Tuesday, October 5, 2010

To Pay or Not to Pay

There has been a spate of articles lately about a fire department in Tennessee that refused to put out a fire at a burning house, because the owner had opted out of paying the annual $75 fee.  This “event” has given rise to many articles and comments about the issue, virtually all of which are on strongly opposing sides:
Side One – the owner gambled, he lost, tough shit.
Side Two – what kind of community fire department would stand there and allow a house to burn down? Of course they should have intervened.
Whether in this instance the fire department had a moral obligation to intervene is, to me, not clear cut.  The department was operating according to the rules set by the community itself. But it raises a host of other similar moral questions.
Suppose someone who could pay for health insurance makes a conscious decision to go without, and then becomes sick. Does the health care system have a moral obligation to care for him? In our current system of care, that question is answered generally in the affirmative. The health care system asks about insurance, but will engage the patient even if no insurance is present. Hospitals then try to get reimbursed from the uncompensated care fund, paid out of Medicare. But many would argue that the health care system should not be forced to subsidize the uninsured.  The trouble in health care is that the uninsured are not always uninsured by choice.
The central issue, for me, raised by this fire department policy is how a community could decide to so “privatize” the fire department function? What is it the community as a whole expected from this policy, and did they ever debate the situation that actually occurred (and that occurrence was inevitable)? I have difficulty imagining how this policy was moved from an idea to a final community policy. Did they, for example, only debate the positive side of this concept (assuming there is one)?  Did nobody raise the scenario that a fire department and a group of neighbors would be forced to watch someone’s house burn down? It is troubling greatly to consider that an entire community could have debated such an issue and then voted to adopt such an approach. What kind of community would do that, and would I ever want to live in such a community?
I find it troubling precisely because that fire department policy defines, on a small scale, where our political process is heading us. It defines the Tea Party, for example, and what I perceive the Republican Party has become—perhaps they are the “pay to play” party.  No, that is wrong. Republicans never actually want to pay for anything. But they do seem intent on denying a bunch of “other people” services that have become an accepted part of American community life.  They want to “privatize” social security, returning us to the system under which my grandparents operated, and under which they ran out of money, mainly because the depression robbed them of their savings. They want health care returned to the purely private sector, eliminating any chance of providing access to care for all of our people. They seem to want to “privatize” education, if their insistence on charter schools is any indication. 
The central problem with privatizing is that, eventually, the privateers will figure out ways to maximize profits by denying services to some subset of people. It isn’t a question of whether, but only when they do that.
And that raises the question of what kind of nation we will be if we consistently opt for increasing private profits over the general welfare of the people.  Perhaps the election of 2008 will answer that question.
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