A real lottery for a population isn't "a lottery" in that sense either. The lottery business is reliable just like the health insurance business and for the same reason.

The thing about having the government pay for healthcare at the national level is that it would also incentivize prevention of diseases, as a way to cut costs over the long term. At least that's what's supposed to happen without too strong Big Pharma lobbying that would prefer the population to be as sick as possible.

How does that happen? Doesn't this imply government interference in people's lives (eat this, eat that, exercise etc.,)? Given that such advice is frequently shown to be wrong, this is problematic.

The NHS doesn't seem to incentivize prevention of diabetes in the UK. To quote 'UK Diabetes': "Diabetes is the fastest growing health threat of our times and an urgent public health issue. Since 1996, the number of people living with diabetes has more than doubled. If nothing changes, it is estimated that over five million people in the UK will have diabetes.". This disease largely results from personal choices often made on the basis of misleading information.

Just keep in mind that we will likely never reach the ideal balance between the voice of the people and megaphone of money. The impact of lobbyists and money is a necessary consideration in any discussion of political solutions to problems.

> I think this is a relatively minor issue, but if necessary, penalty taxes/fees can alleviate the concerns of people legitimately bothered by this.

It is not minor at all. Depending on how you look at it, smoking either costs the health care industry billions (in treatment of the living) or saves them billions (on premature death). Compound this by: diet, exercise, stress, and socialization problems and you see that the lottery has a lot of knobs and buttons, most of which will only be effective if people get effective health care their entire life.

> saves them billions (on premature death)

Smokers don't die healthy. The "saving money" bullshit is literal propaganda from the smoking industry.

Here's an actual meta study on the costs: http://www.tobaccoinaustralia.org.au/chapter-17-economics/17...

>Third, Collins and Lapsley estimate the net costs of smoking, taking into account both those costs that are made greater and those that are reduced because of current and past tobacco use. For example, smoking increases some health care costs because of the higher prevalence of diseases caused by smoking (in smokers and ex-smokers who are still alive). These are the gross health care costs attributable to smoking. However, certain other health care costs are lower than they otherwise would be because of the premature deaths of many people who smoked over the past 40 years. These people did not live to use health care that they otherwise would have, so Collins and Lapsley subtract the costs that would have been incurred from the gross health care costs attributable to smoking in order to estimate the net cost. Similarly, in terms of labour (production) costs first costs that are made greater by smoking are estimated. For example, the time spent undertaking domestic duties because a home-maker is ill or has died prematurely is costed assuming domestic help will be hired. Then, savings due to reduced consumption—for example, household spending on food and clothing—are subtracted because these costs will be lower when there are fewer people in the household as a result of smokers dying earlier.

>Collins and Lapsley estimated that in 2004–05 the total cost of smoking in Australia was $31.5 billion

That would be an interesting analysis: savings of premature deaths from smoking vs long terms costs of people that smoke and don't die and costs of treating those early deaths before they die. Intuition says the costs probably outweigh the benefits there. Even so it feels pretty macabre (and species threatening at the extreme [1]) to consider someone dying before they need medical care a savings.

[1] Considering killing someone before they're born saves the cost of them and any children they would statistically have. So if we wiped out everyone we'd save all the money ever spent on healthcare.

The high taxes for cigarettes (and similarly alcohol) should also be taken into account when considering net gains/losses. According to this [1] in the uk at least the taxes more than cover it for tobacco

[1]https://fullfact.org/economy/does-smoking-cost-much-it-makes...

Here in the US the taxes are much lower for a large portion of the country [1] so it probably doesn't come out so much in favor. Though long term health care is also more expensive here so it might all come out as even or similar enough.

[1] http://taxfoundation.org/blog/state-cigarette-tax-rates-2014

It creates enormous social pressure to increase cigarette and alcohol taxes. In Canada both are quite high and the general population supports it due to the public healthcare burdens.

For health issues I think this type of pressure is a positive social force.

How is [1] distinct from rational control of population (eg birth control by default), which will presumably be necessary to avoid food and resource waste (or war/starvation)? Health care seems to be just another factor affecting population cap.

[1] Differs from normal population control in it's extreme application of reducing costs by any means. Also population control has additional concerns beyond just reducing costs by not having people to deal with like sustainability of resource consumption and to me there's a large difference between a person never being born and dying early. Really my [1] wasn't meant to be seriously at all.

Another way to think about this is if a person comes into existence, then BI demands their immediate universal right to the resources to sustain their life comfortably without any contribution from that body.

So really, those who multiply the fastest win the resource war of the future? Or having kids is somehow constrained now through other hoops, like a "procreation license."

> Or having kids is somehow constrained now through other hoops, like a "procreation license."

Possibly, though better educated and better off people tend to have fewer children so there are other ways to limit population beyond strict China or Ender's Game style limits.

Or maybe asteroid mining will finally break and crash the whole materials economy making everything but space, food, and water extremely cheap.

My point is this: universal BI requires some level of population control (to prevent poverty and misery), and eventually some level of reproductive planning.

Universal BI leads to universal resource control.

Really we'll need either population control or (more likely and) to drastically limit consumption (or the impact of it maybe more closed cycle recycling) with or without BI.

> The common complaint I've seen against this (aside from general complaints against redistribution) is that it forces the general populace to pay for the poor health choices of smokers and other such bad habits.

If you want your 21st century healthcare, you also gotta let go of outdated notions such as that addiction is a "poor health choice" (seriously kind of makes me angry typing that).

> For a population, it generally isn't. In other words, the total expense to provide healthcare for everybody is a pretty stable expense.

The one does not follow from the other. Just because it's predictable does not mean it's stable: you can modulate demand by, for example, making people jump through bureaucratic hoops or wait in long queues to get care.

> The one does not follow from the other. Just because it's predictable does not mean it's stable: you can modulate demand by, for example, making people jump through bureaucratic hoops or wait in long queues to get care.

...as we have seen in far too many countries with universal healthcare (leading those with the means to seek healthcare from other, more market-driven systems...which in turn leads to those without the means to receiving sub-standard care, or quality care subject to bureaucracy and long queues.)

In short, it's a self-licking ice cream cone. (But this is quite the tangent from the BI discussion - wherever your opinion falls on the matter, universal healthcare is an entirely different thing indeed.)