I have now completed my ankle surgery and am no longer in pain from it. Thanks to all the well-wishers in cyberspace and elsewhere! I face 4-6 weeks of annoying walking on crutches and other recovery issues, but it should eventually all be OK. For the moment, it is still extremely difficult and disorienting not to be able to walk or drive, but I'm sure I'll overcome the problems involved over time, at least well enough to get through the recovery period.
I do have a couple of reflections for people who may be going through similar problems, now or in the future. First, do not imagine that you can get through the first few days after surgery living all by yourself. I foolishly thought that I could, but my doctor and relatives set me straight, and one of my family members generously came to live with me for a few days. Trying to make it on your own right after a serious surgery is actually both foolish and dangerous. Don't try it if you have any choice at all.
Second, this experience has given me a new appreciation for the value of extended families. As a friend from an extended family culture pointed out to me recently, that setup spreads the burden of caring for an invalid over a large number of different relatives who can each pitch in a little. That makes things easier for both the injured person and the caregivers/family members (none of whom face a really severe individual burden).
Obviously, extended families also have significant drawbacks and I'm certainly not advocating that we all return to that lifestyle. However, it's worth noting that the extended families have their advantages as well, and dealing with crises is certainly one of their strengths.
OK, I think that's enough surgery-blogging. I will try to return to more normal blogging topics as soon as my recovery permits.
UPDATE: Some claim that reliance on family members to help you during an illness or other crisis is unlibertarian, and that a true libertarian would rely on the market to solve such problems. See, e.g., here. This view is based on a misunderstanding of libertarianism that portrays it as advocating that all problems be solved by commercial transactions in the market. In reality, libertarians advocate the superiority of the private sector broadly defined over government. That private sector includes families, civil society, and charitable organizations as well as commercial enterprises. In some cases, noncommercial private sector options will be better than commercial ones (as is probably true for my recovery from my current operation). There is nothing unlibertarian about recognizing that reality. Moreover, even where family or charitable organizations will do a better job than for-profit businesses, the latter may still be better than government service providers. If I had no family members to help me in my current situation, I'd much rather rely on a commercial firm to provide the needed services than on a government bureaucracy that has little or no incentive to do a good job and that will not lose profits if it performs poorly.
Related Posts (on one page):
- Thoughts on Surgery and Recovery:
- Brief Blogging Hiatus:
I'm just sayin'.
That's not the kind of post I expect on an Objectivist blog like the Volokh Conspiracy.
:)
Oh, and the surgery actually really helped. Before the surgery, I sprained my ankle about once every two weeks---usually while playing sports, but sometimes also just by stepping on random things walking down the street. Since then, I've sprained it about once every four months, which is a huge, huge improvement.
I'm not an Objectivist. Neither are most of the other VC bloggers (if indeed any are). Objectivists represent only one of several wings of the broader libertarian movement.
Good luck!
Best wishes for recovery!
OK then, is this more to your liking?
I had an appendectomy a few years ago. As I was recovering from the anesthetic the doctors asked the traditional questions (to see whether I had completely returned from the Other Side, I suppose) ...
Doctor: Mike, what year is it?
Me: Uhhh ... ummm ... 1995?
Doctor: Mike, who's the President of the United States?
Me: Uhhh ... urrr ... ummm ... Oh my God, it's that @@@@@@@ Bill Clinton!
Not a good thing to say to possible Democrats with scalpels and Plausible Deniability, I guess. ;-)
What drawbacks did you have in mind?
Seriously, living alone is just plain dangerous! If you slip in the shower, or have a heart attack, or suffer a stroke, who's going to call the paramedics?
BTW, a friend of mine had a stroke that could have been life-threatening had she not been found by her roommate; as it was, it permanently disabled her right arm. She was 27.
I hear there are other good reasons to have a family, too ...
I thought your post was funny.
"unlibertarian" views.
Ditto that. When you are on crutches, you can't carrying anything, which is fantastically annoying. (Someday, I'm going to design attachments for crutches which allow their users to carry normal things, like plates of food or laptops. Until then, gimpies need Sherpas.)
Beyond that, things like getting in and out of the shower are nearly impossible, and, often, you're so loopy from the pain meds that you can't function normally.
This brings me back to my college days. My friends took turns escorting me to the dining hall, getting food from the outside world, and giving me piggy backs up and down the stairs. It was tough, even with all that help.
I imagine the Mr. Somin wouldn't be such an advocate for libertarianism if it left him without necessary healthcare like it would for many others if Mr. Somin had his way.
Second, guess what Mr. Somin, not everyone has the good fortune of having families to help them out in this sort of situation.
Basically, the idea is that we should extend the concept of community beyond the family so that people do not fall through the cracks.
But I do not suppose this concerns you, given your health insurance and your helpful family.
Your libertarian utopia is my nightmare.
Hahahaha!
The suffering of others is funny. Typical libertarian.
Experiences like this always make me imagine what life would be like with a serious, permanent disability. Worth pondering.
Ouch! You can spare an arm for a time, but it's hard to walk on one leg, as a doctor friend noted. ANd don't spare the pain killers. Some docs underprescribe. But the fact is that there are addictive personalities and those who are too pigheaded to ever give in over a bit of chemistry.
First of all, it's just bad manners to berate someone who is ill - when discussing his illness, injury, or other malady.
Second, someone without health insurance still has access to the health care system.
Third, those who do not have large extended families can make a family out of their friends, spouse, spouse's family, children, and neighbours. After a while, the quality of people around you has nothing to do with luck, fortune, or happenstance of birth and everything to do with the effort you have put into meeting good people and forming good relationships. Even those who have large, loving, caring extended families will find themselves without good support during times like these if they are bad people.
I mean, if I had to pick out anything in America that is not a function of wealth, class, or social standing, it would be the interpersonal relationships that a person develops throughout his life.
I think its bad manners to advocate the imposition of a system guaranteed to prevent some people from receiving adequate treatment when they have similar medical conditions as Mr. Somin. Cold libertarians are not entitled to warm and fuzzy treatment when it they who need it, given their advocacy of turning a cold shoulder to those without the ability and opportunity to pay for care.
Thankfully the status quo is not libertarian.
I am not expert, but I am not certain that Mr. Somin's condition is an emergency that would qualify for treatment in an emergency room.
In any case, in a libertarian utopia, I do not imagine that there would be any federal mandate the hospitals that receive funding provide emergency care for the indigent.
First, this is only true for people with decent social skills. That does not include everyone. Second, even if you have friends, they had better be really good ones if you expect them to be driving you around.
This is an interesting theory. But I believe that luck, fortune, and happenstance does in fact play a part in who has social capital and who does not. (Part of social capital is the ability to form quality relationship and the ability to distinguish between sincere friends who would be there if you needed them and those who are merely using you or are what would call "fair weather friends.")
Even those who have large, loving, caring extended families will find themselves without good support during times like these if they are bad people.
Mr. Somin would have people who could not afford it go without medical care. He is, under any reasonable conception of morality, a bad person. Yet he still gets good support.
Life is not fair. Bad things happen to good people. Good things happen to bad people.
This is certainly an interesting idea though. It seems that you want to think that those without good relationship support and who fall through the cracks are bad people. I think it is very interesting that you want to think that.
Of course. Because there are absolutely no class or educational factors that influence what relationships you make or who you make them with. In your fantasy world, maybe...
Yeah, I guess all that philosophy and its implications should be ignored when it really matters to your own life. Of course, it is perfectly fine to use that philosophy to justify policies that are bound to affect the lives of others. But when it comes to your own life, that philosophy that is good for others can be safely ignored.
Somehow, I doubt Mr. Somin would agree with your idea here, Mr. Hardy.
As a physician, what I see happening is that there are more and more mandates being applied to the system, meaning on the people who work in the system, but care is getting harder to get. The people who work in the system (I am one of them) are beginning to get out. Read any of the medical/ER blogs, and you will learn that there are far fewer surgical specialists willing to cover ERs than there once were. In the past, there were occasions when an uninsured person could not get needed care. That was unfortunate, and unusual. Now there are laws and regulations that mandate that everyone who goes to the ER gets the same level of care, insured or not. Guess what- everyone is getting less care, insured or not. Because the cost to the physician of covering the ER is now so high, financially and otherwise, physicians are finding ways to stay out of ER coverage. We are starting to hear stories of people being hurt or dying for lack of expedient care- at present isolated anecdotes, but this will begin to snowball. The current system is based on involuntary servitude. Docs are forced to cover ERs if they want to practice in hospitals. Docs are finding ways to practice outside of hospitals, and as a result, a lot of ERs have no one to cover certain specialties some or all of the time. Current regulations prohibit docs from telling the ER that they will take one or two charity patients per weekend, but not all of them, so no charity patient has access to an otherwise willing physician. Nice work.
I don't think you have addressed the merits of any system I have advocated or would advocate. Your stupid labels are meaningless. We do not live in a black and white world, with only two choices, libertarianism and socialism. As an educated individual, I would expect you to have moved beyond such false dichotomies. But apparently, in your case, apparently that is expecting too much.
And we all know that private insurance companies never produce bureaucracy or inefficiency. Right.
Well, just maybe as a physician, you might be able to think about some disadvantages of using an ER for non-emergencies.
A system where people got the care they needed before it came down to going to the ER might be slightly more intelligent. But I guess that would be *insert scare word* socialism. It is amazing how simple labels resolve all debates for the simple minded.
Finally, I am sure that there are more intelligent moves that one could make than penalizing doctors who work in the ER. But that doesn't prove the superiority of no regulation. That proves the superiority of superior regulation.
Ah, but in a binary world, there is either more regulation or less regulation, you might say. But, we don't live in a binary world, do we?
Imagine a world where physicians are well-compensated and everyone who needs medical care gets it. Is your mind boggling? Is there some physical limitation existing in the universe that prevents everyone who needs care from getting care?
You know, I think we might need some more medical schools. I know of quite a few bright individuals who finished all the prerequisites but were not admitted to medical school. Maybe some competition would make doctors more interested in serving in the ER. Imagine that.
If you are truly debating ideas, then you have no need to personally attack Prof. Somin. He, like the uninsured, is entitled to well-wishes for a speedy recovery.
You have yet to point to a single law that says that a person cannot pay out-of-pocket for medical care. For many people (as I will explain below), this is more sensible than getting insurance. The latter does not equate to access, and the former is not a wholesale denial of access.
Furthermore, I have received medical care without insurance. I simply walked into my doctor's office, explained that I would pay out-of-pocket, and received care.
Now, a quick insurance overview:
There are 47 million uninsured in the United States. Of those, approximately 12 million are illegal immigrants.
10 million of the remaining ones are children under the age of 18, 6 million of whom are SCHIP-eligible but not enrolled.
An additional 9 million are between the ages of 18 and 24. They cannot get low-cost insurance in many states, because liberal socialists mandate that insurance companies charge them the same thing that they charge older, sicker people. Many states mandate that insurance companies cover childbirth, dental, and fertility treatments. An 18-year-old who just wants no-frills insurance to cover the bad stuff can't get it. In many states, they also do not have access to catastrophic insurance - i.e. that which will pay everything over $5,000, but nothing under it. Now, $5,000 is a lot of money, but it's something that can be slapped on a credit card and paid off later with a bartending job. Nothing that a young, single kid can't take care of.
Finally, only half of the uninsured are so for more than nine months at a time. A fair percentage of the uninsured earn more than $75,000/year. In New York, those who want to self-insure cannot cover their families for less than about $30,000/year (at which point, you are better off just putting the money into a savings account and paying out-of-pocket). The warm, fuzzy, socialists decided that it was unfair for insurance companies to charge the elderly more than the young, so they eliminated differential pricing. The end result? Everyone gets charged a lot. The healthy refuse to participate.
Now, in all of that, where do you get the idea that we need socialism? Seems as if the market would do a fine job of providing low-cost insurance to people who want it, but we don't let the market do its work.
Oddly, though, that is exactly in contrast to your previous proposal of insuring that doctors all get paid well. Considering that medical school costs something like $200,000 - and that's before the interest is compounded during residencies, internships, and specialised training - I doubt that we could continue to get high-quality doctors if they were not assured of a good salary.
I find it amusing that your solution to the health care "crisis" is to allow the poor to be treated by the people who weren't good enough to get into med school now. Thing is, the med schools admit students based on need. The lowest-paying part of the sector will continue to attract only those who have no other options.
(Shrug.)
Equality of care, as JB points out, will invariably lead into a lower quality of care. First of all, those who can pay for a higher-quality of care will be denied it, as it isn't "fair"; second, physicians will be unable to give any one person treatment that they cannot afford to give to everyone. Third, and most importantly, you are discounting "inflation." Medicine is not a static resource. Initially, new therapies and pharmaceuticals are expensive, as the developers need to recoup development costs (which is everything from FDA approval to clinical trials to higher insurance premiums for riskier procedures). Eventually, the cost comes down after the developers have made their investment back. Now, we need the rich to pay those development costs; otherwise, it would not be economically feasible to innovate.
Personally, I don't want to receive 2007-era medical care in 2050.
First of all, I'm not sure what "reasonable conception of morality" you are using here, and I'm darn sure you are misstating his beliefs. I'm almost certain that Prof. Somin thinks that the poor ARE entitled to medical care, just not at the expense of taxpayers. He simply does not espouse the solution to the problem that you do, and does so for very moral reasons: the welfare of the entire country. Libertarians realise that giving health care to the poor often means that the middle class gets less care; that taxpayer-funded care crowds out charitable care; and that there is a perverse incentive at play when the standard for receipt of care is need. We do not want a race to the bottom, where each person tries to make himself appear more needy than those around him.
Morality, at any rate, is premised not upon social results, nor the methodology that one uses to achieve those results (such as taxpayer-funded care v. charitable care); it is premised upon the person's values and thought processes. A libertarian who believes in medical advancement, access to care, and high-quality care for all is a good person. The fact that Prof. Somin's ideas on how those ideals should be best implemented does not make him a bad person, under any conception of morality.
..in fact, last time I checked, the Bible has quite a few things to say about the duty to care for one's family. Are you now saying that devout Christians are immoral and bad?
You need not snark at me about life not being fair. I would like to think that the current medical crisis I'm facing is not karmic revenge for anything I've done. (Shrug.) It's not all that bad, though - my family is supportive - or would that be a function of the fact that they can afford long-distance calling?, and my extended "family" has been fantastic. I'm 650 miles away from where I grew up and 200 miles away from blood relatives, but have been fortunate enough to have "family" in town who drove me (an hour each way) to the doctor's office the other day and sat with me while I was diagnosed. (Shrug.) Said family are the parents of kids I tutored during my "spare time" (ha!) in law school. (Shrug.) What goes around, comes around, I guess.
My college friends were under no obligation to wait in the ER for me after a car accident, carry my trays when I was on crutches, help me up the stairs, carry my laptop, or walk 20 minutes each way to the grocery store to buy me food - but they did. I would hardly believe that college admissions is predicated upon being a good friend - that the people who don't go to college are selfish, lousy individuals - so pray tell how that was a function of anything but human kindness - the asset which is found equally amongst the poor as the wealthy.
----
Again - Prof. Somin - glad to hear that you are doing well. Please don't mind the collateral bickering.
Basically, your idea is that we should force people at gunpoint to help other people. This is not "extending" the concept of community or family; it's drastically redefining it. Family members help each other freely (or not); they are not required to do so.
No. He would not. That is not a libertarian policy at all. Only a totalitarian would prevent people who couldn't afford it from getting medical care. He would simply -- assuming he's a full-on libertarian, rather than a faint-hearted one -- not force people at gunpoint to provide it.
But we do live in a black and white world, with only two choices: either the government forces people to provide medical care to others, or it doesn't.
And what sort of care would you have received if you did not have money to pay?
Exactly my point.
You proceed to review some statistics. You note that 35 million U.S. citizens are uninsured. You further note that of these, 10 million are children, but that 6 million are eligible but do not use the "socialist" program known as SCHIP. You further note that over half of those who are uninsured lack insurance for more than 9 months.
I am confused. Is this supposed to be a defense of the status quo? I suppose not, since you go on to explain:
Well, I for one do not consider it morally acceptable that anyone who by objective medical standards needs medical care not receive that care. So, it appears to me that we have very different views of what constitutes a "fine job." It is simply undeniable that if the only mechanism for providing care is the market, that some people will not receive the care that they need.
I do not believe it is the case that everyone who is denied admission to medical school is not "good enough" to be a doctor. In fact, I am sure that this is false. There are a set number of seats at each medical school. Regardless of the quality of applicants, precisely n people are admitted. Thus, if you have an applicant pool that includes r qualified people in x year, n people are admitted. If in the next year there is a surge of qualified applicants and you have r + s qualified people applying, still only n are admitted.
The fact is, admittance to medical school is based on arbitrary cutoffs, not whether one is "good enough." This is demonstrated by the fluctuating MCAT scores that will get you into medical school. In one year, a particular MCAT score might get you into medical school, but in another, it will not.
Finally, with respect to the internships and residency periods that doctors go through after medical school, while surely these often provide invaluable training, they are also a source of cheap labor and they do not always represent the most efficient way to train doctors. They are also partially nothing more than a hazing. Studies have demonstrated that interns working excessively long hours make a lot of mistakes, some that even compromise patient safety, towards the end of their shift when the lack of sleep these people are getting is most problematic. Nonetheless, doctors are deeply attached to this "hazing" ritual, perhaps thinking that "if I had to do this, so should you" despite the negative effect that this sometimes has on patients.
The bottom-line. There is quite a bit of room for eliminating inefficiencies and irrational practices in the training of doctors.
But those efficiencies aside, the level of debt that medical professionals get in obtaining their education is not the primary limit to new entrants. The primary limit to new entrants is the n slots that each institution has, and which cannot be easily be increased in response to even a stellar applicant pool. There are more qualified individuals able and wishing to be doctors than there are slots in medical school.
This is assumes that we make no other changes to increase the efficiency of health care delivery, such as increasing the number of doctors or having the government negotiate for better prices for drugs. There is nothing that JB points out that would lead one to conclude anything in particular, except that there needs to be some tweaking done to make ER service more desirable for doctors. It appears that hospitals are using their superior negotiation position to shift the cost of providing such care to individual doctors, instead of absorbing it institutionally. That particular problem could be fixed by a regulation forbidding hospitals from engaging in this practice.
Finally, one can not talk about "quality" without asking "quality for who." Clearly, someone who has early stage cancer that would have been treatable but it is not discovered due to lack of health insurance faces a worse outcome than they would under a system of universal coverage that enabled them to be properly screened. You do not grapple with these issues; your entirely conclusory assertions about quality are thus not very persuasive.
I would be interested in an elaboration of this point. I am not sure what you are trying to say.
Finally, your point about medicine not being static resource is well taken. But, it has limited relevance to this discussion. Providing health care to everyone does not logically require that one not providing a mechanism to provide incentives to and compensate those who discover, invent, or design new medical innovations.
These details aside, it all comes down to a very simple question having to do with morality. Should we as a society ensure that everyone who need medical care receives medical care.
Exactly what charity is it that provide medical care to all people who need it but cannot afford it? This must be an awfully rich charity.
Oh wait. There is none. So, logically, the libertarian view entails individuals who are in need of medical care not getting that medical care. You know, someone who needs surgery on their ankle just might not get it. This is not a morally neutral point of view.
Here is a solution. Make health care available to everyone regardless of need. Don't means test it. End of perverse incentive.
Perhaps. But that is only because that libertarian fails to comprehend the inevitable and obvious result of their beliefs. Namely, some people who need medical care being denied the care they need.
I would not say that libertarians who are unaware of the obvious consequences of their beliefs are bad people. I would say they are ignorant people. But since Somin is an educated individual, I will assume that he understands the obvious consequences of his beliefs and thus properly label him a bad person under any reasonable system of morality.
Last time I checked, nothing in Bible advocates denying needed medical care to those who need it because they cannot afford to pay. But if you know otherwise, do share.
It would be nice to think that. Experience tells us otherwise. Ask the survivors of the Holocaust. Bad things happen to good people. Good things happen to bad people. It sucks, but that is the way it is.
I disagree. I believe your friends did have a moral obligation to help you. If someone decided that they were to busy to take you to the ER after a car accident, that would be positively immoral.
Now, on the other hand, the exact boundaries of what we owe each other are fuzzy. Does any particular individual have a personal obligation to go to the store to buy you food? Perhaps not. I do not see why the duty should fall on any one particular individual rather than another. But, if you are in a situation where you are unable to get food without help from someone, do we as a society owe you a moral duty to ensure that someone (who is perhaps compensated for the trouble) helps you get something to eat? I believe the answer to that question is yes.
I agree that human kindness and goodness are found among both the rich and the poor. And that selfishness and evil are likewise found among individuals in both groups.
I am not sure what your point about college here is. Perhaps the people who helped you are not college-educated. I am not seeing the relevance.
First, as someone who makes fun of the suffering of others, it is hard to take you seriously.
Your language about guns and violence is vaguely amusing even while being totally insensible. No one will shoot you with a gun just because you don't pay your taxes. Maybe you should be part of Shay's Rebellion instead of having a discussion about modern day policy. I don't agree with everything upon which my tax dollars are spent; that does not mean that I do not regard them as legitimate. I consider taxes a fair price to pay for the privilege of being a citizen, living in this country, and being able to form deep and meaningful connections with other citizens.
Everything can be reduced to two choices, if you are hell-bent on framing things in that manner. We have two choices: either we ensure that everyone who needs medical care is provided medical care, or we don't.
That one can frame things in this manner does not mean it is intelligent to do so. Not that I would think of using reason with you. Given your repulsive mockery of the suffering of others, I suspect the defects in your character have likely spread to your ability to properly reason.
I'm bowing out. I cannot fathom where you get off calling anyone immoral based on his approach to a problem, when the desires (for a moral, good society) are the same - especially when that person did nothing to provoke such a personal attack. Logic 101: do not use ad hominem attacks. Class and tact 101: don't denigrate someone on his own get-well card.
No, but if you continue to refuse to pay them, you will be haled into court. If you still continue to refuse to pay, or show up in court, you will be taken to jail - at the point of a gun. The presence of intermediate steps does not negate the fact that the force of government is the force of a gun*. A government without the ability to jail its constituents for wrongdoing is one that lasts only upon the goodwill of the people.
Mr. Nieporent is correct; the force is that of a gun, just with a few steps thrown in to help those who are actually civilised.
*This is exactly why the Framers felt the need for a Second Amendment.
I called Mr. Somin immoral for a very specific reason. Because he advocates a system guaranteed to deny medical care to those who need it.
I am sorry you have such huge problems with the basics of morality.
Of course anyone who breaks the law should go to jail. And tax evasion is breaking the law and should result in jail.
However, no one will use a gun. That is, unless you unlawfully resist, at which point a gun should only be used if it is necessary. But if a gun is being used, it is not because you failed to pay taxes but because you are putting law enforcement in danger through unreasonable resistance.
It is an entirely unreasonable position to think that taxes will go only to that which you personally agree. As a member of a democratic society, you are bound by the spending decisions of the legislature, which is democratically elected and which you have an opportunity to run for and also an opportunity to vote for. I would guess that just about ever person disagrees with some spending decisions made by Congress or state legislatures. Such disagreement is obviously not a license to violate the law by not paying taxes.
I might disagree with the provision of 500 police officers. Perhaps I think that a city would get by with just 400. But that does not give me a right to not pay whatever taxes I owe just like everyone else who is similarly situated.
We should remember that one of the reasons that the Constitution was adopted was to enable the collection of taxes.
But of course you don't mean "we as a society," as if there were any such thing. You mean, "Should people with guns who think they're more moral than other people take from some and give to others." That's not "morality." That's force.
Your problem is that your position is incoherent. You can't argue that voluntary charity won't do it because people aren't that generous, and then pretend that "we" are doing it when government gets involved. But you're still projecting; you're not generous, so you don't think other people will be.
Your description of the health insurance situation in this country is the most sensible I've read anywhere. One of my main problems has always been with the notion that health insurance is in fact a comprehensive health care scheme, rather than INSURANCE against large and unpredictable expenses. During my periods without employer-provided insurace, I would have been happy to buy a major medical plan and self-insure for the everyday stuff. This is the sensible course of action for most people, and it's unfortunate that this option is so hard to come by.
If some people are too poor to cover everyday health expenses, then I would give them general income support rather than a benefit that can only be used to purchase services from the medical industry. If there is going to be a earmarked benefit for the poor, something that can only be used for one purpose and not turned to some other use, then I would prefer that it be education and job training. That helps get people off benefits programs in a way that supporting current consumption does not.
You are correct in thinking that I believe that charity is inadequate.
It is not that people are selfish; it is that they do not want to burden themselves disproportionately in taking on a social responsibility that belongs to everybody. Furthermore, the capacity of individuals, even very rich ones, to take on public works is limited.
It would be nice, I suppose, if rich individuals decided to fund our police forces, our fire fighters, and our public school teachers through charity, making taxes unnecessary. But the fact is, regardless of how generous individuals are or are not, charity is an inadequate source of revenue for these necessary projects. Furthermore, these tasks are a social, not individual responsibility. It is unreasonable and unethical for society to avoid these social duties entirely.
You may complain about taxes all you want. That is part of our American tradition. You may even use your radical hyperbole against them, if you find that especially pleasing even while I find it especially unpersuasive. But it should be remembered that the larger tradition in America has been to impose taxes. And use force, when necessary, against those who break laws requiring payment, just as any other law is enforced with the use of force.
There were those who, in the excesses following the American Revolution, did not want to pay taxes. Shay's Rebellion and the Whiskey Rebellion come to mind as events exemplifying the radical views you seem to be espousing. The later was ably suppressed by George Washington himself. Furthermore, one major motivation behind the adoption of the Constitution was to enable the Federal government to independently collect revenue, because the states shirked their duty to contribute revenue voluntarily.
That I think entirely voluntarily collections of revenue is both impractical (it has not worked historically) and unprincipled (we should not shift social burdens entirely onto generous individuals) does not mean that I believe people are selfish.
Communist.