I’m not wolfpup, but am happy to type a response anyway!
I’d avoid the term “moral obligation.” “Charitable impulse” would be a better term, since unlike the absolutist “moral obligation”, it allows for variable impulse among different individuals. In either case, a democratic society seeks some sort of democratically-agreed common welfare. (I run the other way when I hear “moral obligation” instead of the plain-speaking phrase like “common welfare.”)
I’d turn the question around. Do you, Bone, think it’s wrong children get K-12 education for free? Many people would have significantly higher income if they didn’t have to subsidize schooling of the lower classes.
What about police protection? 911 calls already identify calling number; calls could be rejected if the phone-owner didn’t pay for police protection. Is there a philosophic difference between protection from criminals and protection from bacteria?
Unlike most Dopers, who are often extreme leftist or extreme rightist, I am a centrist. The rich are entitled to better champagne than the poor; why shouldn’t they be entitled to better health care as well? (Though of course, they will be able to buy improved health care even in an ostensibly single-payer environment.) The reasons for UHC are largely pragmatic, especially when the inequities and inefficiencies of the present American system are considered. ACA will lead to major improvements in health care for many millions of Americans, with only smallish extra burdens on the rest of us. It isn’t a hard choice to make for those unperturbed about the “morality” of “the undeserving getting something for nothing.”
Although I am an extreme leftist…I favor a two-tier plan, where the public health care system gives basic coverage, but everyone is free to buy private plans that give additional levels of comfort. The basic plan puts you in a hospital ward, but the private plan moves you to a private room.
The joy of this is you tax the private plans to help pay for the public plan. Everybody benefits!
Public hospitals don’t have the resources to worry about special ‘first class’ room for patients with first tier insurance. They are worried about saving life and limb.
You can only have a two tiered system if you have private hospitals, which means private doctors, which means brain drain from the public sector… So you have to be careful.
It’s not necessarily a right, nor is it a right to be free of it. It’s simply the smart thing to do and the natural progression of an advanced society.
There are all kinds of things we collaborate on because it’s more efficient to do so. In this case, we have plenty of examples that UHC is one of those and we’d be pretty stupid not to follow a better path.
There are different kinds of rights. Life, liberty and the pursuit of happiness are liberty rights, which means rights that do not entail obligations for other parties. There is another category of rights, claim rights. These are rights that other parties have a duty to provide. They include your right to a lawyer of charged with a crime, a childs right to care from its parents (or their obligation to find someone else to care for the child if unable to)
The distinction originates from the legal system of the United States of America, and was first formulated by Hohfeld. Its been taken up by a number of nations since Hohfeld, including ones with older legal systems.
Liberty rights and claim rights are the inverse of one another: a person has a liberty right to do something only if there is no other person who has a claim right preventing him from doing so; and likewise, if a person has a claim right against someone else, that other person’s liberty is limited by it.
Hohfelds codification of rights (also including powers and immunities) give rise to more complex rights, such as property rights.
The people advancing the notion that healthcare is a right, holds it to be a claim right similar to the right to a lawyer. Their view is not universal, but nor is it necessarily out of place besides the other claim rights the US provides citizens with. While liberty and claim rights were codified after the American constitution was written, the constitution includes what is clearly claim rights. For example under the sixth amendment.
Yes - I don’t think morality is very helpful in this type of discussion - but **wolfpup **introduced the idea so I wanted to clarify what he was actually talking about. It looked like two separate ideas, but I’m not sure if they were tied together based on the way the statement was constructed. In any case, I don’t think the phrase “common welfare” is any more plain spoken than “moral obligation”. Common welfare can involve a pretty wide range of activity. Included could be providing healthcare as stated, to controlling diet, to family planning, to curbing recreational activity, etc.
I don’t think public education is wrong, or right. It just is, in our current setup. It wasn’t always that way, and it doesn’t need to always be that way. If it were up for a vote I would vote against it. My take would be that if education must be publicly funded, it should be through a voucher type program at the local level with no federal involvement.
This is similar to education, but different enough that the treatment would be different. Keep in mind though that there are places in the country that have subscription based fire protection service. I think we’ve had threads on this topic where the fire department did in fact choose not to respond or not assist someone who chose not to subscribe to the service. I have no problem with that. Law enforcement is the proper role of government so police fall at a different point on the spectrum than healthcare. Granted that’s my personal take and I agree that collectively people can decide how they want their relationship with government to be constructed.
Depending on how you characterize ‘basic coverage’, this could accurately describe the US system pre-ACA.
Indeed. Back in my foolish youth I was known to indulge in both on the same day!
Yes, though not necessarily the “single payer” part. “Single payer” describes an implementation. The principle of health care should be that it’s universal, unconditional, and provided regardless of ability to pay. There are multiple implementations possible to achieve that.
It came about at different times in different countries – in Germany, since the time of Bismarck; in the UK, as part of post-war rebuilding of social institutions; in Canada, as part of the conscience of social democracy that began in Saskatchewan in the middle of the 20th century, promulgated by the Cooperative Commonwealth Federation. The CCF was largely responding to the tribulations which had been endured by farmers and workers during the Great Depression, but its system of universal hospital coverage and later universal health care proved so efficient and popular that it was adopted by all provinces and later enshrined as a fundamental national principle in the Canada Health Act. Something very similar could have happened in the US even earlier, at the time Roosevelt introduced the principles of Social Security, but was killed by the AMA which, then as now, was intensely fearful of government regulation. Today the vast multi-billion dollar insurance industry is an even stronger lobbying force, which sees UHC and single-payer as threats to its very existence.
I would venture to guess that the reasons universal health care has come about throughout the developed world is a confluence of medical progress and social enlightenment. Medical progress has made health care increasingly capable and therefore increasingly relevant – more and more, it can alleviate suffering and save lives where in the past it could offer only palliative measures or nothing at all. It has also become increasingly more complex and expensive. At the same time, nations have evolved an enlightened social conscience, the same values that have abolished pillories, slavery, indentured servitude, and Dickensian workhouses. And when experience shows that universal coverage under a uniform community-rated system doesn’t just deliver social benefits and moral justice but actually saves money over systems that try to commercialize it for private gain, it becomes a win-win that all nations have adopted in one form or another.
The US federal provisions for ER care for the uninsured and Medicaid for the very poorest are an effort to move in the same direction, but these paltry half measures are so inadequate and so spectacularly inefficient that they may as well not exist at all. What there is instead is AHIP, the AMA, and health care policies being dictated by the most powerful lobbyists that the world has ever seen.
Yes, food, clothing, shelter, education, and the right to earn a living, all of which are generally accepted civilized values and incorporated in the national social systems of all advanced nations and in the UN Universal Declaration of Human Rights. The critical difference from health care is that these necessities are also ingrained in our lifestyles and their quality is an innate expression of wealth, or lack of it. Gourmet foods, designer clothing, and opulent housing are prerogatives of the wealthy, provided by the marketplace in accordance with ability to pay. But there’s a basic level of necessity that is a social responsibility.
Health care is qualitatively completely different. My view and the view of most advanced nations is that there should be only one level of medically necessary health care: the best that is medically possible. And it should never be treated as a commercial commodity. What may surprise many who oppose UHC and single-payer is that this objective – of being the best possible – is readily achievable. It’s achievable basically because the most expensive and complex procedures are rare, and the cost savings inherent in the simple model of single-payer and distributing risks over the entire population are enormous. What certainly shouldn’t be a surprise to anyone is that under private insurance the concept of “best available” is carefully rationed by price, and limited by such factors as coverage conditions, pre-approval requirements, and “health networks” of different degrees of extent and quality. So once again the naysayers against single-payer UHC manage to get the reality exactly backwards.
I don’t dispute that the US has some of the best health care facilities in the world. But these have come about because of the nation’s wealth and technological capability, including a strong medical research base. Health insurance companies, basically parasites on the entire system, have nothing to do with it. Other nations have similarly excellent facilities in proportion to their wealth and technology.
Why? One’s right to life explains police protection. One should be able to call the government in the form of police for protection if they feel they are being threatened. Then why not have the right to get protection in the form of healthcare when threatened by a disease? The right to life is reasonably fundamental, so how come it kicks in when threatened by a crook as opposed to a virus?
And once we have this we tend to spread it to more general stuff. Cops get involved in theft also. Healthcare gets involved for non-life-threatening diseases.
I’m not sure I agree with your assessment that on’es right to life explains police protection. Firstly, I don’t think anyone enjoys a right to life, more accurately I would describe it as a right not to be killed. Just because I possess the means to save someone’s life does not mean they have the right to take it from me. The only obligation I am under is to not cause that person to be killed.
Secondly, police exist to enforce the law. There is no right to police protection. They may choose to do so, but there is no duty that they must. It is a spectrum though - just because the government through the CDC can quarantine folks as a matter of public safety doesn’t mean that they should then have the ability to be involved in all matters of healthcare.
I don’t think the analogy you are trying to draw between healthcare and policing works.
I think it is more accurate to say that government has the obligation to not let us get killed when it is preventable. Despite best efforts by the police, people will get murdered. Despite best efforts by doctors, people will get killed by germs and viruses. Despite best efforts by the FDA people will get killed by bad food.
But the obligation to try to prevent this is there.
Do you know of any police department that would not respond to a call about an imminent threat to life, assuming no one is laughing in the background? Because of funding cuts there are plenty who don’t respond to burglaries these days. I’d suspect lives at stake are treated differently.
CDC gets involved rarely. Kind of like a SWAT team. I’m talking about government support for healthcare that can save lives through known and tested procedures.
Not general policing. Policing in cases of imminent threats to the life of a person.
And what is the real difference between a ten year old kid shot in the street because he lives in a neighborhood the police have abandoned and a ten year old kid dying of a preventable disease because he lives in a society which won’t treat him since his family has insufficient money?
I don’t agree that the government has an obligation to not let us get killed when it’s preventable. If they did, smoking would be banned, unhealthy food would be banned, driving over 10 or some small speed would be banned, etc. There are calculated risks that individuals take and that the government has no part and should have no part in.
I am assuming you know of the case of the NY subway stabbingwhere the police hid while a bystander subdued a person the subject of a manhunt. There are other cases that have been litigated that have solidified the doctrine that the police are under no obligation to protect any individual. It’s rare, sure. An acquaintance of mine called the police as he was running from mass transit - there was a knife wielding man chasing him. He ran to his apartment and hid. The police responded - 8 hours later. This is kind of a tangent but it’s pretty well established.
Medicaid for the indigent already provides vaccines for children. Like I said, I’m fine with a safety net - Medicaid and Medicare in this case. But the analogy is stretched pretty thin here. Ultimately I think policing is different than providing healthcare. One is an enforcement role, the other is as a service provider.
The second sentence of the foundational document of the USA would appear to disagree with you.
Depends on what they’re “taking”. If they’re taking your vital organs you might have a point. If “they” are taking some small percentage of your income that is actually less than what you would sooner or later have to spend on your own health care anyway and using it to support an efficient health care system that YOU are part of, so that neither you nor anyone else ever has to go without necessary health care no matter what, then I would think you should be grateful for that guarantee and for what it says about the society you live in. A society can be cruel, callous, and ignorant in how it treats its member citizens, or it can be compassionate and enlightened, and the choices it makes profoundly shapes all of its values. That’s why we no longer have slavery or throw the poor in jail or in workhouses. Moreover, it’s plainly incorrect to think that you’re financially better off letting your less fortunate fellow citizens potentially die from lack of health care, even if that was a morally tenable position. It doesn’t add up that way in the real world, for many real and practical and proven reasons.
Probabilistic threats are different from direct threat. Which is too bad, since if they weren’t we could control guns better. BTW, one big argument for gun ownership is that the state should allow guns so that people could protect themselves.
On July 25, 2013, Judge Margaret Chan dismissed Lozito’s suit; stating while sympathetic to the Lozito’s account and not doubting his testimony, agreed that police had “no special duty” to protect Lozito. From the Wiki entry, and after your cite. Much as I think the cops who hid were jerks, protection is not absolute. I’m for not paying a million buck to prolong the life of someone who is 110 by a week.
Hey, I agree that police departments screw up all the time - that does not detract from the principle.
It is the protection part of policing I’m talking about, not giving out speeding tickets. Vaccines, though great, are again probabilistic protection. But do you you think that someone making $X, below the Medicaid limit, deserves insurance while someone making $X+100, just above it, does not?
While I agree that probabilistic threats are different than direct threats, this difference is not meaningful in the context you are using. Your previous assertion was that ‘government has the obligation to not let us get killed when it is preventable.’ I think it’s fair to say you were isolating your comment to direct threats [after your latest post], is that accurate? You continue:
But here you get it exactly backwards. The principle in play is that government via police have no obligation to protect anyone, even from direct threats. That’s just not their job. They may end up doing so in the course of their work, but the principle is that they are under no duty to do so. See Warren v. DC,Town of Castle Rock v. Gonzales,DeShaney v. Winnebago County. All of which ruled that there is no duty to protect anyone. These rest on the public duty doctrine - that without some special relationship, a government entity (as a state or municipality) cannot be held liable for the injuries of an individual resulting from a public officer’s or employee’s breach of a duty owed to the public as a whole as distinguished from a duty owed to the particular individual.
In other words, the principle is that police have no duty to protect individuals, either from direct or probabilistic threats. This is why I don’t think the analogy of health care to police is on point. It doesn’t support your argument.
You raised the example of a “preventable disease” - I’m just going with it. In other words, your example of ‘a kid dying of a preventable disease because he lives in a society which won’t treat him since his family has insufficient money’ does not exist in this country. Your question about the difference between that non-existent kid and the kid that is shot illustrates the opposite of the point you are trying to make. We already have a duty and system to care for the sick kid - and there is absolutely no duty to protect the kid living in a bad neighborhood.
I don’t think there is element of ‘deserves’ in that equation how I typically understand the term. Deserves implies something that is earned in my experience. I would say it’s more accurate that below the Medicaid limit someone is entitled through statute, and someone that is above the Medicaid limit is not so entitled. I understand that ‘deserve’ and ‘entitled’ are synonyms but here I think the meaning is sufficiently different than one conveys something the other does not. To adjust the example, if we set the limit at Y in year 1, then raise the limit to Z in year 2, that does not mean that the new folks in year 2 have done anything that deserves the new found benefits they qualify for. They are entitled to them, but they have not done anything to earn them. It’s charity.
Yeah, this is a big one. The fear is that with government in control of paying for healthcare, suddenly The Government ™ now decides exactly what healthcare you do or do not need, not you or your doctor. Oopsies, the government denied your request for lifesaving treatment for some vague “not in keeping with current best practices” reason. At least cemeteries are still private - the rep is coming tomorrow.
A new US study concluded that lack of health insurance may have contributed or led to nearly 17,000 hospital deaths among American children over two decades … “If you are a child without insurance, if you’re seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance.”
… we conclude that at least 23.7 million children in the US, or more than one child in four under 20 years of age, does not have regular full year access to needed health care services due to lack of insurance (11.2% of all children), gaps in insurance coverage (14.4%), or transportation barriers (4%) … Family income is a major determinant of access to health care. Nearly one-fourth, 23%, of children and adolescents in families with annual income under $35,000 goes more than one year – some more than five years – without any medical visits at all … Lack of access to preventive health care is associated with more costly medical conditions later in life, such as cardiovascular disease and cancer.
… When it comes to oral health care needs, the data are staggering … nearly half of preschool age children have never been to a dentist … nearly one-third of the children with dental emergencies were uninsured. Medicaid patients were twice as likely to be seen for an infection rather than an accident … The shortage of pediatric dentists, especially the lack of pediatric dentists willing to accept Medicaid, can have devastating consequences. This was tragically illustrated in February 2007 when a 12-year-old homeless child in Prince George’s Country, Maryland, a suburb of the nation’s capital, died of complications from a preventable and treatable tooth abscess. http://www.childrenshealthfund.org/sites/default/files/WhitePaper-May2007-FINAL.pdf
Again, bearing in mind the OP’s request not to raise straw men, is there any instance where this has happened in a single-payer system?
It certainly doesn’t in Canada. The Canada Health Act provides that provincial plans must cover treatment directed by a medical doctor, and services provided in a hospital. It’s the medical system which decides on your treatment. Doctors in hospitals and clinics are not government employees. They are in private practice and their sole responsibility is to their patients.
See the section entitled “Comprehensiveness” in the wiki article on the Canada Health Act:
And, this critique overlooks that this fear of bureaucrats deciding on health care is currently the situation for people covered by private insurance in the US, only that the bureaucrats are employees of insurance companies whose responsibility to their share-holders is to make a profit, not to provide health care.
What point are you trying to address? A statement explaining the purpose of your quote and how it applies would be helpful. As it stands it’s just noise.
