single-payer system ... singled out

[volatile]

For a laugh, and knowing a little of how corporate entities are structured, I followed up on a hunch.

One of the people running Lehman Brothers, SIR CHRISTOPHER GENT, on the Board of Directors, was also chairman of GlaxoSmithklein.

One of the board of directors of GM , Karen Katen, used to be on the board at Pfizer.

Ironically, DTugg, though you didn't realise it (and neither did I), it really is the same people. Corporate directorships are very incestuous! Just making a silly point here, but there's no point hating governments for being incompetent when the private sector is equally capable of egregious errors.

 

[dtugg]

And in France, Germany, Canada, Australia, New Zealand...

The "government" don't *run* the healthcare system anyway. They just pay for it. In a nationalised system in the US, it would doubtless be run (day-to-day) by nearly the exact same people that run it today.

How do you imagine the "government" runs the system in the UK? Andrew Burnham telling the surgeon where to stick the scalpel?

If the government controlled the purse, it would effectively control the system. Perhaps not on the micro level, but macro, yes.

 

[volatile]

If the government controlled the purse, it would effectively control the system. Perhaps not on the micro level, but macro, yes.

How?

And how would this be a bad thing, even if it were true?

And how would governmental control be inherently, automatically inferior than a private company (or web of private companies) doing the same job?

And how would the end result in either case be WORSE than the system you have at the moment, or the system you're in favour of?

Spell out your objections. A "gut feeling" that the US government is the most incompetent in the Western world doesn't really convince many of us here.

 

[dtugg]

As Volatile said, not just Britain. And there are almost as many ways of organising it as there are countries doing it. Take your pick.

Yes, there are advantages to early adoption. But there are also advantages to treading a well-trodden path. You can look at other experiences and see what works and what doesn't, and tailor these experiences to the particular needs and demands of your own country. You should be able to come up with a system better than any of the others, not just because you have more money, but because you have the opportunity to learn from the mistakes of others.

I don't think it's that simple.

You put a man on the moon. Several men, in fact. How hard can it be?

Rolfe.

I fail to see how that has anything to do with it. Anybody could put a man on the moon provided they were willing to spend a huge amount of money on the project.

 

[volatile]

I don't think it's that simple.

Why not?

What's the hurdle that America cannot overcome, given the templates of working models in other countries? Why exactly is it "not that simple"?

ETA: And wait - are you against UHC systems because you doubt the USA can run one in practice (the current claim), or are you against them in principle (your earlier claim)? The two objections are entirely incompatible, and switching between them when one is countered just makes you look like an ideologue clutching at straws.

 

[lomiller]

But I would rather have a system where these things are widely available on demand rather than heavily rationed due to their high cost as they are in, for example, Canada.

You’ve been misinformed. Physicians in Canada are almost all private businessmen who work for a set fee schedule. If they, and their patient decide a procedure is necessary they simply perform it and send the province the bill. If the procedure must be done in a hospital then may be a short wait for access to facilities. The largest problem is that there simply are not enough physicians to handle the workload so it can take time to see a specialist, and longer for that specialist to slot you for a procedure. Increasingly there is also a shortage of GP family doctors.

The US isn’t as bad off in terms of number of physicians, but there is still a shortage. It may not be as visible due to the large number of people simply excluded from receiving care.

 

[dtugg]

Surely by blaming "the government", you don't mean to blame the specific individuals in charge, but the system in general? Don't you? You really didn't give the impression that you think government intervention would work if there were a different set of individuals in charge...

Care to clarify? Which is it you're against? The current people, or the simple idea of government control?

It's surely possible to run government (more) efficiently. The current individuals in charge have proven that they can't or won't though. Perhaps this will change in the future but I doubt it.

Care to hypothesise? I can guarantee that the people who run the UK government or the French government are not uniquely smart compared to those in the USA... you're the one making the claim that the US government - sorry, the individuals who make up the US government - are uniquely incompetent in the developed world. Are you sure?

I think that it's established that they are grossly incompetent. Why, I don't really know. It could be due to any number of factors but I don't really care to hypothesize.

You're against a better, cheaper, more ethical system for what amount to ill-considered, dogmatically-ideological reasons. Why?

I don't think such a system would be better, and cheaper in the US. At least not for those of us that have decent health care. Whether or not is more ethical is subjective.

 

[dtugg]

Why not?

What's the hurdle that America cannot overcome, given the templates of working models in other countries? Why exactly is it "not that simple"?

The biggest hurdle is that the government is run by a bunch of incompetent fools.

ETA: And wait - are you against UHC systems because you doubt the USA can run one in practice (the current claim), or are you against them in principle (your earlier claim)? The two objections are entirely incompatible, and switching between them when one is countered just makes you look like an ideologue clutching at straws.

Both. Although if I thought it would work well in the US I would just accept it begrudgingly.

 

[lomiller]

However, I still seriously doubt that the USG could effectively run a UHC system.

Then do what Canada does and have the system run by the provices. The Canadain government does kick in funding (about 25% IIRC) in return for gurentess of universtality and quality.

 

[volatile]

I don't think such a system would be better, and cheaper in the US. At least not for those of us that have decent health care. Whether or not is more ethical is subjective.

If it's subjective, make an ethical case that supports your ideal system where no-one gets a hand up, with anything, ever. The end result of that is that poor and unlucky people die. I'd like to hear a convincing argument that makes out that such a system is ethical.

On the point of cheaper: Now - Rolfe, for one, has already explained why it wouldn't be cheaper for you, but perhaps you didn't read her posts in enough detail. Insurance premiums in the UK are lower than you pay at the moment, and our tax take for the socialised care is also lower than that which you pay. There have been numerous links to stats which prove this to be the case.

Just out of interest: How much would you have to pay in insurance, monthly, for an HMO that has no co-pay, would guarantee never to max out, would proivde any drug your clinician decided for a nominal fee ($10, free should the prescription be for a chronic condition), would cover emergency room treatment, routine GP check-ups, physiotherapy, world-class esoteric heart treatments, helipcopter airlifts from mountain tops, mental health drugs, lifetime insulin shots, lung cancer treatment even if you were a smoker, cover for any existing conditions, sports injuries - the lot? Any medical need bar complex dentistry, with no need to put your hand in your pocket, ever. Monthly figure, please.

One poster here said she pays 50% of her monthly salary, and even her policy has a co-pay and a maximum entitlement.

So humour me. How much would you have to pay for the care I get, essentially, "for free" (given that the % of tax taken from my pay packet to cover healthcare is already lower than you're paying for services you can't access)?

On better - you'd have access to all the same extra-fancy stuff you think means you get "better" care, but at lower cost. Why do you like throwing your money down the drain in pursuit of a broken ideology?

 

[volatile]

Both. Although if I thought it would work well in the US I would just accept it begrudgingly.

Even despite the evidence in this thread so far?

 

[Architect]

NHS plus private probably equals the same level of treatment that I get in the US. Of course, you have to pay twice to get NHS and private care. Just NHS though, no way. I'll never have to wait several months to get treatment in the US....

Sorry, but I'm going to have to call you on this one.

The standards of clinical care on the NHS are on a par with other western countries; this is no second class service. And you pay for nothing under the system - hell, they'll even send an ambulance round to your house to pick you up for regular appointments if you have mobility problems.

As Rolfe and others have pointed out, there are waiting lists for non essential treatments, but if there's anything seriously wrong then you're in straight away. One must always be careful with annecdotes but 3 Christmases ago I had an emergency admission for a suspected blood clot (it was "just" double pneumonia and pleurisy) and I was admitted 15 - yes 15 - minutes after I rang the doctor from the house. Within another 20 minutes they'd dragged the senior consultant away from his Xmas dinner and I was hooked up to more monitors than I ever want to see again. They kept me in an extra week for nothing more than monitoring, even once they'd worked out what it was (full body ultrasound scans, what fun).

There are targets for all key clinical treatments set by the Scottish and Westminster Goverments for maximum waiting times and if these are exceeded then very awkward questions (and usually audits) follow.

When my knee was done, the private cover knocked the 3 week NHS waiting list down to 2 weeks. Whoopee dooo! It was the same surgeon and the same anaethetist. I just went private because I got a swanky private room whereas my local NHS hospital is still 6 bed wards (that's changing, all new hospitals are to be at least 50% private rooms). I then got six months physio on the NHS - at the gym, 3 times a week, for as long as it took.

ETA: And if I don't like my local hospital, for whatever reason, the NHS allows me to choose another.

 

[Ziggurat]

I'm sorry, but you appear to wholly misunderstand democracy. If we, as a people, decide by a majority that taxes should be used to pay for healthcare then it doesn't matter whether a minority object; it's the settled will of the people, exercised through their democratic representatives.

I understand that perfectly well. And yet, it doesn't change anything: taxes, whether approved by the majority or even unanimously, still force people to pay money. That is the entire point of taxation, and why we have taxation rather than donations. The justifiability of forcing people to pay doesn't mean that you're still not forcing them to pay. Is that really too hard a concept to understand?

All these arguments about being "forced" to pay are just bunkum.

All your arguments to the contrary are bunkum, because you haven't actually addressed that point at all. You've merely tried to say that it's OK to do so. And sometimes it is. But you have yet to show that being taxed isn't being forced to pay. Since when is paying my taxes voluntary? It's not. It's compulsory.

 

[Ziggurat]

So you should only be able to claim out of the pot exactly the amount you put in?

If you do, you're freeloading. That's not necessarily unjustified (you will search in vain for any statement of mine indicating that it is), but that's what it is.

Does this belief of yours also stretch to you shunning private insurance, which has the exact same problem?

No, primarily because participation in private insurance is voluntary. The people who pay in and don't actually get much in the way of services agreed to do so, so why should I ever object to a choice they freely make? I've been over this before. Why are you recycling an argument I've already answered?

 

[dtugg]

If it's subjective, make an ethical case that supports your ideal system where no-one gets a hand up, with anything, ever. The end result of that is that poor and unlucky people die. I'd like to hear a convincing argument that makes out that such a system is ethical.

In my "ideal system" nobody would be coerced through force to give handouts to others. I don't have a problem with handouts per say, just the use of force to extract them. In my "ideal system" people would would be responsible for themselves. If they couldn't because of back luck, poor planning, or what have you, charities funded through voluntary donations could pick up the slack. Now, I can't say (and neither can you) whether or not charities would be enough- but we are talking about ideal here. Perhaps if people didn't feel that it was the state's job to play nanny, people would feel compelled to voluntarily help their fellow man. My system is more ethical than your''s because nobody is compelled through force give out handouts.

On the point of cheaper: Now - Rolfe, for one, has already explained why it wouldn't be cheaper for you, but perhaps you didn't read her posts in enough detail. Insurance premiums in the UK are lower than you pay at the moment, and our tax take for the socialised care is also lower than that which you pay. There have been numerous links to stats which prove this to be the case.

Showing that it's cheaper in the UK does not show that it would become cheaper in the US overnight if the US nationalized health care.

Just out of interest: How much would you have to pay in insurance, monthly, for an HMO that has no co-pay, would guarantee never to max out, would proivde any drug your clinician decided for a nominal fee ($10, free should the prescription be for a chronic condition), would cover emergency room treatment, routine GP check-ups, physiotherapy, world-class esoteric heart treatments, helipcopter airlifts from mountain tops, mental health drugs, lifetime insulin shots, lung cancer treatment even if you were a smoker, cover for any existing conditions, sports injuries - the lot? Any medical need bar complex dentistry, with no need to put your hand in your pocket, ever. Monthly figure, please.

One poster here said she pays 50% of her monthly salary, and even her policy has a co-pay and a maximum entitlement.

So humour me. How much would you have to pay for the care I get, essentially, "for free" (given that the % of tax taken from my pay packet to cover healthcare is already lower than you're paying for services you can't access)?

I'm not an insurance salesman.

On better - you'd have access to all the same extra-fancy stuff you think means you get "better" care, but at lower cost. Why do you like throwing your money down the drain in pursuit of a broken ideology?

This has yet to be established.

 

[Neally]

Physicians in Canada are almost all private businessmen who work for a set fee schedule. If they, and their patient decide a procedure is necessary they simply perform it and send the province the bill.

Or send them to the U.S.--

Canada's provincial governments themselves rely on American medicine. Between 2006 and 2008, Ontario sent more than 160 patients to New York and Michigan for emergency neurosurgery

If the procedure must be done in a hospital then may be a short wait for access to facilities.

Or long wait--

Only half of ER patients are treated in a timely manner by national and international standards, according to a government study. The physician shortage is so severe that some towns hold lotteries, with the winners gaining access to the local doc.

Overall, according to a study published in Lancet Oncology last year, five-year cancer survival rates are higher in the U.S. than those in Canada. Based on data from the Joint Canada/U.S. Survey of Health (done by Statistics Canada and the U.S. National Center for Health Statistics), Americans have greater access to preventive screening tests and have higher treatment rates for chronic illnesses. No wonder: To limit the growth in health spending, governments restrict the supply of health care by rationing it through waiting. The same survey data show, as June and Paul O'Neill note in a paper published in 2007 in the Forum for Health Economics & Policy, that the poor under socialized medicine seem to be less healthy relative to the nonpoor than their American counterparts.

-- http://online.wsj.com/article/SB124451570546396929.html

 

[martu]

In my "ideal system" nobody would be coerced through force to give handouts to others. I don't have a problem with handouts per say, just the use of force to extract them. In my "ideal system" people would would be responsible for themselves. If they couldn't because of back luck, poor planning, or what have you, charities funded through voluntary donations could pick up the slack. Now, I can't say (and neither can you) whether or not charities would be enough- but we are talking about ideal here. Perhaps if people didn't feel that it was the state's job to play nanny, people would feel compelled to voluntarily help their fellow man. My system is more ethical than your''s because nobody is compelled through force give out handouts.

Why do you think the NHS was started? Or Medicare? Because the charities couldn't do enough! Do you think the politicians just decided to tax us more for fun?

 

[dtugg]

Why do you think the NHS was started? Or Medicare? Because the charities couldn't do enough! Do you think the politicians just decided to tax us more for fun?

I think these programs are mostly an effort to secure votes.

I really have no idea whether charities could do enough when Medicare was conceived. But I will say that tax rates in the 60s when Medicare was introduced were much higher than they are right now. This means less money available to charities.

 

[Ziggurat]

You are forced to buy healthcare insurance which is more expensive than ours.

No, we're not. In fact, that's precisely one of the criticisms of the current system: people at low risk often opt out of buying insurance, and so the remaining risk is not spread as widely. So you have this exactly backwards.

 

[martu]

I think these programs are mostly an effort to secure votes.

Yes it's always a huge vote winner raising taxes...

Or are you saying that these programs are what the majority want but we shouldn't have them because...well because what exactly? Is this one of those taxes are unethical Libertarian things?

I really have no idea whether charities could do enough when Medicare was conceived. But I will say that tax rates in the 60s when Medicare was introduced were much higher than they are right now. This means less money available to charities.

Ok so why aren't the charities stepping in now to take over from Medicare?