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February 24, 2011


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Smokers are charged for what they do. They are taxed entirely out of proportion to any kind of concrete impact they have on the medical industry.

Of course, if we abandoned the absurd notion that people are entitled to "free" health care, that argument against smokers would evaporate, anyway.

Ordinarily, I find your posts and most of the points you make to be insightful, intellectually honest and objective, but your final point here is...well, quite frankly, crap.

So much of 'The American Way' as it pertains to so many things - agriculture and health in particular - is designed in such a way that we are reactive rather than proactive, almost always.

Agricultural subsidies foster a marketplace in which unhealthy, processed foods are the most readily available and economical choice, resulting in a society that does not value healthy eating, and that puts their future health at risk with almost every bite they take. The health care system fosters an environment in which preventable disease is not caught or treated until it presents a real (and costly) problem, rather than providing easy, equitable and economical access to preventative care for all people.

Beyond that, the idea that you can somehow suss-out which health issues are the direct result of individual behavior, and which are just happenstance, and then charge accordingly for access to health care is pretty ridiculous. While correlations certainly exist between certain behaviors and certain conditions, none of this happens in a vacuum, and none of those behaviors and conditions are mutually exclusive. People who've never smoked a day in their life develop and die from lung cancer every day, just like people who've smoked for decades often enjoy long lives unmarked by any kind of adverse health issues. Thin people struggle with keeping their blood-pressure and cholesterol under control, while obese people are pictures of perfect health. Terrible things happen to people who make all the right choices all the time, just like people who make terrible choices often suffer no consequence whatsoever.

And, as has already been pointed out, people who make unhealthy choices ARE often charged for them, in the form of taxes. Smokers pay dearly for the right to smoke, and in some states (such as the one I live in), nutritionally bankrupt food items such as soda are taxed differently from healthy foods.

"US spends more on healthcare than any other country in the world, but has highest rates of infant mortality, diabetes and other ills than many other developed countries."

Not sure when the data collected but it gave you a general idea how much money US needed to spend on health care ($5,711/person). It hit me hard the most was we needed to spend those money because we had too many sick people.

No, Jason, I think you are wrong. Smokers ARE taxed, it is true,
but how much is merely a contribution towards how much tobacco
costs society. (Mind you, I don't KNOW how many smokers you
have seen die.....)

I assume that "boomer parents" are baby boomers who are parents right? I could interpret that to mean parents of baby-boomers but I don't think thats what they mean.

Taxes on cigarettes generate something around $50B a year. Thats just my napkin math of 20% adult smokers and $3 taxes per pack typical. At least one study claimed that smoking costs society about $100B in health care costs. So taxes don't pay for the cost to society (if you believe what anti smoking groups say that smoking costs us).

However a slightly morbid fact is that smokers die sooner and their health care and lower social security payments can be lowered versus than non-smokers as a whole. Think about it, smoking cuts 10 years off your life right? Thats 7 years of social security checks that aren't written, nursing home care that isn't paid for and healthcare bills for all the other non-smoking related illnesses that aren't spent.
One source said:
"Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents."

Alotta Lettuce --

1. You understand the difference between an exception to a rule and what's generally (in most cases) true, right?

2. Are you saying that the current system does a good job of making those that exert extra costs on the system pay for those costs?

Fmf, uh oh. Here we go. You made the mistake of making a generalization. Now every carrot, turnip, and lettuce out there is going to call you on it because they know aboit the exception....

On first point, I would like to know how many parents who have a "real" fear actually have taken any steps to really cut ties with mooching kids. I'd also ask how secure they are financially themselves. My hunch is that this is the poor parents "helping" poorer kids.

I want more competition for health care not less. I want people to have paid taxes into fed/state/medicare for some period before collecting any benfits. (if your parents did/do and you are/were a minor during medical crisis that is ok). Punishing people based on their risks (i.e. Smoking/weight/genetic/health history) is not. If you can charge those people more, you can deny coverage by making it cost prohibitive.

And re: relationships, stay open and honest with everyone. Don't get trapped into unfair or unrealistic obligations, that is where most fights come in. Also be sure to keep friends/spouses who are on the same page, this avoids much conflict.

I vote for Medicare for all, plus more taxes on high calorie low nutrition food and cigarettes.
I think its important to remember that America spends a lot of money on health care for not particularly good results-all of the western countries with universal health care (Canada, Western Europe) spend less money per person over all, for better health outcomes.

The smoker comment makes sense on the surface but as Harm pointed out, they die much quicker than non-smokers and become less of a drag on the health care and social security systems. If you want to offset the 'costs' of smokers on your taxes buy tobacco stocks, they tend to have a healthy dividend.

Actually smokers SAVE the US money. Actuarial tables show that smokers live shorter lives than non-smokers. Therefore, they don't use as much Social Security. They are on Medicare for less time. They spend less time in nursing homes.

On the same subject, I've always found it odd that insurance companies charge people more for life insurance for smoking (and rightly so), but they don't give smokers a discount when they buy an annuity. When I was working in insurance, I mentioned this idea to one of the actuaries. Needless to say, the idea didn't go very far. :-)

The cost of providing healthcare to a human being in a country like the USA is a topic for which it's hard for me to see a solution that the majority would agree with.
Healthy people seem to be biased against smokers, the obese, and unhealthy eaters, but this raises many other questions. How about the extraordinary cost of saving extremely premature or very deformed babies or providing all manner of transplants that would likely prolong the life of human beings of any age. How about the large medical costs associated with many people during the last year of their life.

Is every person in the USA entitled to the best healthcare available or should it be only provided to those with great insurance plans or the very wealthy? Then there's the question of providing care to the mentally ill, the retarded, those poor souls that live in their own little world, or those without any insurance that are incarcerated, homeless, or have suffered very severe injuries.

I happen to be extremely satisfied with my healthcare but I am on Medicare, I am in a great group insurance plan from my former employer, and my plan is accepted by the best clinic in my area - so I'm one of the most fortunate. I have relatives in the UK that are very content with their nationalized healthcare but it's all they know. When I have discussed with them the treatments and services that they have received I realize just how much better the care that I receive is, however their system does cover every single person, even visitors, and is paid for out of the overall tax base, our system has various levels of care for various groups of people depending upon their insurance or lack of insurance.

This is a wide open topic in this country and the opinions about what we should do vary all over the map. The fact is that we live in a country of "Have's" and "Have Not's" and it's not about to change anytime soon.

Before smokers die, they suck up a whole lot of healthcare dollars. Don't fool yourself into thinking that their premature death saves money...quite the opposite.

Don't smokers already pay for their "freedom" through all the taxes they pay for each package of cigarettes?

"Cut the kids loose, let them fend for themselves, and they'll learn."

I'm glad my parents don't take that attitude. If they did, I'd be homeless with no hope of ever surviving on my own. The only reason I'm not homeless now is because my parents took me in after me not being able to get enough work to survive (All I could find were part-time retail jobs that didn't pay enough for basic rent and food. I couldn't get any work in my field). They're letting me stay with them while I go back to college for a degree that's actually useful.

Oh come on. Agri-business subsidies did not make you fat--you did that yourself, yes you alone, and you alone can make the decision to change your behavior and improve your health. Of course, it's more comforting to blame someone else I suppose.

And BD--I bet you wish you had considered what your college degree would do for you in terms of a job, 3-4 years years ago? I'm really puzzled why the problem didn't become evident until you graduated. Didn't you work part time in your hoped-for field or do internships while you were in college, so you knew what the job market/pay would be like?

The America may have the best health care system, but it is not cheap either. If you don't have an insurance, can you still enjoy all necessary treatment? My concern is when we pay taxes to the government, we still need to pay a lot of money to get an insurance and the health care. Some families may not spend enough money to hit the deductible every year, so what they are paying for?

Like a small city Hong Kong, they don't have sales tax and they have a very simple tax system. It has 7 millions population but less than 2 millions paying tax (pay maximum 17.5% of annual income). Their people never need a health insurance to live a everyday life. Seeing a private doctor is affordable, about $25 per visit include prescription. Government doctor is free. The government charges $15 for using the emergency room, another $15 per day for staying in a hospital. Most drugs are free. No charge if you need a surgery.

I mean did the US government really give us any benefits in return from the taxes we give them?

It's hard to compare small homogeneous populations, for example Scandanavia and Hong Kong, versus large diverse populations such as the United States.

KH - I graduated from college with a BFA in Graphic design back in 1994. Jobs were a lot more plentiful in that field then, and computers had barely been on the scene in graphic design for more than a few years. Some places were still cutting rubylith just a few years before I graduated.

I was able to find work (yes, I did an internship back in 1994, then went on to paid employment), and stay employed through 2005. Then, I moved out of SoCal for personal reasons, and figured I could find work elsewhere. That was the beginning of the end. The market for graphic designers was over-saturated at that point, and no one was hiring. Then, two years later, the Recession hit, and that tightened down things even more. I was freelancing from 2005 til now, but it just wasn't enough. In a recession, graphic design/art is the FIRST thing companies cut. In addition, over the years since 1994, graphic design wages have plummeted. Sure, there's a few large companies out there who pay decently, but the odds of getting hired with one of them are about a million to one. Most companies pay their designers close to minimum wage, due to the glut in the graphic design workforce.

So now I'm back in college for a degree in Accounting, which is more recession-proof, and has more jobs available.

Old Limey sums it up pretty well. If we want to start talking about "letting" people smoke and eat poorly, then we should talk about "letting" people breed, raise children certain ways and allow extension of life procedures as well. I, for one, do not want to go down that path. I grudgingly pay my taxes to support other people's "right" to eat a Whopper just like I grudgingly pay my taxes to support other people's children's "right" to go to school (I am a vegatarian and do not have children). There is a point where we all just have to be members of a society and not argue over every detail of who exactly gets a benefit for what amount of money put in - we have bigger fish to fry.

Old Limey makes a lot of good points.

jbhk is right-we spend a LOT of money on health care for very little return, it would be great if we could produce more doctors, allow nurses to provide more basic care, and keep hospital costs from rising so quickly.

Of course, Hong Kong taxes are so low because they have limited social services and no military. We could dramatically cut taxes if we eliminated the 2/3 of the national budget which is military, social security and medicare spending.

"US spends more on healthcare than any other country in the world, but has highest rates of infant mortality...."


The US is the only country in the study that made this claim that calls a baby alive if it is born with a heartbeat or able to breathe, or able to survive on machines. Most of the world classifies it a stillbirth if the baby is born under a certain weight or unable to breathe on its own. Using the common classifications, the US healthcare system has the highest percentage of lazarus babies in the world.

Jason, Nope. If you combine stillbirth and infant mortality than the US is still higher than other developed countries. About 11 for US and 7-8 for the other nations. Canada uses the same classifications as US and their stillbirth and infant mortality rates are all lower than ours. Further, the infant mortality rates in the US are higher for minorities but not whites and that is certainly not explained by the US classifying premies differently.

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