• Why the cheers mattered

    I feel the need to follow up on my post debate thoughts. Specificially, I need to follow up on this:

    One of my good friends is a pretty solid libertarian. He’s also a doctor. While I believe that there’s no chance he would ever let a patient suffer, regardless of his or her ability to pay, I also believe that he likely agrees with Rep. Paul here. He thinks that people should take responsibility for their lives. When we debate, I don’t doubt he’d hold that if a 30 year old who could get insurance decided not to purchase it when he could, then that 30 year old should own the repercussions.

    And, on some level, I understand his feelings. They are consistent with his world view. Yet, as a human being, I know he couldn’t stand there and watch that 30 year old suffer. He’d hate it, but he’d give in.

    But even when we argue in the abstract, and he tries to stand firm, he acknowledges his position leads to a undesirable outcome. He mourns the theoretical 30-year old, even as he argues that letting him go serves the greater good.

    As I said, he’s my friend. I don’t demand everyone agree with my world view. In fact, while I disagree with Rep. Paul’s beliefs, I’m not angered by them.

    What I’m upset about are the people in the crowd who cheer when Wolf blitzer asks, “should society just let him die?” Someone shouts “yes,”  just as Rep. Paul starts to answer, “no”. I think even he was taken aback. Go to about 1:00 and listen closely.

    What disturbs me is the glee and excitement shown by people in the crowd, apparently delighting in the idea that society would let an American die. Not for committing a capital crime. Not for committing treason. They’d let him die for failing to buy health insurance – for making a bad decision.

    I don’t think that we should make the penalty for that death; I really don’t think we should delight in that outcome.

    These same feelings developed during health care reform. Many people wanted their side to “win” so badly that they began to delight in victory and the political game to a point they forgot that we were discussing very important issues with a human cost. We’re better than that. Politics is not an end to itself, it’s a means to achieve better outcomes for our country, whatever they may be. It’s still very early in this election. Let’s try and remember these are serious issues, and that real lives are in the balance.

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    • Hi Aaron,
      Along these lines I’m not sure you saw this but it turns out Ron Paul’s former campaign manager died from pneumonia without insurance and broke.

      Here is the story:
      http://gawker.com/5840024/ron-pauls-campaign-manager-died-of-pneumonia-penniless-and-uninsured

      This just makes everything even more tragic that it happened while Dr. Paul spoke at the debate.

    • Your friend’s libertarian principles are the exact moral equivalent as the principle that the proletariat must own the means of production or remain forever in poverty.

      You can see why someone’s mind might wander down that path, but then you stop to look at human behavior, history, psychology, and sociology, and you realize it’s not that simple.

      The rest of the wealthy world has found that universal health insurance is quite a bit more efficient and cost-effective a means of health care delivery in a society than the US system.

      Now, just because communists were wrong about stuff doesn’t mean that it’s stupid to care about poverty; just because libertarians are wrong about stuff doesn’t mean it’s stupid to care about incentives, freedom from overbearing regulations, and personal responsibility.

      But at the end of the day, when we’re talking about governance, we’re talking about which policies work best given what we know about how humans really behave. And libertarian principles, which work quite well for the production of toasters and televisions, just don’t work well for health insurance. (It’s always seemed to me that libertarianism only makes sense if it’s a transformative vision, a view of how Brand New Man should act. ‘Cause lord knows it doesn’t describe actual human beings).

      You wrote: “We’re better than that. Politics is not an end to itself, it’s a means to achieve better outcomes for our country, whatever they may be.”

      Not for the Republican Party. Look back at the last 10-15 years and tell me what their principles are. They haven’t got any, any more than fans of the Philadelphia Eagles do. They have a side, and they like to win.

      It seems to me that the reason that wildly unreasonable libertarian beliefs on health insurance are so common in the US (while the corresponding wildly unreasonable beliefs about communism are long dead and gone) is due to the Republican Party’s highly successful Southern Strategy. The GOP played on whites’ resentment over the federal government desegregating their schools, and turned it into a hostility toward government generally, because they saw it as working for a hated “Them” rather than for “Us.”

    • Who can forget a handicapped woman speaking in favor of health care reform being heckled at a Town Hall Meeting in 2009?
      It’s about 2 minutes in to the video here:
      http://www.nj.com/ledgerlive/index.ssf/2009/08/health_care_reform_town_hall_n.html

    • The more I look at the video, the more I am forced to disagree with you.

      The cheering wasn’t triggered by the decision to let him die, it was triggered at the moment when Paul defined freedom as being free to make decisions and living with the consequences.

      Yes, two people appear to have shouted out “let him die” or something similar, but taking that as a measure of what the audience (or the broader conservative movement) thinks would be like searching through a bloggers archives and finding the two wackiest remarks there and compalining about them.

    • Wrong decisions are not the only reasons for the hypothetical scenario to unfold. There is a very real scenario of any of us losing our jobs one day, falling sick, and exhausting our resources and coverage, and then dying a horrible death due to lack of coverage……..despite paying a significant amount of money as premiums before we lost our jobs………..

      • I think that wrong decisions IS the only way for the scenario to hold, since being able to afford healthcard and not getting it (i.e., the wrong decision) were built into the hypothetical scenario itself.

        That aside, your scenario of losing your insurance because you lost your job is a valid one in its own right.

    • Actually for an otherwise wealthy 30 year old there is no problem. You would ask him if he wants to be treated and about what it will costs and he would most likely choose to treated and he would then amortize the bill. He might choose to be treated in India by Apollo health care or in Mexico but most likely here. If he had assets like a home, car or 401k he could use these to pay off the bill. He could also get some charity or shop of a research program etc.

    • A harder case would be a low earner 58 year old with no assets. He would have to rely on charity.

    • And BTW by charity I mean friends and family and what we normally think of as charity-church, United Way, The shriners etc.

      • How are their funds currently. Especially in the current economic downturn I bet they are not as financially viable nor could they afford to take care of those people who need it. If they do decide to do so they would be reallocating those funds from other charitable work.

        Put it another way what individual, wealthy or otherwise will give money to a charity that helps people without insurance. I’m asking just in general do we believe that this can work? I understand it worked earlier in the century and past centuries but is it that difficult to enroll for insurance?

        Cause the example I gave was a man who died and his mom has to pay his medical bills through donations.

    • Aaron
      I thought about your post all day. Stuck with me, and not in the best of ways.

      What troubled me was not just the cheering (funny how a small sample of folks, while perhaps not representative of the country at large—I hope, still evokes an unsettled reaction), but what is happening as a result.

      Only in hindsight, when baby steps “commence,” do we internalize that larger forces are on the move. How often do we hear, “this country needs to have a national dialog?” Well if only for a short-lived moment, we are having one.

      Not the anecdote I thought would get this issue on the radar (EMTALA, etc), but nonetheless, an “anchor” moment like death panels and the like. A year from now, this episode may have recall power; and individuals might remember and begin to make associations.

      Average folks are thinking about this, perhaps for the first time. Mainly, who pays, and what do we really do when someone is lying in the street.

      Baby steps. Yes Virginia, this is what a national dialog looks like, sometimes.

      Brad

      • This story does raise important issues:

        If the goal is to make insurance universally affordable (e.g through subsidies), how high would someone’s income need t be to make not paying the 200-300 a month talked about in this scenario a choice, not an economic necessity?

        What should the penalty be for people who choose not to buy insurance and develop a major illness (e.g. bankruptcy,, a lifelong obligation to repay private or public funds spent on their care, etc)?

        Should cost be paid solely by those who choose to remain uninsured and develop a serious medical condition or by everyone who chooses to be uninsured as is true, in a sense, with ACA.?

        What happens if the six months of intensive care mentioned in the scenario only give the person a very small chance to recover?

    • Another interesting question is what if that 30 year old is a Haitian in Haiti? Do you still feel obligated to pay for his treatment?