You are right about the rationale behind employer health insurance.

However, there is an obvious problem with FFS funding for medicine, which is that health costs can be catastrophically - unaffordably - high. In earlier eras, this wasn't a problem, because expensive interventions didn't exist. Now they do. And we all want them if we have a car accident or a stroke or a complex birth, etc.

No country has fully solved how to fund healthcare, and there are problems with every funding model. FFS is more broken than most, not least because there is a natural inflationary component (the more interventions I carry out, the more money I make as a doctor) and individuals frequently can't afford the care. That's why countries around the world are now experimenting with payment-for-outcomes instead. But it's a hard problem to solve.

Eh? This law was doing precisely what you implied should be done, i.e., placing a restriction on junk food companies who are, as you say, in bed with the government. It was not banning people from buying as much soda as they wanted, in the form of smaller amounts.

That said, I fundamentally disagree with this statement of yours, precisely because it is partisan and non-pragmatic: "Using laws to change social norms is stupid, because it doesn't work without having serious negative consequences which outweigh any possible good results." That's partisan and non-pragmatic because it ignores the many instances in which laws have been introduced that aimed at changing social norms where the benefits clearly outweigh the harms:
- seatbelt laws
- DUI laws
- domestic abuse laws
- laws restricting smoking
There used to be a social norm that it was OK to smoke on the London Underground. The Kings Cross fire of 1987 led to a ban on smoking on the Underground. I'm hard-pressed to think of *any* negative consequences of that ban, much less consequences that outweigh the obvious huge benefits of the removal of a significant fire risk and the improvement to people's health.

Actually, bike helmet studies also find that cyclists tend to take more risks and worse, motorists do as well -- eg they drive closer to helmeted than non-helmeted cyclists.

If you think that no-one besides the john or the gambler suffers harm from prostitution and gambling, you've gotta be kidding.

It might be nice if there were a country where prostitutes were universally economically free agents, acting of their own accord, working in safe and happy environments, but it's not exactly close to what we have today....

And gambling losses affect the family of the gambler.

Mods, the comment above is not a Troll. Even if you disagree with it. Sheesh people!

Substantial. When people don't have the option to buy a big drink, a large majority who were going to have bought that big drink will make do with a small one.

Nothing prevents someone from buying a larger drink. The legislation wasn't aiming at 100% efficacy in preventing people from consuming >16 oz in one sitting. It was aimed at materially reducing the numbers who did so.

Are your choices yours to make when you're five? Is it the government's business if you make choices that are detrimental to your child's health? Where is the boundary of acuity, philosophically speaking: presumably you agree the government should attempt to stop you from murdering your child; should it attempt to prevent you from giving your child a cigarette to smoke?

I don't see that this is an easy area in which to be hard-and-fast about things.

You're plain wrong on the facts about diabetes not costing a lot of money. Well-controlled diabetes such as yours may be relatively cheap to treat, but poorly controlled diabetes drives a huge amount of healthcare costs, indeed a material percentage of the whole costs of healthcare. Those costs include, but not are limited to, foot amputations, emergency admissions, retinopathy treatment, CVD treatment, etc etc.

Spot on!

No. I hope that helps.

Actually, you really can force people to make healthy choices by legislation.

You can remove transfats from food. You can ban smoking in public. You can charge sin taxes on alcohol and smoking. You can require car occupants to wear seatbelts. Etc.

All of these things will reduce the quantum of harmful behaviour that people undertake. Whether each such piece of legislation is a good idea or not is a separate question from whether such legislation can be effective.

Note that there is no reason except for a rhetorical desire to win an argument for a piece of legislation to be perfectly effective and cause no undesirable side effects. So some people will still drive drunk, or without a seatbelt, or smoke a cigarette in public, etc. And small businesses may suffer from not selling so many cigarettes. But it is unquestionably the case that governments can and do act to force people to adopt healthier behaviours, and this can lead to a measurable improvement in a population's health.

Those analyses are a bit narrow. Smokers are much more likely to die while still economically active. So the net benefit is rather more complicated to calculate.

In any event, the answer to the problem is obviously not, "encourage more people to take up smoking" but instead "find ways to compress morbidity at the end of life, and provider better cheaper care".

Why do you have to cosider the subpopulations? The whole point here is to work out whether a specific sin tax is worth introducing. Obviously, if the costs of the sin are negligible in the context of the costs of the health system as a whole, then the sin tax is not worth introducing.

Mountain biking is a particularly difficult example to bring, because the injury costs must be weighed against the lower burden cyclists will impose on the health system than other citizens due to their better overall health (eg lower CVD rates).

But in talking about "not encouraging these activities", you have this arse-over-tit.

There is a public health emergency, as exemplified by the fact that the costs of diabetes treatments have risen by 40% in five years. And not from a small base, either.

A large and growing fraction of the US population is adopting eating and drinking habits, under the influence of food and beverage companies who very well understand the psychology at play that influences how people behave(*), that will harm and eventually kill them.

A shoulder-shrug seems like a really stupid response.

* For example, people eat more off larger plates, on average. They may each believe they're not going to, but they do. Similarly with cup size.