Many more people are living into their 80s,90s and beyond — when they haven’t keeled over by 65 from diabetes or a heart attack or cancer, sometimes as a result of those unwise lifestyle choices. You’ll save some money with additional sin tax but it’s magical thinking to assume it will cover all treatments for everyone who did take really good care of themselves. Some people still persist in getting really sick — for no discernible fault of their own. Annoying, expensive, inevitable. If you’re really committed to universal coverage, you have to find a way to pay for them, too.

When I landed in the hospital on an IV for three days in 2007 ($16,000) with pneumonia, it was because, as a self-employed person scared to lose work and income, I kept on working while I was sick. The ward was full of people like me. In a recession where some people are clinging to whatever jobs they have, what do we do with that issue?