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In modern society, if you are uninsured and you get treated in an emergency room, the hospital shifts the costs to those who have health insurance. In other words, the people who are already personally responsible bear even more costs. How else can hospitals survive if they are required to provide free emergency care to those who can't afford it?

What is the Objectivist solution when it comes to providing emergency care to uninsured people?

asked Nov 11 '12 at 16:08

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user890
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edited Nov 11 '12 at 17:35

Greg%20Perkins's gravatar image

Greg Perkins ♦♦
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I would challenge the assertion that all of the costs of the treatment of uninsured patients is borne by those who have health insurance. First of all, trivially, some people without health insurance nonetheless pay (and in many cases they pay more than those with health insurance). Moreover, some of the costs are borne by the doctors, and other employees, and suppliers, and shareholders, and others. (And some of the "costs" aren't really costs at all, but are merely hypothetical profits which don't exist except in a fantasy world where everyone can afford everything.)

(Nov 11 '12 at 17:02) anthony anthony's gravatar image

I would also like to point out that hospitals are only required to provide "free" emergency care to those who can't afford it if they accept government payments such as medicare/medicaid. (I put free in quotes because the services aren't free, they just are commonly noncollectable.)

Also, you mention health insurance. But remember that health insurance is not the only type of insurance which pays for emergency medical treatment. Two other major sources are auto insurance and workers compensation insurance. There are others, as well (e.g. in some cases homeowners liability insurance).

(Nov 11 '12 at 17:03) anthony anthony's gravatar image

With that said, it certainly follows from the principles of Objectivism that hospitals should not be forced to treat uninsured patients.

On the other hand, there are business cases to be made for treating the uninsured, at least when there are adequate resources available. The uninsured, at least those uninsured who are not wealthy and whose emergency cause is act of nature or their own negligence, are unlikely to get the same level of care as those who have rationally prepared for their emergencies, but most of them almost surely will get some level of care even without government mandates.

(Nov 11 '12 at 17:16) anthony anthony's gravatar image
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In modern society, if someone is uninsured and unable to pay for emergency care, then the cost of providing it is typically shifted onto others coercively -- to the hospital, the doctors, insurance companies, taxpayers, others who can pay for care, etc.

Allowing if not promoting such thuggishness is a moral travesty -- especially when it is institutionalized in the government which ought to have a central mission of preventing rights violations instead of committing them.

In an Objectivist society, someone likewise may not be able to pay for emergency care, but the cost of providing it would not be coercively shifted onto others. If the cost is to be borne by others, then that would have to be accomplished through any number of known and as-yet-unknown means which are voluntary, civilized, peaceful. Insurance is one widespread example of peacefully sharing risks and costs; foundations and charities in various forms are another.

There is no limit to the variety of approaches that could and would be developed for addressing real challenges like this -- other than the one limit of simply not permitting the moral equivalent of a stick-up in the process.

answered Nov 11 '12 at 18:06

Greg%20Perkins's gravatar image

Greg Perkins ♦♦
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Where is the coercion? I guess I see it in the case of the hospital, although even with them they choose whether to accept medicare/medicaid or not. In the case of those patients who do have medicare/medicaid, the coercion is from the taxpayers (who unlike the hospitals have not opted in to the system), but those with medicare/medicaid are not typically counted under the "uninsured".

In terms of the doctors, insurance companies, and others who can pay for care, so far as I can tell they are under no obligation which is not voluntarily agreed to in their contract or employment agreement.

(Nov 12 '12 at 00:03) anthony anthony's gravatar image

Please read the first two paragraphs of this on the Emergency Medical Treatment and Active Labor Act

Medicare and Medicaid, gigantic market-shaping programs that crowd out peaceful alternatives, are of course coercively funded.

Nearly every hospital caves to this coercively created reality and is forced to "choose" to be a participant in EMTALA, and those costs and obligations are distributed to other stakeholders similarly forced to "choose" to participate, like doctors, suppliers, and so on.

(Nov 12 '12 at 12:40) Greg Perkins ♦♦ Greg%20Perkins's gravatar image

Yes, medicare and medicaid are coercively funded. But bribery using stolen property is not coercion.

(Nov 12 '12 at 22:19) anthony anthony's gravatar image

I think we need to be careful not to obscure the basic answer which has been provided for the question: all coercion at all levels would be disallowed in an Objectivist society, including here. The prevalent approach to emergency room care for those who cannot pay is routinely (heck, cavalierly) intertwined with and dependent upon coercion (like most any political response in our culture), and Objectivists understand it to be morally abhorrent and practically disastrous.

(Nov 12 '12 at 22:31) Greg Perkins ♦♦ Greg%20Perkins's gravatar image

The basic answer is indeed important, and one on which we agree. Objectivism rejects all coercion at all levels.

I'm sorry if my response was too nitpicky.

(Nov 12 '12 at 23:09) anthony anthony's gravatar image
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Asked: Nov 11 '12 at 16:08

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Last updated: Nov 12 '12 at 23:10