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Socialised Healthcare

I have no children of my own and utterly despise the little brats, yet some people in Britain have decided to force the rest of us to pay to educate their spawn. For that matter I've never had need of the fire services either. Where do I pick up my cheque?

What is this "Society" you speak of? It seems a silly idea, the law of the jungle was good enough for our primative ancestors and by god it's good enough for me! :)
 
I have no children of my own and utterly despise the little brats, yet some people in Britain have decided to force the rest of us to pay to educate their spawn. For that matter I've never had need of the fire services either. Where do I pick up my cheque?

What is this "Society" you speak of? It seems a silly idea, the law of the jungle was good enough for our primative ancestors and by god it's good enough for me! :)

Children are seen as future productive members of society and will contribute positively if properly educated (in theory). If we don't educate them, they will be a further drain on society.

Keeping somebody alive for a few years after their best productive years have past only insures a further drain on the national budget for years to come and delays the federal government receiving its fair share of the estate, should it be taxable.

Seperate issues entirely. :)
 
There is potential, however that hinges on how much control the "single payer" has over what they are willing to pay for certain medical procedures and other items. If the single payer decides they are only willing to pay $1,000 for a procedure that costs $1,250 to provide - then there isn't much profit in that.

...snip...

But consider in your scenario the price the market will pay for the procedure is just $1,000, therefore according to proponents of this "incentive" idea there is a lot of incentive for someone through innovation to come up with a way of making that procedure cost $999 not $1000 so they can make their buck.
 
...the price the market will pay...

Not really applicable in healthcare. Hard to calculate a fair demand curve for a life saving procedure. People will agree to whatever they have to to stay alive. They work out payment plans later. It's not like the market will stop getting MRI's because they simply cost too much. If I have reason to believe I have a brain tumor - I'm getting an MRI to verify. However, it is possible that enough providers will stop buying MRI machines because they have no incentive to provide the service - or simply can't afford the up front capital to buy a machine. So now we've greatly reduced accessability. While this wouldn't impact right away, once all the existing equipment begins to wear out - some medical offices won't be able to afford a replacement.

It truly is the price the payer/government is willing to pay in this case, regardless of cost to provide the service.

That being said, it is true that there will be incentive to come up with a less costly way to provide the service. However, there is nothing obligating the single payer to continue to pay $1,000 for the service once they learn a lower cost delivery method is acheived. But isn't his a goal? Eliminate the profit motive? Just be motivated by the desire to serve the public good?

If we could see the net profit margins (before R & D Expense) for each individual country where a company sells their products, it would answer a lot of questions.
 
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Children are seen as future productive members of society and ....


If you didn't pick up on the heavy sarcasm, then I despair of the reply. If you did, I don't see the point.

Look, what is this "single payer" mantra? I for one don't know what you mean. Even in Britain, the NHS is actually fairly separate between the four countries that make up the UK, with different decisions on availability and so on being taken, usually because of democratic mandate. And below that, there are the different Health Boards, who have a fair bit of autonomy. And that's in a sovereign state about the size of one of your 50-something States of America.

And above that scale, well, is anyone suggesting that all the different countries with universal heathcare systems should amalgamate into one monolithic juggernaut? Of course not. Within the EU there are some interesting scenarios playing out, as courts have decided that people have the right to travel to other states for healthcare if their home state isn't serving them well enough. And the home state has to pay. So, demand follows availablity, and money follows demand.

As I think I said before, Health Economics is something you do PhDs in, and there are whole university departments. So I suspect that my musings, and the musings of any other amateur, are probably pretty half-baked. But even I can see that to label this "single payer" is a complete distortion of reality.

And not only that, even within an arguably "single payer" system you have variations, people prepared to pay for extra (or usually for convenience in the NHS, because it's not often you don't get what you need eventually) out of their own pockets, and people who have their own insurance.

More centralised healthcare may well help to some extent to keep the "obscene profits of Big Pharma" (to quote the woo-woo crowd) from running totally amok, but it's hardly a monopoly. The advantages of dealing with a single (or a relatively small number) of providers may well be welcomed as allowing economies of scale, and also because with the entire population covered for virtually everything, the size of the market just did some very interesting things.

So really, while I also am no health economist (though I did earn my living for 17 years as a partner in a business providing private healthcare, so I do have some idea what pushes the money round), I do have some suspicion that these arguments are more special pleading to find cause to reject an option the individual finds distasteful for other reasons, than genuine economic concerns.

Rolfe.

PS. What do you think happens if a Health Board were to stop providing something pretty necessary because it can't beat the manufacturer down to an unrealistically low price? Guess.

You get riots on the streets, that's what. You get votes of no confidence in the government and threatened general elections, and politicians so scared for their gravy-train jobs that you'll soon find the MRI scanner is right where you want it.

PPS. I could just as easily imagine a scenario where insurance companies decided that they wouldn't pay more than 80% of the asking price, and forced a reduction that way. In fact, it might be easier for a little cartel to get away with it, as opposed to an accountable government body. Either way, you just get "patient power" sorting the whole boiling of them out. One way or another.
 
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CaptainManacles, I've asked you twice now, but you're ignoring me. In my experience that often means the poster doesn't like the answer they realise is inevitable. But hey, who cares? We're just having a conversation here....

I'm geninely interested to find out what it is you personally want from your healthcare system, and how you personally want to pay for it. I can't deduce that from your posts so far. I gave a few examples, but to keep it simple let's concentrate on the first one.

What would your game plan be if you had a child with cystic fibrosis?

Rolfe.
 
If the US shifts to socialized "HillaryCare", where will the Canadians go for expeditious health care? Inquiring minds need to know.

Considering the resistance to implementing some sort of universal health care plan in the US already, wouldn't it make more sense to assume that any plan that was generally acceptable would include private options?

Linda
 
Another shining example of the marvelous innovations possible under socialized medicine:

Seven million patients can't find a dentist on the NHS for two years

And what is this meant to prove. Yous seem to be under the impression that there is not private medicine in the UK. You are quite, quite wrong.

ETA. according to the articel below, 150 million Americans have no dental care, that's almost half the population, rather than the less than 10% of the UK population who may not have dental care (a significant proportion of that 10% will have private care plans)

So, if we want to make smug xenophobic jokes about a nation with bad teeth, who should we pick on, the Brits or the Americans?

Show your work.


http://query.nytimes.com/gst/fullpage.html?res=9F0CE4DF113BF935A15756C0A965958260
 
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Rolfe - thanks for the reply. As far as sarcasm goes- I was trying to be funny too, but seemed to have missed. People opposed to national health care just don't care about the sick and uninsured. I thought it was funny.

Beyond that - I appreciate hearing the views of those from countries with national health care systems as they do clear up some of the misconceptions for me. The OP had asked why people from the U.S. have an aversion to government involvement in healthcare. I was pointing out some of the concerns that have been mentioned by those most strongly opposed to such a system.

I have also heard directly from individuals who live under such as system and have nothing but praise.

At one time, I was in the camp that was absolutely against national healthcare. I'm not as opposed as I once was. Part of that is due to how hard our great private healthcare system has been hitting my budget lately. Additionally - my healthcare related tax burden doesn't seem all that different from those who live with a national system.

I'm here to learn.

By "single payer" I mean the following:

Right now the U.S. has many different insurance companies competing for business. At my company alone I can choose between 3 or 4 different plans. The company I work for negotiates with several carriers in the area I live and decides which are the best for them in terms of price and the best for the employees so they can compete for talent.

The perception in the U.S. is that all those companies would go away and be replaced by an IRS type single payer government agency. The perception may be wrong - but it is a perception none the less. I must say that our Presidential candidates that support a national system do a very poor job laying out exactly what they mean by "National Healthcare". That doesn't help matters. I almost wonder if they even know what they mean or if they're watching the polls and finding out that their base likes "National Healthcare" so they'll support it too and iron out the details later.
 
By "single payer" I mean the following:

Right now the U.S. has many different insurance companies competing for business. At my company alone I can choose between 3 or 4 different plans. The company I work for negotiates with several carriers in the area I live and decides which are the best for them in terms of price and the best for the employees so they can compete for talent.


Given that these competitors are competing to drive down the price, is it not just as likely that this will result in the pharmaceutical companies and healthcare providers being squeezed for cash and strapped to find their innovations budget, as any effect of the government being the primary customer?

Also, given that this system is keeping alive a number of insurance companies, with all their administration, paper-pushing and advertising, how might your overall healthcare benefit if that money was actually going into medicine?

Rolfe.
 
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Another shining example of the marvelous innovations possible under socialized medicine:

Seven million patients can't find a dentist on the NHS for two years

What do you get when you put twenty British people in one room? One full set of teeth.

If the US shifts to socialized "HillaryCare", where will the Canadians go for expeditious health care? Inquiring minds need to know.


So who said the system was perfect? And who said these people were unable to find a dentist altogether? The main reason NHS dentistry has become so hard to find in some areas is that the dentists were finding private practice much more profitable, and so stopped taking NHS patients. They still fix the teeth, it's just that they're being paid privately, and they maintain that they are able to do a much better job out of the restrictions of NHS provision.

That's the market for you! But if there is sufficient public pressure (like the article you quoted) to put more money into NHS dentistry, then that will happen and the pendulum will swing the other way. It's called democracy.

However, we're talking dental care here, not a heart transplant or spinal injury care. It's within the means of many people. And they won't die if they don't get it (as we can see all too well by watching TV footage of poorer US citizens). And more companies are offering dental insurance or spread-the-cost plans, as demand increases. See how the market still operates to provide choice, even when one of the choices is universal healthcare?

Now, if we're talking about actual dental health, I note a few things from my TV habit, and day-to-day experience. Most people's teeth in Britain are sort of OK. Obvious gaps and decay are very unusual. Most people either have decently-looked-after natural teeth, or quite a few crowns, or dentures. However, cosmetic dentistry hasn't really gripped, most people have flaws and irregularities, and even looking at actors you can see all sorts of flaws in close-up. (Going back a bit, look at Gareth Thomas's open mouth in the original title sequence to Blake's Seven. Nice to see that amalgam fillings are alive and well in the 27th century!)

In contrast, US actors have the most amazing teeth. One smile can blind at ten paces! On the other hand, when we see footage involving ordinary US citizens, especially those of lesser economic means, I'm frequently struck by the number of gaps and blackened stumps on display.

Now why might that be, do you suppose?

I suspect the British situation is still affected by the better avaliability of NHS dentistry over the past 50 years compared to the present (above all else, free/subsidised treatment ingrained in many people a regular habit of dental checkups, and most children were forcibly frogmarched there every six months throughout their formative years), and that if things go on as we are, we may see a regression towards the US situation. But I wouldn't see any of that as an endorsement of private-only dental care, or any reason for restricting universal dental care any further, or indeed even as much as it is currrently restricted.

Rolfe.
 
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CaptainManacles, I've asked you twice three times now, but you're ignoring me. In my experience that often means the poster doesn't like the answer they realise is inevitable (Robinson?). But hey, who cares? We're just having a conversation here....

I'm geninely interested to find out what it is you personally want from your healthcare system, and how you personally want to pay for it. I can't deduce that from your posts so far. I gave a few examples, but to keep it simple let's concentrate on the first one.

What would your game plan be if you had a child with cystic fibrosis?

Rolfe.
 
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CaptainManacles, I've asked you twice three times now, but you're ignoring me. In my experience that often means the poster doesn't like the answer they realise is inevitable (Robinson?). But hey, who cares? We're just having a conversation here....

I'm geninely interested to find out what it is you personally want from your healthcare system, and how you personally want to pay for it. I can't deduce that from your posts so far. I gave a few examples, but to keep it simple let's concentrate on the first one.

What would your game plan be if you had a child with cystic fibrosis?

Rolfe.

I have a job and go to school. I know this may be a shock to you, but not responding to you within 24 hours or prioritizing discussing with other people does not mean I'm hiding from you. It mostly means that I think debating with you is a waste of time, because you're delusional and any reasoning I present you will just ignore or intentionally misread. I've stated what I want from my healthcare system if you can't figure it out with the pages of discussion then that's a problem with you, not with me. You debate like michael moore and fortunately I don't have to deal with you if I don't want to. I don't have time to go through endless hypotheticals and restatements of the same lame arguements over and over. I've already answered what I would do in a dire medical emergency, so why then ask what I would do if i had a child with cystric fibrosis? Why don't YOU deal with my response instead of dodging it? Can you not read or are you just lazy or do you think baggering me and wearing me out will help you gain the appearence of winning the debate without ever having to make a sensible arguement? Either way it's clear that there's nothing to gain from having a discussion with you so I'm not going to.
 
Having gained some insight to the libertarian view, I can answer your question since CaptainManacles is too busy.

The libertarian position is that each person is responsible for their own behavior. If a person does not acquire private health insurance to cover a potential future illness then they will simply pay the costs when they occur or do without. If they or their child dies because they could not afford the treatment at the time it is nobodies fault but their own.

Of course, there is the question of wether the children are considered to simply be property of the parents until they are capable of supporting themselves or if the children have independent rights such as the right to health care even when the parents are unwilling to provide it.
 
You "go to school".

O.... K....

As I said, I was and remain genuinely interested in figuring out how you want a healthcare system to work, and what longterm plans you have to cope with possible contingencies. No, I can't work it out from your posts because you have been unclear and contradictory.

I'm not even sure if your intentions/wishes involve insurance. One of your posts suggested perhaps not. That was the one about paying for whatever you needed, and if you couldn't afford it then a forlorn hope of charity (better hope someone else is giving to charity then, because I seem to recall your implying that you wouldn't), and if not then just go without and possibly die.

Other posts of yours suggested that you saw the importance of thinking ahead, and knowing that you had plans in place for eventualities. Finding a great deal of money at very short notice doesn't seem like a great plan, especially if you've chosen not to pay insurance premiums so that you can spend the money elsewhere. Which was also implied by you in a different post. See the problems I have trying to figure out where you're coming from?

So, charity (which you don't hold with contributing to), or do without and maybe die? Not great choices in my book. Or you could rely on state-provided healthcare, which is there at the moment, even if restricted. But then you indicated that you resented contributing to that, and in your ideal system that wouldn't exist. So, I'm confused.

It's easy to be macho and declare, I'll pay my way or die! That was why I asked about the possible scenario of your being responsible for someone else's welfare, someone whom you might care about, someone who might not share your readiness to die if you couldn't spring for a great deal of money. If I were a young person, as you appear to be, and planning ahead, I'd certainly want to consider a possible future family in my plans. And disabled/sick children happen, and even without money worries they can be a huge strain on anyone. Compound the strain of trying to care for a chronically sick child with not knowing where you're going to find the money for medication, and you have a recipe for disaster.

So I think it was a fair question.

On the other hand, perhaps your intentions are to purchase insurance. I'm still not clear. So, what would you look for in an insurance provider. Very comprehensive coverage? Including complementary medicine? Including future family? Good record on meeting claims? Low overheads?

Or would you rather go for cheap, minimum cover, no-frills? What would you lose out on if you did that? Do you intend or hope that an employer will pick up all or part of the tab for your insurance? What happens if you lose your job?

See, I really want to know. Because you're putting forward an interesting, if baffling, point of view, and I want to see if it stacks up under scrutiny.

I'm beginning to think maybe it doesn't. So maybe it makes sense from your point of view to cut off the conversation and declare you won't answer.

I just hope you explain yourself very very clearly to any future wife or significant other, particularly before any children are planned.

Rolfe.
 
Ontario charges a tax on income for the health system. These amounts are collected through the income tax system, and do not determine eligiblity for public health care. The Ontario Health Premium is an additional amount charged on an individual's income tax that ranges from $300 for people with $20,000 of taxable income to $900 for high income earners. Individuals with less than $20,000 in taxable income are exempt.
Ho many Americans can get coverage for $300-$900 per year? Remember $900 is the maximum you pay even for a high income earner. You're not exactly having your money ripped from your wallet in this case.

Note that quoting the $900 is exceptionally misleading. The $900 tax was an 'extra' tax grab instituted by the Liberal government (who had promised 'no new taxes'). However, it constitutes only a fraction of the spending on health care. (Other money comes from general tax revenue, so your 'high income earner' is paying a lot more than $900.)

oh and another thing about my above post. That $300-$900 per year guarantees you will never be denied a necessary service.
Actually, no it doesn't... remember, Canada has a problem with waiting lists. Those fees do guarantee you equal access to the waiting list, but if you die before you get served, are you really better off?

So we see here that Canada spends 10.6% GDP to cover 100% of the population while the US spends 15% GDP to cover 84.2% of the population.
Again, this is a little bit misleading. Your 84% number for the U.S. is just the number that are covered by insurance. Yet there may be people willing and able to pay for expenses out-of-pocket; they would be contributing to the '15% GDP' figure, while not being covered by the '84%' figure. Then, you also have the people who may not be covered now, but only because they have started new jobs (and their insurance hasn't kicked in yet.)

It should also be noted that the U.S. system is generally ranked as the most responsive health care system (even if it is the most expensive and not everyone has equal coverage). So, here its a philosophical question... is it better to have equal access to health care (as in Canada) where everyone ends up with poor to average health care, or is it better to have an American system where there is a much wider range, but where some people will have it worse than in Canada, but the average person will have it much better?

This also covers your chrystal's thing as services deemed medically necessary only if it is performed by a physician in a hospital. So gurus, seers and psychics are not covered by the government.
Why exactly is this relevant? I doubt the cost of 'alternative' medicine and other woo is considered in either country's health care costs. So why mention it?
 
At one time, I was in the camp that was absolutely against national healthcare. I'm not as opposed as I once was. Part of that is due to how hard our great private healthcare system has been hitting my budget lately. Additionally - my healthcare related tax burden doesn't seem all that different from those who live with a national system.


That's a very interesting and mature response. I can understand that people sometimes don't think through the detailed consequences of ideologically-based opinions until they actually find themselves in the relevant situation.

I recall when the "Community Charge" was about to be introduced in England. I was very much against it, and could give a raft of reasons why it was, speaking purely pragmatically, a completely brain-dead idea. My business partner was an active member of the political party which was introducing the tax, and he would agree with not a single word I said. As far as he was concerned my opposition was politically motivated, and that was that. He had a glib party-line answer for every objection, which was trite, superficial, and each one contradicted the others.

Then a little while after the tax was introduced, he started to see how it was affecting some of our staff, who were young and very mobile. The paperwork was a nightmare for the people trying to obey the law, and if they hadn't been lawabiding it was obviously all too easy to disappear. But the crunch came when his own son turned 16 (I think - whatever age an individual had to be to be liable for the flat-rate charge). He suddenly realised that he was going to have to pay for Michael, as Michael didn't have a bean to his name. Of course, the ideology he'd been spouting was all about each person paying their own share, no freeloading for the low-income.

Now the tune changed entirely. It was absolutely iniquitous that he, as the only earner, should have to pay for three people (himself, wife and son). How did that blue-pencilled government expect him to do that? I tried to remind him that these objections were word for word what I had put to him when he was in favour, and which he had rejected. But selective amnesia won - he didn't recall his fervent support, or when he did he blamed it on "nobody realised all these consequences would happen". No, they had never been spelled out to him, not at all! ;)

OK, he's an extreme case. But the point is he was entirely sincere at each stage. He really did believe ideologically that local government costs should be contributed to by every citizen equally, so fervently that he genuinely didn't understand the practical difficulties. It really did take personal experience of these difficulties to get it through to him. And then he just airbrushed out his original position!

I think it helps to try to put yourself in the other guy's shoes - as I'm vainly trying to do with CaptainManacles. It's too easy to believe we'll be the lucky ones who will enjoy good health, and never be out of a job and so on. And to castigate those who fall sick, or lose their jobs, as being responsible for their own misfortunes.

When I look at what healthcare can cost ordinary American families, I'm just horrified. "Co-pay", and insurance costs, and people having to grind on in jobs they hate because otherwise they lose health insurance not just for themselves but for their children - it's appalling.

Then I try to understand the attraction of that system, and I have to say CaptainManacles isn't doing a good job here, with wild talk of faceless bureaucrats that don't actually exist (at least not in the NHS, they may do in insurance companies), and some abstract notion of "choice".

I hear a lot of scaremongering about how much Americans seem to think universal healthcare would cost, and none of it makes any sense to me. I get to take home a perfectly satisfactory slice of my gross salary, thank you, and I don't think in detail about how much of the deduction goes on the NHS. (Maybe about how much of the deduction goes on the Iraq war, and the Trident replacement, but that's an argument for another thread.)

All I see is that for this I get to bother my doctor whenever I feel the need, and I get any further investigation or treatment she sees fit to refer me for, absolutely no further cost. I know that if I should develop a serious illness, maybe even one that would stop me working, one thing I don't have to worry about is how I pay for my treatment. Ditto for my family. So I declare it is the bargain of the century.

And all this leaves me with enough money to take out private health insurance if I want to (right now I don't see it as a priority, as the NHS cover is so good, but I did when I was self-employed), and in fact over the years I have also managed to save enough so that if push came to shove, I could break out those rainy-day savings and pay for a hip replacement or whatever, if I hit a bad waiting list. How much more choice do you want, for God's sake?

Yes, I reserve the right to fulminate about NHS inefficiencies and failings all I like. I can see that improvements are needed. And that some sort of limits may have to be considered on what will be provided - for example, expensive treatments that prolong terminal illnesses by only a few weeks. But I wouldn't change it for any other system I've seen.

I'm prepared to be persuaded, but so far I just feel very, very lucky.

Rolfe.
 
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Originally Posted by CaptainManacles:
Some people in Canada have decided to force other people in Canada to provide collective health care.

You seem to be neglecting the fact that this was achieved by democratic means. That is, legislation was brought to Parliament and the duly elected members, the representatives of the population in their ridings, then voted on whether to make that legislation law or not.
The fact that the health care system was brought into play by a democratic government does not mean that there is not force involved. There ARE people who do not like the health care system and would want to opt-out if they could; however, under the current laws they cannot.

As an example, if 51% of the population had the politicians pass laws to make the other 49% of the population slaves, that would not make it morally right (even if the 51% were able to get all the laws passed legally).

The publically-funded health care system is also not a violation of anyone's rights...
It depends... do you consider people to have property rights? Granted, in Canada we don't have those particular rights. But lets say we actually had a real constitution that actually had such property rights... forcing people to pay into a universal health care system they do not want (and to disallow private health care) is a violation of the right to use property in the way that they choose.
...or else such a case would have been brought before the Supreme Court and won by the plaintiffs.

We did have a case that went before the supreme court, and they did find for the plaintiffs. Not a perfect victory though (it was a Quebec-only decision, which doesn't affect the remainder of the country).

http://www.cbc.ca/canada/story/2005/06/09/newscoc-health050609.html

We do have a Charter of Rights and Freedoms.

You're right, we do. Unfortunately our charter isn't really that good, as I've pointed out.
 
It should also be noted that the U.S. system is generally ranked as the most responsive health care system (even if it is the most expensive and not everyone has equal coverage). So, here its a philosophical question... is it better to have equal access to health care (as in Canada) where everyone ends up with poor to average health care, or is it better to have an American system where there is a much wider range, but where some people will have it worse than in Canada, but the average person will have it much better?

It may be more useful to establish your underlying assumption, first. How do you determine whether the health care is poor to average in Canada, and whether the average person has it better in the US? The US tends to get ranked lower than the rest of the G7 countries on various measures of health/health care. I made no changes to the care I provided depending upon the country I was practising in (excluding the people in the US I was not able to provide care for because they lacked both insurance and money). How do you measure health care, and what are the results of those measurements?

Linda
 

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