Is it ethical to contract for a service you know in advance you'll be unable to pay for simply because you really need it?

It may seem like a simple question with an easy answer, but it's not.

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Same with life saving surgery. If you need it, you need it. If it's so out of this world expensive that it forces you into bankruptcy, too bad! That's a problem with the healthcare system that needs to be fixed. I'm not just going to keel over and die because some fortune 500 CEO needs more money in his pocket to pad his balls, lol...If I have no choice and HAVE to "charge it" and figure out the finances later, so be it.

more money in his pocket to pad his balls

That doesn't even sound remotely comfortable.

.If I have no choice and HAVE to "charge it" and figure out the finances later, so be it.

Interesting you should mention that, I mention something similar in my post below. Look forward to reading your response.

My point was that, isn't it strange that services we need just to maintain life and health need to be afforded, or if you can't afford them, you are in some sense cheating the provider?

It's an argument that necessary medical and health cARE should be a social service not a business.

isn't it strange

Capitalism - not even once!

Health care for profit is a truly evil thing

You are right, this question is not as simple as it seems. I would say no, it is not ethical, BUT, do ethics even apply when basic survival is at stake? I'm going to assume ethics do not apply when basic survival is at stake.

Here's where things get interesting: If the role of government is to produced a civilized society (i.e. one where people are ethical), I see two possible solutions:

  1. De-privatize essential services and offer free/affordable access to those services.
  2. Pay for access to the above mentioned essential services on behalf of your citizens.

I prefer option 1 although I know many in the US, and some on this site, would disagree on principle as taxes would end up paying for the services. To counter that I would state that you will be paying for these services one way or another, either profiting the owners of the services or profiting the health and wellbeing of your society. I know which I would rather.

Option 2 also has some interesting discussions to be had... Leaving essential services privatized means the government provides assistance to those in need of it in order to avoid situations in which ethics are ignored. There are some interesting options on how this can be achieved:

  1. Pay for services outright (either with taxes or fresh "printed" money)
  2. Legislate for service pricing to be controlled and/or nullified for people of limited means to pay
  3. Subsidised loans with minimal repayment expectations

I'd like to talk explicitly about option 3, because that is what is currently in place for university enrolment here in Australia. It's called HECS/HELP (Higher Education Contribution Scheme/Loan Programme). It is available fairly broadly, for approved tertiary education programs. I think the key to it's successful use is that interest is locked to the CPI and there is no expectation to repay it until earnings exceed a certain amount. I think this (or something similar) could be applied to help people pay for life saving surgery and even basic services. Then they can pay it back when they are able, without worrying about being crippled by the debt. I'm curious to know what other people on here think of that.

You're right Unseen. It's not a simple question, nor an easy answer.

After reading the thread, I confirmed to myself that you meant healthcare.

I fail to understand why USA doesn't have the same healthcare as the UK does. In saying that, I kind of do. Too many freeloaders. And it cripples the country as a whole. With an outrageous immigration rate and increased unemployment, it's no wonder the country would go broke if they had free healthcare.

I have been gone from the UK for 15 years now. Things have changed, a lot..

When I was a working class citizen I would pay from my weekly/bi-weekly/monthly pay, income tax and national insurance. Tax went to the government, national insurance went into the health system.

Now I haven't looked into it for quite a while, but I'm hearing that the NHS (national health service) is suffering heavily because of the huge immigration problem now in the UK. Not looking to get any better for the foreseeable future.

The problem lies with the freebie seekers. The ones who do not contribute to society. They are everywhere. That is what has screwed up this country's healthcare.

Now don't get me wrong here. I believe that if you have contributed to this country and paid your taxes etc, you should be entitled to essential care. You've earned it. No ifs, no buts. Veterans, EARNED IT, NO QUESTION. (they way veterans suffer in this country is despicable).

The affordable healthcare act addresses that somewhat. I have enrolled in that this year and I'm entitled to a substantial saving. Which is quite fortunate because since being here in the US I have found it impossible to have healthcare for myself after paying for my wife. It's been some time since I posted on here. In that time my wife had a heart attack. June 5th 2014. Fortunately I had coverage for her, or I'd have lost her, FOREVER. She now has a defibrillator (AICD) and is slowly getting stronger. Her insurance paid $86,000 in total. We are still responsible for $1,300. I am unable to pay for that with my current income. I am hoping to start paying it back this year if work picks up. However, in order to get the healthcare tax premium I had to lie about my earnings. I had to forecast a higher income than I will probably make to qualify. It will cost me about $2,000 more in taxes to save on healthcare. That's just WRONG.

This country is so focused on giving foreign aid, it's forgetting the people who made it what it is. It's so blind to it's problems at home that it's nauseating.

To get back....

I can totally get where you are coming from Unseen. Why should you have to suffer because other people have messed up this nation? I am basing that on the assumption that you've been a long time member of the contribution group. I see no other logical reason for you to ask your question.

I also think that Doctors regard themselves in an unrealistic market value. I like to think of the analogy of myself going to a doctors house to do a simple roof repair. His roof has a similar leak as say my wrist from a metal laceration. He would install a few simple stitches. His invoice would be something like $20 for dissolving stitches and $360 for his hour of attendance. Can you imagine how I would be condemned for charging him $20 for a few shingles and $360 for my hour of attendance. Hmmm...we both had leaks. What's up doc?

Go get your work done brother, and worry not of ethics. The people doing the work sure are not.

Oh, and hello to everyone. It's been a while.

I have always had a hard time swallowing the concept of making money off people's medical misfortune. Especially when the misfortune is costly enough to place the individual into financial ruin, which happens all the time. If you receive medical assistance and are left with bill after bill then one option is to just submit a small monthly payment. This will usually keep the collection agencies at bay if they get involved. We have had to do this for years. In the end they can take what they want after we die and our assets are released to family and debtors. If they don't like that they can take one of their ten dollar a piece aspirins for the headache we have caused them....

One reason health care costs are so high (and that doctors have such an inflated idea of their economic worth) has to do with the cost of their education.

My proposal: free or greatly reduced medical education tied with 10 years of public service.

You see, one reason health care costs so much is the huge debts doctors have to repay once they graduate and can go into private practice.

Ultimately, though, health care should be part of a public health care system with only independently wealthy people (people who can afford it) availing themselves of private doctors.

The other reason health care costs so much is the extravagant cost of prescription meds. Just compare how much common drugs cost in the US vs other countries to see what I mean.

Do you mean doctors think their skills are more valuable than they really are?

Yes. True, they save lives, but so do fire fighters, paramedics, suicide counselors, 911 operators, etc. The difference is years of very expensive education.

"The difference is years of very expensive education"

Yes, and it makes a difference. Both paramedics and doctors can save a life by CPR or preventing blood loss from a wound but paramedics cannot save a life by diagnosing a rare disease based on multiple symptoms which requires extensive knowledge.

It may be true that some doctors have an inflated opinion of their skills (just like people in any other profession) but I don't think it's unreasonable for them to be paid more because of the education they have undertaken. Unless you are arguing that they come out of that education no better informed than when they went in?

I neither know nor care what doctors' opinions are about whether their worth is inflated. It is simply plain that their pay is way out of line and is damaging the healthcare system.

For example, both neurosurgeons and teachers operate on brains, but in different ways, and I think even you can't deny that, in The Big Picture, teachers are of far greater social value, and yet...

"'Becker's Hospital Review' reported that neurosurgeons enjoyed an annual average salary of $767,627 in 2010." (source) I would assume it's crept up a bit in the last four years. Also, remember that that was the average salary in 2010, not the top!

"The average teacher in the state of Illinois makes $61,402." (source) This number surprised me by actually being higher than I had expected. I didn't devote a lot of time to discovering a national figure, but I think we can agree that a national average wouldn't be wildly off that figure. I wouldn't be surprised if in California it was more like $80,000 while in Arkansas it might be more like $45,000, but I feel comfortable with this figure as fairly average.

Which one would you say is inflated? Which one's pay is contributing to out-of-control medical costs.

Okay, so teachers probably contribute little to medical costs. How about nurses?

Hospital nurses made $64,750 in 2009. (source) I think it's fair to assume that nurses working in social service agencies often make considerably less than that!

Why do we pay neurosurgeons whatever they want? You could say it's because of their skills, but isn't it always because when you need a neurosurgeon you basically have a gun to your head? You're paying under extreme duress.


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