Here’s one forwarded by my friend. It was posted by an account named Obama Makes Me Puke

Dear Sirs:

During my last night’s shift in the ER, I had the pleasure of evaluating a patient with a shiny new gold tooth, multiple elaborate tattoos, a very expensive brand of tennis shoes and a new cellular telephone equipped with her favorite R&B tune for a ringtone. Glancing over the chart, one could not help noticing her payer status: Medicaid. She smokes more than one costly pack of cigarettes every day and, somehow, still has money to buy beer.

And our Congress expects me to pay for this woman’s health care? Our nation’s health care crisis is not a shortage of quality hospitals, doctors or nurses. It is a crisis of culture — a culture in which it is perfectly acceptable to spend money on vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. A culture that thinks “I can do whatever I want to because someone else will always take care of me”. Life is really not that hard. Most of us reap what we sow.

Don’t you agree?

STARNER JONES, MD
Jackson, MS

The Breakdown:

This is a real letter to the Editor and it was written in August of 2009. It seems less about Obamacare and more about whether or not a specific individual should be entitled to be on any public support for their healthcare. The comments on this post were all over the board. Of course grandma is exempt from this discussion, we are only talking about people where there is some evidence that they have made some bad financial or health choices in their lives. I’d imagine that Dr. Jones would find that treating the uninsured in the emergency room if they don’t have insurance is equally repulsive as providing Medicaid. I can’t help but wonder how many cigarettes and gold teeth it would take to pay for a decent health insurance plan.

Anyway, let’s assume Dr. Jones has his heart in the right place. What does he want? Does he really think that people on Medicaid (because they have no money) should be held to a higher standard in terms of life choices than the general public? Are vices to be viewed as some sort of privilege or is it merely that we can’t control them in other people who are not in some way dependent on certain types of benefits from society?

“Eat all the garbage you want so long as taxpayers aren’t footing the bill for your health care premiums.”

“Smoke up and drink up so long as you have a good paying job (that comes with health insurance of its own).”

The useful question for me is whether there is a way to humanely use public policy to encourage people to make better choices. Suppose for a minute that Obamacare does go into effect. The biggest part of the program is about spreading the risk… insuring healthy people (and charging them) to help take care of the unhealthy ones.  So at least the new policy partly takes care of Dr. Jones’s issue about taxpayers paying for those who make enough to afford insurance.

Here are some other ideas that come to mind:

1) Ensure that all eligible health plans include smoking cessation, addiction treatment and access to nutritionists.

2) Include blood screenings as a part of  each health plan and make them mandatory for those who would take the premium discounts.

3) Create tax incentives in the form of lower premiums for those who verifiably do not smoke or drink alcohol

4) For those who do not have income sufficient to pay any premiums under the new plan, we could provide incentives for weight loss or smoking cessation as tax credits (again, this would have to be verified for example by a physician)

Policies like these above seem somewhat un-American in a historical sense, but I think that Dr. Jones’s opinions are shared by many. Not everyone is going to make good choices. Some people will get sick as a result. Most of us can agree that it is unpleasant to have to care for an individual who doesn’t want to take care of him or herself – they may even be a self-destructive person. Most of us can also agree that refusing to provide healthcare for a person who has no means to pay for it is also undesirable. Some of us will put qualifiers on this, but when push comes to shove, people I know find that letting poor people die because they are poor and irresponsible is a bridge too far.

In his letter, Dr. Jones was opposed to paying for the healthcare of an apparently irresponsible person with tax money. He didn’t propose anything specific about what to *do with the individual in question as an alternative to treating them. He spent most of the letter discussing their behavior. It would seem that changing the behavior would be a better result – and I agree with that.

So how do we do that?