Unfortunately, this is also a point that advocates for the other side also gloss over. WE NEED DEATH PANELS. It’s not an optional thing if you’re going to remove health care from the private sector. I favor that (before even touching any moral issues, it has become clear that the American public is unwilling to live with the necessary consequences of an efficient, functional private health care system, so the only sustainable alternative is to make it fully public, because if the present system teaches us nothing else, it is that keeping the system quasi-private is a formula for failure).
The single best benefit that allowing a free market to decide where health care gets directed is that it is clear, unambiguous, and objective. You can live until you run out of money or people who are willing to pay for you to be alive. If nobody is willing or able to pony up the cash for that eighth lung…sorry, guy, but your time is up. People who want fully public health care should be lauded for their desire to save lives, but they need to realize that they’re STILL going to have to make a call on when it’s time to stop providing care, and it’s going to shake down exactly like this program in Arizona. Sometimes even treatment that could be successful in mitigating a condition is not worth the cost. For instance, let’s take an eighty year old person in a wheelchair with a developing case of dementia who suddenly comes down with an illness that can be cured through an incredibly expensive procedure. Even in the case of a public system, that person is never going to pay back the money you spend to cure his condition. He will never return value to your economy. The only legitimate argument you can make for providing the service at that point is the existence of a moral obligation to keep living people alive, and that’s not the kind of thinking you can afford to pursue in any health care system (public or private) if you want it to stay functional. One small benefit of the private system is that it has a built-in objective and indisputable switch for making this decision - you get to live until you run out of money to fix things that are broken in you, or you get something you can’t fix, or you decide to stop fixing things. I don’t think it’s enough of a benefit to outweigh the system’s inherent problems or overwhelm the complete unwillingness of most moral people to allow the system to work in the way it needs to, but it IS a benefit that we need to be careful not to lose completely.
That’s why emotionalizing the discussion is precisely the WRONG thing to do. You have to elevate the economic and functional concerns of the system above the emotional reflex response of “but that baby could live forever in a bubble, separated from the environment and largely unable to interact with the world.” In this case, budget shortfalls in Arizona are making a health program untenable. The best response - and the most helpful one - is to describe in objective terms why the program is good and useful and how you would propose for it to be rescued.
I have a dog in this hunt too. I’m a Type I diabetic. My dad lived to 50. I figure that I’ll usefully make it to around 60 or so if I do things right, but my organs are going to get screwed up faster than a comparatively healthy person’s, and I’m going to reach a point at which I am no longer able to contribute usefully to the domestic economy or industry. For now, I would contend that the things I can do provide enough value to offset the cost of keeping me from dying (what with the insulin and the doctor visits and the surgeries for ingrown toenails and the other expensive medications and cetera and cetera), but there’s going to come a point at which that is no longer true, and it’s going to be earlier than I want it to be unless something severely major happens in the medical community between today and when I get there. I won’t want to die at that point, but I honestly find a part of myself genuinely hoping that whoever is footing the bill for my health care at the point that I become nothing but a drain on the world will be able to put aside the emotional concerns about letting me go for the good of everybody else. That’s not a decision that anybody can ever make while there are voices in the discussion shouting about how horrible individual stories of loss and tragedy are. More than anything, what the discussion of health care in the United States needs is complete dispassion if we ever hope to reach a workable, sustainable platform.
It happens that I’m tentatively in favor of the Arizona program currently under scrutiny, but I need to review the costs and benefits more closely to determine whether I’m being ruled by my purely emotional desire not to see anybody die or I’m actually reaching a reasonable conclusion. The way in which this matter was brought up, however - with a shrill, Helen Lovejoy, “won’t somebody think of the children” tenor - is monumentally unhelpful to achieving that goal, and we’ve all got to start being more careful with how we broach and discuss these issues.
