But Aaron Carroll did. He writes:
Let’s start here with the moment I screamed at the TV. I’m sorry, but the audience cheering the idea of letting a thirty-year old who got sick without insurance die is appalling. You can dislike the moral hazard, you can bemoan the fact that people don’t take enough personal responsibility, you can even wish that society wouldn’t have to be on the hook when uninsured people get sick. But don’t take pleasure in that fact. Right now, there are thirty-year olds who don’t have jobs, can’t find work, and can’t afford insurance. Letting them die if they get sick is not “good”. It’s not even “freedom”. Applauding that is depressing.
In the first debate I watched as nearly all the candidates raised their hands when asked if they would authorize torture. In the next debate I listened as the audience cheered the 234 people Rick Perry executed in Texas. And tonight, I missed the cheering of the hypothetical death of an uninsured American.
Now, to his credit, after this clip, Ron Paul says that private charities would handle the bill like they did back in the day when practiced medicine. I don’t think that’s true, but I think he believes it’s true. Back when Paul was a practicing doctor, healthcare was much cheaper. If we could get it that cheap again, maybe private charities could pick up these tabs. If we could get insurance cheap enough that people could all have it (and solve the preexisting condition problem) that would also help. But these are major hurdles, and solving them through government policy is reasonable.
Like I said, the Republican Party has lost its way. A lot of people came back to me in my last debate post saying “You liberals would cheer if you heard a bunch of babies had been aborted!” but this is just nonsense. Most liberals do want safe, legal abortions to continue unimpeded, but the goal of the pro-choice movement isn’t to abort as many babies as possible. It’s just to keep that procedure accessible and safe. I think most liberals would be absolutely thrilled if contraception and sex education led to a huge decline in abortions, and would cheer that in a heartbeat. I also think liberals might very well cheer expansion of access to women’s health clinics where abortions are performed. I would be very surprised to hear the same sort of hooting and hollering over a similarly phrased question in regards to abortion.
And besides, we also have torture and the death of an uninsured person to add to this pile. And while Democrats aren’t great on foreign policy, Republicans are even more hawkish. Rick Perry, the current darling of the right, is just as hawkish – if not more so – than his predecessor.
Oh, and it also looks like the audience booed Ron Paul tonight when he tried to explain that not all terrorism can be attributed to Muslims, and that the Palestinians are human beings, too!
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{ 135 comments }
Back when medical care consisted of clean linen and making people feel comfortable enough until they either died or their bodies made them better, health care was cheap indeed.
It’s only as health care has advanced to include things dreamed to be science fiction and to eradicate certain things that used to be lethal and managed to extend lives that would have extinguished decades earlier that, completely unsurprisingly, health care has gotten more expensive.
I imagine that as we explore more nooks and crannies of the human body, as we master the human genome, and as we demonstrate that we can control things that once killed us, arrest things that once crippled us, and heal things that once would have festered until death — it will continue to get more and more expensive.
Life is expensive. Senescence is expensive.
I deeply suspect that if a cure is ever found for senescence, it will quickly be argued that such ought to be an entitlement.
Hmm… You know what else is expensive? All the stuff that drives health care costs up that has little, if anything, to do with the quality of health care or advances in health care technology.
If only self-righteousness were more expensive.
Perhaps if you pass the right laws, you could tax opinions you disagree with out of existence.
Surely Utopia is just around the corner.
Hey, that sounds like a good idea, perfectly consistent with everything I’ve ever said!
I think you’re confusing health care with medical care a bit here. Medical care has certainly gotten better and more expensive. Health care has gotten worse and more expensive.
If you want to make that distinction, why not the distinction that Medical Care is what doctors do and Health Care is what the patient does (including, of course, going to the doctor)?
But, sure. I can run with that.
You’ll probably have to remind me at least a dozen more times before it sinks in, though.
Wait… then what is Wellness?
In Pro Wrestling terms, it means steroids.
I think it’s an important distinction to make, because all the economic forces of layers of regulations and middlemen between patients and doctors+technology that are generally the source of all our health care problems have little to do with biological and technological forces that are driving changes in medical care:
Thomas Sowell captures this idea pretty well in this piece, although I strongly disagree with his conclusions:
http://www.realclearpolitics.com/articles/2009/04/21/words_versus_realities_96086.html
Medical care is driven by epidemiology more than it is driven by financial economics. Health care is driven by little more than economics.
Health Care is ongoing. Medical Care is “OMG Emergency” land.
The problem is, Health Care prevents Medical Care. Most “insurance companies” don’t get that these days. They want to foist off most of the cost of preventative care and monitoring to the patient, risking the Big Bills (and then simply not paying them anyways).
Meanwhile, Debbie Wasserman-Schultz’s response was wonderful. She correctly identified the problems with all the PeeTardier idiots screaming about “Repeal Obamacare”. I’m right there – screw me with a Preexisting Condition repeal, and I have to hope I never lose my job or even spend a day out of work or “un-covered.” That’s not right.
You can give some people all the Health Care you like but they’ll still order a third cheeseburger.
You mean a bacon cheeseburger, hold the lettuce and tomato and extra mayo please. And supersize the salty fries and add the ultra sized “DIET” coke to go with that (cause they’re trying to lose weight).
This country has the highest rate of obesity on the planet. The astonishing thing is that our “health care” is as good as it is.
“People” aren’t saying “Oh by gawd, I’m 150 lbs overweight and I need to do something about it!” They are saying, “Give me the goddam drugs and when I say GIVE me the drugs I mean I don’t want to PAY for it!”
Very well put.
And I’ll also add that I don’t really think a public system as well-functioning as France’s or Japan’s goes well with the American lifestyle.
… then why not change our lifestyle?
I definitely agree!
But I think it’s both possible and noble for us to try and improve our health care system – one of the worst in the developed world by almost any standard – without taking anything away from medical care – almost unarguably the world’s best.
This would all be much more convincing if health care in the United States wasn’t nearly twice as expensive as your average European country without any discernible improvement in outcomes. But when we know for a fact that lots of other people have all done a far better job of dealing with the health care cost question than we have, this fatalism seems awfully premature. Narrow the cost gap between us and Canada by half and I’ll be willing to talk about the inevitable costs of treating senescence.
I’d be very careful with international comparisons. There are so many confounds that it takes really careful analysis to tease out what’s causing what.
James,
Have you ever seen an emergency room that’s in use?
1) You have homeless people using it for “three hots and a bed”
2) You have diabetes patients using it for “being stupid”
3) You have people who didn’t have the money to pay for medicine using it because they’re bankrupt.
4) You have plenty of things that could be solved in a doctor’s visit, being pushed to an emergency room.
Sometimes it’s the simple things — if all preventative doctor’s visits were free, we could save ourselves some gangrene and cancer.
Clearly Kim is a racist who thinks that black people shouldn’t be allowed to have healthcare.
plonk.
My neighbor is an emergency room physician. Back when he was at Boston Med (arguably one of the best trauma centers in the US) a teenage girl showed up in an ambulance. She had a cut on her finger, a tiny cut. He put the bandaid on it and said, “Why did you even come to the hospital”? She said, “I was out of bandaids”. He said, “Why did you take the ambulance”? She said, “Well duh, how ELSE are you going to get to the hospital?”
Responsible people don’t bankrupt the healthcare system. Irresponsible people? You betcha.
… that person didn’t cost much. it’s the people with diabetes who don’t take their meds who cost a lot. or else they die.
Hence the: “Irresponsible people? You betcha.” statement.
Diabetics who are overweight, don’t take their insulin, smoke, drink, don’t exercise etc. are not exactly topping the list of responsible patients. Not to mention that a reasonably healthy person can practice the “diabetic lifestyle” and wonder of wonders /acquire/ diabetes
… still, even for them, you’re getting their health fixed a lot cheaper if they don’t have gangrene first.
And a person with gangrene costs more than health costs, long term.
You’re still going in with the assumption that the gangrene should be fixed anyway regardless of the cost. I mean, sure, we’d LIKE it to be cheap, but “it’s expensive” won’t STOP you doing it.
… how much is a person’s life worth?$1million? i’d say fixing the gangrene is a net good to society. Might not say that about fixing HIV for fifteen years.
Surely we can find one or two minimally complicated comparisons in this list of countries that have universal health care:
Austria, Andorra, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Isle of Man, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Moldova, Monaco, the Netherlands, Norway, Poland, Portugal, Romania, Russia, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine, the United Kingdom, Argentina, Barbados, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Greenland, Mexico, Panama, Peru, Trinidad and Tobago, Uruguay, Venezuela, Azerbaijan, Bhutan, Bahrain, Brunei, China, Hong Kong, India, Iran, Israel, Japan, Jordan, Kazakhstan, Kuwait, Macau, Malaysia, Mongolia, North Korea, Oman, Pakistan, Qatar, Saudi Arabia, Singapore, South Korea, Sri Lanka, Syria, Taiwan, Tajikistan, Thailand, Turkey, Turkmenistan, UAE, Australia, New Zealand, Algeria, Egypt, Ghana, Libya, Mauritius, Morocco, Seychelles, South Africa, Tunisia
… most of the lives saved in the 20th century were saved through sanitation, not medicine. Antibiotics helped, sure, but not infecting people because we understood quarantine and washing our hands saved more. And quarantine and handwashing is CHEAP.
My understanding is that this is basically correct. Spending more and more and more on medical treatments is still yielding diminishing marginal returns, and getting more health care doesn’t correlate well on the population level with living longer. (Sanitation definitely does, however.)
But still, everyone’s got a right, no matter what the costs! (This is the part I really still don’t get…)
I don’t think we should say “everyone’s got a right, no matter what the costs” — but I do say “everyone’s got a right to the cheap and easy” because that will reduce the need for the more expensive stuff.
What Paul rightly believes, as I believe, is that a free market would drive down healthcare costs and find solutions to indigent care, and private assistance organizations can be just as generous, if not more generous, than the welfare state. Actually, we’re going to witness real stinginess in healthcare when government-run healthcare is in full operation. No one will likely cheer for anything except its repeal and replacement with free market solutions.
Paul’s ideal health care system is the second best I think. The first best is a national public one. There are two primary reasons for this: one is the size of the risk pool; the other is potential for genetic and genomic medicine to extend and expand the definition of “preexisting condition”.
… when one preexisting condition makes 7% of all americans uninsurable, i think we’re already doing pretty bad.
I was specifically talking about a national system that covers everyone; not just a special system for the uninsurable.
The free market will not work with health care because the basic mechanisms of a market are missing in health care. Primarily for a market to work you have to have a choice at the point of sale, either a substitution good you can choose or the option to choose nothing. You have either with healthcare.
When you lying on the pavement after the drunk driver has creamed your car and the helo is being brought in to air-vac you to the large regional trauma center, you are not going to say ‘wait, I want to take a ambulance, its cheaper’. Maybe you would if you were awake (unlikely but possible) but since your unconscious it aint happening.
When the Doc comes in and tells you and your family that its cancer and here are your options for treatment and your world collapses underneath you, you are not going to start bartering on price. Effectiveness of treatment, comfort, how you want to spend your last days, yes, but not price.
And when your 85 and are no longer able to walk without a walker and the Doc tells you that if you had a hip replacement you could walk again, you are not likely to say ‘no thanks, the walker is cheaper’.
90% of all health care money is spent on only 20% of patients, 50% on only 10%. Those are not the numbers a market is made of. It is insurance, you dont need it until you do and then you must have it. Again, not a dynamic that works for a market.
Markets are not magic, they are a construct that works well when the conditions are right. To believe in them like they were a magic fairy that can solve all problems is as ridiculous as believing that govt can solve all our problems. Both are Utopian thinking.
Too much too soon, Erik. Back off to arm’s length: they’re not saying [trying to say] what you’re hearing. Except that Barack Obama is a bad leader for this nation, which he is. Their mission is to convince the American people they’d be any better. A deal far from being sealed.
At least BHO has 2+ years in the Big Chair, and if he was underqualified in 2008 [he certainly was], he remains more qualified than his would-be replacements just by virtue of having seen every presidential intel report, which is why he’s so much like Cheney.
If we gave a colonoscopy to BHO’s ramp-up to national stature a year-plus before his election, well, there were many polyps. His “greatest” pre-election speech was when he threw Rev. Wright under the bus, sort of.
Much left to go. To Republicans, Romney in particular broke Reagan’s 11th Commandment, not to speak ill of another Republican [Perry]. I’ve leaned Romney, just to not piss people like you off, a centrist who can correct Obama’s incompetence without shifting the center too much.
Tonight, I’m thinking a Rick Perry, who calls a spade a spade without the Obama or Romney mealy-mouthing, is what the electorate is really hungering for. If they don’t succeed in painting him as a Goldwater-type maniac—and they sure might—I see no problem with the qualifications of a successful 2-term governor of a bigass state.
The only remaining question is that of temperament. McCain had and has a shitly one, and as previously opined, I will not argue that for all his weaknesses as a leader, Obama wasn’t the better choice afterall.
Politically successful maybe, but not legislatively, judicially, or executively.
If that’s a response to my comment, Mr. Carr, you would have to be specific, as in also rebuttable. Otherwise, it’s a cryptic driveby, and you know how we look down on those around here.
“they’re not saying [trying to say] what you’re hearing. Except that Barack Obama is a bad leader for this nation, which he is.”
Excuse you?
They’re saying Social Security should be abolished.
They’re saying if you don’t have health insurance, you should just die.
They’re saying that if you were born here, but your parents weren’t, you should be deported.
They’re saying that executing the innocent is just fine with them.
If Rick Perry is what the “electorate” is really “hungering for”, then I refer you to H.L. Mencken: “Democracy is the theory that the people know what they want, and deserve to get it good and hard.”
I, for one, think the US can’t survive electing a dumbass texan who failed freshman economics… again.
Yeah, we might end up with 9 percent unemployment.
“To Republicans, Romney in particular broke Reagan’s 11th Commandment, not to speak ill of another Republican [Perry]. I’ve leaned Romney, just to not piss people like you off, a centrist who can correct Obama’s incompetence without shifting the center too much.
Tonight, I’m thinking a Rick Perry, who calls a spade a spade without the Obama or Romney mealy-mouthing, is what the electorate is really hungering for.”
This will probably all be going into the memory hole soon enough, but on the odd chance that anybody still cares, I think this is really bad. Ie, tvd is right to the extent that’s where the GOP voting base is heading, but it’s a bad move.
The Demo’s have fkkked it up enough to the point where we have real problems even if the Dems went away. We need to deal with those problems, represent to the political culture what we think the solutions might be. This sort of thing is too positional and too political.
We’re better off ignoring the President to some extent. At this point, everybody is well aware of his incompetence. There’s no point in going over it again just for the sake of emphasizing our opposition. In an odd way, continuing to get emotional or angry is just allowing the President’s drama to continue when we could just let it sink into the past.
Let’s note, that this operating at the level of the conservative activist base. It is personified in the difference between Romney and Perry, but that is not where the action is.
The Onion has done some good work on the topic of increasing the number of abortions: http://www.google.com/search?aq=f&sourceid=chrome&ie=UTF-8&q=onion+abortion
Let’s propose that this hypothetical person weighs 472 pounds, smokes a pack of cigarettes every day, and insists on riding a motorcycle without a helmet.
Are you going to tell me with a straight face that you think this person deserves the most extreme extent of medical care at no individual cost to him? No cost at all that isn’t paid by income taxes?
Yes. Next question?
All though, I’m also the one in the conversation that would happily remove the subsidies for corn, tax the hell out of junk food, cigaretters, and beer, and increase the fine for riding without a helmet.
But, if a guy still does all the above, he still deserves the same medical care as the 170 pound ripped dude who’s never done a drug in his life.
I’m with Ewiak here. We call caring for the fucked-up mercy, and have rather incorporated into our public Judeo-Christian ethos.
Jews call it justice. Mercy is a tricksy concept, a Moral Good that is not a Moral Requirement (like Charity, in the christian conception). I’d prefer we call it Justice, because that to me means more of a Moral Requirement.
I’d prefer we call it Justice, because that to me means more of a Moral Requirement.
That’s just jury rigging your the terms to get the result you want. What makes something just is whether it is the sort of thing that if included in a system, would increase the prospects of the worst off.
*One not often noted caveat in Rawls is this: Rawls is fairly clear by what he means when he talks about improving the prospects of the worst off. He is talking about the legitimate lifetime expectations. What are legitimate expectations? They are what people can expect vis-a-vis the primary goods (liberties, income, opportunities, wealth etc) in a situation of full compliance with the principles of justice. i.e. Rawls pretty explicitly says that the reason justice as fairness focuses on the basic structure is so that he can set up a sort of division of labour. Governments focus on getting the right basic structure while individuals take personal responsibility for their actions. In a well ordered society (i.e. under full compliance) people are both rational and reasonable. So, while the basic structure provides social insurance to protect against the vagaries of fate, their rationality means that they make a rational life plan that takes into account their abilities and their resources and that they take the appropriate steps to achieve their goals. The legitimate expectations are those primary goods we can expect to have sans bad luck if we take follow through on our most rational life plan. That certainly doesnt involve getting fat, smoking 2 packs a day and riding without a helmet.
Extending Rawls to non-ideal situations like these is tough, and pretty much unexplored territory. It is not clear what, according to Rawls, if anything, the irresponsible are entitled to qua justice.
Note that this is not just an issue (to put it in the most neutral terms) with Rawls, but with all luck egalitarian theories including Gerald Cohen’s
Murali,
Jury-rigging it may be, but it’s done within the context of religion and terminology. I’m allowed to object to someone lumping in my religion as one that characterizes charitable giving as “mercy.” I happen to think, as my religion does, that characterizing charitable giving as justice is a far more sensible thing.
I happen to think, as my religion does, that characterizing charitable giving as justice is a far more sensible thing.
Fair enough, you may think that charitable giving should be considered closer to obligatory than supererogatory, but most people dont have so demanding views. If your aim is at least to convince, if you dont mind my impertinence, you should try to give a deductive argument as to why it would be the case rather than why it is a special religious duty for you (and thus not necessarily a moral duty for the rest of us) Failing that, some analogy or intuitive argument could do. For example “I have a duty to save your life if I can do so by just walking across the room and laying my hands on your brow.”
Can I say that I see it as a positive moral duty? to be a just person, you must do this? It doesn’t mean that I think someone should be forced, or that someone who doesn’t do it is necessarily evil.
There is no one in America with so little time that they cannot give back to the community, at least a little bit. Helping someone else is something that should be done, as it empowers both people (particularly with things like free loan societies).
Note, I do consider governmental charity as part of the whole “social justice” thingy.
“Yes. Next question?”
Where’s the incentive to not indulge my every desire, if the results are paid for by someone else?
The problem is that they indulge in some and not in others. Having people indugle in preventive checkups would be great. Unfortunately they only go after there’s a problem.
If she could have afforded it, Asaro would have gone before there was a deadly issue. As of now, she’s dead. Because her insurance sucked. So is Spider Robinson’s wife, despite large amounts of charity from the community. These are not the sort of people who would skimp on preventative checkups.
Sure, there are some people who are idiots (diabetics referenced earlier). But most people would like to do some preventative medicine.
You’re not a sociopath?
Wait… you’re… not a sociopath, right? I mean, I don’t get that from you, as often as we disagree :)
If your impulse control is so low “indulging your every desire” comes about when someone pays the tab, your sense of self is so ego-centered you’re probably indulging your every desire anyway. Since emergency medical care will be provided even if you can’t pay, I don’t see how this is different from the status quo.
Anybody who’s that self-destructive isn’t going to be put off by the risk of bankruptcy.
Then the only question is how much does it cost us to indulge some list of desires. Not every one, surely.
Now, the flip side is that you’re taking away a tool for encouraging better behavior, and there are drawbacks to that which should be discussed, but I don’t think this is the last block before regressing to animalism becomes popular.
The question I’m trying to ask is not a practical one but a moral one.
As in, “when we say that people should be given health care sufficient to keep them alive without thought of compensation to the provider, do we consider the moral-hazard implications of that statement?”
no, because there are sufficient societal safeguards to prevent rampant stupidity. Also, most risk taking behaviors are insured separately.
Like there’s no societal pressure against overeating?
there’s plenty. check out /b/ if you don’t believe me.
> “When we say that people should be
> given health care sufficient to keep
> them alive without thought of
> compensation to the provider, do we
> consider the moral-hazard
> implications of that statement?”
Without thought? I’m sort of assuming that the provider is actually being compensated. They usually are (at least to a degree, one can of course quibble about Medicaid payments being too low or whatever).
I’m not sure to which moral hazard you are referring. Are you saying that discounting the moral hazard implications means that we’re encouraging immoral behavior, and we bear culpability for that?
Community A agrees on communal health insurance. Some funding model takes money from members of Community A and puts it into Pot A.
Member A of Community A likes riding a motorcycle without a helmet. He gets into a wreck. Members R through Zed have to provide Member A with medical care, which institutes a cost. The funds are pulled out of Pot A.
There are a couple of potential problems here. Member A might not be the type who rides with a helmet if nobody else is paying the piper (I personally think this is ridiculously unlikely; people who like to ride without helmets are generally pretty not inclined to be risk-adverse). Member B may be stuck in a queue while Member A gets medical care and die (not sure who the moral opprobrium falls on and to what degree). Member C might be the type of guy who would normally ride with a helmet but chooses not to because “someone else will pay for it” (also pretty unlikely). The funding model for Pot A may be unjust.
What moral-hazard implications are we considering?
Just in case you aren’t aware of the term I’m using here. “Moral hazard” is associated with risky behavior, not “immoral” behavior.
Yes, I know the term.
I just don’t know precisely how it applies here, I was asking you to clarify.
Are you saying that the availability of guaranteed general health coverage in the event of an emergency substantively encourages highly risky behavior, and thus it represents a dilemma for a society that imposes such a scheme over and above the moral benefits that are accrued from such a scheme?
Yeah, I don’t think there is sufficient evidence to support this claim.
I readily agree that it is possible. I don’t see it as prevalent or systemic; anyone who is going to be risk-seeking enough to be risk-seeking will be risk-seeking. I doubt the majority of them even ever given two thoughts to their medical coverage. That’s sort of part of being risk-seeking in the first place.
… the social consequences of being fat are not mitigated by this law.
… the social consequences of smoking are not mitigated by this law.
let me guess when healthcare reform was being debated you called the idea that it would lead to the loss of freedom crazy. this is what annoys me about the left on minute it’s “any one who believes socialized helathcare will lead to tyranny is crazy” the next it’s “we need to reduce freedom because of socialized helathcare. i wish advocates of socialized helathcare would just admit that their policies will mean the end of freedom.
This seems like a question that can be answered with real-world data, given that your hypothetical obese, chain-smoking rebel biker would currently receive free emergent care in most other developed countries.
Are Britain, Japan, and dozens of other countries currently being bankrupted by fat tobacco addict motorcyclists?
Well, I’d say yes, although I get what you’re driving at.
But even if I said no, I hope I would not be the type of person who’d cheer this person’s death. Yet….who knows what I am capable of.
A better example would be a hypothetical diabetic who is 77 years old who gets (something)… and how much medical care they should get.
Then you can ask, as a follow-up question, about a 78 year old diabetic who has survived, among other things, (something).
You’ll have to put up with fewer people quibbling about the McGuire Twins.
As long as you’re willing to stipulate that if the “170lb ripped dude” breaks his neck rock climbing or mountain biking we don’t have to treat him either I’m good with that.
In fact, if you have an “accident” doing anything that’s not directly related to your job (which your employer should cover) or basic human tasks (I’ll even allow certain controlled exercise in controlled environments for wellness) you should just have to suck it up. It was voluntary, you should eat it.
You still in?
Eat it, or purchase your own insurance that covers the dangerous activity in question. Pay more premiums to cover the risky behavior. I’m perfectly okay with that.
…because it means we all agree that there is no right to be kept alive. We agree that there are scenarios in which “pay or die” is a morally-acceptable outcome. We agree that the combination of choice and chance can put someone in a situation where staying alive requires more resources than they have available, but that they’ve also exceeded the limits of charity.
You might not cheer when the guy in the OP hypothetical dies, but you won’t be emptying your wallet to save him either.
The logical conclusion to this is a world where insurance is useless and everyone pays out of pocket or dies horribly.
If you go down to the corner for a carton of milk and get killed crossing the street your insurance company will say “You could have had that milk delivered. Claim denied. Next!”.
I don’t want to live in that world anymore than I want to defend this one.
That’s what Medicare is for, wouldn’t you say? To provide that basic level of service?
Or are you saying that you would want your money to go to paying the lifetime care bills of that “170lb ripped dude” who breaks his neck rock climbing?
Yes, I do. That’s why I’m for single-payer UHC.
I am, too, but I think that people too often think of it as “save the babies and poor people”, and don’t have a ready response for “what about the fat smokers” beyond chanting “babies and poor people, babies and poor people“.
If you want to make the argument that moral hazard shouldn’t be considered, that’s fine, but be aware that the argument is being made; don’t just pretend like nobody will ever say “no reason to avoid risky behavior if the doctor’s always free”.
… many poor people are fat. they’re fat because of stress, among other factors. Many of them would like to diet (if nothing else, because diabetes is EXPENSIVE. I think it will remain expensive under most things, even UHC — we’re still talking people paying for drugs, right?). UHC may help us find a way to help them be not so heavy (it could happen. maybe a dietician will write something that works).
Me three. I put this hazard in the same category as defending a White Power Rally in a right to assemble and speak case. The fact that certain people are stupid or irresponsible or unlucky or bigoted or whatever is not sufficient to deny them any of the benefits and rights accorded to “The People”. Now the felon question (abrogating the social contract in a particular fashion) I could have a long debate about.
I put this hazard in the same category as defending a White Power Rally in a right to assemble and speak case.
There is a difference between people assembling and speaking and people assembling and speaking and expecting you to pay for it because we all have responsibilities, as a society, to each other.
Which is why I didn’t say it was the same hazard, I said I place it in the same category (i.e. “Hazards I’m willing to accept because of my view on rights and benefits”)
See, the “I expect you to pay for my action” is what places it in a different category for me.
I understand that both are exceptionally distasteful (if not intrinsically immoral) things that you don’t feel like you have the right to prevent.
I get that.
I don’t understand how “you have to pay for this” doesn’t kick it up into a different category from the “you don’t have to pay for this”.
Not seeing the debate, and reading both this post and Isquith’s first, I was expecting something considerable different when I saw the clip in question.
I’m not opposed to single payer, and the current system is a soup sandwich, but that’s not what Blitzer’s hypothetical was all about.
And it’s further tendentious because Mr Hypo Coma would get treatment even in today’s regime. (he’d be screwed as a soon as he woke up, but again, not part of the hypothetical)
This is grasping at straws. The crowd was cheering for individual responsibility, not for death.
If there is a charitable reading, you have to go with it. Even if you prefer the uncharitable one.
Jason, this is what I was going to write, then decided it was useless — people will believe what they want to believe. One idiot screamed out “yes” or something like that, but they started cheering when Paul said we have to be responsible. It’s a nuanced argument and the forum didn’t allow the debate.
A few idiots called out “let him die!”
… since when is mandatory bankruptcy responsible? Beg pardon, but I don’t understand a world where having a medical condition should be the reason for most bake sales, loss of houses, and general loss of middle class status.
and general loss of middle class status
You must re-evaluate whether you have middle class status if any illness can send you to bankruptcy. People love to call themselves middle-class even when they are not. People love to think that they can continue to coast doing 9-5 humdrum jobs and still remain middleclass, when they cannot. The reason people are so resistant to changing their self evaluation is because it is damaging to their self esteem. The reason they allow their self esteem so much play is because bankruptcy law in america is broken. Scrapping garnishee payments created moral hazard, which spread, and has caused the current problem in america today.
I agree – loss of middle class status due to a health crisis is usually just poor financial planning.
… when it accounts for 60% of bankruptcies, your poor financial planning is systemic and a problem for the entire system, is it not?
“just poor financial planning” assumes that you, yourself, have the ability to do better. I claim that many people do not, as they have engineered their lives. This is to Say, without cable, cellphones, or most unnecessaries, they still coudln’t prevent medical bankruptcy. (I’m counting the $4000 a year car bill).
I thought we were talking about the middle class? My experience is that just about everyone in the middle class has a lot of fat in their budget. Some simple longterm planing would cover just about any unforseen problems.
… that’s not what walmart is saying. walmart is saying that high gas prices mean that people are running out of money before the end of the month. And walmart runs on middle class people. It’s a bottomfeeder, as the middle class gets less middle class (loses income vis expenses).
It depends on what you consider fat. If you consider a car fat, then yeah, you’ve got a lot (at least 2% fat). I don’t think combining together all people’s fluff activities will even wind up with the fat of a car.
Do you save half of your income each month? A third? A quarter? How large is your safety buffer, vis a vis your monthly expenses? How about versus unplanned expenses (new roof, etc…).
Decent long term planning is impossible for people living paycheck to paycheck. And I think a large part of the middle class does so.
If you live paycheck to paycheck, unless you happen to be somewhat profligate, you are poor, not middle class. While this looks like a semantics criticism, I think that the refusal to call a spade a spade is symptomatic of a larger american malady.
No, that’s fair. It’s just that when you’re saying that less than 20% of Americans are middle class (and the rest are poor), that we should ask ourselves “is this a good thing???”
We used to have lower middle class jobs in this country. Now, by and large,t hose are working class jobs.
Kim – the global economy is a bitch. Discovering that a worker in China can put Bolt A into Hole B just as well as an American worker (and for a tenth of the cost) has been a revelation that the American workforce has still not completely accepted.
Mike,
luckily, that condition is temporary. though Americans have done much to make it permanent, it will not remain so.
I like expensive oil!
If you live paycheck to paycheck, unless you happen to be somewhat profligate, you are poor, not middle class.
Tell this to Professor James Hanley or the Heritage Foundation. Really, do. Please.
So, you think the average person who makes $50,000/year (which is the national average, give or take) has enough ‘fat’ in their budget to save let’s say, ten thousand dollars for a medical emergency?
The one who lives in South Dakota?
Absolutely.
The one who lives in San Francisco?
Probably not. They’re probably up over their eyeballs in debt.
And this is where Murali’s argument breaks down. We’re prepared to say a $50,000 earner living in SF is poor if in fact they cannot absorb a major medical emergency (which is entirely plausible even if they have insurance)?
There are power couples living in NYC who want to explain that low six figures isn’t *THAT* much.
The flip side of that is knowing that there are parts of the country where ten bucks an hour pays for everything with a little left over for entertainment. (I originally wrote “cities” but I doubt that they’d be considered such by people who live in places where six figures isn’t *THAT* much.)
Why would anyone need to save that much? That’s what insurance is for. COBRA, catastrophic medical coverage, employer provided plans, etc.
The vast majority of people, (I forget the actual number, but it’s somewhere around 2/3), that go into bankruptcy because of medical issues _have_ insurance. So, yes, people can pay for all of the above and still end up bankrupt.
Thus, my question.
Mike,
yeah, you’re so wrong on this one, you oughta hang your head (or run along to a different thread). Even people with the best insurance they could get are still declaring bankruptcy.
Not the least of which is that the insurance won’t pay up if they can litigate first.
Have a miscarriage? They’ll call it an abortion, and refuse to cover it.
Hell, one insurance company refused to cover anything over a set dollar amount. They’d find some excuse to deny ANYTHING.
Thos enumbers have been disputed.
http://www.american.com/archive/2009/august/the-medical-bankruptcy-myth
AEI puts the number at 17%.
I’m not talking about the number of people in bankruptcy because of medical issues. Even though I’m sure the numbers have been cooked by the AEI, I’m not arguing that.
What’s I’m saying is that of bankruptcies due to medical bills, 2/3 of those people _have_ insurance. So, they’ve been responsible _and_ still have to declare bankruptcy.
Thus, my question about a middle-class family having to save $10,000.
A lot of the problems in the American setting is because health insurance is broken really badly.
Mike,
different timeframes will fuck up your statistics. 2009? really? Not even looking at the link, mind.
Kim – I assume the numbers would only be better now with the implementation of Obamacare.
Mike,
what’s funny is taht you think obamacare has been implemented. wait till 2014, please.
What’s funny is that you think it hasn’t.
http://www.theatlantic.com/business/archive/2011/06/why-hasnt-anyone-signed-up-for-the-high-risk-health-insurance-pools/239833/
Also, try using your FSA to pay for over-the-counter meds today and tell me O-care hasn’t kicked in.
Mike,
most uninsurable people have had either:
1) a major depressive episode, ever (any psych treatments can get you tossed into uninsurable)
2) a c-section, ever.
I doubt most of them are aware that they are uninsurable. In fact, I doubt most of them have been denied by insurance (they’d rather take the money, and deny you later if you ever make a claim. That’s stealing in my book, cause they keep your money)
… what was that, 33% of American households have $1000 in the bank? Granted, we ain’t talking raiding retirement accounts, but if we go by that measure, and give 5% as upper class, then we’re looking at less than 30% of Americans being middle class.
Or, we could go with the older measures, and say that anyone making less than $100,000 a year isn’t middle class (thank california, it majorly mucks with this one).
I contend that a large middle class is a good thing for America, and that the policies of our country have served to erode our middle class, over the past three decades. I lay most of that failure on republicans. YMMV
Truly. Especially if the uncharitable reading involves regarding someone as a ‘statist.’
The uncharitable reading here requires not only being a non-statist, but also being actively opposed to private charity.
Yes, but Jason, I’ve been reading your stuff for quite a while, and it is quite clear that you are a Republican apologist.
Don’t deny it!
I can’t tell if you’re trolling or not. Seriously, I just can’t.
Sorry, after I posted it, I realized it could be read incorrectly; I should have crafted my comment better. It was a joke.
(Though I imagine some people actually believe you’re a Republican apologist, ignoring all evidence to the contrary.)
The fact is that I could call for the chainsaw murder of every Republican presidential candidate, and some people would say, “Oh, I see how it is. He’s just trying to distract us.”
It’s almost art, in’it?
I try to balance my posts. The ideal would be to piss everyone off equally.
True Jason, afterall, it was only a few in the audience who actually shouted, “Let him die!” The bulk were just applauding the case for individual responsibility.
Unfortunately, Blitzer asked about a hypothetical young male who chose not to purchase insurance. He should have gone with someone who was laid off from their job and could no longer afford/obtain it.
Actually, the hypothetical completely obscured the underlying issues. Paul’s response, Blitzer’s “let him die?” foll0w-up and the cheering fans of individual responsibility in the audience all ignored there is an EMTALA. The tragic 30-year old wouldn’t be left to die – he’d be treated, likely in an ER, as required by law.
Now, per the hypothetical, the guy had a good job and he wasn’t buying insurance, so he could have had some savings. Likely, the hospital would be able to garnish his assets to recoup some of their costs. But, comas ain’t cheap, so in the end you’ve got a bankrupt guy in a coma and a hospital with remaining costs they are going to pass on to all of those who do have insurance. This guy’s freedom ends up costing people who were not in on his decision to go without insurance and it does so through a grossly inefficient process.
I don’t hear anyone proposing the repeal of EMTALA, so in the end, doesn’t it all come back around to cost shifting? Granted the guy trying to ride free ends up destitute, so you’ve still got the moral hazard thing going.
Yeah. Really a poor job by Blitzer. He lives in a wonderful world of ideas that he uses to concoct these exquisitely entertaining political conundra, and it just so happens that his world is uncluttered with the ugly, chipped brick-a-brack we sometimes call “facts” here on Earth.
How do you know that? Can you read their hearts and minds? Y, when it comes to conservative audience, let’s go with the most charitable audience, but when it comes to liberals, let’s scold them and demand them to answer and justify things said by Walzer and Blitzer they might not even agree with.
E.D. – Let’s try to keep in mind that this is a debate with a limited, partisan audience and I heard maybe 3 people yell something specific. Watching every moment of a televised debate and looking for crowd reactions that you don’t approve of and then implying (or stating outright) that THIS is the Republican party is just ridiculous. Just look at the conservatives who are involved here at the League. I’d say we’re a pretty diverse group – wouldn’t you?
Also,
“A lot of people came back to me in my last debate post saying “You liberals would cheer if you heard a bunch of babies had been aborted!” but this is just nonsense.”
What we all said was that if you believe that a fetus = a life then protecting abortion means protecting an institution which end 1.3 million lives every year. In exactly the same way, if I say I approve of our military actions in Afghanistan then I am also saying I approve of an action which has lead to hundreds (thousands) of civillian deaths. I cannot wash my hands of that and neither can ‘pro-choice’ individuals.
I think Mike captures the essence here; no one thinks that liberals would cheer at aborted babies – anymore than people cheered and executed innocent(s).
Pretty sure that the a liberal crowd would, however, cheer at successful programs the significantly extended the reach of Women’s Reproductive services both in the US and abroad.
A partisan “gotcha” question (should have been in the other thread) might look something like this:
“Candidate Pro-Choice, your administration has vigorously promoted Women’s Reproductive Services throughout the US; and have increased funding for these services by $100M annually. . A recent study by [insert reputable but right leaning research group] shows that for every $1M spent on these services, an additional 30 women are able to terminate unwanted pregnancies.”
[https://secure.aclu.org/site/SPageServer?pagename=SEM_ReproductiveFreedom&s_subsrc=SEM-g-choice-s-womenschoice]
“Mr. Candidate, what do you make of the crowd just having cheered an increase of 3,000 abortions? Have you ever lost sleep at night contemplating that your policies have killed an additional 3,000 babies, more than any other candidate in modern times?”
You [E.D.] hear killing an innocent prisoner, advocating torture, and apathy towards suffering. The other side hears, due process for law, national security, and personal responsibility.
I’m just surprised that you are so confounded by this… its like you have gone tone-deaf to the political music (cacophonous though it might be), or that you are only selectively listening now.
There’s nothing really constructive to this post other than to illustrate the obvious and increasing divide in America… when you cannot even imagine the “other side’s” position as being reasonable…
I tell you naught for your comfort,
Yea, not for your desire,
Save that the sky grows darker yet
And the sea rises higher
oops… it appears that the site does not like brackets other than ( ) or [ ]… the link is therefore missing context – please disregard.
I didn’t watch this either, although in fairness, I haven’t watched anything on tv in the last month or two. Watching the clip, I think they’re just cheering him saying liberty means taking responsibility for one’s self, which is not a terrible thing to cheer. There’s one dick who shouts something about letting the guy die, and really that was graceless and repulsive, but one swallow does not make a summer.
Unfortunately, letting the person not buy insurance and then letting them die as a result is just not a good outcome. At least economically, there’s a case to be made that that individual’s contribution, if they live a longer, healthier life, far outways what we gain as a society by not allowing them a “free ride.”
Is the right to be irresponsible and die really worth that social cost? This is where notions of freedom and unencumbered individuality are taken to dogmatically irrational extremes.
Okay so even Rick Perry was taken aback (his words) by the cheering in this debate.
Edit: fixed link.
I might also mention that the Pew study I cited above notes that people that are married are much less likely to fall out of the middle class. I note that on my salary I would be lower middle class with less cushion but with my salary along with my wife’s we are comfortably in the upper tier. Minorities, especially blacks, have lower rates of marriage, more single parents, etc. This is a cultural feature that was noted as early as the 1940s with the University of Chicago and Black Metropolis.
Mike at the Big Stick: Let’s try to keep in mind that this is a debate with a limited, partisan audience
I keep coming back to this point. Why exactly did they (the candidates especially, but also CNN) think a “Tea Party Debate” was a good idea in the first place? Are they going to do this with every fringe group now? The CNN/A.N.S.W.E.R. Coalition Debate?
I would watch that debate.
Hell, I would liveblog it.
“Senator Clinton, during the Presidency of Ronald Reagan, Mumia Abu-Jamal was convicted of a murder that he did not commit. He remains in prison and on death row. What is your opinion on whether or not he should be freed?”
If you want the freedom to make good or bad choices in life you have to accept the responsibility of the outcome.
The moment you want others to pay for your bad choices, or even bad luck, you invite them to control you, and you will have to accept that as well.
That’s the bottom line — you become at the mercy of others.
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