I can give you one perspective. Moral hazard and fairness.
The vast majority of costs borne by and in the US healthcare system are the results of overeating, oversmoking, and underexercising. Period. Heart disease, many forms of cancer, diabetes, most forms of pancreatic, gallbladder, and adrenal conditions, are largely the result of personal choice.
Setting aside for a moment the fact that congenital defects, hereditary disorders, infections, and accidents are no fault of the victim/patient, it should be important to note that a system that REQUIRES those who take care of their health by eating and exercising properly to subsidize the consequences of the choices of those who do not, is taken by many Americans to be fundamentally unfair.
If legislative initiative were taken to find a way to exclude universal coverage of lifestyle diseases, while still permitting universal coverage of non-lifestyle conditions, many people would not have such a viscerally negative reaction to the notion of universal health care.
I'd have up voted you if you hadn't said "period". Unhealthy behavior is a biggie but anyone that says "here, this ONLY is the problem" just adds to the mess.
The US health care system is melange of many complex and perverse incentives. I recall a study saying unhealthy behavior adds at most 50% to costs but costs have increased many more times than that in the last thirty years. The billing system, medical education system, end-of-life-care, the health insurance system, ad-nauseum. It takes a LOT of crazy schemes to eat up 20% of the GDP of the once-most-prosperous country in the world.
I'll admit it - I'm a former fatty (BMI 34). In Canada the government paid to send me to a dietician, along with an 8-week course that now makes me more informed about nutrition and dietary choices than most of the population.
That played no small part in getting me back in shape.
A single-payer/public system has a strong incentive to preventatively fight lifestyle diseases in a way that bickering insurance companies simply do not.
The thing to do, is if your health care is paid for by taxes (like the NHS), is for taxes to be levied proportionately on the higher-risk things that will hospitalize you. The UK already has sky-high taxation on tobacco. I rather like the idea of the Fat Tax as well.
Placing a tax on fat content would increase the proportion of earnings used for the NHS by those who would use it the most. It would also provide a disincentive to eat unhealthy in the first place. Of course, many many people think this smells a lot like social engineering (what isn't at government level?), so this wouldn't pass in the UK, let alone the US.
Fat content has virtually nothing to do with obesity. I get 20-30% of my calories from fat (mainly butter and cheese), weigh about 155 lb., 6-1, lipid levels good.
Kudos to you. So many people equate fat to increasing your fat. Granted, drinking a glass of bacon grease is no good for you, but replacing it with chemically altered low-fat everything is not a viable replacement.
You could tax calories instead. Calories in - calories out seems to be a pretty good proxy for weight gain. And I bet I wouldn't drink quite so much soda if it couldn't be had for 75c per 2-liter bottle.
Calories in-calories out is a pretty bad proxy for weight gain and health in general. Google Gary Taubes; he's done a great job of digging up and deconstructing a century's worth of research on the matter.
There is massive debate still going about the Taubes' arguments against 'calories in - calories out'. There is a lot of evidence in support of 'calories in - calories out' and it is way too early to conclude that if Taubes said so, it must be right.
The basic problem is the cost. The cost of health care is so outrageous the only way to make it bearable on the population is just to give the government a license to print unlimited money in order to pay everyone's health care bills.
Insurance (which is a horrible system for health care, since insurance depends on people who buy it not to use it, and all of us need health care, usually multiple times per year) and government programs merely mask the root of all of this, which is that health care is completely and utterly unsustainable at its current rates. Something has to change about the way we administer medicine because nobody can afford it.
Everyone outside of the US has seen that people can't afford it and instead of fixing it, they've just said "the government will pay whatever it costs, don't worry any more, peasants!" In the US the problem has existed so long because we've covered it with insurance companies, but that system is crumbling as it gets harder for anyone without a job at BigCo to get reasonable care.
Our options are to figure out how to make health care cost a reasonable and affordable amount of money or let the government print money to fix it all for all of us (in the short term, ignoring the consequences of printing a bunch of money to keep an unsustainable system alive).
The current plan to force everyone in the United States onto an insurance policy with minimal modifications from existing policies is a pretty bad plan imo. The rates will be about the same and I'm sure the insurance companies are going to be thrilled to get tens of millions of new customers to suck dry by legal mandate. The people that will qualify for state subsidized insurance rates are only a handful more than the people that currently qualify for state medical programs like Medicaid anyway.
It's not really moral hazard, since that implies a rational choice is being made to make themselves sick because they know that they won't be bearing the financial costs. However, there are a plethora of non-financial costs to the diseases you've mentioned - up to and including death - so the moral hazard is mostly avoided.
It's simply that some people make irrational, bad choices, and the incentives on the whole make no difference.
Moral hazard doesn't have to be rational, just a deliberate choice.
Such as the choice to smoke, or over-eat. Yes, they can be addictive, but there are supports and cures for both, and involve willpower and sacrifice, but they're there.
I say this as a fatarse who has lost 20Kg by eating less (The Horror!) and doesn't blame anyone except himself.
Moral hazard is a concept entirely based on rational economic actors.
If the potential future cost of dying of lung cancer doesn't deter people from smoking, then the potential future cost of bankruptcy from paying for lung cancer treatment isn't going to, either.
It's about the mispricing of future risk rather than moral hazard. If you brought the cost up-front, by giving them health insurance but charging additional risk premiums to smokers, then you would likely find more rational decision-making around smoking.
The vast majority of costs borne by and in the US healthcare system are the results of overeating, oversmoking, and underexercising. Period. Heart disease, many forms of cancer, diabetes, most forms of pancreatic, gallbladder, and adrenal conditions, are largely the result of personal choice.
Setting aside for a moment the fact that congenital defects, hereditary disorders, infections, and accidents are no fault of the victim/patient, it should be important to note that a system that REQUIRES those who take care of their health by eating and exercising properly to subsidize the consequences of the choices of those who do not, is taken by many Americans to be fundamentally unfair.
If legislative initiative were taken to find a way to exclude universal coverage of lifestyle diseases, while still permitting universal coverage of non-lifestyle conditions, many people would not have such a viscerally negative reaction to the notion of universal health care.