I think Mackey’s essay has some good ideas.

I know that charity care is not free and that hospitals are being squeezed, but the answer as to how/why this is occurring is complex and, I think, beyond the scope of this forum. Suffice it to say that the ‘third party payer’ system, including the massive intrusion into the market of the government (in the form of Medicare and Medicaid) has certainly undercut the possibility of a normal market, even if you don’t feel that a normal market is possible. The government spends 50% of all heath care dollars spent in this current ‘market’, distorting it in countless ways along the way. Those who advocated and pushed for Medicare have created a massive unfunded liability, a large dependent class of people, and destroyed the market for the elderly in health care. It threatens to bankrupt the nation. Nice job. One answer to getting us out of this mess is not further intrusion by the government – but a slow phase out of Medicare – say increasing the age of eligibility by 6 months each year, until almost no one is eligible.

By the way, my real life example of a case of appendicitis is a lot more relevant than your obtuse story about 3 people on a life boat. I don’t get it, quite frankly, although I did have you pegged as an Ayn Rand fan.

I agree that these situations are complex. I am not an advocate of reductio ad absurdum. But neither am I an advocate of out of context examples such as your own which don’t address the whole system, how we got here, and how we can improve the situation. For good ideas please read Mackey’s essay (http://www2.wholefoodsmarket.com/blogs/jmackey/)

To address, none-the-less, your specific examples, the doctors and hospitals may establish their own principles and approaches to this situation – taking on the young man as a charity case if they like (which would be the most common answer, and which is what I would do.) Many people would (and probably should) consider this as the cost of doing business in an emergency setting. The situation with the pregnancy involves (probably) more culpability – but again, the approach would be designed by the hospital and physicians involved. Wouldn’t that be your answer?

But, since you mention Ayn Rand, I will point out that she was not an advocate of such “life boat” approaches to ethics. You know, the analyses that start out with three people in a life boat with only food enough for two. They tend, by design, to eliminate all the important elements of actual morality (personal responsibility, context, the separateness of individuals) and then try to design a morality around this. Underlying the entire approach is always an appeal to the altruist ethic of self sacrifice. The underlying view is: you don’t have the right to exist for your own sake, and if anyone is in need, by that very fact, they have a claim on your life. Instead of recognizing that, in general, benefit for one person does not mean injury to another – they set up unusual circumstances in which conflict is inherent – and the choice becomes: kill another or sacrifice yourself.

I am not against people getting assistance to buy their groceries. I am certainly against one group of people forcing another group of people to give up their money or property in order to buy groceries for yet another group of people. It is not charity that I am against but the use of force against the innocent. Give away all of your money to buy someone’s groceries, if you like – but keep your hands off my money, time, and effort. If I want to give them away, that should be my decision.

David:
An otherwise healthy 40 year old man goes to an emergency room and is diagnosed with appendicitis. He is told he needs surgery but says he is broke and cannot pay for his surgery. What should the doctors and hospitals do? Demand payment up front? Turn him away? Tell him to go home and get peritonitis and die? How about a woman about to deliver a baby?

The truth is that health care does not obey simple supply and demand dynamics. A lot of people receive assistance to buy their groceries. Are you against that? Should people go hungry?

Simple Ayn Rand platitudes do not answer these questions.

By taking the ‘we’ out of that question. Health care should be an individual responsibility, not a group duty. How are you going going to buy your groceries, or obtain your auto insurance? Look at the current republican proposals for health care reform or read the CEO of WholeFoods ideas for better ideas on how to fix the system.

This poster points out a very big lie that is being promoted, mostly by the left, and for obvious reasons. The worse you make the US system look, the more you can justify tearing it up.

I have heard multiple times that if you eliminate accidental deaths and murder, that the US system does very well. In many types of cancer survival, it is number one.

I have looked at the WHO analysis of health care ‘systems’ and find it to be silly. They measure and report all sorts of things that have nothing to do with how we commonly view analysis of a health care system. Indeed, there is an inherently socialistic perspective built into their analysis and results. And yet this is the most quoted study?

I have asked myself how I would analyze a health care system – and the answer is not easy. We all crave standardization where it is very difficult to come by. Genetics, life-style, environmental factors, etc. can all bear on the equation. How should one measure a health care system? It is simply not an easy question to answer. Should you measure access to health care as part of the ‘system’? If 20% of people don’t get the ‘best’ the country has to offer, 20% get the ‘best’, and the rest something in between – how should that be quantified?

These are difficult decisions, but suffice it to say that if you take a certain well-defined disease (like cancer type x), the US is actually the leader. This can be important if you are someone of means who wants to know where to go to treat your particular type of cancer.

And of course, other countries wouldn’t be as good as they are, without the contributions from the US. The US (along with a handful of other countries) pushes the treatment and diagnosis envelope – especially creating new drugs which benefit the world. Cut off that spigot and the world will suffer right along with us.