The whole point of free speech is not to make ideas exempt from criticism but to expose them to it.

Thursday, August 27, 2009

Pick up from below... Telling Stats part 2

Neal asks:
At what point do people have to take responsibility for their actions, and for their decisions? If a guy smokes cigarettes for 30 years -- or engages in some similar sort of self-destructive behavior -- and does not have health insurance, is it really my obligation to pay for his chemotherapy when -- surprise! -- he comes down with lung cancer?



This is the question I'm wrestling with, and my (yet undecided) position on universal healthcare turns almost entirely on the answer, whatever it may be.

And let me just clarify one thing. I'm talking about a government-imposed obligation here, not a social obligation.

I recognize that I have a social obligation to help those in need, regardless of how they came to be in need. That's not the issue I'm struggling with.

My question is about whether or not that social obligation ought to be transformed into a legal obligation, by way of government-mandated and -run health insurance system.
Good questions, Neal! I see Denature has already filed some pretty good answers for you. For my part, I'll add this video of a guy who's trying to stay healthy. It may not quite be the answer you're looking for, but it just might brighten your day a little...


denature said...

Health statistics work well when applied to populations, not individuals. You can't say with certainty that this person wouldn't have gotten cancer anyway--there is a background level of lung cancer outside of smoking. Deciding which individual is worthy of receiving available life-saving medical attention using population level statistics is likely not a role that should be assigned the federal government.

The current system is better for the rich and well-connected, and current congressional republicans attitude of 'kill any reform' is tacit support of that system.

Back to taking responsiblity for actions. Should we similarly deny claims to those who haven't put radon mitigation systems in their homes? Also causes lung cancer. It could be argued it's a personal responsibility issue. What if a homeowner can't afford the repairs?

How about denying coverage to teenagers in car accidents? Statistics clearly show this population has the most dangerous drivers.

Aren't many injuries to people in their 20's and 30's the result of doing something stupid? Haven't we all used something as a hammer that wasn't designed as a hammer? If natural selection doesn't actually kill you, I don't think we want a government, hospital, or business administrator to conduct a stupidity test on patients in order to determine if they are worthy of coverage.

Some families seem immune to cancers. For others it's a family curse. You may argue this last is a genetic not behavioral issue, but addiction and dangerous behaviors also have genetic components. And the business model of health insurance would rather not cover people with pre-existing conditions.

Should we only cover the safe, particularly when, for example, new information may change which particular combinations of foods are safe and which are unhealthy? I say that it's best as a government policy to provide the most coverage for the most people. Unless we pack away that smoker to the behavioral detention camp to die without treatment, he will still use medical and societal resources and drive up health care costs. In the long run it may be cheaper to include him in a coverage plan that also includes the healthy of the population.

It may also be a compelling government interest to effect change in behaviors of members of our population. But the best course is not to deny health coverage. The biggest and most cost effective benefit would come from programs that target younger people for lifelong healthy behavior. For example, spending resources to prevent teens from starting smoking rather than on people who have smoked for thirty years. These are the kinds of policy initiatives that deathers twist around to say that members of the Obama administration want to kill old people, despite the result of these types of policies greatly increasing the numbers of old people who will be walking around.

Miranda said...

The question becomes even more difficult when you consider that the smoker might be making a comfortable income, while many of the taxpayers footing the bill are in good health, but struggling financially.

Why is it their duty to pay?

denature said...

Hi Miranda. I imagine that philosophically the answers you'll receive will be similar to why I have to support those loud little people down the street at that school despite the fact that no one has liked me well enough to produce one. Civic duty.

Myself, society, and private industry are better off with public education that provides everyone with the opportunity to learn. Even those kids that no one thought would ever amount to anything. Even those kids in the lead contaminated houses.

America has long had a goal to maximize the number of citizens that receive a High School education. This is unlike most of the countries you see listed at the top of those academic scores stories that come out. They typically quickly decide which citizens are worthy of full education and which should be tracked elsewhere. In our perceived land of opportunity we have traditionally held a different philosophy.

I view healthcare the same way. I think all citizens are worthy of at least a public option for health care despite the circumstances they were born into or faced later in life. There are many who are deserving in this population. And I imagine under any system developed, the rich smoker tax payer will do more to subsidize vaccinations to the poor healthy person than vice versa for cancer treatments (and population statistics show more poor people smoke).

Private schools still flourish despite public education. But to completley privatize education would lock many of the deserving out. Public education but private insurance are due to historical developments in our nation's history. But I contend a public option for health care is consistent with what most of our citizens would define as long held American values--equal opportunity for life, liberty, pursuit of happiness and all that.

Les said...

"""How about denying coverage to teenagers in car accidents? Statistics clearly show this population has the most dangerous drivers."""
They pay higher premiums and some are denied!

There is a great deal wrong with our insurance systems and health care billing practices that could use reform and other fairness issues to numerous to mention here.

Tell me who is not getting health care in our country? Our emergency rooms take people without health care ins, no waiting lines and a bill that goes unpaid over and over again. To my knowledge, there has not been any denials of health care in our home town facilities. I have financial means beyond many, but there are also those who have a higher means than myself and get a higher quality treatment as well. Do I deserve the same treatment as those willing to pay more?
As to comparing public education giving all a chance, getting into the quality higher ed is sometimes more of, who you are, color of your skin, or the amount of cash dad donated to buy your way in. All can get some education, but not neccesarily equal education.
To my question, is EQUAL health care a right?

betty76 said...


It doesn't have anything to do with rights, it has to do with what's good for the country. We provide a basic minimum of education so that people can at least read, write and comprehend enough to not be a drain on the rest of society. It's hard to see the direct dollar-to-dollar benefit of investing in basic education, but it's certainly there.

I think medical care is the same. It's not a right, but it's in everyone's best interest to provide at least a basic level of health care to everyone, so that people can contribute to society instead of being a drain.

Taunia Adams said...

*polite golf clap for denature

Well thought out and well said. Thank you.

This line made me spit A&W Cream Soda out of my nose:

"...why I have to support those loud little people down the street at that school despite the fact that no one has liked me well enough to produce one. Civic duty."

Les said...

You miss my question Betty. Equal (not basic) healthcare, which seems to me to be a part of many of the options.