‘Poor people will die just because they are poor’

‘Poor people will die just because they are poor’ June 28, 2012

That’s a feature, not a bug. It’s a boast, not an accusation. It is, the speaker says, a “principle” that must be “accepted,” not an injustice that must be corrected.

It sounds like an accusation — “You people think we should just accept that poor people will die just because they are poor.”

That sounds like a really nasty thing to accuse someone of. Jonathan Chait is reluctant to accuse Republicans of anything that viciously cruel. His argument stops short of that, making the case, instead, that Republicans believe in “Health Care as a Privilege“:

Opponents of the law have endlessly invoked “socialism.” Nothing in the Affordable Care Act or any part of President Obama’s challenges the basic dynamics of market capitalism. All sides accept that some of us should continue to enjoy vastly greater comforts and pleasures than others. If you don’t work as hard as Mitt Romney has, or were born less smart, or to worse parents, or enjoyed worse schools, or invested your skills in an industry that collapsed, or suffered any other misfortune, then you will be punished for this. Your television may be low-definition, or you might not be able to heat or cool your home as comfortably as you would like; you may clothe your children in discarded garments from the Salvation Army.

This is not in dispute. What is being disputed is whether the punishments to the losers in the market system should include, in addition to these other things, a denial of access to non-emergency medical treatment. The Republican position is that it should. They may not want a woman to have to suffer an untreated broken ankle for lack of affordable treatment. Likewise, I don’t want people to be denied nice televisions or other luxuries. I just don’t think high-definition television or nice clothing are goods that society owes to one and all. That is how Republicans think about health care.

This is why it’s vital to bring yourself face-to face with the implications of mass uninsurance — not as emotional manipulation, but to force you to decide what forms of material deprivation ought to be morally acceptable. This question has become, at least at the moment, the primary philosophical divide between the parties. Democrats will confine the unfortunate to many forms of deprivation, but not deprivation of basic medical care. Republicans will. The GOP is the only mainstream political party in the advanced world to hold this stance.

The full title of Chait’s column is “Health Care as a Privilege: What the GOP Won’t Admit,” and he writes that, “The maddening thing is that Republicans refuse to advocate the position openly.”

Libertarian economist Tyler Cowen takes up that challenge — admitting everything Chait alleges and then some. Here is a Republican proudly and openly advocating the position Chait describes. Health care, Cowen says, is indeed a privilege — even life-saving health care:

A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree.

And here is another Republican, American Family Association culture warrior Bryan Fischer also freely admitting that he believes health care should be a privilege only afforded to those who can afford it. Fischer fully embraces Cowen’s “principle” that “sometimes poor people will die just because they are poor,” and argues that it ought to happen more often than it already does:

If we want to bring down the cost of health care, it’s easy. What we lack is not the way but the will.

The way is simple.

First, eliminate the federal requirement that hospitals have to treat any patient who shows up. That’s the place to begin. Get government out of telling hospitals who they have to do business with. There is simply no way to control the cost of health care if hospitals are obligated to provide healthcare to all regardless of their ability to pay.

And (via Adventus) yet another Republican happily admitting that, yes, health care is a privilege only for the deserving who can afford it:

Opponents of the federal health care law see the problem of the uninsured very differently. They object not just to the price tag of expanding coverage to millions more people, but to the whole philosophy behind it.

Texans are individualistic and value their freedoms and responsibilities, said Lucy Nashed, spokeswoman for Gov. Rick Perry, who notes  Medicaid spending is a big part of Texas’ budget.

“Individual responsibility is about making healthy choices and taking ownership of your lifestyle — not just about buying health insurance,” Nashed said. “And you can’t legislate a healthy lifestyle.”

As Karoli wrote in response to Cowen’s column:

This is what a sociopath looks like. In the 19th century, the same principle was expressed when Dickens wrote “Let them die, and decrease the surplus population.” Yes, people still believe this, especially those who also claim to be Christians.

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  • Tonio

    I don’t know whether to laugh or cry…


    “Progressivism is in both parties,” she said. “It’s a cancer.” I wanted
    to ask whether this counted as a preexisting condition, but she
    continued: “It’s like the family member of an alcoholic. They’re
    supporting — they’re exploiting human weakness . . . even as they
    destroy our nation”…

    “We are going to be the ones that rebuild our country, who recreate out
    of the ashes the real rule of law where natural consequences happen.” It
    will, she added, be a “spiritual challenge, living in a tyrannical
    government . . . it sounds like government has no limits. But, again, I
    haven’t read the decision

  • There is my story. And I’m wondering if some people would have rather I died in horrible agony by staying home over the kidney-thing.

    No, they do not want you to die.  If you died, they would not get paid.  They want your payment, and if that means you have to get high-interest loans you will never pay off or bind yourself into crushing poverty, well that is your problem, in their eyes.  

  • shadsieblue

    In the case of the kidney-thing, they did get paid – by my excessively wealthy and nice former bosss who gets her money from old military weapons patents. (I just took care of horses and didn’t as questions).  However, the ambulance ride bill is a ghost that will not die… which makes me wonder if it’s a scam somehow tied into the hospital wanting more money than they’re owed.  I continue to respect EMTs, though. They have a hard job.

    I’m supposed to be getting Disability here sometime soon, when the state decides to stop dragging its ass. (Unlreated condtion). It makes me wonder, if I’d died two years ago, would people be glad not to have another drone on the dole?  I only put in my bid for Disability (seven years ago) because my condition makes work difficult and, as a result – poor, poor, poor.  I mean, if I were from a rich family and had my debilitating condition, I wouldn’t have bothered because I wouldn’t have had the need.  



  •  @880483e0216a63aed0a2de621439a5b0:disqus , to add to your point, there has been numerous incidents were hospitals have refused to treat trans* people and/or LGB people. One incident in particular is a good example of the sort of world Fischer seems to be advocating for: A transwoman in a car accident – she was a passenger – and the paramedics refused to treat her. She died because of it.  (Link: http://en.wikipedia.org/wiki/Tyra_Hunter  ).

    I suppose that is the sort of world Fischer would love to see. 

  • First, eliminate the federal requirement that hospitals have to treat any patient who shows up. That’s the place to begin. Get government out of telling hospitals who they have to do business with. There is simply no way to control the cost of health care if hospitals are obligated to provide healthcare to all regardless of their ability to pay.

    If I saw this out of context, I ‘d assume it was a Swift-style satire.

  • Jenny Islander

    Some states already offer free or very cheap health care to minors; in Alaska, this is called Denali KidCare.  However, I think this should go farther.  At the very least, we should go back to the days when the Powers That Were first drew a line between the “deserving” and the “undeserving” poor.  Basically, if you wanted to work but couldn’t, you were “deserving,” and if you could work but chose not to, you were “undeserving.”  That’s more or less where we are now, although the goalposts have been moved.  People who do not rack up lots of income units are being punished, with the excuse that they should have known that their field was going to stagnate or their employer was going to move their job site to another country, or they should be able to attend a job interview in another town on four hours’ notice with a wheezing car, or “unemployed need not apply,” or that new con where you have to work 30 hours of “training” for no pay before they’ll tell you whether you’re hired or not.  Basically people are being punished for not having rich parents or for not having precognitive psychic powers.
    However, there was a third category: the very old, the very young, and the severely disabled (“cripples,” etc.), who were not expected to work at all.  These days, they get punished too.  Think of the rhetoric so-called pro-lifers use when women are faced with unplanned pregnancy.  How often is it heavily implied that the child should be born and raised in poverty in order to punish the mother?  This has to stop.  I say we open Medicare to all senior citizens and all minor children.  We also have to make it easier for disabled people to get benefits and quit punishing them for needing help by making them struggle along for years before they see any money.  Will an easier system lead to more fraud?  Yes, probably.  But I will pay my tax money to 5 fraudulent disabled peoople if that means that 95 other people who really did hurt their backs get to keep their homes, means of transportation, and savings and see a doctor whenever they choose.  What does it profit me if they are desperately poor on top of being disabled?

  • Tricksterson

    He’s also apparently ingnored the Catholic Bishops campaign to cut off women from important aspects of health care.

  • Tricksterson

    After all assholes perform an important function.  If it wasn’t for them we’d explode.  or leak crap through our pores.  Either way it would be unpleasant and messy.

  • Tricksterson

    I wasn’t surprised because I didn’t have any expectations.  it was a given that Scalia, Thomas and Alito would vote against it and a high probability that Roberts would but Kennedy is very tough to predict.

  • Tricksterson

    Wait, it was Roberts who voted with the liberal wing?  That does surprise me.

  • PJ Evans

    misguided concern that billionaires will have to sell five of their 10 vacation homes to pay their tax bills

    Yeah, Ellison might have to sell Lanai. Poooor Baaaaaybee.

    Someone who can afford more than one vacation home is in a position where they ought to be able to afford to pay income tax up to at least a 75% top marginal rate, instead of whining about being overtaxed at half that.

  • Justin.Boston

    In general the poor already do get access to medical care through state run programs.. its the people just above poverty who are working hard that benefit most from this I feel because they do not qualify for government issued insurance.  Why anyone would be against expanding coverage to all makes no sense to me.  I would rather just see taxes go up and Medicare be expanded to all.  Problem solved.  Figure out the details of streamlining care later.  

  • Justin.Boston

    Just to add:  I work MORE than full time, earn a decent salary, but my health insurance is lousy.  The monthly cost between myself and my employer is over $500 yet I also have a $1000 yearly deductible, all tests I pay for out of pocket.. its a terrible plan but its all my small non profit can afford.  

  • Lori


    “We are going to be the ones that rebuild our country, who recreate out of the ashes the real rule of law where natural consequences happen.”  

    The fact that she clearly thinks that she will never be on the bad end of “natural consequence” or that if she is she won’t mind is sort of mind-boggling.

    I’ve said it before and I’ll say it again—the world would be a better place if a lot of wingnuts would just LARP and leave the rest of us out of their fantasies.

  • PJ Evans

     Lori,m I thought they were LARPing, because they seem to think the rest of us are non-playing characters that they can ignore or do whatever they want to.

  • Becky


    Dumb question – if we had Medicare for All, what would happen to the
    for-profit insurers? Did nations like France have insurers before moving
    to national health care?

    Here in Canada we have for-profit health insurance companies that provide things our universal health care system doesn’t cover.  The three biggest being prescription drugs, dental care and vision care.

  • Ima Pseudonym


    At best, we’re a source of labor to be utilized and revenue to be harvested at need.  Nothing more. 

    At worst, we’re more like stray dogs that hang around outside because one of their lesser children made the mistake once upon a time of giving us a snack or a pat, for which said child was subsequently punished.  We’re occasionally vaguely useful in a limited capacity, such as guarding the house against people they want to stay away.  Mostly we just slink around and take up space, and they ignore us unless we call attention to ourselves, in which we get a good kick in the ribs to drive us back under the porch.  And if we’re especially mangy and sick, then they call out the animal control officers…or that particularly ugly batch of cousins who enjoy light target practice with high-powered rifles.  They go out for dinner and a movie, and when they come home a few hours later, only a few bloody spots remain, which Daddy then sprays away with a hose before the wife and kids can see.     

  • I can understand reasonable disagreement about the question of how best to pay for universal access to non-emergency health care, given that a) the employer system is clearly not working, particularly for the unemployed and state and local governments, b) the pre-existing conditions issue, c) the fact that single payer would, indeed, be a major financial feat, d) a lot of people don’t trust the government to run things, and e) the private insurance industry currently exists. 

    Do not forget transitory employees, like contractors and migrant workers.  Even if our agencies and places of employment provide insurances, they only do so when we are on contract, and every new contract represents applying to a new policy.  What happens if we get a chronic condition at one point, then the insurance company refuses a new contract on that basis?  

  • Ciaphas

    The spiteful attitude towards the poor reminds me of something I read which I am now going to paraphrase badly.

    Q:  Why do the poor  resent the rich?
    A: Because the rich have done terrible things to the poor.

    Q: Why do the rich resent the poor?
    A: For exactly the same reason.

    I suspect that people are so quick to demonize those they oppress because then they aren’t bad people for being oppressors.

  • Sorbus

     Fortunately I’ve never been refused care because of my trans* status, but my insurance company has essentially refused to pay for a hospitalization (for severe depression; if my therapist hadn’t argued me into committing myself I would be dead) because the hospital miscoded the reason for my stay as “Gender Identity Disorder” (and refuses to recode it, choosing to send debt collectors after me for a hefty debt I shouldn’t even owe). It makes me wonder what would happen if I had gone to nearly any other psychiatric hospital in the country—this one was specifically pointed out by my therapist as one of the most LGBT+ friendly psych hospitals in the nation. And this is how they treat their LGBT patients.

    tl;dr Healthcare isn’t just an economic issue, it’s an LGBT issue as well (as well as being related to race and feminism and of course disability and nearly everything else under the sun). And I think this often goes unrecognized.

  • mcc

    As explained on the previous page (though this probably wasn’t obvious, it’s hard to tell in this system sometimes what’s responding to what) the comment you’re responding to is talking specifically about a new opt-out Judge Roberts just wrote into the bill, where states can opt out of a requirement they increase their medicaid coverage. 
    As I understand this effectively means shifting costs to the federal government because someone not receiving medicaid will probably wind up getting their insurance through the new ACA subsidies, so Roberts basically just decided he was gonna increase the federal deficit with the stoke of a pen because apparently the time-honored practice of withholding federal funds unless a state does XYZ (like Ronald Reagan did to raise the drinking age nationally) should not be allowed for Democrats or whatever.

  • Tonio

    I had the same thought, because the Just World Fallacy treats all of life as LARPing.

  • Tonio

     The prescription drug part is confusing, because I had read that under Canada’s system, the government negotiates the prices with the drug companies.

  • Sgt. Pepper’s Bleeding Heart

    The ambulance bill is seven thousand dollars?

    O O

  • It’s a confusing patchwork quilt. Some prescription drugs, but not all, have their prices regulated under the agreements, and trying to figure out the rhyme or reason seems to be like navigating shifting sands in the ocean.

    Eg. One time I needed a medication. It was free. A year later I needed said medication again. Price? $10.


    A person I know has had to argue with the Ministry of Health to get a certain drug paid for under provincial Medicare since it’s been deemed necessary by their medical practitioner for quality of life. Since it’s so new, the health authorities haven’t set the fee for it yet, so the price would normally be mucho $$$.

    Finally the government agreed to cough up, so now it’s free to my friend.

  • christopher_young

     the cynical old couplet

    The Latest Decalogue; one of my favourite poems. Clough speaks directly to these people from the first half of the nineteenth century.

  • Erista

    You know, I used to wonder why Republicans went on and on about imaginary death panels.

    Now I know that it’s because Republicans want to institute death panels, but death panels that they and their loved ones are immune from. As long as it’s Other people who are subjected to death panels, Republicans are fine with it; it’s when that they themselves might not be able to escape their own policies that they get nervous.

  • Tonio

    Ever see a child jealous because a sibling has been invited to a party? That’s the underlying mentality at work. They conceive of governments and laws as being like parents, and object to what they perceive as parental favoritism (“No fair!”) only when they don’t benefit from it. At its most basic, a single-payer system would be everyone putting money into a pot where anyone who needs some can use it. But this mentality seems unable to interpret this as anything but a net loss, as if the parent is taking the child’s toy and simply giving it to a sibling. There’s some fear of the Other at work, but much of this is simply sibling jealousy.

  • Ika Musume

    People that earn minimum wage get Medicaid for their children, so sure they are going to take them to the hospital since we are paying for their treatment of a running nose and other minor things. I have to pay monthly to a hospital because we can’t afford health insurance for our children, if one of them gets sick. I have health insurance, but the donut hole kills me once it becomes visible. The poor have a better life then most people and it’s about time to stop this free-give-away.

  • Ika Musume

    Rich people die too, but most of the time it’s because thy don’t want to have themselves check. Poor people seldom die because they take advantage of the free screenings paid for by the tax payers for them.

  • Ika Musume

    They have Medicaid already, if their parents are lazy and low income earners.

  • Ika Musume

    Vote No to Obama and the sales tax increase for ( Pre-K ) in San Antonio that will benefit only children of the poor, and children of the illegals in our city. Those that work and earn a good income your children won’t qualify, so why vote for something that won’t benefit your children.

  • EllieMurasaki

    To clarify: There are people who have to work low-wage jobs and refuse raises and promotions because if they were to earn any more than they did, they and their severely ill kid would be booted off Medicare, and this story predates Obamacare so there wasn’t a health insurer in the country who’d take the kid on.

  • Disqus seems to not like some HTML tags such as img. Chop it all out and paste it as a raw URL instead. Also, your HTML will bugger up easily if you accidentally change a > to a < and don't notice it.


    EllieMurasaki's picture.

  • EllieMurasaki


  • Nobody

     From this day forward, I am going to refer to the Republican Party as the “Sociopathic Party.

    me t00