The rationale works like this - given that some less-fortunate members of society will need assistance at some point in their life, and given that 'conservative' != 'asshole' and we don't want to just let them die in the street, we have to provide some form of limited welfare state.
Since we have to provide some form of limited welfare state, what's the best way to do it while preserving as much freedom as possible? We could set up a large government bureaucracy to do this, with rules and regulations and intrusive measurement for determining who can get what, or we could simply periodically cut everyone a small check.
Hayek thought the small check was a lot less harmful than the large bureaucracy. I'm inclined to agree.
It'd be better still if the government could get out of the welfare business altogether and leave it to our individual communities - I certainly don't mind that my synagogue dues are used to help our poorer members, and if my tax bill was lower, I'd have still more to donate. But that would require a cultural shift to make practical - it's a shame, but most people in America no longer belong to small, supportive communities.
And what do you do when they drink the check and once again lie dying in the street?
I really do agree with you - society can pay up to some point and no more. But at some point people must be allowed to die. For example, today I would not be opposed, in the case of cancer, to society providing payment for all necessary pain medications and hospice care to the point of death rather than paying for (surgery, chemotherapy, radiation) treatment. Lifespans would be shorter, death quicker but it is IMO a reasonable and far less expensive option.
Nobody really survives cancer although they may die trying. We need to terminate the cancer industry (but maintain cancer research). They are an industry selling pure hope with no significant probability of a cure today. They are a cancer on our economy.
For many cancers this is simply not true. I know many people who are 5-10-15 years out from when they were declared cancer free after treatment. Should we have let them die when first diagnosed?
It's time to end the hypocrisy and address these issues head on. Health care is so expensive because of insanely expensive treatments we use to extend the lives of chronic or terminal patients by months. It seems gravely immoral as a society to spend millions extending the life of one person while letting another die from lack of health care at all (whether or not the person is paying for it with their own money is irrelevant).
I'm not saying I know where these lines are, but we need to have this conversation.
Not particularly much you can do in that case, no?
If we can manage it as a society in a sustainable way, people should be protected somewhat from bad fortune, whether it's from a ephemeral event or a bad roll in the genetic lottery. Protecting people from the predictable consequences of their own bad decisions is another thing entirely.
Some quick google-fu teaches me that in 2008, $90 billion was spent in the US on cancer treatment. During the same year, $2.4 trillion was spent on health care in general. Given that cancer is [at least as of 2007] the second leading cause of death in the US, this proportion doesn’t seem blatantly wrong; I would want society to tackle some of the other well-documented inefficiencies in our health-care system before cracking down on chemotherapy.
IIRC one of these inefficiencies is that terminally ill people who would rather get cheap palliative care than expensive, aggressive, and uncertain treatment... can’t get the cheap care covered by insurance.
Nobody lives forever, but some people do survive cancer.
So no one survives cancer? I would say plenty of people survive B-cell chronic lymphocytic leukemia, since the average survival for a negative ZAP-70 is over 25 years and many people don't even get treatment for it because they'll die of other things long before B-CLL.
Educate yourself before making statements like "we need to terminate the cancer industry."
There’s a perverse sort of transaction going on: you receive welfare in exchange for abasing yourself in front of a bureaucrat, acknowledging that the bureaucrat has the right to decide whether or not you belong to The Deserving Poor, and admitting yourself to be Deserving.
One of the reasons I'd ideally like (in that magic fairy land we can't get to from here) small, cohesive, homogenous communities to be the ones that take care of each other, instead of relying on some sort of centralized authority, is because it allows the community to set standards for morality and behavior - not just for the poor but for everyone. When you're dependent on a group, you're accountable to that group, and often held to a higher standard than you might hold yourself as an individual.
Wanting a bureaucrat to evaluate and judge welfare recipients worthy or unworthy is probably just that same desire for accountability - if you're drawing down the resources of a broader, nationwide group, you should somehow be held accountable to that group.
This isn't a bad instinct to have, but it's impossible to implement at the inhuman scale of federal and state governments - the welfare recipient doesn't feel particularly accountable to the abstract community of 'America as a whole', and 'America as a whole' has no shared standard to hold the individual to. So instead we get Byzantine shaming rituals that just waste everyone's time and money.
I was hoping the White House's Office of Faith-Based and Community Initiatives could lead to some interesting changes here, but unfortunately that's largely gone nowhere.
I do think there's something to be said for cohesive groups, but moving between them is quite hard if there's no higher-level safety net from some more neutral source like the U.S. government. I know more than one person who wants to leave a church they don't like or believe in theologically, but stays because they're not sure how they'd replace its social/economic network. Especially the case with groups like the Mormons who combine a strong internal network with shunning of people who leave, making the drop-off in support you'd get by leaving seem like a daunting cliff.
The system is abusive... Intentionally... it's goal is to "improve the numbers" by pushing people out of the system (onto the street, onto relatives, suicide, illegal jobs, whatever).