The idea that your access to healthcare should be linked to your own or your parents financial is crazy.

In the end I agree that a basic safety net is necessary and serves a greater good - providing things like normal checkups, preventative services, and acute trauma care is reasonable. However $200k for a second heart surgery for someone who hasn't taken heed of earlier exercise or diet advice by a practitioner should not be supported.

Do you think that someone who follows all but one of those rules still deserves healthcare? All but two? What's the moral difference between someone who smokes and someone who hasn't taken heed of diet/exercise advice after getting heart surgery? Where do you draw the line?

It's easy to say, "I don't want to pay for the healthcare of some hypothetical 'slob'". But make it real, consider what this actually means, and I think it's not something most of us want.

None of us is perfect. I'm sure that even olympic athletes occasionally eat bacon. Let he who is without sin cast the first stone, right?

Yes. Yes.

Moral difference no idea, but neither one should expect to have society foot the entire bill for their bad habits.

> Where do you draw the line?

Probably around morbid obesity that's unrelated to genetic/chronic issues.

> Let he who is without sin cast the first stone, right?

By setting an unreasonable standard and saying no one under it has the ability to cast judgment is extremely anti-intellectual. If 2 people were telling you about health habits and one of them was an olympic athlete (who occasionally ate bacon), and the other was a random overweight person from the street, whose advice would you give more weight to?

The jury is still very much out on how common this is, isn't it? Who is going to make the decision of whether I am "at fault" for my obesity?

Also how many people actually choose to be morbidly obese? Like, suppose I am genetically predisposed to like "unhealthy foods" (scare quotes because we don't really know what that means). Does that excuse my obesity as genetically caused? How are you going to tell the difference between someone who "selfishly likes" unhealthy foods and someone who can't help themselves? More to the point, is there a difference?

> By setting an unreasonable standard and saying no one under it has the ability to cast judgment is extremely anti-intellectual. If 2 people were telling you about health habits and one of them was an olympic athlete (who occasionally ate bacon), and the other was a random overweight person from the street, whose advice would you give more weight to?

In the face of this claim that my argument is anti-intellectual, I think I get to be pedantic and say that this counter-argument is a straw-person and equivocates.

I am saying that I don't think an Olympic athelete should pass moral judgement on other people. But of course an expert can pass intellectual judgment on ideas (e.g. "candy is healthy").

I can't believe I'm here as an athiest defending Jesus, but there you go. :)

I'm sorry but this is insane. Are we just abolishing any notion of personal responsibility whatsoever? I can't and won't argue from that first principle so we're going to have to disagree here fundamentally.

What if I can't help myself but grope women? What if I'm genetically predisposed to violence? Or kleptomania? Those things also impose a heavy cost on society, but if I just can't help myself, am I really at fault?

> How are you going to tell the difference between someone who "selfishly likes" unhealthy foods and someone who can't help themselves? More to the point, is there a difference?

Of course there's a difference. If your willpower is not sufficient to correct your obesity, then you should take other, more radical steps that do. And if you don't, then you're just selfishly externalizing your problems to society.

> But of course an expert can pass intellectual judgment on ideas (e.g. "candy is healthy")

Good, at least we can agree on something. So to answer the first part of your post, you should ask an expert on obesity. I'm not one, so if their judgment differs from mine, I'll stand corrected. But until then, I'll be of the opinion that most obesity cases are not genetic.

You're saying you have no expertise in this, haven't spent any time reading the literature or consulting with experts, but you nonetheless are going to continue having a strong opinion on this question? What is the basis for this opinion on a question of fact? Hopefully it's not than the fact that fat people are icky and so must be morally at fault for their failings?

Why do you presume people are completely hopeless at controlling what they put in their stomach?

How many experts did you consult with to form your opinion?

We don't know that obesity is caused mostly by over-eating.

Many basic questions about diet are unsolved, including the reason(s) that some people gain weight while others don't and the reasons that the vast majority of people can't lose weight. We just do not know to what extent do genetics, gut flora, lifestyle, and diet affect weight. We also don't know what makes for a "good" diet, or whether the same diet is good for everyone.

This is not obscure knowledge. Literally if you google "what causes obesity?" you'll get pages like this: https://stanfordhealthcare.org/medical-conditions/healthy-li...

> How many experts did you consult with to form your opinion?

I spend a lot of social time around doctors, and I read a fair amount of medical literature (for someone who isn't in the medical sciences, anyway).

I am not claiming to be an expert, but I am claiming to be somewhat informed, yes.

I am also claiming, more strongly, that before we as a society punish someone for causing something we'd better be pretty damn sure that the person actually did cause the thing, with mens rea and so on. I am claiming that the scientific evidence is not there for obesity.

No, that part is obvious and we do know that more calories results in more weight. There's no debate. The only debate is in what causes over-eating.

> Many basic questions about diet are unsolved, including the reason(s) that some people gain weight while others don't and the reasons that the vast majority of people can't lose weight. We just do not know to what extent do genetics, gut flora, lifestyle, and diet affect weight. We also don't know what makes for a "good" diet, or whether the same diet is good for everyone.

Also flat out not true. You're creating some ridiculous standard for "knowledge" when in reality, you only have to have "good enough" knowledge in order to be healthy and not obese. Most people can easily adhere to, but for whatever reason, don't.

> This is not obscure knowledge. Literally if you google "what causes obesity?" you'll get pages like this: https://stanfordhealthcare.org/medical-conditions/healthy-li....

Yes, and? The answers are not equally weighted. Just because there are 3 answers, doesn't mean each answer is equally responsible in the cause of obesity.

> I am not claiming to be an expert, but I am claiming to be somewhat informed, yes.

I am claiming the same. My parents are biomolecular scientists and for them it is not contentious that overeating causes obesity. If we're giving weight to anecdotal evidence, I'm entitled to at least give my own evidence the same weight as you do yours.

> I am claiming that the scientific evidence is not there for obesity.

And there are people claiming that anthropogenic global warming is a myth, despite scientific evidence otherwise. However, I'll take claims that are true (overeating causes obesity - replicated many times), over claims that may or may not be true.

Please realize that you're in the minority on this, but the science is already settled. It's ok to admit that you're wrong.

OK, this is a concrete claim that we can test: "most people can easily adhere to a 'good enough' diet/lifestyle to avoid being obese".

If this were true, then there would exist a protocol that "easily" results in lasting weight loss for most people, right?

Does such a protocol exist?

If you have a link to one of his papers, I'll gladly peruse it.

Might be worth your time at 2x speed. Or not, I dunno.

It is essentially a bill of rights thing - either you support universal rights for everyone or you support them being taken away whenever convenient a.k.a. no rights at all for anyone.

Just go back as shallowly historically speaking as AIDS in the 80s. "Only gays and drug users get AIDS so why should we pay to help those degenerates?" sounds downright satirically stupid but that was essentially a real viewpoint and sadly still is really. Judging the 'guilt' of patients is a very dangerous thing for a society to do and doesn't help the underlying health problem at all.

However, I think if we gather a pool of public funds there needs to be a priority system or some feedback loop or liability included (back to finite resources being at stake).

Those things like sugar may come with a tax so that respective procedures are funded by it. Likewise for driving, insurance is required. For diet and exercise, maybe you can get an income tax credit for following certain things.

Not perfect, but I think we can get better then a simple pool that's support for everything and anything.

I disagree that failing to adhere to a certain diet should be punishable by death.

Then the problem is you have no pricing mechanism for determining how much the provider should actually be paid. If you offer less than what people value the service at, you'll get shortages (or, in this context, waiting lists and less life-saving medical R&D). If you offer too much, you're overpaying (see also US government contractors).

Governments in Europe apparently solve the "paying too much" problem by systematically underpaying, but that doesn't work if everybody does it. The US can't subsidize your medical R&D if they're doing the same thing.

> The idea that your access to healthcare should be linked to your own or your parents financial is crazy.

I've never understood why people have this idea about healthcare but not even more immediate necessities like food and housing. It's not as if the solution you're proposing is even analogous to the solutions we use for the poor there (i.e. free clinics akin to homeless shelters and soup kitchens). If the problem is that free clinics are poorly funded, why isn't the solution to fund them better rather than nationalizing the entire healthcare system?

Hmm but I have the same view for food and housing. Where I live if your mother doesn't have allow money to buy proper food the government will contribute (both for food and housing).

So what do you mean?

Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.

Anyone can go to a doctor to get an appropriate level of treatment. If you want more than that, to the degree that you want to waste your own money, then of course you can do that by paying for it out of your own pocket.

It's funny that we are having this discussion. This is a solved problem in large parts or the world and the only reason it's an issue in the US is due to people being crazy.

When the rich people in europe get sick, they go to the U.S..

I would never again want to have medical treatment in the USA.

Next question, if the patient did go elsewhere, would they get to keep all the test results/would the hospital share the test results with the new facility? Or would the new place have to rerun all those tests?

Huh, is that a thing in the US? I understand the old hospital might not automatically giving them to you or the new one rerunning them anyway for practical reasons. But if you've payed for the tests, I'd expect you to own the results...

First line in Wikipedia (https://en.wikipedia.org/wiki/Healthcare_in_Switzerland) There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).

The difference being their version of the individual mandate was not struck down or watered down to becoming a 'penalty'. Instead it was like what we do with auto insurance.

Most "free" healthcare systems have either (1) horrible quality of service or (2) impossibly long waits unless your life is in danger or close to it. The latter is a systemic issue I've noticed in that healthcare, regardless of pricing or structure, does not aim to foster optimal health, but merely to prevent mortality - so if you go with a 'minor' issue such as recurring headaches or chronic fatigue, it will be dismissed entirely.

I don't have the right answer here and am all for people having affordable options from 'free, wait 3 months' to '20K, full service now', but once again, personally speaking, I'm not rich enough for 'free' things. I'd rather pay and know exactly what (and in this case, much more importantly, when) I'm getting. And from what I've noticed, my personal beliefs that people should strive for optimal health rather than mere preservation of life, is a popular opinion deemed 'unrealistic' by experts.

So I'm not sure what constitutes "most free healthcare systems" but Canada is apparently different from "most"

We generally call this the 'Iron Triangle' in healthcare policy/management. You basically get a pick at most two out of (1) access, (2) quality, (3) cost.

As to your general sentiment healthcare is a bit 'one size fits all' when in terms of insurance/reimbursement solutions. Note that the needs of the aforementioned triangle are weighted differently based on acuity of care. More generalized simple/low acuity care we are happy to get low cost and ready access as our best solutions (e.g. minute clinics, online/virtual care/telemedicine for getting a vaccine or pinkeye/localized infection without complication).

Meanwhile ER representing the other spectrum we instead have greater need for higher quality and access. You must get to an ER ASAP and get stabilized.

Chronic care quality solutions with long term cost-effectiveness are what are needed. Access to a specialist for longer term condition management (or episode or care like a cancer diagnosis).

Similarly more procedures are becoming outpatient, or recovery at home, or at dialysis centers, or at skilled nursing facilities ... you get the point.

I argue the problem is that the insurers have not adequately fragmented the insurance market/reimbursement model. Healthcare is changing in how it is delivered and insurers are not keeping up with it when it comes to modeling their payouts. For example why does being in-network matter for low cost care at outpatient facilities? The added 'negotiation' of being in a specific network doesn't add much value. One size fits all doesn't work with the modern spectrum of care.