Belief in a just world: a case study in public health ethics.

A recent news article in The Atlanta Journal-Constitution profiled a working-class married couple, Connie and Michael Post, whose children were enrolled in PeachCare for Kids, a health insurance program for children that is Georgia's version of the State Children's Health Insurance Program. (1) The Posts were having a tough time making ends meet, and they depended on PeachCare for health care for their three children (and a fourth on the way at the time the series appeared). Michael had recently left his $42,000-a-year job as a full-time pastor to work as a freelance minister, supplementing his income with odd jobs and house painting. Connie had taken a job at a local horseshoeing school for $25,000 a year. Their take-home pay was about $850 per week, and their monthly expenses (mortgage, car payment, auto insurance, health insurance premiums with high deductibles for the parents, food, gas, electricity, water, cell and telephone service, clothes, credit card payment, life insurance) averaged around $2,883 a month, leaving little left over for extras. Living paycheck to paycheck, they seemed nonetheless a happy and stable family. PeachCare for Kids lets families earning less than 235 percent of the federal poverty level get free health insurance for their children up to age six, and to pay a modest premium for health insurance for children over that age. The benefits include doctor visits, immunizations, hospitalizations, and emergency room visits. PeachCare is widely regarded as a successful preventive health program for children in low-income families whose earnings put them above Medicaid eligibility levels. The Posts would likely have been completely insolvent had not PeachCare been paying their children's medical bills. Their middle child, Cadence, was disabled with autism, and she needed two $135 therapy sessions every week on an ongoing basis. An older child had sensory problems but had improved with once-a-week, $135 therapy sessions and no longer needed them. "You can imagine how grateful we are for PeachCare," Connie told the paper. Angry Readers Readers' reactions to the story were almost uniformly negative--which was particularly striking because the newspaper has a reputation for balance and evenhandedness in printing reader responses. (2) Readers consistently complained that the Posts were irresponsible. Some criticized the parents for their employment choices. "[They] have deliberately chosen to limit their income by giving up a high paying job--yet they continue to have children and shift the responsibility for their medical care to the taxpayers," wrote one reader. Another thought that Connie, with a degree in English, should have become a public school teacher with medical benefits. A third observed: "While reading this story, my blood pressure spiked.... Whenever you reward bad behavior, that behavior will continue. This is why we need to cut these programs for all but the truly needy. These people aren't needy, they are lazy, and PeachCare simply encourages said laziness." Almost all readers criticized the Posts for having too many children, and especially for being pregnant with a fourth child. "Unfortunately, it appears that the Posts do not themselves believe in being responsible," wrote one reader. "[P]erhaps without multiple children they could not afford to provide for, they would be doing just fine." Another commented, "as the story progressed my feelings turned to disbelief and then anger when I learned that 'another child is on the way.' ... The responsible thing for this couple to do would be to practice some sort of birth control." Michael Post offered a defense of his family in a column a few days later. (3) He wrote that he and Connie had also felt "disbelief " at news of the latest pregnancy, "since we had employed the same birth control method that had produced unfailing success the previous 2 1/2 years. Once the shock wore off though, we embraced the reality that we would once again be given the opportunity to provide a loving home for another person. …