Are firemen like doctors?
How deep does the
analogy go? Not deep enough to justify universal health
care.
At the Washington Post blog, Ezra Klein discusses the parallel between firefighters letting someone’s house burn because he didn’t pay $75 for fire insurance—which happened a few weeks ago in a rural area of Tennessee that doesn’t guarantee fire protection—and letting a person die because they didn’t purchase health care insurance.
When liberals explain why health care needs an individual mandate, the traditional metaphor is firefighting: Everyone needs to buy insurance for the same reason that everyone needs to buy fire protection. But if you leave the market unregulated, some people won’t buy — or won’t be able to afford — fire protection. And we’re not comfortable letting their houses burn down. Similarly, if you leave health coverage to the market, some people won’t buy it, and others won’t be able to afford it, and then, when they get sick and need it, insurers won’t sell it to them. But we’re not comfortable letting them die in the streets. Hence, the health-care law.
Klein argues that fire protection and health care are both “collective goods” which the government must guarantee.
Sam and I discussed a similar question over a year ago, when I attempted to parallel the government’s obligation to protect its citizens against Swine Flu (remember that?) with its obligation to protect citizens against other serious illnesses like cancer.
The parallel between fires and non-epidemic diseases, generally following Sam’s post, does not work perfectly. Fires spread. Non-epidemic diseases, like cancer, do not. If one person isn’t protected against fires, we are all thereby threatened, because those flames can jump from his house to our houses.
When a person is ill with a non-epidemic disease, we are not thereby threatened ourselves, or at least not enough of
us to say that the community is endangered. This is why fire insurance is a real “collective good” and health care is not. Health care may be (and I think to a degree is) an individual right, of course, but that’s a different argument.
Epidemics, conversely, are like fires; one person having the disease threatens many others. Protection against those diseases (and the panic and instability they engender) is a collective good like firefighting. That’s why we already have the CDC. And that’s probably as far as the parallel will go, as a matter of honest political theory, if our justification for universal fire protection is its status as a “collective good”. It would be different, of course, if we viewed fire protection as primarily a type of individual right, but I don’t think that’s how it’s generally conceived.
-Jake
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2 Responses to “Are firemen like doctors?”
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The argument that unlike fires, non-epidemic diseases pose no threat to others is somewhat faulty.
An example:
A pedestrian is hit by a car and is taken to the hospital while unconscious. Without checking for insurance, the doctors operate to save his life. This person’s injuries do not pose any threat to the livelihood of anyone else (keeping with the non-epidemic argument above). The person survives, but admits that he not only has no health insurance, but no finances to pay for his medical bill. Who pays the bill? Either the government or health insurers (in the form of charity care). In either of the cases, we (taxpayers and health insurance carriers) are hurt both ways, in tax money that does not improve our lives and/or rising premiums to cover these costs.
Non-epidemic diseases still carry a threat to our finances. While I do not completely agree that healthcare should be mandatory, this is a weak argument.
How about, no insurance, no finances? Great, now you’ll have no house and no credit also.
I work in healthcare, it’s scary and needs to be fixed from the top down. Why do prices go up every year? It’s not because the price of stainless steel or plastic has gone up, but because the private insurance groups raise their rates 3% every year, so to follow that, all the suppliers raise their costs, and so forth….meanwhile, what the more expensive insurance covers is getting slimmer.
Most of the facilties that I’ve worked in base numbers of staff or new equipment on magical quotas, based on…insurance reimbursement. This does not trickle down to numbers of people getting sick or having needed surgery, but does effect the number of staff that will take care of you. Our E.Rs are packed, the people are sicker because they do not get pre-emptive care, and the number of staff to care for them is getting smaller, all the while, insurance co’s are making record profits. What about hospital C.E.Os who also run private insurance compaines themselves? Look closely, they are very real.
It needs to be fixed, our current “sick care system” is about to fail us in a big way. People do need to be told how to live, and many of our most expensive medical problems could be nipped in the bud at an early age, extending peoples lives, and vastly reducing the average persons medical debt in later life. No one needs to lose their credit rating or house because they tripped outside, recived a multi thousand dollar knee and then lost their job due to recovery down time.