Pre-Existing Conditions

[PatriotResistance]

I just got home from a Health Care Forum sponsored by a local news station (Denver, 9news). The governor and six of Colorado's U.S. congresspeople and senators answered questions. I plan on blogging about it once I organize my notes. But there is one very specific topic I would like to hear your opinions on.

As I striving/budding Objectivist I understand that health care is not a right. One man in the audience talked about his daughter being born with issues requiring 27 surgeries, and Ed Perlmutter (Colorado Congressman) mentioned his epileptic daughter in his response. The citizen complained of not being able to get insurance for his daughter's pre-existing condition.

Here are my questions - please understand I'm not arguing for these positions, I'm asking how the Objectivist explains rights and values regarding these situations.

First, is it necessary for all couples who plan on having a child to be financially able to deal with all possible birth defects before giving birth to that child? I would think the answer is no, so then those unlucky parents who don't have the means are just that - unlucky, and they just have to do the best they can? For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not? I can see part of the problem is defining which parents can and cannot afford that care. But I need much help on this issue.

Secondly, one of my favorite charities is Operation Smile. Doctors and nurses donate their time and materials to travel around the world, mostly to quite impoverished areas, and perform cleft lip and cleft palate surgery on children whose parents have no possible means to get that service. Now, my first solution to that problem is rights protected by rule of law and free-market capitalism to empower those people. But until that happens how do you justify not helping such a child left behind after Operation Smile has spent all their donations and has to return home. I assume part of the explanation is how do you define who needs what, and where does the definition of "need" end? And I can accept that. But repairing a birth defect like a cleft palate is a simple operation and many of these kids suffer unnecessarily for years. Surely that does fall under any definition of "need" that could be defined? Is it really enough to say, well they are a third world country and the rest of the world just can't fix everyone else's problems?

Bob

[Bob G]

I just got home from a Health Care Forum sponsored by a local news station (Denver, 9news). The governor and six of Colorado's U.S. congresspeople and senators answered questions. I plan on blogging about it once I organize my notes. But there is one very specific topic I would like to hear your opinions on.

As I striving/budding Objectivist I understand that health care is not a right. One man in the audience talked about his daughter being born with issues requiring 27 surgeries, and Ed Perlmutter (Colorado Congressman) mentioned his epileptic daughter in his response. The citizen complained of not being able to get insurance for his daughter's pre-existing condition.

Here are my questions - please understand I'm not arguing for these positions, I'm asking how the Objectivist explains rights and values regarding these situations.

First, is it necessary for all couples who plan on having a child to be financially able to deal with all possible birth defects before giving birth to that child? I would think the answer is no, so then those unlucky parents who don't have the means are just that - unlucky, and they just have to do the best they can? For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not? I can see part of the problem is defining which parents can and cannot afford that care. But I need much help on this issue.

Secondly, one of my favorite charities is Operation Smile. Doctors and nurses donate their time and materials to travel around the world, mostly to quite impoverished areas, and perform cleft lip and cleft palate surgery on children whose parents have no possible means to get that service. Now, my first solution to that problem is rights protected by rule of law and free-market capitalism to empower those people. But until that happens how do you justify not helping such a child left behind after Operation Smile has spent all their donations and has to return home. I assume part of the explanation is how do you define who needs what, and where does the definition of "need" end? And I can accept that. But repairing a birth defect like a cleft palate is a simple operation and many of these kids suffer unnecessarily for years. Surely that does fall under any definition of "need" that could be defined? Is it really enough to say, well they are a third world country and the rest of the world just can't fix everyone else's problems?

Bob

I first looked into your thread because of the title "Pre-existing Conditions", which I expect few really understand. However, your thread is not about that. I suggest that you change it something about children. First let me make a brief comment about pre-existing conditions. All this term means, in insurance speak, is that the person is already sick or injured. Someone complaining about not having insurance because of a pre-existing condition is like someone whose house is on fire complaining that he can't now get fire insurance.

You are conflating two different ideas, and your opponents are doing their best to maintain that confusion. No one with any benevolence at all wants a child to be hurt, impaired, or mistreated. They will wish that they could do what they could or what needs to be done. But this desire is always considered within the context of a person's own context, their own values.

What your opponents want is to use this desire as a justification to force everyone to finance that and much more. They are saying that since you want to help a child we will enslave you. After these bills are passed, you will see some people’s children get wonderful care and other's get almost nothing, depending on time, luck, who they know. The priority of helping your own children or your brother's children, your own values will be undercut.

So they are using your own benevolence to undercut your resistance to force.

They do this all the time. When they forced through the various acts giving the disabled special privileges some Senator or Congressman always had a sob story about their close relative. Everyone cried and voted to force U.S. citizens to submit. Sad, sob stories are always attempts to blur the issue.

Steadfastness and clear answers are always the best response. Answers must always clearly identify the morality involved.

What issues a couple should consider before having a baby is very contextual. I think that it would be tough to be thinking that their child would have manor medical problems. Nonetheless, they do need to have thought about their financial situation and how they will take care of their baby.

Your last question needs to be stated more broadly, in that there are lots of situations that need to be fixed. It certainly is the case that a any particular time there is only a certain amount of assets. Only a limited amount can be done. Our ability to do anything is being limited by the effects of government on our productive ability. This is all within the context of our own values, too. So, yes, we can't do everything. But the real problem in your last paragraph is that it is a thrid world country. It can't do anything for itself because it remains a thrid world country. Really, the best thing that can be done for them is to teach them in some manner how to be a productive country. Then they can save their own children.

[DavidOdden]

First, is it necessary for all couples who plan on having a child to be financially able to deal with all possible birth defects before giving birth to that child?

Necessary in order for what to happen? Let me put it this way. If a couple chooses to create a child, they should know what that means. Specifically, they are taking responsibility for the care of the child, and if they are unwilling to shoulder that responsibility, then they should not create the child (or should eliminate it before it is born). If they know that they cannot afford to care for the child, then it is highly irresponsible to have the child.

However, that does not mean that they must dedicate all of their resources and life to effecting a cure for the condition. There is a difference between being irresponsible, and unbounded self-sacrifice.

For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not?

No, society i.e. the taxpayer does not have a duty to heal those children. That would imply that the child has a right to be healed, which is simply not true. The child has the right to accept whatever voluntarily offered healing comes its way. Any member of society has the right to voluntarily give money to help heal the child. No man has the right to take the live and livelihood of another for the sake of someone else, even a child. No man's life constitutes a valid claim on the life of others.

But until that happens how do you justify not helping such a child left behind after Operation Smile has spent all their donations and has to return home.

The implication is that one does not have the right to live for one's own sake, and that if you do, you must justify not sacrificing yourself. It would be better to ask how one justifies giving up one's own interests in favor of the interests of others.

In the case of doctors and nurses, what they are doing is not self-sacrifice, and they are pursuing their long-range goals. Choosing to engage in ordinary benevolence to others is also reasonable, assuming that your contribution does not constitute a destruction of value. (There is often a misconception that Objectivism holds that one's highest value should be accumulating the biggest pile of cash possible, which ain't so.)

[softwareNerd]

First, is it necessary for all couples who plan on having a child to be financially able to deal with all possible birth defects before giving birth to that child? I would think the answer is no,...

They do, and this is exactly the type of situation where one needs insurance. For starters, assume that birth defects afflict newborns randomly and that there is no way to predict them before birth (these assumptions are not true, but let's start with this simplified position). In such a case, every sensible parent-to-be will make sure they have bought insurance. Via insurance, all parents-to-be would end up paying for the cost of the few unlucky ones. Anyone who is not a parent-to-be would not pay a dime. This is how a free-market would work, and it is free and fair. One would still have outlier cases of people who are poor or just irresponsible, and do not buy insurance. However, that would be the outlier case: in the main, normal, unlucky birth defects would not pose a financial problem for normal, responsible people.

Now, consider relaxing the two assumptions above. First, birth-defects are more common among certain parents, depending on age and other factors. One would expect the premiums to take this into account. So, people who are more at risk pay more, and are not subsidized by those who do not really face higher risks. If some couple has some medical issues that make the risks very high, then perhaps the premium will be unaffordable. If they are not rich enough, maybe they will have to adopt instead: a pretty good solution. The second assumption is about prediction. Often, birth defects or the probability of birth-defects can be detected when the fetus is in an early stage. I suppose some insurances might evolve so that one paid a smaller premium up front, and then a second premium that could be low or high once the fetus is a few weeks into development and basic tests have come back.

[Castle]

The posts above pretty accurately explain why its immoral to utilize force to make others pay for such things. I would like to reiterate that the concept of insurance is to protect from events that might happen, not events that are happening or did happen. Asking for insurance against birth defects is essentially asking to be insured against the past. I agree with the above conclusion that benevolence is a factor in solving this problem. Honestly, its very difficult to estimate how much benevolence would fix this issue, because we have no idea of the prosperity and reduced cost that would likely be a feature of a coercion free system. There is every indication that it would make human benevolence easier and cheaper to practice. There is also the issue of responsibility. Many birth defects can be found well before the embryo has progressed to even a questionable level of development. If a parent chooses not to utilize the available technology or is just negligent, why should anyone else be coerced into paying for that decision? If such a decision were religiously motivated, one has to ask why those organizations aren't pulling together to help their members with the consequences of obeying their own strictures? There is also room for a little planning to mitigate this sort of problem, which might be implemented if the "Hey, I'll just ask the government to fix it with guns!" approach. An example would be a cooperative pre-birth insurance pool. People volunteer to pay a certain amount per month or when the pregnancy is discovered. Money is pooled by the cooperative or hospital and used in interest bearing activities. If a defect is discovered before a certain month of gestation the fund pays for the pregnancy to be aborted. If it is found after the fund pays for a predetermined amount of corrective surgery. In the case of a normal gestation and birth the fund keeps the deposits. As most gestations that go to term are normal, capital would be accumulated to assist unlucky depositors. Another potential would be to start "baby funds" as gifts for new marriages or similar events. Surprise pregnancy insurance? Its possible. I'm just listing things off the top of my head, but as I am just one guy it seems likely that the human race can arrive at more innovative solutions to this issue than violence.

[JeffS]

They do, and this is exactly the type of situation where one needs insurance.

I think the OP is saying the child is not covered automatically under the health insurance that covers the parents. I don't know that this is the case. Assuming the speaker at the forum gave all pertinent information, and that the parents did have insurance covering the actual birth, but not the child once it was born, and he was denied insurance to cover the 27 surgeries, then I wonder what's going on. Honestly, after two healthy births, I don't know that my children were covered under our insurance automatically. I have to imagine they were, or that that's an option available when purchasing insurance. If I recall correctly, putting their actual names on the policy was sort of an afterthought - merely a formality. Don't know if it would've been different if there were problems. Both pregnancies cost something like $200 from conception to several post delivery exams.

Does anyone else know the particulars?

Edited October 18, 2009 by JeffS

[TLD]

As I striving/budding Objectivist I understand that health care is not a right.

Is it necessary for all couples who plan on having a child to be financially able to deal with all possible birth defects before giving birth to that child?

Does society have a duty to heal those children? If no, why not?

______________

I take this as the essence of your post. I.e., you know HC is not a right but are concerned about the issue of affordability and coverage.

Morally: not being a right, one should not be able to demand HC at the expense of anyone else.

Thus, society has no duty....

Politically: Govt. should not likewise impose burdens on some to pay for others.

Everyone should assume responsibility to retain health insurance for such protections. And covering a child from day 1 should prevent the problem you pose.

In today's context:

Many rational things can and should be done to lower HC costs.

Then a very small percent of people would be unable to truly afford insurance. And charity would likely take care of most of them. Beyond that, and still in the interest of charity, Govt. subsidy to help ensure that those still unable to afford insurance are covered would at least keep hospital emergency rooms free for serious illnesses, lower hospital costs, and would eliminate the need for any further Govt. takeover of HC.

Edited October 19, 2009 by softwareNerd
Added quote tags around quoted text

[PatriotResistance]

They do, and this is exactly the type of situation where one needs insurance. For starters, assume that birth defects afflict newborns randomly and that there is no way to predict them before birth (these assumptions are not true, but let's start with this simplified position). In such a case, every sensible parent-to-be will make sure they have bought insurance. Via insurance, all parents-to-be would end up paying for the cost of the few unlucky ones. Anyone who is not a parent-to-be would not pay a dime. This is how a free-market would work, and it is free and fair. One would still have outlier cases of people who are poor or just irresponsible, and do not buy insurance. However, that would be the outlier case: in the main, normal, unlucky birth defects would not pose a financial problem for normal, responsible people.

Now, consider relaxing the two assumptions above. First, birth-defects are more common among certain parents, depending on age and other factors. One would expect the premiums to take this into account. So, people who are more at risk pay more, and are not subsidized by those who do not really face higher risks. If some couple has some medical issues that make the risks very high, then perhaps the premium will be unaffordable. If they are not rich enough, maybe they will have to adopt instead: a pretty good solution. The second assumption is about prediction. Often, birth defects or the probability of birth-defects can be detected when the fetus is in an early stage. I suppose some insurances might evolve so that one paid a smaller premium up front, and then a second premium that could be low or high once the fetus is a few weeks into development and basic tests have come back.

I'm glad you've brought this up. I'm not a parent and have to ask a stupid question. Is there such a thing as "birth-defect insurance" available today, that parents would buy before conception? I agree with your assessment, this would seem to make sense. It is the only way to spread the risk without forcing taxation. But then what of the parents who do not purchase it, or do not purchase enough?

Bob

Edited October 19, 2009 by PatriotResistance

[softwareNerd]

I'm glad you've brought this up. I'm not a parent and have to ask a stupid question. Is there such a thing as "birth-defect insurance" available today,...

Not as far as I know. Your insurance covers it. For the poor, there is Medicaid for kids. Usually insurance policies are capped at a life-time amount around $1 million. Might seem high, but I worked with one dad who had blown that limit. If you are insured, you have to add your kids name to your policy within a certain number of days of birth. Needless to say, policies vary and this may not apply to you. So this is something to check with your own insurance company.

My other advice would be to get all the pre-natal tests, including a few that might be slightly marginal. Also important is to have the right Ob/Gyn. You don't want someone who is a fundamentalist Christian. It is a fair and necessary question for a woman to ask her Ob/Gyn about his stance if she gets pregnant and then decides to terminate her pregnancy.

[PatriotResistance]

No, society i.e. the taxpayer does not have a duty to heal those children. That would imply that the child has a right to be healed, which is simply not true. The child has the right to accept whatever voluntarily offered healing comes its way. Any member of society has the right to voluntarily give money to help heal the child. No man has the right to take the live and livelihood of another for the sake of someone else, even a child. No man's life constitutes a valid claim on the life of others.

I understand that this is the Objectivist position. But I ask you to turn it around and look from another direction. Imagine a neanderthal child is born with a birth defect. That child has no right to cleft palate surgery because they cannot have a right to something that does not exist. But today society has advanced to the point that cleft palate surgery is a non-trivial but relatively inexpensive and easy surgery. Can you really say that child has no right to be healed just because through no fault of the child no one is willing to donate the money? You are willing to let a child suffer the horrors of a cleft palate for years, instead of fixing it during infancy as it should be, just because donations fell short? What does it say about the human race when we allow a child to suffer and I stress - through no fault of the child?

The implication is that one does not have the right to live for one's own sake, and that if you do, you must justify not sacrificing yourself. It would be better to ask how one justifies giving up one's own interests in favor of the interests of others.

I would answer that anyone who voluntarily contributes to a charity has made that justification, so as you point out below Objectivism does not prohibit charity. But you are making me think in new ways about the issue, so I have to admit here that my question does suggest that there would have to be some definition of rights for newborns (the topic is birth defects), that would definitively preclude that right from sliding the slippery slope to include any other rights. I realize that I am only emoting about the issue at present. It just seems to me that birth defects taken as a whole would be a trivial amount spread across all prospective parents. I realize that it's triviality in no way justifies enforcing it. But is it really a sacrifice to ensure that no child lives with the horror of a cleft palate when our society has advanced to the point that the repair is trivial?

In the case of doctors and nurses, what they are doing is not self-sacrifice, and they are pursuing their long-range goals. Choosing to engage in ordinary benevolence to others is also reasonable, assuming that your contribution does not constitute a destruction of value. (There is often a misconception that Objectivism holds that one's highest value should be accumulating the biggest pile of cash possible, which ain't so.)

I agree and I wish that Objectivists would more often point out that while Objectivism objects to force, it does not prohibit compassion.

Bob

[Eiuol]

"But is it really a sacrifice to ensure that no child lives with the horror of a cleft palate when our society has advanced to the point that the repair is trivial?"

It is if you prefer to give money for some other cause. For me, it is a sacrifice, even if I had money. I'd rather give donations to places that affect me directly. Kids with cleft palates don't matter to me at all. At least, not beyond the level of acknowledging that cleft palates are bad.

You seem to be focused on the fact that you'll get the money you need from donations or insurance. Creative solutions do exist, but unfortunately, only really in a free market. The way the US medical system works now is horrible so you can't really use the way things work as a reflection of how they could work.

[TLD]

Can you really say that child has no right to be healed just because through no fault of the child no one is willing to donate the money? You are willing to let a child suffer the horrors of a cleft palate for years, instead of fixing it during infancy as it should be, just because donations fell short? What does it say about the human race when we allow a child to suffer and I stress - through no fault of the child?

Every person - child or adult - has the same rights; but a right to life is a right to action to pursue life, not a right to demand something from others. A parent has the responsibility for protecting the life of his/her children; that means here the responsibility to buy insurance for the children. Where the parent truly cannot afford insurance, charity can subsidize it. One certainly should not ask for Govt. support at the expense of others. And philosophical answers to such questions should not rest on "emergency" examples.

I agree and I wish that Objectivists would more often point out that while Objectivism objects to force, it does not prohibit compassion.

That is simply a given. That is what AR was all about.

[whYNOT]

I agree and I wish that Objectivists would more often point out that while Objectivism objects to force, it does not prohibit compassion.

Bob

Sorry, Bob; once you become a bona fide Objectivist you are forced to give up compassion and relinquish all your humanity. Feeling is prohibited!!

I do think that there is a reason that Objectivists do not concentrate more attention on the 'soft' virtues (if I can call them that), and it's because they assume that they are a given, - or, taking them for granted. Well, that's my opinion. But they do merit closer attention, more often, as you point out.

To be human at the fullest subsumes a vastly wide array of values. Just think of how limited and limiting this human was for so long under the dogmas of mysticism and collectivism; how narrow the possibility of a Man was. With the result that those minor virtues of compassion and benevolence became entrenched as the fullest range of Value, and altruism emerged as the ultimate 'goodness.'

Objectivism has blown the lid off that one. Incorporating that lower range, of awareness of the suffering of fellow men, continuing all the way up to the noblest values of Reason and Individualism, Rand has shown that there is no longer the excuse that Humanity, or any person, cannot know and strive towards his full potential.

I just see it as a centuries old (B.R., Before Rand) tiny, narrow, bandwidth of conventional 'goodness' ---- now up against the huge broadband of O'ist Morality.

Rational selfishness will never prohibit an act of selflessness within a context, when appropriate, and completely voluntarily. These are one-off scenarios, within a life dedicated to egoism, - an exception doesn't define the rule.

A disclaimer : the above methodology of combining lesser virtues with higher values on a scale was something I came up with to aid my own understanding, and is not necessarily implicit in Ayn Rand's teaching. Though I believe it is. Anyone's thoughts?

Anyway, hope it helps.

[Jake_Ellison]

Rational selfishness will never prohibit an act of selflessness within a context, when appropriate, and completely voluntarily. These are one-off scenarios, within a life dedicated to egoism, - an exception doesn't define the rule.

A disclaimer : the above methodology of combining lesser virtues with higher values on a scale was something I came up with to aid my own understanding, and is not necessarily implicit in Ayn Rand's teaching. Though I believe it is. Anyone's thoughts?

Anyway, hope it helps.

While there are lesser values and higher values, which often conflict, that does not apply for virtues. Virtues do not contradict each other: if egoism is a virtue, then selflessness is a vice, not a lesser virtue.

However, benevolence, properly defined (to not create a contradiction with selfishness) is a virtue. But the idea of sacrifice, even once, is opposed to Rand's teachings. (selflessness is sacrifice) You should be benevolent toward those who deserve it, selfishly. You should never, not even once, allow yourself to be selfless. That rule does not allow for exceptions. Rules/principles in general don't allow for exceptions/compromises.

Edited October 19, 2009 by Jake_Ellison

[whYNOT]

Right, Jake, I think you got me there. I do think I was casual in my use of "selflessness", as opposed to my preferred "benevolence, "goodwill" or "compassion".

Not to make excuses, but I do often post too speedily, so's I don't lose my plot. And then accuracy suffers.

Actually, I'm glad there is someone to keep me on my toes.

I take it that you agree with the bulk of my post ?

[TLD]

Right, Jake, I think you got me there. I do think I was casual in my use of "selflessness", as opposed to my preferred "benevolence, "goodwill" or "compassion".

Not to make excuses, but I do often post too speedily, so's I don't lose my plot. And then accuracy suffers.

Actually, I'm glad there is someone to keep me on my toes.

Note also that values are those things one acts to gain/keep; virtues relate to the actions taken to gain/keep them.

Thus another reason why they cannot be combined.

[PatriotResistance]

"But is it really a sacrifice to ensure that no child lives with the horror of a cleft palate when our society has advanced to the point that the repair is trivial?"

It is if you prefer to give money for some other cause. For me, it is a sacrifice, even if I had money. I'd rather give donations to places that affect me directly. Kids with cleft palates don't matter to me at all. At least, not beyond the level of acknowledging that cleft palates are bad.

You seem to be focused on the fact that you'll get the money you need from donations or insurance. Creative solutions do exist, but unfortunately, only really in a free market. The way the US medical system works now is horrible so you can't really use the way things work as a reflection of how they could work.

Well, I meant is it really a sacrifice to society. In other words, I believe the amount of money required to fix birth defects of truly needy children would be a tiny fraction of the unjust taxes that you are forced to pay today. Cleft palates are just a single example so we have something concrete to think about. Pick your birth defect! We don't mind paying some taxes for roads and police and such, right? I'm just having trouble understanding how allowing a child to suffer from a physical birth defect, regardless how badly their parents or government screwed up, is just in a modern society. How do you balance your right to selfishness with unnecessary suffering? If other donations are a sacrifice then I guess I need to attempt to come up with a reasonable explanation for why birth defects are not a sacrifice, that they are somehow like roads and police..... ???

What creative solutions, assuming a truly free market and a properly run medical system, are you suggesting? I'm very curious, I think this is critical to my understanding this issue.

Bob

[bluecherry]

Society sacrificing? Society doesn't do anything, individual people do. There are plenty of people, especially here, who DO mind the taxes for stuff like roads that you mention, who object to taxation as such in principle even though they know they'd choose to pay for road use and support of police in a system without taxes. Rather than try to argue for what you think is the best allotment of essentially stolen goods, especially when you know anyway that free markets would fix the problems you want to see fixed much better, just keep arguing for the respect of people's individual rights. Long term the plan is a much better bet. "How do you balance your right to selfishness with unnecessary suffering?" You don't balance it. There is nothing requiring you to do anything at all if you can't find a way it would support your well being. That said though, there's already been explanations on how under various circumstances plenty of people may find it in their interest to choose to help out a kid from parents in a jam.

[Eiuol]

Well, I meant is it really a sacrifice to society. In other words, I believe the amount of money required to fix birth defects of truly needy children would be a tiny fraction of the unjust taxes that you are forced to pay today. Cleft palates are just a single example so we have something concrete to think about. Pick your birth defect! We don't mind paying some taxes for roads and police and such, right? I'm just having trouble understanding how allowing a child to suffer from a physical birth defect, regardless how badly their parents or government screwed up, is just in a modern society. How do you balance your right to selfishness with unnecessary suffering? If other donations are a sacrifice then I guess I need to attempt to come up with a reasonable explanation for why birth defects are not a sacrifice, that they are somehow like roads and police..... ???

What creative solutions, assuming a truly free market and a properly run medical system, are you suggesting? I'm very curious, I think this is critical to my understanding this issue.

It would be up to some entrepreneur to develop a better method to deal with problems in the world. I don't mean it like "how do we reduce poverty in the world" but "there is a market of people that have a problem that needs addressing". You could start a business that focuses on cleft palates, finding the best in that field to quickly and efficiently fixing as many lips as possible. Maybe it will be taken care of automatically because it is part of the hospital's service. Maybe hospitals will work primarily on subscription plans from its customers. Maybe insurance will move away from the consumer and oriented towards hospitals themselves, the providers of health care. The point, though, is that as it stands now, the only solutions even considered are entirely regulatory-oriented, that congressmen seem to be the ones determining how the medical system works.

If you want to fix a problem because it is "good for society", that is altruism, a self-sacrifice. If you want to fix a problem because you enjoy problem solving, profit, helping someone you know or all of the above, that is not a sacrifice by any means. Physical birth defects are bad things, but it happens. It is not possible to worry about *all* "suffering" without some sort of selflessness. Individuals should simply figure out what is most important to them, rather than what is "reducing happiness in the world".

[softwareNerd]

In other words, I believe the amount of money required to fix birth defects of truly needy children would be a tiny fraction of the unjust taxes that you are forced to pay today. ... ... I'm just having trouble understanding how allowing a child to suffer from a physical birth defect, regardless how badly their parents or government screwed up, is just in a modern society.

If you think you and others like you would be happy to give to a cause like this, then why involve the government in the transaction? How is that helping make the charity better?

I know I would donate to certain types of charities (like this and a few other categories) if the government was not so involved in wealth distribution.

Edited October 19, 2009 by softwareNerd

[TLD]

Well, I meant is it really a sacrifice to society. In other words, I believe the amount of money required to fix birth defects of truly needy children would be a tiny fraction of the unjust taxes that you are forced to pay today. Cleft palates are just a single example so we have something concrete to think about. Pick your birth defect! We don't mind paying some taxes for roads and police and such, right? I'm just having trouble understanding how allowing a child to suffer from a physical birth defect, regardless how badly their parents or government screwed up, is just in a modern society. How do you balance your right to selfishness with unnecessary suffering? If other donations are a sacrifice then I guess I need to attempt to come up with a reasonable explanation for why birth defects are not a sacrifice, that they are somehow like roads and police..... ???

What creative solutions, assuming a truly free market and a properly run medical system, are you suggesting? I'm very curious, I think this is critical to my understanding this issue.

"Society" is not sacrificed, individuals are.

To solve such a problem, you can't simply pick the least harmful tax.

A truly free market always has a solution. You don't need to assume that a child will have to suffer if individuals, insurance companies, hospitals and doctors are free to negotiate to fill the need to take care of him/her.

If the need and willingness to pay for services is not great enough, then we turn to charitable organizations for support. No sacrifice is required.

Even in our current state, it has been stated in this forum that insurance is available to most to solve this problem.

You are thus taking the worst case scenario and extrapolating. You are assuming a child is "allowed" to suffer; allowed by whom? My selfishness is not weighed against such suffering. Those closest to such a child have the greatest responsibility (e.g. parents), need and desire to help the child in some manner. If they don't, do they have a right to turn to us and demand assistance?

Govt.'s role is to defend individual rights. Unless you define health care as a right, then it is wrong to redistribute the wealth to cover everyone's health care. Turning to Govt. for solutions is the easy way of avoiding responsibility for one's self and family.

[Grames]

"Insurance" is supposed to be a lottery ticket you do not want to win. It is not an installment payment plan for medical treatment.

If you read Toqueville's Democracy in America you learn that the free people of early America were incessantly organizing themselves into all kinds of voluntary associations. It will not be difficult for a competent, reputable children's hospital or charity to raise funds for the treatment of cleft palates and other birth defects. See Shiner's Hospitals for Children. It isn't hard even now, increasing freedom can't make it more difficult.

[Thomas M. Miovas Jr.]

You are willing to let a child suffer the horrors of a cleft palate for years, instead of fixing it during infancy as it should be, just because donations fell short? What does it say about the human race when we allow a child to suffer and I stress - through no fault of the child?

You are looking at this not from an egoistical point of view, but from a collectivist point of view. All sorts of things can happen to someone through no fault of their own, but they are nobody else's fault either. I didn't bring that child into existence and I don't see why I or anyone else has to pay for its recovery. It is not "society's child" it is the child of one group of parents, and they should be the ones responsible. There is no right to take something from another just because you need something, even if the need comes through no fault of your own. Is it terrible that these things happen, sure, but that doesn't give you the right to force someone else to pay for it.

Voluntary charity is the only reasonable solution. It is not a reasonable solution to enslave everyone for the sake of the lame, the halt and the blind -- or the cleft pallet. Each individual has enough problems of his own to take care of, he doesn't need to be burdened with anyone else's problem from birth.

So, no, dealing with birth defects as if they are required to be fixed by someone else is evil.

[Jake_Ellison]

I'm just having trouble understanding how allowing a child to suffer from a physical birth defect, regardless how badly their parents or government screwed up, is just in a modern society.

I don't think it is just, I don't believe anyone ever said physical birth defects are "just". Justice is a man made concept, that pertains to actions, while physical birth defects are metaphysically given. Justice does not apply to cleft palates, any more than it applies to gravity, oranges being orange, or 2+2=4, or anything else except the actions of men, toward other men. Specifically, an injustice is the violation of another person's rights, while justice is Objective punishment for such violations.

If the birth defect is man made, then it becomes a matter for justice. For instance if someone's mother did cocaine while pregnant, I think they should be allowed to sue, and seek justice for their birth defects.

How do you balance your right to selfishness with unnecessary suffering?

Here's my idea of a balance between my principles and yours: you follow yours, I follow mine. If they conflict, it will be your fault, since I want nothing from you that you're not willing to give.

We don't mind paying some taxes for roads and police and such, right?

I'm not paying anything to the government, never have. I happen to get robbed of about half my income, every year, but as far as I know, being the victim of extortion, and paying someone money, are two separate things, in English.

If the extortion stops, I'll consider giving money to the government, for the service of protecting my rights.

And, on a separate note, I do and will continue to consider giving money to charities, to help children with easy to fix birth defects such as cleft palates, as long as those charities don't also accept money that was stolen by various governments.

I take it that you agree with the bulk of my post ?

I agree with paragraphs 2 to 4 (and the joke at the beginning:), so yes, that's about the bulk...

Edited October 19, 2009 by Jake_Ellison

[DavidOdden]

That child has no right to cleft palate surgery because they cannot have a right to something that does not exist.

That's actually not the reason: the reason is that nobody has any right to a thing. You may have a right to an action. You're building your argument on the presumption that people have rights to things. Where does that come from?

Can you really say that child has no right to be healed just because through no fault of the child no one is willing to donate the money?

What action would the child have a right to? The right to accept any donation -- most certainly. I can really say that a child has no right to force me to pay for his surgery. (Never ask "can you really say?" when you know that the answer is going to be "Of course yes").

You are willing to let a child suffer the horrors of a cleft palate for years, instead of fixing it during infancy as it should be, just because donations fell short?

You are completely off topic now. You're asking about rights and the use of force. Once you grasp the moral essentials, that no man (or child) has the right to force a person to act for their benefit, then we can address the question of how such a hapless child might end up getting cured. But first we have to get clear on man's rights. Which is the title of a Rand essay, which I strongly recommend.

I realize that I am only emoting about the issue at present.

Understood. What are these emotions a reaction to? It is the recognition that these conditions are deleterious to the life of the sufferer; that not having the condition would be good for the sufferer. "Benevolence" means "wanting good for others", and "wanting good for others" is certainly not a vice. The important thing is that a benevolent attitude should not translate into self-destruction.

But is it really a sacrifice to ensure that no child lives with the horror of a cleft palate when our society has advanced to the point that the repair is trivial?

Whether something is a sacrifice or not has to be determined by each individual and is meaningful only relative to the individual. Remember that sacrifice is the destruction of value, but there is no universal hierarchy of values. For a person who makes $2,000 a year, a $200 contribution for cleft palate repair may well literally mean death. For a person who has no purpose for their $200, a donation might be reasonable. We'd have to look at the person's goals. For example, I could have a personal stake in such a contribution because some friend in Tanzania might have a defective child; or maybe a friend of a friend.

I propose, though, that cleft palate repair is not the highest priority for charitable donations. At least not for me, so I'd like to see the argument that cleft palate trumps education.