A couple of interesting comments on the whole public health thingie:
John “Akatsukami” Braue from Rat’s Nest comments:
[Update: Just went to his blog to get an email address, and saw that he’s posted some suggestions. I already owe him a bunch of attention and comment, so this just will have to get added to my giri.]

There are a number of issues here, some of which are explicit in your discussion, others of which are not. Let me suggest a couple that have to be dealt with:
1. You’re going to die. I’m going to die. Extropian yivshish to the contrary, we’re all going to die.

Fair comment; I think that the core corporate-liberal value is becoming ‘death avoidance’ rather than ‘life embracing’; but there are stupid and avoidable ways to die and some that are less so. You have to figure out where your personal point on that spectrum is and where the social point ought to be. And I don’t think ‘We’re all gonna die anyway’, absent a framing philosophy (which from your Bushido nickname, I’ll assume you have) gets us very far. The issue is how we fit the inevitable fact of our death into what we make of our lives; but that conversation takes us fairly far afield.

1a. The usual standard for medical care has been “everything that we can do”. In 1925, this cost almost nothing, because it was almost nothing. Today, it’s a lot, and costs a lot.

Very true. Think about the classic conundrum of medical expense in the last weeks of life being the largest proportionally; personally, I went through this with my father. But I’m not talking about overall or encompassing medical care (although we will need to at some point), I’m talking about a narrow slice of care that deals specifically with communicable diseases.

2. Public health is not necessarily compatible with other civil rights. Would the forcible quarantine — that amounted to imprisonment — of “Typhoid Mary” be acceptable today? Even stipulating that we could cure from being an asymptomatic carrier, would forcing to take medications, remain where she could be found to have them dispensed to her, etc., be acceptable today. Think about anti-vaccination advocates before answering.

Yup. Closer to home, think of the bathhouse issue in San Francisco. I have a dog in this fight, as my best friend and the godfather of my older sons died of AIDS, which he probably caught at a circuit party or bathhouse.
As I’ve said before, people have the right to be stupid. The question becomes where we draw the line; I’ll suggest that there is a balancing act between rights and health and that we have stood firmly on the side of rights and perhaps ought to slide a step or so over toward health.
Sassafras of the eponymous blog, says:

We’re going to get government healthcare in times of major epidemics whether we like it or not. One thing that would make it much easier to adjust in the event of epidemic, whether natural or bioterrorist, would be implementing some form of universal health coverage *now.* Side effect of universal health coverage: more people treated in clinics, instead of going to the ER where triage nurses put adults who are not accident / trauma patients or suffering heart attacks on the schedule to wait for 6 1/2 hours.

I just returned from a conference, and in my hotel were people attending a national conference on public health. It was sobering to hear their views …

I have to agree; I think that when we get a good scare and 10,000 or so people die of something transmissible, we’ll be reacting quite vigorously rights be damned. One of my thoughts is that by implementing some kind of skeletal public health/healthcare system we can begin to build the infrastructure for identifying and coping with the kind of public health shock I think we’re gonna get.
Andy via email forwards a libertarian friend’s thoughts:

But here’s the thing: here’s where “public” as a word falls apart… Not in its first usage, but in its *second* usage. Change it to
“others’ health is truly good for you”
and now you have the beginnings of a campaign to get people to voluntarily “pay” for healthcare for other people, *because it is in their own very personal private individual interest*. Campaigns for the *public* good are never going to get people to voluntarily participate; but campaigns for their own *personal* good might.
I put “pay” in quotes because there is a LOT of room for creativity, innovation, and personal choice in terms of who will pay into what kind of system, just like private charities operate in different modes.

There is certainly room for voluntary and charitable action in these areas. But the kind of health infrastructure I’m talking about is to some extent atomic (meaning it comes in indivisible chunks), and as a consequence, it only works if everyone plays. I’m sympathetic to the libertarian striving for a purely voluntary life, but somehow it seems like it would work about as well if one could make gravity voluntary as well…I’ll now flee the room in anticipation of the net-libertarian response…

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