Well, there were only nine miners to be saved...once.
There are 300 million Americans to give unlimited healthcare to...forever.
I just don't think we can afford it.
tPA or streptokinase, as I'm mentioned before...

With all due respect Toren, does that argument really hold? How can you value those 9 miners at a higher level than any patient I see? How can one compare the value of 2 humans?

You make tPA or streptokinase sound like a simple decision. It really is more complicated. Not all patients can take streptokinase. My reading of the data suggests a 1% absolute mortality benefit for tPA. What is that worth? How much money were we willing to spend on a CHANCE of saving 9 miners?

Obviously, I'm pushing this point for argument's sake. Nonetheless, I really do not think that you can continue to justify the huge amounts of money we spend to save accident victims and deny someone who is ill. Where is the moral equivalence? I consider this an ethical problem for our society. (stepping back down from the soapbox)

I'm sympathetic--while those miners were on the front page, there is no doubt at all people were dying for lack of basic medical care--but the reality is medical treatment costs money, and modern medical care is increasingly expensive (vide $200 per dose for streptokinase vs. $2500 for tPA...for a 1% improvement, on average).
Full, unlimited medical care to the extent of our capability for everyone all the time would bankrupt the country. The EPA says a life is worth $6 million. How many people even make $6 million in a lifetime? Who is going to pay for all this medicine, especially once there are no cost constraints on it?
I'm not a heartless guy, really I'm not, but where is all this money going to come from? I'll cough up an extra dollar this year to "save the nine miners," but how much will it cost to "save everyone"...?
My Blue Shield costs recently jumped 20% because the State of CA mandated mental health coverage. I have no choice in the matter--I can't opt out to save the money, because the coverage is required. I wonder how many people had to drop their insurance completely because they couldn't afford it any more?
We ignore the reality of cost at our peril, even though our hearts tell us to dream.

Now we are getting at the key feature. Even though we do not each directly pay for our health care (at least few of us do), most of us contribute to health care spending with insurance. We are significantly removed (financially) from the decision to save the miners. We feel the monthly expenditure when our health insurance rises, and when the government raises the Medicare tax.

If you had severe esophagitis, you would willingly spend $4 daily to relieve the pain (never had a patient complain about PPIs - Prilosec, Prevacid, Aciphex). If you have mild heartburn the current OTC drugs work perfectly well. Patients do complain about the cost of lipid lowering agents and antihypertensives. It is not just the money, it's the lack of any easy connection between the money and the benefit. Much medical care (at least those that internists do) has delayed benefits. And those benefits are usually statistical. We know we are helping some people, we do not necessarily know that we are helping you. Maybe that is a barrier and a reason for our concern about the finances. If we used the EPA figure, an amazing number of medical treatments become cost effective.