Free to Die

Economist Paul Krugman in today’s New York Times takes a closer look at Libertarian views about ‘freedom’. Millions of American children, for instance, make the ‘bad choice’ of being born to to poor parents– should taxpayers bail them out?

So would people on the right be willing to let those who are uninsured through no fault of their own die from lack of care? The answer, based on recent history, is a resounding “Yeah!”

Think, in particular, of the children.

The day after the debate, the Census Bureau released its latest estimates on income, poverty and health insurance. The overall picture was terrible: the weak economy continues to wreak havoc on American lives. One relatively bright spot, however, was health care for children: the percentage of children without health coverage was lower in 2010 than before the recession, largely thanks to the 2009 expansion of the State Children’s Health Insurance Program, or S-chip.

And the reason S-chip was expanded in 2009 but not earlier was, of course, that former President George W. Bush blocked earlier attempts to cover more children — to the cheers of many on the right. Did I mention that one in six children in Texas lacks health insurance, the second-highest rate in the nation?

This sounds like flaming partisanship but it is sober fact– such a shocking truth that we don’t want to face it. We have a highly developed system for dealing with acute health emergencies, but we are failing in preventive care. It makes no sense in terms of basic self-interest, never mind morality.

The unspoken assumption in the concept of ‘choice’ is that we are all born with a menu of choices before us, and some foolishly choose to be sick, or poor, or victims of discrimination. In real life, most of us choose as best we can from what seems possible. If health care is available and affordable to most, but out of reach for some, then individual choice is not the problem. The problem is justice and wise leadership.

It is the role of government to promote the public good, and especially the good of the next generation. We will all be older, most of us won’t be richer. What kind of nation do we want to be?

MORE: Echidne of the Snakes has a good explanation of why the current mess, which has disincentives for young people to buy health insurance or use preventive care, is economically dumb.

11 thoughts on “Free to Die

  1. The problem is solved pretty much in the rest of the industrialized world with universal health insurance that costs much less and covers everyone and gets better results on life expectancy and more. No one size fits all, there are different ways to do this, but all involve government mandates that makes health care availalble.

    The problem here is the greed of the rich that like our system because it encourages great state of the art care for those who can afford it, and the dominant ideology that big government is bad, constantly drummed into people by the corproate media and other servants of the upper class.

    At least Obama made a start at reform, inadequate as it is, and used up most of his initial political capital to get 10 of millions insured and curb health insurer abuses even for those who have insurance. He gets little credit for it anywhere and if current trends continue the next President will repeal the reforms and leave the poor on their own or up to charity. Talk about death panels!

    1. Thanks for validating health care reform, I feel pretty lonely defending the start we have made to fixing the system. I froze my garbanzos many hours holding signs, and often alongside Dave St. Germain– a casualty of lack of care.

    1. those at the bottom of the pyramid are some of the same people who are delivering the health care, and some of them are uninsured themselves. your wish is not only moral but commonsense.

  2. The health care legislation should have been introduced in about 4 or 5 separate bills spaced apart long enough for the public to understand what they were actually about-the omnibus deal was too big,too complicated,and too fast.
    We had legislative leaders who didn’t know how it would work-that was a real confience builder for the public.
    Parts of it were really good-like curbs on abuse by insurance companies,but parts of it had potentially serious and poorly understood consequences.

  3. The excellent commentator David Pakman did a piece on this:

    He pointed out that Wolf Blitzer’s framing of the question is very leading; he describes a healthy young man with a good job and good income who simply chooses not to pay the premiums. Good catch.


    1. congrats on finally getting insurance.
      health care requires a large work force. the good part is that health care workers spend their money locally and pay taxes locally. the bad part is that many of the jobs are low-paying and don’t offer health insurance for several months, or at all.
      the woman who is caring for the elder on Medicare might not be able to afford care for herself.
      we need to do better.

  4. One thing that wastes a ton of money is Medicare’s refusal to pay for wheelchair transports for things like dialysis and dental appointments. Medicare will pay for a stretcher transport ($300) for patients who cannot reasonably sit up in a wheelchair in a moving vehicle ($50).

    In practice that means that a lot of people who need to be transported all the time (i.e., dialysis patients with a minimum of 6 transports a week) end up going by stretcher. They can’t realistically pay out of pocket for wheelchair van transports, so their physicians deem them stretcher necessary on paper. This puts doctors and transporters into a really bad situation where they have to either skirt the edges of Medicare fraud, slant their assessments, or eat the cost of transport.

    Medicare would fulfill its mission better and still save a ton of cash by paying for wheelchair transport at $50/trip (with an obvious bulk purchasing discount) as opposed to assessments being manipulated to get them to pay $300/trip for stretcher. It’s a mess. The providers don’t want to do it, either. We’re not in this because we love fraud. (I don’t do it myself.)

    FF Xavier Onassis, EMT-P

    1. You’re right. I used to work for an ambulance company and I know the situation. There’s a gap in the transport network for people too disabled to ride in a car, but not acute enough to need an ambulance. There’s also a business opportunity and jobs for a company that could fill that need.
      As we become an older society the transport problem will need to be addressed, or we will overpay, and eventually all be run over by ancient people who really have no decent alternative but to keep on driving.

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