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Comment by me_myselft | Hacker News Reader

Yes, but in US you have to have a lot of money for receiving a very basic and fundamental human right: medical care...

I wasn't going to respond to this to avoid prolonging this burgeoning off-topic health care flamewar, but I figured that in the name of cross-cultural understanding, I'd correct you:

Hospitals in the US are obligated to treat any emergency patient regardless of whether they can pay.

They then charge those people least able to pay a higher rate, add interest, and turn it over to a collection agency.

http://www.democracynow.org/2012/2/15/new_york_hospitals_sad...

http://www.democracynow.org/2004/1/7/state_secret_why_are_un...

[somehow Democracy Now seems appropriate for a Stallman discussion]

This isn't entirely true and varies from state to state and hospital to hospital. We had a trip to the hospital last year (non-ambulance, but was an actual emergency). Prior to checking out, we refused to sign anything from the hospital itself until checkout time. (quick sidebar, I've never seen anything as sleazy as an administrator trying to get someone who's heavily sedated and mediated but hasn't been fully diagnosed yet (triage and stabilization only) to sign paperwork related to billing and insurance, and then to authorize a room change to long term and the to an overnight room...all before they even knew what was going on). At checkout time, they had no insurance info...if we had no insurance, they would consolidate the fees from all groups (contracted doctors, anasthesiologists, equipment use, medications, etc.) and waive 2/3 of it and set up a payment plan (non-loan style, so no interest, or fees). This total was lower than if we used insurance and paid what was remaining on the deductible for the year and happened late enough that we wouldn't have benefited from using the insurance. I have no idea if it was attitude, handling it like business, persistence or just how they do business, but it greatly impressed me.

Medical Care != ER

The problem with that is that emergency care is absurdly expensive. I was in an accident last year that put me in hospital for one night for observation, and I was billed almost $20k. Where illness rather than accident is the problem, people postpone going to a doctor or hospital until they are really ill, even though it would be much cheaper to address a minor illness before it becomes a medical emergency - a stitch in time saves nine, and all that. But people without insurance find access to non-emergency care difficult because of cost, and so the emergency spend half their resources dealing with completely avoidable medical problems.

And even if you do have insurance or the ability to pay, or (AFAIK) if a hospital waives payment for someone indigent, there's still a metric ton of paperwork to be filled out, which makes doing my taxes seem simple and fun by comparison. Don't even get me started on the catastrophically bad state of medical record-keeping.

It's coming. The law is a mess, and phasing in slowly. But it passed, and it's real. It will no doubt have to be fixed over the coming decades, but universal health care in the USA is a reality.

But the "lot of money" thing is just reality: health care costs a lot of money, period. And it must be paid. Coming up with a regime to do so without leaving people out or inappropriately burdening them is a hard problem, and frankly no entity, government or private, can claim to have solved it "well".

In the US the "lot of money" is somehow a lot more than in every other state, even though most western states have better quality care than the US.

Inflammatory statement, and not true. I happen to know doctors in the US who do not refuse care for those who cannot pay.

I happen to know doctors in the US who would refuse to take care for those who cannot pay.

As I mentioned here (https://news.ycombinator.com/item?id=3955537), living in Boston, Massachusetts, we have the best of both worlds when it comes to access to health care at some of the best healthcare organizations in the world.

I should also add that even if you don't have money, you still have access. I was seen at a clinic at Mass General (http://www.massgeneral.org) recently by making an optional $2 donation.

Why is medical care a fundamental right?

It can't be, because if it's a fundamental right (read: entitlement) then someone else is obligated to provide that care. So, in a hypothetical world where no one chooses to go into the medical profession, we'd have to put guns to people's heads and force them to become doctors, because, after all, medical care is a "fundamental right." There's an obvious paradox in that.

Medical care is a "right" in the sense that it's something you shouldn't have to ask for permission to seek, but we aren't entitled to it. It's a service that can be provided and bought on the free market like all other services.

That argument is perfect in a theoretical world where no one choose to go into the medical profession. Back in real life, that doesn't happen. At most, you have to hire foreign doctors. So yes, it's a right, which like any other right, it's subject to the constraints of reality.

Real world / hypothetical world / thought-experiment aside, the point stands: treating a service as an entitlement entails imposing an obligation on somebody else to provide that service, OR to pay for that service, etc.

If granting one person a "right" means violating someone else's rights (that is, their right to choose how to direct their energy and the fruits of their labor) then it's unjust.

I don't think it's unjust to make people contribute to society through taxes if they want to live in it. They're free to opt-out from that implicit contract by going to live elsewhere. There's plenty of inhabited places on Earth still.

In any case, rights can and are sometimes eclipsed by others. The idea of natural, absolute rights is just ridiculous.

I respectfully disagree, but this really isn't the forum for this discussion, so I'll bow out here.

Yeah, I think me_myselft meant rights in terms of social justice, and not "fundamental rights" in the sense of abstract political philosophy. So many arguments get caught up over semantics and not what people are trying to say.

"They're free to opt-out from that implicit contract by going to live elsewhere."

Is it your position that everything can be justified by a persons ability to get up and move?

No, just some.

> It's a service that can be provided and bought on the free market like all other services.

Maybe in a hypothetical world where you can find this hypothetical free market. In the real world, health care can be treated as a fundamental right because there are enough doctors available.

Try making those doctors work for free, and see how long there are "enough doctors available."

And we would do that... why?

Either the doctors will have to work for free, or the rest of us will, to pay for others' health care.

We don't work for free, we work in exchange for the privilege of living in society.

We pay for lots of services that only other people end up using. It's part of being in a society.

When something is reasonably considered optional, ideally and hopefully you aren't forced to pay for other people's partaking of that optional service.

Healthcare is not one of those things. It's optional in the sense that everyone has the option of refusing medical care, even if sometimes that means dying, but it's not optional in that almost every sane person with more than a minor cut or sniffles or food poisoning opts for medical care if it is available rather than the alternative.

Other mandatory goods and services, like food, clothing, housing, city utilities (water/electricity), even internet access, work better in a mostly private model for a couple major reasons. First, the price variance for the necessary part of those goods and services is very low compared to variance for the medical costs someone might incur. Second, a lot of people can afford and want more than the bare necessities. Not so with medical care, where few people can afford major surgery or routine treatments for some major chronic conditions.

Another aspect of medical care is that we benefit even if we're never treated. Do you know anyone who has ever needed significant medical care at a hospital? I doubt your relationship with those people means nothing to you.

Is living a fundamental right?

Thinking that way, btw, is bound to make you feel bitter. Why should you pay for other people?

Why not think of it as insurance instead (social security)? Less desperate people means less muggers on the street. Less sick people means less risk to get infected yourself. Plus, should you ever happen to fall on hard times yourself (god forbid), you would be provided for.

I believe in selfishness as the best basis for a society, and I still think it is in favor of social security and public health care.

Discussing fundamental rights is bound to be bullshit. The only right that exists is the right of the stronger party (established by guns, majority votes etc). If the stronger party believes x is a right, it is a right. So if a majority of voters in a democracy is convinced x is a right (perhaps because the better smooth talker convinced them), it can become a right. That is all there is to it. Philosophy is irrelevant.

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