[CarreraS2]

The Libertarian model is fine, but, it's really an all or nothing thing. No helmet laws, no seatbelt laws, etc. are fine, if you are willing to let people fully accept their responsibility (i.e. they are responsible for their own health insurance - state and hospitals are gonna let you die if you don't have it).

But of course, that is never going to happen in the US. So the complete Libertarian utopia model can never work.

As you state: " once you introduce state-funded healthcare, the state has an interest in regulating your personal freedom in order to keep its costs low."

So the premise must be accepted that there is always going to be regulation of personal freedoms, and that is right.

The concept of "Implied Consent" for healthcare, though, just won't work. Why? For the exact same reason the Libertarian model doesn't work, as discussed above. Because NO MATTER WHAT, the state isn't going to let someone die. You drink 3 gallons of Tequila and come into the County ER with an exploded liver and no insurance, they will treat you the same as the innocent uninsured victim hit by a car.

Besides that, it would be a regulatory nightmare. Deny treatment to someone who is overweight at 280 lbs? 275? 250? 249? Implied consent with regard to a drivers' license works because the issues involved are black and white. (You WILL submit to the DUI test, or you WILL lose your license).

If you'd be willing to do what is necessary to make the Implied Consent theory work ("Smoke all you want, but if we detect nicotine in your blood, you aren't covered!" - by that I assume you mean you aren't covered, no one is going to pay, and we are going to leave you to die), then it would be a lot simpler to just adopt a "Full Responsibility" system - no insurance, no payment, you are left to die. The "Full Responsibility" system works just fine if one is willing to let the irresponsible die - and without all of the regulatory complications of an "Implied Consent" model.

(P.S. Your example of cigs is interesting. Aren't there restrictions on cigs already? Highly regulated, highly taxed. How much is a pack in NYC? My understanding is that cigs are highly taxed at least in part to discourage consumption. They are also regulated, and use discouraged, by bans on advertising, and public funds supported anti-smoking campaigns.)