> We cannot say "that's fine for everything, but not here" if we operate on a principle
We already say that, for smoking.
And through mandatory school vaccinations (DTaP, varicella, polio, MMR, meningococcal).
Which is a big part of my point. What we claim our system to be (Freedom! With guaranteed care! With equal rights to opt out!) and reality (We won't pay for certain dumb things you do. And we'll give you basic guaranteed care and probably not let you die) are two different things.
Which is the main thing that's shredding our health care efficiency in terms of per capita GDP spending.
"We" don't, but maybe you do. I'm from Germany, the only time smoking/alcoholism/substance abuse comes up in a relevant way is when you need a transplant and there are multiple recipients and too few donors.
And it's not a punishment for what you previously did, it's because of a prediction of what you're going to do, e.g. an alcoholic who has shown no sign of compliance will probably not get the liver if there's a non-alcoholic who also needs it and does what it takes to get/stay healthy.
Deaf people whose condition could be cured/massively improved with implants are free to choose not to, and won't lose their disability status, it doesn't turn into a choice/hobby just because there's a choice in fixing it.
I'm not sure that's what makes healthcare in the US so expensive. Again, we do it and we spend significantly less than the US. The country is much more densely populated though, university is free and physicians' income is much closer to the average than in the US.
We (US) do in that national law allows a surcharge for smokers.
States may (and some do) override and decrease this, but it's allowed as the default. Notably, that and age are some of the few factors allowed to influence insurance pricing.
Regarding transplant, my understanding is people are transplanted on (1) current health state (worse = higher priority) & (2) ability to comply with post-transplant protocols.
So someone who burned their liver out with alcolism and is very sick, but makes a good case that they'll be able to stay sober post-transplant, gets an organ over a less-ill, sober victim of circumstance (e.g. dehydration/heat injury or something).
One of the key features I've heard that allow other countries to drive down health care costs is a regulatory requirement that approved treatments (pharmaceutical, surgical, etc) demonstrate greater efficacy and/or lower cost. In the US, the FDA approves on efficacy only.
End result being that in the US you can reformulate a medicine, try your best to sell it for $1,000 a pill, even when a cheaper alternative that produces the same results is available.
We already say that, for smoking.
And through mandatory school vaccinations (DTaP, varicella, polio, MMR, meningococcal).
Which is a big part of my point. What we claim our system to be (Freedom! With guaranteed care! With equal rights to opt out!) and reality (We won't pay for certain dumb things you do. And we'll give you basic guaranteed care and probably not let you die) are two different things.
Which is the main thing that's shredding our health care efficiency in terms of per capita GDP spending.