thread has gone this long and no one has challenged the idea that health costs related to behavior represent that big a slice of the overall health care pie. Does anyone have any data to back that presumption up?

    Most of the testimonials I have seen around the benefits of extended health insurance involve people who suffered from disease or accident. Surely no one is suggesting that people who have newly acquired insurance will now go out looking to get a brain tumor or fall out of a tree.Report

    • Jaybird in reply to 62across says:

      Well, I think it more has to do with the number of problems that are related to diet and (the lack of) exercise… as well as problems related to drugs/alcohol and/or smoking.

      But that does lead to a handful more of interesting questions…

      What about rock climbing?
      What about sky diving?
      What about the bends?Report