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Dying in the Street?


In reading Theodore Dalrymple’s excellent observations about the consequences of accepting the “moral right” of health care yesterday in the Wall Street Journal, this jumped out at me:

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination. Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?”

When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.

Left to die in the street? This indelible image pops up in nearly every discussion I have on this topic with a Briton or a French person disapproving of America’s refusal to do things the European way. So what if almost every nationalized-health gambit on the Continent is sunk in bankruptcy? Eventually the conversation will veer to include the notion that in America, the streets are paved with the impoverished dead.

The myth that the poor are deprived of medical treatment in the U.S. is a cherished one in the current debate. When I tried to point out a week or two ago that in France (as in Britain and as on the planet generally) there are two levels of medical service — one for the rich, one for the poor — Yglesias and others similar couldn’t wait to point out that at least the French poor can get treatment when they need it. What a stack of angry e-mails.

Yet, in the U.S., as many Americans (although not, apparently, many Europeans or Yglesians) know, under the Emergency Medical Treatment and Labor Act, anyone who can be dragged through an ER door will receive medical treatment so long as their condition is an “emergency” — and being left to die in the street probably qualifies. In fact, when I asked an expert on this topic (for reasons I can’t understand, she didn’t want her name or the name of her organization cited) if a sprained ankle or broken leg would qualify as an “emergency,” she told me that an ear infection would probably qualify. Common sense would tell you that if you walk into an ER filled with chest-clutching geezers, you might be happier coming back another day, but treatment can’t be denied. Hospitals are not allowed to ask about money before giving this kind of medical treatment and ability to pay cannot be a factor in providing it. It’s given to all comers, no matter where they’re from or what language they speak. As Ramesh Ponnuru pointed out here some years ago, the penalties for violating the statute are severe.

The free treatment is paid for not by federal tax dollars, but by all the insured patients who can afford treatment. This is a staggering burden, of course. Even in small states the numbers can be huge. For example, in Kansas (pop. 2.8 million or so) in 2007, 125 hospitals provided nearly a billion dollars worth of health treatment gratis.

Those who pay for all that medical treatment given under the law also enjoy medical care. The distinction between these two things is important, obviously. If insurance pays for your medical care, you can go find a doctor (if your HMO allows you to) and get check-ups and ongoing care and therapy not available to those who don’t have insurance. If you’re poor and want treatment, you find a community clinic and take your chances.

Of course, if everyone can get free medical care, then it becomes a two-tier system — like the one I described in France. In Europe, in theory, medical care is guaranteed. For it, taxpayers pony up billions of pounds and euros for a health service they have been assured is theirs. Tell that to a British NHS patient on a one-year wait-list for cataracts or hoping for help with a flu epidemic. The only people who think the NHS is great are American journalists like this happy chappy from the LA Times. In Europe, as in the U.S., those with money get better care than those without — often at one of a growing number of private hospitals. Those that don’t are left in the streets to queue. We can either spend a trillion dollars and get a two-tier health system or not spend a trillion dollars and get a two-tier health system. To get a one-tier health system, you have to outlaw money.

Obviously, I’m no expert on this stuff, but neither are the politicians trying to implement it all. Besides, as Dalrymple suggests, maybe expectations about health treatment and care should be lowered a bit, no? The assumption seems to be that under the Democrats’ health plan, all our ills will be cured. That won’t happen, of course. I tried pointing this out to those who felt they had to send me angry e-mails after I mentioned the problems the French were having with their national health system. One correspondent, who signed himself Nick, wrote back saying, sarcastically, “That’s rich. Next time I have cramps I’ll just walk into an emergency room.”

Cramps? Nick must think that under Obamacare, cramps-for-guys will be totally covered, so he’ll be dancing in the street, instead of cramping in it.


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