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Source: (consider it)
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Thread: Purgatory: Health Care
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The Exegesis Fairy
Shipmate
# 9588
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Posted
Okay, so maybe we have 'good as the enemy of best' in the UK. Then again, maybe not.
quote:
The British whinging about the NHS doesn't help either. It's easy enough to find examples of rude people and poor care in any system, but Brits do turn whinging into an art form! It's easy to put out scare stories which dampen the effect of the statistics, as most people don't understand or trust statistics anyway.
And this is exactly why. We whinge and whine about the poor quality of care. Like that time I spent X hours waiting in Accident and Emergency because I had a...whatever.
And the newspapers going on about the crying shame when Person A doesn't get the same treatment as Person B, and the 'postcode lottery' for treatment, and such and such.
But I think the reason for that is: we don't know how good we've got it.
As for choice: can't you now go to any NHS hospital for your treatment/operation? So you can choose shortest waiting time/lowest bug rate/closest/the one near Aunt Maisie if you so desire. Yeah, the NHS needs some trimming. But in spite of our much-vaunted crappiness, we're still, what, 18th in the world?
I'm all for improving our efficiency. But even if there weren't a thing I could do about it, I'd take those odds.
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I can only please one person a day.
Today is not your day.
Tomorrow doesn't look good either.
Posts: 500 | From: the clear blue sky | Registered: Jun 2005
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Marvin the Martian
Interplanetary
# 4360
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Posted
quote:
Originally posted by Macx:
If those politicians would have listened when they were politely written to, if they would have listened when they were politely spoken to, if they would have listened when they were spoken to a little harshly, if they would have listened when they were spoken to very harshly, it wouldn't have needed to come to that. If the shouting down doesn't get them to listen, perhaps a little violence & if they continue to abuse the people, they may very well encounter extreme violence.
The problem with this, of course, is when the ones writing, speaking, shouting and threatening violence are in the minority. What happens then, Macx, what happens then?
You claim to speak for "the people", when you're only speaking for the right-wing fundamentalist minority. What about all the people who are in favour of this? Should they get their weapons out to oppose you the same way you're threatening to oppose them? Is that what you want - politics reduced to the level of who has the most firepower?
Actually, having read your posts over the last months that's a really daft question. Of course you do.
It's a frightening attitude for your minority to have, though. What's next - overthrowing the government if your favoured candidate doesn't win at the next election? Setting up a quasi-military junta "for the good of the people"? Banning elections if the people can't even be trusted to vote for the "right" candidate? Suddenly you ain't got America, you've got Zimbabwe...
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Hail Gallaxhar
Posts: 30100 | From: Adrift on a sea of surreality | Registered: Apr 2003
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Ricardus
Shipmate
# 8757
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Posted
IME, when the British moan about the NHS, they are generally comparing it to the French or German systems, and never to the American way.
Posts: 7247 | From: Liverpool, UK | Registered: Nov 2004
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Hawk
Semi-social raptor
# 14289
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Posted
I love how the British moan and whinge about everything. I feel sorry for the providers of course but it is certainly a stimulus. We are never happy and so things will always naturally strive to get better. The NHS is improving all the time. The moaning is natural to Britain but underneath it we are well aware of how lucky we are and if we’re not aware, we have the wonderful example of America to show us what the terrifying alternative is. ![[Big Grin]](biggrin.gif)
Personally, I’m not convinced that a single-payer system will turn us into the French. They might have better healthcare than us but I suspect the reasons are a lot more complex than single payer vs service provider. The points Amorya made about privatisation ring true in a British context. Correct me if I’m wrong RadicalWhig but a single-payer system seems mighty similar to privatisation of the NHS while the government pays the bills. And privitisation certainly hasn't made the trains more efficient or cheaper or better in any sense of the word. Private companies seem petty and squabling and too small to run things properly on a national level. I suspect the NHS would end up the same if single-payer was introduced. While money won’t hit us directly I sincerely doubt we will get the value for money that we’re getting now. Nationally, the cost will skyrocket. Private companies in competition doesn’t always decrease prices, the idea of natural market forces is a nice theory but often sticks in practice. What it does do is mean that suddenly a non-profit organisation becomes a profit-making organisation. The medical profession will have to make money, and the only way is to raise the costs, to make more money to pay for their managers, and their marketing campaigns to convince the consumer to go to hospital A rather than hospital B.
Choice is a good idea but there’s already quite a bit of choice. You can pick which GP surgery you go to, within reason. Ideas to increase choice are already being floated in Parliament. Things are only going to get better in this regard. The NHS is great and could be better but I really think that scrapping it and replacing it with a single-payer system will be counter-productive, will increase costs and will just make everything more confusing for the patient. I hate buying a train ticket now as you have to pick between a hundred different train companies, each with their own website, times, prices and ticket types. It’s a nightmare and I can’t be bothered to research each one and find out which is best. Sometimes choice is a pain rather than a blessing. I would hate even more to have to do this every time I wanted to see a doctor or go to hospital. I like it being given to me by the system without having to worry about it. If there’s a problem with being given it, such as I’m not happy with the service or the delays then I’d like to have other free options on the table but all within the same public service, certainly not having to deal with a multiplicity of companies all vying for attention. It would be confusing, disorienting and far too much effort, especially when someone’s sick and can’t deal with it.
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“We are to find God in what we know, not in what we don't know." Dietrich Bonhoeffer
See my blog for 'interesting' thoughts
Posts: 1739 | From: Oxford, UK | Registered: Nov 2008
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Hawk
Semi-social raptor
# 14289
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Posted
quote:
Originally posted by Marvin the Martian:
Is that what you want - politics reduced to the level of who has the most firepower?
That's the American way. They founded a country on that principle.
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“We are to find God in what we know, not in what we don't know." Dietrich Bonhoeffer
See my blog for 'interesting' thoughts
Posts: 1739 | From: Oxford, UK | Registered: Nov 2008
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The Exegesis Fairy
Shipmate
# 9588
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Posted
quote:
It would be confusing, disorienting and far too much effort, especially when someone’s sick and can’t deal with it.
Exactly. Back when my ME was really bad, I hauled myself down to the GP's surgery that I'd registered with after moving there, said 'Urgh' and attempted to communicate in some meaningful way my symptoms. And I was comparatively mild. I would hate to think how I would have coped if I had to choose between providers or whatever at that point.
I hate buying train tickets when I'm perfectly healthy. The same idea when I'm sick? Next to impossible.
The question then becomes not 'Is that how the French system works in practice?' though that is an important thing to ask.
The question is, 'If we introduced this in Britain, is it what is most likely to happen?'
(If the trains are anything to go by, the answer is yes.)
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I can only please one person a day.
Today is not your day.
Tomorrow doesn't look good either.
Posts: 500 | From: the clear blue sky | Registered: Jun 2005
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by Moth:
...what we have now works OK, so why risk change?
The same can be said of any mess. Everything "works ok" if you have no knowledge or experience of something better. Good grief, even the "British Constitution" works ok to some people. If people were not prepared to "risk change" to improve on what "works ok", we'd still have slavery and child labour.
quote:
The British whinging about the NHS doesn't help either. It's easy enough to find examples of rude people and poor care in any system, but Brits do turn whinging into an art form!
I'm not whinging! Have you seen me whinging? Whinging is negative. It complains but does not propose any alternative. I, on the other hand, am trying to start a transatlantic debate on the options of health care reform. My basic argument is that we should take neither Britain nor the USA for our models, but instead look to European countries for possible solutions. I argue this based on limited first hand experience of a system which, from the patient's perspective, seems to work so much better than the NHS. I'm not criticising the NHS or the people who work for it (insert obligatory tabloid comment about them all being bally heros here), but I do think that it is hindered by a severe structural flaw - public provision instead of public funding - which means that patient choice and quality tend, inevitably, to get squeezed out.
quote:
Originally posted by Josephine:
This article explains the Dutch and French systems, which seem to be less well-known in this country than the UK and Canadian systems.
Thank you, Josephine. I found that article very interesting.
quote:
Originally posted by Hawk:
The points Amorya made about privatisation ring true in a British context.
Yes, probably. We can't trust the British State to get much right these days. We can't expect to get the decisions right until we first get the decision-making processes right (which means, I hate to say it, fundamental constitutional reform).
If and when Scotland does become independent, and does get a proper Constitution which holds the government accountable, we can think about implementing health care reform in a new and flexible nation of 5m people, supported by a fledging civil service (tutored by some French ENA graduates) and a more open and accountable style of policy making. That would be so much easier and more likely to succeed than trying to introduce reform into a British State which has shown itself to be so tired, so incompetent, and so ossified, as to be incapable of reform.
quote:
Originally posted by JillieRose:
The question then becomes not 'Is that how the French system works in practice?' though that is an important thing to ask.
The question is, 'If we introduced this in Britain, is it what is most likely to happen?'
Again, a fair point. This is the one real objection that I've found so far to the idea of an National Health Insurance Scheme. Single-payer is great in theory - and great in practice in France - but would it work well in Britain? I don't know. See my above comments about the dysfunctionality of the British State (I think the British State should be abolished!).
quote:
Originally posted by Hawk:
Correct me if I’m wrong RadicalWhig but a single-payer system seems mighty similar to privatisation of the NHS while the government pays the bills.
Um, not exactly. I think perhaps it is closer to a school voucher system (something that I'm not necessarily a fan of in education, but for different reasons) - some hospitals and other health care facilities will still be provided by the State or local authorities, alongside non-profit foundations and for-profit professionals (by which I mean your local doctor trying to make a living - the idea of a "for-profit hospital" is an anathema).
I like the idea of making a (small, even token) up front payment - even, or especially, if that payment is actually made through a public insurance scheme. It establishes a customer-professional relationship which I find very refreshing in France, rather than the supplicant-authority relationship which I find so annoying with doctors in the UK.
quote:
Originally posted by Hawk:
Personally, I’m not convinced that a single-payer system will turn us into the French. They might have better healthcare than us but I suspect the reasons are a lot more complex than single payer vs service provider.
Indeed. Public health outcomes have as much to go with farming, transport and planning policies as they have with health services. The French are still overwhelmingly a nation of small towns; food comes from farms, not factories, and people can still walk to work, or to the local shops. Providing a healthy overall living and working environment is a part of the health-care process in which the State must be actively (and pro-actively) involved. Every public policy has a health implication. Cycle lanes are not just a road safety issue, they are a public health issue too. The Scottish Government is trying to tie these things together, but it is an up-hill struggle.
[ 12. August 2009, 11:27: Message edited by: RadicalWhig ]
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
How is the cost determined in a single-payer system? As an example, if I had condition X and there were two local hospitals competant to provide the treatment for that I get that I'd be free to choose which hospital to go for. If hospital A charged £100,000 to treat me, and B charged £150,000 would I be allowed to choose the more expensive option on the expectation that that extra £50,000 was being translated into better service? Or, would the payer fix the price and expected level of service?
The problems I see are that if the "customer" (ie: me) was allowed to choose based on expectation of service quality then there would be a strong temptation to go with the more expensive option and hence boost the overall costs. There would seem to be little incentive for the provider to keep costs down if they'd be met anyway.
On the otherhand, if the costs were fixed by the payer then there would be an incentive to the provider to keep costs down (to maximize profit) while maintaining good service (to attract more customers). But, there would need to be competant people within the payer organisation able to define both what minimum level of service would be expected for every treatment, and what would be a reasonable cost for that treatment. Which seems very beaurocratic to me. Plus, I could see the situation where providers look at a given treatment, say "we can't provide that service for that amount" and refuse to treat people ... which would be a disaster if repeated by all the providers in a given location.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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Moth
Shipmate
# 2589
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Posted
quote:
Originally posted by RadicalWhig:
quote:
Originally posted by Moth:
...what we have now works OK, so why risk change?
The same can be said of any mess. Everything "works ok" if you have no knowledge or experience of something better. Good grief, even the "British Constitution" works ok to some people. If people were not prepared to "risk change" to improve on what "works ok", we'd still have slavery and child labour.
I'm not disagreeing with you. I'm putting fear of change forward as a reason why it's hard to get people to agree to what seems a sensible idea. Most people just find change far too stressful, so will put up with a situation that is not ideal to avoid it.
Personally, I quite like change, but experience teaches me that I'm in a small minority!
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"There are governments that burn books, and then there are those that sell the libraries and shut the universities to anyone who can't pay for a key." Laurie Penny.
Posts: 3446 | From: England | Registered: Apr 2002
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by Og: Thread Killer:
Even the most right wing of governments up here did not try to break the Doctor's hold over who gets to practice where and for how much money.
Since when did right-wing governments try to break up wealthy people's clubs?
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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Erin
Meaner than Godzilla
# 2
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Posted
quote:
Originally posted by CorgiGreta:
Erin,
It is Kaiser.
I suppose that I am biased since the extraordinary diligence of one their doctors saved my life a few years ago.
Greta
I get that, and Kaiser is a good one to have. Hell, I'm thrilled with my current insurance (granted, I was more thrilled several years ago, when I had 100% coverage at "very prestigious organization" and could see 10 specialists a day and never pay one cent). But Kaiser is an exception, not the rule. Most MAPs fight tooth and nail to keep every dime they have, insisting that the provider and patient jump through 800 hoops just to get an x-ray authorized, and then sit back for the rollercoaster ride that is the billing and reimbursement process. The only reason they pay at all is because the government says they have to, and even then they give you the attitude of a 13-year-old girl who's just been told to hang up the telephone.
God I want to strangle them just writing this. But seeing as how they're almost all administered by traditional insurance companies who routinely fight tooth and nail not to pay, their behavior is not surprising.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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la vie en rouge
Parisienne
# 10688
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Posted
quote:
Originally posted by Alan Cresswell:
How is the cost determined in a single-payer system? As an example, if I had condition X and there were two local hospitals competant to provide the treatment for that I get that I'd be free to choose which hospital to go for. If hospital A charged £100,000 to treat me, and B charged £150,000 would I be allowed to choose the more expensive option on the expectation that that extra £50,000 was being translated into better service? Or, would the payer fix the price and expected level of service?
In France, the vast overwhelming majority of doctors all charge the same eg. a GP apointment is €22. I think it's about €30 for a specialist (normally you have to be referred by a GP or the Social Security / insurance won't pay). I think these standard rates are set by Government, although I could be wrong about that. In the old days you used to pay up front and then get a refund, these days you hand a card over and it all goes through automatically. The Social Security pays 70% and then you take out (fairly inexpensive) insurance for the rest. People who are really poor get the full cost of their treatment paid for by the State. The 70% refund is based on the standard rates, and the amount your insurance will pay is also related to these standard rates. For example, my insurance pays for 100% of all standard consultation fees, prescription medicines and hospital costs and then up to fixed amount a year for optician, dentist etc.
Some very spiffy fancy-schmancy doctors that famous people go to charge more than the standard fees. If you want to see one of these, the Government will still only refund you 70% of standard rates so you will either have to pay the extra yourself or take out more expensive insurance.
In reality, most people are happy with the service provided by the doctors charging standard fees and don't bother with paying more to get fancier service. (Although I can see why you might - for example I am completely covered for staying in hospital on the ward, but I'm not sure my insurance pays for a private room.) But at any rate, the service you can get for Social Security + inexpensive insurance (you get can one that pays 100% of standard fees for about €30/ month) is already very good.
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Rent my holiday home in the South of France
Posts: 3696 | Registered: Nov 2005
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by RadicalWhig:
quote:
Originally posted by Hawk:
Correct me if I’m wrong RadicalWhig but a single-payer system seems mighty similar to privatisation of the NHS while the government pays the bills.
Um, not exactly. I think perhaps it is closer to a school voucher system (something that I'm not necessarily a fan of in education, but for different reasons) - some hospitals and other health care facilities will still be provided by the State or local authorities, alongside non-profit foundations and for-profit professionals (by which I mean your local doctor trying to make a living - the idea of a "for-profit hospital" is an anathema).
Isn't that roughly what the Conservatives were proposing with their Patient Passport?
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by davelarge:
Isn't that roughly what the Conservatives were proposing with their Patient Passport?
Err... ...well, yes, sort of... ...it seems a bit like it...
...oh dear, yet more evidence to support these baseless accusations that I'm just an Evil Wicked Tory in disguise.
(I'm not, you know.)
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
My, what a lovely shade of Blue you are, RadicalWhig.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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Crœsos
Shipmate
# 238
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Posted
A blogger writes an account of her encounter with an actual "death panel":
quote:
You have no idea what it’s like to be called into a sterile conference room with a hospital administrator you’ve never met before and be told that your mother’s insurance policy will only pay for 30 days in ICU. You can't imagine what it's like to be advised that you need to “make some decisions,” like whether your mother should be released “HTD” which is hospital parlance for “home to die,” or if you want to pay out of pocket to keep her in the ICU another week. And when you ask how much that would cost you are given a number so impossibly large that you realize there really are no decisions to make. The decision has been made for you. "Living will" or no, it doesn't matter. The bank account and the insurance policy have trumped any legal document.
If this isn’t a “death panel” I don’t know what is.
Government providing living will counseling on an as-requested basis = "death panel".
Insurance company pulling the plug on your treatment = "free market".
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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Honest Ron Bacardi
Shipmate
# 38
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Posted
The "Death Panel" gambit sounds precisely like the sort of rhetoric that is liable to explode in your face at any time.
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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Macx
Shipmate
# 14532
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Posted
![[Killing me]](graemlins/killingme.gif) You meant that as a joke right?
Put your hand in the box . . .
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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Honest Ron Bacardi
Shipmate
# 38
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Posted
Your reference, alas, eludes me.
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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Imaginary Friend
Real to you
# 186
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Posted
In your defence, RadicalWhig, I think the patient passport was more about freeing up NHS money to be spent in private hospitals. This is probably too simplistic, but each individual could choose to take 'their money' to which ever provider they chose, and if the treatment cost more than 'their money' would cover, they would have to top it up out of their own pocket.
So it's not really what you were talking about. It was more about pandering to middle class foibles. You're off the hook
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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Macx
Shipmate
# 14532
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Posted
Sorry Ron, Frank Herbert's Dune, the 1984 movie version. Scene where in the messiah is ordered to put his hand in a box that will generate pain & if he removes his hand, the "witch" will kill him.
quote:
The "Death Panel" gambit sounds precisely like the sort of rhetoric that is liable to explode in your face at any time.
Your post just struck me as the same brand of humor that brought us products such as this.
Of course it is entirely possible that you were serious.
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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RuthW
liberal "peace first" hankie squeezer
# 13
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Posted
quote:
Originally posted by Hawk:
quote:
Originally posted by Marvin the Martian:
Is that what you want - politics reduced to the level of who has the most firepower?
That's the American way. They founded a country on that principle.
Yes, and we've decided every single political issue we've faced on this principle alone ever since one group of Englishmen won a war over another group of Englishmen in the late 18th century. Your country on the other hand has never, ever resorted to firepower to decide political issues. Except for the battles with the Luddites. And Culloden. And the Battle of the Boyne. And the English Civil War. And the Wars of the Roses. And Owen Glendower's defeat. And Simon de Montfort's little rebellion. And the Norman invasion. To name a few examples.
Posts: 24453 | From: La La Land | Registered: Apr 2001
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Honest Ron Bacardi
Shipmate
# 38
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Posted
quote:
Your post just struck me as the same brand of humor that brought us products such as this.
Of course it is entirely possible that you were serious.
Well - it's also entirely possible I meant both.
RuthW - that does illustrate nicely how hyperbole renders a reasonable argument absurd. But any further comment on that is probably better on the other thread.
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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John Holding
Coffee and Cognac
# 158
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Posted
quote:
Originally posted by RuthW:
quote:
Originally posted by Hawk:
quote:
Originally posted by Marvin the Martian:
Is that what you want - politics reduced to the level of who has the most firepower?
That's the American way. They founded a country on that principle.
Yes, and we've decided every single political issue we've faced on this principle alone ever since one group of Englishmen won a war over another group of Englishmen in the late 18th century. Your country on the other hand has never, ever resorted to firepower to decide political issues. Except for the battles with the Luddites. And Culloden. And the Battle of the Boyne. And the English Civil War. And the Wars of the Roses. And Owen Glendower's defeat. And Simon de Montfort's little rebellion. And the Norman invasion. To name a few examples.
Strictly of course, all these except the "battles with the Luddites" are as much part of US history and cultural formation as they are of British history and cultural formation, since they all occurred well before the Declaration of Independence.
As for the "battles with the Luddites", in fact these affected a fairly small number of people in a fairly constrained part of the country. What looks today (from a PC perspective) like a major social uprising -- and was, to be fair, viewed by some of the authorities at the time in the same way -- really wasn't such a big deal at the time for most of the people living in the island. It's relatively recently that historians and analysts have given the Luddites the kind of profile they seem to have today.
John
Posts: 5929 | From: Ottawa, Canada | Registered: May 2001
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Adeodatus
Shipmate
# 4992
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Posted
A darkly funny episode in this debate is reported here today. The bit I especially like is the IBD editorial saying quote:
people such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless
Erm ... anyone spot the "mistake" here?
(For the record, Professor Hawking has said quote:
that he "wouldn't be here today if it were not for the NHS".
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"What is broken, repair with gold."
Posts: 9779 | From: Manchester | Registered: Sep 2003
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
quote:
Originally posted by lady in red:
quote:
Originally posted by Alan Cresswell:
How is the cost determined in a single-payer system? As an example, if I had condition X and there were two local hospitals competant to provide the treatment for that I get that I'd be free to choose which hospital to go for. If hospital A charged £100,000 to treat me, and B charged £150,000 would I be allowed to choose the more expensive option on the expectation that that extra £50,000 was being translated into better service? Or, would the payer fix the price and expected level of service?
In France, the vast overwhelming majority of doctors all charge the same eg. a GP apointment is €22. I think it's about €30 for a specialist (normally you have to be referred by a GP or the Social Security / insurance won't pay). I think these standard rates are set by Government, although I could be wrong about that.
So, if the rates set by government (or, whoever) also apply to treatments (to cover cost of drugs, time in hospital etc in addition to actually seeing the doc) then the system has the customer choosing the person to see ... but there's still a nice group of bureaucrats deciding what treatments the single-payer will pay for and how much will be paid.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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Clint Boggis
Shipmate
# 633
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Posted
quote:
Originally posted by Adeodatus:
A darkly funny episode in this debate is reported here today. The bit I especially like is the IBD editorial saying quote:
people such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless
Erm ... anyone spot the "mistake" here?
(For the record, Professor Hawking has said quote:
that he "wouldn't be here today if it were not for the NHS".
All it needs now is for some right-wing blogger or other twister of facts (or Palin) to claim "this world famous scientist has been held captive for years by socialists!" and the simple drones would all accept it without question as the absolute truth.
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Posts: 1505 | From: south coast | Registered: Jun 2001
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by Alan Cresswell:
...but there's still a nice group of bureaucrats deciding what treatments the single-payer will pay for and how much will be paid.
Was that an intentional pun?
Anyhow, your point is obviously true. Under any system which uses public money, someone has to decide how that money gets spent. Personally, I like the model from Oregon because it seems to involve medical professionals and administrators in the process, and is relatively transparent. I'm sure the system's not perfect, but (as I said before) I don't believe that there is such a thing as a perfect system anywhere that resources are limited.
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
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Josephine
Orthodox Belle
# 3899
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Posted
You know, there's one aspect of the American system of having your insurance tied to your job that I've never seen discussed. That is, our system makes it far more difficult, if not impossible, for many talented people to start small businesses.
If you're self-employed, you have to buy your own insurance on the open market. If you've got pre-existing conditions or major risk factors, you may not be able to buy it. And if you decide to go without, if you develop a long-term condition while you're without insurance, you may not even be able to get into a group policy later on -- gaps in your coverage change the normal rule that group policies can't refuse to cover pre-existing conditions. (Although, in this state, they can only refuse to cover for a fixed period of time; I don't know the rules in other states.)
I was running a successful small business when it became clear that my first marriage was going to end. I immediately began closing my business and looking for a "real" job, since, after the marriage ended, I would not be able to continue converage on my then-husband's healthcare through his job.
I know other people who dreamed of starting their own businesses, who I'm reasonably sure could have made it work, who couldn't because they would be unable to buy insurance.
If small businesses are truly the lifeblood of our economy, this aspect of our system should be front and center. I'm not sure why it's not.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by Josephine:
If small businesses are truly the lifeblood of our economy, this aspect of our system should be front and center. I'm not sure why it's not.
Because the loudest supporters of small businesses are also the loudest opponents of healthcare reform?
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by Josephine:
You know, there's one aspect of the American system of having your insurance tied to your job that I've never seen discussed. That is, our system makes it far more difficult, if not impossible, for many talented people to start small businesses.
If you're self-employed, you have to buy your own insurance on the open market.
Another factor is that in many cases you're also having to buy insurance for your dependents as well. A lot of people who might be willing to gamble on their own future good health are a lot less willing to do so with their kids.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by davelarge:
quote:
Originally posted by Josephine:
If small businesses are truly the lifeblood of our economy, this aspect of our system should be front and center. I'm not sure why it's not.
Because the loudest supporters of small businesses are also the loudest opponents of healthcare reform?
Why, though? Access to healthcare is a real barrier to starting your own business. Reforming healthcare removes the barrier.
If you were truly supportive of small businesses -- including and especially the entrepreneur just getting started -- seems like supporting healthcare reform would be a no-brainer.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Alan Cresswell:
[QUOTE]So, if the rates set by government (or, whoever) also apply to treatments (to cover cost of drugs, time in hospital etc in addition to actually seeing the doc) then the system has the customer choosing the person to see ... but there's still a nice group of bureaucrats deciding what treatments the single-payer will pay for and how much will be paid.
Just as, in the US, there is a nice group of insurance co. bureaucrats decide what treatments they will pay for and how much will be paid.
death panels
At least with government bureaucrats there is some means of accountability every couple of years.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by Josephine:
If you were truly supportive of small businesses -- including and especially the entrepreneur just getting started -- seems like supporting healthcare reform would be a no-brainer.
OK, I'm thinking out loud here, but perhaps both smallbusinessism and non-healthcarereformism are both manifestations of the conservatives' desire for small government. Small government means private provision of health services, and it means that small companies provide many of the services that the state would in other countries*, in an environment where regulation is minimal and the tax burden low. Therefore, the two derivative principles for which conservatives campaign aren't necessarily compatible with each other, but are manifestations of an overarching philosophy.
* Actually, primary health care would be a good example of this in itself. Wouldn't most doctor's clinics count as small businesses?
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by davelarge:
quote:
Originally posted by Josephine:
If you were truly supportive of small businesses -- including and especially the entrepreneur just getting started -- seems like supporting healthcare reform would be a no-brainer.
OK, I'm thinking out loud here, but perhaps both smallbusinessism and non-healthcarereformism are both manifestations of the conservatives' desire for small government. Small government means private provision of health services, and it means that small companies provide many of the services that the state would in other countries*, in an environment where regulation is minimal and the tax burden low. Therefore, the two derivative principles for which conservatives campaign aren't necessarily compatible with each other, but are manifestations of an overarching philosophy.
* Actually, primary health care would be a good example of this in itself. Wouldn't most doctor's clinics count as small businesses?
I disagree with the premise that conservatives, in the modern sense of the term, have a "desire for small government". Most conservatives are in favor of increased military spending and they typically favor whatever wars are proposed, both examples of government at its biggest. They're also in favor of increased regulation, just so long as it applies to individuals (particularly regarding their sexual choices) and not businesses. In short, it's not big government they're opposed to, it's just a difference of opinion about which aspects of the goverment should be big. In the American paradigm it can usually be summed up as favoring government interests over individual liberty and favoring business interests over government interests.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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Imaginary Friend
Real to you
# 186
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Posted
So, if I were to amend the highlighted portions of my previous post to be
"the conservatives' desire for minimal government welfare provisions"
and
"regulation of businesses is minimal"
would you agree?
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by davelarge:
So, if I were to amend the highlighted portions of my previous post to be
"the conservatives' desire for minimal government welfare provisions"
and
"regulation of businesses is minimal"
would you agree?
Yes.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by Crœsos:
quote:
Originally posted by davelarge:
So, if I were to amend the highlighted portions of my previous post to be
"the conservatives' desire for minimal government welfare provisions"
and
"regulation of businesses is minimal"
would you agree?
Yes.
Yes. Although baring in mind that "minimal regulation of business" tends to favour big businesses over small ones.
Those opposed to health care reform are not the ones who support small businesses; they are the ones who are supporting the "Walmartization" of the economy and forcing small businesses to go bust.
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by RadicalWhig:
Yes. Although baring in mind that "minimal regulation of business" tends to favour big businesses over small ones.
Those opposed to health care reform are not the ones who support small businesses; they are the ones who are supporting the "Walmartization" of the economy and forcing small businesses to go bust.
Yes. And an ironic choice of metaphor, given that in the past (they've recently cleaned up their act somewhat) Walmart's disgraceful track record on employer-provided health care forced so many of their employees into government funded programs for low-income families that it caused a significant strain on the system.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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ken
Ship's Roundhead
# 2460
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Posted
I doubt if oppostion to public health care in the USA can be put down to desire to keep big government out of the medical business. The US government, and US taxpayers are hugely involved in healthcare. More so than in many other developed countries, including the UK. And there is a huge amount of regulation as well. Again, mroe than most other countries
The paradox of the American system is that they pay the taxes, and they put up with the regulation, but they don't get what they are paying for.
quote:
Originally posted by davelarge:
Wouldn't most doctor's clinics count as small businesses?
Certainly in Britain. The largest category of doctors are the GPs, who are not employees of the NHS.
[ 13. August 2009, 17:18: Message edited by: ken ]
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
Some of it arises from pure ignorance--there was an incident at one of these "town meetings" a couple of weeks ago where a guy complained that the liberals were trying to create a government-run health plan and take away his Medicare. when it was pointed out to him that Medicare is a government-run health plan, he refused to believe it.
There's even less awareness of how insurance regulators operate, and what their effect is.
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
Posts: 6114 | From: PDX | Registered: May 2001
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Scot
Deck hand
# 2095
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Posted
quote:
Originally posted by ken:
I doubt if oppostion to public health care in the USA can be put down to desire to keep big government out of the medical business. The US government, and US taxpayers are hugely involved in healthcare. More so than in many other developed countries, including the UK. And there is a huge amount of regulation as well. Again, mroe than most other countries
You are exactly right, except for the first sentence. The American public is strangely oblivious to the vast amount of government involvement in our current health care system. I think this is largely due to the mandate that insurance be provided through employers. Most individuals don't realize what they are really paying or how the system works.
I'd prefer a truly open market in health care and I'd willingly accept a government-run or single-payer system, but right now we've got the worst of both worlds. We lack both the universality of a government system and the competitive advantages of a free market system.
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“Here, we are not afraid to follow truth wherever it may lead, nor tolerate any error so long as reason is left free to combat it.” - Thomas Jefferson
Posts: 9515 | From: Southern California | Registered: Jan 2002
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by Scot:
I think this is largely due to the mandate that insurance be provided through employers.
Mandate? Is that the word you want? You can buy individual insurance plans in the USA. Further many, many employers don't provide insurance for their employees (most famously WalMart).
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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Scot
Deck hand
# 2095
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Posted
Fair enough, it's not a mandate. Employer-based insurance is, however, the norm in the US due to historical precedent, the tax code, and public expectations. I still maintain that it's the primary reason why most people are so astonishingly ignorant of the cost and limitations of their own coverage, let alone what will happen to them if they go outside of the employer-based system.
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“Here, we are not afraid to follow truth wherever it may lead, nor tolerate any error so long as reason is left free to combat it.” - Thomas Jefferson
Posts: 9515 | From: Southern California | Registered: Jan 2002
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jlg
What is this place?
Why am I here?
# 98
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Posted
quote:
Originally posted by Alan Cresswell:
Plus, I could see the situation where providers look at a given treatment, say "we can't provide that service for that amount" and refuse to treat people ... which would be a disaster if repeated by all the providers in a given location.
Actually, this has been of problem in some areas of the US with OB/GYN services. As the malpractice insurance premiums went up and up, less doctors opted for this speciality (especially since it also comes with a basic inability to control your schedule).
If they did opt for it, many of them wanted to work where they could run what I call a "medical business" (as opposed to a medical practice) where they would have a much better chance of making a good profit with which to pay off their school loans and then 'live the good life'. That translates into major population center with decent average income and easy access to major (and prestigious - e.g. downtown Boston, not the suburban) hospitals.
Here in the Greater Boston area some years back there was a lot of press coverage about the number of hospitals which were eliminating their obstretics operations, leaving women to travel long distances to the now overcrowded remaining hospitals.
In rural areas of the US (especially with large areas of poverty and/or low population density), it has long been a problem to attract enough of even the basic services (some GPs, a pediatrician or two, a couple of OB/GYNs plus some sort of reasonable facsimile of a hospital).
Posts: 17391 | From: Just a Town, New Hampshire, USA | Registered: May 2001
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mousethief
Ship's Thieving Rodent
# 953
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Posted
quote:
Originally posted by Scot:
Fair enough, it's not a mandate. Employer-based insurance is, however, the norm in the US due to historical precedent, the tax code, and public expectations. I still maintain that it's the primary reason why most people are so astonishingly ignorant of the cost and limitations of their own coverage, let alone what will happen to them if they go outside of the employer-based system.
Agreed.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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jlg
What is this place?
Why am I here?
# 98
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Posted
quote:
Originally posted by Scot:
I still maintain that it's the primary reason why most people are so astonishingly ignorant of the cost and limitations of their own coverage, let alone what will happen to them if they go outside of the employer-based system.
I think this is one of the biggest problems with the US system. It depends on the individual consumer to flag up problems, but that consumer really doesn't know squat about medical costs, much less how the insurance system works.
I noticed this (since I and my family don't use much medical care) when I had my gallbladder removed about ten years ago.
My surgeon simply accepted whatever payment he received from the particular insurer. He didn't bill you for the difference, he didn't argue with the various insurers/providers. This meant that he could run a tiny and simple office.
Nearly everyone else involved in the surgery I caught double-billing (i.e. once under the name of the individual,once again under the name of the Group Practice). I reported two or three of these by phone to my Insurance Carrier and received a simple Thank You for Calling Us with no further action taken.
I never received any revised statement indicating that they had debited any of the firms for the (obvious even to me) double-billing. So a roughly $6,000 procedure cost my insurance company $11,000.
And they don't care?
The clear message I received was that it was too much trouble for the Insurance Company to pursue any particular instance of fraud. Maybe if I had come up with a lawsuit documenting many multiples of instances over a great number of years....
But it's "obviously" "not cost effective" "to pursue a particular isolated instance" "of what would be a tiny loss compared to the overall picture".
Meanwhile, these same insurance companies are refusing to cover diabetics or elderly heart patients or cystic fribrosis or multiple schlerosis or other "existing conditions". Why do I suspect that they get a nice cut from these double-billings for routine and one-time procedures?
Posts: 17391 | From: Just a Town, New Hampshire, USA | Registered: May 2001
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Imaginary Friend
Real to you
# 186
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Posted
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.
Surely all reasonable people must be opposed, in principle and in practice, to the idea of for-profit insurance companies being the main means of funding health care. Those who are not so opposed must either:
(i) be doctrinaire libertarian capitalists with the intellectual sophistication of a teenage Hayek Society member; or
(ii) have a selfish vested interest in maintaining a for-profit system; or
(iii) be so stupid as to fall for the lies peddled by an unholy alliance of those in the first and second categories.
Sorry if this sounds a bit harsh, but really can there be any other reason to support private for-profit insurance as the main means of funding basic health care?
(I'm not including those who advocate a basic state-funded universal scheme with an optional private top-up - that is an entirely different matter).
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Honest Ron Bacardi
Shipmate
# 38
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Posted
quote:
Surely all reasonable people...
Well, there's the weakness of your plan right there, RadicalWhig. Reasoning requires a level of civility in discourse that is in distinctly short supply right now. Seriously.
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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