Cigarette use kills 480000 people every year in the US alone. 300 billion dollars estimated to be spent per year with treatment of smoking-related illness.

I don't want even to look at the numbers of the more critical epidemic on the US: obesity and metabolic diseases.

By arguing that "the unvaxxed" are a burden and that they deserve discrimination, you are opening the gates for those arguing that smokers should be forced to stop smoking, or that obese people need to be forced to stricter diets.

We already have discrimination in medical care its called 'triage', unfortunately it doesn't involved removing care once granted.

We also charge smokers more for health care due to the burden they put on the system, yet another form of discrimination.

You're also making the naive mistake of relating a stable system (smokers with health issues) with an unstable system (covid patients). These two types of systems have VERY different impacts on the medical infrastructure.

QED: no one is opening any flood gates. we've had this shit in place for over a century. we use to let you just die at home when you caught the plague.

Then go charge more for those who are at risk and reject the recommendation for vaccine. I'd argue that would be a lot more effective (and fair) to get people to vaccinate then any of the current sociopolitical pressure and ostracization.

But we could already charge more for certain things like being overweight and cover this issue anyway. IMO if your BMI is over a certain amount you should probably be required to take a Covid vaccine, but not everyone.

I’ve wondered why increased healthcare premiums for unvaccinated persons isn’t a tool we’re using.

I’m assuming it’s a bad idea for reasons that I haven’t thought through; I’d love to hear them from anyone who has spent time on the issue.

They're illegal because of Obamacare, I believe. My understanding is that smoking is the only pre-existing medical condition that can be used to discriminate.

>We already have discrimination in medical care its called 'triage', unfortunately it doesn't involved removing care once granted.

Based on seriousness of the case, not really on whether it was preventable in the first place. For extremely limited resources like organs there is consideration of future risks, but that isn't really the same thing.

>We also charge smokers more for health care due to the burden they put on the system, yet another form of discrimination.

So let insurance adjusters charge different rates for vax/unvac'd people covered by insurance like they do for smokers.

> Based on seriousness of the case,....

incorrect its based on likely hood of survival. no point in wasting resources on a soon to be dead individual when you can save someone who actually has a chance.

The Affordable Care Act (Obamacare) doesn't allow medical insurers to set premiums based on vaccination status.

To be consistent, we probably shouldn't be covering people who ride or drive vehicles. https://www.cdc.gov/media/releases/2014/p1007-crash-injuries...

I mean, that's a pretty decent comparison. Society has spent the last few decades encouraging people not to smoke, using everything from campaigns to actual laws that make it harder to smoke. This has caused smoking to go down a lot.

So in that sense, the response to COVID is similar - though on an accelerated time scale, because the epidemic is much worse.

> So in that sense, the response to COVID is similar - though on an accelerated time scale, because the epidemic is much worse.

Tobacco still causes 480K+ deaths a year in the US so saying covid is worse is a very strong claim.

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

Thanks for bringing those numbers. Kind of crazy to me that tobacco still causes so many deaths - I had no idea.

I think the epidemic is worse in a few particular ways (though obviously not as bad in other ways as smoking, since I doubt COVID will keep causing 480k deaths a year). Ways in which it is worse:

1. It causes a spike of hospitalizations - this causes much less healthcare to be available in general. Smoking is already (regretably) factored in, I imagine, and doesn't cause sudden spikes.

2. COVID is generally not something you can protect yourself from - unlike smoking, which is to a much greater extent a personal choice.

3. Efforts to contain COVID are having a drastic effect on the economy in a way that smoking doesn't (both government-mandated and personal actions.)

1, Sure it does stress the hospital system in a different way.

2, Whole heartedly disagree with. Covid has specific health risk factors (Obesity, Diabetes etc) that long term people have a similar level of control over as smoking. People also have direct control over how much risk they want to take; there are vaccines, there are therapies, there are N95 Masks & no one is forcing you to go to a bar/club/sporting-event.

3. I'm not going to attribute to Covid the panic and over-reaction because of its novelty. Just like we don't attribute to the 9/11 terrorists the destabilization of the middle east and hundreds of thousands of deaths.

2. that's partially true.

But people don't always control having diabetes. People don't control having cancer. People don't control other forms of immunocompromisation. People don't control being older.

3. I don't think it's an overreaction. You said in 2 that there are vaccines, therapies, masks. These things took a year to get to. If not for the actions in the first year, there'd be many more dead.

Tobacco has killed millions in the US and will keep killing millions in the US for the foreseeable future... I don't know how you can objectively even begin to justify saying Covid-19is worse... Especially in a world world with multiple highly effective therapies and vaccines

> you are opening the gates for those arguing that smokers should be forced to stop smoking, or that obese people need to be forced to stricter diets.

Honestly, then good, we should open that can of worms.

> 300 billion dollars estimated to be spent per year with treatment of smoking-related illness.

AFAIK this treatment doesn't include "clogging an ICU because these people are on ventilators". I could be wrong though.

I'd be interested to see a poll of pro-vaccine-mandate individuals asking these questions:

1. Should smoking be banned? (by smoker status)

2. Should obese people be forced by the government to restrict calories? (by obesity status)

I honestly have no idea how it would go. Most people are more coy about those opinions.

Some countries are starting to ban smoking - look at New Zealand. Personally I am not against it specifically - if you are going to do some kind of extra harmful drug it might as well at least be one that is not so damn boring like Nicotine.

Obese people is a more complicated issue and I would argue that (at a societal level) it is an indicator of a larger social problem that is then causing the issue downstream just like other issues of addiction. I think we would be better off targeting that issue upstream.

That being said I do really like that in some countries (Japan, from what I hear) your general doctor can prescribe you basic things like "exercise". It must be painfully obvious to so many doctors out there that the best solution to some problems is to get the person actually moving more but instead they have to beat around the bush with after the fact duct tape type medical fixes.

> I think we would be better off targeting that issue upstream.

I'm not sure I understand. You mean like banning certain foods?

Smokers, obese people and metabolic diseases are not filling up hospitales at the unsustainable rate unvaxxed people are; and none of those can be quickly fixed with a pinch in the arm, not even nicotine addiction.

Yeah, at this time of the year they are being filled by all types of seasonal respiratory diseases, like it happened for most years in recent times, even before Covid. The flu shot is widely available and recommended for most over-55 (I think?), but you don't hear anyone claiming that it should become mandatory.

Actually, that's not true.

We have some hypotheses that children are the flu reservoir and that if we required them to get an annual shot it would tamp down flu seasons.

The primary difference is that the flu vaccine is predictive and can miss. It's kind of hard to demand that people take something that may not work.

If we got something genuinely terrible like Spanish Flu, yes, everybody would be demanding that people get a flu shot.

So let me get this straight, what you are asking is why not add one more huge problem to an already near-collapse system because there are already huge similar issues that caused it to be in that state?

What I am saying is that we have for two years already heard that the restrictions and mandates were to avoid overloading a then-unprepared-and-taken-by-surprise health system, but the US still can't even have large-scale availability of rapid tests.

I am also saying that if problem of the health system is lack of personnel, then firing healthcare workers who refuse the vaccine (even after being infected) is counter-productive and can only be seen as a bone-headed political move.

But most of all what I am saying is that we should not accept the policy theater. Making this about vaxxed vs unvaxxed is just yet-another way for governments (worldwide) to hide their ineptitude.

It's been two years already. Countries in Europe with comparable levels of vaccination to the US are already treating Covid as "just a endemic, seasonal respiratory disease". Yet the US still wants to pretend that things just don't get solved because of rednecks and "problematic people" that need to submit to the will of the elite.

So vaccines are "the will of the elite"? I can't wait until this guy finds out most vaccines are mandatory to enter the public education system and has been that way in most countries for decades, even in red states like Texas.

Don't be stupid.

It is not the vaccination, per se[*]. It is the political maneuvering and using the unvaxxed as a cover for their failures, this perpetual "if only they did what we are asking of them", etc. The will of the elite is that we accept this perpetual terror until we give them carte blanche for them to do whatever "Big Reset" they want.

In Germany we are testing our kids twice a week at a minimum, and everyday when/if a positive test is found in the school. Case numbers are high, measures are in place, but people are mostly living their lives without waiting for Mary from Bumfuck Alabama to get her shot. Why is it so hard for the US to drop the empty pointless rhetoric and get their shit together?

[*]If it helps you, I am not against the vaccines. I got mine, boosters and all. What I am against is the policy theater. What I am against is schools being closed and causing a lot more long-term harm to kids than the potential risks of them getting covid. What I am against is firing health care workers for political reasons while claiming that the system will collapse unless everyone complies.

I actually think children are much better off with what you call "long-term damage", this generation will now be way more likely to be ready for the next pandemic which is _not_ a question of if but _when_, with this first-hand experience hopefully they will avoid many of those failures you complain about (when many of the reach political positions in their adulthood); and is not like they are getting anywhere near serious long-term damage like during the black plague when most children saw half of their family die and there was no internet, or electricity or any of the niceties they now enjoy.

You are kidding, right?

Granted, a very cynical view of the educational system is most Western countries is that it is a glorified time-waster for kids to be busy while parents work. But even that was lost during the pandemic. Most schools basically have given up on getting students to learn anything this past year. Lockdowns have acted as prolonged stunt on children's socialization opportunities. Anxiety levels for teenagers are through the roof.

The effects of these two years on younger kids will be profound and long-lasting. They are paying a lot more than their share of risk. And saying "they are not dying" is not a consolation because - unlike with the Plague - kids are basically zero-risk compared with other age groups.

> At least they had internet and other niceties

Are you serious? The last thing you should want for kids is for them to become dependent on something like the Internet. Such a comment is almost offensive to a parent that does not want to see their kids turning into mindless, socially-inept drones like the average HN-commenter.

Actually, they do. It's not the young unvaxxed athletes who end up in ICUs, it's those people with obesity and other comorbidities who fill up hospitals.

You are being pedantic, in this context I obviously meant vaxxed smokers, vaxxed obese people, et al.

And most of the people (vaxxed or not) who need critical care with COVID have those pre-existing conditions.

Well that is not true actually - they likely are filling up hospitals quite a bit. The big difference is that smoking, metabolic diseases, car accidents, etc etc are all relatively PREDICTABLE diseases year to year. Our medical system then sizes to be able to deal with these predictable rates of disease.

Unvaxxed are not filling up the hospitals at a higher rate than vaxed now. The two doses you got in the summer doesn't work anymore.

This is one of the reasons for motorcycle helmet laws and maybe seat belts

The same reasoning can be applied to obesity.

...only if (and if only!) obesity were a problem that could be solved by a couple of quick, free shots at the local pharmacy.

"free shots"... hah those shots cost Tens of billions of dollars if not more. It was a totally worthwhile investment to make (we probably should have invested more in it) - but lets not pretend like there is nothing we could do about obesity if threw 100 Billion at the problem.

It'd be interesting to see what big pharma could come up with in a year.

Obesity isn't exogenous, infectious or subject to exponential growth. Even a superficial consideration of the facts shows that analogies between obesity and covid are unsound.

Not really. Various groups may disproportionately take up health resources, but the risk we're talking about is acutely overwhelming health systems.

This is definitely the most pressing issue, but shouldn't we also, as a society, build the ability to e.g. double ICU capacity when needed? We're not talking about 100x here.

As much as I support vaccination, it feels like gaps in vaccination are also used as an excuse to blow off repairing an extremely fragile public health system. We've had two years at this point.

Two years doesn't seem like very long to double ICU capacity. How are you going to staff them? Nursing degrees take 3 years. Medical degrees much longer. And capacity to train doctors and nurses is also stretched by the pandemic and non-trivial to expand.

I do agree that this is something governments ought to be looking into over the long term though.

If the short-term problem is specific to Covid, you just need to bring/train people for that.

Training people to assist Covid cases, run PCR tests, should be a matter of weeks, not years. Germany did it, I have 4 (four!) test centers on within a block of distance, all of them are filled with students and otherwise-unemployed people who got some minimal training.

I don't think test centres are the problem. I live and the UK and the only time tests were scarce was a few days around Christmas when there was very high demand.

A standard nursing degree in Europe takes three years. That's not a scientific law, it's not like it takes 365 * 3 * 2/3 = 17520 hours to learn how to be useful in an ICU. An LPN can be done in a year. We trained mechanical engineers in as little time during WWII.

If we're to treat this like an emergency, why aren't we treating it like an emergency?

> If we're to treat this like an emergency, why aren't we treating it like an emergency?

Because in truth it probably never was. We assembled fully staffed field hospitals that went completely unused.

Junk food has consumption tax

Also, assuming their obesity is a life style choice instead of type 1 diabetes, I suspect many obese people would be willing to take a easy vaccine if it exists considering how big the lose-weight-quick industry is

Next time I have to postpone an elective surgery for 3 months because obesity cases have filled the ICU, then you can apply the same reasoning.

Obesity isn't contagious and doesn't have spiky behavior in hospitalizations. We also know a reliable cure even if its very difficult to put into practice (impossible for some).

Obesity is one of the big contributors to Covid infections that require complex hospital care. The two are linked.

That's why I think vaccination schemes that offered free food were undermining the "following the science" bit.

As was the banning of the popular "Parkrun" in the UK, which is a collective outdoor exercise event, during the lockdown.

So many policies have undermined the "follow the science" bit in my mind.

one run and one meal is not gonna make or break someones weight. one vaccine might save their life

You edited your comment.

> one run and one meal is not gonna make or break someones weight

On the contrary, we have had two years of this pandemic. Government messaging could have been a lot stronger on the benefits of exercise. That's 2 years for people to become healthier.

And "one vaccine" has turned into one vaccine plus boosters. Everyone is going to get Covid at some point. General fitness will remain one of the best long term ways of combating the virus.

The Parkrun is a weekly occurrence, and is popular even for those who do not have an interest in exercise as a hobby, as it is informal. As such, it acts as an important gateway to a healthier lifestyle.

I'm by no means alone in seeing banning it as counterproductive, and not "following the science".

https://www.bbc.co.uk/news/uk-wales-59816344

If the government wants to serverely curtail individual liberties, then I expect good reasons for doing so. It's not good to encourage blind adherance to illogical policies.

I highly recommend reading this series if you think obesity is a personal failure: https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-p...

Obviously, yes, medical conditions do place burdens on health systems. That's why we tax cigarettes highly. However, in spite of considerable public health initiatives, the obesity rate continues to rise...

The numbers are equal now with the new variant.