I am sorry to hear about your mother. As I have mentioned before, rare diseases should be covered by insurance. I have nothing against insuring unpredictable, rare, and protentially lethal or disabling conditions. But if someone has the misfortune to carry a genetic disposition to develope a deadly condition at a reletively young age, and if s/he knows about it, or should know about it from early on, then it is a sightly different and more complicated story. It is certainly a sad unfortunate situation. But tragedy happens in life from time to time.

I think the senario, where “we all cannot have access to good health insurance policies” as you put it, is extreme and not a fact. The reality is that most of the prudent, discerning and responsible individuals in a society can, should and do get decent health care.

The case of children harmed by pollution is a totally unrelated matter. Those pollution victims ought to file class action suits against the polluters, who ought to compensate for the damages they caused themselves. But the society at large should not get penalized for the irresponsible and illegal acts of few bad apples. In fact, arguments could be made that the society has been victimized by pollution as well. And that is often why some polluters are criminally prosecuted.

I do not claim that people have “full causal power” over their health. That is a gross oversimplification. There is a large body of philosophical literature on causality, determinism/indeterminism, moral responsibility, blameworthiness, legal obligation and so on and so forth. I don’t want to give a tiresome lecture about my philosophical positions on these issues. But please let me say this: I definitely do not think people have, or can possibly hold, “full causal power” over their health. In fact, I do not even think that any agent has any “full causal power” over anything. Although causation is a crucial, necessary condition for responsibility, responsibility does not require “full causal power.”. Often times, people who are quite removed on a causal chain from an incident are still held responsible for it (think about negligence cases).

If the less-privileged are suffering from bad health, because of poverty and the consequent unhealth life style, how is good health care going to solve the root of this problem? You would have to solve poverty first. So that is a different issue.

You may wish to set a bare minimum for every member of the society that includes rights to health care and so forth. But the reality is that it is just way too expensive. The welfare state is never sustainable in the long run, even for the wealthiest, most productive nations. There has been many crises in rich European welfare countries (for example, in Michael’s country, Sweden in 1992). And even after widespread welfare reforms in many welfare countries in the 1990s, they still cannot escape the debt spiral. Given the current economic condition of Europe, I expect to see collapses of welfare systems across Europe in the next decade or two. It is already happening in Iceland and Ireland. In the US, Medicare and social security are already broke, which is the real reason behind the proposal of Obamacare. But even when Medicare was looking fine, the funds were run like a giant Ponzi scheme. (This is no exaggeration. Look up the details if you will. It may scare you.) If the US couldn’t cover all its citizens during the boom years, how can it possibly achieve it now?

But there is something more basic and important. I know it is unpopular and politically incorrect, but the truth is there is always going to be stratification in a human society. There will always be helpless cases that are bound to fail no matter what, because as I said, evolution by natural selection just happens everywhere. You can never stop it, unless you are willing to take it over, and to substitute some artificial selection for it, such as family planning, ostracism, and eugenic programs, to ensure some minimum quality standard for entering the society. But to the PC crowd, any vaguest allusion to such artificial process is just far too abhorrent. Yet, on the other hand, they simply cannot admit the existence of Darwinian natural selection among humans, even as it carries on in its powerful but inconspicuous way. So I suppose the high-minded people will just keep playing with their lofty ideas, wishing for the unattainable egalitarian utopia, and keep getting disappointed.

Compassion is a euphemism for pity in my mind. It is a lovely concept, and a noble feeling. But it amounts to nothing but kin selection in scientific terms. Arguments that appeal to emotion rather rationality are moving and touching. But one cannot take them seriously. I, too, prefer good neighbors. But I would want them to be reasonable rather than emotional. Mindlessness is always more dangerous than heartlessness, because history made up of episodes of the heartless defeating the mindless.

I agree totally. To let someone die or suffer on economic grounds is horrible. A Chinese friend of mine explained to me about the difference in health care service in America (New York) and in China (Beijing). He said that if you need emergency hospital care in USA you will get if, even if you are uninsured. No hospital will let you die. But this happens from time to time in China. If you need emergency health care here you have to pay, otherwise they wont treat you. In fact they need a deposit before they treat you.

In fact some people die because they can´t even afford a simple treatment. We see this on Cctv (Chinese tv) all the time. Sick people tell their story and some other people collect money so they can get treatment.

Coming from a country that has universal health care for all I feel horrified of some of these stories. To hear that some people die because they can´t afford a simple visit to the doctor is very, very sad. When you see them it is often to late. Something that could have saved there life at an early stage can´t be treated now.

Outside of Beijing’s biggest hospitals you often see poor people sleeping, they might have some relative in the hospital. They are to poor to stay at a hotel so they sleep outside on madrases they cary with them. Winter and summer you see them there. I think about my easy, lazy life , so rich in comparison and I feel shameful. I admire the strength of these Chinese, but they deserve better. My heart breaks every-time I see a very old person among them, especially wintertime.

But there are people who try to do something about this: like the Chinese Christian female dentist who treats patients in her little hospital that she pays by herself. the cost? What they can afford. If they are old, sick or poor it´s free. I felt very moved by this when I heard here story. I talked to some of her patients and some said they had never been to a doctor.

You can´t help being moved by such compassion whatever your views are on religion. Coming from the worlds most secular country I have never seen something like this before, you Americans see this all the time of course? I admire her.

Jocelyn: you write very good articles! Keep up the good work!

You are right that death is inevitable. Nobody would argue that there is something wrong with an elderly individual passing away in their late 70s, 80s or 90s — for the most part, many of these deaths are because the body has aged to the point where that person cannot survive any longer.

Yet, you are missing one point — death is a problem when it hits people at a younger age, when they still have families to care for. Dieing when you are, say, in your 30s or 40s is not a certainty, yet it happens. And when it happens due to illnesses that could have been completely prevented by medical treatment that is commonly available, it is, again, a travesty. This is why we have term life insurance policies. If a husband or wife should die while they are still within child-rearing years, and have a family to care for, they need monetary support to make sure that they can get through those years ahead. Now, once your children have left the home and are independent, and as you get older, yes, life insurance becomes less meaningful. But not while you’re young and having to provide for your family.

The fact that we all cannot have access to good health insurance policies means trouble for those who are younger and within child-raising years. Because even with the best of intentions, stuff happens — including illness that has nothing to do with your diet or exercise or reckless life choices (my mother, who wore sun screen her entire life, died at 47 from an advanced melanoma that no one caught until it was too late — and she took very good care of herself on diet/exercise). Some people even are getting sick because of pollution in the area (think, the kids with high levels of lead in their blood in Shaanxi Province). No one ever has full “causal power” over illness, despite what you believe.

You also say:

Moreover, your lifespan is directly causally linked to your own behavior: Lack of exercise, unbalanced diet, reckless attitude, and unhealthy life style in general can all compromise your health.

Studies have shown that those in poverty — especially in the US — tend to be the most obese, because the cheapest foods (think processed) are also the worse for your health. Should we yell at them to get off their fat butts and start working out, and buying better foods? These people are just trying to survive and pay the bills. Sometimes they live in neighborhoods where, if they would go out to run, they might be afraid of getting shot. Note this quote from the article I linked to above:

Many poor neighborhoods lack large grocery stores that offer the lowest prices and greatest range of fresh produce, brands, package sizes and quality choices, or farmers markets that sell locally grown fresh fruits and vegetables. Transportation to large stores and farmers markets may be unavailable or expensive. Consequently, many people in low-income neighborhoods depend on local convenience stores — stocked with expensive, processed, prepackaged foods — to feed their families. Their other alternative is fast-food restaurants, where value meal pricing provides calorie-dense, low-nutrition foods.

In your desire to put all of the blame on the individual, you fail to recognize the barriers that individual faces. And you fail to acknowledge the inequities.

Also, you need to recognize that covering all individuals lowers the overall costs to the system. If people, even those with less-than-perfect diet and exercise, actually had access to preventative health care — you know, regular physical exams, screenings (things people might skip because they don’t have the money) — they would catch problems earlier and be able to treat them at a lower cost. Rather than, say, going to the emergency room when it becomes a crisis and then leaving the hospital with yet another huge unpaid emergency room bill.

As for the idea that every human life is invaluable in and of itself, I am not here to decide what lives are more valuable than others, nor would I ever enter into any debate about whether a plague was a good idea. I do believe, however, that every human life deserves basic compassion. Even prisoners and people on death row get health care services here in the US. Compassion is not nonsense — it is about being selfless, about caring for others, about being good neighbors. I don’t know about you, but I’d rather live in a world of “good neighbors” who look out for each other, rather than people who think that every life is a dime a dozen and stand on the street corner watching a person die slowly after being hit by a taxi — when that person could have been saved by a 911 call and a little compassion and concern.

I’m afraid you and I are just going to have to agree to disagree on this.

I have never said that we should abolish health care altogether, or that we must not provide it to more people. I only maintain that it is not a universal, inalienable right, that it comes at a huge cost, and that it does not necessarily have to cover everybody equally (and in practice, it cannot).

Besides, there is a fundamental difference between fire or crime and death. Fire and crime are preventable and avoidable, at least on an indiviual basis. A person may live his/her entire life without ever getting cought in a fire. In fact, that is what happens to most people in their lives. But death is an absolute certainty for everybody. A well-organized society can cut crime rate significantly. But it can never stop death. Everybody still has to die.

This is also why I believe the very concept of health insurance or life insurance is inherently doubtful. Insurance is, or should be, intended for catastrophic eventualities which are unlikely to happen, hard to predict, but whose consequences are unbearable: Fire, flood, rare diseases, earthquakes, plane crash etc. It is a way for you to bet against the insurance company to hedge against those unlikely yet catastrophic senarios. Now the risk of getting sick and die is 100% for everyone. So strickly speaking, it is not a risk, but a certainty. How can one bet on the inevitable? Insurance is certainly not the way to go. Moreover, your lifespan is directly causally linked to your own behavior: Lack of exercise, unbalanced diet, reckless attitude, and unhealthy life style in general can all compromise your health. The basis of insurance is distorted, when you have such causal power over the events that your insurance supposedly covers. Therefore, health insurance is not real insurance. It is incompatible with the essence of insurance.

In my opinion, the only rational way to deal with such inevitables as illness and death is to understand them, anticipate them, and to prepare for them, not by feeding money to insurance companies, but by saving money on your own, setting aside resource, and making wills. It is impossible by definition to avoid or prevent the inevitable. And there is usually little point in delaying it. So I am not against euthanization. I also find religious people, who pray not to die, and oppose euthanization, to be quite funny. Isn’t it the case that they can’t wait to join their creator in heaven? To be fair, I must admit that I am always more concerned about those “seriosly and consistently religious” nut-jobs who are eager to go to heaven with 72 virgins.

As to the comment on “common good”, I think people too often buy into rosy, comforting nonsense like “Every human life is invaluable in and of itself” and so on. I am confident, for example, that, in hindsight, few would object to a bloody, premature death of Hitler on the front line of WWI, if we could unwind the tape of history. Realistically, and on a large scale, it was the plague that undermined the foundation of the old Christian theocracy, broke down the feudalistic mode of property ownership and production in Europe, and in effect brought about the the Renaissance. Without it, Europe might still be in the dark ages today. My point is that death is not necessarily a bad thing. Like with many other natural phenomena, it is us humans who imposed our moral views and value judgements on deaths, and interpreted them as bad. But this is all very subjective, self-regarding, and anthropocentric, and lacks rational basis.

I appreciate your suggestion on adding statistics. With this piece, I wanted it to be more anecdotal — seen through my own experiences in China, and the experiences of my family members. It’s not intended to be an academic report, just give people a feel for the situation in the countryside. That said, my husband provided a lot of input and help on this piece and I can tell you that data on rural health insurance is not easy to come by. Even the data I did collect from my family members required several phone calls.

However, my main emphasis in this piece is the inherent inequities in health insurance in the countryside. From your comment above, it seems that you don’t think this is an issue.

You mention that “health care is a privilage and luxury. In the long run, we all die. It is a matter of fact, the inevitable end of life. Nobody has any inalienable right to health and life.” Yes, we all die, but I’m not sure that is a good reason why health care should be a privilege and luxury. Should we then argue that, since fires are inevitable, there should be no fire fighters — or that because crime is inevitable in society, we should have no police? That fire fighting and police protection are luxuries, and we should just grab a gun and pail of water, and live in the wild, wild west all over again?

You also say that “Some deaths may have happened for the “common good”.” Who decides that a death is for the common good? This thinking is a slippery slope which leads to a society where humanity is lost — where there is less compassion for those who suffer and die. And when that suffering and dying happens because those people did not get the health care that would have been available — had they had more money, better insurance, etc. — it is a failure of society that should never be labeled as something “for the common good”.

I’m just kidding.

Thanks for the detailed first-hand accounts. But it does seem a bit anecdotal. It might be better if you could cite some statistics and surveys to back up your general claims (e.g. rural health insurance is inadequate). And I don’t think it would hurt your journalistic impartiality by pointing out some interesting facts, such as that China does not leave a sixth of its citizenry uninsured.

Those fake nutritional suppliments are bad, but probably not as bad as blind faith in some invisible man, “the opiate of the people”. And it is certainly not as bad as real opium that was once advertised in a similar way, and pushed upon uneducated Chinese by western colonial and commercial interests. Maybe the correct way of doing this business in the 21st century is to rebrand Zhen’ao as “Zhen’aomycin”, “Zhen’aophine” or “Zhen’aovill”, pass some “scientific” clinical trials at some Zhen’ao sponsered labs, get it approved by some FDA-like bureaucracy, and put up ads that states “side-effects may include joint pain, diarrhea, dizziness,….., and blah, blah, blah, ask your doctor about Zhen’aomycin.”

Big pharmaceuticals are the same everywhere. Their aim is to make profits, not to save people. The most profitable approach, therefore, is to focus not on cures or effective prevention, but on treatment, and the more costly, unnecessary and prolonged, the better.

If there is one thing about health care on which I can entirely agree with the conservatives in the US, it would be that health care is a privilage and luxury. In the long run, we all die. It is a matter of fact, the inevitable end of life. Nobody has any inalienable right to health and life. And the world will always move on regardless of individual human deaths, or even completely human extinction. Evolution occurs. Differential survivorship and differential reproduction happen, all the time, whether you like it or not. Nature cares not about rights, individuals, equality, or senescence, because they are all evolutionarily insignificant. Some deaths may have happened for the “common good”. Or perhaps there is no good versus bad. Mother Nature must be a nihilist.