Thursday, January 05, 2006

A forty for you life? Make it a Old E.

An article by Steven E. Landsburg, who will not be teaching my children anything, condemns another YucatanMan
arguing that poor people who cannot pay their medical bills should not be given medical care, even if it means that, as a direct result, they will die. On a ventilator and conscious, but can't pay? Die. And, he argues this is the compassionate thing to do. Why? Because he suspects this particular poor person, if they had been given the choice between $75 in cash and an insurance policy that paid for ventilator care (although such choice they did not have), would have chosen the cash.

Once again, a simplistic economist gives the social science a bad name.

Of the reasons why he is unfairly attacks the YucatanMan, and why his argument fails:

1.The YucatanMan's main point was that conservatives who claim to be for a “culture of life” and went to great lengths to keep alive a liquefied brain, do not give a shit about a poor conscious person, or anyone in need of health care who cannot pay. Landsburg does not address this hypocrisy. I wonder which political party he votes for?

2.He argues that the question of how much assistance to give the poor and what assistance to give them are completely separable questions. Thus, he assumes government first decides how much to spend on the poor, say 5% of GDP, then decides how that amount will be distributed. Alas, the system does not function that way. A cut in health care will not be met by an equal increase in cash payments. In reality, advocates for social spending maximize support by focusing on particular issues that connect emotionally with people.

3.He assumes that one poor person is equal to another. Giving $75 to a poor, healthy 21 year olds is equal to giving the same amount of care to people in need of emergency health care who would otherwise die. Most people do not see it this way. For obvious reasons, one person is clearly in more need than the other.

4.He assumes that people simply wish to transfer wealth to the less fortunate; two things of equal value to the recipient are perfect substitutes. However, this is not the case. The person giving, or society though government, has different interests than the potential recipients: Some people don't give cash to a person who begs because they worry the money will be spent on something they do not approve of, such as alcohol; instead, they give money to an organization that provides food and shelter for the needy (while some people give the money anyway, knowing they would not give to a charity later – this is connected to #2 above, most people do not first decide how much to give then divide it up, they give as they come upon the need).

And I am much more sympathetic to his argument than most people. For example, people are much more willing to pay to help others when the risk of harm is close in time and the person harmed is clearly identified. People will pay to sew up a gun shot wound, but not for a vaccinations that will cost less and save more lives. I see refusing to fund a vaccine that will save many lives the same as refusing to treat a person in the emergency room with a gun shot wound, but refusing a person in direct peril is severely condemned, while ignoring the peril that afflicts many is simply a bland negligence we all engage in. I could imagine a social policy where some heartless seeming decisions are made: I do not support Siamese twins with a 50% chance of living with severe brain damage after receiving an operation costing one million dollars when other more pressing medical needs are not being met (I heard about this on TV years ago. After hearing about the story, people called and and gave money for the operation. I don't know what happened).

This point has been made before, by people much more evil than I: One death is a tragedy; a million is a statistic.

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