This is the Government that You Want to Run Health-care?

[jimbob]

Which is why Churchill immediately repealed the unpopular National Health Service Act when he returned to power in 1951.

Why was he returned to power in 1951?

Well, it wasn't to dismantle the NHS:

Conservative party manifesto: 1951

Housing is the first of the social services. It is also one of the keys to increased productivity. Work, family life, health and education are all undermined by overcrowded homes. Therefore a Conservative and Unionist Government will give housing a priority second only to national defence. Our target remains 300,000 houses a year. There should be no reduction in the number of houses and flats built to let but more freedom must be given to the private builder. In a property-owning democracy, the more people who own their homes the better.

In Education and in Health some of the most crying needs are not being met. For the money now being spent we will provide better services and so fulfil the high hopes we all held when we planned the improvements during the war.

 

[jimbob]

Do you want to live in a society where those who can afford it live, and those who cannot, suffer and die? If you do, this is going to get very interesting, very quickly.

Is blowing straw-men a profession or just a hobby?

Why was that a strawman, Jerome?

look at the rest of the post:

Well, I was talking to Jerome, as he has expressed an opinion that the market would leave no-one behind.

Nevertheless, is your position different? Would you rather the poor died of diseases instead of being helped by the state? Do you disagree with all state-funded healthcare, even when it would save the life of someone otherwise unable to afford treatment? You'll note, by my figures, this happens already in the US, and would no doubt get worse were Medicaid suspended or further rationed.

Do you want to live in a society where those who can afford it live, and those who cannot, suffer and die? If you do, this is going to get very interesting, very quickly.

If I read your posts correctly, you are not arguing that the poor shouldn't get affordable healthcare, but that the free market will enable even poor people to have adequate healthcare; please correct me if I am wrong.

Balrog666, on the other hand seems to be saying that it isn't worth spending (his?) hard earned tax-dollars on healthcare for the poor. To me this reads that the poor shouldn't be entitled to healthcare. (Again please correct me if I am wrong).

 

[JEROME DA GNOME]

If I read your posts correctly, you are not arguing that the poor shouldn't get affordable healthcare, but that the free market will enable even poor people to have adequate healthcare; please correct me if I am wrong.

You are correct here.

Balrog666, on the other hand seems to be saying that it isn't worth spending (his?) hard earned tax-dollars on healthcare for the poor. To me this reads that the poor shouldn't be entitled to healthcare. (Again please correct me if I am wrong).

He is asking what is the threshold for your labor to be used for others.

 

[Rolfe]

If I read your posts correctly, you are not arguing that the poor shouldn't get affordable healthcare, but that the free market will enable even poor people to have adequate healthcare; please correct me if I am wrong.

I don't think he's arguing it, I think he's asserting it. I don't see the faintest ghost of a reasoned argument to support the assertion.

Rolfe.

 

[Darat]

You are correct here.

...snip...

Yet all of history and the current lack of even the most rudimentary health care for the majority of the world's poor population demonstrates this not to be the case.

 

[balrog666]

He is asking what is the threshold for your labor to be used for others.

Yes, exactly.

There are limits to what I can pay. Or choose to pay. There is a limit to the amount of money that a government can grab and spend. Thus, we must set priorities on government spending and limit/ration the dollars to those on the dole (whether it be for medical care, food stamps, rent subsidies, child welfare, or any other purpose).

Anecdotal stories, whether about some addict who didn't get a new liver or some poor child who didn't get a third kidney transplant, don't bring anything to the discussion.

 

[volatile]

Yes, exactly.

There are limits to what I can pay. Or choose to pay. There is a limit to the amount of money that a government can grab and spend. Thus, we must set priorities on government spending and limit/ration the dollars to those on the dole (whether it be for medical care, food stamps, rent subsidies, child welfare, or any other purpose).

This we can agree on. Of course there are limits.

Now: where do you draw the line? Is it above, or below, people dying because they cannot afford healthcare?

Remember, this is not an "anecdote". Thousands of US citizens die because they do not have medical insurance already. Your desire to eradicate Medicare will increase this number. Is that a price you are willing to pay?

 

[balrog666]

This we can agree on. Of course there are limits.

Now: where do you draw the line? Is it above, or below, people dying because they cannot afford healthcare?

Remember, this is not an "anecdote". Thousands of US citizens die because they do not have medical insurance already. Your desire to eradicate Medicare will increase this number. Is that a price you are willing to pay?

It may not be an anecdote but it is a rather vague and meaningless question. What exactly are you proposing, how much will it cost, how will that prevent "people dying", and why is that "good" for society?

Or do you intend to imply that some threat of (more-or-less imminent) death mandates that all possible means be employed to keep someone alive, regardless of cost or efficacy?

 

[jimbob]

Jerome, haven't you accepted in the post below that healthcare is expensive?

In a deregulated market, will economies of scale suddenly vanish?

Nope.

Will the capital cost and depreciation of medical equipmens suddenly reduse?

Nope.

Will medical treatment and diagnosis suddenly not need highly qualified workers? Will highly qualified workers, in a field where there is demand for their services suddenly not command high wages?

Nope and nope.

Will large hospitals not be needed, or will the capital cost of the hospital also not need to be covered? Will the land value of new hospitals vanish.

Nope and nope.

So large hospitals will be needed, how could they function without an attendant bureaucracy? Large insurance companies will be needed, how could they function without an attendant bureaucracy? How could they maximise profits without minimising payouts? Can large bureaucratic organisations really have such efficiency savings that the total cost is less than if they didn't exist?

How could someone in the 20th to 40th centile (median family income of USD25.7k in 2004, let alone someone in the 20th centile (median family income of USD11.1k in 2004) afford to pay for medical treatment without some help from the state?

Suppose this person needs surgary that will take (say) five hours.

The median salary for a General surgeon with less than 1-years experience is USD170k according to this website.

Suppose this peoron is on the (2008)federal minimum wage of USD6.55/hour

If you ignore all other costs and assume that the patient will just need to pay the surgeons wages alone, and assuming that this surgeon works a 60 hour week for 50 weeks a year, then this would come out at an equivalent rate of USD56/hour.

The person on minimum wage would need to work for 43 hours just to pay the wage-costs of a genreal surgeon for 5-hours. They would also need to eat, and other luxuries, like transport to their job and rent.

Of course the above is a small fraction of the actual cost of a five hour operation. It doesn't actualy matter for this argument whether the person pays for the treatment up-front, or whether they pay insurance. The insurance company exists to make a profit, so will still have to recoup the costs of medical treatment and their profits from their clients.


Now, at the very least you would also need an anaesthitist (median salary of 145k for someone with less than 1-years experience). You also need several nurses, expensive medical equipment, the use of a hospital theatre, and associated facilities, You also need to stay in hospital to recover, and whilst you are doing this, you need are not earning anything. So any insurance also needs to cover the costs of your lack of income too.

Why do you claim that medical care needn't be expensive?

Why do you think poor people could afford it without state support.

I have not even started on someone with a chronic condition, who wil need lots of costly intervention. Why should an insurer take such a person in the first place?






*Yes I know that seems a strange way of asking the question, but you have a look at the Federal reserve PDF here

 

[balrog666]

Your desire to eradicate Medicare will increase this number. Is that a price you are willing to pay?

I forgot to address this part.

I have not proposed to eliminate Medicare.
I would like to reform Medicare/Medicaid responsibly, but such plans have already been shot down.
But, yes, of course, since actions have consequences.

Or, more directly, the value of a human life is quite finite.

 

[jimbob]

Balrog,

Most of my taxes go to pay for things that have little direct benefit to me, but which are considered a social good.

As has been pointed out earlier in this thread, the lack of adequate medical care in the US does push up labour costs there, because employeers need to pay for this as part of their renumeration packages, at salary-levels which wouldn't merit (or need) this in other countries with universal healthcare.

I feel confident that most of the other UK posters in this thread would be as unhappy as me if our tax was spent on a system like medicaid, which in 2004 cost more than the NHS, and failed to be universal.

 

[jimbob]

Further to my post #289, does anyone have any figures for what percentage of working time a surgeon actually spends in theatre?

 

[Rolfe]

Yes, exactly.

There are limits to what I can pay. Or choose to pay. There is a limit to the amount of money that a government can grab and spend. Thus, we must set priorities on government spending and limit/ration the dollars to those on the dole (whether it be for medical care, food stamps, rent subsidies, child welfare, or any other purpose).

Anecdotal stories, whether about some addict who didn't get a new liver or some poor child who didn't get a third kidney transplant, don't bring anything to the discussion.

Like volatile, I agree with most of this.

However, you have not indicated where your limits lie.

How about, I get full healthcare, free at the point of need (and I'm being dragged out of work lunchtime tomorrow because my name came up as being a candidate for routine screening, and children even get their third transplants on occasion), and all this universal coverage costs me a lower proportion of my salary in tax than your contribution to Medicare costs you. And yet, if you're earning a reasonable salary, you personally get nothing for your Medicare contribution.

Who is getting the better deal?

Remember, a universal system isn't all take and no give. The benefits for all sections of the community are so overwhelming, despite problems which beset any system doing something this big, that I doubt if you'd find ten people in Britain who would rather switch to your system.

Approaching the question by assuming that you will always be contributing and never benefiting isn't the way to look at it. Unless you drop dead suddenly after an astonishingly healthy life, you'll benefit from universal healthcare sooner or later. And when you consider how expensive some illnesses can be, you could well be very glad of it. Indeed, even when you're healthy, the knowledge that you don't have to worry at all about yourself, or your family, or your neighbours not being able to pay for their healthcare, is remarkably liberating.

Rolfe.

 

[volatile]

I forgot to address this part.

I have not proposed to eliminate Medicare.
I would like to reform Medicare/Medicaid responsibly, but such plans have already been shot down.
But, yes, of course, since actions have consequences.

Or, more directly, the value of a human life is quite finite.

Please outline what you mean by "reform Medicare responsibly". Exactly what is the value you place on human life?

The NHS, in the UK, has an operating budget of something in the order of £100 billion (UK billion, I assume), or just shy of 10% of GDP. This covers everything from dentistry to prescription drugs, ambulances, surgery, post-operative care, maternity, accident and emergency, nursing, geriatric care, virtually everything. In the UK, healthcare is entirely free at the point of use save for a small, flat-rate charge paid for by a small number of people for drugs.

http://64.233.183.104/search?q=cach...er+person&hl=en&ct=clnk&cd=3&client=firefox-a

"In 2002, the NHS cost the average British household £2400 per year; that is roughly £1000 per person. By 2007-08 the UK NHS budget is set to rise by over 44% in real terms to over £90 billion, roughly £1400 per person"

This is, of course, just the total budget divide by the number of people, not a set contribution rate. This is approx. $3,000 per person per year, though of course this is taken from central taxation and not from individual purses - how does that compare to how much you'd have to pay for a similar level of coverage under a US private insurance plan?

How much to have total, unlimited, no-exceptions, no-quibbles, all-eventualities-from-failed-suicide-to-skiing-accident-to-cancer care in your country?

 

[balrog666]

Like volatile, I agree with most of this.

However, you have not indicated where your limits lie.

How about, I get full healthcare, free at the point of need (and I'm being dragged out of work lunchtime tomorrow because my name came up as being a candidate for routine screening, and children even get their third transplants on occasion), and all this universal coverage costs me a lower proportion of my salary in tax than your contribution to Medicare costs you. And yet, if you're earning a reasonable salary, you personally get nothing for your Medicare contribution.

Who is getting the better deal?

Remember, a universal system isn't all take and no give. The benefits for all sections of the community are so overwhelming, despite problems which beset any system doing something this big, that I doubt if you'd find ten people in Britain who would rather switch to your system.

Approaching the question by assuming that you will always be contributing and never benefiting isn't the way to look at it. Unless you drop dead suddenly after an astonishingly healthy life, you'll benefit from universal healthcare sooner or later. And when you consider how expensive some illnesses can be, you could well be very glad of it. Indeed, even when you're healthy, the knowledge that you don't have to worry at all about yourself, or your family, or your neighbours not being able to pay for their healthcare, is remarkably liberating.

Rolfe.

Yes, quite true. A major illness can easily wipe out a small fortune and that's why people buy insurance.

At this point I don't see how we can transition to a similar system. Doctors, hospitals, clinics, labs, MRI facilities, etc. are all essentially independent businesses (or charities). If you nationalize heath care service, the best doctors will leave for greener pastures and the disgruntled will change jobs or retire. Compensating for the seizure so much convolutedly owned private property and coordinating all the resultant mess will take a bureaucracy of staggering proportions many years. I'm not sure what the payoff would be other than promising the last hermit in Alaska free healthcare that he can't take advantage of.

A single payer system will just disincentivize insurers and leave Uncle Sam stuck with the tab for the neediest of patients. As well as increase the already rampant fraud and abuse. Big whoop there too.

 

[balrog666]

Please outline what you mean by "reform Medicare responsibly". Exactly what is the value you place on human life?

The NHS, in the UK, has an operating budget of something in the order of £100 billion (UK billion, I assume), or just shy of 10% of GDP. This covers everything from dentistry to prescription drugs, ambulances, surgery, post-operative care, maternity, accident and emergency, nursing, geriatric care, virtually everything. In the UK, healthcare is entirely free at the point of use save for a small, flat-rate charge paid for by a small number of people for drugs.

http://64.233.183.104/search?q=cach...er+person&hl=en&ct=clnk&cd=3&client=firefox-a

"In 2002, the NHS cost the average British household £2400 per year; that is roughly £1000 per person. By 2007-08 the UK NHS budget is set to rise by over 44% in real terms to over £90 billion, roughly £1400 per person"

This is, of course, just the total budget divide by the number of people, not a set contribution rate. This is approx. $3,000 per person per year, though of course this is taken from central taxation and not from individual purses - how does that compare to how much you'd have to pay for a similar level of coverage under a US private insurance plan?

How much to have total, unlimited, no-exceptions, no-quibbles, all-eventualities-from-failed-suicide-to-skiing-accident-to-cancer care in your country?

I preferred the Oregon Health Plan from 1989 - a rational approach to a difficult problem. The Feds killed it.

Actuarially, pick a number. Start with $250,000. Analyze. Revise as necessary.

Do all doctors/nurses in the NHS work for the state? Do they draw a fixed salary or do their earnings depend upon their patient service and performance? Are doctors required to work for the NHS? Can they open an independent practice and pick and choose their patients and set their own rates?

Oh, and why not contact Lloyds of London for an insurance quote on that last question.

 

[JEROME DA GNOME]

As has been pointed out earlier in this thread, the lack of adequate medical care in the US does push up labour costs there, because employeers need to pay for this as part of their renumeration packages, at salary-levels which wouldn't merit (or need) this in other countries with universal healthcare.

You are moving the cost from one basket to another. You have provide Zero savings in cost. In fact the cost and quality are going to increase and decrease respectively in your proposal.

 

[JEROME DA GNOME]

How about, I get full healthcare, free at the point of need...

It is not FREE. This is your complete misunderstanding of the subject and why you are unable to see the arguments from the opposing point of view.

 

[Tsukasa Buddha]

It is not FREE. This is your complete misunderstanding of the subject and why you are unable to see the arguments from the opposing point of view.

Ahem:

How about, I get full healthcare, free at the point of need (and I'm being dragged out of work lunchtime tomorrow because my name came up as being a candidate for routine screening, and children even get their third transplants on occasion), and all this universal coverage costs me a lower proportion of my salary in tax than your contribution to Medicare costs you. And yet, if you're earning a reasonable salary, you personally get nothing for your Medicare contribution.

I think this is an accurate understanding.

 

[JEROME DA GNOME]

Ahem:

I think this is an accurate understanding.

Not really. What is the tax rate in the UK compared to the tax rate in the US?