My dear reader, I do not care about your politics (other than, say, as an anthropological curiosity), but I would like to think that no matter your politics, you were put off by the cheering Ron Paul received at the recent GOP debate. Paul was explaining his uber-libertarian ideas about health care, and was given a hypothetical case of an uninsured patient who needed emergency care.
“That’s what freedom is all about: taking your own risks.,” Paul said, repeating the standard libertarian view as some in the audience cheered.
“But congressman, are you saying that society should just let him die,” Blitzer asked.
“Yeah,” came the shout from the audience. That affirmative was repeated at least three times.
Paul did not actively endorse the cheers of the death-frenzied audience, but his longer answer would effectively lead to the same end:
Paul, who has always had a reputation for being a charitable man, disagreed with the idea that sick people should die, but insisted that the answer to the healthcare problem was not a large government.
“I practiced medicine before we had Medicaid, in the early 1960s when I got out of medical school,” Paul said. “I practiced at Santa Rosa Hospital in San Antonio. And the churches took care of them. We never turned anybody away from the hospitals. And we’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves, our neighbors, our friends; our churches would do it. This whole idea — that’s the reason the cost is so high. The cost is so high because we dump it on the government. It becomes a bureaucracy. It becomes special interests. It kowtows to the insurance companies, then the drug companies.”
This is one of the most nonsensical answers I’ve ever heard from a politician (that’s saying a lot, no?). First, he gives the Back When Giants Walked The Earth opening, one familiar to most medical students and residents. This can be heard when an attending physician says things like, “When I was an intern, we collected and Gram stained all our own patients’ sputa, plated them out for sensitivities, administered the antibiotics ourselves, then collected the patients’ urine, and went to the chemistry lab to re-extract the antibiotics, and re-administered them. And I’m a better doctor for it.” Followed by looking at the floor, shaking his head at the inferior breed of doctor the year has inflicted on him.
I am skeptical of every statement made by Paul. When the hospital refused to turn away patients, who bore the cost? Did “the churches take care of them?” If it was a Catholic hospital, the answer was probably yes, but of course patients would have had no access to birth control or abortion. What about secular hospitals? And do hospitals “turn patients away” now?
The first statement is full of the ignorance of someone who hasn’t practiced medicine in a very long time. Hospital emergency rooms (at least those that benefit from any federal funding, which is pretty much all of them) cannot turn away sick people. They are required at the very least to stabilize a patient and find a safe, suitable transfer. In reality, the hospitals usually admit any sick patient and eat the cost of any unfunded care. There is no magic coalition of churches to take care of an uninsured patient who wanders into an ER bleeding. They are cared for and the hospital and we as a society eat the cost. Hospitals that take care of a certain number of poor patients receive federal monies to help defray the costs, but this hardly covers it. This system is easily strained. There are a number of infamous cases, especially in Southern California, where hospitals simply dump patients on the street. But in general, hospitals care for the ill who wander in.
What exactly is Paul proposing? If you read his words, he is proposing that all uninsured acutely ill patients be cared for charitably. By churches. So should the uninsured carry some sort of passport stamped with their religion so that a bill can be sent to their church? (I’m intentionally leaving off the atheist thing—I’m sure he’d fold that in.) Or should all hospitals be turned over to being run by religious institutions in case uninsured patients show up?
His further sentences about cost being high because “we dump it on government” is a non sequitor. The direct question asked by Blitzer was clearly stated: what do we do with an uninsured patient who is about to die?
The crowd cheered for death.
Paul turned his thumb.