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March 29, 2010
The final abolition of charity
Last night I read Cathy Young's piece on health care reform just before going to bed, and some of what she said had me tossing and turning. the life-and-death nature of medicine throws a major wrench into the libertarian paradigm.Ouch! I hate wrenches are thrown into libertarian paradigms, and I wish I could just ignore this whole thing and make it go away. But she really rubs it in, and makes me feel like an atheist in a foxhole. Freedom of choice is an empty concept if one of the options is death or disability; whats more, this is one area where better and costlier goods and services may be a matter of necessity rather than luxury. Indeed, as with atheists and foxholes, there are (almost) no libertarians in emergency rooms.Well, in fairness to the cruel old days of Ebenezer Scrooge, there used to be such a thing as charity care. Hospitals would provide care for the poor, and so would doctors. Not only were there general hospitals, but teaching hospitals and private hospitals used to run free clinics. I don't know why and exactly when that mostly stopped, but it did. Nowadays, poor uninsured people use the Emergency Room, with the taxpayers footing the bill. I think a little history is in order. People today may find it hard to believe, but hospitals originated as charitable institutions for the poor and destitute. It was only because of the birth of modern medicine as we know it (especially the discovery of anesthesia) that they became places where people with money would actually go in order to get well: The concept of charity care has been closely linked to the development of hospitals. As these institutions have evolved, so has the relatively vague definition of charity care. Today's hospitals differ considerably from their predecessors. Founded in Europe during the middle ages, and centuries later in America, hospitals served as the last resort for the infirm, the mentally and physically disabled, and the homeless.1 Hospitals performed multiple functions,3 but primarily provided shelter for the poor. Those who were better off usually received care in their own homes from private physicians.1 The growing number of epidemics and the need to isolate those affected led to establishment of city and voluntary hospitals during the 19th century. However, it was not until the advent of anesthesia and antiseptics that modern hospitals began to develop.1At first, though, many of these hospitals remained true to their originally charitable tradition. (I know that this is true. When my father was a medical student in the 1930s, he and other medical students used to be sent out to the homes of poor people to deliver babies -- something which would be unthinkable and probably illegal today.) But there remained a sort of split between private and secular hospitals (which took the earliest form of government subsidies) and religious or "ethnic" hospitals, which remained charities in the true sense of the word. In the United States at the beginning of the 20th century, the prevailing hospital systems in major cities consisted of municipal and private secular hospitals, most of which were charitable in character and affiliated with medical schools. They relied upon government appropriations rather than fees to sustain their operations. Religious and ethnic hospitals, less prominent at the time, relied entirely on fees and donations to finance their operations.1 Until the 1970s, some hospitals managed to provide care for the poor by marking up the standard charges of the medical services they provided to the general population, a practice known also as costshifting.2 Insurance plans emerged in the 1930s, as the non-poor began to demand hospital care.Eventually, government grants were provided in order to "modernize" hospitals, and then Medicare and Medicaid. With the government money came (surprise!) new government rules: The Hill-Burton Act of 1946, which sought to promote hospital modernization, provided government grants to non-profit hospitals. In exchange for these grants, Hill-Burton required non-profit hospitals to provide charity care or discounted care for those who could not afford care at regular costs.3 Financing of the hospital industry shifted again with the creation of Medicare and Medicaid in the 1960s. By the end of that decade, about 90 percent of hospital revenue came either from government programs or private insurance.3In other words, the present "system" (for lack of a better word) is a result of government created subsidies which gradually replaced genuine charity care with taxpayer-paid care. Modern hospitals as we know them became business ventures, and much of their funding consisted of government money paying for what had once been charity care. And Obamacare is the final coffin nail in charity care. Why would any doctor or hospital treat a patient for nothing if there's a blank check from the government? Charity (once a very honest and moral concept) has been replaced ("engulfed and devoured" would be more accurate) by a very dishonest and immoral concept, called "entitlement." People are worried about the government taking over medical care, but they should also be worried that the government is taking over what was once a form of morality. In the name of charity, charity is being destroyed. Unselfishness was once a free choice. But while it purports to abolish selfishness, the "entitlement" model actually perpetuates it. What I cannot understand is this: once selfishness is removed from the equation, how is it that unselfishness will be able to exist? posted by Eric on 03.29.10 at 11:09 AM
Comments
When state medicare is an entitlement, how is it selfish to use it? Unlimited, state of the art treatment for all will reduce overall costs??? Hugh · March 29, 2010 12:50 PM Post a comment
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I totally agree with your history of hospitals, but the present situation is perceived entitlement, if one is entitled to unlimited and first rate health care how is it selfish to use it?
The Hospitals and health care providers are being paid for all that is done, seems like a no limit expense account to me.