Stossel Solves the Health Crisis with Capitalism

[Rolfe]

Yes.

http://www.bmj.com/cgi/content/extract/336/7641/400

Probably because by using private companies it avoids the cost going on the governments' balance sheet for a while, and a belief that "the market" always provides better services than the public sector.

Thank God I live in Scotland. I can only hope the SNP keep getting in and we get independence or a reasonable facsimile thereof before Brown tries to find a way to make us do the same.

Rolfe.

 

[Earthborn]

This seems to be a good comparison of different models of healthcare:

http://www.amsa.org/uhc/IHSprimer.pdf

It is pretty good, but out of date for the Netherlands and perhaps other countries. Since 2006 the Netherlands has a homogenised system in which everybody has private health insurance. The last paragraph mentions this is a plan, right now it is already implemented.

 

[Darat]

Rolfe & Ivor the Engineer - you seem to be forgetting that currently most GP access in the UK is via private companies contracted by the NHS.

 

[Rolfe]

Touche! (We can haz html bak plz?)

Not quite what he's talking about though, you have to agree.

Rolfe.

 

[Darat]

No not quite but we do have to be careful of a knee-jerk reaction when we hear of "private companies" in the NHS. Private enterprise has always been an integral part of the NHS.

(And no.)

 

[Ivor the Engineer]

http://www.guardian.co.uk/society/2006/jun/30/health.politics

A secret plan to privatise an entire tier of the NHS in England was revealed prematurely yesterday when the Department of Health asked multinational firms to manage services worth up to £64bn.

The department's commercial directorate placed an advertisement in the EU official journal inviting companies to begin "a competitive dialogue" about how they could take over the purchasing of healthcare for millions of NHS patients.

The advertisement should not have appeared until after ministers announced the policy next month.

...

Lord Warner, the health minister, defended the policy in a statement to the Guardian at 3.46pm yesterday but had changed tack at 6.05pm. He said he was withdrawing the advertisement to correct "a drafting error", but insisted the contracting out of NHS management would go ahead.

The advertisement asked firms to show how they could benefit patients if they took over responsibility for buying healthcare from NHS hospitals, private clinics and charities. The plan would give private firms responsibility for deciding which treatments and services would be made available to patients - and whether NHS or private hospitals would provide them.

...

Contenders for the contracts are likely to include big US companies such as United Health and Kaiser Permanente. They may be joined by British insurers such as Bupa and PPP and their EU rivals.

...

 

[Rolfe]

No not quite but we do have to be careful of a knee-jerk reaction when we hear of "private companies" in the NHS. Private enterprise has always been an integral part of the NHS.

(And no.)

There's a dichotomy. I know most of my vet colleagues genuinely work for the love of the job, and with the animals' best interests in mind. You do it right, you make money too.

But there are some whose main object is the money, and that thought is always uppermost in their minds. I say there's enough work in the world without inventing it, they seem not to agree. There was supposed to be a Tonight special about this earlier this evening but it was postponed to tell us all about Jade Goody - again.

And it is the vets who turn themselves into limited companies I watch out for. And then when the limited companies come under the control of non-professionals who have no interest but making de money, I get really worried. I've seen it, first-hand.

Doctors come in these different flavours as well. The professional partnership is usually a good model. The limited company healthcare enterprise, not so much.

Rolfe.

 

[ponderingturtle]

the reflectance meters are about the same so it's not the potentiometry. I suspect that to some extent the sale of the strips is subsidising the cheap meters. (Like inkjet printer cartridges.) Nevertheless, there is certainly enough competition in the system to drive these prices lower if there really was a lot of slack in the pricing.

Rolfe.

This is true

 

[DaN K. StAnLeY]

The involvement of private companies in the National Health Service always generates controversy. Some people believe that only commercial interests can bring innovation and efficiency to modernise the NHS. Others assume that the profit motive is incompatible with the pursuit of excellence in health care.

This debate has been reignited by the announcement that United Health Europe, a subsidiary of a large American health company, has won a contract to run three NHS general practices in London. This is the latest in a series of similar acquisitions by commercial companies throughout England. The government is also investing £250m ({euro}335m; $487m) in establishing at least 150 new health centres, many of which will probably be run by private companies.1

These developments are meant to increase access to primary health care in areas where existing contractual arrangements have not provided adequate services.2

So the UK's going private now??

 

[DaN K. StAnLeY]

Contenders for the contracts are likely to include big US companies such as United Health and Kaiser Permanente. They may be joined by British insurers such as Bupa and PPP and their EU rivals.

I made a call and had some buddies of mine just buy the NHS so we can prove to everyone in Europe that our system is better, LOL!!!

 

[Darat]

So the UK's going private now??

No.

 

[Rolfe]

I made a call and had some buddies of mine just buy the NHS so we can prove to everyone in Europe that our system is better, LOL!!!

Oh great, a really mature and constructive post, just what we needed.

Dan, why do you have this need to prove that "your" system is better? This shouldn't be about ownership. Has it not occurred to you that patriotic hanging on to something that's broken just because you don't want to face up to the fact that not everything you have is the best in the world is a good chunk of the reason you have such a problem?

One of the things that struck me about the AMSA dissertation was that the NHS is quite obviously not the best-performing system out of the ones considered there. Not that anyone really thought it was, mind you. I'd love for us to look more at systems in other European countries and even Japan to see what they're doing right that we could learn from and improve our standard of care. The one place covered in that dissertation that I would not be interested in learning from, on the available evidence, is the USA.

The reason we refer a lot to how the NHS works is that the NHS is what we're familiar with, and by and large we're happy with it and we can see it works pretty well. Ceretainly massively, enormously, incomparably better than what passes for healthcare access in America. That even one of the poorer-rating universal systems is doing so well compared to the USA is pretty telling, actually.

The trouble is, our bloody politicians are too dazzled by the apparent Eldorado that is Merika to look elsewhere for inspiration and guidance. Even if the system there is appalling, hey, it's America, they're this great superpower doncha know, so anything we copy from them must be great.

Blehhhhh.

Rolfe.

 

[DaN K. StAnLeY]

Oh great, a really mature and constructive post, just what we needed.

Dan, why do you have this need to prove that "your" system is better? This shouldn't be about ownership. Has it not occurred to you that patriotic hanging on to something that's broken just because you don't want to face up to the fact that not everything you have is the best in the world is a good chunk of the reason you have such a problem?

Are you seriously singling me out for non-constructive posting??? Lighten up.

 

[Rolfe]

No, not at all. But a lot of thought-provoking and relevant things have been posted, and I'd genuinely be interested in hearing your reaction.

The 39-page AMSA dissertation you dismissed four minutes after the link had been posted just because it quoted the statistics you don't want to hear about is well worth a read, even if it is a bit out of date now. There's another document on that site about universal healthcare I found very interesting.

At its root, the lack of health care for all in America is fundamentally a moral issue. The United States is the only industrialized nation that does not have some form of universal health care (defined as a basic guarantee of health care to all of its citizens). While other countries have declared health care to be a basic right, the United States treats health care as a privilege, only available to those who can afford it. In this sense, health care in America is treated as an economic good like a TV or VCR, not as a social or public good.

The most visible victims of America’s decision to treat health care as a privilege are the 45 million Americans who lack insurance. In contrast to prevailing stereotypes, 80% of the uninsured are hardworking Americans who are employed or come from working families. However, they are unable to obtain insurance through their work either because their employer does not offer it, their employer does offer it but the employer share of the premium is too expensive, or they are not eligible for health insurance (e.g. they are part-time or have not worked long enough at the job).​

Bear in mind, this is coming from Americans. And not just any old pinko-liberal-bleedingheart Americans, but medical students.

You say the majority of Americans don't want universal healthcare. Well, first, I think I've seen statistics quoted that say you're wrong about that. But second, even if that is the case, maybe it's not so surprising if their opinions are being formed by liars like Stossel who have their own reasons for frightening the public away from the idea.

You (and many other US posters) seem completely fixated on the concept of healthcare as "a privilege, only available to those who can afford it". When you consider that every other developed first-world country has decided to declare healthcare to be a basic human right, are you quite so certain that your attitude is unquestionably defensible?

Rolfe.

 

[Rolfe]

So the UK's going private now??

Just in case that was a serious question.

No.

Healthcare will remain a basic human right available to every resident. Paid for out of general taxation, so that the more you earn the more you contribute. Free at point of need to everyone, from the Prime Minister to the homeless guy on the streets. With "need" being defined by the doctor seeing the patient, with the state unable to veto that provision, and the patient unable to "grab" more than he needs.

What the government seems hell-bent on doing (in England) is to allow some American companies into this market to provide the services paid for by the taxpayers. We worry that these companies may cut back on services in order to maximise their returns to shareholders.

Rolfe.

 

[DaN K. StAnLeY]

Just in case that was a serious question.

No.

Healthcare will remain a basic human right available to every resident. Paid for out of general taxation, so that the more you earn the more you contribute. Free at point of need to everyone, from the Prime Minister to the homeless guy on the streets. With "need" being defined by the doctor seeing the patient, with the state unable to veto that provision, and the patient unable to "grab" more than he needs.

What the government seems hell-bent on doing (in England) is to allow some American companies into this market to provide the services paid for by the taxpayers. We worry that these companies may cut back on services in order to maximise their returns to shareholders.

Rolfe.
__________________

Word.

 

[Rolfe]

and suppose this, and suppose that......

He could get on SSI, or get another job with HC benefits. Again, maybe there should be other ways for insurance to be available. Banks are starting to offer insurance coverage, my college is offering HC coverage to students.

Well, as I said, you have to "suppose this and suppse that". Because these things happen. Quite a lot.

What do we discover about SSI?

Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes):

• It is designed to help aged, blind, and disabled people, who have little or no income; and
• It provides cash to meet basic needs for food, clothing, and shelter

We're also told that you have to be essentially destitute before you qualify.

And just "get another job with healthcare benefits"? Just like that? Walk into one, no problem at all?

In the face of rising health care costs, fewer employers are able to provide their workers with health insurance; the percentage of employers offering health insurance dropped from 69% in 2000 to 60% in 2005. Even if employers are able to provide health insurance benefits, the trend is towards providing high-deductible insurance that covers an ever-shrinking percentage of health care costs.

Not much more than half of all employers offering insurance at all. Many that are, offering schemes with high excesses on them. But no, someone with a known serious chronic health problem who is guaranteed to be taking a lot out of such a scheme, will be able to walk into such a job without any problem? Really?

And no chance at all of starting his own business. No chance at all of becoming a musician or an artist or an inventor or anything like that. Any job with healthcare coverage has to be grabbed, no matter how uncongenial.

Job lock refers to the idea that people stay with their jobs when they would rather work elsewhere because their current job offers health insurance. For example, many individuals opt to stay with their job instead of starting their own business because they are unsure of whether they can get health insurance on the individual market, which has higher premiums and often denies people with pre-existing conditions. Although the number of people who would be self-employed if there were universal health care is controversial, one study from 2001 put the number at 3.8 million Americans. This loss of entrepreneurship is a real economic cost in a society that is relying on start-ups to offset the loss of jobs that are moving offshore.

This applies to everybody, but it's a real killer for those with chronic diseases. So the employee just has to stick with the job.

Until the employer decides to terminate the healthcare benefits, as they are of course free to do, or hits hard times and makes many people redundant, or just goes bust.

"Other ways for insurance to be available." What, for someone who will definitely require repeated expensive procedures, costing way above the price of any premiums he could possibly pay? How are you going to force an insurance company to accept someone like this?

Oh yes, that's how some countries with universal healthcare provision do it. But you don't want that, do you?

How you are happy to live with a system with this inbuilt insecurity and stress and lack of freedom, I can't understand. Especially when it could be you in that position tomorrow.

Rolfe.

 

[GStan]

<snip>

Bear in mind, this is coming from Americans. And not just any old pinko-liberal-bleedingheart Americans, but medical students.

You say the majority of Americans don't want universal healthcare. Well, first, I think I've seen statistics quoted that say you're wrong about that. But second, even if that is the case, maybe it's not so surprising if their opinions are being formed by liars like Stossel who have their own reasons for frightening the public away from the idea.

You (and many other US posters) seem completely fixated on the concept of healthcare as "a privilege, only available to those who can afford it". When you consider that every other developed first-world country has decided to declare healthcare to be a basic human right, are you quite so certain that your attitude is unquestionably defensible?

Rolfe.

I've been torn by the healthcare debate since the early 90s and am still having trouble settling in to what I believe is the most rational position. I've followed most of this thread with interest, but skipped over a few pages, so apologies if I'm covering ground already discussed. (In the interests of full-disclosure, I generally like Stossel and tend to lean toward the small "l" libertarian view of government in most cases.)

You mentioned that every other developed first world country has decided to declare healthcare a basic human right. Is this not just a form of appeal to popularity? (X % of people in the world have declared that God does exist, so we should acknowledge his existence, right?) The same would apply to the argument that "most Americans don't want universal healthcare." (Although, I think in some sense, the only way to have basic human rights at all is through some form of democratic appeal to popularity; that is, if most people agree that something is a right, it will become a right. And if most people agree that something is not your right, then it will not be your right. But perhaps this tangent should be discussed in a different thread.)

Another question I have, if you'll entertain a hypothetical, would your view of this right remain unchanged if there were not enough doctors or hospitals to meet the demand for services? I'm not suggesting that this is happening or inevitably will happen, but if market conditions and educational capabilities were to result in an insufficient quantity of doctors, hospitals or supplies to keep up with demand, would you still have that right, even if there is no one available to give you that right? If not, is it really a right? What I think might be more likely in the US than simply not enough is disparity within the system, much like the US education system. Everyone has the right to an education, and there are enough teachers and schools to grant that right, but it is not granted equally in many respects. So does everyone's right to healthcare imply that everyone should have equal access to the best healthcare?

I have more questions, but I figure this is a good enough jumping off point to get into the thread.

 

[Rolfe]

Not entirely an appeal to popularity. I see a tendency in some US posters to declare that access to healthcare simply is not a human right, period. Jerome was coming from that point of view. "Your problem is that you think healthcare is a right when in fact it is a privilege."

[I should say that I've never encountered Stossel before, until I watched that show online at Dan's urging. He may be better in different contexts. However, that was a dreadful exercise in cherrypicking, false analogies, non-sequiturs and special pleading, all apparently designed to frighten Americans away from the idea of a universal healthcare system.]

The simple fact is that where I live, access to healthcare is a right that has been granted by a democratically elected government, and this is true for all but one of the developed western democracies. What I'm trying to say is that it is not self-evident that access to healthcare should not be a human right. It can be made a human right in any country by the stroke of a pen. So while it is true to say that healthcare is not a human right in the USA, this is not a reason why it should not become so.

Of course any right can be rescinded. Preventing that happening is part of "standing up for your rights". However, the fact that a right may be rescinded doesn't mean it wasn't a right while it existed. Does the fact that you may sell your house mean that you don't own it at the moment?

So does everyone's right to healthcare imply that everyone should have equal access to the best healthcare?

Not necessarily, it would of course depend on the detail of the legislation which granted the right. This almost certainly varies between countries. Some may grant universal rights to relatively basic treatment but mandate that more expensive procedures be paid for, while others may go the whole hog. I would expect that relatively impoverished countries would be cautious about the extent of the promises they made to their citizens, while affluent countries could afford to put a more comprehensive system in place.

The USA is of course extremely affluent.

This question sounds a bit like an earlier objection to universal healthcare in this or another thread. "Of course we can't have universal healthcare, because then everybody would have the right to be operated on by the best surgeon and would settle for nothing less!" No, it doesn't happen like that. What happens is that Best Surgeon gets Top Consultancy Post with Big Salary, then all the really complicated and high-risk cases get sent to him irrespective of ability to pay. So in theory everyone has the right of access to Best Surgeon, but only if their clinical condition justifies his attention.

The other related objection was, "we can't have universal healthcare because then patients in Anchorage would be able to demand to be flown by air ambulance to Miami to have their varicose veins operated on!" Well, for a start, no universal healthcare system I'm aware of offers free transport for patients to their routine medical appointments. So given that the transport is the patient's responsibility, that would put a bit of a crimp in that sort of request. Then of course, how many people want to travel many hundreds of miles away from family and friends for routine surgery they could have in their own town? It's just a non-argument.

Forget "innate, inalienable, God-given rights" here. We're not talking philosophy. We're talking about the rights granted by a democratically elected government to its citizens. These can be anything the government chooses. If they choose to give me the right to free library books, then I have that right. If they don't, I haven't. And if I have, but they decide to abolish public libraries next year, then I lost the right. I also have the right to vote against them if I don't like what they're doing or promising.

Healthcare is essentially no different.

So, can the USA, as a country, afford to grant all its citizens the right to a certain level of healthcare, funded in such a way that the contributions of the wealthy but healthy supprt the service provided to the poor but unhealthy? As the USA is probably the most affluent country in the world, I think the answer has to be yes. If all the European countries, and Australia and New Zealand and Japan and God alone knows who else can do it, so can the USA.

Does it want to? Only the citizens of the USA can answer that, and there seems to be an agenda running to try to persuade them that they don't. I can't understand this.

If it does want it, how should the funding be organised? Again, a question for the citizens of this democratic country. There are a number of options that can be seen to work in other countries.

And how extensive should the provision as-of-right be? Again, a question for the citizens. Experience in other countries may suggest that some restraint is exercised. However, given that US healthcare spending is currently about 15% of GDP while in countries with universal systems it tends to average around 8% of GDP for pretty comprehensive coverage, I'd say there's a fair bit of wiggle-room there.

Rolfe.

 

[DaN K. StAnLeY]

The other related objection was, "we can't have universal healthcare because then patients in Anchorage would be able to demand to be flown by air ambulance to Miami to have their varicose veins operated on!" Well, for a start, no universal healthcare system I'm aware of offers free transport for patients to their routine medical appiontments. So given that the transport is the patient's responsibility, that would put a bit of a crimp in that sort of request. Then of course, how many people want to travel many hundreds of miles away from family and friends for routine surgery they could have in their own town? It's just a non-argument.

Okay, well lets suppose that everyone who needs heart surgery wants to have the operation performed by the best heart surgeon? How do you decide who gets the best and who gets the rest?