21 September 2011


I just really wanted an excuse to post this video.

I had a few comments and private emails in the last post about the uninsured which I find really perplexing. They essentially say, "I'm charitable, I give to my church, I'm all in favor of voluntary charity. But when the government makes it compulsory and steals my money to give it away, that's not charity, that's fascism."

I'm paraphrasing, I admit. But not by much.

But it's one of those things that really make me scratch my head. These people have a fundamentally different understanding of the concept of charity than I do. Full disclosure: I was raised catholic and enjoyed endured 12 years of catholic education. While I have wound up not particularly religious (to say the least), it's fair to say that the core values of catholicism really have infected me, in a good way, at a very basic level. One of those values, one of the most important ones, is charity. Christ talked about it a lot. But what does "charity" mean? Or, maybe I should say, what does that mean to me, and how do I put it into action?

The definition of charity is:

1: benevolent goodwill toward or love of humanity
2  a : generosity and helpfulness especially toward the needy or suffering; also : aid given to those in need
    b : an institution engaged in relief of the poor
    c : public provision for the relief of the needy
3  a : a gift for public benevolent purposes
    b : an institution (as a hospital) founded by such a gift
4: lenient judgment of others
Love of humanity -- that's where I draw my moral compass from. Not some niggling distinction over whether a particular cause rises to my discretionary level of "this is important and I personally want to support it," or whether the plight of a particular person inspires me to contribute. Those are important aspects of charity, to be sure, and certainly maybe ones I could be better about. Nor do I view charity as a mere personal virtue, which allows me to take pride in my personal munificence. The concept of charity I absorbed was the first one: the universal goodwill and love for fellow mankind -- the rich, the poor, the drunk, the irresponsible, and the moral imperative to care for them. All of them.

That understanding of charity encompasses it all. Personal charity, giving of yourself to support those in need.  Institutional charity, where my (catholic, incidentally) hospital provides $30 million in indigent care annually. And yes, public charity, where society, as expressed in public policy, creates institutions and systems to take care of those in need.

That's why I favor universal insurance or whatever method of assuring that nobody would go without access to medical care. It's charity writ large. Policy goals are in some degree moral goals expressed and organized on a society-wide basis.

I don't want people to die unnecessarily.

I don't want people to suffer if it is preventable.

I don't want people's financial lives wiped out by illness.

This is why advocate for our country to create systems, be it individual mandates or medicaid or some other system, all too imperfect, to make sure that those who are needy can be cared for -- even if their need was created in part by their own irresponsibility. I pity them, and I hurt for them. We can do better for them -- indeed for all of us, since there but for the grace of god go we and those we care for.

So, anonymous commenters, I do not understand you. Your concept of charity is self-serving, narrow and harsh and not one I recognize. You give with one hand but turn a blind eye to those you deem undeserving. You place ideological purity in importance over real human suffering. You view charity as a personal virtue rather than as a force for good. Fair enough, I'm glad that you are so assured in your own moral rectitude. My vision is ... rather different.

And while I may understand your words, I don't think I'll ever really understand how you came to view charity that way.


  1. My personal frustration is that in my experience giving insurance to the needy doesn't actually improve their health much or change how they utilize health care. (This is based only observation, not on any fact). Just like you can't be an alcoholic and be on the liver transplant list, I don't think you should be able to smoke crack and then have the taxpayers pay for your visit to the ED for chest pain. Those cases out number, by at least 20:1 the number of needy moms bringing their kids to the ED because the baby is sick, which is the type of situation that would make me happy that we are able to help, aiding a family who is trying to do the right thing.

    Basically, it boils down to that I'm happy to help you up and let you lean on me while you get back on your own feet, but I'm not going to carry you on my back.

  2. And that's what he's talking about: picking and choosing who's worthy of charity, vs. giving without judgment.

  3. Some observations from up north...

    1. The absolute PARANOIA about "government interference" in healthcare (amongst others). Heck people, you live in a DEMOCRACY, YOU elected a majority government to make decisions for the greater good of your society. You fear government "rationing", but yet fail to realise you are already being rationed - by private insurance company beaurocrats denying authorisation for an investigation or procedure, in the name of preserving profit for their shareholders.

    2. Capitalism works (or so we hope, the last couple of years have made that premise a tad shaky). That does NOT mean you need to turn HEALTHCARE into yet another commodity. Up north, we have capitalism (and we're doing quite well thank you, due to GOVERNMENT keeping our bankers honest and reining them in), but we keep almighty profit out of our healthcare system : the walls have not come tumbling down... And the MAJORITY of Canadians LOVE it.

    It's amazing how the fundamentals can differ between countries so close to each other. I can't carry a private weapon, does that make me "less free" than you ? Perhaps technically, but societally I KNOW I'm safer when I walk downtown...

  4. @ ER Jedi..

    My personal frustration is with people who say they'd give insurance to the needy if it only show it actually worked according to my observations and not based in any facts are really just greedy bastards trying to come up with way to feel good about not giving. (This is based only on observation, not on any fact.)

    See what I did there?

  5. I am sure this will not come out the way, I want it to, but I hope that my point comes across.

    Charity is a personal trait. It is an important trait, and people need to develop it in their lives. It is about having a generous spirit and freely giving of yourself to others in need.

    But Government can't be charitable. Government, by it's nature, can't be charitable, it is amoral. Taking money from people by force of law, and giving it to other people isn't charity.

    The use of Government Power to make other people make the decisions you wish they would make on their own isn't charitable. It doesn't make you charitable to vote for these uses of force.

    That is why even good Christians can disagree with Government healthcare and still be Charitable people. Because they know the difference between true charity and government power.

  6. Wow. I hope its just old codgers waiting to die off, and not some infestation of "fuck you I got mine" into my generation. That would make for a pretty shitty world. "Oh no da gubments be takin my money!" WRONG! You are paying for services fuckwit! Some of us might one day decide that healthcare is a service we would like to be universal, like police and firefighters. And when we do, we won't be "forcing you at gunpoint to pay for other people's healthcare" unless I was "forced at gunpoint to pay for two violent wars I vehemently oppose", I just paid my taxes. Its how government works, sometimes you pay for stuff you don't like because we live in a representative republic. Grow the fuck up and deal with it.

    Oh and not to mention that it would be less expensive overall and for all for a single payer system. But fuck that! I prefer the demagoguery of the talking heads on TV that simultaneously espouse jesus as their god or whatever, and then tell the poor that sometimes they're undeserving. Something about claiming the moral high ground and then spurning the needy must have an appeal but I can't see it. Maybe you should admit you just aren't compassionate. This is the hypocracy that turned me into an atheist humanist as soon as I reached the age of reason.

    Thanks for being good to other people Shadowfax, it gives me some hope for humanity, and healthcare, to see that at least one ER Doctor has compassion for all.

  7. You can give money. You can give heat and telephones and money for homes. You can't GIVE healthcare. You share healthcare or you don't. Even the insured share healthcare dollars; paying a little extra than they use now in hopes that there will be some left over when they need it. I paid into the system for over 40 years. And with the recent downturn find myself forced into self employment. I'm working harder than ever but am uninsured. Can't get insurance---turned down because of pre-existing and probably couldn't afford it if I could get it.

    But I paid through my higher premiums into the system for years. I paid for a little girl who had leukemia on the same health plan. I paid for someone else's diabetes. I paid for another's asthma.

    We either SHARE or we don't. Somewhere there is a little girl who is now a full grown adult woman because I paid into the system. I would still have paid even if I knew that I would reach this point in time when I have to do without.

  8. Taxes are the price we pay for living in a civilized society. Elizabeth Warren gave a nice little speech explaining that today.

    Nice example is Ron Paul saying today that his employee that didn't have health insurance got health care anyway even without the government. Well, the reason why he got healthcare was because of federal regulation that required the hospital to treat him regardless of his ability to pay. Otherwise he just might have been turned away at the ER door.

    When the nice comfortable upper middle class drive to hospitals they drive there on roads that were paid for by taxes. The hospitals are funded in large part by tax dollars, built using roads, federal regulations that keep them from collapsing on our heads etc.

    You want a libertarian free for all, then Sommalia would be your idea of paradise.

  9. I have to agree with Don here. I think that it's important to distinguish between being charitable on a personal level and having the government take care of us.

    I volunteer at the nearby free clinic because I know that I can provide some help to those people in front of me. I see the people in a very personal level and try to provide the best care possible to someone who would otherwise not see a doctor. That is very different from having some govt bureaucrat make demands to the public. Sure, wider govt action has the POTENTIAL to produce larger results, but the possibility of failure does not sit well with me. I would much prefer to help someone with my own two hands rather than stick a check in the mail and hope the govt will do it for me. I mean look at how incompetent our Congress is! That's who we're forced to trust?

  10. Maybe it makes you feel all warm and fuzzy to donate with your hands. Well, if I was broke and needy it would make me feel all warm and fuzzy to know that I could rely on my government to provide a social safety net. Not to have to go scrounging around, looking for a free clinic some where.

    Have you tried to find free health care? Nothing is stopping people from providing it now but try to get your gallbladder removed for free and check back with me and tell me how it goes.

    Everyone is happy to have the government pay for the services they need and when they need them. Oh we love our roads, our police, our regulations that benefit us. Oh and don't forget our subsidized medical educations. I paid $200 a year for my nursing school. Even 30 years ago I don't think that totally covered the costs by a long shot. I think someone pitched in some tax money to subsidize it. And the same thing goes for MD training. These doctors act like they've never heard of DME payments.

    When you did your residency did the feds fund it or did your patients volunteer to give you a stipend and you just got to live on whatever they doled out, out of the goodness of their hearts. You know, if they felt like donating to you that day, you got paid. Because that is the system of health care you're recommending for the poor. They get whatever we feel like giving them on any given day.

  11. So you don't want peoples' financial lives to be ruined by illness, but it's totally cool to continue to increase the tax burden of the working shmucks like me who have two weeks' salary saved up and nothing in their child's college fund to pay for able-bodied men and women when they either feel the need for a fix of narcotics, a script for benzos, or acquire some actual illness in need of real medical care.

    I'm sorry, sir, but screw you. I work my ass off. I don't get a dime of child support because my ex is a degenerate that one of you libbies is going to have to save by taxing someone at a higher rate at some point when he kills his liver. I don't get any help from anyone. I get people swinging at me, cussing at me, and, as of yesterday, biting me in my job. I do all this crap at bizarre hours of the night, forgo friendships in favor of extra shifts, and haven't seen most of my family in a year.

    I'll keep working the 50 hour weeks, the double shifts, and all that if you tax me more, but I'd rather just help my son with his homework and watch at least one of his upcoming choir concerts instead of hearing about it. I should have that choice because, hey, I've earned that choice.

    Telling me to suck it up for the greater good is insulting.

  12. I think if the majority of your country is drug-seeking addicts abusing the system, your country has a bigger problem than health care reform.

    On the other hand, I'm just gonna call this the hyperbole that it is. Chances are good the tax burden wouldn't increase enough for it to be noticeable just to cover health care reform and there's plenty of fat to be trimmed elsewhere, but there's an entire political party devoted to never raising taxes for any reason ever ever, nevermind the fact that debt in the US is unsustainable. Chances are good you'd actually save money because insurance risk would be better spread out and there'd be less stupid and ineffective plans that essentially make you pay tons o'cash out of pocket for the privilege of paying your own way for your health care out of pocket. Chances are really, really good that a system which is less patchwork and piecemeal would have an easier time detecting said addicts abusing the system and would be more effective at diverting them towards rehab, but fuck addicts, right? Because they're doing something illegal so they should all just be thrown in jail. Which doesn't cost tax money at all.

    If you don't want to suck it up for the greater good, don't live in a society where sometimes you are required to suck it up and pay for things for the greater good, things like, oh, fire protection services, and police, and roads, and building codes, ad nauseam. Or you could complain about how since your life sucks, that means that necessarily we should not attempt to improve the quality of life for people whose life believe it or not, literally sucks worse than yours.

    That part floors me. I mean, I wanted to come here and be articulate, but after reading that comment I just have to congratulate this person on achieving peak ignorance. That there is some varsity-level derp. That is one step away from professional derp. Bravo.

  13. maribel chavez9/22/2011 10:43 AM

    I don't think most people are opposed to helping those less fortunate - they're not saying "f*ck the poor". I just think they are skeptical - that a new program will be abused by some people and ultimately fail in what was intended for it to accomplish. EMTALA is good in theory but it ended up costing too much when people started using the ER for things that aren't emergencies. That in combination with the expectation that doctors not miss anything,ever and the threat of malpractice lawsuits for bad outcomes (that have nothing to do with the quality of care the patient received) has lead to out - of - control costs. Now hospitals are closing due to unpaid bills. I don't see how the new law will bring costs down. It just seems to make promises to people that it cannot carry out.

    One needs to take human nature into account when coming up with policies. Poor people are just as likely to take advantage of the system to help themselves as rich, selfish conservatives. Most people will end up with high deductible insurance plans under President Obama's law. When the doctor bill/hospital bill comes it will just end up in the garbage because you can't take away the care received like you can repossess a car or turn off the electricity.

    Giving doctor freedom to use their medical judgement without fear of lawsuits or having to live up to unsustainable "standards of care" will probably bring costs down and allow for more equal access. People will have to accept "no" for an answer to requests for futile care. Keep ignorant politicians on both sides out of it. It won't be perfect but we may have to accept that like anything else in life medicine isn't perfect.

  14. Keep in mind, that I've been extremely poor in the past. I lived without central heat for a Winter. I lived without indoor plumbing for a Winter as well (pooping at the gas station gets old after awhile). All of this landed me in the stupid hospital for carbon monoxide poisoning because I just opened the oven and let 'er rip to keep me from freezing to death.

    I sold everything I owned at some point to keep from getting evicted from the same place with no heat and no plumbing. Luckily, I had three jobs which I perfectly timed so that I was working or in school between 6 am and 2 am 4 days a week and 3pm-12am the other days so I only had to heat my house for 4 or 5 hours a day. I was so tired that I literally started hallucinating at one point.

    I don't want to pay for others anymore. I did my time eating oatmeal for every meal and making tomato soup out of ketchup. Let me send my kid to college. Quit taxing me more and more and more with no end in sight. People like me are just sick of the handouts to ungrateful, obese people with better cell phones than I have who don't have goals nor drive to work despite being perfectly capable.

    Working in the ER is a steady stream of these people, and I don't want to work extra to pay for them and everyone else anymore.

    Call me crayzee, but I'm sick of it. Let me decide what I should do with the money that I earned. I pay for millions of peoples' health care as it is. Where does it end?

  15. It ends, apparently, with kicking the can down the road, letting the problem compound itself, sticking your fingers in your ears and pretending it won't get worse.

    Then, once your kids have gone to college (which is an enormous other debate unto itself) THEY get to deal with it.

    What a gift.

  16. I'm not saying that the state shouldn't use taxation to help those that can not or will not help themselves and their families. It should. We might disagree on the extent, but that is all.

    However, all tax is coerced. If you do not pay you go to jail. Nothing in any definition of charity covers coercion. Our host here is quite well off, and deservedly so. If I go to his house and steal his stuff or somehow manage to raid his bank accounts, then give all the proceeds to the poor, that does not mean he is being charitable.

    Charity is when he voluntarily gives part of the proceeds of his hard work to the causes he supports (which he has discussed here).

    Redistribution of wealth is not charity. Charity is voluntary.

    Again, to stave off at least some of the flames, I'm not saying don't tax people to feed the poor, I'm just saying that it absolutely is not charity.

  17. Look no further than Maimonides 8 levels of charity/giving.


    At the top is providing a gift or a loan, entering a partnership, or providing someone with a job. (Under Obama's current economic plan, pretty much impossible). While one might say that giving money to the government to subsidize the poor entails a "gift," look no further than the last rung on Maimonides ladder - to give unwillingly. THIS is the representation of taxation on this scale. NO ONE wants to willingly pay taxes, you are forced to under penalty of imprisonment. The second rung is anonymous giving to a person who does not know where the money even came from. THIS is voluntary. I have voluntarily given to charities of my choice, for causes that I believe in. None of these charities to which I freely give is called, "The Federal Government." Being forced to be "charitable" is not charity, it is redistribution of wealth. A concept that many on the left cannot grasp. To quote the great Andrew Wilkow, "Liberalism - ideas so good they have to be mandatory." Charity is not mandatory, it is strictly voluntary and personal.

  18. Charity is for the giver. It is a spiritual act that everyone should do to be a better person.

    Welfare is for the society as a whole. It is a matter of justice.

    When Jesus says you cannot enter the Kingdom of God without helping the poor, Jesus does not modify it with the deserving poor. That is because Jesus is talking about charity. Likewise, when Jesus tells the rich man, who otherwise followed all of the laws, to give his money away to the poor so that he may enter the Kingdom, he doesn't say the deserving poor. That is because charity is for the giver.

    The government designed by God's followers described in the Hebrew Scripture requires caring for the poor. That is because they are a part of the society and now society with God at its head can ignore them. Note: Allowing the Second Harvest, leaving grain for the poor to gather after making the first harvest, is distinct from tithing.

    We live in a society with hundreds of millions of working poor. They deserve food stamps and medicaide because they are a part of the society that made the rest of us so wealthy by the world's standards, or so ordinary by American standards. While it is surely impossible to develop a formula to make sure each person is justly compensated, it is possible to establish a floor below which no member of societ should sink. Welfare is a matter of justice.

    To be a Christian one must practice charity and pursue justice. That this remains on the heart of one who has long since abandon the ritualistic trappings and ancient beliefs of the faith is a witness to its truth.

  19. Let me try to explain the difference: Charity is a personal, voluntary act. The person who donates to charity makes a conscious decision about the distribution of his donation, evaluating the need of the poor and determining the best way to help them (example: I have been very rewarded when approached by panhandlers when I respond by taking them to eat, instead of giving them money. The interesting thing is the ones who turn down the meal and get angry).

    Paying for "charity" out of the public treasury is neither personal nor voluntary. It's a forced redistribution of wealth. You, in the guise of the government, are putting a gun to my head and telling me to contribute. Think that's a harsh exaggeration? Try not paying your taxes. When this is done at the behest of a majority of voters who have noses in the public trough, it becomes a protection racket - something we used to throw mob bosses in prison for. I guess the government doesn't like competition. Sorry, I don't feel very charitable when there's a penalty if I fail to contribute. The current rhetoric coming from the liberal camp that the rich "must pay their fair share" (They do, many times over, as even the liberal news organizations have had to admit) shows the flaw in your "charity" plan - the greedy beast who demands your charity at the point of a gun will become more and more bold, with an appetite that far exceeds the productive capacity of the wealth producers.

    Sorry, shadowfax, I don't think you've thought this one through, and you are on very shaky moral grounds here.

  20. I suppose it depends on if you think health care is a charity or a basic human right. If you don't think providing some sort of a safety net to citizens is part of the social contract or not of a civilized society. Should all roads be toll roads?

  21. I'm on board with using taxes to pay for this.

    Here's why. We've been very lucky - due to decent graduate-level educations from state schools, my wife and I earn about $200k annually.

    We have no kids.
    We have a nice house in a pretty good suburb.
    We have insurance - both of us - and if one of us loses their job, we'll have coverage.

    So we've been very, very, very lucky.

    ....and our net tax rate is lower than when we were back in the eighties when we were in school. And relative to the amount we keep vs pay in taxes, we're paying a *much* lower percentage than people earning less than us. Part of it is investment income; that's taxed at very low rates by comparison to my childhood days. Part of it is just overall lower tax rates. Part of it is a tax structure that's biased towards lower-wage earners.

    That's neither fair nor equitable.
    I'm willing to pay more.
    Just because people are selfish and have decided that euphemisms that mean "fuck you, I've got mine" is acceptable doesn't mean that they're right. As a society, we have to have a bottom, a floor; otherwise, we'll wind up like India, where a person can fall through the cracks and no one will even care - they'll just go through his pockets & look for spare change.

    I grew up in an America where the wingnut right-wingers declared taxation confiscatory. We've got tax rates which are the barest shadows of those rates and the extremely rich still complain. I'm a top-ten-percenter, which these days is pretty good, and the general attitude I see from people in my tax bracket makes me ill.

    I want an America where kids can go to school and be taught properly - fact-based education, with good math and science education, not thinly disguised religious beliefs (like ID) or idiocies like setting pi to 3.

    I want an America where science and the arts are funded as they were in the sixties and seventies - when we sent people to the moon and designed some of the most groundbreaking technology ever invented, some of which gets used for medical care.

    I want medical care that is available to everyone.....because when an epidemic happens, I want people to be able to get treatment, to get into the system, before they become vectors of disease. And I want people to enjoy a decent standard of health, which allows us as a people to do better on the whole.

    Selfishness runs counter to the goal of great things happening. And it's why I will advocate increasing taxes on the very rich - and on myself. Because I want the America I grew up in, which was far from perfect, but far more equitable than today.

  22. I don't have insurance, and I'm making about $600 a month at the moment (with $423 a month in child support, which could change at any moment). We don't have stairs inside to my son's attic room; we use an old wooden ladder instead. The rungs are smooth enough, but he got a splinter that went in too far for us to remove. I took him to the Saturday After Hours clinic, and they said, "Nope, we can't deal with it. It will require an anesthetic." So we went to the emergency room. I received the bill this week, and I have yet to open it--in fact, I think I'll delegate it to my daughter. Sure, they'll probably write off a lot of it, but now I'll have to fill out reams of paperwork to prove that we're poor. To get my son a cheap checkup so he could get more asthma medicine, we said he needed a sports physical--those are only $35.00. Yes, I suppose that my poverty is my fault. Silly me.

  23. My idea of charity is to sterlize those who have too many babies they can't take care of. To assume that everyone has common sense is to assume too much. Some people really do need someone (maybe government) to take care of them and make decisions for them.

    Go North Carolina!

  24. Charity should be a personal decision, not a government mandate. Charity is nice, when you can afford it. I just can't afford it right now. (Thank you bankers, for destabilizing the world economy, again. See 1929 Great Depression.)

  25. Government doesn't really do charity. They pick winners and losers. Healthcare costs have shot up in proportion to how much the government has involved itself in deciding what care we can and cannot have. Only a government could spend $5 in enforcement to eliminate $1 in waste, fraud, and abuse, and consider that to be a dollar saved. It's this sort of mindset that causes the transfer of any productive activity to at least double the unit cost of production.

    And, as Papa Ben has said, "The State which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person—every person—needs: namely, loving personal concern." Trust me, the notion that everyone be cared for is important to him, and he's smart enough to recognize (and remember) some methods that just do not work.

    Requiring the selfish to be charitable is sort of like swordpoint baptism.


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