My wife's aunt has been on disability for years because she hurt her back and refuses to quit smoking. The doctors said the smoking is preventing her back from healing correctly, and 3 back surgeries later, she still hasn't quit. Because she's poor and on disability, she doesn't have to pay for any of it, and is pefectly content sitting in her trailer watching TV and taking pain killers as her health deteriorates.

This is simply not a compelling argument against reform. It is a sad story and surely there will be people like this abusing any system, but making people face down bankrupts and death of loved ones is not the correct incentive against abuse of socially funded systems in my book.

And you think if she wasn't allowed to either have private health insurance (which is subsidized by others with health insurance) or have government-paid insurance, that she would suddenly stop smoking?

I think she'll keep smoking as long as she doesn't face any repercussions for it. Right now, she keeps getting free medical care to fix anything wrong with her, so she has no incentive to get better. If she didn't have that, then she'd have to make the choice between continuing to smoke, or having to be immobile and in pain because she couldn't keep getting medication and surgery to mask the health problems she's bringing on herself.

Speaking as someone who has parents whom smoke a lot, I think you don't understand the mentality of smokers or the addictive behavior of smoking.

Nothing is going to stop her from quitting smoking, even if she was denied pain medication or surgery. They'd find other ways to numb the pain and just walk straight into an early grave.

But... she does have repercussions? She has chronic back pain and deteriorating health...

Pain pills are either A) not going to be strong enough B) harshly addictive. Probably opioids.

Insurance and single-payer aren't the only two choices. It is possible to not like either.

Wow, she is living the dream.

You must live in a pretty blissful bubble. I have known or known of many people who continue bad habits in their life (e.g. excessive drinking and smoking) using government provided subsidies like disability, medicaid, and local programs.

Besides, if the prospect of lung cancer was enough to scare everyone off tobacco there would be no one smoking still. People are not always rational and yes I can see someone rationalizing their decision to smoke, in part, on the fact that if they do get sick they won't have to worry about paying for it. Or from the other direction if you know doing something could make you sick the prospect of simultaneous health and financial problems will be enough to push a larger portion of the public into making the healthy decision.