Even if you argue that preventive care is not cost-effective, and this again can be debated over and over and probably depends greatly on the specific health issues in question, there again is the emotional and social losses associated with lack of medical care, early death and disability, etc., which are very difficult to assign numbers to.

Lastly, in this country we are fascinated with WAR — not just real war but we always talk about the “war on drugs”, “the war on crime”, etc. In fact, one of our country’s most popular sports, football, is like war — we talk about the “air assault” of the passing game, the “ground attack” of the running game, etc. There are many other references to war in the language of football which you can probably think of, but that I won’t go into. Why am I bringing this up? Because with firefighting, it is war-like and very macho — “an ARMY of firemen went to BATTLE today under extreme conditions and came out VICTORIOUS”, the news media might say. They also might talk about how fire crew travelled from northern california to help their southern california compatriots battle a big blaze and talk about solidarity (army-like). There is a fascination with firefighting in my opinion due to its macho-war-like qualities inspite of the fact that firefighting is a GOVERNMENT-RUN program (government-run programs are SOFT)!?

Most people who are against government-run anything think that socialism is for weak pansy Europeans (I am completely paraphrasing). But if a program or activity is war-like in any way, then we don’t even consider or mention that it is government-run. When’s the last time you heard on the news something like, “today the government-run fire department was delayed in putting out a fire and many critics are now questioning the ability of the government to run the fire dept., arguing that private industry is best for everything…”? You never hear that because it is war-like! No one ever questions the strength of our military SIMPLY BECAUSE it is GOVERNMENT-RUN. The military is for war, which is OK for the government to run. Macho!

So maybe if healthcare was macho and war-like, it would be ok to have it government-run. But since helping people stay well and treating and caring for them when they are ill can be seen as a soft, more nurturing endeavor with out much macho-ness to it, then forget it, no way in hell the government will do that!

As far as disease outbreaks such as H1N1 flu, or more exotic infections like ebola for example, everyone likes the government getting involved not only because the government is probably better suited to do so for the public good, but because it is exciting and war-like! “The war on supergerms!” There are many good exciting thriller-type movies covering scary disease outbreaks. But a family doctor taking care of a family and their medical needs is not war-like or exciting enough.

Perhaps my thoughts seem a little out there or off base, but I am confident that we are a nation fascinated and addicted to war. You got a problem that requires a war to fix it, better chance of getting the government involved and getting support for it. People suffering with cancer or diabetes or asthma or heart disease — too soft to be war-like for this country. So I am tired of hearing people say the government can’t run anything. It’s more of a difference of what people want the government to run. The same people that don’t want government in healthcare would never even consider removing government from the defense of this nation. My two cents.

Stevo — Definitely some good points and I appreciate your take on this. One thing about fire departments: we didn’t always have public fire departments. When houses were more spread out, you had to pay for fire protection and if you didn’t pay, they let your house burn. But with urbanization, people lived closer together and now if I don’t pay for fire service and my house catches on fire, then my neighbor who does pay can call the fire company and have them put my house out because it’s a danger to him. This creates a “free-riding” problem, where nobody wants to pay since they think their neighbor is going to pay — that makes government provision the more sensible approach to a case like this. There are still some areas of the country that make people pay for fire protection. I use this article in my class.

I guess the analogy to health care would be in a situation of communicable diseases. If my neighbor gets sick, I’m more likely to get sick, so he poses a public health risk and the government should help pay for him to get a virus or treatment — we all pitch in for that so that we minimize our risk for exposure to the disease.

Stevo, I think you make some good points. The point I was trying to get at is that I don’t think it’s necessarily the case that letting someone die early is always cost efficient. That would ignore the possible wealth creation from that person. A living individual, while being able to enjoy things like spending time with family, also has the opportunity to be productive, work, invent, create benefits to society, and so on (in ways that are quantifiable).

That might not be the case after they retire, at which point they’d solely be creating accounting costs for society. After that point, I think it’s conceivable that letting them die would save costs. Of course, as Dr Switzer points out, that’s only looking at one half of the picture.

I think of healthcare in our country much like the micro-world of a family — are we going to take care of each other no matter what, or not? A family that cares about and for each other is a healthy one (whether literally so or not). The more we discuss COST of health care, the less the USA is a family or a people. If we are a society of individuals with our individual freedom being our main value, where in our values do we have that we care about each other? I suppose liberty and freedom do not include caring for one another — that is a separate value which us Americans have not been so big on, in my opinion. My argument follows that if we don’t care much about each other but more about ourselves (“liberty and freedom”), than why do we defend our country with a government-run military? Why do we have a government-run fire department that ‘battles’ fires with ‘armies’ of firefighters to protect our common land? Who cares about our common land or property if we don’t care about each other? If it’s every man for himself, then it should be every man for himself through and through — anarchy!

Why should I pay tax dollars for a fire dept to protect my neighbor’s property but not my neighbor’s health? Oh, I get it, if my neighbor’s property is destroyed by fire, then the value of my property goes down, so I guess it all goes back to individual priorities.

If on the other hand, someday we ARE going to be a people that care about each other, let’s prove and actually take care of each other, starting with health care. People who are anti big government but want the biggest government-run military in the world and who are proud of our firefighters but don’t care about their neighbors with cancer make no sense to me!

“Wouldn’t it be cheaper to prevent someone froms moking and drinking than to have to treat the smoker and drinker?” No, because they live longer lives and we have to pay for them when they’re old. The problem is that when all you look at is costs, it’s better to have them smoke, drink and die young. But if you also look at benefits, as you should, then obviously it’s better to have them be healthy. I agree with you, Benjamin. (The problem is that the government pays the costs but doesn’t get the benefits of the extra time you get to spend with your grandkids, because they can’t tax that…yet.) That’s the point of the post — the Republicans who don’t want to spend more money on prevention just because “it costs more” are only looking at half of the picture and making what I believe to be a faulty conclusion.