Universal Health Care - Still Not Possible in US

[Epi]

I'd like to see more prevention. For starters I think a minimum fitness standard for a high school diploma would go along way towards reducing health care costs in the long run.

Actually in a strictly money sense, it costs far less for that 60 year old working person to die of a massive heart attack, then for the 85 year old previously physically healthy person who's been withdrawing from CPP and OAS for years, who gets dementia and slowly deteriorates over 5 years requiring long-term care, assisted living and repeated hospital admissions in the end for things like pneumonia. And since as far as we know now, dementia rates rise exponentially as you get older and we still don't have any real treatments or prevention for it (being physically healthy doesn't help with Alzheimer's), and so does cancer rates which we aggressively treat older and older, for sure the person who lives longer will eventually cost the system more.

I think the real issue with health care is that at some point we need to find a balance that 'doing everything you can do' is not in society's best interests even if it is in the best interests for the individual. Using experimental cancer care which costs a bundle and only 10% live longer, or endlessly prolonging the lives of severely disabled or demented people is commonplace now. Morally we should help individual people as much as we can, because that's probably what one would want for themselves. But we may reach a certain tipping point with ever more expensive, directed and specific treatments and technologies (and ever more old people) that the entire system may come crashing down.

Well unless Japan invents us some robotic care workers fast...

 

[afransen]

Tax credits for fitness could well be more difficult to achieve. How do you test people and give credit for good behaviour? We can tax goods that are bad for you (cigarettes, alcohol, UK sugar tax) but it's kinda hard to implement a tax break for the fit. And while I am sure we could find some way to implement it, I am skeptical that any tax break given to them would be enough of an incentive to get others more fit. That's like the argument for the transit tax break. It just rewards those who use transit anyway. The impact on ridership has been minimal. I fear that we'd have to have a substantial tax cut to motivate people on fitness. And that seems off to me. We shouldn't have to pay people to take care of themselves.

It's an idea to continue the incentive to stay healthy after people get their diploma. It could be evaluated as part of an annual physical--even if it requires more of a doctor/nurse's time, the benefits of improved fitness and even some earlier screening for people who don't regularly go for physicals could be substantial enough to defray much of the cost. It's of course a bit of a trick. Raise taxes by 1% and offer a 1% fitness tax credit . I don't see the harm in paying people to keep fit, as it's worth it in terms of prevention and it may be just enough of a reason for people to meet their fitness goals.

Honestly though, we need to start getting creative about preventive medicine. We have an epidemic of diabetes in Ontario like nowhere else in North America, and it's going to cost us colossal amounts to treat the disease and its complications.

 

[Hydrogen]

Another afransen tax!

One thing noted in the study concerning diabetes in Ontario is that the increasing rate of the disease may have something to do with the changing ethnic makeup of population. Ontario has seen a large increase in at-risk populations such as people of South Asian origin. It's possible that that this contributed to the increased rates of the disease.

It's also worth noting that diabetes mortality has declined in Ontario over the past decade.

Tax breaks for the fit etc. really smacks of social engineering. Some people just love the idea of dictating how others ought to live.

 

[afransen]

It's no more social engineering than prohibiting narcotics, telling Sikhs that they have to wear helmets when they ride motorcycles, or even forcing children to attend high school until 18.

 

[kEiThZ]

It's an idea to continue the incentive to stay healthy after people get their diploma.

We can work on that after we work on setting a bar for the high school diploma. If like jade_lee there are people who would resist what's arguably a very minimal standard as draconian, then can you imagine the public opposition to more other efforts (particularly those targeted at adults). And really, I still don't understand how it's any more draconian for high-schoolers than any of the other standards we set for them (number of credits to finish school, tests and exams in courses, etc.). Actually, it's probably far more draconian than the fact that we actually make them attend school till their 18 even if they aren't interested. To me a PT test is simply like any other test that students are given and exceptions can be made just like we do for students taking other tests if they have limitations.

 

[Hydrogen]

It's no more social engineering than prohibiting narcotics, telling Sikhs that they have to wear helmets when they ride motorcycles, or even forcing children to attend high school until 18.

Then, with respect to your tax idea, you sit down and define a clear and measurable definition for fitness. Who is supposed to do all the measuring? Who bears the cost of that?

You might (finally) discover that human bodies don't easily conform to institutional or bureaucratic categorizing.

 

[afransen]

Should I draft some legislation for you, Hydrogen?

 

[Hydrogen]

Is that your way of avoiding the problem?

 

[afransen]

I don't know what is so inconceivable about a test of fitness. Keith suggested one. I am not particularly sold on any particular test, and I am not an expert in medicine or fitness. I don't know why it's important how many pushups or whatever would be necessary, or whether it should consider BP, cholesterol, heart rate, etc.

Should we disband the military and fire departments because they have fitness tests, in effect attempting to measure something immeasurable in your view? Or just let anyone become a soldier or firefighter because we can't trust the bureaucracy to develop an adequate (not perfect, but useful nonetheless) test for fitness?

 

[Hydrogen]

I don't know what is so inconceivable about a test of fitness. Keith suggested one. I am not particularly sold on any particular test, and I am not an expert in medicine or fitness. I don't know why it's important how many pushups or whatever would be necessary, or whether it should consider BP, cholesterol, heart rate, etc.

Should we disband the military and fire departments because they have fitness tests, in effect attempting to measure something immeasurable in your view? Or just let anyone become a soldier or firefighter because we can't trust the bureaucracy to develop an adequate (not perfect, but useful nonetheless) test for fitness?

There is nothing "inconceivable" about it. It's just not good idea. But if you really like it to the degree to want to draft legislation, then all you have to do is come up with a clear and verifiable definition of what constitutes "fitness." You have not done that, so maybe it's inconceivable to you. Besides, who would administer the test? Would the testers or the test take into account the subtle differences between individuals, or would the test rule over all?

As for the military and fire department, we aren't talking about them here, are we? We are making reference here to society at large - particularly when it comes to your musing about taxation. Last I checked, no one needed a 'fitness test' to see if they were allowed to be a member of a society. In fact, history is littered with examples of how prejudicial notions of 'fitness' (many based on fashionable ideas of their time) were used as a means to create divisions among people. Don't be so presumptuous to pretend that you know what is best for everyone.

Before you go off to see how best you can tax people based on your assumptions, or restrict their egress from school, it'd probably be good to clearly know the content, meaning and breadth of what your definition of fitness is. Without that, you're probably going to venture into wholesale discrimination.

 

[afransen]

My entire point is that you're getting bogged down in details in an attempt to discredit the idea of measuring physical fitness. I've provided some examples of how this is done--again, not perfect, but useful.

I've also already pointed out that exceptions would be necessary for reasons of equity.

We already have backdoor policies that do something like what I suggest: the child fitness tax credit.


"Before you go off to see how best you can tax people based on your assumptions, or restrict their egress from school"

Dumb. I suppose we shouldn't expect any level of achievement in any dimension for people to receive diplomas? Why should we discriminate against people who don't feel any need for literacy or numeracy skills, etc.?

 

[Whoaccio]

I must say, I love the marketing options for a "revenue neutral fat tax, as part of a larger 'fat shift' to end our fat dependence."

Anyways, in the USA are HMOs allowed to charge varying rates based of physical health? That would be the most logical way to remove some of the moral hazard involved with high calorie lifestyles.

 

[Hydrogen]

My entire point is that you're getting bogged down in details in an attempt to discredit the idea of measuring physical fitness. I've provided some examples of how this is done--again, not perfect, but useful.

I've also already pointed out that exceptions would be necessary for reasons of equity.

We already have backdoor policies that do something like what I suggest: the child fitness tax credit.


"Before you go off to see how best you can tax people based on your assumptions, or restrict their egress from school"

Dumb. I suppose we shouldn't expect any level of achievement in any dimension for people to receive diplomas? Why should we discriminate against people who don't feel any need for literacy or numeracy skills, etc.?

Your entire point? What point? Are you one of those people who confuses exercise with fitness, or test passing with intelligence?

Again what do you mean by fitness? You've avoided answering that question for some time now. As for the details, you might want to consider just how central they are when actually trying to define or measure something.

As for the "exceptions," how would you presume to list or discover those if you can't even define what fitness is? The very notion of fitness you might introduce may very well inflate or deflate the potential number of exceptions because any concept of fitness is quite subjective.

The last point you attempt to make (the one in which you stoop to ad hominem) suggests a lack of understanding of what constitutes an adequate level of skills in order to graduate from school. Historically, those have changed. Regardless, fitness is not a skill, it's an assumption - and one you've failed to adequately define.

 

[golodhendil]

Anyways, in the USA are HMOs allowed to charge varying rates based of physical health? That would be the most logical way to remove some of the moral hazard involved with high calorie lifestyles.

HMOs charging different premiums based on health status is exactly what the US is doing now, and is something that reform proposals are trying to do away with with the mandatory implementation of community rating.

 

[afransen]

Sorry if I hurt your feelings. If you'd like a definition of fitness, here you go:

fit·ness (fĭt'nĭs)
n.

1. The state or condition of being fit; suitability or appropriateness.
2. Good health or physical condition, especially as the result of exercise and proper nutrition.
3. Biology The extent to which an organism is adapted to or able to produce offspring in a particular environment.

I'd say the second definition is most applicable.

You're welcome.