Purple wrote:I'm surprised no one has mentioned the role of public education in this matter. The big bad gov'ment already had public schools and PSAs in a variety of media to employ. Instead of writing stupid laws why not try to teach people to avoid what's bad for them.

It would be better, of course. But our diets are usually a product not of our education but our home environment, so it will have limited effect.

PS: hi. Newbie.

Hi. You've joined at a very interesting time. Hope we can make you feel welcome.

danivon wrote:Well, when (as in the UK) the health problems of people are largely paid for by the public via the state, it does change things a bit. This does present a case for pushing prices up, because the state is saying essentially "if you want to do X which leads to higher costs, you pay for it - if it costs you too much, well, luckily you'll be healthier as a result".

I have problems with this argument as well. However, I am not sure I can articulate it clearly enough so please bare with me. It is my understanding the U.K. has a separate and specific tax for the healthcare system. If that is the case, then I would think already "pay" for the healthcare system so what business of the government's is it what I eat.

I would also then make the same argument to you Dan that I made with Freeman. Why not put a special laziness tax over and above any other VAT on video games and its console systems. I mean if you are going to sit on your ass playing video games you're going to get fat and have increased health problems. Hasn't scientific studies proven that?

Where do you draw the line?

Examples of SNP banning? I'm aware that they are introducing a miniumum price for alcohol, but what have they actually banned, and what else have they made more expensive?

By the way, the UK PM, David Cameron, has also talked about using 'nudges' in public policy.

I exaggerated a little. The SNP have shown a remarkable intolerance to individual lifestyle choices though, along with an alarmingly authoritarian streak in other areas. There's been the minimum alcohol pricing legislation, this is the centrepiece. On top of that though they were foursquare behind the early introduction of the smoking ban in Scotland, and they've even looked into banning all cigarette vending machines, although I believe this may not have happened yet. In addition they're currently looking into banning advertising of fatty foods.

This stuff is relatively minor though. Far more concerning is the anti-sectarian chanting bill they recently passed which effectively criminalises rude words at a football match (or in fact on the way to or from a football match). This is a very intrusive piece of legislation that curtails free speech, but the SNP are proud of it.

I'm aware of Cameron's infatuation with 'nudging' btw. I don't agree with it when it comes from a centre-right government either.

Well, when (as in the UK) the health problems of people are largely paid for by the public via the state, it does change things a bit. This does present a case for pushing prices up, because the state is saying essentially "if you want to do X which leads to higher costs, you pay for it - if it costs you too much, well, luckily you'll be healthier as a result". Other measures do make sense, although 'maximum portions' are not what I'd call the most common sense approach.

I don't agree with this. You might just as easily say that anybody who takes part in mountain biking stands a much greater chance of suffering a severe injury, or people who jog a lot on concrete roads might incur long-term damage to their knee joints, or vegans might suffer long term health problems due to their lack of a properly balanced diet. Why is nobody calling for these people to be 'nudged' into a lifestyle that doesn't cost so much to the state ?

Besides which, 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, and by far the bigger proportion of healthcare spending is on care of the elderly. These things average out over time, and there are many behaviours which are not being punished.

Ultimately, while the whole 'costs being borne by society' argument is widely used, it's disingenuous and doesn't really stand up to close scrutiny. It isn't about the cost and never has been. Certain behaviours are looked down upon and busybodies seek to control them through legislative means. Other behavours could lead to similar costs but they're not seen as socially undesirable so they're actively encouraged.

Sassenach wrote:Besides which, 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...

LOL. This is so non-factual as to call into question your entire credibility. I dare you to cite any credible studies supporting this absurd proposition.

Google is your friend.

This is pretty much the first thing I found:

http://www.ahrq.gov/research/ria19/expendria.htm#HowAre

Older People Are Much More Likely To Be Among the Top-spending Percentiles

The elderly (age 65 and over) made up around 13 percent of the U.S. population in 2002, but they consumed 36 percent of total U.S. personal health care expenses. The average health care expense in 2002 was $11,089 per year for elderly people but only $3,352 per year for working-age people (ages 19-64).5 Similar differences among age groups are reflected in the data on the top 5 percent of health care spenders. People 65-79 (9 percent of the total population) represented 29 percent of the top 5 percent of spenders. Similarly, people 80 years and older (about 3 percent of the population) accounted for 14 percent of the top 5 percent of spenders (Chart 2, 40 KB).2 However, within age groups, spending is less concentrated among those age 65 and over than for the under-65 population. The top 5 percent of elderly spenders accounted for 34 percent of all expenses by the elderly in 2002, while the top 5 percent of non-elderly spenders accounted for 49 percent of expenses by the non-elderly.4

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.

Purple wrote:I'm surprised no one has mentioned the role of public education in this matter. The big bad gov'ment already had public schools and PSAs in a variety of media to employ. Instead of writing stupid laws why not try to teach people to avoid what's bad for them.

I think that the reason is quite clearly that the law has little to do with health. I just noticed that contrary to my prior assumption, c-stores are exempt from the law. Now how is that going to have any effect, when a lot of people buy from c-stores and bodegas?

Purple wrote:I call the law "stupid" because as Bloomberg admits (and some below have noted) it's not a ban on soda merely an annoyance - you have to make multiple purchases to attain more than X quantity. You'd think that in this day and age g'ment would be smarter than to go about making an intentional annoyance of itself. The people are already thoroughly annoyed by/with the g'ment. Passing "annoyance laws" is just bad salesmanship.

The sad thing is that the state of modern us political thought is that this is an "oh-well" and some boneheads actually praise this stupidity. The thing that scares me the most is that it seems that Americans will take any sort of punishment. They've been beaten into statist submission to the point that governments can make completely irrational and annoying laws, and nobody seems to care.

How much more are you willing to take?

Purple wrote:PS: hi. Newbie.

Welcome! Let me know if you are interested in an Adjutant only (newbie) game on the forum. I'll be glad to host one if we can scrounge up enough new members

Archduke,

I think you draw the line is where it is prudent to do so. Putting calories counts on fast food items is helpful (I believe that was required by the new health care law); I think we should be spending money on ads to educate people about the dangers of eating too much fast food and soft drinks; and I think some moderate levels of taxation are appropriate.

See this website for the scope of the problem: http://www.caaccess.org/pdf/6_unhealthy_truths.pdf

I think fast food and soft drinks are comparable to tobacco. The way we solved tobacco was by spending a lot of money on informing consumers and we taxed tobacco to the hilt. Guess what? A lot more people smoke less which means we will be spending a lot money on caring for diseases caused by the consumption of tobacco.

Lke it or not, we already have a form of socialized medicine. If you're poor and you're not eligible for Meidcare of Medicaid, you still are entitled to emergency room treatment. And of course the very poor and the old are entitled to be treated. Of course, I don't have a problem with that. The issue is that if we are going to get health care costs under control (regardless of what system we are going to use), we need to discourage behaviors that are driving health care costs through the roof.
(As an aside, I remember in California there was a proposed law to require the use of motorcyle helmets. At first I felt like well why should the State care about that, but when the estimate was that the cost of taking care of brain injured motorcyle riders was something like 100 million dollars in California, I was definitely for the law).

Yes, we need to "nudge" better eating behaviors or pretty soon we will have a bankrupt government. We are not doing this for the good of the individual but for the good of the society). If everyone was responsible for their own health care costs, there would be no need to discourage poor eating habits. But that is not the system we have and so there is a governmental interest in putting moderate impediments on eating whatever you want. Look, if you really want your fast food, you can get it-- I am not in favor of banning things. But I see nothing wrong in making it a little harder to get. Health care costs are 17% of GNP-want to see it to go 25% of GDP (the stats on childhood obesity make it likely that this problem is just getting to get worse)?

Archduke Russell John wrote:It is my understanding the U.K. has a separate and specific tax for the healthcare system. If that is the case, then I would think already "pay" for the healthcare system so what business of the government's is it what I eat.

Your understanding is incorrect. We have National Insurance that is similar to your Social Security payroll taxes, and which is used towards state pensions and the NHS (so it's not specific to healthcare, and it predates the NHS by some 35 years). However, it is not really hypothecated, and the NHS budget is about the same level as total NI revenue, so in reality the health budget is largely funded from general taxation.

Even so, it's the business of the government here to provide the NHS and healthcare, and if the costs rise due to people making stupid choices, the government will have to deal with it somehow. They could just increase NI, but that means that healthy people are subsidising the lifestyle choices of the unhealthy, which doesn't appear to be particularly equitable. That would appear to mean giving people freedom to eat what they want as they like but handing some of the responsibility to everyone else.

That's the thing about 'freedom' - if you are externalising the costs of your choices, someone else is losing a bit of freedom so you can do what you like.

They could, of course, decide to ration treatment based on previous lifestyle, but that's acting a little too late, and it's generally better to have people less likely to make bad choices to begin with.

I would also then make the same argument to you Dan that I made with Freeman. Why not put a special laziness tax over and above any other VAT on video games and its console systems. I mean if you are going to sit on your ass playing video games you're going to get fat and have increased health problems. Hasn't scientific studies proven that?

Well, when you put it that way...

Why not?

Of course, as video games and consoles are quite expensive new, the VAT on them is fairly high already. And you'd want to exempt Wii Fit and the Wii Sports ranges, as well as Kinect games and whatever comes next.

Where do you draw the line?

It's got to be drawn somewhere between allowing people to sell arsenic as food and people being hooked up to Matrix-style feeding tubes. Other than that, I don't know really, as it's a balancing act between different concepts - freedom of consumers, freedom of producers, responsibility of the consumers, responsibility of producers, effect on wider society, costs borne to government...

How about this idea? Rather than declare now, for all time, the arbitrary point where the line is to be drawn, what about looking at each proposal that comes up on it's merits and saying yea or nay to it?

Sassenach wrote: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.

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?

danivon wrote:Your understanding is incorrect. We have National Insurance that is similar to your Social Security payroll taxes, and which is used towards state pensions and the NHS (so it's not specific to healthcare, and it predates the NHS by some 35 years). However, it is not really hypothecated, and the NHS budget is about the same level as total NI revenue, so in reality the health budget is largely funded from general taxation.

Thank you for the clarifications.

danivon wrote:Even so, it's the business of the government here to provide the NHS and healthcare, and if the costs rise due to people making stupid choices, the government will have to deal with it somehow. They could just increase NI, but that means that healthy people are subsidising the lifestyle choices of the unhealthy, which doesn't appear to be particularly equitable. That would appear to mean giving people freedom to eat what they want as they like but handing some of the responsibility to everyone else.

Isn't that the point of a national, singlepayer healthcare system. To equalize the cost over the whole populations or in other words make the healthy cover the cost of the sick?

danivon wrote:How about this idea? Rather than declare now, for all time, the arbitrary point where the line is to be drawn, what about looking at each proposal that comes up on it's merits and saying yea or nay to it?

Because then there is always a fight to push the line a little bit further. I can't tell you how many times I heard someone who didn't qualify for a gov't program because they exceeded the income limit by some small amount say something along the lines of "I only missed it by $10 why couldn't they make an exception."

I guess my point is the line is your healthcare tax. If it isn't enough to cover your gov't run healthcare cost raise the tax. It is not the gov't job to "nudge' my behavior.

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.

But of course I also had a wider point, which you ignored. This is the point that there are many activities which may result in a health burden on the state which are not currently afforded pariah status. I don't really believe that the potential burden on state funds is the real reason why we now see busybodies attempting to control the lifestyle choices of others. It's a bogus argument.

archduke

Isn't that the point of a national, singlepayer healthcare system. To equalize the cost over the whole populations or in other words make the healthy cover the cost of the sick?

Isn't it the point of ALL insurance programs?

The difference being that in national single payer systems there are administrators of the plan actively working to limit the fees and charges from suppliers... Which has been proven to keep down the absolute cost of procedures, medicines and treatments...

purple

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?

There was a rumour that there was a remote trube in Africa where everyone lived to be 135. When a jourmalist was sent out by the Guardian he asked the Chief of the Tribe "Why does everyone in your tribe live to be 135" and the Chief answered " We find when we let them live any longer they start to get on your nerves..."

Archduke Russell John wrote:Isn't that the point of a national, singlepayer healthcare system. To equalize the cost over the whole populations or in other words make the healthy cover the cost of the sick?

That's an over-simplification of it. It's really about making sure that those who need care can get it free at the point of delivery. Essentially so that the poor can get treated and the middle don't have to worry if the worst happens. What we have is not 'singlepayer' so much as universal coverage.

danivon wrote:How about this idea? Rather than declare now, for all time, the arbitrary point where the line is to be drawn, what about looking at each proposal that comes up on it's merits and saying yea or nay to it?

Because then there is always a fight to push the line a little bit further. I can't tell you how many times I heard someone who didn't qualify for a gov't program because they exceeded the income limit by some small amount say something along the lines of "I only missed it by $10 why couldn't they make an exception." [/quote]And there's always a fight to push it the other way, "they don't deserve what they are getting..

I guess my point is the line is your healthcare tax. If it isn't enough to cover your gov't run healthcare cost raise the tax. It is not the gov't job to "nudge' my behavior.

But as I've pointed out and you have acknowledged, we don't have a 'healthcare tax', and there are other ways to raise revenue that coincidentally target higher risks.

Dan, I think Russ has grasped the basics of NHS funding well enough to make a point on this subject. The exact specifics of how we fund it are not especially relevant.

The wider question is whether the state really has any business in trying to push us into certain patterns of behaviour that have been deemed to be 'good'. I don't think you've yet made a sufficiently convincing case that the decisions made by smokers, drinkers and eaters of fatty foods to indulge their pleasures incurs such a burden on the rest of society that it justifies interference in our choices.