Socialised Healthcare

[Skeptic Ginger]

This article belongs in a couple threads so I will be posting it in more than one.

Paraplegic man dumped in LA gutter sues hospital

Lest you think this is an isolated incident, it is not.

The Olvera case was one of about 50 reported incidents in the past 12 months of sick, confused and homeless patients being left by ambulances in the 50-block area of downtown Los Angeles thought to have the highest concentration of homeless people in the United States.

But it also illustrates the problem in not having a national health care service of some kind. Just who is responsible for this person and others like him and who pays? Here is a hospital who perhaps admitted this man (the article didn't describe the circumstances under which this guy was admitted but the typical scenario is someone dumps the patient off in the ED and indeed the patient is sick enough to be admitted to the hospital.

So who pays for that person's care? The hospital is obligated by law to care for the person. But citizens refuse to vote in taxpayer supported services. It is pure ignorance and denial. Everyone is paying for these uninsured people. We simply pretend we are not by claiming we don't want government provided health care or health care insurance.

People need to get over it and pay for proper care, it is more cost effective.

 

[Abe_the_Man]

No they haven't. Some people in Canada have decided to force other people in Canada to provide collective health care. I have no problem with people pooling their resources or providing charity. And even if that were the case, I'm not telling them what they can and cannot do, I'm criticizing their policies. I am allowed to criticize Canada, correct? Seriously, equating criticism with attacking someone's rights is a hallmark of the intellectually lazy.

By saying it is force you are implying that it isn't wanted. If the government tried to repeal the canada health act there would be riots. Ask any Canadian if they don't want our free Universal healthcare. I'm not saying it's perfect. I'm not saying that everyone is 100% satisfied all of the time. The system is designed to do the most possible good for everyone. Not just those who can afford it.

Also you didn't respond to my previous post noting tha Canada only pays 10% of GDP for healthcare (about average) to cover 100% of the population with full free healthcare. While the US pays 15% of GDP to provide varying coverage to 85% of the population (the highest cost in the world). So who is having their money ripped away?

 

[Abe_the_Man]

I realised that the figures quoted by Abe the Man couldn't be right. But I'm not convinced yours are right either.

Upon further review I am inclined to think you may be right about the actual cost per person. I was quoting the figures I have found. I will try and find more correct figures if possible (I will be visiting Stats-Can to see if they have more). But my statement about GDP out put still stands I think.

 

[CaptainManacles]

By saying it is force you are implying that it isn't wanted.

I'm implying it's not wanted by some people. If it was wanted by everyone it would not have to be a government program, it would just be a private charity that everyone voluntarily donated to.

If the government tried to repeal the canada health act there would be riots.

Which only further proves my point that the system is based on a foundation of primitive dark ages style mob rule.

The system is designed to do the most possible good for everyone.

And how do you determine the most possible good for everyone?

Also you didn't respond to my previous post noting tha Canada only pays 10% of GDP for healthcare (about average) to cover 100% of the population with full free healthcare. While the US pays 15% of GDP to provide varying coverage to 85% of the population (the highest cost in the world). So who is having their money ripped away?

Canadians. The percentage paid has no relevence to whether or not it is being forced from someone's pocket.

 

[CaptainManacles]

It's easy to be macho and declare, I'll pay my way or die!

That's a perfect example, that's such a gross mischaracterization of my point you're either unwilling or unable to understand it. Besides that, there were a number of blatent fabrications in your post.

 

[fls]

Canadians. The percentage paid has no relevence to whether or not it is being forced from someone's pocket.

The average American has $2727 forced from their pocket (taxes) to pay for healthcare. The average Canadian has $2210. If anyone's money is being ripped away, it's yours.

http://www.commonwealthfund.org/usr...hltsysdata2006_chartbook_972.pdf?section=4039

Linda

 

[Rolfe]

That's a perfect example, that's such a gross mischaracterization of my point you're either unwilling or unable to understand it. Besides that, there were a number of blatent fabrications in your post.

If I misrepresented you through failing to understand your almost impenetrable replies, I'm sorry.

Maybe in that case you could try to express more clearly what your actual position is, so that there's no likelihood of your being misunderstood.

Do you want to purchase insurance, or not? Is reliance on an employer funding either healthcare or insurance premiums an important factor for you? Do you have plans to meet potential healthcare costs if for any reason you find yourself without adequate insurance cover? Do you take into consideration possible dependents who may require significant healthcare expenditure?

By saying it is force you are implying that it isn't wanted. If the government tried to repeal the canada health act there would be riots. Ask any Canadian if they don't want our free Universal healthcare. I'm not saying it's perfect. I'm not saying that everyone is 100% satisfied all of the time. The system is designed to do the most possible good for everyone. Not just those who can afford it.

Pretty much the same here. Any concept of even a sizeable minority opposed to the provision of universal health care is a total mischaracterisation. Oh yes, we'll bitch and moan about trivial (and not-so-trivial) failings of the NHS, but ask anyone if they'd rather not have it, and be personally responsible for buying their own medical care from private providers, and I think you'd have to scour the country to find even a handful of takers.

Oh dear, this hypothetical handful is being oppressed! Quick, alert the European Court of Human Rights!

Rolfe.

 

[Segnosaur]

But its the responsiveness (getting people in for treatment/diagnosis, establishing infrastructure where and when its needed) that affects death and disability rates.

Not entirely. If responsiveness is good in emergency cases, with proiritisation according to clinical urgency, the effect may not be nearly as marked as you imply.

I think by responsiveness, the WHO wasn't referring to emergency room situations... they were referring to the changes in the medical infrastructure as they are needed. (How fast new hospitals get built in areas that need them, how quick new medical technologies become available, etc.)

 

[Spock Jenkins]

This article belongs in a couple threads so I will be posting it in more than one.

Lest you think this is an isolated incident, it is not.But it also illustrates the problem in not having a national health care service of some kind. Just who is responsible for this person and others like him and who pays? Here is a hospital who perhaps admitted this man (the article didn't describe the circumstances under which this guy was admitted but the typical scenario is someone dumps the patient off in the ED and indeed the patient is sick enough to be admitted to the hospital.

I would reserve judgment until I get more details on the case, but just a couple of observations. Whether or not the person that was discharged could walk is not relevent. Many people can't walk. That doesn't mean that particular trip to the hospital was a necessary one. After a while, I would guess that you do become pretty jaded to people abusing the hospitals obligation to at least consider whether treatment is necessary. I would also guess that some of these homeless abuse that ability to sit in the ER for a period of time whether or not it's necessary. The employee in charge of bringing them back to the homeless shelter likely gets sick of making that run for people that don't need care - so they rather calously drop them near a homeless shelter (as stated in the article).

Of course, the lawyer sees "parapalegic" and "homeless" and uses that to garner the public sympathy. The hospital doesn't have the time or the resources for a lengthy defense - so they agree to a settlement. The public hears "settlement" and translates that to "admission of guilt". Hospital says the right things, "Going foward, we will always wheel them to the front door of the homeless shelter and hold their hand on the way." Until the 15th drunk that month gets an ambulance ride into the ER in no more need of treatment than time to sober up because somebody with a cell phone saw a person passed out in the street and called 911.

Should hospitals be obligated to provide room and board for the homeless until a proper residence can be secured? At what point should a hospital be allowed to kick a person out who is in no need of medical care? How would this obligation or lack thereof change under a national system?

 

[Segnosaur]

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

Who are these Canadians going to the States for treatment? I've lived in all areas of Canada and know of only one person who has gone to the U.S. for anything medical and he was invited there by the Mayo clinic so they could do tests to help find out why he had dramatically out-lived all other recipients of an experimental treatment. Every time this debate pops up someone mentions the "fact" that large numbers of Canadians are crossing the border for rapid treatment and yet I don't know any of them. Can any other Canadians confirm that this actually occurs?

Did you ever think that even though you've lived in many different areas of the country, you simply may not be associating with the exact people who NEED (or can afford) to travel for medical care?

Here's an article that mentions a small number of Canadians who have either gone abroad (or plan to go abroad) for treatment. So, it does happen.

http://www.cmaj.ca/cgi/content/full/174/9/1247

From what I've read, the U.S. may not be the main destination for 'medical tourists'... places like India, Cuba, etc. are.

 

[Wildy]

I think by responsiveness, the WHO wasn't referring to emergency room situations... they were referring to the changes in the medical infrastructure as they are needed. (How fast new hospitals get built in areas that need them, how quick new medical technologies become available, etc.)

So why is it then that they aren't ranked 1 for "distribution" and instead get a rather wide range (3-38)?

Hell the UAE is only 30 for responsiveness but 1 for distribution. Australia, which is a similar size (land area) is in the same range as the US and a lower responsiveness rank as well, but has a better overall rank compared to the US (32 compared to 37, and to point it out the UAE which I also mentioned is overall ranked 27).

 

[Beerina]

You cannot have first class medical care without the best medical technology, and you cannot have that without profits driving innovation.

Can you elaborate on how this is relevant to a multi-payer vs. a single-payer system?

Linda

Single-payer is for a reason. What's that reason? To reduce costs by forcibly outlawing people from negotiating pay rates with their doctors on their own (which, in "multi-payer", i.e. free societies, is handled by private individuals, which are what insurance companies are at root).

If doctors cannot say, "To heck with you and your low rates, I will not treat any of your people" (i.e. one half of the free market equation that works so well for video games and computers), then there is no incentive for the "single payer" to do anything but keep ratcheting down the amounts they pay. This gives a shortage of money, which drives people out of the medical industry, which slows development, which leads to a net increas in misery and death as treatments and cures lag further and further behind.

 

[Segnosaur]

I agree. For many products and services the free-market works better than planned economies. Health care is quite a unique service though, in that it is often required quickly, the consumer is usually unable to make informed choices, and it requires highly skilled providers, the supply of which are rationed by medical schools.

Yes, health care may be required quickly. (But then again, many non-health care services are also required quickly.) But regardless of how quickly a health care service is required, it still requires infrastructure to be created, something that doesn't happen quickly.

And yes, it does provide skilled providers... but there is still various medical infrastructure where less-skilled individuals make an impact.

If a hospital, clinic or doctor tries increasing costs excessively, what will prevent other health care providers from moving in, and charging less in order to undercut the competition?

I'd have to say that the increased cost of health care in the U.S. is likely due to 2 things:

- Higher costs of lawsuits
- Overcapacity (after all, if you want to allow immediate treatment you have to have unused resources which cost money to maintain)

While I agree your first point certainly has an impact on the cost of medical care, the second is bizarre.

In how many other markets when there is overcapacity does the price increase? If I flood the market with my product, the reduced demand for it should lower the price, not keep it inflated, if the market is working.

Let me explain...

Lets say you had a city of a few million people that needed (on average) 10 hospitals to serve its population. Now, this is an average... sometimes there will be more patients (enough to fill 15 hospitals), sometimes there will be fewer (only enough to fill 5 hospitals).

Now, consider a country like Canada, where the government is the only provider of health care services... We may build only 5 hospitals. What this means is that the hospitals will always be filled... few (if any) empty beds. The costs are for the beds in use only. But, it does mean that you will have situations where people get stuck on the waiting list at certain times.

Now, consider a place like the U.S. Some big evil medical corporation decides that people don't want to wait for health care service, so they build 15 hospitals in the city. In that situation, nobody has to wait... ever. However, it means that (on average) 1/3 of the available beds are sitting empty. So, the evil medical corporation has to charge more to the remaining patients to help pay for the beds that are unused now, but will be used in the future.

Its a simplified example, but hopefully it gets my point across.

What incentive is there for physicians and other health care providers to lower their charges and/or restrict their treatment to that which is necessary?

Yes, its quite possible for doctors to order more tests/treatment than is necessary. But then, I'm pretty sure insurance companies would provide at least some oversight over what treatments are given.

 

[Beerina]

Seconded. The innovators still get paid in a universal healthcare system, so they still have incentive to innovate and compete.

Rolfe.

Incorrect. They are partially paid, but the amount from government is only a small fraction.

To put this in perspective, when the Internet boom started, many trillions of dollars were poured into all forms of software and electronics. Microsoft became a bigger corporation than GM. Cisco, who builds the high tech router backbone equipment, became worth more still.

The amount of private cash for investment that's available in a free society absolutely dwarfs the government's investment.

If something financially magnificent were discovered in space travel, you can be sure the trillions suddenly dumped into it would dwarf all the efforts of NASA up to this very day.

Medical research, genetic research, and all that, are in the same position as the Internet some years ago. The promise, and the financial payouts are enormous. Therefore it sucks in tremendous amounts of money to do research that "only" government research could never afford in their wildest dreams.

 

[Beerina]

And if you say, well, they're not paid directly by the government. They're just paid amounts fixed by government bureaucrats for whatever they happen to invent, then you will drive out innovation as well.

 

[Segnosaur]

Also you didn't respond to my previous post noting tha Canada only pays 10% of GDP for healthcare (about average) to cover 100% of the population with full free healthcare. While the US pays 15% of GDP to provide varying coverage to 85% of the population (the highest cost in the world). So who is having their money ripped away?

Captain Manacle may not have responded to your post... but if you go back and look at my posting (#117) you will see where I pointed out that your particular assertion is misleading.

 

[fls]

Single-payer is for a reason. What's that reason? To reduce costs by forcibly outlawing people from negotiating pay rates with their doctors on their own (which, in "multi-payer", i.e. free societies, is handled by private individuals, which are what insurance companies are at root).

If doctors cannot say, "To heck with you and your low rates, I will not treat any of your people" (i.e. one half of the free market equation that works so well for video games and computers), then there is no incentive for the "single payer" to do anything but keep ratcheting down the amounts they pay.

There's lots of negotiation going on. Pay rates are negotiated between physicians, hospitals, and various other services, and the public administrators. The amount put into the system is negotiated by the public through their elected representatives.

This gives a shortage of money, which drives people out of the medical industry, which slows development, which leads to a net increas in misery and death as treatments and cures lag further and further behind.

You can make up all sorts of doom and gloom scenarios, but at some point you need to check whether or not they match up with reality.

Linda

 

[fls]

Incorrect. They are partially paid, but the amount from government is only a small fraction.

To put this in perspective, when the Internet boom started, many trillions of dollars were poured into all forms of software and electronics. Microsoft became a bigger corporation than GM. Cisco, who builds the high tech router backbone equipment, became worth more still.

The amount of private cash for investment that's available in a free society absolutely dwarfs the government's investment.

If something financially magnificent were discovered in space travel, you can be sure the trillions suddenly dumped into it would dwarf all the efforts of NASA up to this very day.

Medical research, genetic research, and all that, are in the same position as the Internet some years ago. The promise, and the financial payouts are enormous. Therefore it sucks in tremendous amounts of money to do research that "only" government research could never afford in their wildest dreams.

I still don't understand why you think that private cash for investment somehow becomes unavailable. Wouldn't there be more cash available if medical care was significantly cheaper?

Linda

 

[Beerina]

Actually, bureaucrats (and the politicians) make decisions all the time about a patient's health care. They may not do so directly, but their impact is still felt.

For example, when the bureaucrats or politicians decide to build a new MRI machine (or set the running hours on an existing machine) they are making decisions about your health care. They aren't directly telling you what your treatment should be, but they are affecting the way your disease is treated. Under a more free-market system, the owners and/or operators of the clinic could decide to install a new machine or extend the operating hours on the old one (in an attempt to get more profit), but have no incentive to do so when there is no reward.

Exactly. There is no logical reason for a full, true, single-payer system whatsoever.

Why? Think about it a minute.

If some doctor wants to open his own clinic, put in an MRI, and give MRIs to people who can and are willing to pay for it, it's no skin off the ass of anyone else. If it's a free country, free people should be able to do this.

The reason this is not allowed, and cannot be allowed is because it makes the government system look bad with inferior treatment.

It's nothing more special than that.

There was a special on a few months back where many such clinics have opened anyway to meet the demand, even though they are technically illegal. Some are run by highly placed government medical people.

People of Canada. I call to you. Give up your rage! Let people be free.

I sense fear in you. Fear leads to hate. Hate leads to anger. Anger leads to violence command-and-control desires. Violence command-and-control desires lead to death. Calm you must be.

 

[Segnosaur]

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.

The same can be said for taxes going to public education. Or the military. Or to government-funded programs of various types.

At what point do you draw the line as to what individuals can opt out of paying taxes for?

You're right... there is no clear line about what is reasonable for the government to pay for, and what is not.

I just have a problem with people insisting that they aren't being forced to pay into health care... Yes, they are forced. We just have to decide whether that force is a good thing.

(We could get sidetracked into a discussion about natural monopolies and such but that would derail the thread.)

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).

That's a silly analogy because there are certain rights accorded to all citizens under the Constitution and the Charter of Rights and Freedoms.

The argument was that people aren't being forced to pay into health care because, as was stated in a previous post... You seem to be neglecting the fact that this was achieved by democratic means.

Believe it or not, the charter can be changed, by democratic means. In theory, it could could be altered to remove rights to free speech, free assembly, etc. if enough democratically elected politicians in enough areas of the country decided to. (Heck, the government wouldn't even need to change the constitution... just invoke the notwithstanding clause.) I don't expect that to ever happen, but it is technically possible.

The fact is, assuming something is morally OK just because it was democratically decided on is incorrect. In fact, there's even a term for it... tyranny of the majority. (http://en.wikipedia.org/wiki/Tyranny_of_the_majority) We do have a tradition of democracy that must be respected, but we also have to worry that people with minority opinions are also respected.