Saturday, December 12, 2009

On Entitlements (part I)

As a realtor I regularly process rental applications, which entails a conversation about their credit. I am frequently told "I have a few bad marks on my my credit, but don't worry they're only medical collections..." The majority of these collections do not reflect an individual's inability to cover the costs of seriously medical treatments. A surprising number of them are for minor treatments or delinquent co-payments that are under $250. Before turning over a medical bill to a collections agency, most doctors and hospitals offer payment plans that allow individuals of moderate incomes to fulfill their financial responsibility.

So, I have concluded that many of these individuals do not feel the need to pay their medical bills, because they feel that medical treatment is a right that doesn't entail any responsibility. Many rationalize their behavior with the belief that "doctors, hospitals and governments have deep pockets and can afford to pay for the little guy," conveniently avoiding the fact that the cost of their unpaid services are passed on to responsible citizens in the form of higher insurance premiums and higher taxes.

So, we come to the terrible dilemma - how does a humane society ensure that all its members receive vital services without fostering the very costly belief that these entitlements are rights bereft of equally important responsibilities? I fear that this dilemma is so difficult to address because it stems from changes in culture and values more than government policies.

I recall an interview with the actor Jerry Stiller in which he spoke of the intense shame his father felt during the Great Depression when he had to receive government assistance. Accompanying this shame, many individuals spoke about the heartfelt appreciation they held for those who provided them private or public assistance. On an individual level this sense of shame may not be healthy, but on a societal level it is a key component of a functional welfare state. If shame is the "brake" that keeps the welfare state under check, then our growing sense of entitlement is the "gas pedal" that is fuelling our impeding collision course with an unmovable wall of fiscal reality.

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