on 9/18/07 Paul Hsieh, MD wrote wrote:
Dear [Musashi]:
That's an excellent question. When I've discussed this topic with patients and fellow doctors, it's clear that one of the major reasons driving the political push for government-run medicine in America is precisely the fear that ordinary people might not be able to get the care they needed if they were unlucky enough to experience a serious accident or illness. Given the way costs are rising, I can understand their concerns.
Since I don't believe that it's the proper role of government to guarantee health care to people in those circumstances (since that violates the individual rights of the taxpayers who are forced to foot the bill), the short answer is private charity.
Americans have traditionally been very generous towards others, particularly when they've experienced tragedies through no fault of there own. The outpouring of giving for victims whenever there's been a major natural disaster (or a man-made catastrophe such as 9/11), is evidence of that fact. As a doctors, I've waived my fee many times over the years for patients in tight financial straits with whom I sympathize, and the same is true for nearly every other doctor I know.
But the key is that the charity is *voluntary*. I donate to numerous charities because such giving accords with my rational values. I don't view someone else's misfortune or need as an automatic moral claim upon my life and wealth. And the recipient understands that any assistance he gets from me a *gift*, not something he is owed by "right". All the patients to whom I've given free care recognize that and are appreciative of that fact; in turn, I get to see good done for people whom I consider worthy recipients.
Also, please bear in mind that a large part of the skyrocketing costs of medical care is due to bad government policies. Onerous FDA rules jack up the prices of drugs and medical devices unnecessarily. Government mandates and red tape increase the price of insurance policies. Laws that force emergency rooms to provide charity care to all comers, even if those with obviously bogus complaints and who are just seeking to get a free meal and a free dose of narcotics drive up hospital costs for everyone else. If these bad government policies were reversed, health care would be much cheaper for everyone, and there would be a lot fewer needy people that would have to depend on charity care.
Numerous other free-market reforms (such as allowing Health Savings Accounts, insurance deregulations to allow companies to offer high-deductible, low premium catastrophic care, etc.) would go a long way towards reducing health care costs for everyone. Health insurance should be like other forms of insurance - basically, it pays for the rare but expensive catastrophes. For instance, my car insurance covers me in case it gets totaled in an accident, but I pay for my regular oil changes. Similarly, my homeowner's insurance protects me in case of a fire or a flood, but I cover the regular utility bills. Catastrophic health insurance would cover the bad illnesses, whereas the Health Savings Accounts would allow people to budget and pay for the routine expenses.
(John Stossel of ABC News has a good article on Health Savings Accounts at:
http://abcnews.go.com/2020/Stossel/Stor ... 579&page=1)
If you are interested in learning more about some practical concrete steps in that direction, I'd recommend the book, "The Cure: How Capitalism Can Save American Health Care", by Dr. David Gratzer. Dr. Gratzer is a physician who has practiced in both Canada and the US and he has many good suggestions on how to move the American health care system in the right direction.
http://www.amazon.com/Cure-Capitalism-S ... 594031533/
At a more fundamental level, Dr. Leonard Peikoff covered the central philosophical issue nicely in his article, "Health Care Is Not A Right', which can be found on the FIRM website at:
http://www.WeStandFIRM.org/docs/Peikoff-01.html.
Here's an excerpt that relates directly to your question:
Peikoff wrote:
Some of you may ask here: But can people afford health care on their own? Even leaving aside the present government-inflated medical prices, the answer is: Certainly people can afford it. Where do you think the money is coming from right now to pay for it all -- where does the government get its fabled unlimited money? Government is not a productive organization; it has no source of wealth other than confiscation of the citizens' wealth, through taxation, deficit financing or the like.
But, you may say, isn't it the "rich" who are really paying the costs of medical care now -- the rich, not the broad bulk of the people? As has been proved time and again, there are not enough rich anywhere to make a dent in the government's costs; it is the vast middle class in the U.S. that is the only source of the kind of money that national programs like government health care require. A simple example of this is the fact that all of these new programs rest squarely on the backs not of Big Business, but of small businessmen who are struggling in today's economy merely to stay alive and in existence. Under any socialized regime, it is the "little people" who do most of the paying for it -- under the senseless pretext that "the people" can't afford such and such, so the government must take over. If the people of a country truly couldn't afford a certain service -- as e.g. in Somalia -- neither, for that very reason, could any government in that country afford it, either.
Some people can't afford medical care in the U.S. But they are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off -- charity, not right, i.e. not their right to the lives or work of others. And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity.
But the fact is: You don't abolish charity by calling it something else. If a person is getting health care for nothing, simply because he is breathing, he is still getting charity, whether or not any politician, lobbyist or activist calls it a "right." To call it a Right when the recipient did not earn it is merely to compound the evil. It is charity still -- though now extorted by criminal tactics of force, while hiding under a dishonest name.
If someone were to establish a charity for decent ordinary people who have come down with rare but expensive medical conditions through no fault of their own, I bet there would be no shortage of donors in America willing to contribute. (Such a charity would exclude alcoholics who have destroyed their own livers through years of heavy drinking, etc.)
Another good source on the broader topic of caring for the needy in a free society can be found in Ayn Rand's essay, "Collectivized Ethics" in her book, "The Virtue of Selfishness". I can't quote the whole thing here, but if you haven't read that essay before (or if you haven't had a chance to re-read it in a while), I'd recommend taking a look. Here is an excerpt:
Rand wrote:
...Objectivists will often hear a question such as: "What will be done about the poor or the handicapped in a free society?"
The altruist-collectivist premise, implicit in that question, is that men are "their brothers' keepers" and that the misfortune of some is a mortgage on others. The questioner is ignoring or evading the basic premises of Objectivist ethics and is attempting to switch the discussion onto his own collectivist base. Observe that he does not ask: "*Should* anything be done?" but: "*What* will be done?" -- as if the collectivist premise had been tacitly accepted and all that remains is a discussion of the means to implement it.
Once, when Barbara Branden was asked by a student: "What will happen to the poor in an Objectivist society?" -- she answered: "If *you* want to help them, you will not be stopped."
There's much more in the essay, including an excellent discussion of Medicare and helping the needy. It's very thought provoking essay because she cuts to the philosophical heart of the issue in a way that (at least for me) was not obvious when I first read it.
I hope this helps, [Musashi]!
You have my permission to forward this e-mail to others or to post it onto any discussion forum, as long as the contents are not altered or edited.
All the best,
Paul Hsieh, MD
Freedom and Individual Rights in Medicine:
http://www.WeStandFIRM.org
On 9/17/07, Musashi wrote wrote:
Mr. Hsieh
As an Objectivist, I struggle with the concept of a single payer medical care system. Obviously a single payer system is totally incongruent with Objectivism. No man should be made a slave to another man.
My problem comes with medical necessity, what happens when you need it and can't afford it? Is the short answer that you suffer or die because you can't provide for yourself?
Some friends have suggested that doctors and hospital could enter the financing markets. But is someone with meta-static cancer a worthy credit risk?
How does medicine work in an Objectivist world?
What happens to the needy?
From my personal experience, yes socialization of medicine has many problems (from standards of care, to rationing, and bureaucratic largess and corruption). But as it is now in the US, we have a growing population without access to healthcare. And the mechanisms of the current US system utterly destroy the finances of entire families based upon a single catastrophic medical event. The current system is almost like a lottery for debt peonage.
PS. We have discussed this topic at length on the Taggart Transdimensional forums. If it is alright with you, I'd like to post any reply you can make on these forums.