Ron Paul: No free lunch, no free health care

Ron Paul

Rep. Ron Paul, Republican candidate for president, is being blasted for indicating in the Sept. 12 GOP debate that a critically ill 30-year-old man with no health insurance should be allowed to die. At least that’s what his opponents would have you believe.

The audience applauded and yelled, “Yes!” when moderator Wolf Blitzer asked if the man should just be allowed to die, and in some quarters that’s being represented as Paul’s stand.

I agree with what Paul said, not the misrepresentation of what he said. Each of us is responsible for paying for our own health care. Whether we pay cash, insurance premiums and co-pays, or goods and services to some old country doctor, paying our bills is our responsibility. No one else’s. Where did anyone get the idea that anyone is entitled to “free” health care?

What may look like “free” care from emergency rooms or other entities is not free. Somebody is paying for it — usually other patients or taxpayers or policyholders or customers who are paying more to subsidize your “free” care. That’s wrong. It’s your health, your care, your responsibility. You should pay.

So, what about Ron Paul’s uninsured 30-year-old? The hypothetical man was said to be healthy and just didn’t want to buy insurance. Understandable. Insurance is expensive. It’s also a game of odds. Do you feel lucky? If so, don’t buy it. If you stay healthy, you win. But if you don’t, you lose, you pay big, and you might even die. So you have to weigh the cost of insurance premiums you know you’ll pay against the high medical bills you might have to pay. It’s a gamble. Which will cost you more in the long run, a $300-a-month insurance premium or a one-time $500,000 hospitalization? The gamble is yours. Why should anyone else have to pay your bills if you lose?

Ron Paul’s patient lies dying in a hospital because he can’t pay for the surgery he needs. Chances are, things will work out as they have in the past, long before Obamacare tried to “fix” things. Chances are his friends and family will hold fundraisers, his church will pitch in, his community will help. The hospital might waive some costs. A doctor might donate his services. Chances are he won’t be left to die in his bed. But if he wants to improve his chances, he’ll carry insurance, even if only a minimal major medical policy. (And no, I don’t support Obamacare‘s public mandate; I think it’s unconstitutional.)

Paul has been made to sound heartless, when in fact he’s only saying we should all be responsible adults and pay our own way. He and I are both old farts, so maybe we think alike. Maybe we both think that the way we used to care for ourselves and our health and our financial obligations worked just fine.

35 comments

  1. Philosophically, I agree with you and Paul on this issue, and I’ve said as much to people I know as well as on my blog. I think that those who are now attacking him on it are dead wrong. However, my philosophical agreement derives from the vision of what I think a “fair and just” world would look like – which is starkly different from the real world, where everyone and his brother seek, and often find, ways to “tilt” the system in their favor. And, quite frankly, it pisses me off to no end that the guys who write the laws affecting the lives of so many will never again have to worry about who’s going to pay for their medical care!

    1. That’s my problem with a lot of his positions — they make sense philosophically, but they just don’t work in the real world as it exists right now. I’d like to enforce “no free health care,” but we can’t get there from here. ERs now are required by law to render aid to all comers (I guess medical ethics weren’t good enough.) Hospital costs are sky high — in part to pay for the freeloaders. When they can’t make up the costs by increasing charges to you, me, and the insurance companies, they close their ERs and everybody loses. You and I, in many different ways, are paying for those who don’t pay. It’s not fair, but I don’t know how to put the “freebie” genie back in the bottle.

      1. It’s really a shame Pied, but I must admit to feeling that it’s a lost cause. Ironically, that leaves me in the same position that the politicians have been finding them selves in for years – hoping it’ll all hold together until I’m out of the picture! The problem is that no decent person can remain sane for long while living with such a feeling of impending doom. At least that’s my excuse. Understanding how politicians manage to live with it is beyond me. 🙄

    1. That’s a great quote, kind of like Rand’s “A is A.” I never liked the implications of Plato’s “shadows on the cave wall” thing, because of it’s implication that we’re incapable of seeing the truth. But when it comes to the monstrosity this system has morphed into, I have to admit to feeling like one of those blind guys feeling up that poor elephant! 😀

      1. I think philosophers got a bad rap from all that talk about angels dancing on the head of a pin. The funny thing is that those New Apostolic Reformation people backing Rick Perry sound far, far crazier than that to me, and yet they’re still taken seriously. What’s up with that? 😯

  2. Pied says she doesn’t approve of making people buy insurance. I’m fine with that, but only if Congress revokes ERISA, the law that mandates ER’s give freeloaders the same level of care as anyone else. The two situations are not compatible. (My friend Anson finally took a stand on this and said, OK, revoke ERISA, give anyone the care but then garnish their salary, take it out of their hide, or do what it takes, even if it drives them to bankruptcy.)

    However, the Constitution does give Congress the power to tax, and if we were to roll back the so-called Bush II tax breaks for the wealthy, it would return to being a reasonable and progressive system. What’s wrong with taxing people to provide uniform care equally for everyone while at the same time using that universal patronage to dictate prices? Heck, we virtually dictate first-class postage rates, don’t we? And utilities like water and electricity are so heavily regulated that they might as well be government controlled. And finally, Social Security, Medicare and Medicaid are socialist programs, all of which people like a lot. My friend Duane Graham believes the easiest way to do it would be to basically extend Medicare to everybody. I think he’s right.

    If you call that socialism you would be right, but Canada and Europe are doing just that and achieving life spans and infant mortality scores better than ours, and at half the cost. I think it’s the way to go because I don’t think the Medical Industry will ever let their profits decline. (Did you know that the pharmaceutical industry is the world’s most profitable industry?)

    1. I thought my objection to ERISA was implicit in my comment above. I don’t recall how the government got away with telling hospitals and doctors they had to give care away.

      I’ve said repeatedly that the Bush tax cuts should be allowed to expire as they were supposed to. They were intended to be temporary and a specific expiration date was included in the legislation. Those affected have known this and should have been planning for it. However, the economy being what it is, I might concede that the lower end of the higher tax bracket should be raised to maybe $500,000.

      As for extending anything that looks like socialized, government-controlled health care — I’m not only an old fart, I’m a doctor’s daughter. I’ll probably resist to my last breath the idea of any third party telling me and my doctor how to conduct our relationship. The bureaucrats right down the street don’t know enough about me to dictate my care; it’s a cinch the bureaucrats in Washington won’t know or care. They’re all trained to look at the $$$, not the patients. Them telling my doctor what to do is the tail wagging the dog; my doctor should be telling them what needs to be done. (I’m sure I’ve said that before on this blog somewhere. I’ve written a lot about health care.)

      Yes, Social Security, Medicare, and Medicaid are socialist programs. But my liking them doesn’t mean they’re a good thing; it means they are the only thing. They are bloated, mismanaged, and rife with corruption. Typical government programs. We can’t do away with them unless and until there’s something to replace them; besides, they have obligations to current participants. But they can certainly be improved and alternatives phased in for younger adults. There’s nothing wrong, for example, with gradually raising the retirement age; given our longer life expectancies, that’s only logical.

      As for the pharmaceutical industry, I’ve written a lot about Big Pharma, too. I don’t recall saying anything good about the industry or its ethics. Canadian and European health care — I suppose it depends on what you read. In my book, having to wait months for surgery is not acceptable. Neither are foreign trained doctors. (Yes, I suppose I’m a medical snob.)

    2. I hardly know where to start… but:

      Is it moral to steal in pursuit of a noble goal? Congress has the authority to pass laws and to tax in support of the article and section in which that authority in the constitution is contained… Article 1, Section 8. There is no authority in that section granted to the federal government for the purpose of giving some people money for any of our cherished entitlements. Taxes levied to fund actions outside of the enumerated twenty two that are authorized is theft.

      If citizens want to amend the constitution – essentially legalizing theft, in order to create winners and losers, then the honest thing would be to support amending it. I’m fairly certain people who feel like our “society” owes them something, would happily do so in spite of the fact that the bulk of our previous history of freedom created the most successful, least impoverished society the world has ever known.

      Social Security is a Ponzi scheme. It was never designed to be anything other than a revenue stream providing new funds to be “invested” in treasury instruments. At it’s enactment, mortality tables listed 62 as the average life span – them moment at which it would begin distributing “retirement” funds.

      How anyone who is over 70 years old, as I am, who has parents who related some of FDR’s most idiotic schemes, and who can remember Lyndon Johnson’s “Great Society” and remember any of the other idiotic schemes apparently designed to foster dependency — how any such as that can doubt that both major political parties attract leaders who fancy themselves as smarter than ordinary citizens, and divinely endowed with the wisdom to control the millions of citizens decisions that collectively determine the price, availability, quality, frequency, and the benefits of future production schedules and implementation strategies – is beyond my comprehension.

      FDR slaughtered millions of heads of livestock of every description in order to make scarce commodities bring higher prices at a time when 1 out of every 4 citizens were unemployed. That was universally viewed as reasonable. He confiscated citizens gold because the US could no print money that was not backed by gold.

      Government creates no jobs that aren’t funded by theft. Theft that removes capital from any possible use by a business that actually builds capital capable of being both saved and reinvested. Virtually every government program these days amounts to a preemptive bailout scheme, a government created monopoly, a misdirected, malinvestment of scarce resources, or a direct infusion of funds into some group with the ability to influence elections.

      I am literally sick to death of codified stupidity.

        1. Of course, I’m on both medicare and social security. I don’t need either, but I’m certainly not stupid enough to refuse to take it from a government that is too stupid to realize that other people’s money could be better spent by them and at the current rate, it will soon be worthless.

          I realize that Libertarianism isn’t an easy sell. When you’re not invested in the libertarian philosophy, it’s single axiom – the initiation of coercive force is never ethical, moral or justifiable is a hateful thing.

        2. I’m on both also. And I’d be up the proverbial creek without them, even though I do have some other resources. Not that I ever intended to be dependent (I hate it), but I wasn’t smart enough to make other plans, or vindictive enough to take two exes to the cleaners. I was raised to be dependent and unfortunately that’s exactly the way I turned out. It seems even well-educated people can end up dependent on the state. Who’d of thunk it?

          Seems to me that pure libertarianism could work only if you could turn back time to some “zero point” with no pre-existing social structure. (I feel like I’ve already said something like that somewhere … )

        3. I am completely dependent on my SSD. I have no other resources, not even family I can count on. The only way I can even “get by” on my SSD alone is because I can get medical services through the VA (no Medicare “premium” taken from my check). But as dependent on the existing system as I am, I know with all my being that it cannot stand.

          Joe R’s statement about coercive force being a hateful thing is absolutely right – and coercion IS the base on which the current system stands. But Pied is also right about libertarianism needing a “zero point” with no preexisting social structure in order to work – backtracking through such a complicated legal minefield would be next to impossible.

          The sad irony of both being right is that the former is what will undoubtedly bring about the latter. The trick will be to survive the transition 😐

        4. Mak, your analysis is exactly right. And it’s the reason for my almost frantic support for nominating Ron Paul. We desperately need someone who agrees with you (and me, and Pied, and Jim) in a place where they MAY be able to help make that transition less traumatic for those who have been victimized by the synergistic collusion between government and business.

          I convinced that if we elect another macro-economically brain-dead typical Democrat or Republican I’ll be in the same boat with you as far as resources go. When the dollar dies, so do I. And so does Romney, Perry, Santorium, Bachmann, Gingrich, Huntsman, Obama die – and all the rest who don’t understand the significance of our being obligated to come up with more money to pay world bankers than there is in existence.

          At the same time, I’m not delusional. I realize that one person, especially the president has few real tools, or weapons they can use to create a return to constitutional republicanism. Other than his veto pen, his bully pulpit and the ability to rescind previous presidential orders and letters, he’s virtually powerless.

          No real change is going to come about until a majority of us realize that there’s a finite amount of natural resources and other peoples money – and take action to prevent them being squandered by arbitrary decisions made by political nincompoops.

        5. @ Ima,

          A couple of years ago I found myself getting interested in the Libertarian point of view, just as you are, but I have come to change my mind. You know, it is appealing from the viewpoint of someone who has already found some measure of security in the existing structure of life, and that appears to include you because you say you don’t really need Medicare and Social Security. But, there’s a different perspective I wish you would consider.

          Human beings, as we all know, come in a full spectrum of qualities, smart to dumb, attractive to ugly, strong to weak, altruistic to selfish, honest to crooked. But at the end of the day, as we age and as we succumb to the vagaries of fate, we eventually find ourselves in the care of others. We are social creatures through evolution and we need other people. So isn’t it not only arrogant, but actually impractical to declare one’s self independent of others, even excluding one’s family? Nobody knows what really awaits us as we trudge through life, whether disease (like cancer, stroke or heart attack), natural disaster (like tornados, hurricanes or lightning), or accident (like automobile crashes or falling off a ladder), or loneliness when our loved ones die (my personal greatest fear). And when something does happen, we depend not just on other individuals but the systemic structure of society such as hospitals, hospice, churches, social services. Hell, even seeing the postman once a day can be a big plus. Is is not in your own best interest to see that the quality of that social structure for everybody is as good as it can be?

          Anyhow, that’s the line of thinking that changed my mind. C’mon, Ima, you look entirely too grim. How about a little smile on that Clint Eastwood puss, huh? 🙂

          Jim

        6. I don’t mean to make light of your comment Jim, but you just reminded me of why I changed my avatar from a raging blue “hulk” to the “alien” thingy I use now. No matter how hard I try, I just can’t ignore wisdom when I hear it, regardless of which “side” the speaker is on. These days, it seems, that is pretty much the definition of “alien!” 🙄

        7. Yeah, it works well a a social lubricant too. People don’t roll their eyes at me nearly as much when I say I’m an Independent as they do when I call myself a Libertarian or, heaven forbid, an Objectivist! If I could only keep my mouth closed from that point forward… 🙄

        8. I advocate all the care and compassion that you do, but I don’t advocate it’s implementation by the use of lethal force. Most of my life has been lived within an environment that was much less coercive than it is now. My Father died in 1960 leaving a full time housewife with 4 kids. I alone was out of high school and able to contribute to the household expenses. In 1960 there were none of the coercive income redistribution schemes that many have come to believe are so necessary that people like me would have surely died in the gutter. It wasn’t until the real hate mongers gained a foothold in federal politics that the notion was accepted that dependence on masters who owned us body and soul and all the fruits of our labor was essential to life itself. It wasn’t true then and it isn’t true now.

          I’ll promote charity and volunteerism of every nature, but the idea that people actually learn how to respect and accept responsibility looking down the barrel of a federal gun is something I’ll never again support.

          The notion that we’d have to go back to some square one, zero point in order to begin again with a new ethical beginning is almost persuasive until you realize that most of the things we think we can’t live without… we did live without for the bulk of our history – and until very recently.

          Worst of all is the failure to realize that the greatest strides in reducing massive poverty – the norm throughout recorded history – was accomplished predominately in this country and only BEFORE we began to develop a master/slave relationship with our infallible DC overlords. These overlords are the same legislators and bureaucrats who spend the bulk of their time between election cycles trying to legislate and mandate tactics designed to hide the symptoms of the negative unforeseen consequences resulting from the last legislative session. Every problem in the news today is a direct result of constitutional overreach. Everyone knows this, but almost nobody cares.

          The initiation of coercive force is either ethical, or it isn’t. I prefer persuasion, but as long as you don’t advocate solutions that bring harm to someone else, as a libertarian (small L) – I support your freedom to choose.

  3. There is an interesting page on ERISA on Wikipedia, Pied. The way it got enacted was a crisis caused by “dumping” of impecunious patients by some hospitals on other hospitals that would still take them. The system was obviously failing fast, and some clever bureaucrat came up with the idea of using Medicare reimbursement to extort them into stopping the practice. ERISA was the extortion instrument.

    I totally get your instinctive revulsion for the idea of socialized medicine, but I submit that it doesn’t have to be as bad as you fear and can even be better than the present system which is also rife with corruption through the profit motive – as you admit. Here’s an example of how it’s starting to happen already. I went with my wife to her doctor’s appointment last week. The doc works for the hospital now and they are introducing electronic medical records – there’s a terminal in each interview room. Instead of scribbling notes in longhand like he used to, he now enters everything in the formatted software. Looking over his shoulder I saw that it uses drop-down menus of diagnoses and drugs and flags any and all inconsistencies, making it virtually impossible to miss known drug interactions or to match the wrong drug with a diagnosis. I thought it was pretty darn neat.

    I assume you know the enormous size of the medical-error problem, being a doctor’s daughter. I think it’s a scandal. I have posted about it from time to time:

    http://jwheeler59.wordpress.com/2010/03/30/an-engineer-comments-on-medical-errors/
    http://jwheeler59.wordpress.com/2010/10/22/graybeard-reflections/
    http://jwheeler59.wordpress.com/2011/04/03/hello-this-is-your-doctor-returning-your-call/

    Change is coming, and it has to. We can not afford the present “system”. I say we should embrace it. Thanks for your comments – I value thinking correspondents like you, Pied.

    Jim

    1. I assume you meant EMTALA, the Emergency Medical Treatment and Active Labor Act. Great article. Explains a lot of things. Recommended for anyone who wants to understand why our ERs are so crowded and why so many of them are closing — which of course leads to still more crowding in those still open.

      Electronic medical records are a great way to leverage new technology, if used by someone with a brain. The GP I first saw when I moved to Denver used electronic records, and didn’t help a bit. She didn’t remember me from one visit to the next, she diagnosed a different area of major concern every time I saw her (none of which has ever been mentioned by my current doctor), and once, with another patient’s chart on her screen, got very concerned about an abnormal lab reading and had actually ordered follow-up lab work before noticing her mistake. Not surprisingly, after extensive research, I decided on a new doctor and asked the first doctor to send my records to the new doctor. Supposedly one of the big advantages of EMR, right? For some reason they were unable to do it. So I asked for a print-out that I could personally deliver to the new doctor. It took them weeks to produce a 3/4″ sheaf of paper that was not formatted in any intelligible way and that no one but I had time to pore over for dates and details.

      The new doctor also uses EMR, but effectively. She and her nurse assistant always have their laptops in hand; I’ve never seen either use a pen. They are linked to everyone in their large multispecialty group, which in turn is linked to several hospitals and clinics where those doctors practice. All have instant access to the same file when I show up. Now if only I could get used to the idea that if/when I’m hospitalized for any reason, it won’t be “my” doctor tending to me and directing my care but a “hospitalist” I’ve never seen before.

      1. Absolutely, EMTALA. I have so many dang acronyms in my head, they get mixed. Thanks for not yelling at me. 😀

        You provide a terrific anecdote here, Pied. Just imagine how many patients the confused doctor must have messed up without the help of the EMR software! And not being able to transfer them electronically is just unforgivable. Let’s hope that the ACA’s mandated adoption of EMR’s will help clear out some of the medical deadwood and confusion that has been causing our national error disgrace.

        Our hospital has also gone to the use of “hospitalists”. I agree, it’s a concern. On the other hand, our family physician, bless his dedicated heart, was getting very stressed out trying to juggle unpredictable visit schedules along with his practice, so I can see how using the hospitalists could potentially make things better. It helps the patient’s doctor and the hospitalist should provide continuity relative to the hospital’s equipment, organization and staff. In a perfect world, anyway.

        1. I’m stuck in the past when it comes to medicine; old habits die hard. Making rounds at the hospital was a regular part of my dad’s routine, and his partner (my doctor for 30 years) did the same thing. The last time I was hospitalized, doctors were still visiting their hospitalized patients every day. It seems to me it’s good for the hospitalized patient to see their doctor, the one they already know and trust, there among all the strangers. I don’t know if taking primary care doctors away from that routinely scheduled part of their day is a good thing or not (other than allowing them to avoid travel and see more patients instead) — but once again, nobody asked my opinion! 😦

  4. Oops. I just saw that my comment above appeared as “anonymous” because your format requires a log-in. I hope it doesn’t make me do that each time. Not all do, and mine doesn’t. Might be an option variable on your dashboard. Anyhow, that was me, Jim.

  5. Well, you know I disagree with you. I think insurance companies should be abolished because they only serve their shareholders and executives. I do think health care is a right, not a privilege, and I find the notion of profit in health care–which is what the sky high costs are really about–beyond unethical and disgusting. I’m for a single-payer system like the UK. It is not free: It is paid for by taxes. I do not have any problem with my tax dollars going to save someone else’s life. I’m already paying for the folks on Medicare and Medicaid, aren’t I?

    There is no earthly good reason, other than selfishness and greed on the part of some, for anyone in this country to have to choose between paying rent and paying for health insurance, and I do not think it remotely reasonable to mandate that people pay for private insurance, which to me is forced commerce. The U.S. health care system is a national embarrassment and a disgrace. If the wingnuts want to call me a socialist for saying so, so be it.

    1. As it was initially proposed, I had high hopes for the health care reform bill, surprising even lil ol’ always-against- socialized-medicine me. But then Obama made a secret promise to Big Pharma at the beginning not to touch their profits. And he didn’t lift the anti-trust exemption the insurance companies enjoy and open them up to national competitive marketing. And then the pro-lifers started taking their shots at it. And then finally they dropped the single payer plan, which was the heart of the thing. And that’s just what I remember off the top of my head at one in the morning. The resulting plan was garbage – expensive bureaucratic garbage.

      Yes, I thank you for contributing to my Medicare, as I did for myself and for those before me. I’m still confident youngsters will contribute to your plan, along with your own contributions, and that in addition, other options for you will be phased in.

      I’m much too used to American medicine to wish for a different system, especially at my age. And although I’ve not researched it, I don’t like anything I’ve heard about British health care.

      1. You know Pied, I was surprised at myself for having high hopes for the health care reform bill also. I was also disappointed for pretty much the same reasons you listed at the final bill. And then I was disappointed at myself for ever believing that this corrupt duopoly of a government would ever put aside the political infighting long enough to actually do something right.

        But it was your final sentence that brought me to realize something that never quite registered before. The news media stuck their cameras in the faces of quite a few people during The Great Health Care Debate, and quite a few of them talked about how much poorer the quality of health care would be under a single payer system like they have in Canada or in the UK. But one question that never came to the fore was: poorer for whom?

        As someone who has lived at or below the poverty line for my entire life, I’ve never had the benefit of the kind “advanced” care those people were claiming would be diminished. And none of the people I grew up around did either. I think that a realistic breakdown of heath care quality received versus income would show that a large percentage of the population would actually see better health care under a single payer system. And for those who want better than that, and can afford it, they can simply pay for the extra service – just like they do now.

      2. Pied,

        You said,

        And although I’ve not researched it, I don’t like anything I’ve heard about British health care.

        Me either – I too have heard some bad stories about the U.K’s version. However, I have heard some good ones too, including from donvphilly and HLG who have both offered some personal experiences. The devil’s in the details, you know. I recommend the research before you completely write off the idea. What we’ve got ain’t workin’.

    2. @CULT OF TRUTH

      Since food, clothing, shelter and safe transportation are prerequisites of good health, I’m assuming that I have a right to your property in order to fulfill those needs. Because of your generosity, I have no reason to make any effort to supply those needs for myself. Therefore, you have my sincere thanks.

  6. @ Pied,

    You said,

    donvphilly and HLG? Visitors on your blog?

    Yes, I have good reason to trust the integrity, judgement and honesty of each of those, one through personal friendship and the other through extended online conversations.

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