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Sunday, September 23, 2007

What is "moral", anyway?

Reader-submitted question: I'm confused. Why would it be a moral issue if someone paid for medical care?

This is a very Canadian problem, I admit. Here in Canada, there is a real debate over whether it is right for people to get faster/better/etc medical care by paying for it. I seem to have at least one reader who thinks this is wrong, and he or she is definitely not alone.

Our health-care system is one of the only things left that ties us together as Canadians. We cherish it. We believe that everyone should have the same basic right to health care, no matter how much money they make. At its most fundamental level, I believe this. People with life-threatening illnesses should be able to get treatment. Hail, holy mandatory group-insurance plan!

Unfortunately, wait times are choking our system. When something's free, it has no value. Our clinics and ERs are clogged with people who don't really need to be there. They all get to see a doctor if they wait long enough.

Private clinics have started to spring up in western Canada. They provide all of the care your money can buy, and many people think it is morally wrong to use these clinics because rich people should not get different health care than poor people.

If you have enough money, you have the choice of waiting in line at the publicly-funded hospital or "jumping the line" by paying a doctor at a private clinic. You can also go to another country and be treated there. I personally don't think of this as jumping the line, but as moving to a different line. In fact, there are people in Canada who argue that anyone who can afford to pay for health care has a moral obligation to get out of the line at the public hospital altogether. I can't figure out if these are the left-wing freaks or the right-wing weirdos who are saying this.

It is very easy to tell other people they should wait in the line. It's harder to wait in line yourself.


Dad said...

If it is immoral for the rich to purchase better medical care, wouldn't it be also immoral for the rich to purchase better food? Likewise, wouldn't it be immoral for the rich to send their children to better colleges? To live in better housing? To drive better automobiles?
What - - morally - - would the rich be allowed to do with their money?

Cindy said...

The problem isn't the rich getting out of the line. The problem is that when they do this, the rich take all the best meidcal professionals with them, because they can afford to pay them exorbitant amounts the public system can't afford. That's the real crux of the moral argument.

Paying your own way isn't the issue. It's buying the way of the poor away from them, if you get my drift.

The Capitalist said...

I'd have to say the immoral people are those waiting in line when they don't really NEED to be there. Isn't that the whole problem to begin with?

If person 'X' decides to spend his/her life working towards prosperity, and always struggling to better himself, does he not deserve the care of a doctor who has done the same (ie: the 'better' doctor)?

Plus the rich are paying for the system us poor fellows are using whether they use it or not... I'm not sure whether that makes them heros or just suckers, but hey, the government makes them so there's no real choice involved anyways.

As a side note, I've had good chicken and bad chicken. One could argue these chickens were all created equal, but in the end... Sorry, one's definately 'better' than the other.

Torq said...

Heh, Not all chickens are created equal. Or would that be more like one chicken being "first among equals?"

I suppose that I don't necessarily consider this to be much of a moral question. If someone is dying and can stave off death because he happens to be rich, while another is is the same boat and cannot because he is poor, there is luck involved, but I don't think morals.

I guess I don't think that being rich is moral or immoral. It is a condition like being good looking or smart. Sure you can do things to become richer or smarter or better looking, but it is not a moral condition.

It may be a more moral choice for the rich man to pay for the poor man's medical procedure, but if one of them is going to have to die and all other things are equal, can you blame a doctor for taking more money? Should we penalize the rich for being rich?

Megan said...

While I understand Cindy's point about doctors going where the money is, I can't say that it is immoral for them to do this, even if we put the blame on "the rich". We all continually take new jobs because they're better than our current jobs, and certainly increased pay is one of the things that would make a new job better. This leaves our former jobs (and clients/patients) without our services until the boss can fill that position.

I'm nervous about where the chicken argument is going, but the capitalist is right about one thing: wait times are insane because many people don't need to be in the line at all. I really do believe that if there was a cost to being in the line, many people would decide that they could deal with their problems on their own.

Our system is not working. People die waiting for tests and treatment. I know that the other option, in the extreme, sees people die because they can't afford tests and treatment, but there has to be some middle ground.

I also think it's easy to talk in generalities about what would happen if everyone with money took themselves out of the line. Meanwhile, our buddy Joe is still waiting for a diagnosis and thinking that he could buy an answer instead of waiting.

Dad said...

Your comment assumes there is a scarcity of medical care. Of course, in Canada, there is a scarcity, but that's the consequence of socialized medicine. If you adopted a market system of health care, the scarcity would disappear.
You'd have other problems, but you wouldn't have scarcity.
Kevin Holsapple

Megan said...

Canadians aren't ready for the market system. It goes against everything our citizens stand for. Take away life and liberty, but don't take our socialised medicine.

I am only partly joking.

I lean toward a system that would provide a basic form of health insurance but allow for private clinics. Anyone who wanted to, and who could pay, could get out of the line. This would make lines at the public clinic much shorter. However, it's possible or even likely that the best medical professionals would choose to work in the private system, where they could make more money.

We call this idea "two-tier health care", and you are supposed to spit right after you say it.

Perhaps we really need a fully privatized system with something like food stamps (medical stamps?) for poor people. That would give us something else to argue about: what should the cutoff be? The government is so heartless!

Cindy said...

There is also a scarcity of doctors and nurses in the States. So much so that US hospitals poach from Canada.

As for the capitalist's comments about working towards prosperity. Sorry, I don't buy the theory of meritocracy. Most of the rich in both Cananda and the US were born rich, as were their parents and grandparents. The American dream is just that, a dream.

I don't even buy the idea that being rich is a good goal in life. I have no desire to be rich. If I had, I would have taken the place Harvard offered me, never married my wonderful husband or had my three kids.

I also don't believe the poor earn or deserve their lot. I grew up among the poor and was often considered poor myself (although I think I was immeasurably blessed and never went hungry), and I observed the people around me who worked the hardest were the poorest. I still see that often today.

What brought me out of poverty wasn't really hard work. It was hard academic work. In other words, education betters people, not necessarily hard work.

As for the health system, I've said this before: my last pregnancy almost killed me, and any little bit of stress made my disease worse. I can't imagine having to deal with paying for my care while trying to keep myself and my baby alive, as so many of my friends in the States with the same pregnancy condition did. I can't imagine an insurance company arguing with my doctor over the kind of care I should receive.

I especially can't imagine an insurance company rep calling me at the hospital and suggesting an abortion. That happened to four, count 'em, four of my friends.

There's plenty wrong with the Canadian system, but its basic tenet is sound: money should not determine whether you get good medical care.

Dad said...

I appreciate what is being said here, but we should acknowledge one fact: there is no scarcity of health care in the US. In Florida, we see billboards advertising hospitals and clinics: trying to lure customers!

Ben Holsapple said...

I think there's a scarcity in the States... In my experience, when I go to a doctor's office, I can generally expect to wait for at least an hour before I actually see so much as a nurse. I find this to be one of the industries with the longest wait times...unlike other services where the provider strives to content their customers, in the medical field the professionals are quite certain that their time is more important than yours. Of course that's probably true, but it's no way to conduct a business.
Since this is a pattern, it would seem to indicate that there is an ongoing shortage of doctors in the States. This would also suggest that, since this problem has not eased with time, there is an artificial barrier to entering the medical's unions, perhaps? I suppose I know too little to really comment.

I have had no experience with the Canadian system, but from what Megan has been saying, it sounds like it's even worse than this. I go to the doctor rarely enough as it is (it would cost me both time and money), but if it took days for me to see a doctor, I don't think I would ever go. They may think their time is more important than mine, but I disagree.

Megan said...

Hold on a minute. You can't possibly mean that you show up at the clinic without an appointment and see the nurse within an hour. You mean that the clinic's scheduling is an hour behind. Right? Right?

Alison said...

To get back to Megan's original topic of the 'morality' of paying for health care, I can say that six years ago when my mother was diagnosed with an aggressive form of breast cancer and she was told her wait for treatment was going to be close to six months, I would have sold all of my morals to the highest bidder for a chance to get her the care she needed as fast a possible. When the life of someone you love is on the line you'll do anything you can to help them, and as someone who's been there, morality isn't that high on the list of considerations.

The Capitalist said...

The barrier to becoming a doctor is several things. The main one being the ambition to do it, then the intelligence to do it, and the willingness to invest so many student loans into the education.

Where my 'chicken' was going is here: Suppose I'm working for a call center. So are you. I treat my customers with respect, while you may be ignorant and not care about the people calling in. Now, suppose we both need to place a call to a call center. I fully expect to be treated kindly, as I treat my callers kindly, while if you are to get some ignorant idiot, well, fair's fair.

--I'm not saying you are not as 'good' a person as I am, but I do believe I deserve to be treated more kindly on the phone.

I'm well aware that in most cases riches come from ancestors, however, parents pay for thier childrens medical care. There really isn't much of a difference here.

Another problem is that without the $ of the rich people WE WOULD NOT HAVE MEDICAL CARE! This stuff takes research, and research takes time & MONEY! Without those rich people we wouldn't even have tylenol, let alone cures for cancer.

Megan said...

No! No! Everyone look away! Nobody talked about drug research on this blog! And if anyone did, they certainly didn't suggest that anyone who invests money in pharmaceutical research deserves to earn money on his investment!

You've done it, Capitalist. Now the Canadian authorities are going to put my blog under surveillance.

The Capitalist said...

Hah! No, that's definately not what I said (as true as it may be)!

I also must point out that we are ALL born rich today, due to what people did in the past. You can flip 25 burgers and use that money to pay for running water for a month! And there's no way you've EARNED a month's supply of water just by fliping a few burgers, but hey....that's what you can get! We're all such victims of the rich!

Ben Holsapple said...

You guys have to get appointments in Canada? What is this, the Dark Ages?

Torq said...

Alison: While I may sympathize with your situation, it is not one which I have myself ever experienced. My following statements have to be made in the light of my ignorance and the possibility that if our positions were reversed I might say the same thing.

If you "sell" all your morals to save the life of one you love you are making a choice that DOES impact morality. This would make the conversation one about genuine moral questions. You are placing one moral virtue, that of preserving the life of loved ones, above that of all others. This is a very dangerous position which (if carried to an extreme) might lead you to kill off all the people who were in line in front of your mother. I know... I am exaggerating, but surely you can't mean that you would sell ALL your morals to save a life?

Megan said...

Wait, who let the philosopher king in here?

Apparently I have very few morals to begin with. I have this on the authority of people who are in direct contact with God.

Considering this, the laws of supply and demand would suggest that each individual moral ought to be very valuable. I'm going to start by selling the ones that keep me from idling my car. Who's buying?

Karen said...

Hmmm. I've learned a lot about your family on this particular comments page, Megan.

For my entire working life, I have frustrated my capitalist corporate banker father by saying I like paying my taxes. I actually like living in a country where I pay into the pool and I get actual useful services in return, like universal health care. I haven't minded the ridiculous wait times, overall, largely because I have been fortunate to be healthy all my life, so it didn't seem like a big deal to wait my turn.

My entire perspective has changed this summer because my elderly mother has gotten sick, really sick, and no one's been exactly sure what's wrong with her. She lives in Quebec, where she waited nearly four months to get in to see the neurologist she was referred to by her GP, and then when he wanted to order a CAT scan of her brain, we were looking at six more months just to get into a clinic and have access to the machine. The option was to pay a very reasonable $250 and get in within a couple of weeks. I'm not proud to say we opted to pay the cash and get the quicker test results, but we did. Partly we made this choice for her health - just how much sicker can a frail tiny person get in six long months? - and partially for my own, because the stress of not knowing what's wrong is, I think, far worse than even bad news. At least with news, you can do something other than bumping along in the dark.

So, when put to the test, I completely lost interest in the entire morality question one way or the other. I might be more inclined to take the high road if my own health was involved, and not that of someone I'm responsible for, but I really don't know anymore. I guess as I continue to age I'll find that out about myself too.

Cindy said...

I'm not saying that paying for quicker service is wrong. I'm saying that it may cause somethng wrong to happen if lots and lots of people did it.

Ther's nothing wrong with the action itself. It's the possible consequence of draining all the good docs and nurses out of the public system that concerns me.

Does that make sense? I'm tired tonight.

Torq said...

Meg: I have never said that you are lacking in morals! You don't seem to have any piercings and you haven't dyed your hair so obviously you have SOME morality!

What I did say is that you haven't paid enough attention to where your morals come from.

Cindy: I guess that I am biased. In the US we pay for all our medical procedures so it seems perfectly natural to pay a couple hundred dollars to have a procedure done and save a life. The Blueberry Princess had a pretty rough time about a year ago which cost a pretty penny, but when it came to saving her life they could have taken ALL my money (little as that is) and I would have been happy.

I suppose not paying for the procedure might be conceived as unethical... caring more for money than for your fellow man.

Sorry, Philosopher King out.

Megan said...

Cindy, you make a lot of sense, but you're just in the minority in this particular group. I thought you'd have more company, to be honest, but the poll results seem to be moving in the opposite direction. This has been an interesting few days, to say the least.

And now I have another moral conundrum: should I tell the philosopher king that I have six piercings?

Dad said...

You should tell the philospher king you are sorry, for giving another gratuitous insult. You slip far too easily and way too quickly into ad hominen "arguments".

The Capitalist said...

OK, try not be be blown away here, but imagine this:

I go into a restaurant. I want the steak. I can afford the steak. I get the chicken instead.

Now why would I do such a thing??? Uh... The chicken is half the price, and I don't really NEED the steak, I kinda like chicken too anyways. I'll save my money for something I really need, or that will make me happier than the steak would.

Now picture this:

I go into a restaurant. I want the steak. I'm told by the waiter that everything on the menu is free. I get the steak, along with a bottle of Canada's finest, and top it of with a chocolate explosion for desert.

I'm sure you can all see what is going on here. 'Free' health care cannot work. It is impossible, because we are humans and always want the best. If we did not want the best we could have never progressed to the point where we could have health care to begin with, since we would not have progressed at all. What we need is AFFORDABLE health care. It's really quite simple.

When you pay your water bill you pay a portion that is generic amoung all households in your community, and another portion based on your personal usage. This system makes sense to me. C'mon people, I'm not eccentric in the least... Just Aware.

Megan said...

The capitalist is, of course, completely right.

Dad: I'm not sure if you're joking. I certainly was, and I was pretty sure the philosopher king was, too. (Seriously, piercings? Maybe I was wrong, but I still doubt it.) And my earlier comment about supply and demand was not about anyone in the family: I had someone else in mind, someone you've never met.

Torq said...

The Capitalist is justly named, very smart with systems of money and supply and demand. Would you suggest that breast implants and nose jobs for non-medically required (cancer or disfigurement) purposes should be more expensive as they are luxuries?

Megan: No offense taken, as I trust none was given!

Megan said...

Breast implants, when not medically needed -- and I will lump (ha!) cancer patients into the "medically needed" group -- are a luxury. They are not even close to being in the same class as medical procedures like EEGs or appendectomies.

Torq said...

As one of those people who check blogs from work, I did not see your v-log until today. This means that my comments about cancer were coincidental.

Love you Meg. I'm praying all will be well.

The Capitalist said...

They are definately luxuries, but I don't see why that translates into a need for them to cost more. The cost should be based on the cost of the procedure you are undergoing. The question is whether the government should fund the 'luxury' procedure. The answer is no!

Dad said...

Megan, I wasn't joking, but I misunderstood your comment. I apologize.

We're waiting for a good report. The air is full of prayer.