sin revenue

[happythoughts 0]

There seems to be an easy target for taxes. The sins of others.

Alcohol and cigs are often targets. At first, they were taxes
on evils of society. "We'll let them exist, but we'll punish them financially."

Then, they were the taxes on people who must have
excess cash to lavish on pointless chemical entertainment. A tax on "others".

Now, it has become reparations. Cig manufacturers must
pay for the damage done to society. Anyone stupid enough
to still smoke must pay for their future health care.

So... here we are. Society has determine that the latest
threat to health is... obesity.
How long before there is an obesity tax?
"That will be 9 dollars for that hamburger sir."

We can affectionately call it the "bacon tax".

(Interesting, and possibly NSFW, attachment)

[justinb138 0]

Quote

"That will be 9 dollars for that hamburger sir."

The minimum wage increase will probably take care of that pretty quickly.

[kelpdiver 2]

It certainly is a threat to our national debt over the few several decades. If we can't move to a working, cheaper system, attacking obesity probably is the other 'easy' way to drop costs substantially.

Personally I'd rather see it focus on the activity side rather than attacking the food. After hiking Mt Whitney, I deserve a whole pizza for myself. I think it's very difficulty to apply a fee system to 'unhealthy' food that is remotely fair when the issue with good fatty food is about balance.

In CA we saw a precursor to this sort of bureaucratic sillyness with the application of sales tax to certain food items deemed as junk/snack. It used to be that all food products did not have sales tax, but a decade back we adopted a highly complicated and inconsistent list of food items that should be taxed.

[riddler 0]

Reparations is correct. Alcohol can and should be taxed because it represents a great social and financial strain for society - drunk driving, uninsured health effects, etc. Cigarettes for the same reason - health cost, second-hand smoke, even pollution from cigarette butts.

It's not about "sin", it's about the financial and social burden imposed by our addictions. I don't cry boo-hoo over the plight of heroin addicts, and I don't feel bad for smokers that have to pay a fortune for a carton of cigarettes. If you can't take the tax, then give up the addiction.

Trapped on the surface of a sphere. XKCD

[TomAiello 26]

Quote

Alcohol can and should be taxed because it represents a great social and financial strain for society - drunk driving, uninsured health effects, etc. Cigarettes for the same reason - health cost, second-hand smoke, even pollution from cigarette butts.

It's not about "sin", it's about the financial and social burden imposed by our addictions.

Hey, I've got a weird idea.

What if people were to face the consequences of their actions for themselves? If they got lung cancer from smoking, they'd have to pay for the treatment (or buy a health plan that would). If they got fat, same story. That way, each person could decide for themselves if the cigarette, or the donut, was worth the true cost of their actions (including their future health costs). It'd be crazy, but that way we wouldn't have to police each other's actions, because we wouldn't have to pay the bills for them.

I know it's a crazy, revolutionary idea. I think I need to come up with a fancy new name for it. I've got it.

I'll call it "Personal Responsibility."

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[NewGuy2005 53]

Quote

I know it's a crazy, revolutionary idea. I think I need to come up with a fancy new name for it. I've got it.

I'll call it "Personal Responsibility."

That would never catch on, here. No way.

[nerdgirl 0]

Actually, higher obesity rate & smoking rate should correlate with *decreased* cost overall.
Sounds counter-intuitive at first, eh?

Healthy (non-smoking, non-obese) people cost more over a lifetime. Perhaps not per year … but they live longer and the amassed cost of living longer and diseases of old age make them cost more, e.g., 10 years at $5K is still less than 14 years at $1K + 1 year at $50K. Health care costs increase as one get older. If you die young, one avoids long-term care (that costs more) and diseases of old age, Parkinson’s, Alzheimer’s, etc.

Primary Data “Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure”

“The obese cohort has the highest health-care costs for diabetes and musculoskeletal diseases compared to the other cohorts. Lifetime costs for cancers other than lung cancer are equal for all cohorts. Despite differences in life expectancy, the costs for stroke are similar for all cohorts. The most pronounced difference in costs occurs in the category ‘costs of other diseases,’ which is purely the result of different life expectancies.

“Despite the higher annual costs of the obese and smoking cohorts, the healthy-living cohort incurs highest lifetime costs, due to its higher life expectancy, as shown in Table 1 (attached). Furthermore, the greatest differences in health-care costs are not caused by smoking- and obesity-related diseases, but by the other, unrelated, diseases that occur as life-years are gained. Therefore, successful prevention of obesity and smoking would result in lower health-care costs in the short run (assuming no costs of prevention), but in the long run they would result in higher costs.”

Secondary accounts,

Science Daily “Lifetime Medical Costs Of Obese People Actually Lower Than Costs For Healthy And Fit, Mathematical Model Shows

NPR “Study: Healthy People Cost Governments More”

MSNBC “Actually, it's a long, healthy life that costs more”

The model is purely monetary driven and does not make attempts to value quality of life or opportunity costs either from longer, healthier years, on public health concerns, or from quality medical care. Nonetheless, it does suggest that the perceived correlation between "sinful" activities and healthcare cost needs more examination.

And while I agree that some "sinful" activties certainly suggest variables worth investigating, a limited set (there are others beside smoking and obesity, those two just seem to be fixated on, imo) of behavioral traits do not appear to be the (an?) independent variable in determining healthcare costs.


[semi-facetious/farcical]
Us non-smoking, healthy-eaters -- & vegetarians are worse , stair-climbers, should get down off our high-horses … because on average we’re going to cost the healthcare system more in the long run. The most personally responsible thing to do is to die at age 65.
(Logan’s Run anyone?)
[/semi-facetious/farcical]


Now am I going to start smoking, stop eating healthy, and stop climbing stairs? No.
I like having a resting heart rate in the 50s (albeit upper 50s). When I had more free time and was running a lot more I tried to get it down to the 40s (never made it).
I’m going to maintain those behavioral choices not because I irresponsibly want to cost more in healthcare (statistically) but because, admittedly quite selfishly, I like climbing mountains and trekking to really big ones in other countries.

/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

[kelpdiver 2]

Marg, I've read claims suggesting the otherwise (and sorry, I'm not nearly so good at keeping them handy) - that the obese will live long enough, yet need far more expensive care. I think this will only get worse as we come up with better and better means to cope with our poor health.

With regards to the Dutch study you cite, is that cost model based on European care, or American? (Do they do gastric stapling in Europe?)

I also think the secondary costs - namely productivity - need to be captured as well.

WRT smokers, otoh, I can easily see the shorter life expectancy making up for the higher costs, unless we come up with ways to do lung replacements. Still have the productivity loss, though.

[TomAiello 26]

Quote

Marg, I've read claims suggesting the otherwise (and sorry, I'm not nearly so good at keeping them handy) - that the obese will live long enough, yet need far more expensive care. I think this will only get worse as we come up with better and better means to cope with our poor health.

...

WRT smokers, otoh, I can easily see the shorter life expectancy making up for the higher costs, unless we come up with ways to do lung replacements. Still have the productivity loss, though.

Perhaps there ought to be a "two tier" system for care after a certain age. Say, after 40, if you are ruled to have an "unhealthy" lifestyle, then you just get the basic care--no expensive measures to keep you going. If you have a "healthy" lifestyle, you could qualify for the stuff that's more expensive, and would keep you going longer. Maybe even allow an "uber-healthy" category, in which people would continue to get the most expensive procedures after age 70.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[FallingOsh 0]

Quote

Quote

Marg, I've read claims suggesting the otherwise (and sorry, I'm not nearly so good at keeping them handy) - that the obese will live long enough, yet need far more expensive care. I think this will only get worse as we come up with better and better means to cope with our poor health.

...

WRT smokers, otoh, I can easily see the shorter life expectancy making up for the higher costs, unless we come up with ways to do lung replacements. Still have the productivity loss, though.

Perhaps there ought to be a "two tier" system for care after a certain age. Say, after 40, if you are ruled to have an "unhealthy" lifestyle, then you just get the basic care--no expensive measures to keep you going. If you have a "healthy" lifestyle, you could qualify for the stuff that's more expensive, and would keep you going longer. Maybe even allow an "uber-healthy" category, in which people would continue to get the most expensive procedures after age 70.

This is somewhat related to one of my questions about universal healthcare. It drives me nuts to see people riding a harley at 70 mph through the city during rush hour traffic without a helmet on. If he chooses to do that then fine, but should his dumb ass be covered by universal care? What about the guy who's broken 43 bones in his body skydiving but continues to jump? My parents have smoked for 30 years. Should they be covered?

All of those actions are a great part of living in this country. We get to choose whether or not to go for a run or go to McDonald's. The argument is usually that the rich shouldn't pay for the poor. I think the deeper issue is whether the healthy should have to pay for the fat and lazy. Or the responsible should pay for the idiots who throw themselves out of airplanes.

--------------------------------------------------
Stay positive and love your life.

[SpeedRacer 1]

shit happens, though. You can still get lung cancer even if you've never smoked. Jim Fixx, who started the whole jogging fad in the 70s, died of a heart attack while running.

Any efforts to live a healthy life (exercising, eating right, not smoking) are only pushing your odds in the right direction, they're not securing any guarantees.

Speed Racer
--------------------------------------------------

[billvon 3,116]

> but should his dumb ass be covered by universal care?

Ask yourself if you saw that dumbass wipe out, and break his back in 3 places, if you would call 911 or just leave him to die. The answer to that question is also the answer to "should he be covered?"

> My parents have smoked for 30 years. Should they be covered?

For basic care, if they show up at the ER needing immediate treatment? Yes. For a lung transplant? No.

[TomAiello 26]

Quote

Ask yourself if you saw that dumbass wipe out, and break his back in 3 places, if you would call 911 or just leave him to die. The answer to that question is also the answer to "should he be covered?"

You've used that example a lot. We all know it's fallacious. All of the universal care proposals cover a ton of stuff that is far less urgent than a broken back.

If we were just talking about emergency care, your example would be useful. Since we're not, it's really just misleading.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[billvon 3,116]

> We all know it's fallacious.

I think you just don't want to think about it because it demonstrates what the end result of "every man for himself" really means.

>If we were just talking about emergency care, your example would be useful.

That's what I AM talking about. Treat him, put him in traction, and release him when someone can come and get him. If he wants non-emergent surgery, then he has to pay.

[TomAiello 26]

Quote

>If we were just talking about emergency care, your example would be useful.

That's what I AM talking about. Treat him, put him in traction, and release him when someone can come and get him. If he wants non-emergent surgery, then he has to pay.

That's your proposal. But you interject your hypothetical into discussions about the actual proposals being considered by Congress, which look nothing like your proposal. You're basically shifting the meaning of the terms (like "universal coverage") in mid-stream. It looks like an effort to hide what you are really arguing for, because you use your argument in discussions about a much larger coverage, while claiming "but I just meant basic emergency care".

Quote

I think you just don't want to think about it because it demonstrates what the end result of "every man for himself" really means.

Again, I think you're over-exaggerating in an effort to prove your point. Calling 911 when you see an accident doesn't mean that you don't want the injured person to pay for their care. It means that you recognize that they need help, and want to help.

Calling 911 is not morally equivalent to volunteering to pay a half million dollar hospital bill. The vast majority of Americans carry health insurance, so it's actually a fair assumption to think this hypothetical person has it, in which case you're not trying to obligate anyone (aside from him and his insurance company) to pay for his care.

Wanting people to pay for their care is not morally equivalent to wanting them to die if they can't pay up front. It's possible for people to arrange payment over a longer period of time, for services rendered (or goods received) immediately. It happens all the time in other areas (vehicle loans and home mortgages being two very common examples). Yet you seem unwilling to wrap your mind around the idea that it could apply here, too, and keep returning to your idea that an unwillingness to provide services for free is somehow going to eliminate medical care. Do you think that people who take out mortgages for their homes are somehow not actually being housed? Are people who take out loans to buy cars unable to drive to work?

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[billvon 3,116]

> Calling 911 when you see an accident doesn't mean that you don't want
> the injured person to pay for their care. It means that you recognize that
> they need help, and want to help.

Exactly. And that's true even if you know they can't pay. By calling 911, you are asking (indeed, expecting) that someone else pay for their care. Ideally them, but even if you know they can't pay, you want SOMEONE to come, and someone else to pay.

>Calling 911 is not morally equivalent to volunteering to pay a half
> million dollar hospital bill.

Again, agreed. It is morally equivalent to asking someone _else_ to pay the bill.

[TomAiello 26]

Quote

>Calling 911 is not morally equivalent to volunteering to pay a half million dollar hospital bill.

Again, agreed. It is morally equivalent to asking someone _else_ to pay the bill.

No, it's not. You can call 911 and still expect them to pay their own bill. Simply calling for help does not establish that you don't think the person should pay for their own care.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[georgerussia 0]

Quote

What if people were to face the consequences of their actions for themselves? If they got lung cancer from smoking, they'd have to pay for the treatment (or buy a health plan that would). If they got fat, same story. That way, each person could decide for themselves if the cigarette, or the donut, was worth the true cost of their actions (including their future health costs). It'd be crazy, but that way we wouldn't have to police each other's actions, because we wouldn't have to pay the bills for them.

Hey Tom, you'll be called a heartless person in a second. Just think what will happen to those 40 million people who just cannot think for themselves, or accept any responsibility for their actions? Obviously they're all uneducated and poor because their grand-grand-father was a slave, their grandma was unable to find a job being a female, and they did not have Nintendo Wii during their childhood which would nowadays qualify as child abuse. Don't you think of children, kitties and Jesus?

* Don't pray for me if you wanna help - just send me a check. *

[billvon 3,116]

> You can call 911 and still expect them to pay their own bill.

I have asked you this before, and you didn't answer. If you had a friend, and knew as surely as you could that he would refuse to pay for his care if you called 911, and you saw him break his back, and you were the only one around - would you call 911?

[TomAiello 26]

Quote

> You can call 911 and still expect them to pay their own bill.

I have asked you this before, and you didn't answer. If you had a friend, and knew as surely as you could that he would refuse to pay for his care if you called 911, and you saw him break his back, and you were the only one around - would you call 911?

Sure. I'd also expect him to pay (over time, if need be). Or to refuse treatment.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[nerdgirl 0]

Quote

I've read claims suggesting the otherwise (and sorry, I'm not nearly so good at keeping them handy) - that the obese will live long enough, yet need far more expensive care.

If you can find something like that I’d be curious to see the methodology.

One can find lots of studies that compare single years or costs with things associated with being fat, e.g., the costs of Type 2 diabetes. Something like comparing the cost of prostate cancer or cervical between two groups: men and women; one incurs a higher cost in each category. And in each category one sex incurs a much lower cost. But in each case, one is going to have an advantage or disadvantage over the other.

The Dutch researchers acknowledged that what they expected to find initially was something like what you described. And that’s part of what makes it such a notable finding, imo, that it challenges the dominant perception with data.

Quote

I think this will only get worse as we come up with better and better means to cope with our poor health.

If “this” is cost of health care, I agree.

At least some significant components of the rising costs of health care aren’t necessarily coming from “sinful behavior” tho. And I'm not enough of a health care policy wonk to know which is the biggest contributor.

“In eight of the top fifteen conditions [by cost not by incidence], a rise in the cost per treated case, not rising numbers of cases treated, accounted for most of the growth in spending. For instance, the treated prevalence of heart disease remained constant between 1987 and 2000. Thus, a rise in the cost per treated heart disease case accounted for nearly 70 percent of the rise in medical care spending between 1987 and 2000.”

Why did care cost more per incidence? (I don’t know … I can speculate … but don’t know.)

The 6 mostly costly conditions are heart disease, pulmonary issues [asthma, etc], mental health conditions, cancer, hypertension, and trauma; see data table 2. At least 2 have clear "lifestyle" connections, but not in all cases as the Jim Fixx case illustrates. (Recognize that is not the norm.)

If current expectations of care continue with the aging of the population (read: baby boomers), even among the healthiest of them, eventually hard choices are going to have to be made.

/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

[kallend 2,148]

Since you're talking revenue and not specifically tax...

I think the cost of an airline ticket should depend on the total weight of passenger + baggage.

...

The only sure way to survive a canopy collision is not to have one.

[billvon 3,116]

>Sure. I'd also expect him to pay (over time, if need be). Or to refuse treatment.

I find it very telling how hard you are trying to avoid answering this question!

I'll ask one final time:

A friend of yours craters in the landing area. His back is broken, and he's unconscious. You know as surely as anyone can know anything that he will NOT pay. You can tell yourself anything you want to, but you know that, in fact, he will refuse to pay. He is not aware enough to refuse treatment.

Do you call 911?

[StreetScooby 5]

Quote

I'll call it "Personal Responsibility."

+1

We are all engines of karma

[TomAiello 26]

Quote

You know as surely as anyone can know anything that he will NOT pay.

Please explain further. How do I know this?

Has he been in the situation before, and not paid?

Did Mr. Spock come along and join our minds together?

Does he have some kind of religious aversion to modern medicine?

If I know for certain he doesn't want the care enough to pay for it, then I'm going to respect his wishes. In the hypothetical case where we have experienced a Vulcan mind meld and I know fore certain, then why would I contradict his wishes?

But unless I am absolutely certain of that, I'm going to move to help him, and sort out his payment later.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com