Francesca R
Girl
Sure you do. So do we in the UK. And that's a good thing IMO.
So? That doesn't make it not capitalistic.
Stossel Solves the Health Crisis with Capitalism
- Thread starter DaN K. StAnLeY
- Start date
Francesca R
Girl
It is significantly privately owned and makes money.
The seamans priest in felixstowe complained about that and recommended (a).
I found it hard to belive, those strange foreign ways.
And the rest?
Rolfe
Adult human female
I don't know if you were just being sarcastic there, but I really don't think this is true. Americans are among the most charitable and philanthropic people in the world. But there seems to be a difference of mindset on the healthcare issue, which is probably related to differing experience.
We're used to healthcare being available for everyone, and we certainly don't see someone else's met need equating to ourselves being deprived of something. We know our own need will be met, so we don't worry about someone else's need being met. And our need is being met with minimal effort on our behalf.
I think this generates a very relaxed attitude to who can benefit. Some of it may indeed be as unthinking as an assumption that the healthcare fairies provide, so why shouldn't they provide for everyone? A more considered view still tends to conclude that there's enough there to allow some asylum seekers and so on to share the benefits, and this is probably preferable to having these people dying in the street in front of us. What we don't get are protests about people "taking without contributing", because our own contributions are so painless that we don't often stop to consider that we are contributing.
On the other hand, people in America often do have to struggle to ensure that their healthcare needs are covered. I can see why this might predispose to resentment of people who appear to be getting the same benefits without having put in that struggle.
I think there's a bit more to it though. Guilt. Of course nobody wants to see anyone dying in the streets. But given the size of the problem, the amount of the need, what can anyone do? How much difference will a $10 donation make? One way of deflecting the guilt could be to rationalise this away by blaming the victim. If someone can't afford the healthcare they need, it's because they didn't work hard enough, or they frittered the money away on luxuries. So I no longer have to feel guilty, or responsible for these people.
OK, it's cod psychology. But it might at least partly explain the cognitive dissonance we're seeing in this thread.
There's also the deeply ingrained rejection of anything that sounds like "communism", and/or of compulsory contributions for anything. Voluntary charity is fine, but fair, proportionate contributions aren't, because they're compulsory.
The problem is that voluntary philanthropy will never fund healthcare for everyone. Voluntary contributions tend not to be proportionate to means, and a significant proportion of people are skinflint enough simply to refuse to contribute, thus unfairly increasing the burden on others. Also, people often pick and choose what they're prepared to fund - as Tim indicated above. He'd change his doctor if the doctor was providing pro bono treatment to patients he didn't approve of.
When the only rational way to fund the system is reflexly dismissed as communism and theft by many of the citizens, you're struggling.
Rolfe.
Rolfe
Adult human female
Stossel set up a complete straw-man idea that instead of shopping to a budget, everyone would be filling their trolleys with caviare and smoked salmon. And the supermarkets would hike their prices to astronomical levels because the shoppers wouldn't care. It was ludicrous.
I enquired, how might we arrange food insurance if we actually wanted to do that?
Well, we could deliver a basic, nutritious diet to everybody's house. But that would be logistically difficult, and might result in piles of boring, healthy food rotting in the streets when people chose to buy something more to their taste instead.
Or we could give everybody the same amount of food stamps, to the amount they'd need to buy a decent basic diet. However, we'd have to increase taxes to compensate, so for most people it would represent nothing but more bureaucracy and administration.
Or we could ensure that everybody was simply given enough money to buy that decent basic diet. But how could we do that? Well, perhaps by allowing a certain amount of income to be tax-free, up to a level that would allow everyone to eat. And then people who didn't actually have that much income could be assisted directly.
Oh wait. We're doing that.
Rolfe.
Rolfe
Adult human female
Well, yes. We went over that bit in some detail. He said that was OK because he wasn't forced to contribute to an insurance policy.
He seems to see insurance as a sort of necessary evil until he (and John Stossel) have cracked the problem of healthcare costs so that a quadruple bypass will only cost the same as a Big Mac.
Rolfe.
If you read the responses from folk who currently live in a society that has a universal health care system you will find that not one of us believes the current system we have is perfect. Indeed many of us are quite happy to point out the failings of our system and where it could and needs to be improved. The problem is not that any particular scheme is imperfect.
Part 1 - if you are unlucky to have a chronic disease you will probably need more money in your health fund than in your 401, how many can afford it?
Part 2 - The fact that the VA is underfunded and some of the hospitals are privately run and with a captive audience (so no incentive to improve or spend money) is no reason to judge all UHC provision by them. UHC also provides some of the best hospitals in the world with pioneering treatments.
Steve
Rolfe
Adult human female
Stossel's preferred funding mechanism involved the compulsory sequestration of a proportion of everybody's salary in an account which couldn't be accessed except for healthcare costs. Compulsion, anyone? Coercion, anybody? Nanny state, anybody?
Well, when people are on a tight budget, perhaps this sort of compulsory saving is necessary - otherwise they might fritter away the money on luxuries like the children's shoes or even a modest holiday, and then be unable to pay when and if they get ill. (But still, the compulsion! I'm amazed Dan was so attracted to it.) I'd still like to know what happens to the money if someone dies while there are several thousand dollars in their account. Who gets the dosh?
And the solution to the big-ticket items was still just insurance. With no attempt made to address the very fundamental problems with the insurance model presented at the start of the programme.
It might be a reasonably workable solution for people in work, with secure employment, and no chronic health problems. But as a panacea to deliver healthcare to everyone, it's a non-starter
You know, maybe it is the case that the Americans really can't run a piss-up in a brewery.
In Britain, your doctor specifies what the prescription is for. Normally, this will be for the cheapest alternative that will meet your need. Maybe there is a reason you need a more expensive glucose meter. If so, you will get the prescription for that (or it will simply be given to you). If not, you will get the cheapo one. If you want a fancier model, you're at liberty to buy it of course, but you won't get it as a matter of right.
[One of my students told me how, years ago, he had one of the first glucose meters dispensed by the NHS. At that time diabetics were expected simply to eyeball the colour change on the stix. However, his father was colour blind and couldn't read the stix accurately. So the NHS coughed up for a meter. That's how it works. Of course now he has an amazingly nifty little gadget. Chosen by his diabetologist for compatibility with the central record-keeping system, and to suit his particular needs as a type I diabetic. You don't leave these choices up to the patient.]
Patients don't get to choose which drugs the pharmacist dispenses either. Years ago, doctors would write prescriptions for the (more expensive) proprietory drugs, rather than using the generic name so that a cheaper alternative could be dispensed. (Pharmacists must dispense what the doctor prescribes, even if they think something else would be just the same or just as good or even better.) There was a big campaign by NHS managers to get them to use the generic names, and save the system money. The campaign was extended to patients, to explain why their pills might be a different colour from what they'd been used to, or even from one prescription to the next. If you think you have some reason why you should get the more expensive version, then you would have to persuade your doctor to prescribe it specifically.
What's so hard about this? I'm mildly surprised that the insurance companies haven't come up with a similar system to save money. But maybe it takes a centralised system to get up the motivation to address the matter.
Anyone who doesn't think universal healthcare is a great idea needs to come and live here for a while. Srsly.
The problem, as I see it, is the demand for solutions to conform to ideological principles rather than examining them on pragmatic grounds.
Rolfe.
Earthborn
Terrestrial Intelligence
What sort of bizarro world insurance company allows such a thing? If there is no medical need to pay for a more expensive device, why would it bother to fund it?
Why doesn't the insurance company pay for the generic?
quixotecoyote
Howling to glory I go
- Joined
- Jun 25, 2006
- Messages
- 10,379
Because the bureaucrats in corporate insurance are that much more efficient and thorough than lazy socialist government bureaucrats?
Rolfe
Adult human female
First, if you just prescribe the generic name, then that leaves it up to the pharmacist to choose which flavour of that is cheapest this week. So it's a no-lose strategy.
Second, what benefits of proprietory drugs? Doctors aren't stupid, and they know that sometimes there really is such a thing as a free lunch.
Rolfe.
Last edited:
Well, I heard it described as a problem by pharmacist´s.
Best guess would be that it causes confusion among patients, and that doctors are as vulnerable to adverticing as everybody else.
Ivor the Engineer
Penultimate Amazing
- Joined
- Feb 18, 2006
- Messages
- 10,622
Doctors don't respond to any incentives which are not aligned to their patients' interests.
This is the blindingly false premise of private healthcare and the reason why any system based on it will be bound to fail through massive inflation.
http://www.healthinflation.com/HealthINFLATION_News_News.html
This is the blindingly false premise of private healthcare and the reason why any system based on it will be bound to fail through massive inflation.
http://www.healthinflation.com/HealthINFLATION_News_News.html
Rolfe
Adult human female
Yes, they are vulnerable to advertising. But not anything as blatant as that. The very least that has a hope of working is to promote a subtly different but essentially equivalent "me too" drug which is still within its patent, rather than the original version which is out of patent.
I don't know how it works in Denmark though, but in Britain some NHS committee, or maybe NICE, will simply send round a set of guidelines effectively telling the doctors what they ought to be prescribing unless they have a very very good reason for deviating. And at the same time there are financial incentives for doctors to stay inside a total prescription cost ceiling.
Now somebody is going to start screaming about "loss of our precious Freeeeeedomsssss!", any minute now. But you can't have it both ways. Firm guidelines regarding economical prescribing, but leaving the doctor with final discretion, seems to be a reasonable compromise.
Rolfe.
I don't know how it works in Denmark though, but in Britain some NHS committee, or maybe NICE, will simply send round a set of guidelines effectively telling the doctors what they ought to be prescribing unless they have a very very good reason for deviating. And at the same time there are financial incentives for doctors to stay inside a total prescription cost ceiling.
Now somebody is going to start screaming about "loss of our precious Freeeeeedomsssss!", any minute now. But you can't have it both ways. Firm guidelines regarding economical prescribing, but leaving the doctor with final discretion, seems to be a reasonable compromise.
Rolfe.
To get technical for a moment. Generic drugs should have the same active ingredient, the bulk the tablet will be "filler" which will be different. There have been cases where the difference in filler has caused an adverse reaction. In the NHS this is an issue, because like a capitalist they want to save money so in this case they can treat more people, not make more money, however there can be side effects from using generics because they are different and that can actually cost more money in the long road.
There have also been cases where the "generic" drug is just filler and is useless.
Question.... you are having (paid by yourself) chemo. What do you want, the branded drug, from a known and QC'd source which costs £2,500 or the one they got off the internet for £250?
Been there, done that, I'm still alive so I'll take the (NHS provided) one (free at the point of delivery) any day.
Steve
blutoski
Penultimate Amazing
- Joined
- Jan 10, 2006
- Messages
- 12,454
Sure, but anybody who has dealt with the phone company knows that government is not the only source of bureucrats. Most GPs in the US work for an HMO, and the HMO bureucrats' job is to tell the GP which customers he can see, where, when, for how long, and to tell the customer what care he can get under the plan before he has to go outside and get it a la carte.
ie: the US looks a lot like Canada, except it costs about twice as much.
This may or may not be accurate, depending on the health district. There are three prevailing systems for remuneration in Canada, and the one you describe is called 'fee for service'. The other two are 'capitation' (paid by the number of patients in care) and 'outcome' (paid for the health status of patients in care).
All three systems have benefits and drawbacks, and I don't have a preference. However, the fee-for-service you describe above is more common in HMOs or private individual care than in the Canadian single payer system, so if you don't like it, or if you think it produces worse outcomes, I don't understand why you think privatization would be a better alternative.
Protests also came from BCSkeptics and other quackbusting organizations.
The problem with the private MRI clinics is that the profit motive appears to blind them to the patient-focused cost/benefit weight. For example, they were promoting MRIs for screening, when all the medical literature indicated this was a net harm to patients.
And you're right that it's important to help people on the forum understand Canadian healthcare laws, as there is mixed information.
Basically, the system has been undergoing a transition toward the UK model of private and public, but it is mostly public at this time.
That means that there is a 'schedule' of services that MDs can charge to their provincial ministries of health, but they cannot offer or charge for these services independently.
The actual hospital administrations are either public or private. The trend since the 1980s has been toward privatization of operations, but the budget is usually ultimately paid for by taxes.
eg: St. Paul's hospital in Vancouver is owned and operated by the Sisters of Providence, and they contract their labs to MDSMetro and their housekeeping to private cleaning companies. But, their operating budget is provided by taxes.
Many things aren't covered, so Canadians usually also subscribe to an extended health plan, which may see partial subsidization based on need and income. For example, many prescription drugs are not covered, and dental is not covered, so an extended health plan would be sought for these.
The third type of service is cosmetic and the like, which is also not covered by the provincial plans, and rarely covered by extended health plans. I paid out-of-pocket for laser eye correction because I'm a competitive lifeguard, and glasses and contact lenses impact my performance.
Contrary to Tim's thoughts in an earlier post, it's very clear that healthcare in Canada is becoming much more privatized. It's not just these few new private clinics: privatization of hospital operations has been progressing nationwide since the 1980s, with very few examples of new nationalizations. If he really believes things are 'getting worse' then this is food for thought, although I don't think there is any evidence of worsening given the endpoints I take into consideration, and even if that were true, privatization may just be coincidental.
Of course I can. This is why the argument degenerates into ideology and vague unverifiable generalizations, rather than facts.
My perspective: the US has a blended system, and people are less healthy, and the costs for maintaining an equivalent health level are about double that in Canada. Americans spend more tax dollars than Canadians do on their semi-privatized system, and then they pay even more out-of-pocket. eg: the average wageearner in the US will pay approximately $800/mo in taxes to support their public healthcare and get no coverage, but also spend another $800/mo in private health insurance with worse results than anywhere else.
I believe that the only reasons they don't adopt a single-payer system is that the public is given false information, and also some simply subscribe to ideology over self-interest. See: "What's the Matter With Kansas."
I have no reservations engaging in an ethical debate about values, but what happens is that most people want to get good value for their dollar, and a single-payer system delivers the goods. This means that most rational people will choose it, and we have seen this trend globally.
Free-market cranks just can't accepte it, and invent stories or scare tactics to distort the public's ability to make a rational decision. That's the part that concerns me as a skeptic who focuses on healthfraud. The claims on Stossel's program were just as much an example of healthfraud as anything produced by the makers of Q-Ray, and they're all fellow-travellers in the world of patient-as-consumer caveat emptor.
Just to give one anecdote about ideologues... my dad is a perfectly good example. He was ranting and raving a few years ago about a report that St. Paul's hospital was declared the least clean during a province-wide audit. He said that this was finally solid evidence that the public healthcare system was broken and we need to scrap it in exchange for a private solution. I pointed out to him that not only was St. Paul's a privately owned hospital, but that the housekeeping was done by private contractors.
The result: I overheard him talking to a friend about how the unclean conditions at St. Paul's prove that the public healthcare system is broken, and we need to replace it with a private solution. It's like the conversation never happened.
"Don't confuse me with the facts!"