# UHC Ethical Dilemma: Where do you draw the line? **URL:** \ **Category:** Great Debates\ **Created:** [December 29, 2009, 5:48pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930 "2009-12-29T17:48:03Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Blalron](https://avatars.discourse-cdn.com/v4/letter/b/35a633/32.png) [@Blalron](https://boards.straightdope.com/u/Blalron)\ **Post date:** [December 29, 2009, 7:48pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/21 "2009-12-29T19:48:19Z")
> [@Rumor\_Watkins](#): > > No. Because we have an unacceptable degree of non-certainty that your free choices caused your medical affliction. Further, we don’t ration other government services based on poor choices (other than in the penal/criminal system); we do not live in a society where we prescribe and proscribe behaviors on an individualized level. That’s the entire point of living in a free society - society bears the externality costs of your shitty decision making. I think it’s perfectly fair, with the taxpayers funding healthcare, to tax negative externalities such as tobacco and junk food. If, purely hypothetically, it were calculated that each carton of Twinkies costs the taxpayers an extra 3 dollars in health care costs, then I say slap a tax on it for exactly that amount. I’m ok with taxing dangerous hobbies as well. ---
**Author:** ![Diogenes\_the\_Cynic](https://avatars.discourse-cdn.com/v4/letter/d/e99b99/32.png) [@Diogenes\_the\_Cynic](https://boards.straightdope.com/u/Diogenes_the_Cynic)\ **Post date:** [December 29, 2009, 7:50pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/22 "2009-12-29T19:50:44Z")
The preemie is an individual with rights of its own. The parents are neither here nor there. ---
**Author:** ![otternell](https://avatars.discourse-cdn.com/v4/letter/o/ecc23a/32.png) [@otternell](https://boards.straightdope.com/u/otternell)\ **Post date:** [December 29, 2009, 7:55pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/23 "2009-12-29T19:55:00Z")
> [@Diogenes\_the\_Cynic](#): > > The preemie is an individual with rights of its own. The parents are neither here nor there. **Sateryn’s** point is that the parents have to make any decisions about the preemie, obviously the preemie can’t make their own decision. Do the parents have an ethical obligation to consider the “greater good” of society in the healthcare choices for the preemie? **Sateryn** glad you made it to the debate! I was disappointed that your questions kept getting ignored in the pit! ---
**Author:** ![Diogenes\_the\_Cynic](https://avatars.discourse-cdn.com/v4/letter/d/e99b99/32.png) [@Diogenes\_the\_Cynic](https://boards.straightdope.com/u/Diogenes_the_Cynic)\ **Post date:** [December 29, 2009, 7:56pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/24 "2009-12-29T19:56:40Z")
> [@otternell](#): > > **Sateryn’s** point is that the parents have to make any decisions about the preemie, obviously the preemie can’t make their own decision. Do the parents have an ethical obligation to consider the “greater good” of society in the healthcare choices for the preemie? Taking care of the preemie IS the ethical obligation of society. It’s society’s obligation, not the parents. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 29, 2009, 7:59pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/25 "2009-12-29T19:59:08Z")
> [@Shodan](#): > > Sure we do - there are all kinds of means tests for government services like Medicaid and educational scholarships. Educational scholarships are the result of a student’s family’s poor choice? Whaa? Medicaid is more probably than not the result of poor choices? Please. > [@](#): > > Actually we do that too, in things like the civil court system. Or even in things like smoking bans in privately-owned restaurants and bars. Civil court systems address injuries caused to other members of society, or did you miss that sina qua non on your way to a point? And I missed the part where banning smoking in public restaurants, writ large, was individualized. > [@](#): > > Actually, in a free society we do as little of that as we can manage. I may make a shitty decision to spend the rent money on gambling, but that doesn’t mean that society has to bear the cost of making the mortgage payment. Society incurs an externality cost when you’re homeless and pandering on the streets too. > [@](#): > > Having the government tell you how to spend your money is about as far from being free as might be imagined. We have to have a certain amount of that, but it certainly is not the “entire point” of being free. And no where did I say that that was a valid governmental objective. Thanks for cooking up a straw man - the farms outside my city recently took theirs down on account of winter and i missed looking at them. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 29, 2009, 8:01pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/26 "2009-12-29T20:01:46Z")
> [@Blalron](#): > > I think it’s perfectly fair, with the taxpayers funding healthcare, to tax negative externalities such as tobacco and junk food. > > If, purely hypothetically, it were calculated that each carton of Twinkies costs the taxpayers an extra 3 dollars in health care costs, then I say slap a tax on it for exactly that amount. I’m ok with taxing dangerous hobbies as well. There is no human activity that isn’t dangerous to some degree. Precisely because figuring out the exact social costs of a Twinkie is purely hypothetical is why taxing bad behavior doesn’t work that well. Thus, the most efficient way for society to reduce these costs (apologies if I gave the impression that society must bear _all_ costs) is to let people act in the manner that they see most fit. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [December 29, 2009, 8:05pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/27 "2009-12-29T20:05:28Z")
> [@Rumor\_Watkins](#): > > And no where did I say that that was a valid governmental objective. Thanks for cooking up a straw man - the farms outside my city recently took theirs down on account of winter and i missed looking at them. So the entire point of living in a free society is that society bears the externality costs of your shitty decision making. But that is not a valid governmental objective. Oooookay. Regards, Shodan ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 29, 2009, 8:10pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/28 "2009-12-29T20:10:53Z")
> [@Shodan](#): > > So the entire point of living in a free society is that society bears the externality costs of your shitty decision making. But that is not a valid governmental objective. Sacrificing intelligibleness for glibness netted you neither. I can’t make heads or tails of this post or your point. ---
**Author:** ![otternell](https://avatars.discourse-cdn.com/v4/letter/o/ecc23a/32.png) [@otternell](https://boards.straightdope.com/u/otternell)\ **Post date:** [December 29, 2009, 8:13pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/29 "2009-12-29T20:13:20Z")
> [@Rumor\_Watkins](#): > > There is no human activity that isn’t dangerous to some degree. Precisely because figuring out the exact social costs of a Twinkie is purely hypothetical is why taxing bad behavior doesn’t work that well. Thus, the most efficient way for society to reduce these costs (apologies if I gave the impression that society must bear _all_ costs) is to let people act in the manner that they see most fit. So, by your standards, its perfectly ok for me to sit on my butt, eat vaguely food-like items that are nothing but empty calories, smoke 5 packs a day, drink a quart of vodka a day, and everyone’s tax dollars have to pay for my T2 diabetes, my lung cancer, my heart medications and quadruple bypass and whatever the hell my liver would need? [scratches head] gee, I wonder why some people are opposed to UHC? :rolleyes: ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 29, 2009, 8:17pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/30 "2009-12-29T20:17:26Z")
> [@otternell](#): > > So, by your standards, its perfectly ok for me to sit on my butt, eat vaguely food-like items that are nothing but empty calories, smoke 5 packs a day, drink a quart of vodka a day, and everyone’s tax dollars have to pay for my T2 diabetes, my lung cancer, my heart medications and quadruple bypass and whatever the hell my liver would need? > > [scratches head] gee, I wonder why some people are opposed to UHC? :rolleyes: Ok, but who really does that? You argue absurdities that have no basis in normal societal actions. And yes, for the one person in 300 million that does that (and manages to hold steady employment while drunk and constantly out on a smoke break to pay for his afflictions) it’s a cost I’d be willing to incur. I mean if this is why people are against UHC, to (not) pay for the lardbutt char-lung drunkard, then I really question their analytical capacities. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 29, 2009, 8:26pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/31 "2009-12-29T20:26:53Z")
> [@otternell](#): > > Outsourcing is an interesting idea. I am not sure I understand your point about education though. > > **Rumor Watkins** I agree: infants get a 50/50 shot before an 85 yr old. And your question regarding choices and visibility of costs to the end user is an important one. But really, if my taxes are going to pay towards it, why shouldn’t I get all the care I want? > > Next question: do we start to ration care based on poor health choices? If someone is obese and always eats at McD’s (as in their health problems are directly related to poor choices in food and lack of exercise) do we limit the care they get for not taking care of their body? My point about education is that someone could make the argument that those 20 students who went to college and never used their major wasted $600,000. However I do not feel it was a waste. You have no way of knowing if this premature child who needs $1,000,000 in medical care will grow up to the be next Ted Bundy or if they will grow up to discover a cure for Alzheimers. Or where they will fall in the middle. Do you apply that thinking to other areas like law enforcement? If someone commits one rape, then becomes a fugitive it will cost tens of thousands to find him, arrest him and put him on trial. A 40 year sentence will cost $1,000,000 when all is said and done since it is roughly $25000 a year for imprisonment. Is it better to just let the rapist go free since it will cost over a million dollar to catch, try and incarcerate him? If not, why should we let a child die for $1,000,000? I don’t see the difference. We do not ration law enforcement. However law enforcement is not as expensive as health care overall (I think it comes to $200 billion a year vs 2.5 trillion for health) so maybe that is a bad comparison. With law enforcement maybe costs are low enough that we do not need to ration. As far as rationing based on poor health choices, no. The big reason is that it’ll become a tool to persecute unpopular people. Being obese is unpopular in the US. However having an extremely high income is popular. Nonetheless having a high income usually requires unhealthy behaviors like high levels of stress, a poor work/life balance and chronic sleep deprivation. All of these things are very destructive to health. However I am 100% sure we would not punish people who are workaholics, despite their lifestyle harming their health. ---
**Author:** ![otternell](https://avatars.discourse-cdn.com/v4/letter/o/ecc23a/32.png) [@otternell](https://boards.straightdope.com/u/otternell)\ **Post date:** [December 29, 2009, 8:28pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/32 "2009-12-29T20:28:42Z")
> [@Rumor\_Watkins](#): > > Ok, but who really does that? You argue absurdities that have no basis in normal societal actions. > > And yes, for the one person in 300 million that does that (and manages to hold steady employment while drunk and constantly out on a smoke break to pay for his afflictions) it’s a cost I’d be willing to incur. > > I mean if this is why people are against UHC, to (not) pay for the lardbutt char-lung drunkard, then I really question their analytical capacities. Of course it was absurd - but I don’t agree that everyone should just get to live how they want with healthcare that everyone is paying for and not hold them responsible for their choices. If you make bad choices once in a while, that’s one thing. If you make bad choices consistently, with no regard for others, then why the hell should other people foot the bill. And while my example was absurd, there are still people who would abuse the system, and that is a problem. ---
**Author:** ![otternell](https://avatars.discourse-cdn.com/v4/letter/o/ecc23a/32.png) [@otternell](https://boards.straightdope.com/u/otternell)\ **Post date:** [December 29, 2009, 8:33pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/33 "2009-12-29T20:33:27Z")
> [@Wesley\_Clark](#): > > My point about education is that someone could make the argument that those 20 students who went to college and never used their major wasted $600,000. However I do not feel it was a waste. You have no way of knowing if this premature child who needs $1,000,000 in medical care will grow up to the be next Ted Bundy or if they will grow up to discover a cure for Alzheimers. Or where they will fall in the middle. > > Do you apply that thinking to other areas like law enforcement? If someone commits one rape, then becomes a fugitive it will cost tens of thousands to find him, arrest him and put him on trial. A 40 year sentence will cost $1,000,000 when all is said and done since it is roughly $25000 a year for imprisonment. Is it better to just let the rapist go free since it will cost over a million dollar to catch, try and incarcerate him? If not, why should we let a child die for $1,000,000? I don’t see the difference. We do not ration law enforcement. However law enforcement is not as expensive as health care overall (I think it comes to $200 billion a year vs 2.5 trillion for health) so maybe that is a bad comparison. With law enforcement maybe costs are low enough that we do not need to ration. > > As far as rationing based on poor health choices, no. The big reason is that it’ll become a tool to persecute unpopular people. Being obese is unpopular in the US. However having an extremely high income is popular. Nonetheless having a high income usually requires unhealthy behaviors like high levels of stress, a poor work/life balance and chronic sleep deprivation. All of these things are very destructive to health. > > However I am 100% sure we would not punish people who are workaholics, despite their lifestyle harming their health. You make good points, but I am still torn about the idea of people abusing their health because healthcare is free. Why should I quit smoking if I won’t have to pay any cost for it? (which is only speaking of $ cost and I fully acknowledge that there is an emotional/physical cost as well, which they (and their loved ones will pay.) Can we draw any line at all that makes sense, that holds people accountable for their choices? ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 29, 2009, 8:38pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/34 "2009-12-29T20:38:24Z")
> [@otternell](#): > > Of course it was absurd - but I don’t agree that everyone should just get to live how they want with healthcare that everyone is paying for and not hold them responsible for their choices. If you make bad choices once in a while, that’s one thing. If you make bad choices consistently, with no regard for others, then why the hell should other people foot the bill. And while my example was absurd, there are still people who would abuse the system, and that is a problem. Private insurance through an employer doesn’t hold them responsible for their choices, either. Other employees and the company are footing the bill for that one, or is that okay? Who have you ever heard of who makes bad choices (of the type that they are knowingly committing these knowingly bad choices) consistently with no regard for others who is either a) not incarcerated b) not in a mental hospital c) so on the fringes of society that they wouldn’t have the capacity to figure out how to go ahead and procure government-provided health services, and then actually follow through with a healthcare practitioner This is the same bogeyman in the welfare queen story. Mythical people who “abuse” the system. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 29, 2009, 8:41pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/35 "2009-12-29T20:41:04Z")
> [@otternell](#): > > You make good points, but I am still torn about the idea of people abusing their health because healthcare is free. Why should I quit smoking if I won’t have to pay any cost for it? (which is only speaking of $ cost and I fully acknowledge that there is an emotional/physical cost as well, which they (and their loved ones will pay.) > > Can we draw any line at all that makes sense, that holds people accountable for their choices? Well you just eviscerated the most important cost mechanism that effectively keeps most people from doing crazy, costly shit - self-preservation. You also seem to forget that smoking is an extremely well documented and potent addiction. ---
**Author:** ![Blalron](https://avatars.discourse-cdn.com/v4/letter/b/35a633/32.png) [@Blalron](https://boards.straightdope.com/u/Blalron)\ **Post date:** [December 29, 2009, 8:41pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/36 "2009-12-29T20:41:58Z")
> [@otternell](#): > > You make good points, but I am still torn about the idea of people abusing their health because healthcare is free. Why should I quit smoking if I won’t have to pay any cost for it? (which is only speaking of $ cost and I fully acknowledge that there is an emotional/physical cost as well, which they (and their loved ones will pay.) Nicotine is among the most addictive substances out there, I don’t think the existence or non-existence of UHC will make even the slightest dent on the smoking rate, because addicts simply don’t plan that far ahead with regards to the consequences of their addictions. If the prospect of dying in agony from lung cancer isn’t a deterrent, do you really expect a huge hospital bill to do the trick? ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [December 29, 2009, 9:02pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/37 "2009-12-29T21:02:31Z")
> [@Shodan](#): > > So the entire point of living in a free society is that society bears the externality costs of your shitty decision making. But that is not a valid governmental objective. > > Oooookay. > > Regards, > Shodan So, because it would be ethically dubious to deny health care to somebody under Universal Health Care, we’d be better off with no health care. After all, it’s only ethically dubious to deny $1,000,000 treatments to sick newborns if the country has implemented Universal Health Care. If we haven’t implemented Universal Health Care, denying that baby treatment is perfectly ethical. We already have a system where newborn babies are denied health care, and you’re perfectly happy with the status quo. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [December 29, 2009, 9:17pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/38 "2009-12-29T21:17:11Z")
> [@Lemur866](#): > > So, because it would be ethically dubious to deny health care to somebody under Universal Health Care, we’d be better off with no health care. After all, it’s only ethically dubious to deny $1,000,000 treatments to sick newborns if the country has implemented Universal Health Care. If we haven’t implemented Universal Health Care, denying that baby treatment is perfectly ethical. No, the ethics of denying or granting health care to sick newborns is separate from UHC. As I said in my first post to the thread, if we could do rational allocation of resources, we would not be spending as much as we are on health care, and there would be no need for UHC. > [@](#): > > We already have a system where newborn babies are denied health care, and you’re perfectly happy with the status quo. I am? Where did I say this? IIRC, I suggested a rather major change. Did you happen to read the thread before you posted? Regards, Shodan ---
**Author:** ![otternell](https://avatars.discourse-cdn.com/v4/letter/o/ecc23a/32.png) [@otternell](https://boards.straightdope.com/u/otternell)\ **Post date:** [December 29, 2009, 9:22pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/39 "2009-12-29T21:22:33Z")
> [@Blalron](#): > > Nicotine is among the most addictive substances out there, I don’t think the existence or non-existence of UHC will make even the slightest dent on the smoking rate, because addicts simply don’t plan that far ahead with regards to the consequences of their addictions. > > If the prospect of dying in agony from lung cancer isn’t a deterrent, do you really expect a huge hospital bill to do the trick? alright, you and **Rumor** have excellent points, and I can’t argue. Agreed that smoker’s don’t make smart decisions and a large hospital bill won’t change that. Also agreed that self-preservation is the primary factor to get people to do the right things. If the US ever passes UHC, I hope it works the way you think it will. I still have a sinking feeling that someone will end up getting it in the shorts, but that’s just my pessimism about the US gov’t doing something efficiently and effectively. As mentioned, I am a waffler, and while the pro-UHC folks have made some really good arguments that are moving my opinion, there are still some knee-jerk concerns that have not been allayed. ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [December 29, 2009, 9:24pm UTC](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930/40 "2009-12-29T21:24:43Z")
> [@Shodan](#): > > No, the ethics of denying or granting health care to sick newborns is separate from UHC. As I said in my first post to the thread, if we could do rational allocation of resources, we would not be spending as much as we are on health care, and there would be no need for UHC. > I am? Where did I say this? > > IIRC, I suggested a rather major change. Did you happen to read the thread before you posted? > > Regards, > Shodan So your solution is that newborn babies should have to pay for their own health care? And this will save all of us money? Or what? [Previous page](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930.md?page=1) [Next page](https://boards.straightdope.com/t/uhc-ethical-dilemma-where-do-you-draw-the-line/522930.md?page=3)