Public Compassion, Personal Responsibility, & the Tea Party Debate

  Jacob Weisberg at Slate, Paul Krugman at the New York Times, and my esteemed colleague Emeritus Professor David Newquist, all drew the same conclusion from a now infamous moment the Tea Party Express debate in Tampa, Florida. Of the three, only Professor Newquist did not lie about what happened.

Wolf Blitzer asked U.S. Representative and presidential candidate Ron Paul a very good question.

You're a physician, Ron Paul, you're a doctor so you know something about this subject. Let me ask you this hypothetical question. A healthy, thirty year old young man has a good job, makes a good living, and decides, you know what, I'm not going to spend two hundred or three hundred dollars for health insurance 'cause I'm healthy, I don't need it. But something terrible happens and all of sudden he needs it. Who's going to pay for it he goes into a coma…

After Paul's initial response, Blitzer pressed the question again. He doesn't have health insurance. Who pays? Paul responded:

That's what freedom is all about: taking your own risks. This whole idea that you have to prepare and take care of everybody…

In the middle of that statement, after the word "risks", the crowd erupted in applause. Then Blitzer forcefully restated the question:

Are you saying that society should just let him die?

At that point a couple of people shouted "yeah"! It sounds like one or two more may have cried out in agreement. It is simply false to state that "the crowd," as Krugman puts it, or "the rabble" as Lord Weisberg puts it, cheered the prospect of this man's death. What the crowd applauded was Paul's forceful insistence on personal responsibility. In Weisberg's case, the lie distorts his otherwise reasonable argument

Ron Paul is a libertarian. Personal responsibility is the bottom line of that school of thought. Freedom means that you get to do pretty much what you want with whatever is yours, but you can't expect anyone else to shield you from the consequences of your choices. Libertarians believe that any attempt to protect people in spite of themselves will result in serious curtailments of liberty. Weisberg agrees and he is just fine with that. But is this really an either/or decision?

I don't think we should let the hypothetical man die, but that is a moot point. We don't, in fact, let such people die. Hospitals don't turn away the uninsured. We aren't going to start letting such people die, even if Libertarians are right that we should.

That, however, is a public choice and the public ought to take full responsibility for it. We the people will have to pony up for what we the people insist doing. Since it is our decision and not the decision of Blitzer's hypothetical man, it does not justify any interference with his liberties. It does not authorize us to force him to purchase health insurance for the same reason as it doesn't authorize us to compel him to stop smoking or start exercising or go on a diet.

Libertarians think that if we were all given the maximum liberty possible and had to take full responsibility for our choices, we would all be better off. We would all be healthier, happier, and more prosperous individually and collectively. That is either true or false, but it is not immoral to think it.

Liberals think that we sometimes have to let vicious killers go free if their Miranda rights have been violated. What if they go on to kill again? Are we just going to let their innocent victims die? Yes. That is what we are going to do if we want to preserve the Miranda rule. Contrary to the logic of my colleague Dr. Newquist, I don't think that makes Liberals the moral counterparts of pro-slavery Democrats.

Comments

[bettydoman]

You do your best to keep your children healthy, but sickness and accidents are a part of life. Getting health insurance for your children gives you peace of mind knowing they have health coverage when they need it. Search one the web "Penny Health" for kids they are the best.

[duggersd]

What is not mentioned here is there is a finite number of dollars to be spent on anything, health insurance included. Let us take the case of the comatose young man who refused to purchase health insurance and the comatose person who does purchase health insurance. Every dollar spent on the uninsured person is taking money away from those who put money into the pool. So who should get the benefit of those dollars? I believe that is the real question.

[Pierreite]

I don't think anyone has yet answered the question-what happens to the young man? No hospital administration is going to remove care yet they are left providing the uncompensated care. It's easy to talk theory and liberties but what is the legal and ethical solution to this situation? Who should pay for this care? This happens and the facility, having no recourse, languishes just as this young man would. Answer the question.

[Donald Pay]

"I don't think we should let the hypothetical man die, but that is a moot point. We don't, in fact, let such people die. Hospitals don't turn away the uninsured. We aren't going to start letting such people die, even if Libertarians are right that we should."

In a fully Libertarian world, however, the CEOs of the hospital would set the policy on which patients to accept. They could discriminate on any basis whatsoever---race, income, insurance. In a fully Libertarian world, and probably in the Republican Party's world, that man would die.

The link below explains that we have laws--gasp!!! yes, laws---that require hospitals to treat indigent patients. Social contracts (Hippocratic oaths) apply to physicians and other health professionals, but not necessarily to for-profit or even non-profit corporate executives who run hospitals. Laws and regulations are why we don't have people dying in the streets.

http://www.tnr.com/blog/jonathan-cohn/95071/ron-paul-libertarian-health-insurance-charity-care

[A.I.]

There was an incident earlier this week that perhaps offers the perfect counterpoint to any of this "let them die" nonsense: I refer to the 10 or so people who risked their own well being to lift a car off a pinned motorcyclist while the motorcycle was laying in front of the car burning and perhaps about to explode. It's a pretty good bet that those rescuers were some mix of liberal, conservative and moderate. All rushed to the aid of someone they did not know. We, as a people, do not sit idly by while people die--we try to help. And while a few crackpots in that Tea Party audience may believe otherwise, they are representative of virtually no one--probably including themselves if confronted with a real life or death situation rather than Blitzer's hypothetical.

So if we aren't going to let people die, what then? Do we continue to pass the costs of care for the indigent and otherwise uninsured along to counties, hospitals, those who are insured and others, or do we try to come up with a system that covers all and is paid for by all according to their ability to pay--that forces the very "individual responsibility" conservatives and libertarians idolize? Imperfect as it may be, the Affordable Care Act's individual mandate does just that.

[Ken Blanchard]

Pierreite: I HAVE answered the question. If the young man cannot afford care, society collectively will have to cover it. That will happen no matter what system we have in place.

A.I.: "forced responsibility" is like a round square. There is no content that can logically be indicated by the term. I like the story of the ten people who lifted the car off the cyclist. Would they have been justified if they had taken cash out of his wallet to cover their time? Had they gone to him a day early, would it have been alright for them to force him to pay up in advance? Or else! If the guy was a bit chunky, maybe a couple of the boys should monitor his eating habits. Can't let him die.

We let people die all the time. If you are desperately in need of a heart transplant but aren't an eligible candidate because of severe alcoholism, we let you die. If we insist on treating people who behaved irresponsibly, that is our problem. It does not entitle us to curtail their liberties.

[Pierreite]

So who do you think should make the decision to withdraw care in this case?

[Stace Nelson]

Mr. Blanchard smacks the crux of our problem fully on the nose. We have taken to carrying for those who act irresponsibly to a level that some now feel it is their right to be so taken care of. Those entitlements do end up curtailing the liberties of others, whether through financial deprivation or through the actual imposition of having to accomodate the perceived entitlements over the rights of others.

[Stace Nelson]

or caring as the case may be..

[William]

I really think that Donald has, again, misspoken the libertarian position on this issue - "In a fully Libertarian world, however, the CEOs of the hospital would set the policy on which patients to accept. They could discriminate on any basis whatsoever---race, income, insurance. In a fully Libertarian world, and probably in the Republican Party's world, that man would die."

IMHO, in a libertarian (small "l") world, the marketplace would allow one to buy insurance based upon one's willingness to assume risk. As it stands now, insurance companies are required to include as "standard, or baseline" coverage conditions which I would choose NOT to insure myself for, ie. pregnancy, HIV, etc.. We are also limited in choice as to those policies approved by our State.

If I were to select the coverage for myself, I could pick and choose those areas that I feel make me more at risk and buy coverage for them accordingly.

Those risks I CHOOSE not to cover, should be the risks I'm willing to take.

There certainly are circumstances where one may be unable to afford even limited coverage, but that is the exception to the rule, and can be dealt with accordingly.

Without allowing personal choice and the corresponding acceptance of personal risk, we are simply allowing unlimited access to limited medical resources, which is a recipe for economic disaster.

Having witnessed the obscene waste in medical resources for those with terminal outcomes (both parents), it would have been not only more rational economically to have limited "treatments" that had no benefit in outcome, but more humane to have simply allowed them to die what used to be considered a "natural death".

Despite the fact that I had power of attorney for health, there were far too many instances where my parents were taken to emergency rooms for "treatment" for conditions that were terminal in the best case. I was even called from hospice, to see if I wanted them to take my mother to the ER for treatment of a terminal illness...

I don't mean to sound bitter, but we ALL die. What risks we take are OUR responsibility. Our current system is expending HUGE resources to those who have no reasonable outcome but an imminent death.

Is it unreasonable to allow individuals to CHOOSE the risks they take in life, and suffer the consequences if they choose wrongly?

[Ken Blanchard]

William: good points, all of them. I would add that European nations with the kind of healthcare some of our commenters admire make decisions to let people die all the time.

Pierreite: I do not understand your question. I think we have to treat the poor fellow, as I have said. I just think that's our problem and not his. It is not a question of 'withdrawing care'. It is a matter of whether to extend it.

[Donald Pay]

See, libertarians seem to ignore that there are several sides to an issue beside their own self-interest. For example, William here thinks he should decide which risks to insure against and which he should ignore. That assumes that the insurer give a crap about your particular needs and desires. THEY DON'T. If they did, they would be out of business.

Why would an insurance company want to insure you against risks that you see as more likely to happen to you? They would look at your list of risks you want to insure against and think, "Hmmm this guy must know something about his lifestyle and/or genetics and/or state of health that we have no clue about." They would automatically price you out of the ability to cover the risks you want, or find an excuse not to cover you. Now there are insurance companies who will write these policies, but they have lots of escape clauses. Only a fool would buy one.

See, the way insurance companies work is to insure you for risks that you aren't going to face and to cover a broad group of people. That way everyone's risks are able to be covered. Yes, you spend money to cover other people's risks, risks that you won't face. In exchange you benefit from their participation in covering your risk.

[A.I.]

Not so fast KB, your baffle-em with Bull S... ain't gonna fly this time.

You say, "A.I.: "forced responsibility" is like a round square. There is no content that can logically be indicated by the term."

You twist my words to indicate I am saying someone can be forced to be a responsible person while my obvious meaning is forcing someone to buy insurance makes them "financially" responsible for their health care even if they are irresponsible by nature. That is a distinction with a difference and I find it hard--no, make that impossible--to believe you did not understand my true meaning.

You say, "I like the story of the ten people who lifted the car off the cyclist. Would they have been justified if they had taken cash out of his wallet to cover their time? Had they gone to him a day early, would it have been alright for them to force him to pay up in advance? Or else! If the guy was a bit chunky, maybe a couple of the boys should monitor his eating habits. Can't let him die."

The cyclist story was meant to show the absurdity of the "let-em-die" nonsense that is part of the unrealistic world view that is often the basis of current conservative debate--nothing more. If I remember my psychology basics correctly, the 10 were self-actualizing" when they rescued the cyclist. Money was never and would never be a factor in their actions and your throwing such an idea out appears to be nothing more than a rhetorical red herring again meant to detract from my true meaning.

First you tell Pierreite: "If the young man cannot afford care, society collectively will have to cover it." Then you skip down a few paragraphs and tell me: "We let people die all the time. If you are desperately in need of a heart transplant but aren't an eligible candidate because of severe alcoholism, we let you die. If we insist on treating people who behaved irresponsibly, that is our problem. It does not entitle us to curtail their liberties."

What you said to Pierreite is pretty much what I said. We don't let People die if we can help it, be it by risking our personal safety to help as in the cycle accident or collectively paying for care in our fee-for-service health care system. But, the latter and how the individual mandate relates to it is only about money--who pays and how. It has nothing to do with denying a futile treatment to someone who destroyed their health with alcohol, or insisting on treating someone or individual liberty--at least the liberty to forgo care.

You might argue the mandate interferes with our liberty not to buy health insurance which indeed it does. And the Supreme Court may rule the mandate is unconstitutional because it forces purchase of private insurance rather than taxing for a public plan. But no matter how the Court rules, the notion that not providing for our own health care to the extent we can is a protected liberty is dubious at best. It would be tantamount to saying those of us who believe we have no need for a fire or police department should not have to pay taxes that go toward supporting them.

As I said before, the Affordable Care Act is not perfect. I would add that it would be better and unquestionably constitutional if it taxed for a public plan rather than mandating purchasing a private plan. But in any case, the law as it stands does force individuals to be financially responsible for their own health care to an extent comparable to their responsibility for fire and police protection. And when you cut through all the smoke and BS offered up by opponents, that certainly seems like a good thing.

[Ken Blanchard]

A.I., my old and cherished friend, I do not think I was "twisting your words." I think I was taking them seriously. Responsibility means letting people make their choices and then holding them responsible for the consequences. The Libertarians are right about that. "Forced responsibility", if it means anything, means forcing people to behave has A.I. would have them behave, or at least forcing them to pony up for whatever social policy A.I. prefers. In context, I was right to say that this was an oxymoron.

We agree that we should rescue the irresponsible person. I, however, insist that his agreement imposes on burdens on him nor does it authorize any infringement of his liberties.

Whether compelled purchase of health insurance amounts to an infringement of liberty is another question. Your mention of fire and police protection doesn't help much. If my house were a fire and police free zone, that would endanger all of Jay Street. To argue that health insurance refusal is analogous would authorize the state to tell me how many packages of Cheetos I could eat per week. I think that is tyranny. I am not sure what you think.

[Dave]

Curious... The "state" can force everyone who drives, to have insurance... But it is an act of treason to force people (who have health) to have (health) insurance... Very strange...

[Ken Blanchard]

Dave: no, it can't. It can make a license a condition of legally operating a car or plane, for reasons of public safety. No one said anything about treason. Forcing someone to purchase health insurance because you and I can't resist taking care of him later may be to our credit but it is entirely our fault.