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Health Care is Not a Right

Discussion in 'Topics in Healthcare' started by GH253, Aug 22, 2015.

  1. GH253

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    http://westandfirm.org/Peikoff-01.html

    Health Care is Not a Right
    by Leonard Peikoff (1993), updated with permission by Lin Zinser (2007)

    [Introductory Note by Lin Zinser: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "single-payer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.]

    Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea--which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical. Of course, it is impractical--it does not work--but I hold that it is impractical because it is immoral. This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice. I want to focus on the moral issue at stake. So long as people believe that socialized medicine is a noble plan, there is no way to fight it. You cannot stop a noble plan--not if it really is noble. The only way you can defeat it is to unmask it--to show that it is the very opposite of noble. Then at least you have a fighting chance.

    What is morality in this context? The American concept of it is officially stated in the Declaration of Independence. It upholds man's unalienable, individual rights. The term "rights," note, is a moral (not just a political) term; it tells us that a certain course of behavior is right, sanctioned, proper, a prerogative to be respected by others, not interfered with--and that anyone who violates a man's rights is: wrong, morally wrong, unsanctioned, evil.

    Now our only rights, the American viewpoint continues, are the rights to life, liberty, property, and the pursuit of happiness. That's all. According to the Founding Fathers, we are not born with a right to a trip to Disneyland, or a meal at McDonald's, or a kidney dialysis (nor with the 18th-century equivalent of these things). We have certain specific rights--and only these.

    Why only these? Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want--not to be given it without effort by somebody else.

    The right to life, e.g., does not mean that your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes yourself, if necessary by a hard struggle, and that no one can forcibly stop your struggle for these things or steal them from you if and when you have achieved them. In other words: you have the right to act, and to keep the results of your actions, the products you make, to keep them or to trade them with others, if you wish. But you have no right to the actions or products of others, except on terms to which they voluntarily agree.

    To take one more example: the right to the pursuit of happiness is precisely that: the right to the pursuit--to a certain type of action on your part and its result--not to any guarantee that other people will make you happy or even try to do so. Otherwise, there would be no liberty in the country: if your mere desire for something, anythingg, imposes a duty on other people to satisfy you, then they have no choice in their lives, no say in what they do, they have no liberty, they cannot pursue their happiness. Your "right" to happiness at their expense means that they become rightless serfs, i.e., your slaves. Your right to anything at others' expense means that they become rightless.

    That is why the U.S. system defines rights as it does, strictly as the rights to action. This was the approach that made the U.S. the first truly free country in all world history--and, soon afterwards, as a result, the greatest country in history, the richest and the most powerful. It became the most powerful because its view of rights made it the most moral. It was the country of individualism and personal independence.

    Today, however, we are seeing the rise of principled immorality in this country. We are seeing a total abandonment by the intellectuals and the politicians of the moral principles on which the U.S. was founded. We are seeing the complete destruction of the concept of rights. The original American idea has been virtually wiped out, ignored as if it had never existed. The rule now is for politicians to ignore and violate men's actual rights, while arguing about a whole list of rights never dreamed of in this country's founding documents--rights which require no earning, no effort, no action at all on the part of the recipient.

    You are entitled to something, the politicians say, simply because it exists and you want or need it--period. You are entitled to be given it by the government. Where does the government get it from? What does the government have to do to private citizens--to their individual rights--to their real rights--in order to carry out the promise of showering free services on the people?

    The answers are obvious. The newfangled rights wipe out real rights--and turn the people who actually create the goods and services involved into servants of the state. The Russians tried this exact system for many decades. Unfortunately, we have not learned from their experience. Yet the meaning of socialism is clearly evident in any field at all--you don't need to think of health care as a special case; it is just as apparent if the government were to proclaim a universal right to food, or to a vacation, or to a haircut. I mean: a right in the new sense: not that you are free to earn these things by your own effort and trade, but that you have a moral claim to be given these things free of charge, with no action on your part, simply as handouts from a benevolent government.

    How would these alleged new rights be fulfilled? Take the simplest case: you are born with a moral right to hair care, let us say, provided by a loving government free of charge to all who want or need it. What would happen under such a moral theory?

    Haircuts are free, like the air we breathe, so some people show up every day for an expensive new styling, the government pays out more and more, barbers revel in their huge new incomes, and the profession starts to grow ravenously, bald men start to come in droves for free hair implantations, a school of fancy, specialized eyebrow pluckers develops--it's all free, the government pays. The dishonest barbers are having a field day, of course--but so are the honest ones; they are working and spending like mad, trying to give every customer his heart's desire, which is a millionaire's worth of special hair care and services--the government starts to scream, the budget is out of control. Suddenly directives erupt: we must limit the number of barbers, we must limit the time spent on haircuts, we must limit the permissible type of hair styles; bureaucrats begin to split hairs about how many hairs a barber should be allowed to split. A new computerized office of records filled with inspectors and red tape shoots up; some barbers, it seems, are still getting too rich, they must be getting more than their fair share of the national hair, so barbers have to start applying for Certificates of Need in order to buy razors, while peer review boards are established to assess every stylist's work, both the dishonest and the overly honest alike, to make sure that no one is too bad or too good or too busy or too unbusy. Etc. In the end, there are lines of wretched customers waiting for their chance to be routinely scalped by bored, hog-tied haircutters some of whom remember dreamily the old days when somehow everything was so much better.

    Do you think the situation would be improved by having hair-care cooperatives organized by the government?--having them engage in managed competition, managed by the government, in order to buy haircut insurance from companies controlled by the government?

    If this is what would happen under government-managed hair care, what else can possibly happen--it is already starting to happen--under the idea of health care as a right? Health care in the modern world is a complex, scientific, technological service. How can anybody be born with a right to such a thing?

    Under the American system you have a right to health care if you can pay for it, i.e., if you can earn it by your own action and effort. But nobody has the right to the services of any professional individual or group simply because he wants them and desperately needs them. The very fact that he needs these services so desperately is the proof that he had better respect the freedom, the integrity, and the rights of the people who provide them.

    You have a right to work, not to rob others of the fruits of their work, not to turn others into sacrificial, rightless animals laboring to fulfill your needs.

    Some of you may ask here: But can people afford health care on their own? Even leaving aside the present government-inflated medical prices, the answer is: Certainly people can afford it. Where do you think the money is coming from right now to pay for it all--where does the government get its fabled unlimited money? Government is not a productive organization; it has no source of wealth other than confiscation of the citizens' wealth, through taxation, deficit financing or the like.

    But, you may say, isn't it the "rich" who are really paying the costs of medical care now--the rich, not the broad bulk of the people? As has been proved time and again, there are not enough rich anywhere to make a dent in the government's costs; it is the vast middle class in the U.S. that is the only source of the kind of money that national programs like government health care require. A simple example of this is the fact that all of these new programs rest squarely on the backs not of Big Business, but of small businessmen who are struggling in today's economy merely to stay alive and in existence. Under any socialized regime, it is the "little people" who do most of the paying for it--under the senseless pretext that "the people" can't afford such and such, so the government must take over. If the people of a country truly couldn't afford a certain service--as e.g. in Somalia--neither, for that very reason, could any government in that country afford it, either.

    Some people can't afford medical care in the U.S. But they are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off--charity, not right, i.e. not their right to the lives or work of others. And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity.

    But the fact is: You don't abolish charity by calling it something else. If a person is getting health care for nothing, simply because he is breathing, he is still getting charity, whether or not any politician, lobbyist or activist calls it a "right." To call it a Right when the recipient did not earn it is merely to compound the evil. It is charity still--though now extorted by criminal tactics of force, while hiding under a dishonest name.

    As with any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call "medical care" a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada (I was born in Canada and I know a bit about that system first hand).

    I would like to clarify the point about socialized medicine enslaving the doctors. Let me quote here from an article I wrote a few years ago: "Medicine: The Death of a Profession."

    In medicine, above all, the mind must be left free. Medical treatment involves countless variables and options that must be taken into account, weighed, and summed up by the doctor's mind and subconscious. Your life depends on the private, inner essence of the doctor's function: it depends on the input that enters his brain, and on the processing such input receives from him. What is being thrust now into the equation? It is not only objective medical facts any longer. Today, in one form or another, the following also has to enter that brain: 'The DRG administrator [in effect, the hospital or HMO man trying to control costs] will raise hell if I operate, but the malpractice attorney will have a field day if I don't--and my rival down the street, who heads the local PRO [Peer Review Organization], favors a CAT scan in these cases, I can't afford to antagonize him, but the CON boys disagree and they won't authorize a CAT scanner for our hospital--and besides the FDA prohibits the drug I should be prescribing, even though it is widely used in Europe, and the IRS might not allow the patient a tax deduction for it, anyhow, and I can't get a specialist's advice because the latest Medicare rules prohibit a consultation with this diagnosis, and maybe I shouldn't even take this patient, he's so sick--after all, some doctors are manipulating their slate of patients, they accept only the healthiest ones, so their average costs are coming in lower than mine, and it looks bad for my staff privileges.' Would you like your case to be treated this way--by a doctor who takes into account your objective medical needs and the contradictory, unintelligible demands of some ninety different state and Federal government agencies? If you were a doctor could you comply with all of it? Could you plan or work around or deal with the unknowable? But how could you not? Those agencies are real and they are rapidly gaining total power over you and your mind and your patients.
    In this kind of nightmare world, if and when it takes hold fully, thought is helpless; no one can decide by rational means what to do. A doctor either obeys the loudest authority--or he tries to sneak by unnoticed, bootlegging some good health care occasionally or, as so many are doing now, he simply gives up and quits the field. (The Voice of Reason: Essays in Objectivist Thought, Ayn Rand, NAL Books, 1988, pp. 306-307)

    Any mandatory and comprehensive plan will finish off quality medicine in this country--because it will finish off the medical profession. It will deliver doctors bound hands and feet to the mercies of the bureaucracy.

    The only hope--for the doctors, for their patients, for all of us--is for the doctors to assert a moral principle. I mean: to assert their own personal individual rights--their real rights in this issue--their right to their lives, their liberty, their property, their pursuit of happiness. The Declaration of Independence applies to the medical profession too. We must reject the idea that doctors are slaves destined to serve others at the behest of the state.

    Doctors, Ayn Rand wrote, are not servants of their patients. They are "traders, like everyone else in a free society, and they should bear that title proudly, considering the crucial importance of the services they offer."

    The battle against socialized medicine depends on the doctors speaking out against it--not only on practical grounds, but, first of all, on moral grounds. The doctors must defend themselves and their own interests as a matter of solemn justice, upholding a moral principle, the first moral principle: self-preservation.

    [Concluding Note by Lin Zinser: In addition, we must join the doctors in their defense and in our own. Hospital administrators, nurses, physical therapists, health insurance companies, and patients must speak out against these plans, on moral grounds, as a matter of justice. If the doctors become slaves, so will we all.]

    Leonard Peikoff is a philosopher living in Southern California, and is the founder of the Ayn Rand Institute, and the author of The Ominous Parallels and of Objectivism: The Philosophy of Ayn Rand, the definitive presentation of Ayn Rand's philosophy of Objectivism. He is currently at work on his third book, The DIM Hypothesis.
     
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  3. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    This message brought to you (literally) by the Ayn Rand Institute.

    "Leonard Peikoff is... founder of the Ayn Rand Institute"
    Lin Zinser is Director of Public Outreach for the Ayn Rand Institute.
     
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  4. GH253

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    And your post is brought to us by the ad hominem logical fallacy.
     
    #3 GH253, Aug 22, 2015
    Last edited: Aug 23, 2015
  5. GH253

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  6. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    What a mind-blowing video, telling me that someone has to pay for health care. That's some next-level stuff.
     
  7. suzlee

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    For those to actually believe that healthcare is not a right, just imagine how you would feel if you were in an accident and could not afford to pay for it. Should you be left untreated? What about if it was a parent or a spouse? How would you feel?
     
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  8. GH253

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    Feelings are not facts. Nor are they claims on someone else's livelihood.
     
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  9. Instatewaiter

    Instatewaiter But... there's a troponin
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    So your arguement is that you should force someone to give you their free labor and materials? That seems unethical.

    No one is saying that they should be left untreated, but you should have to incur the debt and pay it off.
     
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  10. Slave to the Game

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    If there is already a system in place to compensate healthcare professionals (i.e. someone who normally couldn't afford to pay for medical care comes in with Medicaid), then they should be treated because it was already paid for by the system. If you're asking whether health professionals should forsake their income to provide healthcare, you're essentially arguing that people should work for free.
     
  11. pulmoblast

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    How about a middle ground...basic health care should be a right IMHO like access to primary care, vaccinations, pregnancy and delivery care, treatments for accidents and injuries etc....but intensive expensive treatments like cancer chemotherapy, infliximab for your RA, Joint replacements, spinal fusion etc cannot be for free
     
  12. Instatewaiter

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    And how do you go about providing this "right" if no one wants to provide it especially for the price the Gov't is willing to pay for your services? Necesitatitng coercision does not provide a strong foundation for a "right"
     
  13. Apollyon

    Apollyon Screw the GST
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    Indeed. Healthcare has to be provided - which means someone has to provide it. What if no one will? Do you force someone at gunpoint, for free? Involuntary servitude is prohibited by the 13th amendment.
     
  14. pulmoblast

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    Is food a right in the US? Should someone who is in need of food not be given food for free? Just asking
     
  15. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    They are.
     
  16. The Wobblie

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    Please google Temporary Assistance for Needy Families. While TANF is nowhere near what the government used to provide nor what it should provide, in effect the answer to your question is, yes, food is a right.

    However, I don't feel that comparing health care to food is really a valid economic comparison. Rather, I would compare it to other large scale services and ask, "Are roads a right in the US?" or "Is education a right in the US?" or "Is the military a right in the US?" These are far better comparisons and I'd be interested to hear why or why not.
     
  17. Instatewaiter

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    Food is not a rigth. For that matter, there are no such things as positive rights- things that necesitate others providing them because it interferes with a true right- one of liberty. A right cannot rely on coercion which is must happen if others do not want to provide them.

    That the gov't opts to provide these things also does not provide any foundation for a right. The two are unrelated. A govt can provide things it deems are useful but not rights and it can be unjust and take away true rights. So that there is a program called TANF makes no difference as to whether food is a right.

    The only true rights are those which require no coerced labor to have them. These tend to be negative rights- things that cannot be taken away from you (but don't need to be provided). So for instance, people have a right to life such that no one can take that life away but NOT such that someone must provide a means for that life.

    Education is not a right. Roads and infrastructure are not rights (but rather public goods). Again for the same reason, they require someone's labor (a teacher or construction worker). A group can come together to form an alliance to protect individual rights and decide that these things benefit each person. Again this doesn't mean these are rights but rather priveledges that a group of individuals sees reasonable to pay for to protect true rights (roads for ease of moving property, military/police to protect life, liberty and property, education for an electorate which will be educated enough to elect a group of people who will continue to protect their rights).

    You can make a strong argument that taxation without consent as a means to pay for things the individual does not want to is unjust and a violation of a true, basic right. A gov't is an organization of people who come together to protect their individual rights. When it starts usurping those it is unjust... But that's an argument for a different day.
     
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  18. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    Well, you do have the right to a trial by jury..... which involves coerced labor from jurors.
     
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  19. Instatewaiter

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    As inalienable rights go, no you do not have this right. You do have a right not to lose your liberty without just reason.
    Our society and our gov't has decided the best way to prevent unjust loss of liberty is by trial (either by jury or by judge). The gov't delivers this as a gauranteed privedege. While they call it a right in the bill of rights, as you allude to, it cannot be a right if it requires citizen participation.

    Similarly, you have a right to your property, but the gov't and its citiznes don't gaurantee you the police protection as a right. Society has come together to determine that it is in the best interest of people to havea police force.
     
  20. Mad Jack

    Mad Jack Critically Caring
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    Food distribution, manufacture, production, and sale isn't a large scale service? Let me go inform big Ag, et al...
     
  21. pulmoblast

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    Can we do this (changed a couple of words in your last paragraph)

    Similarly, you have a right to your health, but the gov't and its citiznes don't gaurantee you the health protection as a right. Society has come together to determine that it is in the best interest of people to have basic health care.
     
  22. Instatewaiter

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    This isn't a reasonable parallel for many reasons First the police force is necessary to protect your rights of property and life such that another cant take it away. Healthcare is not needed such that another cant take your life away. It is helpful for maintwnance. A more apt parallel would be if you taxed people to maintain your property- say a tax to paint your house. Seems a bit ridiculous when a true parallel is made.

    More importantly the burden for paying for a police force is very minimal (100-200 dollars a year per citizen) and everyone gets protection. Medicare/Medicaid costs the U.S. a trillion dollars each year ($15,000 per person covered) I for instance will pay over $24,000 in taxes to Medicare/Medicaid this year alone. Were I to steal 20 grand out of your pocket to pay for my family's healthcare I would go to jail... domt get me started on the tyranny of the 16th amendment.

    Next what is basic healthcare? Is it only cheap generic drugs only? Is dialysis in a 75 year old included? What about Tavr in a 90 year old? Is it keeping granny alive on a ventilator for 10 days at a cost of a million dollars just so she can die less than 3 months later. If we are going to steal people's hard earned money there need to be limits which the public isn't going to like.

    And I disagree that society has come together and decided it is in our best interest to provide health care. Not everyone gets healthcare paid for which belies the idea that society decided everyone should get basic healthcare. It seems society has decided that certain people should not only pay for their own healthcare but the healthcare of the entire population.

    The problem with socialism I s that eventually you run out of other peoples' money.
     
  23. ruskimed

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    Good morning, or afternoon gents.

    As a dual citizen of the United States and Canada I have been exposed to both healthcare systems in my limited 22 years. I did some reading in this topic and there is one glaring aspect in my mind.

    Say a woman is pregnant, and gives birth to a chronically ill child. A lifelong disorder that I am certain this baby did not ask for. Would healthcare be withheld for an individual born to a different circumstance that is beyond our control? Does this individual end up having to pay for their own medical costs when they turn 18? I don't necessarily think thats fair or just.

    Or perhaps, the investment in tax dollars is well worth the reward. If free healthcare for the masses, helped keep you healthy, avoiding all those nasty contagious diseases.

    On the other hand, we do revoke what must be a privilege to those who need organ transplants based on their lifestyle, which really does seem like hypocrisy in a country where healthcare is free. Additionally, transport to a facility is also generally not free, and in Canada these Ambulance costs may be quite hefty.


    There are glaring issues with socialism's healthcare. In Canada for example, their are numerous wait lists, inequity and expenses. Inequity is interesting, because rural Canadians have access to healthcare, paying the same amount, and receiving less. They are further from hospitals, and their hospitals are less funded, staffed, or equipped.


    I am however, a very firm believer of healthcare as a right.
     
  24. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    We've decided that everyone needs and gets emergency care whenever they need it whether they can or will pay for it or not. We decided that nearly 30 years ago. We recently passed a law saying that everyone needs to get health insurance if they don't have it.

    We have this kind of dumb halfway system where we're too uncomfortable to tell people to go die in the street but we're fine with telling them to die slowly at home because it's their own fault for not getting health insurance.
     
  25. Mad Jack

    Mad Jack Critically Caring
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    They also just stripped the legal requirement that insurance pay a reasonable amount for emergency care. So now you're required to provide care and not entitled to compensation that is reasonable. That's going to end well.
     
  26. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Not quite. We decided that you can't withhold it if they can't pay up front. You can go collect on the back side.
     
  27. Instatewaiter

    Instatewaiter But... there's a troponin
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    Much of life is beyond our control and much of life is not fair. This individual does have to pay for their healthcare one way or another either through taxes or their own money. Healthcare doesn't magically become free in a capitalistic, crony-capitalistic or socialist system.

    I am not sure how you can justify something is a right when it necessitates a service of another unless you put that "right" above the right of both liberty and property. See argument above.
     
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  28. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    We've already decided emergency care is a right. Hospitals are required to provide it even when they know they won't be compensated.

    There's nothing unprecedented or extreme about the idea. Other countries do it. Why can't we?
     
  29. Instatewaiter

    Instatewaiter But... there's a troponin
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    We have not decided emergency care is a right. That the gov't forces a hospital to provide care, does not a right make. If anything, gov't coercion essentially proves it is NOT a right.
     
  30. pulmoblast

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    @Instatewaiter
    Remember, you are one paycheck and one calamity away from being uninsured yourself too...and being turned away because of your inability to pay ...it could happen to anyone...that's why societies need safety nets...
     
  31. Mad Jack

    Mad Jack Critically Caring
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    >implying half of us aren't so cynical about healthcare that we've got standing DNR/DNIs for anything serious
     
  32. jonnythan

    jonnythan Some men play tennis, I erode the human soul
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    And if we're going to move to a model where virtually everyone has insurance either from work or from a government safety net (Medicare/Medicaid/subsidized private) then why the heck not just make it actually universal? Because insurance companies are just so awesome?
     
  33. Instatewaiter

    Instatewaiter But... there's a troponin
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    First, I never said people should be turned away. See above. Despite my libertarian core, I actually agree society needs safety nets specifically for this reason and because a degree of unemployment is healthy and needed for a capitalistic society. I think however, you and I would disagree on how big that safety net needs to be.

    Second, sure but life is a game of statistics. In every society, ours as well as socialist and communist ones, everyone is one calamity away from ruin. We decide to go to school, and not do drugs, and not get pregnant (or someone pregnant) at age 15, and work hard because these things are more likely to lead to a better life. That doesn't mean we won't hit by a car and be unable to attain these things.
     
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  34. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Exactly. This is why I have a robust life insurance and long term disability policy. And its really very cheap. $4333.00 per month post-tax money for disability costs me $120/month. A 1 million dollar life insurance policy is $80 per month.
     
  35. DrMason

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    Hospital administrators, "clinical directors", "compliance officers", "quality control RN's" ,university faculty and specialists that STILL make money on seeing Medicaid/Medicare patients ALL tend to be in strong favor of socialized medicine, along with the "bioethicists".

    I wonder why that is?? Maybe because they don't have to worry about having to work for free, but just have to tell others to do? These same people demonize the poor private practice PCP for shutting his/her door to more Medicaid/Medicare. The PCP,s working for corporations mostly say nothing or embrace it whole heartedly.

    In front of these people saying "Obamacare" and not ACA can get you in trouble or give them a permanent "impression" of who you are.

    Finally, insurance companies mostly supported ACA as well, along with big pharma. Th notion that they are such victims of Obamacare is another falso notion. In short, only more Ayn Rand MD's in primary care will make politicians and their AMA specialist lobby realize that people don't like working for free and still be treated like garbage...
     
  36. Promethean

    Promethean Syncretist
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    Basic healthcare, food, shelter, etc. are something that no one in our extremely affluent society should find themselves entirely unable to access.

    The terms of that access are what are really up for negotiation. There are more solutions than just the dichotomies that get presented in these arguments. The options aren't really just "Either I get free healthcare from doctorslaves or else they will laugh and sip champagne while watching me bleed out in the street because I left my wallet at home." The arguments on both sides are quickly driven out to the absurdist extremes and the flames rage until they burn themselves out.

    Look, we are a social species. That means that sometimes, we gotta help one another, even if we don't see the immediate benefit for ourselves. Those who are most terrified of being exploited by not being directly compensated for every single contribution that they make are also usually people who don't appreciate how much of what they have accomplished involved inputs from others around them. Only by discounting the benefits you receive from participating in a social system can you claim to be victimized by being asked to put back into it.

    Ayn Rand collected social security.
     
  37. DrMason

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    If AR collected SSI, that would be because she was legally entitled to. Should all libertarians stop getting first aid from an ambulance, just because they happen to be against socialized medicine?

    Yes, you are correct that there are lots of shades of grey. However, to take it from there and insinuate that Liberarians are anti-social selfish species pretty much invalidates you as a serious person to debate, IMHO. Such words, although not technically breech of some TOS, are just as hurtful as calling someone a "quack" in an online conversation among people who clearly can read and grab true semantics and underlying tenor.

    Nobody talks about "sipping champagne", maybe with the exception of the healthcare elite that DOESNT walk their own talk. Personally, Me&my wife volunteer time and have done so from get-go. We also were volunteers during Katrina and got a LOR from a leading physician in the town we received the evacuees from BatonRouge. It is MY impression that direct practice physicians volunteer MORE time for free than if you are a Mon-Fri with Q4-6 call and one weekend of living Hell a month at a hospital.


    Finally, "putting back".. What do you call several years in residencies and fellowships that doctors do? Isn't working for a wage below minimal standards a bit of sacrifice? Then tack in student loans, loss of the best years of someone's youthm paying tons of thousands in tort tax and highest bracket in other taxes and I think the payback has been done IN ADVANCE with interest and more so. Then add in everybody that thinks you are a rich SOB and the Kafkaesque audits and it is clear this is not a zero sum game at all.
     
  38. Promethean

    Promethean Syncretist
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    "Legally entitled to..." - okay, so if it is legal, it is kosher. Got it. Then what is all opposition to socialized medicine? Or welfare benefits, for that matter. Everyone who can access them, should. If they are legal, then they are entitled to it, yes? This isn't reflective of my opinion necessarily: I'm just assessing for consistency.

    "volunteerism" - yup... that would be one of those other options that I mentioned. Like I said, I was presenting an absurdist extreme, such as I usually see these arguments devolve into. The reality is that even those who contribute happily in their actual lives seem to turn into extremists on forums.

    "what do you call residencies/fellowships?" Paid training. You aren't a fully trained physician yet, so no, you don't get to command an attending salary from the gate. Those years are not about making up a debt to society. That is a period of time when you are earning well above the median per capita income even though you are continuing to learn (often at the physical, if not financial, expense of those patients who will endure your rookie mistakes.) Again, there is room to discuss whether the payment is adequate, whether the combination of compensation and educational opportunity are fair exchange for the labor involved, but it is ridiculous to suggest that post graduate training is pure community service.
     
  39. DrMason

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    Just because I don't believe in socialized medicine doesn't mean I will reject my piece of the pie as long as my tax money are spent upon it.

    Your "paid training" would be illegal if there was any sensible unions that took this on. Since medical students are a milk-cow to be, they have to put up and shut up, even if they are Q3 in a surgery rotation. Residency is even worse, in addition to never getting any positive feedback for anything you do, along with not getting paid overtime, not getting paid for awkward hours. Again, if "minimal wage" laws applied here, no hospitals, or attending would benefit from this. Pay people what they are worth and not who they are. This is even worse when you think of the astronomical student debts of today. Ultimately, this is one of the major reasons for people not entering primary care and medical students can read the writings on the wall. How many times do you hear all kinds of specialists making outright fun of generalists, even IN hospitals. That would never happen if these doctors had more right to set their own worth.

    Finally, it is not "paying back" anything. Hospitals make money off residents labor. Attendings make money (essentially by having to do less of the crude work, so time=money). What makes this even MORE ridiculous is that an NP working in a hospital will command way higher salaries with LESS training and expertise than any senior, or even junior resident. They also have much less student debt and no outrageous boards to sweat for. Where is THEIR reduced pay for "still learning"?

    Otherwise, this is a good debate. You also seem to admit that there should be grounds for looking at their pay. What do you think would be approaching more proper compensation then?
     
  40. Instatewaiter

    Instatewaiter But... there's a troponin
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    Sure residency and fellowship are paid training but at levels artificially kept well below market value. Why do you think moonlighting pay is somewhere between 600-1500% higher than what a resident or fellow is paid by hour.

    Perhaps you are earning above the median per capita income but you are also working more than twice the average weekly hours and to boot you have a doctorate. We put up with it because most of us are more altruistic than the average Joe and most importantly because there is a light at the end of the tunnel. Take that light away and you can be sure we would be a lot more vocal about this bull**** we have to go through.
     
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  41. Promethean

    Promethean Syncretist
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    The NP who is "still learning" won't then graduate from that phase to become an attending with the potential to earn 3-10x the rate that they earned during their first 3-7 years in practice.

    More than the pay, I think that the biggest problem with residency is that newly minted doctors are essentially trapped in their positions, where they dare not complain or stand up for themselves, lest they lose their seat and find themselves unable to complete their training. This system perpetuates abusive treatment and exploitation of residents.

    I'm not sure exactly how to go about it, but it should be easier than it is to quit and find a new residency position. Even if changing programs were still relatively rarely done, if that were a more viable option, programs would have a compelling motivation not to be malignant. Just knowing that there are options, that one could quit a terrible position without risking one's entire future, would go a long way toward improving quality of life.

    I get that there are all manner of logistical problems in what I want. Problems with tracking resident performance between programs, having adequate exposure to a wide enough range of patients and conditions, etc. I'm sure that I don't even begin to grasp all of the potential pitfalls. What I do know from personal experience is that, even if the pay were tripled, indentured servitude lacking the ability to change employers is misery.
     
  42. DrMason

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    First of all, consider the NP scenario again

    *Less overall training and demand of rigors than a first year medical student.

    *Less liability and shallower pockets than MD makes them less targeted

    *NP's can take home 6-digit sums 7-10 years longer, while medical students get massive debt and residents cannot even afford to pay it off yet.

    *Minimal or no hazing of NP's, while MS/Residents are abused by everyone from the CNA to the CEO.

    Overall ROI is nothing like being an NP and if you bring CRNA into this, it's even worse.

    Yes, residents are even more vulnerable to abuse than medical students. They get beaten up and then get conditioned to do the same. Scars from obnoxious and "reputable" attendings who act like Hitler can affect people differentLy and it's just like the notion that abusive,it's often become abusers. Unfortunately, most residents or MS are smart enough not to repeat a Picket charge here. I say unfortunately, because it would not take many cases if residents were united the day one of them has had enough and snapped. You are likewise correct about quitting a place at the wrong time. A "hospital committee" will be drilled before you know it and I know people who had to go through such and they do t look the same afterwards.

    Politicians will NOT lift a finger to solve this Why? Because the leading organizations (AMA especially) are more interested in practicing cronyism than trying to do what US physicians want to. No wonder only 1/4 or so of physicians are members. The moon lighting example is a great one. Steer away from residency programs who won't let you moon light. See hospitals don't want residents to do that, as they could figure out their real market values.

    Altruism and perceived " unselfishness" coupled with fear of the unknown strips young physician graduates of their self-esteem, ability to make money in their younger years and worsens the problem.

    I always discourage people from going to medical school if they ask. Once you ARE there, making the best out of it all would be crucial wherever you are. More physicians need to opt out of. Medicare ( for a start) and Medicaid shouldn't even be on your radar. THIS, of course can only be done if you are on your own. Taking care of yourself first is NOT selfishness, but a rational thing to do. Since people tend to do things better at full motivation, it leads to more productivity overall as well.


    The "light at the end of the tunnel" is still there, but don't let some residency attending paint you that picture. They are most likely, IMHO, clueless about realities for young and (still) somewhat free of cynicism and frustrations- physician.
     

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