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Debating Libertarianism

I used to be a Libertarian. I'm not anymore. I think this exchange I had with a Libertarian on Plastic does a good job of explaining why.

The basic story was that a Utah woman named Briana Lane was severely injured in an automobile accident while she was driving under the influence, without a seat belt, without a license, and without health insurance. Emergency treatment to save her life required that part of her skull be removed. In what is apparently standard operating procedure in such cases, the skull fragment was stored so that it could be replaced a few weeks later. The hospital cancelled the restorative surgery at the last minute, hoping to get the state to pay for it. Meanwhile, Briana was walking around with half a skull. Media coverage ensued, her mother's insurance company agreed to foot the bill, and all was well. However, this engendered a heated discussion on about health care and human rights. Here's the relevant portion:

Crass Observations
by Russ Morrison
  1. This should have been a case of evolution in action. Precisely how stupid do you have to be to (a) drive drunk and (b) do it without a seat belt?
  2. The law that requires hospitals and doctors to treat emergency patients, regardless of their ability to pay, is one example of modern slavery: one is required, by law, to render service to another. Hospitals are, in essence, modern day plantations; the slaves are better educated, but they are slaves, nonetheless.
  3. Much will be made on this thread regarding the "high cost of medicine". It is not, however, the "medicine" that costs. It is that the costs of treating the Briana Lanes must be spread among the swiftly shrinking group that does pay. This, coupled with the fact that individuals seldom pay for their own medicine -- most treatment is paid for by government or insurance companies -- creates a strong upward pressure on the price of treatment.
Re: Crass Observations
by borkus

I've seen several posts pointing out that Lane's problems are the result of her poor judgement and break two laws (DUI and driving without a seatbelt) in the process.

Now, if Lane had been pulled over, charged and convicted of DUI and driving without a seatbelt, would her punishment have been to saw off her skull under anesthesia and subject her to six weeks of pain and blackouts? Probably not. Punishment for illegal and careless behavior are the purview of the criminal and civil courts -- not the healthcare system. Denying someone medical care because of a crime they committed has to be cruel and unusual punishment, especially since such a punishment would only apply to the poor and indigent. Also, she's a 22 year old waitress without health insurance; she's not necessarily indigent, but like many young people, she has an low skill job without health coverage.

Admittedly, it cost $200,000 to put Lane's skull back together. However, ongoing care of someone with half a skull would probably be a considerable sum as well; in Lane's case, she would have been a burden to society for the rest of her life. Now, with a skull completely covering her brain, she has 40 more years of work to pay taxes and contribute to society. Hopefully, she remembers to not drink and drive and to keep her seat belt buckled.

Re: Crass Observations
by Russ Morrison

...would her punishment have been to saw off her skull under anesthesia and subject her to six weeks of pain and blackouts?

Of course not. She isn't being "punished" -- she is suffering the consequences of her own stupidity. It is immoral to force any other person to suffer for her actions, and shielding her from any part of those consequences deprives her of the opportunity to learn from her mistakes -- if she is capable of doing so.

I wouldn't put any bets on that. Stupid people tend to remain stupid. It is unlikely in the extreme that Lane will learn anything from this event, other than that the taxpayer can be very generous.

Lane has already demonstrated that she is a net burden on society someone who not only refused to do a minimal task in her own defence (put on a seat belt), but also actively pursued an activity (drunk driving) likely to cause her, and others, injury.

As to her paying taxes and "contributing" to make up the $200K: On a waitress' salary? You're joking, right?

Re: Crass Observations
by boosman

[S]he is suffering the consequences of her own stupidity. It is immoral to force any other person to suffer for her actions, and shielding her from any part of those consequences deprives her of the opportunity to learn from her mistakes -- if she is capable of doing so. (emphasis mine)

I want to be really clear about what you're saying here. You believe that, given that she was without insurance, no hospital or other treatment facility should have been required to treat her, whether to save her life in the first place or to replace her skull later on? If so, I presume you believe that if a hospital chooses not to accept insurance company X, and you're wheeled into the emergency room, 10 minutes from death, with a card from insurance company X, they can say, "Sorry, you'll have to go down the road to the next hospital."

This is why I gave up being a Libertarian a long time ago. Some of its precepts sound good in a theoretical sense, but then there's that pesky matter of the real world. In a Libertarian world, anyone should be able to refuse service to anyone on any basis. In the real world, we want to know that if we follow the big blue "H" signs, someone's going to save our life. In a Libertarian world, people should suffer all the consequences of their stupidity. In the real world, everyone makes mistakes, and compassionate people think that allowing someone to die for a mistake they've made is usually a bit harsh.

Re: Crass Observations
by Russ Morrison

I presume you believe that if a hospital chooses not to accept insurance company X...they can say, "Sorry, you'll have to go down the road to the next hospital."

Sure. And, in the real world, that hospital will lose all of the money that it could have gotten from X. Kaiser used to do this all the time, before the law forced them to treat all emergency patients; once the emergency is done, they still send you, frequently at great risk, "down the road".

In the real world, everyone makes mistakes, and compassionate people think that allowing someone to die for a mistake they've made is usually a bit harsh.

Depends on the mistake. And people die from mistakes all the time, compassion or no -- frequently from other people's mistakes, something that could easily have happened here (DUI accidents frequently kill or injure the sober party).

Compassionate people, for centuries, have created charitable and not-for-profit hospitals, and they do so with their own money, rather than taxpayers'.

I'm a very compassionate person. I've helped many folks, both directly and through organizations I support. But I refuse to be compassionate with your money. Courtesy (at least) and justice (at best) would seem to demand the same consideration from you.

Re: Crass Observations
by boosman

Well, the reality is that I doubt that most Americans want to live in a society where maybe a given hospital will treat their critical injuries, maybe it won't. I know I don't want to live in such a society.

Now, don't get me wrong: our health care system is broken, and I know it. We spend far more of our GDP on health care than any other OECD country and yet manage to have 40+ million uninsured Americans. To my mind, the right solution is to decide that we have reached a point as a society where everyone should be entitled to health care, and make it so. At the same time, though, I think we should implement a universal health care system in such a way as to preserve maximum choice and to encourage people to make responsible health care decisions.

Before you scream about this universal health care would be an unwarranted expenditure of your money, tell me how it's different in theory from universal primary education. Both are examples of the people deciding that what was once a privilege is now a right.

Re: Crass Observations
by Russ Morrison

To my mind, the right solution is to decide that we have reached a point as a society where everyone should be entitled to health care, and make it so.

I see. You would take a broken system, use a sledge hammer on the remaining pieces that work, and then declare that everyone should use the same broken system.

Want to preserve "maximum choice"? Then preserve it for doctors, too. And nurses. And hospitals (or, as someone else pointed out, "hospital administrators"). One does not increase freedom by removing it; no one should be forced to serve another, not matter how "necessary" or "good" the service might be.

Re: Crass Observations
by boosman

Did you actually read my comment? All I said was that I would institute universal health care and that I would do so in a way that would preserve choice and encourage good decision-making by consumers. How exactly is that taking "a broken system" and using "a sledge hammer on the remaining pieces that work"?

Here's the simple reality: within 50 years -- and probably less -- we'll have universal health care in the US, because a majority of Americans will have decided that health care is a fundamental right (just as we decided a century ago that education was a fundamental right). You're on the side that will ultimately lose this battle. The question you have to ask yourself is, do you want to be made irrelevant in the debate by advocating ludicrous ideas like allowing hospitals to let patients die on their doorsteps in the name of devotion to Libertarianism, or do you want to influence the debate in useful ways by proposing efficient market-based structures within a universal system?

Re: Crass Observations
by Russ Morrison

within 50 years -- and probably less -- we'll have universal health care in the US, because a majority of Americans will have decided that health care is a fundamental right (just as we decided a century ago that education was a fundamental right)

And in 50 years, we will have universal health care with the same high quality product that is provided by universal education. You don't want to just break what little is working, you want to destroy it altogether, and replace it with something that works just like public education.

I can hardly wait. Not only will my grandchildren be illiterate, so will my doctor.

Re: Crass Observations
by boosman

Holy crap! Do you comment on my postings without reading them, or do you willfully misrepresent them to suit your purposes?

I didn't assert an opinion about the state of the US K-12 education system. If I had, I would have said that I strongly believe in universal public-funded education. (I presume you don't, but are unwilling to come right out and say it, possibly because you know how extreme it would make you sound.) But I would also have said that I think the US K-12 education system needs far more market-based structures than it has today. There's nothing incompatible with guaranteeing every child an education while giving their parents far more say in how and where they're educated than they have today.

With all that said, for debating purposes, I'm willing to take your bait. According to the CIA, 97 percent of US citizens aged 15 and over are literate. If we take literacy as prima facie evidence that the educational system has done its job, at least at a minimal level, then that means the system has worked for all but 8.7 million people in the US. Compare that with the 40 to 44 million people who have no health insurance in this country.

You may bitch about our education system -- we all may from time to time -- but all in all, it does a reasonably good job of educating children. Yes, we all know of horror stories, and it's not to say the system couldn't work much better, but most of us send our kids to school every day feeling that we're sending them to a good place, with teachers who care, and where they can learn. (Note that I don't live in Washington, DC.) So, although I don't want a health care system structured just like public education today, even that would be an improvement over what we have now.

How about this: if we structured public education like our current health care system, we'd have 40 to 44 million illiterates in the US while spending half again as much on education as most other OECD countries. Now there's a good idea.

The same person who wrote, "I'm a very compassionate person," also wrote, "This should have been a case of evolution in action" -- or, to put it more directly, "I think that person should have died for her mistake." I think that qualifies as a use of the word "compassionate" I hadn't encountered before.

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Comments

all i can say is if ever i am missing part of my skull and need it attached, i want you arguing my side, please.

If you're ever missing part of your skull and need it reattached, I'll be happy to argue your side. Just don't ask me to look at your throbbing brain, okay?

Do you even realize you are discussing a real person here? I don't think you do, especially when you talk about "evolution in action" when referring to real people whose actions are, quite frankly, not all that terrible and probably nothing worse than anything you've done. Briana Lane is my sister. How kind of you to think that, because my sister was driving home from her low-paying job waiting tables at a ski lodge in the mountains of Utah, working at her job that couldn't see fit to provide her with health insurance, driving in a Jeep with bald tires because she couldn't afford to replace them, and having a beer before leaving work with her friends, that because of all this, she deserves to die.

I hope you or your loved ones never have to experience such a thing, but frankly, I'm afraid that for such a compassionate person as yourself, it might actually be necessary for you to experience such a thing (and it might be likely, considering that a huge chunk of Americans cannot afford health insurance these days, my husband and myself included) for you to understand exactly how repulsive and how inhumane your ideas truly are.

How exactly was she supposed to have health insurance? Her job didn't offer it. Most jobs offered to people with her experience and education usually don't offer insurance, and when they do, it is usually highly expensive. (And it doesn't change for those of us with more education and experience, either.) So what do you propose for those of us who work the low paying crap jobs (that are totally necessary - after all, who brings your food to the table when you eat out? Who cleans your toilets after you shit in them at work? Who rings up your groceries at the store? Who checks your health insurance and gives you injections and changes your bed pan?) for long hours and little pay? What do you propose for these people? They work hard, just as hard as the doctors and the lawyers and the vice presidents and the sales managers. So why should only the wealthy be able to gain access to life-saving health care? Are you going to violate your own libertarian views and mandate that businesses provide affordable health insurance for everyone? The current system sucks, we both agree on that, but what do you think would be the correct way to approach it that would be in line with your libertarian views?

I take solace in knowing that your views are in the very, very small minority. Most people I've come into contact with regarding my sister's story have been extremely sympathetic, as most of them have had struggles with health care at some point in their lives. And I'm not just talking about people who I've just told the story to. I'm talking about people who read her story in their newspaper and then started discussing it with me or around me, not knowing she is my sister. Under this anonymity, not one person said, "She deserves to die." This story touches a nerve in the public, one that you apparently do not possess, and it represents to them the worst possible scenario of all of the bullshit they've had to deal with in the current health care system.

I must know the answer to this - do you bitch anywhere near this much about bailouts of airlines and corporate welfare? Because I can assure you that a much larger chunk of your paycheck ends up lining the pockets of such gifted industrialists as Ken Lay and his passle of buddies than ever makes it into the hands of poor young women in desperate need of surgery to repair their skulls.

P.S. I don't necessarily mean the owner of this site when I say "you", just those who agree with the idea that my sister's issues are nothing more than "evolution in action". Those people can go fuck themselves as far as I'm concerned.

Caitlin, please know that I'm disgusted with the attitude of the person with whom I argued in the debate I excerpted here. I find it reprehensible that anyone would call it "evolution in action" for someone who suffered an accident such as your sister did. If I didn't make that clear in my post, I'm terribly sorry.

Caitlin, I understand your feelings about your sister. Frank didn't write all the posts I made, including the ones about my contributions to organizations that probably would have paid for Briana's treatment.

I was in an accident of similar stupidity 26 years ago, and was nearly killed. I spent ten years paying off the doctors, and the people whose property I damaged.

My wife lay bleeding her life out, and was saved by a good doctor and nurses. I paid them, as well, though I'm pretty sure they would have treated my wife anyway, with or without any law.

All three of my children have had life-threatening illnesses or injuries. All three pulled through fine, thank God.

I do know what you're feeling. I have been there, more than once.

Having said that, let me make an apology for the "evolution" comment. It was hyperbole, an exaggeration, and, given the subject matter, was pretty stupid. I am sorry for the distress it caused you. I do not wish any ill toward you or your sister, in any way.

Correction: I should have said that Frank did not include some of my posts about charitable contributions.

I appreciate the correction and I'm sure Caitlin appreciates the apology.

Frank - I wasn't aiming my rant at you. I hope I clarified that with my PS. Sorry if there was confusion.

Russell - Thank you. I appreciate your apology. I know political debate can get heated and stuck in hyperbole, but we have to remember that we aren't just discussing abstractions and inventions of the media here, that the people in the newspapers are real, actual people who bleed and dream just like you and I.

I was a libertarian during much of my college years. Fortunately, I grew out of it.

You can see something I wrote about libertarian ideas here. http://www.spectacle.org/0403/loo.html

I think it's important to realize that in a truly capitalist(libertarian) society health care insurance would be cheap and easily availible to 99% of the populous. The remaining people who for whatever reason can't cover themselves would be helped by private charity.

Chilly, what evidence do you have to support your assertion?

Dennis, thanks for the pointer. It's an interesting article. If a real-world experiment in Libertarian economic ideas has existed in the last half-century, we would be wise to examine its results before implementing such ideas here.

I believe strongly in individual freedom, and I believe strongly in the overall efficiency of open markets and distributed systems. But I don't find those beliefs to be in conflict with the idea that the people of a nation can decide for themselves that it is their collective responsibility to ensure that, say, every child has the opportunity for an education, or that every person has access to health care. The question is how we go about implementing such decisions. Do we do so in a manner that enhances flexibility, freedom, innovation, and efficiency?

Just the entire body of economic work which shows that private free markets provide goods and services better, faster, cheaper. Is that enough?

Oh, really? They provide electric power and fresh water faster, better, cheaper?

I'll just bet they do.

Face it, when you're dealing with a resource transmitted through finite channels (your house only has one set of pipes, you only have time to go to one hospital when you get in a car crash), where an inferior product can mean life or death within days, or even hours...well, I'll give you faster and cheaper, but better, no friggin' way.

Just wondering if this russ morrisson is from NJ because ive been looking for an old friend.. this is where a google search will get you. posts are old, but i have hope it may work

Just wondering if this russ morrison is from NJ because ive been looking for an old friend.. this is where a google search will get you. posts are old, but i have hope it may work

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