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There’s obviously the concept of ‘free riders’ in any significantly developed economic system. We can’t all pay for our own roads, individual police, etc.

I was using excessive examples, but the point I was trying to make is that health care isn’t free, so we, as a society, need to decide where to draw the line between collective and individual responsibility. It is unreasonable to ask each individual to pay for their own police force or highway system. We benefit from a lawful society even when not directly interacting with law enforcement. We benefit from the highways we don’t personally use, via more efficient commerce.

The question that arises in this context is, “Is it unreasonable for each person to pay for their own individual health care?” You seem to imply ‘yes’, since you draw the line at more money, rather than a greater sense of security. How, though, are we to give the janitor as good of a sense of security as Bill Gates unless we spend enough money to give him the same quality of healthcare? Unless we transplant him to a better neighborhood, or buy him a home security system? What if the conversation extends to emotional security? How can we guarantee the same feeling of stability unless we fill his bank account? how are we to provide him the same level of nutrition unless we buy him the more expensive organic food that Gates might hypothetically eat?

Give me the philosophical underpinning for where you drew the line. Is there a value system that can pick apart the borderline cases with any degree of objectivity? If not, would you trust the government with the same level of subjectivity over your own health care?

I admit the quip regarding ‘humility’ came off as emotional rather than logical, but it was more in response to the mentality of entitlement that many advocates of universal health care have. I’m actually a lot more heartless than you might believe. Heck, I’d even advocate free markets over socialist systems strictly for societal efficiency, even if it meant a few people had to die. I’m not advocating the death of those unable to take care of themselves, of course. But a fear of lack of food and medicine if a damn good motivator for those marginal cases who can but won’t if they don’t have to.

Maybe it does, in a small way.

Tell me where we draw the line:
A janitor should have the same longevity as Bill Gates.
A janitor should have the same quality of nutrition as Bill Gates.
A janitor should have the same sense of security as Bill Gates.
…
…
the same amount of money as Bill Gates.

I draw the line at: “A janitor should have the same amount of money as Bill Gates.”

I know it’s a logical fallacy to imply a slippery slope, but that’s not what I’m doing. I’m giving a list to motivate the necessity of a philosophical basis which determines where the line should be drawn. If we do it emotionally rather than logically, we can’t even discuss it intelligently. Do I want to turn away a person who’s having an asthma attack, when all they need is a $30 nebuliser treatment? Of course not. What if they’re 103 years old, and they need a $2000 treatment, daily? Who makes that decision?

I drew my line. Now I ask the writer to draw a line. First let me say that I do not think there are enough folks who are 103 years old to take much out of the writer’s pocket – or the taxpayers’ collective pockets – even at $2,000 per day – to be much of an economic burden on the taxpayers or the writer.

It seems impossibly complicated to me unless we make every person responsible for their own wellbeing, and let the rest be a result of charity rather than entitlement. At least it would give those who live off of others a sense of humility.

One of the issues that seems to be important to the writer: of everyone being “responsible for their own wellbeing” and of folks “who live off of others” not having the necessary degree of “humility” for living “off of others.”

Dictionary.com defines humility as:

the quality or condition of being humble; modest opinion or estimate of one’s own importance, rank, etc. and goes on to list synonyms for humility as … lowliness, meekness, submissiveness.

So it is evidently important to the writer that those who need medical care and cannot pay for it and do not have an insurance company willing to pay for it be confined to getting whatever medical care they may need and receive through charity and not through any entitlement so that the writer may thus be satisfied that those who seek medical care will be properly meek and submissive – because the care will be endowed entirely through charity.

I find that to be an interesting thought but not very logical. It seems to me to more emotional than logical to be focused on whether or not folks who seek medical care be endowed with the writer’s idea of their proper degree of humility. Such a thought smacks of anger – not logic. Perhaps it is justifiable anger but it is definitely not unemotional logic.

What about people who receive the services of the police or the fire department? In our present system no one pays directly out of their pocket for these services – yet we all receive these services. I am certain that most people would consider these services as essential to their “wellbeing.” Shouldn’t we all feel ashamed? Shouldn’t we all consider ourselves to be excessively prideful if we believe these services to be … entitlements?

Shouldn’t we all go out and hire our own police so that we can be properly “responsible” for our “own wellbeing?” Does the writer pay directly out of his own pocket for police protection? If not, by the writer’s own philosophy, shouldn’t the writer be deeply ashamed for living “off of others?”

grackle > I feel that a janitor, farm worker or any other low-class, low-wage earner should have as much longevity as Bill Gates or George Soros. Does that make me a Marxist?

Maybe it does, in a small way.

Health care isn’t free. If a person claims a right to health care, they claim a right to another person’s time, effort, and money. Nobody should have the right to force me live my life for them, even in the smallest amount. It’s not the quantity, it’s the logic.

Tell me where we draw the line:
A janitor should have the same longevity as Bill Gates.
A janitor should have the same quality of nutrition as Bill Gates.
A janitor should have the same sense of security as Bill Gates.
…
…
A janitor should have the same amount of money as Bill Gates.

I know it’s a logical fallacy to imply a slippery slope, but that’s not what I’m doing. I’m giving a list to motivate the necessity of a philosophical basis which determines where the line should be drawn. If we do it emotionally rather than logically, we can’t even discuss it intelligently. Do I want to turn away a person who’s having an asthma attack, when all they need is a $30 nebuliser treatment? Of course not. What if they’re 103 years old, and they need a $2000 treatment, daily? Who makes that decision?

It seems impossibly complicated to me unless we make every person responsible for their own wellbeing, and let the rest be a result of charity rather than entitlement. At least it would give those who live off of others a sense of humility.

Substitute “providing” for “redistributing” and I’ll perhaps agree with the writer. When you are “redistributing” wealth you are giving money to folks that didn’t earn the money. But to me the term is kind of strange to use in regards to healthcare – because you are speaking of mere money in one case and life itself in the other. I feel that a janitor, farm worker or any other low-class, low-wage earner should have as much longevity as Bill Gates or George Soros. Does that make me a Marxist?

This[making folks pay for health insurance] has the huge added benefit of motivating people to take better care of themselves so that they avoid the constant Dr. visits.

Well, people are going to “pay” – no matter what. They pay now in various ways. I’m wondering if the writer believes there is a correlation between owning health insurance and good health habits. Or that there is a correlation between owning insurance and number of office visits. I would be willing to bet – if there were a way of proving it one way or another – that folks who do not have health insurance visit doctors’ offices LESS often than those who do have insurance.

Let’s say a person smokes a pack a day, drinks good whisky, eats steak heartily and often. Isn’t this person, by probably dying earlier and quicker, more likely to cost the healthcare system LESS? Isn’t part of the problem due to the demographic fact that folks are living longer these days?

Speaking of longevity, I wonder what the life expectancy is for folks who live under some version of a nationalized healthcare as opposed to a mainly private system as we have in America. Anyone care to look that up?

If the government knew how to end health care waste why would they not work their magic to improve Medicare/Medicaid?

Yes, I have been wondering this myself. Why didn’t the Republicans, while they were in power, do ANYTHING to improve “Medicare/Medicaid?” After all, they had ALL that time while they were in power to “improve” things. But they didn’t. What they DID do was to act as if the problem did not exist. Too busy worrying about gay marriage, shamnesty and family values, I guess.

Now the Democrats are in power. Too bad the Repubs did NOTHING while they had a chance, because all this healthcare stuff might not be such big thing if they had. But here we are, on the verge of large and probably detrimental changes in how healthcare is administered. Missed opportunities can sure bite you in the butt, as the saying goes.

Mistakes made that cause suffering or death in Great Britain.

Mistakes are also made here and now in the good old USA. Let me assure everyone that medical mistakes and malpractice happen all the time in America. In fact, malpractice suits – brought on by medical mistakes – are often cited as the bane of the American medical community and as contributing significantly to the cost of healthcare.

Literally, they[Medicare patients] pay a minor fraction of typical billing amounts.

Literally, they(patients who can afford health insurance) pay a minor fraction of typical billing amounts.

I guess it all depends on how “typical billing amounts” is defined. There will be those patients that have no insurance and are not covered by Medicare. They will pay whatever the doctor wants to charge, which will probably be more than those covered by insurance or Medicare. Should we call that “typical?”

My prescient vision sees the following: NHS Bureaucrat…”I’m sorry sir/madam but the drug/procedure/treatment is much too expensive for the risk/benefits. I’m afraid I must deny services.”

MY vision sees the same thing said by insurance company executives when disallowing benefits to insurance claimants. Many claims adjusters are paid and promoted on the basis of how many claims they can disallow. And if the claim is disallowed unfairly? Well then that individual can hire a lawyer and try to fight it out in court. Good luck on that, considering that the insurance companies keep a bank of the best and brightest lawyers money can buy. You stand a good chance of dying before the issue would be resolved by the legal system.

We’re spending hundreds of thousands of dollars per person to keep people alive for an extra 5 to 10 years, when they would be better off dying.

I think the writer probably does not have a life-threatening health issue. I’m thinking also that if the writer did have a life-threatening illness, at whatever age, that the writer would probably not want to lose those “extra 5 to 10 years” and would not believe he would be “better off dying.”

I pay right now, either through my taxes or my insurance premiums, for plenty of expensive drug cocktails and medical equipment and repeated surgeries for young people who have disabilities or chronic illnesses and will need all that care for a whole lot longer than my m-i-l will. Would you tell parents that their sick four-year-old should die rather than receive years of some expensive “cocktail of drugs” or other costly but available medical services that would allow him to enjoy his life? If so, you’re way beyond anywhere I’m ready to go. If not, I have to ask, how come the four-year-old who’s done nothing to earn any care should get it, but not my m-i-l, who spent her whole life paying for other people’s medical costs through taxes and insurance premiums, and hardly used any health care services at all until she finally began to need some recently?

Obviously, we are going to have to make hard decisions and we can’t afford everything. Clearly, we need to find ways to cut costs. But I don’t think we are forced, yet, to cut them at the expense of the most vulnerable and powerless members of society when we have not yet tried available measures that are within the power of the rest of us (such as, perhaps, treating health insurance more like motor vehicle insurance — there to pay for the expensive catastrophes, but not for day-to-day maintenance and repair, which would be the responsibility of the body’s owner. I realize that idea raises problems of its own, but so does every proposed solution, including yours.) I was reacting to what seemed to be your suggestion that the combination of age and need for expensive care makes a person expendable. If that’s not what you meant to suggest, I once again apologize.

I do firmly believe, mesmerized though I may be, that recognizing that we have to cut costs is not the same thing as recognizing that we have to devalue human beings to do it.

At some point, we’ll have to make a decision that we aren’t going to spend hundreds of thousands of dollars to keep alive people who would quickly die if not for their two dozen medications and life support systems.

It is my respondents who are mesmerized by the dumb culture of “compassion.” At some point in the future, we will run into hard reality.

How much are you willing to spend to tack on five years to the life of a person who really cannot survive without a pharmaceutical cocktail or life support.

There is a price tag to everything.

This issue is why medical costs cannot be controlled. Everybody is interested in limited costs in the abstract. In the individual case, everybody wants maximum care, damn the cost, no matter how ridiculous the situation. Each of the respondents to my post is guilty of this. You are the cause of the outrageous cost of medicine.

In the past month I’ve attended patients whose every system had broken down, who will never get out of bed again and who could not survive for 15 minutes without their chemical cocktail.

What is we’re just broke and we don’t have the money to prop of this monstrosity?

Anybody interested in a sane discussion of this? This is the problem we face. Go ahead. Call me names and insist that your 93 year old auntie should be maximum care without regard to cost.

Who’s going to pay for it?

She is not being kept alive to keep anybody’s paycheck coming. She is being kept alive because she likes being alive and wants to continue in that fashion as long as possible. She may not be worth much to Shouting Thomas and his ilk but she’s worth a great deal to her family and to herself. I do not accept that the fact that she’s a few years older than S.T. makes her any less valuable or worthy of necessary health care than he is. In fact I might argue that she is more valuable, because she would never have had the smallness of soul to suggest that our more expensive citizens ought to be bumped off in order to save the rest of us a few lousy bucks.

There are ways to cut costs that do not require us to sever ourselves from our souls. Any governmental attempt to establish some sort of sliding scale of human value as a cost-cutting metric will drive me straight to the barricades. It might be good enough for Shouting Thomas and his loved ones, but not for me and mine.

He also cites the old shibboleth of most money is spent on the last few months of life. Let’s kidnap Shouting, threaten him with death unless a large ransom is paid, and let’s see how he feels when his family refuses.

Shouting is the type of guy who undertakes “mercy killings” while working in health care. Very caring, indeed.