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in a piece titled Scott’s Story and the Election. He wrote this in part because of the response he got from readers after they read his first piece on Scott, about which I previously wrote in Nick Kristof offers a personal story of why we need Obamacare.

We saw the selfishness that has become too endemic, in part because of conservative rhetoric, in responses Kristof received.

For example:  

“Your friend made a foolish choice, and actions have consequences,” one reader said in a Twitter message.
  And also this:
“Not sure why I’m to feel guilty about your friend’s problem,” Terry from Oregon wrote on my blog. “I take care of myself and mine, and I am not responsible for anyone else.
  Those are mild compared to someone named Bruce who argued in part
Extreme age and debility, patients so sick, old, demented, weak, that if families had to pay one-tenth the cost of keeping the poor souls alive, they would instantly see that it was money wasted."
To his credit, Kristof takes a different viewpoint, which I explore below.

First, Kristof turns to the Pew Poll to show us how attitudes have changed, that among Republicans the percent who think government should function as the provider of last resort for those who cannot care for themselves has dropped from 58% 5 years ago to 40% today.

Kristof offers 2 counterarguments.

First, a civilized society compensates for the human propensity to screw up. That’s why we have single-payer firefighters and police officers. That’s why we require seat belts. When someone who has been speeding gets in a car accident, the 911 operator doesn’t sneer: “You were irresponsible, so figure out your own way to the hospital” — and hang up.
  He thinks those who argue from a Randian perspective are being sociopathic, and that
Compassion isn’t a sign of weakness, but of civilization.

And then

My second argument is that if you object to Obamacare because you don’t want to pay Scott’s medical bills, you’re a sucker. You’re already paying those bills. Because Scott wasn’t insured and didn’t get basic preventive care, he accumulated $550,000 in bills at Seattle’s Swedish Medical Center, which treated him as a charity case. We’re all paying for that.
 Here I might note that we do not necessarily ALWAYS pay for emergency room treatment - if you are treated in an emergency room to stabilize you but you do not have insurance you will still be billed.  Thus what is happenings to Scott is something different - treating him as a charity case, and for that the expenses incurred by the hospital are covered by spreading them incrementally across all paying patients, in a way not dissimilar from how being in large pool of insured spreads the costs/risks of expensive treatment across all members of the pool, even those who rarely need any kind of treatment.

Let me stop for a moment and point out the obvious - the larger the pool the less the additional costs imposed on individual members who do not use the services.  Logically and financially what would make sense is to put everyone into a single pool.  That is what Medicare does with our seniors, although there is nothing to stop them from obtaining additional insurance in private pools.

The costs that are experienced in Medicare are higher than they need to be had all who participate in the program had health insurance throughout their lives and thus been able to get preventative care or early treatment, many would need less treatment later in life, because they would have been healthier over the years.

Obamacare is a weak first step towards complete coverage.  It is weak, but it is still very important, in part because it provides for preventative screenings, including for seniors, because it provides an opportunity for young people to remain covered on parental plans until they are 26, because it addresses many issues of women's health.  We should remember it is a first step, and that we will still need more.

The coverage needs to include vision, mental, hearing and dental.  We need to stop cutting off much medical coverage at the neck.  Again, I remind people of Deomante Driver, the 12 year old from the school district in which I taught at the time who died from a toothache, an abscess.  His mother did not have enough access to dental care to treat both of her children.  The abscess spread to his brain.   Had he been able to get an $800 extraction he would have been a healthy young man.  Instead, he had multiple operations and the costs absorbed because he was a charity case exceed $250,000, yet he still died.

Kristof reminds us that an American dies every 20 minutes because of lack of insurance.

He reminds us that it is not like this in other civilized countries.

He compares the deaths he has seen in places of conflict like Darfur when they would not have died if born in Britain to how we have Americans dying because of lack of healthcare easily obtainable in other civilized nations.

His friend Scott has now died. Kristof views his death as unnecessary, and that life expectancies are greater in countries that have universal coverage.  He ends on a personal note:

So Scott, old pal, rest in peace. Let’s pray that this presidential election will be a milestone in bringing to an end this squandering of American lives, including your own.
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