"We are now contemplating, Heaven save the mark, a bill that would tax the well for the benefit of the ill."
That's not a quote from oral arguments at the Supreme Court over the constitutionality of the Affordable Care Act or from one of the earnest conservatives demonstrating against it outside. It's actually the beginning of an editorial in the Aug. 15, 1949 issue of theNew York State Journal of Medicine denouncing the pernicious effects of health insurance. To be clear: not government-mandated health insurance, but all third-party health insurance.
I wrote about that editorial in a July 16, 2009 blog entitled, "GOP to Uninsured: Drop Dead." My blog was prompted by a Wall Street Journal op-ed the previous day from Dr. Thomas Szasz, an emeritus professor of psychiatry, who counseled readers not to confuse ethics and economics:
"The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion....We must stop talking about "health care" as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it.... If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price."
"What he should do is whatever he wants to do and assume responsibility for himself," Paul responded, adding, "That's what freedom is all about, taking your own risk." When Blitzer followed up by asking, "Congressman, are you saying that society should just let him die?" a group of audience members in the Tampa auditorium began audibly cheering, "Yeah!"
The individual's responsibility for "taking your own risk" was precisely what the New York State Medical Society worried that health insurance would undermine. As the Aug. 15, 1949 editorial put it:
"Any experienced general practitioner will agree that what keeps the great majority of people well is the fact that they can't afford to be ill. That is a harsh, stern dictum and we readily admit that under it a certain number of cases of early tuberculosis and cancer, for example, may go undetected. Is it not better that a few such should perish rather than that the majority of the population should be encouraged on every occasion to run sniveling to the doctor? That in order to get their money's worth they should be sick at every available opportunity? They will find out in time that the services they think they get for nothing -- but which the whole people of the United States would pay for -- are also worth nothing."
Of course, today's liberty lovers are not denouncing health insurance per se, nor even calling directly for the abolition of government-funded health insurance for the elderly, the poor and veterans. Still, faint footfalls of this same fend-for-yourself argument, if not so bluntly stated, can be heard in GOP plans to control Medicare costs by turning it into a "premium support" program that risks leaving those too sick, too poor or not savvy enough shoppers for private insurance to fend for themselves.
Certainly, creating a situation where "the great majority of people... can't afford to be ill" is an effective cost-control mechanism. In 1949, when 90 percent of the American population had no health insurance, medical expenditures were a tiny percentage of the gross national product. In our day, when medical technology is far more advanced, the economic principle remains the same. The Great Recession prompted a sharp drop in doctor's office visits and even caused some individuals with cancer to stop taking their medications simply because they couldn't afford it. Someone with Ron Paul's flair for phrase-making might call this a case of "give me liberty and give me death."
The Wall Street Journal op-ed by Szasz was entitled, "Universal Health Care Isn't Worth Our Freedom." That sentiment was vociferously endorsed by the anti-Obamacare demonstrators outside the Court and, oral arguments suggested, by some justices within it. Freedom, too, was on the minds of New York State physicians in this Sept. 15, 1949 commentary advocating what might be termed a robust medical consumerism:
"It is time that someone -- everyone -- should hoist Mr. Charles Darwin from his grave and blow life into his ashes so that they could proclaim again to the world his tough but practical doctrine of survival of the fittest...The Declaration of Independence said that man was entitled to the "pursuit of happiness." Any man who wishes to pursue happiness had better be able to stand on his own feet. He will not be successful if he feels that he can afford to be ill."
That no Republican presidential candidate has ever presented a serious plan to cover all the uninsured -- isn't that why we have hospital emergency rooms? -- is irrelevant to the legal issues, but it is highly relevant to the political context of the legal debate. The difference between Democrats and this generation of Republicans -- unfortunately including even the GOP Doctors Caucus -- is not at its core a disagreement on what government can legitimately do to help create universal access to health care for the 50 million Americans without it, but whether the goal itself is worth pursuing.
(A version of this blog also appeared on www.thedoctorweighsin.com)
Miles Mogulescu: Conservatives and Liberals Agree: Medicare for All Would Be Constitutional
No, millenials, you don't have to die. Demand Medicare for all. Organize. Vote and elect a Congress that will meet your demands.
Yes, you can.
And when she does go to prison, the tax payers money which was saved (apparently) by not paying for her insurance would be used to house her in the jail.. or wait, shud she be just executed without trial saving more tax payers money?
Repubs make quite a brilliant argument/case for their thinking process...
ahhh... now that is a conundrum.
It may FEEL like a crisis if you want to live but can't afford a doctor. But that feeling will pass when your respirations cease. When you're quite still, the feeling of "crisis" is over. It is quite presumptuous of the poor to want to live.
If God had wanted them to live, he would have made them rich. Medical care is for the insured, and insurance is for people who can pay for it. As a famous and beloved man once said (I believe Ebenezer was his name) :
"SCROOGE: Are there no prisons?
2ND MISSIONARY: Plenty of prisons, sir.
SCROOGE: And the workhouses? Are they still in operation?
1ST MISSIONARY: They are.
3RD MISSIONARY: I wish we could say that they are not.
SCROOGE: The Treadmill and the Poor Law are in full vigor, then?
1ST MISSIONARY: Both are very busy, sir.
SCROOGE: Oh! I was afraid from what you said at first that something had stopped
them in their useful course. I am very glad to hear they are still operating.
2ND MISSIONARY: (Not looking up.) A few of us are endeavoring to raise a fund to
buy the poor some meat and drink, and means of warmth because at this time the want is
more keenly felt.
3RD MISSIONARY: What shall I put you down for?
SCROOGE: Nothing."
Is that REALLY the model of health care we want for ourselves, for our children, etc? If that is the widespread belief among our population, our nation is beyond help.
Pr Chris
At least the Canadian and UK health plans, and those of most other countries provide decent health care to ALL their people.
Why does everyone who rails against the Canadian system, for instance, expect they are going to need a heart transplant or something? Most of us will experience the average sorts of illnesses and injuries which are average. For these people, the Canadian system, the Japanese, Germans and Brits, all have health care that really is health CARE.
PR Chris
The unborn vs the sick ???
They are so full of contradictions it'll make your head spin.
Unless, you feel that the world is right to be divided into haves & have nots. I do not.
If you believe in Jesus Christ, logic says you should be on the side of affording healthcare to ALL citizens.
IF, it can be done in other countries -- It darn sure could be done here.
I'm not saying that insurance should account for all expenses in health responsibilities.
BUT, to be denied a chance of life because you are part of the working poor.... is unjustice, unfair. Surely, there is a place for GOVERNMENT care for all citizens, regardless of ability to pay.
Maybe the insurance market should provide extra's -- leaving the real matter of disease care to a socialist program.
There. I said it. I, life Bernie Sanders, am a socialist.
And, now that I've thought about it. I'm not ashamed.
If this law goes down, it will only demonstrate that we -can't- reform health care through private insurance, and we'll have to do it either through tax-funded public insurance or not at all. Either way, I'm not sure how the insurance, pharma and biotech industries win in the long run.