Charity Ward

Recently, at a journal club one of the most erudite hematologists I know, a man who can explain the intricacies of DNA repair mechanisms, departed from his usual sphere of molecular biology to comment on a journal article about the suggestion for a "Public Option."

He told a story about his father, a radiologist in Maine, who had opposed the proposed Medicare legislation in 1965. His father had said government cannot do anything right, cannot be trusted. But, his son asked him forty years ago, what then to do about all those elders who were living on pensions and unable to pay for surgery or for hospitalizations?

"We always take care of those folks," his father said. "We write it all off. They come to the hospital, pay what they can, if anything, and if they can't, well we just take care of the patient and don't worry about the money. We won't starve."

That sounds pretty magnanimous, doesn't it?

But when you examine that idea, especially if you use that to guide public policy or consider it an expression of ethical behavior, it becomes very disturbing.

From the point of view of the doctor, it works pretty well. He may not get paid, but this approach leaves him with a good feeling about himself. It reinforces his sense of saintliness, of practicing medicine as it ought to be practiced, as a calling.

But one must ask, beyond the doctors, who will pay the nurses, the ER clerk, the guy who cleans the patient's room, and who will pay for the equipment? The doctor's fee is only the beginning, from the patient's point of view.

From the point of view of the patient, how does he feel? Does he feel grateful for the free care? Or does he feel humiliated?


The impulse toward charity, toward acting in a Christ like way to give to those in need conjures up all sorts of warm and fuzzy feelings, but what does this approach say about America?

When you listen to this doctor, what you are hearing sounds eerily familiar: "We take care of our people." Heard another way, you might hear the master of the plantation: "Our people are like children, and we take care of them." See where I'm going with this? When the master of the plantation gives out benefits to his slaves, he feels good about himself. And the slaves on the plantation are supposed to be grateful for his largesse. But of course, the master is better off under this system because if he doesn't feel like it, he doesn't have to do a thing. Nobody is taxing him, forcing him to pay for someone else's care. His obligation to his slaves is totally discretionary.

But the problem is the slaves should never have been put in the position of needing a hand out to begin with.

The whole structure of a dependent group of people, who depend for their lives on the beneficence of a powerful set of masters is pretty obnoxious.

My high school history teacher, Mrs. Von Doenhoff, used to declaim, in
moments of exasperation when her students had claimed she had violated their rights, "You have only one right on this earth and that's the right to starve and die."

This is as bald a statement of "American values" as you get.

Or at least, this is one strain of American values--the living off the grid set of values.

My home is in the Live Free or Die state. But how many people in this country have actually considered what that might mean? If you live off the grid, you are free. But if your appendix blows up in the middle of the night on your self sufficient off-the-grid farm, with its windmill generating electricity, and its fields of food growing around it, you still need the help of others at that dark hour. Someone has to haul you into a hospital and some surgeon, who has been trained in a medical school and in academic teaching hospitals (all creatures of a large government and large bureaucracies), someone has to help you or you will forfeit your life for the principle that you live off the grid and don't need the rest of the world.

Now, I do not accept uncritically the notion, "Healthcare is a right not a privilege." Do you have the right to make me get out of bed in the middle of the night? Someone has to pay me to do that.

On the other hand, Governor Mario Cumo once used the image of the wagon train going across the Great Plains and when someone fell of the wagon, the others stuck out a hand to pull him back on again. Or you might like the image of a boat, as in we are all in the same boat. You get the idea.

The fact is, that image of all of us sharing a fate, of looking out for your fellow American, that is not something which even half of this country embraces. We do not like each other that much.

So President Obama is correct when he says the reason this debate over health care has gotten so hot is because it emanates from the one of the most basic disagreements we have in this country, which is how much the government ought to be doing and how much ought to be left to the individual.

Democracy ordinarily means compromise. Medicare actually began as a very limited program in which the government paid for only doctor's services in hospital. No lab tests, no out patient care, no X rays. When it was apparent America had not gone communist with socialized medicine after a few years, more things were added. In fact, those doctors who decried it, soon discovered they were making more money than ever because now more of their services were actually paid for. Now you cannot get doctors to think about life without Medicare, which may be one reason 70% of American physicians say they prefer the "Public option."