CDR: Re: why should it be trusted?

[Dave Emery]

On Sun, Oct 22, 2000 at 10:41:06PM -0700, Tim May wrote:
> At 1:10 AM -0400 10/23/00, Dave Emery wrote:
> >
> >
> >	Nobody dies without healthcare under our present system.
> 
> Actually, many people do. What planet have you been living on?
> 
> 
> Many do not have insurance, and do not receive care for various 
> ailments until it's too late.  Many do not have insurance and do not 
> have annual physicals, or mammograms, or prostate exams, or pap 
> smears, or any of the hundreds of such things.
> 
> Some hospitals offers limited free services, some free clinics exist. 
> But clearly many Americans are not receiving such care. And of course 
> these "free services" are often a huge distance from _good_ 
> healthcare. So much for "nobody dies without healthcare."
 
	I said healthcare. Not good healthcare, or even adaquate
healthcare (though in fact substantially better than almost anyone got
perhaps 50 years ago or most get in the third world today).   With
certain minor circumstantial exceptions people need not die without
benefit of significant health care resources in this society.  True they
are unlikely to have received much proactive care (often a major problem
for the system since treating them after the fact is greatly more
expensive), and true that many poor and especially working poor
uninsured people deny themselves treatment that might save their lives
until its too late because they don't want to or even understand the
need of allocating their very scarce resources to  seeking medical
treatment until they are very sick.   But there is a minimal safety net
in place, and while many do die from receiving inadaquate and too late
treatment not very many are pushed out the door to die in the streets.

	But this raises the obvious question of what should society  do,
if indeed society as a whole 'should' do anything - I assert that no
economic or political system is ever going to supply ideal "_good_"
healthcare to those at the margins, so all of this is a question of how
much freedom we are willing to give up and how great a burden we are
willing to assume to push closer to adaquate health care for everybody.

	Certainly a classical libertarian society might supply a whole
lot less health care of last resort to those too lazy, too stupid, too
weak, too crippled by circumstance to take prudent steps to provide it
for themselves.   Some would even argue that this is appropriate.


> 
> This is not true. Again, I have to question your connection to 
> current events. Surely you have heard of folks being turned away at 
> emergency room entrances and shipped off to the "public hospital"? 
> There are many cases in many cities where people died in ambulances 
> that had been turned away at the _nearest_ (or _better_) hospital and 
> sent off on a 30-minute ambulance or taxicab ride to the "public" 
> hospital in town.
> 
	I live in a very liberal state, where there are laws against this
practice.   I have heard it is more common elsewhere.


> Again, I am not advocating that medicine be socialized or that 
> hospitals be forced to treat those they choose not to treat.
> 

> (Were it my hospital, I would not think highly of Men with Guns 
> telling me I must give $10,000 worth of ER services to someone who 
> won't pay me back and who has no insurance.)
> 
	OK, so you would turn them out to die in the streets.  Or at least
want to believe that if you didn't it had been a voluntary act of charity
rather than something forced on you as a social obligation.


> >
> >	Of course, in the libertarian ideal universe someone not
> >completely indigent who had a genetic condition that made them high risk
> >might still be unable to get any kind of catastropic medical insurance
> >and might be wiped out of virtually all assets by a serious illness,
> >even one  completely unrelated in any way to his genetic predisposition.
> >
> 
> 
> Yes...so?
> 
	Whether or not you view this as bad depends on your very basic
views about the social compact and fairness - is it just bad luck and
tough sushi for the poor unfortunate or should we as a society offer
at least some safe harbor for those who drew the short straws ?  And
if we do offer such, how much of our collective wealth should we spend
on it - .005%, 0.5% 1 %, 5%, 35% ?    And how should we decide this ?
And what happens in a world in which the mechanisms by which we express
such sentiments erode as states wither... 


-- 
	Dave Emery N1PRE,  die at die.com  DIE Consulting, Weston, Mass. 
PGP fingerprint = 2047/4D7B08D1 DE 6E E1 CC 1F 1D 96 E2  5D 27 BD B0 24 88 C3 18