Maybe some should

No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day.

I have mixed feelings about this. It is a black-and-white statement that paves over nuance. Unfortunately, for any sort of reform to pass, we probably have to make those kinds of black-and-white statements. But it irks me somewhat.

Why?

Because while it is a laudable goal, the truth is that any health care system has to make tradeoffs. I can imagine any number of cases in which people will die because they couldn’t afford health care, and that’s the way it should be.

I had to make the somewhat difficult decision not to bank my son’s cord blood. It’s not something covered by insurance, and it costs–depending on the company–well north of a thousand dollars. We asked lots of people. A friend, who is a genetics researcher, had his daughter’s cord blood banked. The AMA was saying it was probably not necessary at this point, but that it was something that may provide a benefit to your child if certain breakthroughs are made.

Now, if I were rich, the decision to do this would have been easy. If I were poor, it would have also been easy. But I am in-between, and so the decision was harder. That money, wisely invested, could buy him a lifetime of bikes. There were significant opportunity costs in paying for banking.

If he dies of a disease that could have been cured with that banked blood, I will, of course, be crushed. And it will be tempting to say “if only he had access to better health care.” But as a practical matter, people die every day because of rational decisions about the cost of care. No health care system is going to pull out all the stops for every citizen.

Moreover, I suspect that we will not change the fact that the rich live longer than the poor do. It’s not just access to better health care that aids them, it is access to healthier food, better education about health, safer environments, and less dangerous working conditions. In some ways, if we are to have any vestige of a capitalist incentive, it’s difficult to say “those who can afford it should not be able to buy better health care.”

None of this changes the fact that today’s health care system is a mess, and that we should be embarrassed as Americans that we allow it to continue to be a mess. And it seems likely that “socialized medicine” in some form is a better solution. But the idea that people won’t die because there is a public option for insurance is just silly.

Health care is now and always will be “rationed.” Society should make decisions about how best to allocate its resources. I think the stronger argument is that today we spend more per citizen on health care than most industrialized nations, and get the least out of it. In a country where “productivity” is often our proudest accomplishment, our health care represents a shocking counter-example. Particularly because this so fundamentally affects the lives of so many people, efficiency means compassion.

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6 Comments

  1. jason
    Posted 9/12/2009 at 6:57 am | Permalink

    “No one should die because they cannot afford health care, and no one should go broke because they get sick.” is very different than the fact that healthcare is rationed. ours is rationed, but ration according to different criteria than wealth, largely. I routinely get bumped from my MRI because someone who needs one now gets it. That’s rationing. And somethings are not covered, like your issue with chord blood. And opera singers in Toronto have better access to the top audiologist. And my Dr can get me in faster cause he’s a famous fundraiser for community needs downtown and is well connected. This is pretty much just variations on how it works in the rest of the world. Whether the over-all system sucks or not.

    What strikes me is the absolute lack of compassion that comes with lack of universal health care. That combined with the sense that if me and mine get what they need, fuck the rest of the world and the rest of america. There is not even the illusion of the equal value of each individual. Those who fall between the cracks seem to be punished for their failures, while those who have not fallen assume they are better due some metric that means richer is more worthy.

    Thank god I’m not religious. Seriously. If god’s followers, and I think that this is the mentality that infuses this lack of humanity, damn the fallen and the unbelieving to hell, I want no part of it, on heaven or on earth.

  2. Posted 9/12/2009 at 11:04 pm | Permalink

    I love playing devil’s advocate, so I will. If I were a Christian (I’m not, though I’m not anti-Christian–hate the belief, but love the believer is my motto), I would say:

    “The US has always celebrated a separation between church and state. The fact that I want the Church to be my humanitarian arm, and not the State, does not mean I lack humanity. On the contrary: I think that the Church can provide for health care for the destitute, and at the same time guide them toward His Light. So, you know, bonus!

    “Moreover, if I help the poor with their health care through my tithing (and mind, 10% is a way better tax rate than I’ll have to pay to the gov) and donations to religiously affiliated health organizations (which are also tax write-offs), I can make sure that the care on offer is of much higher quality. It won’t, for example, allow the sinful practices of obeying a DNR request, or terminating a pregnancy.

    “So, it’s not fair to suggest that government run health care is the only humanitarian solution, especially when certain practices of health care professionals are immoral.”

    I think Obama has played this poorly. The better bet would have been to introduce it as “Medicare for all.” Easily understood, clearly drawing the battle lines. Instead, it ended up mush.

  3. Posted 9/12/2009 at 11:11 pm | Permalink

    Oh, and as for “me and mine get what they need,” if Canadians are all so compassionate why are they only paying for Canadians’ health. Why aren’t you subsidizing your friends and neighbors to the south? That’s what I want to know. No, no, it’s always “Us Canadians first, let the Americans fend for themselves.”

    People dying because of lack of adequate health care in the US? I blame Canada.

  4. Torgonator424
    Posted 9/13/2009 at 5:10 pm | Permalink

    Oxford insurance is raising some of their rates by nearly 40%; my employer has to find a new provider service by the end of the month; as they say, the good news is money isn’t everything; the bad news, it’s the only thing.

  5. Torgonator424
    Posted 9/13/2009 at 6:10 pm | Permalink

    Dick Morris put it all succinctly: unless the gov’t is going to expand services, build hospitals, financially encourage new doctors, etc., gov’t run medicine can’t work (remember when Obama compared this to UPS/FedEc/Post Office? He said the only one that wasn’t working was the gov’t controlled one !

  6. Posted 9/13/2009 at 6:42 pm | Permalink

    Dick Morris puts lots of things succinctly, and demonstrates that you don’t have to be very bright to have an opinion.

    I don’t think anyone is arguing for government-run health care. What they are arguing is that government should expand it’s role (remember, it already has this role) in insuring Americans. Yes, Obama made a mess of his statement about the post office–obviously the USPS is working well, that’s why I and many others choose it. I think his example of public and private universities is clearer.

    But the best example is probably Medicare and Veteran’s Affairs. These are far from perfect, but far better than what most private insurers provide. Here’s the kicker, though, if you don’t agree, stick with private insurance.

    We have some of the worst health care–on average–in the industrialized world. We rank below some third world countries in infant mortality. Our doctors charge more for worse care. In other words: we suck, let’s fix it.

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