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If I come into the ER with my head spilt open, are you really going to ask for my insurance card? Or are you going to treat me? It seems obvious to me that I would be treated. If I go for an ear infection, then I suppose I could be turned away unless I had insurance or cash (under a GHI system).


In college I had a job as the nighttime ER check-in clerk at a big central urban hospital two nights a week. I was the guy with the clipboard asking exasperating questions: name?, address?, next of kin?, health insurance status?, SS#?, and "what seems to be the problem?" of people having heart attacks, allergic reactions, bleeding from gashes in their abdomens that they were holding shut with blood soaked rags, drifting in and out of consciousness or babbling incoherently (drugs? fever dementia? psychotic break?) while their boyfriend looked on in barely contained fear and rage, gunshot wounds (1971 -- not many) with the victims shrieking in fear and pain while I doggedly tried to extract the data needed to admit them. Some nights were calm and I could study, plan physics lab work, etc. Other nights all hell broke loose, and I would stay extra hours to help cope with the load -- typically an uptick in gang warfare. One night I was trying to get my data from a guy who literally had a stiletto knife stuck into his brain through the right temple.

One reason you want Universal Healthcare is that when you need medical attention, you want trained committed nurses and doctors taking care of you who don't give a damn about what you signed, how stupid you were when you bought your motorcycle without a helmet, or whether you chose to pay your health insurance bill when faced with the choice between it and eating. And you certainly don't want an exhausted college sophmore, like me, deciding your fate.

Almost all individual health care is Public Health care: if you are sick with communicable diseases then you are a danger to everyone, if you are disabled or die prematurely, you leave your dependents on the public tab, etc.

It is a mistake to think of health care as an individual acquisition, something that individuals can chose to have or not have. Health care is in fact a pubic good largely paid for already with public funds (research, education, hospitals, emergency personnel, and tax deductions for corporate and private health bills, charities, etc.) It makes sense to acknowledge this, and use taxes or FICA like fees to kick in the last dollars required to access the system.

I am a firm believer in markets and individual choice where they can work well. With regard to health care, the use of markets is a miserable failure. Another poster pointed out that when you need medical treatment you have neither the time nor the emotional capacity to make an informed and quality choice. Trying to use markets for health care is best thought of as superstition based on distorted and irrational quasi-religious beliefs about markets.

Certain goods are much cheaper and better when acquired publicly than privately that it is usually stupid to provide them in some other way: urban water supplies, fire protection, police protection, and public health protection.

A completely separate issue, and one that must be faced regardless of the organization of medical insurance, is that we are fast acquiring sufficient medical knowledge and technology to make it possible to use all the GDP for health care -- which would be insane. We need to enter into a Moral and Ethical Debate about what should be provided and paid for as a Public Good for All, and what should be left as optional and, in fact, as a luxury for the very wealthy or crazy to fall prey to, if they wish to pursue the vain and demeaning dream of eternal life and youthful beauty.

Sorry for the length. I do seem to be ranting these days.

david flyerboy
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