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Oct 16 2013

How to Cripple Healthcare

This isn’t up for debate really. A socialised medical system is pound for pound the most cost effective method of guaranteeing the health of a population.due to a large emphasis on preventative medicine, subsidised costs, economies of scale and the like.

Now people look at the NHS bloat and don’t realise that the bloat is bad but not as bad as the USA’s. The US government spends nearly double what we do for a slightly worse system of healthcare with regards to outcomes.

In addition? The privatised medical sector played a large part in the destruction of the economy. One of the major reason for bankruptcy and foreclosure or indeed taking out a overdrawn sub-prime was healthcare costs.

So along came Obama Care and IMHO it’s not enough. It’s propping up a failing system. You may as well go the whole hog really.

Okay the NHS has problems and it’s problems due to the fact it’s bureaucratic. It needs to become effective and cut the red tape.

But the USA is facing an ideological issue. Basically? Anything democrats do, republicans oppose. And some of the reasons they do so are rather terrible.

See in a socialised medical system you are doing one major thing. You are removing the business cost of healthcare and simultaneously removing the burden of disease economically.

But it needs newbies, like any healthcare system Obama Care is a promissory. You pay now, when you are old the youth will pay for you. It is how even private healthcare works.

So how do you fight the system? You stop young people from signing on with immediate benefits. Because the entire premise of privatised healthcare boils down to “I am not sick right now, why do I need to pay for healthcare” and young people? Well? Young people don’t think too far ahead.

I was young, I thought I was indestructible. Still am young but have been to the hospital a couple of times and realised how much of a safety net universal healthcare is.

And this thing is a farce. Republicans do not care about your healthcare. They pretty much want you to be sick. That’s the problem with a privatised healthcare system. Things are done for profit and at every stage there is a cut  and those add up a lot. So you do end up with expensive things that aren’t because they system has to function. And there are always going to be things like ER services which are expensive taking the brunt of privatised healthcare’s have nots and want nots.

Uncle Sam giving proctology exams or gynaecological ones is nonsensical. It’s demonising government healthcare to a group of kids who have no idea what real healthcare is like.

They have no idea of the lengths the British Medical System will go to help one person. Or despite the dreaded waiting list still getting surgery that’s necessary. Or schemes such as the Indian ICDS Food Supplementation schemes. Or even things such as the Finland Baby Box scheme.

Why? Because they think “Socialism boils down to wearing lots of red and referring to everyone as Comrade”. Because they don’t know any better. Want to know something? Some poor student getting his stomach pumped after a night of too much beer may appreciate it if he was protected by free healthcare and didn’t come out in debt. Or for basic women’s healthcare.

But no, the Republican Propoganda machine seems hellbent on telling young kids that healthcare is great if you pay for it with your hard earned money. All that bankruptcy won’t feel as bad as the feeling you stood on your own two feet.

It’s a disgusting tactic from Republicans and Libertarians that make up the Tea Party.

It’s some of the richest people in the USA telling the poorest that they would be better off gambling with their healthcare costs. “Let them eat cake” at it’s finest.

30 comments

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  1. 1
    peicurmudgeon

    We have those in Canada who look south with envy rather than dismay. We have problems as well, but Americanizing the system will not help any.

  2. 2
    M can help you with that.

    My Bay Area startup-guru brother insists that the big problem with medicine is that nobody has figured out how to monetize good outcomes; and that as soon as someone does, the market version will immediately be the best possible approach. And this is a fairly mainstream opinion among what passes for left-leaning educated types in the U.S. And this is a problem.

  3. 3
    smrnda

    @M

    The problem with ‘monetizing good outcomes’ is people will only pay for something that they will benefit from. This is *kind of* the idea behind employer sponsored health care already; you keep your workers healthy so they will get more work done, but that’s only ever going to be an issue for a very small # of very skilled workers who are very hard to replace. Given your brother’s occupation (I’m work for several start-ups) I’m thinking he hasn’t thought much about what life might be like for someone who is sporadically employed at a local meat packing plant – who will cash in on that person’s health?

    Something which has made me very supportive of a nationalized health care system is that I’ve never been young and healthy. I have epilepsy, psychiatric problems, vision problems, and a few other things wrong with me. I mean, I’m in good health in other ways but I’ve always had tonnes of problems that always required lots of care and medication. I think too many people talking about how people don’t need guaranteed health care access are just people who either have always had it, or who are too healthy. I mean, with good insurance I’m spending quite a bit of money a month, and even with a relatively decent income I know that I cost more in terms of health care than I made in some years.

  4. 4
    besomyka

    I was too young in the 90′s the previous time this was debated publicly. This time around, I gave it some thought, and came to the conclusion that a single-payer system would be preferable. Something like what our neighbors to the north have.

    I remember Democrats arguing for it, the GOP opting out of civil, intelligent discourse, and then having the main opposition come from conservative Democrats in the Senate. At the time, it seemed like the ‘Public Option’ (sometimes called Medicare for All), was a good compromise and step forward: at least then the for-profit insurers would have to compete against the non-profit national government.

    That when down the shitter pretty quick, though.

    Now we all have what the Heritage Foundation first advocated in the ’90′s and a Republican Governor implemented in a state, and the GOP in general supported right up to 2009, at which point once the President endorsed it, it became a Death Panel and unconstitutional. Because, of course.

    Thing is, all this nonsense from the Right is left over from our nations founding. Just like the how the seperation of church and state was argued in the newspapers while the Constitution was being written, and argued ever since (with remarkably little variation in the argument!), this political fight is born out of our countries original sin: slavery.

    Here me out.

    The South had a labor-intensive economy, farming cotton, tobacco, etc. Slaves provided an economic boon to the region, but the White property owners were quickly outnumbered by the slave population. The owners, however, were the movers and shakers. They had power, locally. They mattered to the people around them.

    When the constitution was debated, the low population states (and many of the southern states) realised that they’d not have much power if Congress was proportions only by population. A compromise was reached: we’d have two chambers. One consisting of representatives, population proportional, and Senators of which each state, no matter how big or small, would have two chosen *by the states government*.

    That was a big win for the slave states. But they wanted more. If the only people that counted towards the population of a state were citizens, then they’d have almost no representatives in the House. To pull the Nation together, the 3/5th compromise was reached, allowing slaves to count as 3/5th of a person for purposes of representative proportion.

    Ever since then the fundamental political struggle in the south has been how those established, influential white people can hold onto power. When they – FINALLY – seemed to be losing it because despite all the rebalancing to give the slave states disproportionate power, their livelihood was being threatened, they rebelled and caused the Civil War.

    Then it became a game to prevent PoC from voting – because if they did they’d be out of power. And they did for a bit post-reconstruction, but it didn’t last long.

    It took another hundred years of playing that political game before the civil rights movement was successful in fighting back the horrible political imbalances that were in place. Of course, by that time poverty was entrenched. even then, it was the same people. They fear what they can’t control and always have, because their grasp on power is so tenuous and based on the subjugation of people.

    They hate the federal government, because that means non-historically slave-owning states might be forced to empower the people they desperately need to be disenfranchised. They can’t control it – or at least haven’t been able to.

    The Voter ID bills are a manifestation of this political dynamic, a child of slave-state politics. So is the idea of ‘States Rights’. So it is with ‘privatization’: if you just give states money, then they can make sure the right people get it. Not the wrong people.

    Thing is, this isn’t about the political parties. Southern Democrats fall into this too. More so pre-civil rights era, but still now. It’s NOT an accident that the people who effectively argued for the current form of the ACA were southern, conservative, Democrats.

    The Tea Party is slave-state politics condensed into as pure of a form as I’ve ever seen.

    My country’s original sin still haunts us today.

  5. 5
    besomyka

    I guess I just want to add: the Tea Party really does see their world ending. They are seeing their grasp on power, their way of mattering to their community, eroding away. The nation is no longer tolerant of their politics, and their way of life is threatened.

    They will never give up. They are marching to their figurative deaths and they know it, but they are also ‘dead’ if they do nothing, so they will make it as costly as they possible can.

    The way out is for northern Republicans who aren’t dependant on the slave-state politics to make a break with them for the good of the country. To cast them aside, finally, as relics of the past. Let the Tea Party become a neo-Whig party and die a social death in the modern world. Alone.

  6. 6
    ...

    “This isn’t up for debate really. A socialised medical system is pound for pound the most cost effective method of guaranteeing the health of a population.due to a large emphasis on preventative medicine, subsidised costs, economies of scale and the like.”

    Really? Not up for debate is it? Well, now that you have pronounced, I imagine all of the rest of the world will snap into line. For some reason, socialised anything proved to be the single WORST method of distributing, say cars, food, steel, etc. for the last century, but somehow the most complex industry of medicine is different. I’ll take your word on that.

    “Now people look at the NHS bloat and don’t realise that the bloat is bad but not as bad as the USA’s. The US government spends nearly double what we do for a slightly worse system of healthcare with regards to outcomes.”

    That is because, in the United States, you have the unique screw up known as socialism for the rich and free enterprise for the poor. You have a cartelized system run by insurance giants who have stupid and just plain corrupt politicians in their pocket, and the whole racket is supported under the name of “reform”. Vide the Clinton administration. It is, in effect, a crude form of feudalism. Increase in state power means increased security with those with access to it stay at the top and those with no such access stay at the bottom. The gigantic mess of red tape and regulation confirms established firms in their power and crucifies the little guys who have next to no chance to even get started. The class system is maintained by the state, and cheered on by those parasitic on it. Priests in the old days, ‘intellectuals’ today. Hell, you even have your own version of “noblesse oblige” to justify it all, and your political bosses can get kingly – sorry, presidential – dispensation.

    Which brings me to your tendentious reading of economic history. The slight flaw in your reading of the history of the civil war is that it is a demonstration of the absolute power and efficacy of capitalism, as the _capitalist_ north annihilated the _feudal_ south. This was noted at the time by that noted right wing lunatic Karl Marx. Later echoed by other demented, knuckle-dragging, right-wingers like Lenin.

    So those who wish to replace the US’s neo-feudal system are much more in line with the northern abolitionists than with the feudal south.

    But, hey. Don’t bother learning history. Keep repeating the boring line that anyone who is fed up with economic serfdom is motivated by racism. It’s much easier that way.

  7. 7
    Avicenna

    Karl Marx is Right Wing? Come on, at least get your villains right! Marx is left wing, Hitler is right!

  8. 8
    ...

    You don’t even know enough to see when a joke is made at your expense? You seriously don’t see the point in my citing both Marx and Lenin in that post?

  9. 9
    smrnda

    @…

    The market supplies some things well, and other things poorly.T heoretical explanations/justifications aside, socialism didn’t deliver on steel, cars, etc. Empirical evidence. However, we aren’t seeing the same problem with medicine. Some things like education, infrastructure, health care, police, fire and military are better provided by the government than by private sector vendors. When it comes to supplying booze, porn, electronic devices, coffee and video games.

    “Really? Not up for debate is it? Well, now that you have pronounced, I imagine all of the rest of the world will snap into line”

    Check out the list of countries with nationalized health care. It’s every industrialized country except the US. Avi is just pointing out that it’s been adopted and has worked. The rest of the world ‘snapped into line’ decades ago, with the US the lone holdout for market solutions.

    A reason why private funded roads don’t work well is that infrastructure has immense start-up and maintenance costs, without any real immediate gain for the person who sinks in the money.

    Health care is bound to exceed the ability of anyone to pay for it, since we can’t export the production of health care to China and health care has to be administered by trained professionals -you can’t de-skill health care until being a doctor or a nurse are minimum wage McJobs. The way you handle something like this is distribute the cost over the largest # of people you can.

    On your rambling on about the power of the state serving ‘big players’ – if you’re talking about it leading to privileges for larger BUSINESSES (as opposed to individuals) then yeah, but that’s just since it’s legal to buy the government in the US. If you’re talking of individuals, a powerful state can prevent businesses from firing women for getting pregnant.

  10. 10
    ...

    “Check out the list of countries with nationalized health care. It’s every industrialized country except the US. ”

    You are missing a number of pieces from that puzzle. The first is that the rest relies heavily on the innovation and development of new medical technology from the United States (or at least it did). The second is that calling the situation as it has stood for decades as “market oriented” is ridiculous; it is a heavily subsidised racket. If one wanted to look at something much closer to a market-oriented approach, Singapore is a much closer system. The final thing you are missing is that in those states in which a socialised scheme worked as well as it did, e.g., Sweden, the state began the project at a time of high prosperity and, this is crucial, extreme ethnic homogeneity and autarky. That matters because, to the extent that collectivist schemes have ever worked, it has been where the people have an very powerful sense of themselves as “we”, rather than an assortment of different groups. You cannot generate that except through a long historical process of combined interests and combined enemies. This is why you can see the systems at work in Europe and why they are now breaking down. You cannot have a collective enterprise without a powerful collective sensibility, and you cannot get that just by wishing, anymore than you can get a good sports team by throwing players that have never played together into a mix, no matter how skilled they are. That can only come with time. It’s a twisted irony that the political faction in America most in favour of collective action is also the most in favour of diversity. I love diversity, it has a lot to recommend it, but you cannot have both diversity and collectivism, by definition.

    Compare the Swedish case to the American: America is broke, it is much bigger, and it is incredibly diverse and it has the class system that the Anglosphere is prone to. To even try this invites failure on a colossal scale.

    My irritation with the “not up for debate” line is that there is every debate still to be had, especially in a world that is changing so much. I will grant you the point about military and police force, but the idea that education is better provided by the state than the private sector is debatable, to put it mildly. It is especially debatable in the United States which spends more per pupil than any country except Switzerland and has less to show for it. That’s the price of diversity; it will be the same with health care.

    As regards “de-skilling”, you will find that de-skilling and generation of minimum wage McJobs – that happens quite easily in a socialised economy. The sort of horror stories I hear from the way doctors are treated by the NHS don’t bear repeating.

    If you look again at my US/Sweden comparison, what you have in the US is the set up for a feudal system where the common folk are kept in line by playing the one off against the other. Which is effectively what is happening. To return to Marx, this is why he praised capitalism as the great, indeed the only, way to break down old tribal allegiances.

  11. 11
    smrnda

    So, you’ve *heard horror stories* about the NHS. Where did you hear them from? Avicenna is a medical student in the UK, if there existed such horror stories, I’d imagine he’d have heard of them. If you’re just going to tell me they are there and don’t bear repeating, that’s not really a credible point.

    The belief that you can’t have a welfare state with diversity is just a line spouted by racists, and then repeated by people who refuse to believe that people can overcome tribalism. It’s assuming that people think of themselves as members of ethnic groups rather than people who live under a government. I recall a tribute to the NHS at the London Olympics, with the idea that a program like the NHS, not a shared culture, is what makes the UK one nation. I live in a very diverse area where there’s strong support for collectivist measures. If you look at politicians who oppose them, they’re usually from very white areas who can more easily create the horror of the Other to argue against collective action. This is why those people hate education – heading to a diverse university is one way of removing prejudice, and they don’t want that.

    I’ll agree, the US is full of racist bigots who hate the idea of pluralism, but not everybody in the US is like that, and people can feel themselves united by things like being citizens of a government where they get rights and some benefits more than they might focus on tribal alliances. Some people hate this idea since it threatens their power and dominance, or it makes them afraid, but I don’t think this is something that cannot change.

    On public versus private education, my take is that making education a ‘pay for service’ type deal will just price lower income people out of education. The US spends more per pupil on education NOT because of diversity, but because we have lots of kids living in poverty. There is a limit to what schools and teachers can do when the big reason why a kid isn’t doing well has to do with life outside of school.

    Cities have experimented with using private sector vendors for education, and the results have not been very good – look at the case in Chicago. The reason is that charter schools exist to make money by treating teachers like McWorkers, and they’re all failing to realize that the real issue is that students who liven poverty will not do well in school no matter what you try to do *in the school* unless you fix problems outside of schools. Their business concerns linked with people who promote high stakes testing. And, if public schools are so bad, why are so many foreign students rushing to attend public universities in the US? We seem to do OK at college and not so well before.

    the thing with health care is that people want health care for themselves, and across the board, health care access is a huge issue in the US. People will eventually tilt towards a new system because they see themselves and not Others as the beneficiaries. Schools have not worked the same way since they tend to be funded through local property taxes, so there’s almost no way to get more $$$ into a poor area.

    And the US is not broke, it’s just been handing out tax breaks to rich people for too long.

  12. 12
    ...

    I’ve heard it from numerous doctors with decades of employment in the NHS.

    As to the rest of this, the American tendency towards ahistoricity and parochialism always stuns me. If the point about diversity conflicting with collectivism is “just a point racists spout”, then that just means that the racists are right on that. But in actual fact, it is an observation that has been made by many on the hard left, and has been studied by every serious political thinker back to Aristotle. The more diverse a society, the less chance that a one-size-fits-all solution will work. If you want diversity, you have to give up on collectivism, by definition. You try to put a collectivist solution onto a highly diverse society, what you get is a continual circus where different groups try to stitch each other up, to the ultimate benefit of no one except the boss class. And so my point about class returns.

    Note that I did not say you can’t have a welfare state. Just that it will be a highly dysfunctional one. Oh, sure there will be stacks of wailing editorials about its failures, and think tanks making good money that way, and politicians promising them, and kickbacks to NGOs and “socially concerned” companies, and racialist bigmouths of every colour stirring up trouble, and people like you wailing that its all down to racism – and there will be no improvement whatsoever because none of those are interested in improving the lot of the submerged, they are interested in maintaining their position by talking up the lot of the submerged. They will be for problems, not solutions. You’ve already got that situation as it is. You only ever get real improvement by a collectivist method if your leaders feel a real, visceral connection with the plight of low, and you cannot have that without a strong sense of unity which by definition is opposed to diversity.

    As regards education and poverty – cry me a river. An American can earn more than 91% of the rest of humanity and still be considered ‘poor’. In Asia, or Eastern Europe, or much of sub saharan Africa (believe it or not) people know what real poverty looks like and their schools still trounce the mess you have there. Slovakian kids and Thai kids and Indian kids can mop the floor with American kids when it comes to math scores, and they’ve seen real poverty up close. As you concede, the rest of the world isn’t interested in American schools, it is interested in American Universities – and there only in the world class science and engineering and medical departments. Note that many of those students go home afterwards.

    And, sorry, the US is broke. Your debt is ranked in the trillions. You are broker than any nation has ever been in human history.

  13. 13
    smrnda

    If you can link me to any actual facts and figures on the NHS, please do so. Anecdotes are not data.

    My take on poverty was simply to compare US schools to Europe.

    Overall though, I’d have to agree that the US is full of parochial, anti-intellectual people. We have politicians arguing against teaching science in school because it conflicts with their bronze-age religious beliefs. This isn’t all of us, but it may be that as I’ve lived either in large cities or university towns my whole life, I’ve missed those people up close.

    I would suspect that in India, Thailand, (heck, even Kenya I know someone who taught in one of the med schools there) there are no powerful political factions demanding that schools abandon teaching facts to teach Dark Ages nonsense. They simply can’t afford that type of stupidity. However, you have places like Texas that want to teach Creationaism, erase labor history, and though they have a high rate of teen pregnancy want to refuse to teach contraception in school.

    And yeah, we’re out of money, mostly since we’ve decided to cut taxes on the wealthiest earners (who often simply move their taxes abroad into offshore havens. We are broke because the people who screw the workers dodge paying taxes. Part of the issue might just be that we have a government up for sale, and that there exist greater barriers to workers voting in the US. We do have elections on weekdays, and you can check the correlation of income to propensity to vote.

    I also am by no means a fan of the US; it’s a vendor I pay $ to and I’m disappointed with the results. I also don’t deny that racism is something which is exploited by members of the ruling class to keep people divided. I just don’t think people are so inherently locked into tribalism as you do. Keep in mind that the voices which speak the loudest don’t necessarily reflect the views of the majority.

    And as I said, I just live here and wish I wasn’t living in such a dump. I’m actually considering emigrating, mostly since with my education and credentials I’d be able to, and I get tired of living in a country where we have such high levels of willful ignorance, and where I might not have to worry about health care access.

  14. 14
    Rich Woods

    @— #6:

    That is because, in the United States, you have the unique screw up known as socialism for the rich and free enterprise for the poor.

    Sadly it’s not unique. That approach has been exported around the world for quite some time now. The results are not impressive, as you might be able to see if you cared to look around you.

    This then undermines many of your points about health, education, etc.

  15. 15
    ryanb

    Two things I never can understand about the “Socialised healthcare never works!” brigade is that:

    1) They never can respond to the wealth of countries with working government healthcare (whether it be single payer or insurance based) other than with anecdotes

    2) They never can respond to the fact that even in countries like the UK where healthcare workers are government employees and hospitals are government owned why the private health companies which still exist can’t outcompete the national ones. Honestly why? If private healthcare is so much more efficient then why hasn’t a company or group of companies managed to out compete the NHS on service and cost in the 60+ years of its existence? Sure some people have private insurance and yeah private hospitals can usually book you in faster (but still not immediately) but few people bother with it because it’s far too expensive for what it provides compared to a socialised system.

  16. 16
    smrnda

    @ryanb

    Yeah, I get anecdotes all the time, or some highly specific claim that, apparently, shows that US health care is better. One was a stat on the waits for hip replacements in Canada vs. the US. A problem with that is that though a hip replacement is serious, it isn’t like a heart attack or gunshot wound that has to be dealt with immediately, so even if true, mostly irrelevant.

    On the absence of private sector vendors or their failure to take over the market, it’s usually attributed to some kind of evil government conspiracy to squeeze out other players, or that people’s income is being sucked away in taxes. Of course, if it was so bad I’d assume people would have voted away the nationalized health care a long time ago.

    I actually think the distaste for socialized medicine in the US is a cultural thing. The people who oppose it are grouchy white guys who view dependence on doctors and medicine as a kind of weakness.

  17. 17
    aca consulting

    some times socialized healthcare also works in beautiful manner…

  18. 18
    ...

    To continue my discussion with smrdna – sorry, but the US is still pretty rich even compared with much of Western Europe. Case in point, many of the recent protests complain about bills such as “mortgages, car insurance” – lots of people with advanced degrees in the UK don’t own cars or their own homes.

    Your point about the conflict with creationism makes my general point of diversity – that is diversity in action.

    I’m afraid that it isn’t the case that the US is broke because of top-hatted moustache twirling barons; that’s a tendency that’s too easy. The problem is that the US spends way more than it takes in. Norway’s gov’t spending is 46.4% and its revenues are 42.2%. Know what the figures for America are? 42.2% and 24% respectively. You cannot square that circle. Moreover, the Norwegian taxes, like most continental taxes, are relatively evenly distributed. In the US the richest 20% pay 70% of the total revenue. It’s actually a far more redistributionist system.

    This is why you cannot have a collective solution without a powerfully collective society – there has to be a very strong sense of “we”. Else what you get is a number of gangs who want to vote themselves goodies, but want to vote “the other guy” to pay for it. The ultimate result of this is not collective enterprise but formalised civil war.

    You make my point for me. You don’t care for a significant chunk of your society and you say you want to leave it behind. This is the attitude that will make a collective solution work?

    @Ryanb, this is silly:
    ” If private healthcare is so much more efficient then why hasn’t a company or group of companies managed to out compete the NHS on service and cost in the 60+ years of its existence? ”

    Seriously? Why cannot private companies that have to pay their own bills outcompete a government behemoth that receives an automatic flow of cash from the state? That’s your argument?

  19. 19
    ryanb

    I don’t see it as silly at all. It is your contention that private healthcare companies can provide a better return on investment for the consumer than a socialised system. If this is the case then why has it not been demonstrated? Why in the 60 years since the NHS was founded has a private healthcare company not managed to grow from strength to strength enticing people away from the inferior (in your view) NHS to the superior services of a private company? Even at a local scale? There are healthcare companies in the UK that own and operate a variety of hospitals on an insurance model but they have never been able to grow beyond niche, by your own argument they offer a superior service so why haven’t we seen a gradual increase in private healthcare adoption over the years? Remember I’m not asking why a company hasn’t been able to displace the NHS in one go but why in all the time one hasn’t managed to slowly grow on the basis of better service taking a larger portion of the market.

    Socialised healthcare has several advantages over private systems. Firstly it’s democratically controlled so unethical artefacts of market forces (like higher costs for those with preexisting/congenital conditions) can be removed. Secondly a socialised system removes a for-profit market keeping costs down (argue all you like that without competition there will be reduced inefficiency but that isn’t demonstrated). Thirdly the NHS is a monopsony representing the entire population which results in massive discounts when it comes to procuring supplies which is better for the consumer: the public. Lastly it’s a fairer system because whether or not one uses NHS services directly one will benefit from living within a society with good health coverage.

  20. 20
    ...

    “I don’t see it as silly at all. ” I am aware of that. I’m just finding it a little difficult to believe.

    “Why in the 60 years since the NHS was founded has a private healthcare company not managed to grow from strength to strength enticing people away from the inferior (in your view) NHS to the superior services of a private company? ”

    For the simple, inescapable reason that, having been ALREADY forced to pay for a public health system, they don’t have the cash to pay for an additional, private system. Do you seriously not get this?

    “Secondly a socialised system removes a for-profit market keeping costs down (argue all you like that without competition there will be reduced inefficiency but that isn’t demonstrated).”

    Really? If that was true then the Cold War would still be going. How much evidence do you need? Not to mention the fact that the socialised systems effectively relied on the United States to do the bulk of the innovation.

    But, as I pointed out before, where you can kinda, sorta get it to work in small, very homogenous countries. In a country as large and diverse as the United States?

  21. 21
    opposablethumbs

    Let me see …

    with universal healthcare, nobody – regardless of circumstances – has to live with the constant background fear of being bankrupted by illness. Nobody has to live in fear of losing their and their family’s healthcare through losing their job (as if that weren’t bad enough on its own). Nobody has to live in fear of suffering or dying for want of treatment they can’t afford. Only a tiny handful of rare cases are forced to resort to begging for extra money to get treatment that is not available in the home country. As opposed to vast numbers of people routinely forced to resort to begging – or crawling to a church, which amounts to the same thing – when all healthcare is cash on the barrel.

    Sounds pretty good to me.

    Added to which, let’s compare “bloat” – yes, absolutely, there is a significant problem with an excessive managerial layer in the NHS, plus attendant inefficiencies. Compare that with the existence of an entire, multi-billion dollar parasitical industry … how many people and how many dollars are tied up in the health insurance industry in the USA?

    Not to mention the fact that if you’re rich or well insured, you run the risk of getting over-treated and over-medicated for profit.

    Frankly, for anyone not brought up from birth without any alternative, the mere concept of a healthcare system being run on a for-profit basis is self-evidently, heartbreakingly, mind-bendingly insane.

    No wonder the NHS, for all its very real faults, achieves better outcomes for half the cost. And that’s not even counting the precious, irreplaceable, priceless freedom from fear.

  22. 22
    ...

    Having discussed the rest of these points before, I am going to focus on the following:

    “Frankly, for anyone not brought up from birth without any alternative, the mere concept of a healthcare system being run on a for-profit basis is self-evidently, heartbreakingly, mind-bendingly insane.”

    Yes, I’ve always been stunned by this line of argument. People take it as read that people making tobacco, or comedies, or the entertainment industry are allowed to make their profits – but the most important people, to whom we entrust our lives are expected to be profitless serfs. Does anyone else see the problem there?

    This returns me to the point that the European healthcare system has relied on the innovation of the American system (the system in the US is a cartel, a mercantile arrangement as I’ve said, but it still allows for significant innovation).

  23. 23
    opposablethumbs

    Oddly enough, it is better for a patient if the physician’s greatest goal is their good health - not how much profit they can screw out of them.

    And oddly enough, there are a number of things that don’t translate well into being traded as if they were commodities; good health outcomes are one, and childhood education is another.

    “profitless serfs” – you really think it’s realistic to describe surgeons, consultants, anaesthetists, gynaecologists, oncologists, GPs, radiographers and the rest as “profitless serfs”? Thanks for the laugh! These are some of the most financially stable and respected people in the entire country (nursing staff should be paid a hell of a lot more, though).

    Are you so in love with the elegance and purity of the mythical magic wand of the free market that you can’t see the appalling health outcomes of the poor in the USA? Or don’t they count as real people?

    Incidentally, you say you’ve discussed the other points before, but to be honest I can’t quite see where it was that you explained why the UK (as just one example; I’m sure pretty much any country in Europe does as well or better) achieves better outcomes for almost half the cost as compared with the only for-profit health system in the industrialised world. Perhaps you wouldn’t mind clarifying that one for me.

  24. 24
    Maureen Brian

    Will someone kindly give me a list of these medical innovations which happened in the US and could only ever have happened there? That’s so that Avi and the rest of us can check them out – facts always being better than rhetoric in these cases.

    As for “forced to pay … can’t afford insurance.” Nonsense! I could afford private health insurance on top of my taxes and I’m a pensioner. Thing is, Dotty, I’d be bloody stupid to waste my money that way.

    Right now I see a doctor, get my flu jabs, have blood drawn for my six-monthly check (cholesterol and that sort of thing) by walking down the street for 500 metres, chatting with neighbours until it’s my turn and walking home again. Private hospitals are a vast distance away and the don’t offer a general practitioner service so that I’d be whizzing back and forth to see one doctor about this and another about that. It could become a full-time job. No way is that cost-effective, whichever way you cook the books!

    Sure, if I went into a private hospital there’s be more and better carpet and wine with the meals but if anything was suddenly serious or needed specialist skills or hi-tech equipment, I’d be sent down the road to an NHS hospital which has all the staff and all the kit.

    And don’t tell me the outcomes are better. I have a friend whose husband was in a private hospital, was transferred to an NHS teaching hospital for his operation then back, after a couple of days, to the private hospital for the carpets. Except that a so-called nurse, helping him to wash one evening somehow managed to dislodge his tracheostomy tube. She had no idea and there was no-one on the premises who knew how to replace it. Yes, he’s dead and that’s an anecdote.

    Now give us some facts so that we an actually discuss and check them and less of this macho arm-waving. Please.

  25. 25
    ...

    @Maureen, a former President said he “uses the google”. I suggest you do the same as it took me all of five seconds to come up with this:

    http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies

    Not that I think you know what to do with facts, given that I have repeatedly addressed the fact that the US system is not a free market one. Nor do you seem to get that:

    “Nonsense! I could afford private health insurance on top of my taxes and I’m a pensioner. Thing is, Dotty, I’d be bloody stupid to waste my money that way.”

    That rather proves my point.

    @opposablethumbs,

    Thank you for proving my point – that you need to pay for service. That seems to argue against your idea that there should be no profit in healthcare, but I doubt you have thought any of this through. I find that you can probably get better service from people who know they are serving their own interest by serving yours – not from people who are just expected “to serve”.

  26. 26
    opposablethumbs

    Dotty, do you fancy actually answering any of the questions instead of just repeating your mantra?

    I find that you can probably get better healthcare from a doctor whose focus is on your health – not from bean-counters who have a direct, personal financial interest in selling you care at the highest price they can get, while spending as little as possible on it themselves.

    Like vital infrastructure, like clean air and clean water, healthcare is a social as well as a personal good and should be paid for by taxes predicated on ability to pay, not on how sick you have the misfortune of being. This is not only a moral issue – we are looking at multiple nations’ worth of evidence that it actually works better this way both practically and economically.

    Why do all the European healthcare systems – imperfect though they doubtless are – do so much better for the health of the population than the US system, at a fraction of the cost?

    Well it’s been fun and all, but it’s starting to get a little stale now. An actual answer would be nice, but I don’t really expect one at this stage. I’ll just go on feeling deeply sorry and angry on behalf of too damn many wonderful US friends who have been forced to do without healthcare they need, and being grateful that – for all its imperfections – I am privileged to enjoy an excellent healthcare system to which we can turn at any time without directly paying a penny or even thinking about the cost.

  27. 27
    ryanb

    @20 “For the simple, inescapable reason that, having been ALREADY forced to pay for a public health system, they don’t have the cash to pay for an additional, private system. Do you seriously not get this?”

    Do you not see the disconnect with what you are saying? Firstly having to pay taxes does not mean you don’t have the cash to pay for another private system. That’s a laughable suggestion. Secondly if your proposal is that the private sector is better than the public then why has it remained niche? Surely it should have grown far bigger considering that private healthcare is affordable to pretty much anyone not working class in the UK.

    The reason is that the private sector can’t offer anything good enough that people are bothered to pay for it. The NHS is enough for them and for the few that it isn’t well they go and pay for it.

  28. 28
    Maureen Brian

    Bloody ‘ell! There is slightly more to the practice of medicine, or indeed to the design of a healthcare system, than pharmaceuticals.

    I’m not sure exactly what that wiki page was supposed to prove to me but a list of global companies proves only two things – that we live in a global economy and that pharmaceutical companies have a tendency to combine and to operate in more that one country.

    Just glancing at it, AstraZeneca is largely the pharmaceuticals division of ICI, Imperial Chemical Industries. When that division split completely from the industrial chemicals side it took a new name, Zeneca, and later merged with a Swedish company. All this is very recent. I recall arranging the printing of invitation cards for a fundraiser at ICI’s HQ (Millbank, London) not much more than 20 years ago and having trouble with the correct Pantone colour for the ICI logo – so that was before the split.

    With Glaxo Smith Kline you even get a diagram and pictures which I recommend to people – http://www.gsk.com/about-us/our-history.html – full of company mergers going back for centuries.

    So six of the top 12 companies this minute are US and six are European, perfectly reasonable on the basis of wealth and population and likely to change as the Indian companies grow a bit more.

    All of which gets us precisely nowhere on the subject of medical innovations. Ever the optimist, I am hoping there are facts behind your chauvinism. So, again, please tell me of the medical innovations which happened and could only have happened in the US.

  29. 29
    ...

    As I said, facts are wasted on you: companies are the centre of innovation, and, as you can see, the bulk of them are based in the US. You can run this metric with other things – citations, nobel laureates, papers published etc. Such as here:

    http://www.scimagojr.com/countryrank.php

    Or, what about patents?

    http://en.wikipedia.org/wiki/List_of_countries_by_patents

    You will notice that only Japan is even in the same ballpark.

    But, as you have demonstrated, Maureen, you aren’t interested in facts – just in stupid assumptions. What “chauvenism” is on display here, exactly?

    Now, as regards this:

    “Why do all the European healthcare systems – imperfect though they doubtless are – do so much better for the health of the population than the US system, at a fraction of the cost?”

    Leaving aside the questionable assumptions in that, I have already answered it: because Americans have, as I have said repeatedly, a quasi-feudal system in place. The option for a one-size-fits-all system, such as the one in Germany, just isn’t on the cards for anything as diverse as the US. This is just going to get worse and worse as people like you cheer it on.

    “Do you not see the disconnect with what you are saying? Firstly having to pay taxes does not mean you don’t have the cash to pay for another private system. That’s a laughable suggestion.”

    What’s laughable is your apparent knowledge of economics. I have a friend in the US – one of the hardworking, working-class that are so despised there – who just found herself unable to afford health insurance thanks to the, hah, Obamacare initiatives. I did a little bit of poking and I found no end of similar stories, and not ones restricted to the working class either. As I’m sure you could do, if you were to read anything outside your own bubble.

  30. 30
    Ani J. Sharmin

    It’s demonising government healthcare to a group of kids who have no idea what real healthcare is like.

    I really do think that people do not understand how healthcare works. I’ve been in online arguments with people who compare paying for other people’s healthcare to paying for various optional things. One even compared it to paying for someone’s tattoos. People don’t want to admit that there is significant harm done if people don’t have access to healthcare, including preventative care even when they are not sick, because if they admitted that, then they’d have to admit they are being cruel. It’s convenient science denial to back a political ideology about Libertarian economics.

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