Wolf’s Question and the Ethical Answer

"Upon reflection, perhaps failing to buy health insurance was a mistake..."

Wolf Blitzer’s question to Rep. Ron Paul at the CNN/Tea Party Express Republican debate in Tampa, Fla. has received most of its publicity because of the idiotic response it elicited from the audience, or some of it. That is good fodder for the Tea Party-slimers, but it was the query itself that raised the most interesting ethical issue.

What should happen, Wolf asked, when a healthy 30-year-old man who can afford insurance chooses not to buy it, and then goes into a coma and needs intensive care for six months? Ron Paul, true to his libertarian soul, muttered unhelpfully that we should all take responsibility for ourselves, which is true, but non-responsive. Blitzer followed up: “But, Congressman, are you saying the society should just let him die?” (This is where the barbarians at the gates added their bloodthirsty shouts of “Yeah!”)

Slate’s Jonah Goldberg has written about what he calls the three possible options available to American society to handle the comatose slacker:

“The first is a system with an individual mandate of the kind included in the Obama bill, or what Romney enacted in Massachusetts in 2006. Under this kind of system, individuals are not given a choice about whether to insure themselves. If they fail to meet the insurance requirement, they pay money, which you can call a fine or a tax, as you prefer. Under this alternative, the costs incurred by Blitzer’s young man are not broadly socialized because they are covered by the fine on those who avoid signing up for insurance.

“The second option is our current system, or other systems without mandates. In this universe, our hypothetical young man receives at least emergency care because hospitals are required to treat the urgently ill without regard for their ability to pay, thanks to a bill signed by Ronald Reagan in 1986. But the costs of his treatment are not absorbed by the hospitals. They are passed on to consumers, employers, and the government in the form of higher insurance premiums…

“The third option is that of the Tampa Tea Party mob: Let the young man go to the devil.”

Talk about lousy choices, and unethical ones. The first option is arguably unconstitutional, and an abuse of power that creates a frightening precedent for future Government incursions on our freedom to be dumb. The second option is expensive, and allows the uninsured miscreant to place the burden of his care on the rest of us. It is unfair. The third option is unconscionable. But there is a fourth, though Paul wasn’t quick enough to articulate it.

Why not make the man pay for his care? Sure, give him the medical assistance he needs, but structure laws so he is required to accept responsibility for a low-interest government loan repaying some or all of his medical costs, and make sure that they cannot be discharged by bankruptcy. Require any employer to subtract some portion of his paycheck to pay off the loan. If he has to sell his home and belongings, fine: he gambled, and he lost. If he gets an inheritance and hasn’t paid for his hospital stay, it goes to pay off the loan. If he is a working pauper for the rest of his life, well, he’s alive.

Perhaps we don’t want to make him pay the full cost of the care. Maybe we would choose to limit what he would pay to what he saved by not paying insurance over the years, plus an additional and significant penalty. Maybe we would make the charges variable according to what the jerk can (barely) afford: a kid on a trust fund who tries to skimp on insurance might find that his months in intensive care will eat up his nest egg completely, while someone with more modest means will just be knocked another level down the socio-economic scale. But if there are real, expensive and life-altering consequences of gambling on having no health insurance, and the media highlights plenty of sad-sack stories about Fred, who is alive but who will be working to pay off his debt to the health care system as long as he lives (think all those weepy stories about the travails of illegal immigrants whose enjoyment of life is so unfairly limited by the fact that they broke the law to come here), I would think that the number of future Freds would diminish significantly.

This is fairer than Goldberg’s options 2 or 3, and doesn’t require creating a precedent that will allow the next Democratic Congress to mandate that we all join gyms, buy electric cars and get our daughters breast implants so they can work on Capitol Hill, as in Option 1.

Eugene Robinson, Washington Post knee-jerk liberal extraordinaire, authored one of two op-eds in today’s paper by panicked Obamaites shaking rhetorical fists to the skies that Republicans are so darned mean…mean, as in they don’t even think the system should pick up the medical bills for someone who tries to avoid his obligation not to become a burden on his neighbors. In Robinson parlance, Fred the Deadbeat Insurance Gambler is someone “less fortunate” who we are morally required to help  avoid the fair consequences of his own stupidity. This is apparently so ingrained into America’s guilt complexes that the natural solution to the problem doesn’t even occur to GOP Presidential hopefuls.

Make people pay for their own mistakes. What a concept!

9 thoughts on “Wolf’s Question and the Ethical Answer

  1. Make people responsible for the consequences of their own actions? Why, Jack, you must be mean-spirited. You must be influenced by all the criminal court judges I know.

  2. The problem with all of these solutions is that they fail to address the big elephant in the room. Medical care is too expensive. As a college professor, I will not make enough money in my entire lifetime to pay for 1 year in the hospital to recover from a serious accident. It would take half of my entire estimated lifetime earnings to pay for a serious cancer treatment. Why should a serious illness require someone to become a pauper for life to pay for it? We have a system where we will all become indentured servants to the physicians if it continues on as it is. None of the answers really touch on the actual problem, they are just trying to prop up the broken system that is causing serious damage to a large chunk of the American population.

    • Until we allow a secondary system of practitioners, people that aren’t held to the same standards, someone who can set a dislocated shoulder, wrap a cast without doing extensive x-rays and consultations, we’ll be stuck with this system of “perfection”.

      Do we really need every doctor to go through full blown Med School to do basic “trade” work such as make house calls?

      I mean, look at mid-wives who deliver babies in the family’s home. That’s a viable option for giving birth and the cost is a fraction. The risk is higher, but why not give people the choice?

  3. I’ve suggested this solution before… it’s sensible, ethical, and humane – which is why it will never happen.

    As Michael points out, however, medical costs are ridiculously out of control. It’s partly due to the way physicians are reimbursed – they aren’t paid to make patients healthy again, they’re paid for each patient visit, for each procedure they perform, and each test they order, so patient visits get shorter as doctors must see more and more patients, they perform often unnecessary procedures, and prescribe drugs of questionable efficacy, “just to see if it works,” and order more and more tests, because god forbid they forget one and it turns out the patient had what the test would have discovered, meanwhile, the profusion of tests leads to increased chances of getting a false positive, leading to another procedure…. Change the system so that doctors are paid for keeping patients healthy.

    Another reason is that our overuse of antibiotics has lead to the need for ever increasing guard against infection, meaning endless supplies of single-use, disposable appliances and supplies, filling landfills with tons of contaminated plastic, and providing a never-ending revenue stream to the medical supply manufacturers.

  4. Jack, your solution is functionally the same as solution #2. Since catastrophic medical costs (which is what Wolf Blitzer was asking about) are commonly more than anyone at or below the median income could pay even if they used 100% of their income for decades. (For example, someone with colon cancer might be told to take Erbitux, which costs $12,000 a month.)

    In fact, what you’re describing — “people who can’t afford their medical care go into debt” — is already the status quo. The hospital I visited last week even had a branch of an affiliated bank right there, in the hospital building, to arrange for loans for medical care. What you’re suggesting as a radical new solution is what’s already happening, and has been for years, and it hasn’t actually solved anything.

    The only thing you’re suggesting that’s any different from the status quo is that you want to take bankruptcy protection away from uninsured sick people. That’s not going to make any significant difference.

  5. One more comment:

    But if there are real, expensive and life-altering consequences of gambling on having no health insurance, and the media highlights plenty of sad-sack stories about Fred, who is alive but who will be working to pay off his debt to the health care system as long as he lives (think all those weepy stories about the travails of illegal immigrants whose enjoyment of life is so unfairly limited by the fact that they broke the law to come here), I would think that the number of future Freds would diminish significantly.

    Again, this is the status quo. There are plenty of stories already in the media about people suffering horribly and going bankrupt due to lack of health insurance. We hear about this all the time.

    The problem is not that Fred is not suffering under the current system. The problem is not that we never have Fred’s story covered in the media. (Indeed, the very fact that Blitzer asked this question shows that the media does talk about the Freds of the world.) And everyone who lives in a low-income community knows or knows of people who are broke and in huge debt because of medical costs.

    If you think the problem is either that Fred isn’t suffering enough, or that we’re unaware that cases like Fred’s exist, then you don’t have any understanding of the problem.

    Here’s the truth: No matter how much Fred suffers, or how much the media reports on Fred’s suffering, there are still going to be people who make what turn out to be the wrong choices. This will always happen. If your health care policy doesn’t deal with that, then it’s not based on how humans actually act in real life, and it’s useless.

  6. Will your system be applied to all transactions taking place with a backdrop of economic duress? If you are drowning (due to inappropriate risk-taking on your part), could I row a boat out to you and say “Ah, you can come in my boat, but you must promise to give me one half of all of your worldly goods and 10% of all of your future income.”? If you agree to do so, should I be entitled to performance of your promise? After all, “Well, [you’re] alive”, and it was your own fault for getting yourself in the situation in the first place.

    Alternatively, if you are starving and I know that you are the heir to a large fortune, could I purchase your birthright for a mess of pottage?

  7. Ron Paul’s former Staffer died from complications from pneumonia. The hospital bill was $400,000. He had no health insurance. If</i he had life insurance the hospital gets paid before his wife sees anything. His family is still out the wage earner.

    The leading cause of bankruptcies in America pre-Bush Recession was insured health bills. A heart attack can still set the insured back by over $50,000 with co-pays and deductibles.

    There is no free market in hospitalizations. Phone around and find which hospital will offer the best price on an emergency appendectomy or stroke. Ask all the local cardiologists what it would cost for them to monitor a heart attack. Find out how much it costs to set a broken tibia.

    The argument and Affordable Healthcare Act always miss the real problem. We need universal health coverage for all Americans. Now.

    • Not relevant. I said that mandatory loans for paying health care bills should be ineligible for bankruptcy. An individual who refuses to get health insurance should be made, by law, to pay back as much of the expense, plus a penalty, as is possible. Your political advertisement is off topic. The nation cannot afford universal health care coverage, and those that have it must either make choices we don’t want to make—that is, severe rationing—or have inferior care. Stick to the topic, please, This is not a policy blog.

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