Perhaps if we had some stats on tbe costs of smoking, alcohol and obesity related health problems to the NHS, we'd get an idea?

Unfortunately I will be drinking heavily over the next 36 hours in a bid to avoid Jubilee related craziness, so it may have to wait

Sassenach wrote:

A principal reason why health care spending is spread out more evenly among the elderly is that a much higher proportion of the elderly than the non-elderly have expensive chronic conditions.

Honestly, I'd have thought it was taken as a given that older people need to spend more on healthcare. I'm surprised you even questioned it.

But it doesn't prove that healthy lifestyles end up costing as much as unhealthy ones. People can live longer and still be unhealthy.

My nan lived into her seventies, but the chain smoking is what killed her. After a long period of health problems that meant plenty of visits to hospital and homecare and equipment installed at her flat to keep her going.

Which is why when smokers smugly tell me that they are doing me a favour by killing themselves early I am not impressed. Lung cancer and emphysema are not a nice way to go and can take a long time. I think they imagine the only risk is a nice quiet heart attack over night.

Point is, the elderly people most likely to be having chronic conditions, or complications to them are perhaps also the ones who led a less than healthy lifestyle when young.

An example is soft drinks. Heavy use can lead to osteoporosis. That won't kill you usually on its own, but it means later in life a fall will be more likely to break a bone and the breaks will be worse.

Sassenach wrote:

You didn't assert "that older people need to spend more on healthcare". You said, "those who live a healthy lifestyle will inevitably end up costing the state far more in the long run because they're likely to live longer..." The stat you provided was for ALL old people, not just those who lived a healthy lifestyle. Can you see the difference?

Yes, I do understand the difference. My point was that healthcare costs for the elderly tend to go up sharply, and the longer you live the steeper the curve. This is because the older you get the greater your dependence on prescription medication and the more likely you are to pick up chronic conditions. These things happen whether you lived a healthy lifestyle or not, but a healthy lifestyle is probably more likely to mean you won't die young and so by logical inference it's likely to mean that the period during which you incur the steeper healthcare costs will be prolonged. I suppose my use of the word 'inevitably' was misplaced, but I do think it's a pretty logical inference that a longer life will end up costing more in healthcare. I should add btw that since things like smoking and drinking tend to be taxed heavily the chances are that those who indulge in these activities will have contributed more over their working lifestimes than those who don't.

Just on this smaller point, I think it is more complicated than you describe. People who are obese die earlier, but also develop chronic conditions earliers in their lives. Heart disease, diabetes, and dialysis are all very expensive chronic diseases. If you have them in your 40's and 50's which is becomming more common, it is very expensive, even if you die in your 60's. I'm not commenting on the larger issue of soda portions, and I really don't know which way this detail issue goes, but I don't think you can make the logical inference that soda drinking saves the state money with that sort of confidence.

(Oh, I now see that Danivon made the same point.)

If people had to pay for their own health care, they could make the choice themselves. Then they could smoke, drink soda, live healthily. Their choice.

bbauska wrote:If people had to pay for their own health care, they could make the choice themselves. Then they could smoke, drink soda, live healthily. Their choice.

possibly. Of course, infectious diseases can affect the 'healthy' as muc as the unhealthy.

Just another way we are all equal...

Let me respond to Archduke's critique in a more formal fashion. I would say government can regulate such things as the consumption of soft drinks if the govenrmental intrusion is minimal and there is some kinf of rational basis for government inrusion (in this case trying to reduce health care costs). I would note that the governement regulates whether we can take certain drugs and the intrusion is great (incarceration) and the purported government interest being served is highly questionable.

Yes, I agree with you Brad--as long as every person paid in cash for their medical care then we would never have a reason to care whether another person makes poor choices with regard to what they eat or drink. I think it gets more complicated when you have insurance involved, however. A person might pay for their own insurance, and they can afford that, but what happens when they get a chronic disease? At that point, either the person has to be fairly wealthy to afford expensive treatment or the insurance plan subsidizes their poor chocies. In order to be fair once someone gets cancer or diabetes their health care premiums should be adjusted to account for the fact that they are a poor risk. We also have the fact that insurance should be there to deal with what a person's health care costs should be in a year along with anadditional amount for profit for the insurance company. But a person can affect this risk by making poor choices. And that means the insurance company has to raise premiums on persons making healthy choices to subsidize the ones making poor choices. In other words, once insurance gets involved then there can a justified concern that people don't get to be 400 pounds without us putting some minimal impediment to their doing so.

So, again, you need a cash only system for there to be no concern about others making poor health care choices. But given how expensive treatment can be when it is needed, having a cash only system doesn't make sense either.

IIf you want to argue that the fact that Americans eating so much fast food and soft drinks is not correlated with the increase in chronic diseases, that's fine, I disagree with you but that's fine. But really, do people think they have a Consitutional right to a big gulp?

Look at it the other way, Freeman2. Does the government have a right to prohibit the big gulp?

I will post a link about cash medical costs and how low they are comparatively after my son's 1st baseball game as a fan.

freeman2 wrote:Yes, I agree with you Brad--as long as every person paid in cash for their medical care then we would never have a reason to care whether another person makes poor choices with regard to what they eat or drink. I think it gets more complicated when you have insurance involved, however. A person might pay for their own insurance, and they can afford that, but what happens when they get a chronic disease? At that point, either the person has to be fairly wealthy to afford expensive treatment or the insurance plan subsidizes their poor chocies. In order to be fair once someone gets cancer or diabetes their health care premiums should be adjusted to account for the fact that they are a poor risk. We also have the fact that insurance should be there to deal with what a person's health care costs should be in a year along with anadditional amount for profit for the insurance company. But a person can affect this risk by making poor choices. And that means the insurance company has to raise premiums on persons making healthy choices to subsidize the ones making poor choices. In other words, once insurance gets involved then there can a justified concern that people don't get to be 400 pounds without us putting some minimal impediment to their doing so.

So, again, you need a cash only system for there to be no concern about others making poor health care choices. But given how expensive treatment can be when it is needed, having a cash only system doesn't make sense either.

IIf you want to argue that the fact that Americans eating so much fast food and soft drinks is not correlated with the increase in chronic diseases, that's fine, I disagree with you but that's fine. But really, do people think they have a Consitutional right to a big gulp?

A cash only system is not the only way medical procedures could be paid for. I used to get dental work on trade. I exchanged his services for mine. I still paid about 50% cash, but the costs were not very high. Cash payments lower costs. And while trade isn't available to everyone, it is still cheaper.

As you indicated, the insurance system is the problem. So why continue to punish people with stupid laws, trying to dictate health? Moreover, why should the government be involved in protecting insurance liabilities? Adding more layers of bureaucracy and silly laws like this only serve to raise costs.

If the problem is the insurance system, fix that. It's no excuse for more vice laws.

I also recommend checking this company out. It's owned by the doctors, they have up front costs, and a cash pricing system.

People can figure out what they're likely to be prone to and save accordingly.

But even with the insurance system, there's still no justification for these types of laws.

guapo

But even with the insurance system, there's still no justification for these types of laws

While I agree that the Big Gulp Cup Size ban is dumb .... if you consider the history of taxation and restriction on tobacco .... perhaps there is justification.
http://www.cancer.ca/canada-wide/about%20cancer/cancer%20statistics/stats%20at%20a%20glance/lung%20cancer.aspx?sc_lang=en
Lowering cancer deaths isn't just justified by lowering health care costs, because there was significant damage by second hand smoke, people who didn't directly smoke were affected.

However, whenever the govenrment chooses to intervene with a law it has to be reasonably enforceable. Its not terribly difficult to tax a legal product, or restrict areas of use to private premises... However, as Freeman argues the "War on Drugs" hasn't been particulalry effective and it has had a lot of collateral damage. (The incarceration of many, the creation of violent crime cartels...)

It isn't sugary drinks that are a problem. Its their relative cost. Because they are cheap, over indulgence is possible for even the poorest person. In fact, their relative price versus healthier choices makes them doubly dangerous.
If government wants to copy the success of the battle to decrease obesity and diabetes it has the same weapons to use as have been rather successfully waged against cancer and other smoking related disease.
First make the product more expensive. One by eliminating the subsidies in place. Second by taxing the product. The example of tobacco here is clear.... Tax sugar similarly...
Second, educate the public ... Already being done.But could obviously be increased.
Third: restrict. More problematic. Drinking large cups of soda does't really interfere with other people the way second hand smoke does.... However restricting soda machines on school property is one small move.
Already, the consumption of sugary drinks is down from previous years because of education... . However the US leads the world in consumption. Some 216 litres of soda a year... Its not surprising then that the US is also a leader in diabetes...

http://www.nationmaster.com/graph/foo_s ... onsumption

If there were a tax on overly large cups, easy to enforce at the few factories that produce cups, perhaps portion size could be addressed? (Portion size being the biggest contributor to over consumption of calories...) However, it attacks only one conveyor of sugar, and a product wide tax would be fairer and easier to implement and collect.
But banning the cups in one region, in one kind of venue is both difficult to enforce and unlikely to have a significant impact.

The libertarian arguement is "Why should society give a damn what an individual does? and I have a great deal of sympathy for that arguement. With adults.
One of the problems with sugar water is that children are the most adversely affected, before they have an individual ability to make decisions for themselves. If their parents are irresponsible and feed their kids soft drinks several times a day, the children enter adolescents and adult hood obese and addicted to sugar...
By the end of subsidy and sugar taxation, adults would find it cheaper to sustain their children on healtier products than on sugar.

1) FYI here is Michael Bloomberg explaining his action in a brief piece in USA Today: http://www.usatoday.com/news/opinion/editorials/story/2012-06-03/sugary-drinks-Michael-Bloomberg/55366444/1

2) I recently had health reasons (nothing very serious) to lower my intake of simple carbs (i.e. sugar and starch) and increase my intake of complex carbs (i.e. whole grains). This is not impossibly hard to do if you put your mind to it, but you have to do some research and pay a lot of attention to food labels. I found that although my sugar intake had been way below the US average before, once I cut back I developed sugar cravings. I'd start searching the house for something sweet to eat. I'd never really considered whether sugar might be addicting. There's scientific evidence that it indeed is. Look up "Sugar addiction" at Wikipedia.

While I'm enough of a libertarian to want government to avoid nanny-state regs as much as possible, I'm more sympathetic when it comes to addictive substances. If Michael Bloomberg is imposing his will on me via his regulation, sugar, as an addictive substance, is robbing me of my will to resist its biochemical effects on my brain.

Being addictive is bad enough but sugar is diabolical in a second way. We evolved in a world without refined simple sugars. Honey was the closest thing to pure sugar but it wasn't easy to get. Healthy fruits and veggies do produce some complex sugars and we're attuned to seek them out, their sweetness being a sign of ripeness and nutritional value. We thus have evolved with a "sweet tooth" - craving sweets is biologically beneficial so long as sugar isn't available in simple form and unlimited quantities. But now that it is so available - overwhelmingly so - our once-adaptive instinct has become self-destructive.

Normally, when our bodies take in too much of a good thing, we excrete the excess. But because we never experienced any excesses of sugar intake as we evolved, we never developed the capacity to recognize that we were obese and to simply let sugars pass through us. We metabolize every molecule of it we can, even when it hurts us.

So while it's tempting to say "let us eat as much or little sugar as we wish" the fact is we're not biologically tuned to let even our well-educated wishes translate through willpower into appropriate action. I'm not saying it's impossible to resist sugar, but just look around... it ain't easy. So of all the things government (of, by and for the people) might try to regulate, sugar makes more sense than most.