lookingforlissa

Escape your life for a little while — come play in mine.

Responsibility

Posted by Lissa on October 12, 2009

I’ve been struggling lately with the idea of Responsibility.

When people are not held responsible for their actions, it leads to their taking more irresponsible actions.  Whether it’s moral hazard (folks with insurance behaving more recklessly than those who have none) or simply being Too Big To Fail, allowing people to escape the inevitable rules of Action-Consequence subsidizes the feckless at the expense of the cautious.

So, great, adults should be held accountable for what they do and don’t do, and a safety net should not turn into a safety blanket.  Simple enough.

But what about their kids?

Children don’t have control over their situation nor the actions of their parents.  Is it fair to let children go hungry or without adequate medical care because their parents are too irresponsible to care for them?

On the other hand — is it fair to rob Peter to pay for Paul’s kids, especially when Peter *was* responsible enough to care for his offspring?  If it’s taking money from Peter that he intended for his kids’ college educations, his grandchild’s baptism, whatever?

One of the inescapable rules of economics is that if you subsidize something, you will get more of it.

How do you provide a lifeline for a family like Paul’s without encouraging more parents to behave like Paul?  How do you provide care for children who deserve it — having done nothing wrong themselves except be born to *ssh*les, which is hardly their fault — without having more adults assume it’s someone else’s job to provide for their kids?

I’m groping for a solution here, but all I’m coming up with is social stigma — providing that care to children of feckless parents, but emphasizing the idea that it’s shameful to be on the public dole.  Of course, for all I know, raising kids with that idea — that their parents failed their responsibility test and their children should see that — would screw up the poor kids to the point that they’d all end up on welfare or be gang-bangers.  Goodness knows I’m not a sociologist and haven’t done the studies.

But suddenly the culture wars don’t seem nearly as silly to me as they did when I was growing up.

I shall end my rambling here and ruminate further.  Tell me — do you have clear thoughts that can help untangle the jumble of my own?

UPDATE:  Jay G links.  Thanks!

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11 Responses to “Responsibility”

  1. Brad K. said

    Back in the day, some 40-50 years ago, in rural NW Iowa, I seem to recall that the county (not private) hospital got some funds from the county for poor people that got help but couldn’t afford it. There was no program, no one had a “right” to care, and if it wasn’t urgent, you might well be turned away.

    Care was simpler then. Most pharmaceuticals were less expensive, if less effective. There was less expensive testing or equipment. Much less insurance for the hospital, doctors, nurses, etc.

    The attending doctors and nurses were mostly compassionate,but they determined who to care for and what to treat – and there was little recourse if you were turned down. Find yourself a family doctor, or risk not being cared for. Unless you needed urgent help, your family doctor, not hospital staff, admitted and treated you.

    Sometimes tragedies happened, sometimes there was no doctor available when someone hurt arrived at the hospital. That was before the county hospital had an “Emergency room” cost center with stellar emergency room prices (since insurance plans will pay emergency room prices and make the facility cost effective).

    There were some supporting practices that made it work. One was vagrancy laws that kept down the number of homeless and permanently unemployed; there was the county “poor” farm to take care of various issues. Hospital stays, barring surgery, cost less than hotels – or motels! – do today.

    Lissa, I can recall over the last 20-25 years that communities across America, good places to live and work, have been looking for doctors to practice family medicine. Remember “Northern Exposure”, about one remote community jumping through hoops to get a doctor? Or Michael J. Fox’s “Doc Hollywood”? Increasing regulations have caused some to avoid family practice, or medical practice. Or convinced students not to enter medicine. The increasing cost of practicing medicine, due to regulations, reporting requirements, insurance, association fees, etc. means that the rates they must charge to make a living – bar many of those hurting for care from seeing a doctor. Which might be what some considering a career in medicine wanted to do, to help those that need help.

    Today hospitals badly misuse Emergency rooms. The Emergency room concept, is primarily a profit center, a very profitable cash cow. Despite wails and complaints about costs of serving the poor and uninsured, hospitals still make excellent revenue on the insured people they serve, that they collect insurance payments and copayments for their services. And what Obama wants is to make the Emergency room everyone’s medical clinic.

    What Congress should be doing is stop their madness. The answer is not to expand impromptu hospital visits, not to guarantee insurance. The answer is to fund medical school expansions for larger classes to graduate more doctors and nurses. To encourage local governments to operate hospitals to serve local needs, even though services will be limited by local economic conditions. Cie la vie.

    I worked with a software engineer in Colorado Springs some 20 years ago. Mike was irate that his daughter couldn’t attend the public school across town from where he lived – the school he wanted her to attend was in another district, a district that spend loads more money on their schools. I asked why he didn’t move to that district – he told me he couldn’t afford to live their, the real estate costs and taxes were too high. I asked why he should use, for his daughter, a school that others were paying for – and he got irate at me.

    I see many aspects to medical care. One is ability to pay, and level of care one should expect. Now that hospitals are mostly privately owned, and for-profit, now that insurance feature and requirements are factored into everything from level of staff to length of stay and type of meds prescribed, I expect it would be tough to regain control for the good of the people, instead of for the profit of the medical and insurance communities.

    Nothing I have seen of any of the proposed variations of ObamaCare address the fundamental issues – and I think the fundamental issue is abuse of medical care by the medical community for profit, and abuse of medical care by the people being served, from malpractice claims and awards to frivolous use of emergency services.

    As far as insurance goes, Senator Coburn’s proposed insurance exchanges have taken some seriously nasty twists that lock out potential participating insurers. And much of the inequity and local monopoly aspect of medical insurance is due to inept regulations within individual states.

    If you treat unpaid medical bills as essentially unpaid taxes, you could leave to various counties and local governments the option to collect, if they want, exactly as if you failed to pay property taxes or keep your registration current on your car. Before you lament losing the house for medical care, consider that the county would understand the impact – of social service costs vs the medical care, and make the judgment that serves the most people with the money they have on hand.

    Either that, or let each uninsured person sue Barack Hussein Obama for each medical bill. Since he is the one that wants everyone to get cared for.

  2. Mike said

    All those questions are, essentially, about how to use scarce resources to get the best outcomes. How do we balance equality vs. efficiency (dividing the pie vs. growing it)?

    My take is this:
    It’s important–to me, at least–to have compassion, but sometimes that has to mean tough love because, well, incentives matter.

    Beyond that basic rule of thumb, when faced with bleeding heart liberals, don’t let them put you on the defensive like that. Have “third way” solutions actually worked? Have their ideas solved world hunger, created enduring world peace, or helped the “working class” in any meaningful way? Why must the policies you support be perfect and have no downside when they push policies that are 90% downside? Why do they get to base all their policies on wishes and magical unicorns? Why don’t they have to recognize or resolve the ethical dilemmas inherent in their ideas?

    As a case study, it actually doesn’t matter–when considering specific policy questions–if our health care insurance and delivery systems are good or bad. If someone wants to change them, the important question is whether the changes will make it better or worse. Just about everyone supports “health care reform”, as long as you let them define what “reform” means. There are surely changes I think would help, but they’re just about the opposite of everything Obama wants.

  3. Jay G. said

    Lissa,

    Excellent post. I’m hoping to expand on it further later on today/tonight. Thanks for the inspiration!

  4. Borepatch said

    An engineer would say that it’s less important what the specifics of where you set any public benefits, and more important that the system be self correcting.

    This suggests short term benefits, focused on moving the recipient towards self-sufficiency. If you can do that – and it’s not easy – then you can get at least a small taste of win-win.

    If you set it up like it is now, you get a big taste of lose-lose.

  5. wolfwalker said

    My 2c worth:

    “Is it fair to let children go hungry or without adequate medical care because their parents are too irresponsible to care for them?

    On the other hand — is it fair to rob Peter to pay for Paul’s kids, especially when Peter *was* responsible enough to care for his offspring?”

    Neither one is fair. So, how about a third alternative: parents who refuse to care for their kids properly, don’t get to keep them. The kid(s) get taken by the State long enough to place them with a foster family or adoptive parents who will take proper care of them.

    We can and do take kids away from parents who abuse them, and we can and do prosecute parents when their kid dies because they refused to get a life-threatening illness treated. I admit up front that it’s a really, really ugly precedent to set, because the possibilities for abuse by the State are enormous. I don’t know how such a program could be run without turning into a horror show where kids in Massachusetts are taken away from gun-owner parents, while kids in northern Arkansas are taken away from parents who teach them about evolution.

    But it’s an idea to consider nonetheless, and I doubt the outcome could be much worse than either of the two you gave, Lissa.

    “One of the inescapable rules of economics is that if you subsidize something, you will get more of it.”

    This isn’t just a rule of economics. It’s not even just a rule of human nature. It’s a blanket law of organic life, from humanity all the way down the scale to bacteria. If you reward a behavior, you encourage it; if you punish a behavior, you discourage it.

    There’s also a corollary that few people ever grok, except kids and those who remember what being a kid is like: Absence of an expected punishment is itself a reward; absence of an expected reward is itself a punishment.

  6. totwtytr said

    Sorry, Wolfwalker, I’d rather see little kids starve than let the state decide who is fit to be a parent and who isn’t. Once you open that door, even a little bit, then it will swing wide and the state will decide EVERY aspect of parenting. Uh-uh, I’ll take my chances with an unfair society.

    Lissa, you ask a difficult question. I’ve commented more in JayG’s post, but there should be limits on how much those who are responsible have to help those who aren’t.

    Brad_K, last time I checked Emergency Departments weren’t big money makers for hospitals. Specialty units are, and in many cases the EDs are used as the gateway towards those places. All while being understaffed themselves.

  7. Sailorcurt said

    Back when charity was still charity and was not a state-provided “entitlement”, there WAS a stigma attached that generally kept it limited to the people who actually needed it.

    Our society has worked very hard to remove the stigma and is now (and actually has been for quite some time) feeling the unintended consequences of it.

    Children don’t have control over their situation nor the actions of their parents. Is it fair to let children go hungry or without adequate medical care because their parents are too irresponsible to care for them?

    Life isn’t fair. Never has been, never will be.

    Is it “fair” that the vision in my right eye barely meets the minimum requirements for military service, I have no depth perception and so, was not capable of volunteering for the more prestigious military jobs that would have enhanced my career?

    Is it “fair” that little johnny down the street was born borderline retarded and will never be capable of any employment that doesn’t require repeating the phrase “would you like fries with that” at the end of each customer interaction?

    Is it “fair” for the kid who, although physically cared for, was raised in a home of alcoholics and never got any emotional support or caring?

    We already have laws on the books (too many if you ask me) against neglect, child endangerment etc.

    Fairness of circumstances cannot be legislated no matter how badly we wish it to be so and trying to do so only leads to tyranny.

    The path to Hell is paved with good intentions.

  8. Borepatch said

    A short but interesting discussion here.

  9. Borepatch said

    Linky no goody.

    http://tjic.com/?p=13025

  10. TBeck said

    My personal belief is that anyone receiving public assistance should not be permitted to vote in elections for that level of government until they are no longer receiving those funds. Otherwise we end up with multigenerational dependency and the grasshoppers voting themselves the keys to the ant’s larder.

  11. Some guy named Peter called me, said that the 15% of my income that I shell out for my family’s medical insurance each month was going to go up by 1/3, so that the $0 a month that he spent on HIS family’s medical insurance can be used for essential services like nose jobs to improve his kids’ self-esteem.

    Paul

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