Hunter at Daily Kos has a post up about the “let him die” moment in the last Republican Presidential debate. Wolf Blitzer posed the question to Ron Paul of an apparently healthy thirty year old who decides not to buy insurance because he thinks he’s healthy; but then something unexpected happens and he requires expensive medical treatment. What should happen to that guy? Rep. Paul responded that a guy should be able to choose their own risks. Blitzer pushed just a bit further, “should we let him die?” The obvious, though unpleasant answer to that — following Rep. Paul’s logic to its conclusion, is yes. Paul hedged on saying, “yes.” But, members of the audience shouted out the answer for him; perhaps with undue enthusiasm.
Hunter’s post mentions that a real life version of this seems to have played out with a former campaign manager of Rep. Paul who died, leaving behind $400,000 in medical bills. Hunter notes that this is not something that can be paid with bake sales and through voluntary charities. He further notes that the people in the crowd yelling to let the hypothetical man die must be aware of this. He says of such people:
It never ceases to amaze me, the emotions that we will wrap up in a flag and call patriotic if it suits us. A large swath of America is made up of very cruel people, people who value their own self-indulgence over the welfare of their neighbors, and they seem uniformly to be the most pompous in their exhortations of both patriotism and godliness. They are here to defend the nation from monsters who would parcel out a modicum of support to all citizens, and not just ones they personally know of or approve of: If they help their fellow man, they want to see the person grovel for it a bit, and helping an anonymous soul is deemed not just a pointless exercise but an insult to their very freedom.
That’s where I disagree with Hunter. I think these people are wrong; but they aren’t cruel; at least not knowingly so. He gets at this a little when he reference the people they “personally know of or approve of.” There are very few actual monsters among us. But, there are plenty of people for whom strangers are little more than an abstraction. And that’s why no sense of empathy stirs them to be concerned about whether the unknown person lives or dies. When confronted with dissonance between their stated logic and the plight of someone they know and care about, there will be some justification about why the person they know is entitled to assistance. But, I suspect social proximity is the determining factor.
As for the “let them die” advocates – and I’m not one of them; I think it does bear mentioning that, until we do let them die, the market is not going to be an effective tool in allocating resources for medical treatment.
Update Following up on this post, Tipsy has some excellent questions of his own.
I’ve been conflicted for a long time about how we allocate the particular scarce economic good of health care. The country obviously has been, too.
This is no place, and I have neither the time nor the skill for a comprehensive treatise on our mish-mash system. But at the idea that single-payer at least “makes the allocation decision democratically,” I’ve almost always shuddered, because it bodes, I think, death for “useless eaters.”
Have a look at Bleeding Heart Libertarians for another take …
Be well,
Dave H.
A quick read of the Bleeding Heart Libertarians take suggests that he wouldn’t actually get so far as to actually confront the question — should we let the person die? Instead, he urges a response that begins with a bit of wishful thinking: prices would be affordable if health care was allocated under a free market.
Is there a place on the planet where this is empirically true? If not, have libertarians questioned why not? I would suggest the answer is that the free market can’t work with health care unless we are willing to let people die in a rather callous fashion; and, by and large, people aren’t willing to let people die in that fashion.
Of course social proximity is the determining factor. Otherwise, why haven’t you sold your belongings and sent the proceeds to Africa? Or even West Virginia? Nobody has a monopoly on this cognitive dissonance, Doug.
The problem arises when the justification is made on pretext in order to avoid coming out and saying, “I want Person A treated better than Person B because I know Person A.” Too often, the pretext involves some form of dehumanizing Person B — they’re a parasitic leach, or whatever. (See Rand, Ayn — looters and.)
I just want to know where a 30-year old can get health insurance for $200 a month, per Wolf’s question. My plan with almost laughably high co-pays and deductibles, purchased through my wife’s employer, costs more than twice that amount.
I seem to remember that my individual policy as a 30 year old was pretty cheap — something like $150 – $200/mo. But, that was 10 years ago. Now, for a family policy (ages 40, 35, 8, and 6) it’s more like $410/mo. with an enormous ($7k or so) deductible. An as yet untested variable with that policy is how much hassle it will be to get the provider to pay for services should catastrophic illness ever strike.
Federal employees pay $187.18 for the standard singles BlueCross policy (which is very good) but this cost is heavily subsidized…
Well, Doug, I think that’s exactly the problem. That’s exactly the white elephant in the room. We don’t want to come right out and say exactly that, that we value people we know more than we don’t. But we do. Gotta choose your kids or your neighbor’s kids? It’s your own kids every time. If we’re honest, that is. If not, run it by your wife, and see if she doesn’t clock you over the head with the most convenient large object at her disposal. Mothers are usually very good with dispensing the reality checks.
Paul’s point about prices (and the Bleeding Heart Libertarians argument) not only isn’t empirically supported, but it also has no basis in economic theory.
Anyone who has taken an intro course to Microeconomics should be familiar with Price Elasticity of Demand. It is a measure of how quantity demanded changes with a change in price, i.e. the slope of the demand curve. A steep curve indicates small changes in price result in huge changes in quantity of the good demanded and vice versa with flat curves.
Certain goods approach a perfectly inelastic curve – the quantity demanded does not change with price. These are usually things that are addictive (cocaine), required for life (water), or the like.
I can’t think of a more perfectly inelastic good than health care – particularly emergency health care. One gets in a car accident and is on the way to the hospital. Where is the competition? Where is the decision process on which doctor to use? Where is the invisible hand? Answer: doesn’t exist.
If you get certain cancers, you may have a single source of treatment, such as Ohio State’s James Center. How does the market regulate a monopoly where participation is compulsory for continued existence? It can’t.
Oh, but it would be so nice if the market were the solution and, more importantly, not the government. And, therefore, it must be.
Mike’s point deserves more attention. Why doesn’t “universal” health care include all of Africa, India, and China?
Once we make the statement that health care is a human right, and that we should spend all of our resources preventing death, we start down a certain road that we just can’t sustain.
Anything less than doing the above is admitting that someone’s life only worth a certain amount of money, and that the amount has something to do with our proximity.
Who makes the decision what that amount is? The government? Insurance companies? Is one really better than another?
Personally, I’d like to see health insurance companies made to be non-profit, and their benefits standardized. A mix of capitalism & charity, I think that is the best we can do with this.
At the same time, we have to get over our irrational fear of death. Everyone dies. Accept it, learn to cope with it, and move on.
“Who makes the decision what that amount is? The government? Insurance companies? Is one really better than another?”
Yes, government is, by a mile, because it has a level of accountability that private companies don’t have. If you don’t like what the federal plan is doing, you can vote in or out people accordingly. With a private insurance company, even a mutual (are there any of those left in health care?), you don’t have that power.
Keep in mind, in most of the country, one or two health plans tend to dominate local markets, so there isn’t competition. And if you’re fortunate enough to get health insurance through work, you at best have two plans to choose from — otherwise, it’s paying four times as much for an individual plan. Also, until this changed with the dreaded Obamacare, a private insurer (in an individual plan) could refuse you because of a pre-existing condition, and in many cases private plans bounced people out after filing a major claim. Not so with government care. Also, the expenses, believe it or not, are much less with the government, because there is no need to achieve maximum profit, or pay executive bonuses, or shell out for executive pay.
I agree, private insurance uses dirty tricks like pre-existing conditions to avoid paying for covered expenses.
However, my fear isn’t that the government will “pull the cord on Grandma”. My fear is that they won’t. What elected official will be able to stay in office if they are running with the “I pulled the cord on Grandma” campaign slogan?
At some point, it will be unsustainable. However, I find government control less offensive than private for-profit work-based healthcare, to your point. Perhaps it is the only option that is realistic.
I don’t think that I’ve seen one serious critique of R.P. on here.
Instead of replying to this echo chamber of self reinforcing strawmen, let me just link to a decent libertarian discussion of what R.P. actually said:
http://www.econlib.org/cgi-bin/searchblogs.pl?blog=5&pgct=1&sortby=DD&searchfield=P&author=&datelist=0&query=Ron+Paul&andor=and
Start at the first link and move back in time.
BTW, I wonder if anyone would think to ask WHY the 30 year old doesn’t buy insurance. Is it too expensive? Why is that?