Health care and death

September 13, 2011 | By | 4 Replies More

Progressive sites are howling at the insensitivity of the Tea Party based on a hypothetical. This is how the conversation went down at a recent Republican debate:

Wolf Blitzer: A healthy 30 year old young man has a good job, makes a good living, but decides—you know what? I’m not going to spend $200 or $300 a month for health insurance because I’m healthy—I don’t need it. But something terrible happens … all of a sudden he needs it. Who’s going to pay for it if he goes into a coma.

Ron Paul – He should do whatever he wants to do and assume responsibility for himself . . . My advise to him is to have a major medical policy . . .

Blitzer: But he doesn’t have that and he needs intensive care for six months. Who pays?

Ron Paul: That’s what freedom is about . . . taking your own risks. This whole idea that you have to compare and take care of everybody . . .

Blitzer: Are you saying society should just let him die?”

[A couple voices in the large crowd shout “Yes!”]

Ron Paul: . . . The churches . . . [will help him]

Several things come to mind. The hypothetical was designed to make us not want to take care of this man. After all, if I am working overtime to scrape together huge payments for my family’s health insurance and the man in the hypothetical decides he won’t bother to pay even though he “makes a good living,” my gut feeling is he is trying to cheat the system, which makes me highly ambivalent about him, and much less sympathetic about his terrible situation. How much do I care about this man? I once told a friend of mine that I “cared” about a sad situation, and he said, “No you don’t. If you cared, you would do something to fix the problem and all you’re doing is complaining.” I think he was dead-on with that comment. If we care, we get involved. If we’re merely complaining, we don’t really care, no matter what we say. How do Americans often show they really care? By reaching into their pockets and giving money to the cause. With this in mind, allow me to offer a few of my own hypotheticals.

Let’s consider, again, the man who refused to buy health insurance and is now in a coma. If his family went door to door and asked for money would people care enough to give money to defray his medical bills? If they came to my door and honestly explained to me that the man made a conscious decision that he’d rather go on fancy trips or buy a big screen TV (or whatever) rather than pay for his health insurance, and now he’s in a bind, I might give them $5 and wish him well. I wouldn’t be very generous based on these circumstances. I’m not proud to admit this, but I think I know myself well enough to make this prediction.

I doubt that most Liberals would give more than a couple dollars each to help out the man in a coma. I believe that many of the liberals who are screaming at the fact that a couple people in the audience would let the man die are being hypocritical. Assume that a typical liberal family were asked to hand over the $2,000 they had saved-up for a family vacation to the Grand Canyon. How often would you hear this: “Sorry, kids. A man who decided to take a huge risk by not buying health insurance needs our vacation money for his respirator fees. No vacation this year.”

Now imagine a different situation: A man lost his job two months ago after working for 30 years, and his insurance was cancelled two days ago. He fell into a coma yesterday while volunteering to cut an elderly woman’s grass. Now assume that HIS family is going door to door and they honestly explain this situation to you. I could image contributing as much as $100 (if I believed the family). I still wouldn’t hand over all the money my family had saved up for a vacation. I’d like to claim that I’d take this man’s problem on as my own, but I honestly wouldn’t—not all of his financial problem. I’m trying to be honest here, and it embarrasses me somewhat to write this, but I doubt that more than a smattering of liberals would give more than ten of their own dollars even to help this “innocent man.” I further believe that most liberals would give nothing to this family if this were the third or fourth deserving case that came to their door in the same month. If I’m correct in my assumptions, how different are liberals than Tea Partiers when it comes to “caring”?

I know many conservative folks who take church seriously, by the way. Most of them would go to extraordinary lengths to help sick co-members of their congregations, and these are many of the same people who want the government to cut back the social safety net.

Here’s another thing that comes to mind as I consider the Tea Party shouters. Barack Obama took single payer off the table while he promoted “health care reform.” Instead, he did backroom deals with quasi-monopolistic health insurance companies requiring us to “shop” for health insurance from companies that are gouging us, and requiring us to procure our health care to use in a highly inefficient health care system. We could have Medicare-for-All, like most civilized countries, but we don’t, because Barack Obama decided he wouldn’t fight for it. Because of that, it is possible to have moral quandaries like the one Wolf Blitzer raised. If we had single-payer coverage, we wouldn’t be talking about the man in the coma. Who am I more mad at? The smattering of audience members who were willing, in the abstract, to allow a cheater to die? Or Barack Obama, who consigned us to a wretched system, pretty much guaranteeing that this is the best we’ll do on health care reform for decades. And pretty much guaranteeing that we’ll have a lot of cases like Blitzer’s hypothetical when it didn’t need to be this way.

Now it’s time for some nuances. Even though I am in favor of national health care, I am not convinced that I we can afford a national plan that covers every conceivable medical treated desired by every person. For instance, I’m not in favor of providing liver transplants for long-term alcoholics. I’d rather spend that money researching cures for cancer. I’m not interested in providing full coverage for those who engage reckless amusements like base jumping. I don’t think that taxpayers should be made to fund most “elective” surgeries (e.g., breast enhancement or hair replacement). I’m not in favor my country being co-dependent regarding anyone who consciously destroys his or her own body through long-term bad choices, even if they later beg forgiveness, and especially if they demand the taxpayers to come to their rescue. I’m not in favor of paying for liposuction for people who never exercise and who constantly eat potato chips.

Be honest, liberals: If the families of these sorts of folks came to your door, how much cash would you donate to these causes?   Wouldn’t you be thinking to yourself “Sorry but you decided to take some risks or you consciously did damage to yourself, and I’m not inclined to come to your rescue.” If so, you’d be a lot like the Tea Party people who were willing to let the man in Blitzer’s hypothetical die.

Here’s another “medical” issue that is laced with moral judgment (most of them are). I’m not in favor of artificially maintaining heartbeats and breathing in unconscious people who have almost no hope (or no hope) of ever becoming conscious again. Imagine if a family came to your door and asked for big money to maintain the heartbeat of someone whose doctors believe she will never again be conscious? Wouldn’t most of you be thinking “This seems hopeless, and you’ll need to come to terms that this person’s life is already over.”? I realize that many conservatives insist on keeping those heartbeats of brain dead people beating as long as Medicare is footing the bill. I wonder whether they would still consider grandma to be “alive’ if they had to go door-to-door to raise the funds?

Ok, and here’s yet another hypothetical. Imagine a the poor family across town who might knock on your door, asking you to pitch in to help pay for their 8-year old boy to have a cast put on his broken arm. He broke his arm when he tripped and fell while walking down the sidewalk, and the total cost to be $800. If he had no other way to pay that bill, maybe I’d throw $50 into that collection basket. What about you?

Perhaps the elephant in this room is that “health care” is not a monolithic concept. There are plenty of uses and abuses of health care dollars and an effective health care program will need to make judgments that often seem crass. As much as I don’t like many aspects of big health insurance companies, I understand that that they must often play the role of bad cop in order to stay solvent. Any effective public program would likewise require gate-keeping in order that the tax dollars are efficiently spent to promote public health.

While I am in favor of a broad-based national policy, I’m not in favor of a universal gold-plated policy that provides endless medical care to anyone who asks for it. Society has many needs, and we need to consider our budget in relation to all of society’s needs. It might be that we need to establish a policy like Oregon state’s public health program, where we would pay for the kinds of coverages that we can afford based upon an analysis of what treatments are both effective and cost-contained. $1,000/day for a cancer drug that gives the patient a 5% chance of living 100 more days is not something that should be covered unless treatment more effective than that is already covered. If that patient’s family came to my door to collect money, I would likely tell then that I am sorry but I will not be contributing to that cause.

I believe that we can’t declare any program to be “sacred” when deciding budgets. When we fund health care, we need to consider the need to fund ALL of society’s needs, which include such disparate things as elementary education, bridge repair and space exploration. We need to also consider chopping hugely wasteful programs (Department of Defense) before we even begin to decide what type of national health care program we can afford.

I believe that there is a way to construct such a national health care program that would actually appeal to liberals and conservatives, and which would cover most of the medical needs of most of our people as a basic civil right, but I can’t imagine this program becoming a reality. We have too many sanctimonious liberals and too many narrow-minded heart-hearted conservatives in key positions. Thus, our national dialogue is dishonest, pretentious, uninformed and thoroughly infested with innumeracy. It is strewn with intentionally promulgated misinformation by those in a position to financially profit from a particular outcome. And mostly, the dialogue is simplistic and monolithic. We talk about the “poor” and the “sick” as though we don’t need to do much thinking when making draconian across-the-board cuts to valuable (and admittedly imperfect) national programs.

Before we finish talking about who is letting who “die,” we also need to take a look at the spending habits of liberals and conservatives. We like to pretend that there is a moral oasis that we can climb onto periodically, so that we can freely spend our fungible dollars on amusements like trips to Europe, movie tickets and fancy clothing. I hate to be the bearer of bad tidings, but those same dollars can save people’s lives, both here at home and overseas. All of us are hypocrites some of the time. We all let some people die, some of the time. And we sometimes just kill their minds, as when we spend money on our private amusements while millions of children are made to endure crappy schools without basic books and school supplies. This happens every day in America. Consider, that if we are overly-generous in doling out health care, we are further depriving some children of educations.   We will never have a perfect budget, but if we are self-critical, we can have a smart budget that stretches to cover many more of society’s needs.

Image by Karenr at Dreamstime.com (with permission)

Maybe all of us need to think about that person we see in the mirror every morning before we complain about those honest Tea Party louts who shouted that the coma with terrible judgment should suffer the natural consequences of his actions. Really, if you think it’s OK to stop buying health insurance, then tell your friends and neighbors that you’re going to stop buying health insurance. Instead, you’re going to buy a new car and you expect those friend and neighbors to reach deeply into their own pockets if you ever have medical needs that you can’t “afford.” But I digress, because our allegedly progressive President gave up the fight and cut secret deals, meaning that we are actually in a position to argue about these hypotheticals.

Establishing a decent and sustainable national health care plan would require smart and honest conversation, and willingness to negotiate, the likes of which we haven’t seen in this country for a long time. In fact, I can’t even imagine this kind of conversation these days.

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Category: American Culture, Health, Health Care Reform, Medicine

About the Author ()

Erich Vieth is an attorney focusing on consumer law litigation and appellate practice. He is also a working musician and a writer, having founded Dangerous Intersection in 2006. Erich lives in the Shaw Neighborhood of St. Louis, Missouri, where he lives half-time with his two extraordinary daughters.

Comments (4)

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  1. IFKaramazov says:

    Although I agree with most of the more “controversial” statements you’ve written (the ones about, in essence, making choices under conditions of scarcity), I think the genesis of this line of thinking may be missing the larger point, even if you have the finer details straight.

    Granted, I don’t know which progressive blogs are saying what, so I don’t want to presume to speak authoritatively for all “liberals,” but when the Tea Partiers scream “let him die” and leftists come back and shout them down as monsters, the reason is that the Tea Partiers would say the same thing for any example you care to come up with (albeit perhaps with somewhat less zeal) because they are ideologues.

    For my part, I also have to wonder at the rate of instances such as the one Blitzer came up with actually happening. Most of the people I have known who have, at some point or another, forgone some type of insurance have usually done so because they they couldn’t afford it and with the understanding that they would attempt to get it back at the earliest opportunity. And if health care were nationalized to begin with, such problems would be excluded outright.

    The completely careless and blatantly stupid are, I would agree, generally not the sort of people I would want to support either. With that said, I don’t think that those types of rare examples should be used to sway policy.

    Weight problems are a different story, and when it comes to those sorts of things there are more issues to be looked at. One is social. Obesity isn’t just going up because more people are “deciding” to be fat. Behavior is not so easy to control as popular wisdom would have it (ever try to stop biting your nails? nervous yawning? plucking hairs?). Although I understand you couldn’t just give out every treatment for every problem, and obesity is an easy one to target since it’s a huge underlying problem which generates all sorts of complications (and no one forced fed you those hamburgers, after all), there is a question of how much treatment should be denied when it’s questionable precisely how much responsibility is attributable to a given individual and how much to other factors.

    But these are all questions to be answered after the debate has been settled with regard to the legitimacy of government management of any sector, particularly health care. Thanks precisely to the types of people shouting “let him die,” it is not and will not be for some time.

  2. Erich Vieth says:

    This post should be read in conjunction with my earlier post regarding our inability to negotiate regarding those things we deem to be “sacred.” http://dangerousintersection.org/2011/07/28/sacred-things-are-tearing-us-apart/

    I know that I’m overgeneralizing, but it seems to me that liberals tend to state as undeniable fact that we, as a country can afford unlimited healthcare for all citizens. I don’t believe this. My understanding is that all countries with single-payor systems pay for some treatments or many of them, but not everything anyone might demand.

    Conservatives tend to claim that we can’t afford any type of single-payer system, and I don’t believe this either. Further, many conservatives are willing to tolerate a system that would leave millions of people without any healthcare at all, resulting in many deaths and permanent injuries and illness. I find this intolerable, especially since this position lacks even a modicum of compassion.

    I do believe that their is a way to arrange for reasonable health-care coverage such that other important budget priorities are not blown away in the process. No budget items should ever be treated as “sacred” such that they always get fully funded, even if other important budget priorities are destroyed in the process.

    As I wrote this post, I was also incredibly frustrated with our money-corrupted political process, which would not be able to produce any sort of health care program, even if were well-planned and reasonable in cost and scope. To implement a reasonable plan would take intelligent, uncorrupted people who are willing to discuss this highly nuanced topic like adults, and show a willingness to compromise. There’s no room in such discussions for talk of “death panels,” for people who have no concept about how to financially plan and stick to a budget, or those who think that all government programs are inherently evil.

  3. Erich Vieth says:

    “In the United States 10,000 to 25,000 adults and 4,000 to 10,000 children are in PVS.” That means that in the U.S., there is an entire city of people who have virtually no hope of ever being conscious. http://www.dana.org/news/brainhealth/detail.aspx?id=9790 It has been estimated that the annual costs of caring this population is as much as $7 billion.

    I have personally expressed to many people that I do not want to be kept alive if I were in a persistent vegetative state. I don’t want to receive food or water through a tube with such a tiny chance of gaining any consciousness, with almost no chance of having substantial function restore, and a guaranteed annual cost of treatment of more than $200,000. In my view, it would be immoral to spend that kind of money on any PVS patient while there are children and young adults desperate for basic medical care, or even while there are children who are trapped in terrible schools.

    I’m fully aware of the huge amount of money we waste on our military, but even if we drastically cut the military budget, it might not be enough to give a gold-plated health policy to everyone; our Medicare expenses are exploding.

    According to an estimate by the Congressional Budget Office, by 2082, combined spending on Medicare and Medicaid would be 19% of GDP. Today that figure is just 4%. The American Academy of Actuaries says that Medicare Deficit Elimination over 75 years would need an increase in Medicare payroll tax by 122%, a 51 percent reduction in benefits or a suitable combination of both options.

    http://medicaresupplementinsurances.com/supplement-plans/what-is-medicares-future-amidst-exploding-health-care-costs/

    We are keeping many thousands of corpses breathing, much of this being tax dollars, so that families can pretend that their loved ones are still “alive” and being cared for. This might be a luxury we cannot afford.

    The point I tried to make in this article is that even after slashing the military budget (if that were feasible in our warmongering country) we might still not have saved enough to provide every person with every medical treatment they seek.

    To decide what we can afford, we need to have people in the room who understand budgets, who understand that spending money we don’t have is a hidden tax, one way or the other. If we were a country of mature and wise minds, we could has this out and come to some reasonable national health program, even if not perfect. I’m not optimistic that we will ever be capable of having this conversation with one another.

  4. Niklaus Pfirsig says:

    It is very easy for someone up with money to put down those without money. With enough wealth a person can be self insured and instead of paying premiums to an insurance company can maintain a health savings account which then pays interest so instead of throwing money out the window to insurance companies which are incentivied pay for health care, they can actually earn money which puts them ahead.

    The problem with Tea party rhetoric is they preach a gospel of selfishness and ignorance to those who would benefit the least from their policies but are convinced that they will become wealthy under the proposed rules. The problems with the tea party ideology are ignored by their followers who want to believe some great evil is responsible for their condition and that by following the punditry, Simple answers to complex problems will result in their wealth,

    They believe the lies so much that they will ignore any hypocrisy on the part of their leaders. It’s a cult, based on paranoia, selfishness, and fueled by a drive for dominating authority with absolutely no accountability or responsibility.

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