Future American Socialism: Healthcare, et al.

Alright. Not a rant. A concession. Well, a concession to discuss.

Most of you Orgah oldtimers know my politics. And I am conceding a defeat here. The American healthcare system is a disaster. There are great benefits to private healthcare- innovation, excellence in treatment, entrepreneurialism, and other similar free market gains.

BUT. We have a major cost issue here. I am willing to concede to the largest government entitlement in American history. Namely, public healthcare. Gah.

Now before I go on, (if anybody cares), this new point of view has been extended to other parts of the private-public domain. Schooling. Governance. Bureaucracy.


Here is how this mess can be solved, in my humble and moderately educated opinion:

The Equalization of Basic Opportunity

Regardless of contribution to society,

(1) Every American should be entitled to basic healthcare to sustain life. Emergency Rooms, Clinics, Medication, and Hospital Care.

(2) Every American should be entitled to a basic education that will aid them in caring for themselves and making a contribution to society. High School + Vocational School or 4 Year Public College.

(3) Every American should be secure in a meagre pension that will sustain their life in old age. Retirement at 65 with Social Security Benefits at that age.


The following regulations to support free enterprise and competition MUST be included for me to sign on 100%:

(1) Private Hospitals can refuse patients who cannot pay for service unless it is an immediate life threatening emergency. All other non-life threatening conditions will be refused and directed to public health care facilities. This will reduce medical insurance premiums, drastically cut customer costs, promote competition and innovation, and support our wolrd-class private health care entrepreneurialism.

(2) Tuition vouchers must be provided to parents who choose to remove their children from public education facilities. This will promote accountability and efficiency in administration.

(3) Social Security may not be distributed until an individual is medically disabled or 65. With such good healthcare, folks can work alot longer.


Anyway. Just some thoughts. A far cry from the right wing I must say. Edit: My stance has always been one for personal responsibility. But you cannot ask someone to take responsibility if they do not have them means to do so.

Were is DA and what have you done to him?:furious3: :skull:

It's true that we've managed to concoct the worst of both worlds in the U.S. when it comes to healthcare -- we pay more per capita than any other nation, and we aren't even in the top ten on any metric. Except for, um, how much we pay.

As things stand, these crazy costs are shuffled off onto employers, who hesitate to hire people not because of salary but rather because of insurance. Can you imagine the employment boom if I could hire a guy for eight bucks an hour ... and actually pay him eight bucks an hour?

I shudder to think of the sort of mess a government bureaucracy could make of the medical system. But then I look at the mess our half-private, half-subsidized, blame-and-cost-shuffling system has created, and, well, the alternatives don't sound so bad.

"Basic helthcare". What is that? Is it OK that some have proceedures that are out of date with a higher mortality?
And "life saving"? Again, so many things can be life threatening, but aren't usually. Even heart attacks aren't life threatening. And again after treatment will affect mortality and morbidity.

Hospitals will still not want to treat people that are poor, need a lot of treatment with a small mark-up and basically aren't worth treating from a financial point of view.

Here we have people squealing as they can't have new drugs costing £30,000 per person per year that occasionally work in some people.

Is not allowing them this dooming some people to death (of course it is); is doing this on the basis of their wealth OK?

Healthier? The facilities to merely sustain life in what is becoming the most unfit country on the planet ain't enough.

Pension at 65? Why 65? Just because this was decided on in the 1860's in Germany doesn't make it the "right" age. Considering the increase in life expectancy, a pension at 70 is probably more fair, and of course much, much cheaper.

Healthcare innovation is aimed at getting money out of the greatest number of people. Nothing should be cured if at all possible; a once daily pill is a much better option.

Treatments are also there so that people can be told they need things - increasingly as they might be useful. A whole body MRI isn't going to harm most people, and might help diagnose all those things that might be killing you.

So, innovation to make more treatments. Entrepreneuralism to get people to take them.

~:smoking:

Hey, just a few ideas. I've kind of been busy. New kid, new job, dead cat, new dog, yada yada yada.

OH. And Solypsist called me yesterday. He asked me to feed his fish. :laugh4:

Ive decided we need to fix America. These are some good steps but we have a long way to go. Thats ok though becuase Christmas break is nearly here. We can do it then.

How do you propose we pay for this Divinus Arma?

The government already cannot manage the balance the biggest tax base in the world, adding more entitlements would just sink us farther into debt.

There are definately problems, but socialization is never the answer. Look what a burden SS has become, and look how little people are getting in return.

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Originally Posted by Divinus Arma

Hey, just a few ideas. I've kind of been busy. New kid, new job, dead cat, new dog, yada yada yada.

OH. And Solypsist called me yesterday. He asked me to feed his fish. :laugh4:

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Oh no!!! :no:

On topic - I think youve raised some interesting issue - Ourselves (The brown land) and the UK are slowly shifting more towards the american health model - with our National health services failing to meet even basic needs, huge and lengthy waiting periods (with some people dying before they get treatment) - ie problems that are not life threatening are delayed so long they become so.And finally crippling rising cost of modern health care (due to expensive tests, cutting edge billion dollar equiptment, specialists salaries, and lets not forget the big one liability and proffessional endemnity insurance. The combination of these factors is causing the social health care to fail badly - because a) everyone needs to be given a full suite of tests even if they dont need them because not to do so would be neglegent. b) innovation in modern medicine has meant there is a raft of expensive treatments to even the simplist ailments - the old leeches just arnt good enough anymore c) aging populations means more of the pop is needing regular services to stop bits falling off and keep the engine running.

So countrys with limited pops and hence tax bases (like Oz) cannot afford modern health care for everyone - it would mean people would be paying 100cents in the dollar tax - as opposed to the 50c in the dollar we now pay - damn it why cant we just execute prisoners and put the unemployed and disabled building roads and fighting wars like the good ol days - damn wastefuls :furious3:

In Australia we recognised this... the government basically scapped public health - by the age of 30 all people have to have private health cover - those that cannot afford it stay on the crippled public health medicare - and play the waiting game - lets hope that cancer isnt too aggresive.... But hey they arnt taxpayers so better to be rid of them, and they cant afford private so clearly they are just a drain on society... better they die of their cold or infected big toe.....:yes:

I understand the UKs national health also isnt coping

whats the upshot - wonderfull first world healthcare for those that have the money to pay for it - otherwise Ive got a pair of pliers and a rusty knife in the shed - and Ill do a bang up job for 50 bucks and a carton of beer (to be paid before the operation) :2thumbsup: :skull:

while I used to believe these things were the responsibility of goverment along with education etc - now I think peoples expectations are too high - everyone wants the worlds best but no one wants to pay for it... why should the workers pay for everyone else - probably having to work till they are 80 just so they can pay off their house ect because of the horendous taxation bill, for the sake of all the wastefuls. The same people who want to lay around not working, not exercising and getting obese smoking cigarettes and drinking - and then crying that they cant get a quadruple bipass :no:

people have to take responsibility for themselves - I dont want to work another day to pay for some idiot who chain smoked his life away and then want me to pay for his new set of lungs - sorry you lived like a slothful pig - you die at 35 and smile about it - that same smile you made when people told you that smoking kills or eating and no excersize leads to a heart attack - reap what you sow :skull:

now I think it has to be user pays - you want the best health care - you pay
you want best education - you pay :whip:

edit: and if you cant pay - then please die quietly without any illiterate moaning or whining

that or just kill all the lawyers and solve the worlds problems:oops:

Of course banning McDonald's would probably make people healthier, live longer, and be cheaper...

Blimey, I go away for a bit and DA goes all euroweenie on us. Good to have you on the team dude.

Rory, I guess you are referring to £30,000 per Quality Adjusted Life Year, which is generally taken to be NICE's threshold for recommending drugs (in fact there is no threshold per se). NICE is actually a pretty damn good answer to how you deal with the tensions between a limited overall budget and many, many competing demands on it. Of course, as a medic, you want to use whatever works regardless of the cost, and that's right, that's what your perspective should be. But a system where politicans set the overall budget of X Billion, a truly independent body reviews the scientific evidence for clinical effectiveness and looks at cost effectivness, and then publishes its findings, and local trusts impliment them (or not) strikes a fair balance. Most importantly it keeps the politicians sticky fingers out (mostly, although Patricia Hewitt made a right mess for the NHS over herceptin. Which proves the point, she got excited because breast cancer is a political issue. In fact as you know herceptin has some pretty major drawbacks, (although at least it does work, which is more than can be said for a lot of these so called wonder drugs) but hey, Hewitt had to be seen to be piling in for the wimmin.)

One last thought. Average life expectancy in the UK at birth is 78.54 years. This does not speak to me of a failing heathcare system. We do need to keep a sense of perspective. We aren't arguing about failure, we are arguing about the difference between A and A+

Welcome to the sane side.

:medievalcheers:

The reason American Healthcare is so expensive is because we have no rhyme nor reason to tortes in this country. Look at a malpractice payout in France or Italy versus what it is in the USA, and you have your smoking gun.

Lemur's got a good point about the boost to the economy. Except for one small problem. If I can pay an employee $8/hour, and I'm off scott free, woo hoo. But I won't be. The taxman is going to need to find somebody to pay for the Hillary Clinton slush fund that occassionally passes money on to the health care system.

The potential for waste and abuse in a one-payer system is frightening. If we enact a British style one-payer system, the USA will be a 3rd world nation within 20 years... with rampant inflation and the inablity to fund the system to legally required limits. Just stop and ask yourself what happens when judges start 'finding' that citizens have a constitutionally protected right to a $150,000 procedure that may or may not do anything to actually improve their condition?

If you want to drop the cost of healthcare in the US:

-Limit punitive damages in malpractice lawsuits.
-Force plaintiffs to pay the legal bills in frivalous lawsuits (no more of these 'if we don't win, you don't pay a dime' late night TV ambulance chaser ads).

You cannot begin to solve our health care problems as long as you allow lawyers to break and destroy the system to make themselves rich (no offense, Pindar).

On a side note....

Dude, socialized medicine? Of all the issues you might have sided with the Democrats on, socialized medicine? It doesn't make any sense...

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You cannot begin to solve our health care problems as long as you allow lawyers to break and destroy the system to make themselves rich (no offense, Pindar).

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Oh, but offending English lawyers is OK is it? Funny, seeing as defamation is about the one tort we are more agressive on than you Yanks...~:)

Seriously though DC your proposals don't go far enough. I've never really understood why we keep fault in medical negligence cases (or, for that matter, RTAs). If a guy goes into a hospital with an ingrowing toenail and he comes out quadrepedic, what he needs is 24 nursing and a specially adapted home. Who cares HOW he got injured? So just give him the nursing and adapted home, and leave medical malpractice to be dealt with as a professional competence issue. (Naturally requiring highly paid lawyers on each side ~:cheers: )

This is especially egregarious in the UK, where the NHS self insures and we have a reasonable welfare system. So, if medical negligence is established, the pay out comes from the taxpayer via the NHS and is then spent on health and social care, and if medical negligence is not established, the patient then depends on NHS heath and social care funded by...err, the taxpayer.

A no fault system seems to be a no brainer to me but then, as you can probably guess, I am not a med neg lawyer.

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Originally Posted by Prince of the Poodles

How do you propose we pay for this Divinus Arma?

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Decreasing your defence budget intuitively seems a sound way of doing just that.

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Originally Posted by English assassin

Oh, but offending English lawyers is OK is it? Funny, seeing as defamation is about the one tort we are more agressive on than you Yanks...~:)

Seriously though DC your proposals don't go far enough. I've never really understood why we keep fault in medical negligence cases (or, for that matter, RTAs). If a guy goes into a hospital with an ingrowing toenail and he comes out quadrepedic, what he needs is 24 nursing and a specially adapted home. Who cares HOW he got injured? So just give him the nursing and adapted home, and leave medical malpractice to be dealt with as a professional competence issue. (Naturally requiring highly paid lawyers on each side ~:cheers: )

This is especially egregarious in the UK, where the NHS self insures and we have a reasonable welfare system. So, if medical negligence is established, the pay out comes from the taxpayer via the NHS and is then spent on health and social care, and if medical negligence is not established, the patient then depends on NHS heath and social care funded by...err, the taxpayer.

A no fault system seems to be a no brainer to me but then, as you can probably guess, I am not a med neg lawyer.

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You sir, have hit the nail on the head. :bow: A no-fault system would indeed solve most of these issues. As for malpractice, it should be dealt with by professional review boards and standards committees, not two lawyers trying to get their hands on every last dollar they can.

I meant no offense at English lawyers either, but honestly, from what I can tell, American lawyers are a special breed. They know fully well their constant frivalous lawsuits are destroying our medical system, yet they care not. Malpractice insurance is so high in some states, physicians are leaving en masse. Last i checked, England didn't have any of those sorts of issues, so clearly you and your brethren must be more restrained and far-sighted than your American counterparts.

Well, a system of 'peer review' as you propose it isn't perfect either, we have (had ?) a lot of problems because doctos are essentially a closed community judging themselves.

Though I don't understand why they don't just put doctors on 8h shifts instead of 12h or 24h or whatever the standard seems to be. That would probably make the error rate drop liek crazy. (a normal person can only concentrate for about 6 hours a day or so, I believe)

EDIT: Also, the reason socialised health care is the only sane option is because it is the only option that grants all people acces to decent medical facilities.

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Originally Posted by Sjakihata

Decreasing your defence budget intuitively seems a sound way of doing just that.

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I'd say putting a leash on lawyers preying on their already limited budget is even better.

Honestly, how bad is it. When I look at Holland, which has a pretty good record, we have all the same problems, save for one thing, the ways for those that want to make money from it when it goes wrong. If you have no insurance you are pretty screwed here, but if you are shot you have the right on treatment, just like in the US. In Holland we say that you shouldn't tie the cat on the meat, such is the same with lawyers. With enough good people your system should do fine, when it doesn't, don't blame yourselve.

FYI, NICE has explicitly an upper limit of £30,000 per year of added healthy life as the cut off for a treatment (we had a lecture on it recently). Those that need to know this know it. There are highly paid people who ensure that a new treatment ends up costing as close to (but below) the £30k threshold as possible to ensure it gets approved but also gets the most money.

Doctors and healthcare professionals that aren't able to see the "bigger picture" than the patient that they are currently are treating are IMO part of the problem. Guidelines need to be nationally consistent with all clinicians aware of what can and can not be done for a certain condition. Money is not infinite, and spending masses on one lost hope is indirectly causing others to suffer (at least that should be the case, but the NHS is far from perfect).

~:smoking:

What the U.S. fails to realize is that if they tax the richest people 3% more of their income, they will have a lot of money to use for hospitals. Don, I doubt you are part of the richest 10% in America (because you don't seem aloof). In that case, you wouldn't mind the tax hike for the richest of the rich. The rising difference between the rich and poor is making America very social class oriented. The lack of class distinction was why everyone emigrated there. You have to go back to your roots.

Whoa... way too many things to respond to.

I'll just focus on one, because it got no other focus...

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Originally Posted by Divinus Arma

(2) Tuition vouchers must be provided to parents who choose to remove their children from public education facilities. This will promote accountability and efficiency in administration.

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It also promotes segregation and severely unequal education. And that's not an opinion; it's a fact.

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Originally Posted by rory_20_uk

FYI, NICE has explicitly an upper limit of £30,000 per year of added healthy life as the cut off for a treatment (we had a lecture on it recently). Those that need to know this know it. There are highly paid people who ensure that a new treatment ends up costing as close to (but below) the £30k threshold as possible to ensure it gets approved but also gets the most money.

Doctors and healthcare professionals that aren't able to see the "bigger picture" than the patient that they are currently are treating are IMO part of the problem. Guidelines need to be nationally consistent with all clinicians aware of what can and can not be done for a certain condition. Money is not infinite, and spending masses on one lost hope is indirectly causing others to suffer (at least that should be the case, but the NHS is far from perfect).

~:smoking:

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Yeh but who decides who lives and dies - who decides who gets treatment and who doesnt

are you going to to tell the dying guys family that your not going to continue treatment

and what if person with ailment x is given the ABC treatment and then dies because of it - who pays for the malpractice - the government (taxpayer)?

It seems to me people inability to deal with and understand the inevitability of death is the root of many problems - I have some experience of this - people will go into this 'false hope' mode - maybe its for themselves, so they dont have to deal with it, maybe its for the dying to keep there spirits up - but basically the doctors always have to hand out a sliver of hope with their diagnosis - so theyll keep the treatments coming till the end - its their oath to do so... you hear people say stuff like - the doctors think this new radiation and chemo combo treatment might reduce the cancer and give him another 6 months - the fact that that 6 months is lived out in agonising pain and nausia from the side effects of the treatment seems to escape - people go into this - we must exhaust every option the doctors give us - even if this means the patient has lost any QUALITY of life, and become a glorified test tube. But who will say - sorry theres no hope the patient is going to die and there is no treatment - the doctor will not - and if you find one that will - the family will go out desperately searching for another opinion that disputes this and give false hope.

theres something deep down in all our hearts and minds that we need to get our heads around called mortality - but no one wants to talk about it - particularly when someone close to them is dying - good luck finding someone that will. I mean we had to invent a GOD and an afterlife - just so we didnt have to deal with it - that goes a long way to telling how deep and difficult to change this thing is.

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Originally Posted by Yunus Dogus

Oh no!!! :no:

On topic - I think youve raised some interesting issue - Ourselves (The brown land) and the UK are slowly shifting more towards the american health model - with our National health services failing to meet even basic needs, huge and lengthy waiting periods (with some people dying before they get treatment) - ie problems that are not life threatening are delayed so long they become so.And finally crippling rising cost of modern health care (due to expensive tests, cutting edge billion dollar equiptment, specialists salaries, and lets not forget the big one liability and proffessional endemnity insurance. The combination of these factors is causing the social health care to fail badly - because a) everyone needs to be given a full suite of tests even if they dont need them because not to do so would be neglegent. b) innovation in modern medicine has meant there is a raft of expensive treatments to even the simplist ailments - the old leeches just arnt good enough anymore c) aging populations means more of the pop is needing regular services to stop bits falling off and keep the engine running.

So countrys with limited pops and hence tax bases (like Oz) cannot afford modern health care for everyone - it would mean people would be paying 100cents in the dollar tax - as opposed to the 50c in the dollar we now pay - damn it why cant we just execute prisoners and put the unemployed and disabled building roads and fighting wars like the good ol days - damn wastefuls :furious3:

In Australia we recognised this... the government basically scapped public health - by the age of 30 all people have to have private health cover - those that cannot afford it stay on the crippled public health medicare - and play the waiting game - lets hope that cancer isnt too aggresive.... But hey they arnt taxpayers so better to be rid of them, and they cant afford private so clearly they are just a drain on society... better they die of their cold or infected big toe.....:yes:

I understand the UKs national health also isnt coping

whats the upshot - wonderfull first world healthcare for those that have the money to pay for it - otherwise Ive got a pair of pliers and a rusty knife in the shed - and Ill do a bang up job for 50 bucks and a carton of beer (to be paid before the operation) :2thumbsup: :skull:

while I used to believe these things were the responsibility of goverment along with education etc - now I think peoples expectations are too high - everyone wants the worlds best but no one wants to pay for it... why should the workers pay for everyone else - probably having to work till they are 80 just so they can pay off their house ect because of the horendous taxation bill, for the sake of all the wastefuls. The same people who want to lay around not working, not exercising and getting obese smoking cigarettes and drinking - and then crying that they cant get a quadruple bipass :no:

people have to take responsibility for themselves - I dont want to work another day to pay for some idiot who chain smoked his life away and then want me to pay for his new set of lungs - sorry you lived like a slothful pig - you die at 35 and smile about it - that same smile you made when people told you that smoking kills or eating and no excersize leads to a heart attack - reap what you sow :skull:

now I think it has to be user pays - you want the best health care - you pay
you want best education - you pay :whip:

edit: and if you cant pay - then please die quietly without any illiterate moaning or whining

that or just kill all the lawyers and solve the worlds problems:oops:

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Whoa! I'm thinking about moving back to Australia but if this is a prevalent attitude at home I think it may be best I stay abroad.:no:

Seriously, what has happened? Where's the "fair go" and egalitarianism Australians are famous for? I hope it has not been replaced with this cold, callous and selfish attitude.

Yunus, you do understand that plenty of working people will not be able to pay for insurance also if this were to happen? Imagine having to make the choice of getting that little lump that might be nothing looked at by a doctor or paying the rent. What would happen if the industry you worked in crashed and burned and suddenly finding a job that pays high enough to cover health insurance wasn't possible? Maybe at the same time one of your kids is diagnosed with leukaemia but couldn't receive adequate health care because you couldn't pay. Maybe you can afford to stay with the same company and they start dramatically increasing your premium till it's more than you can handle. Or perhaps you can afford to get some kind of new health insurance but the new company wont cover what they claim is a "pre-existing" condition. I wonder if you would maintain the same attitude as your daughter slowly and painfully dies in front of you.

Sorry to come in hard there, but this is what we're talking about it. People's lives and families being devastated. I know it's popular to crap on dole bludgers etc.. the whole "why should I pay for that bastard to sit around on his arse all day". However an advanced society takes care of its people so that they can all have access to education, health care, shelter and food. Sure some people abuse such a system but in the overwhelming majority of cases it serves as invaluable social safety net and is vital to our way of life as a nation.

It's Christmas surprise!

*grins evilly*

By the way, welcome back. :)

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Originally Posted by Divinus Arma

Most of you Orgah oldtimers know my politics. And I am conceding a defeat here. The American healthcare system is a disaster. There are great benefits to private healthcare- innovation, excellence in treatment, entrepreneurialism, and other similar free market gains.

...

BUT. We have a major cost issue here. I am willing to concede to the largest government entitlement in American history. Namely, public healthcare. Gah.

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The Canadians are quite proud of their dual system, apparently. You can have the best of both worlds, I'm sure; but America have the worst of both.

It's that "we-are-not-trying-socialism!(because that would be a political suicide for those who admit that in the traditionally anti-socialist America)-but-we-actually-are" actions and attitudes of the successive governments which means they create a haphazard system with complex, screwed-up distribution and administration trails. When I look at the budget of the United States I realize how much this has become a burden of the country. Undoubtedly, I agree wholeheartedly with you on this.

The same reason why Japan is so expensive, I believe. A very much pathetic and self-serving internal economic/bureaucratic organ. Historically, among the best ways a nation could reform itself is to clean out this kind mess...which historically is one of the hardest and most daunting tasks for such governments to even try...

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Originally Posted by Divinus Arma

Now before I go on, (if anybody cares), this new point of view has been extended to other parts of the private-public domain. Schooling. Governance. Bureaucracy.


Here is how this mess can be solved, in my humble and moderately educated opinion:

The Equalization of Basic Opportunity

Regardless of contribution to society,

(1) Every American should be entitled to basic healthcare to sustain life. Emergency Rooms, Clinics, Medication, and Hospital Care.

(2) Every American should be entitled to a basic education that will aid them in caring for themselves and making a contribution to society. High School + Vocational School or 4 Year Public College.

(3) Every American should be secure in a meagre pension that will sustain their life in old age. Retirement at 65 with Social Security Benefits at that age.

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1. In principle, of course, anyone with any sense of reality and compassion would support that. Any other who goes all "they don't deserve it!" acts like an overborne Victorian gentleman with too much comtempt for others. The true debate lies in the limits of what defines basic healthcare and what defines unnecessary cosmetics and effects of too much advertisement. Even then there would, of course, be cases where the defined line becomes inappropriate and even unjust.

For example, as something of a once-foreigner (still technically am), I had a little culture shock of my own when I saw ads of drugs selling on TV. I doubt Americans who grow up with those things on TV would find my surprise to be in any way familiar to them, though.

I was like, "Can they do that!?"

The pharmaceutical industry is, to me, just a cartel. A.k.a. they deserve some old-style TR's corporate-busting.

That ties into a bigger issue of the disproportionate powers lobbyist/pressure groups have on the government and its detriment of American Democracy.

2. Many have the attitudes that kids being forced into college would unnecessarily burden the colleges into the same level of public high school education: cumbersome; as an inclusion of theoretically an entire populace indicates that such institutions must be more careful and respective of rights and privileges the public at large feels entitled to and responds with an extra layer of bureaucracy or two. Though I do think finding colleges right now is just pathetically expensive and troublesome, and indicates a clear problem.

First, however, there's some issue with a few monopolies in the "education business." Like, you know, student loans. Just for the record, I believe that student loans are not cancelled when a person declares bankruptcy. Just goes to tell how [bad word]-up the corporate interests in what even the Prussians think should be universal is.

3. To be frank, the Senior voting base disgusts me at times when it comes to things like Social Security/Medicare/etcetera. They don't care if it becomes bloated and unbearable since it's unlikely that they will see the day it falls.

Well...

So I'm sure that while a basic safety net should always be there for the poor and destitute, an affluent person should not receive it as an extra for their new, bigger, Hi-Def TV or something. I never bought "they're all parasites!" arguments in any case. Those arguments were echoed from times when they were the prevalent opinions and many of the poor suffered beyond an affluent modern society's comprehension.

Wow, I think I'm being more conservative than DA. Something is very, very wrong with me. It must be the lack of sleep. :sweatdrop:

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Originally Posted by Divinus Arma

The following regulations to support free enterprise and competition MUST be included for me to sign on 100%:

(1) Private Hospitals can refuse patients who cannot pay for service unless it is an immediate life threatening emergency. All other non-life threatening conditions will be refused and directed to public health care facilities. This will reduce medical insurance premiums, drastically cut customer costs, promote competition and innovation, and support our wolrd-class private health care entrepreneurialism.

(2) Tuition vouchers must be provided to parents who choose to remove their children from public education facilities. This will promote accountability and efficiency in administration.

(3) Social Security may not be distributed until an individual is medically disabled or 65. With such good healthcare, folks can work alot longer.

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1. What defines "non-life threatening?" It becomes much harder once one gets into the details. One doctor would say one thing and another doctor another thing, and they're both experts and could be right.

2. Tuition vouchers? What's that?

3. There are, however, areas that are economically depressive enough where one cannot walk out of the door and find work. I am in Las Vegas, the fastest growing frickin' city in America, with a massive gambling empire that brings wealth in from all corners of the USA. I can walk out and get a work whenever I want. If I leave Las Vegas a hundred miles behind and go to the destitute areas in Northern Nevada, stuck in some small-town nightmare, and if my family won't be there to help me for some reason, I would likely need government support now. And I won't be 65 for a long time to come.

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Originally Posted by Reverend Gonzo

It also promotes segregation and severely unequal education. And that's not an opinion; it's a fact.

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*nods to President Bush and almost-President Kerry; neither are particularly known for their intelligence; both goes to the "best" and richest schools in the country. Bloody Richie Riches...*

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Originally Posted by IRONxMortlock

Whoa! I'm thinking about moving back to Australia but if this is a prevalent attitude at home I think it may be best I stay abroad.:no:

Seriously, what has happened? Where's the "fair go" and egalitarianism Australians are famous for? I hope it has not been replaced with this cold, callous and selfish attitude.

Yunus, you do understand that plenty of working people will not be able to pay for insurance also if this were to happen? Imagine having to make the choice of getting that little lump that might be nothing looked at by a doctor or paying the rent. What would happen if the industry you worked in crashed and burned and suddenly finding a job that pays high enough to cover health insurance wasn't possible? Maybe at the same time one of your kids is diagnosed with leukaemia but couldn't receive adequate health care because you couldn't pay. Maybe you can afford to stay with the same company and they start dramatically increasing your premium till it's more than you can handle. Or perhaps you can afford to get some kind of new health insurance but the new company wont cover what they claim is a "pre-existing" condition. I wonder if you would maintain the same attitude as your daughter slowly and painfully dies in front of you.

Sorry to come in hard there, but this is what we're talking about it. People's lives and families being devastated. I know it's popular to crap on dole bludgers etc.. the whole "why should I pay for that bastard to sit around on his arse all day". However an advanced society takes care of its people so that they can all have access to education, health care, shelter and food. Sure some people abuse such a system but in the overwhelming majority of cases it serves as invaluable social safety net and is vital to our way of life as a nation.

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you obviously havent been here since Lil Johny took power mate... Oz is all changed now - the new economic rational has taken over

now we train our troops by policing SE asia - we are a province of the US, and Johnys the Governer to Emperor Bush.

and clearly you havent heard of our new work place laws - we want you to work longer hours for less money - sign here - no - your fired!

A fair go!! ha ha ha - now theres a laugh (thats for the tourists - we needed to invent a national identity)
[EDIT] how much of fair go did those refugees get when put them in concentration camps in the middle of one of the hottest deserts on earth

having been unemployed for some years (during the late economic downturn in resources in the 90s) - made redundant in the month I got married. Being a child of 7 who never had anything - had to work in the mines to pay my way through high school & uni - yeh I think I can say I have a fair idea how the other half lives

well when my father got cancer we sold the family home and begged everyone we knew for money to pay the hospital bills because he didnt believe in wasting money on health insurance

so yeh mate I expect you remortugage the house and sell everything and do whatever you had to do to pay for your childs operation - to quote another Australian - life wasnt meant to be easy "Malcolm Fraser"

Advanced society takes care of its people - if it can afford to - if it cant but still tries the systems fails everyone - which is what the case was in Oz. Im sorry but as a result of the capitalist western system - 'life' is user-pays mate. And I have spent my life and will continue to spend it doing whatever I have to - to make sure Im not one of those poor b@st@rds who dont get any choices.

As I said - if you cant pay for the private health you have to rely on medicare - not a position I want to be in - but its better than nothing. This is the reality mate - not some future scheme.

but I hear what your saying - if I seem unsypathetic I guess I figure a person lucky enough to be born in a first world country has more opportunity to make a life - or help themselves from life nasty surprises - than someone born in a third world country - wheres their MRI, CAT scan, and AIDS cocktail?

I say thats a good idea if....
1.We didn't have the whole 'defend the world' and anti-isolationist.
2.Lawsuits for malpractice weren't so there.

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Originally Posted by Don Corleone

On a side note....

Dude, socialized medicine? Of all the issues you might have sided with the Democrats on, socialized medicine? It doesn't make any sense...

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Immunisation works better with the more who take it. So unless you want to create a divide between immunisation and the rest of healthcare... in which case why/why not?

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Originally Posted by AntiochusIII

The Canadians are quite proud of their dual system, apparently. You can have the best of both worlds, I'm sure; but America have the worst of both.

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Actually it's only a dual system in Alberta. Where their idiot premier is more than happy to violate the Canada health act. However 2 teired health care is more than likely coming for the rest of us. If only to give provinces the ability to handout treatments sooner, and reduce costs. Quebec has started to set up private clinics so they can buy time for overflow if they need it. But these are mostly for the big scaning machines, MRI's, CT's, etc. Those are few and far between (at most 1 per hospital). And in most cases have to scheduled months in advance.


Still I don't know if the implementation of our style of health plans would work in Yankee land. It would require a sharp increase in federal income taxes. Our tax burden is, IIRC, 42% to your 30% after all. Plus our federal government collects more taxes than anyother of it's type globally. Our health care system is one reason for that. Each year the feds hand out massive transfer payments for healthcare, education, and social sevices to all the provinces. also our health care system is almost totally decentralized, like most other government services here. All health Canada is there to watch over the provincial health organs. When I go to the doctor he bills the provincial health plan instead of me. That's what my health card is for.

[QUOTE=Yunus Dogus]Yeh but who decides who lives and dies - who decides who gets treatment and who doesnt

are you going to to tell the dying guys family that your not going to continue treatment

and what if person with ailment x is given the ABC treatment and then dies because of it - who pays for the malpractice - the government (taxpayer)?

It seems to me people inability to deal with and understand the inevitability of death is the root of many problems - I have some experience of this - people will go into this 'false hope' mode - maybe its for themselves, so they dont have to deal with it, maybe its for the dying to keep there spirits up - but basically the doctors always have to hand out a sliver of hope with their diagnosis - so theyll keep the treatments coming till the end - its their oath to do so... you hear people say stuff like - the doctors think this new radiation and chemo combo treatment might reduce the cancer and give him another 6 months - the fact that that 6 months is lived out in agonising pain and nausia from the side effects of the treatment seems to escape - people go into this - we must exhaust every option the doctors give us - even if this means the patient has lost any QUALITY of life, and become a glorified test tube. But who will say - sorry theres no hope the patient is going to die and there is no treatment - the doctor will not - and if you find one that will - the family will go out desperately searching for another opinion that disputes this and give false hope.[QUOTE]

Who decides who gets treatment? A panel decides what treatments are allowed in the first place, and then this is enforced by doctors.

People that get treatment and die though no negligence was evident, well nothing happens.

In the UK people accept "there's nothing we can do" a lot more readily than in the US (I imagine). And if there are strict guidelines what can and can't be done it is a lot easier than with hospitals all competing for money who will do anything to anyone for the cash.

~:smoking:

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FYI, NICE has explicitly an upper limit of £30,000 per year of added healthy life as the cut off for a treatment (we had a lecture on it recently). Those that need to know this know it. There are highly paid people who ensure that a new treatment ends up costing as close to (but below) the £30k threshold as possible to ensure it gets approved but also gets the most money.

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No it doesn't. Trust me, I would know. NICE has published a statement that treatments below 20K per QALY will generally be approved on cost effectiveness grounds alone, above 20K they will look for an increasingly compelling reason to recommend a treatment not based on cost effectiveness alone, but that is all it has said on thresholds. There is a perception that there is a 30K cut off but there is no rule to that effect.

Don't think NICE doesn't know drug companies try to game the system either.

The issue all healthcare systems have in developed countries is effectively infinite demand. Patients want their 100K drug if it gives them even three months more life, and they all imagine there must be such a drug even if there is not. Which is fine, as far as it goes, although I agree with Rory that perhaps a bit more acceptance that we are all going to die at some point might also be beneficial. (Possibly that sounds hard hearted. Its not. My mum died from bowel cancer recently, and, given the quality of palliative care we have these days, it was her inability to accept impending death that was by far the most distressing thing about the illness)

The trouble is that your 100K drug probably denies ten people their hip replacement. Its easy to get an oncologist to argue for a cancer treatment, and so on, but who advocates a responsible and fact based balancing of the needs of different patient groups, based essentially on spending the money where it has most clinical benefit? NICE. But where's the story in that? Who ever reported the results of five RCTs on the ten oclock news? the media just goes to find a patient who says they want the drug, as if that told us anything new.

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it was her inability to accept impending death that was by far the most distressing thing about the illness)

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I know a woman (one of my Mum's collegues) who has what is probably terminal cancer, and yes, the most distressing bit is she doesn't accept it. She should be out doing things that are important to her and enjoying life, but instead she just keeps coming into work. It's sort of odd.

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Originally Posted by doc_bean

Welcome to the sane side.

:medievalcheers:

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Lolz

yeah welcome!
Now let me make a good left socialist from you!

I wander tough why so manny people find it normal that if somebody is wounded, you need to show a creditcard before they get help. Aren't they human because they might have not that much money? Indeed they aren't then why aren't they threated this way?

DA:

You do know how to get the inmates to bounce around the walls of our cages don't you?:laugh4:

I'd add one proviso if we're to head down the path of socialism.

Ammendment: In any year that you receive more money from the government than you pay in taxes to the government, you lose the franchise. Otherwise you have a system wherein too many representatives have a vested interest in putting more people on the dole simply as a means of job security.

And yes, I think we need such an ammendment now. If a majority of those who will be paying the freight for such programs still think they're a good idea, then the support is genuine and should be enacted.

Otherwise, what is intended as a means to redress imbalances and provide a safety net 'morph's into a system designed by the political ruling class to perpetuate their power.


Remember folks, in the USA we do not tax wealth. We tax income. Properly sheltered wealth is largely untouchable, allowing those with real economic clout to maintain their status and keeping all but a few lucky entrepeneurs out of the halls of real economic power. If you're saying we should tax the highest wage-earners more, you are REINFORCING the division between haves and have nots, not eliminating the barrier.

(Can you tell I just took a C.E. class in estate planning?!:beam: )

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The trouble is that your 100K drug probably denies ten people their hip replacement.

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Yep, people need to realise this. I remember reading a survey done a while back-the majority of people interviewed, around 70 percent I think, said that they believed all life-prolonging treatments should be provided on the NHS, regardless of cost, which is pretty scary in itself. However, the kicker was that a majority of people also said they wouldn't be happy paying higher taxes to fund the health service!

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Originally Posted by Big King Sanctaphrax

Yep, people need to realise this. I remember reading a survey done a while back-the majority of people interviewed, around 70 percent I think, said that they believed all life-prolonging treatments should be provided on the NHS, regardless of cost, which is pretty scary in itself. However, the kicker was that a majority of people also said they wouldn't be happy paying higher taxes to fund the health service!

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People want to be able to have their cake and eat it too.

Of course that is what people are going to say in a survey but ask someone who needs a hip replacement if they would like to skip the procedure to prolong someone else’s life or pay more for coverage and get their procedure too. ~D

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Originally Posted by Big King Sanctaphrax

Yep, people need to realise this. I remember reading a survey done a while back-the majority of people interviewed, around 70 percent I think, said that they believed all life-prolonging treatments should be provided on the NHS, regardless of cost, which is pretty scary in itself. However, the kicker was that a majority of people also said they wouldn't be happy paying higher taxes to fund the health service!

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This is the number 1 problem to the NHS, people complain when they get what they percieve as poor quality healthcare, but then hugely object to paying taxes!

It also annoys me when people complain about local hospitals to close down, the NHS tries to cut out unneeded hospitals so the money needed to maintain them can be redirected to others in the area to provide a greater quality of care, but people object to travelling an extra few miles, and so complain, the local council dont want to be seen as unpopular, and so the hospital stays... leeching money from the NHS when it could be better spent elsewhere, and still serve the local community just as well (the most recent example i'v come across recently is st Barts, which will be costing the NHS money for years now, especially as it is already in debt..

add to this the high cost of new drugs that the NHS is forced to buy through the government needing the good publicity, and well... the NHS can't win... people want a perfect health service for free!


:2thumbsup:

DA - Though what you state might be an improvement over your current situation over there, all you are proposing is an awefully unequal two tier system, in which the poor and those who cannot afford better services get fobbed off with what you state as 'universal' healthcare and schooling, yet those who can pay can still get fabulous treatment - at even cheaper prices!!! - at better institutions. That isn't far different to the current situation over there is it? Ah yes, at the moment you merely don't think of the poor at all, at least this way you clear your conscience first!

If you actually want to help everyone in society, you don't build in to a system a way of creating such huge unbalance, such as private institutions who refuse all but those who can pay and school voucher systems which completely undermine a public schooling system. Have Private hospitals yes, but for use within the public sector, rather than have a voucher system make every school better. Etc..

...which is utterly unrealistic unless the government outlaws private hospitals and forbids people to go abroad for treatment.

As long as there are people willing to pay for treatment, people will provide the service.

The rich few will always be able to pay for better than is provided for the masses, until the impossible time where every patient is seen immediately by the best specialist in their field for the most modern treatment.

Why is it that people are happy that houses cost different amouonts of money, as do cars and to be honest everything else.

But for some reason healthcare and education somehow there isn't supposed to be a two tier system in a free market economy... :wall: :dizzy2:

~:smoking:

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Why is it that people are happy that houses cost different amouonts of money, as do cars and to be honest everything else.

But for some reason healthcare and education somehow there isn't supposed to be a two tier system in a free market economy...

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Maybe because even in this capitalist system, we are led to believe that everyone can get to the top of the social scale, regardless of their position at birth. But a system where the poor do not even get educated somehow flies in the face of this or a system where the poor do not get effective treatment for their ills, flies in the face of this. Not to mention that in a 'civilised' country, which is one of the richest in this world, we cannot even provide a society which allows those born of complete innocence to the surroundings they find themselves in, a life not destined for misery and obscurity.

Or how about because it is simply wrong, on a moral and theoretical level.

What I stated is also not unrealistic at all, it is in fact what this current government is actively trying to do, with hospitals at least. The inclusion of private hospitals into our current system has been a great move forward along with the inclusion of private companies to do the donkey work for the public institution that is the NHS. If we can get patients through the NHS by using private hospitals, I don't think any person in their right mind has a problem with it. Look at Sweden, the best healthcare system in the world, though it is not a nationalised service in principle - there is a tiny payment every year which is the same for everyone - it uses this principle and it works.

There is also a difference between creating a two tier system in which the super rich are at the top and everyone else is on the 'second' tier and that of a system where everyone but the poor is on that top tier, as I am sure you recognise.

We are told that we can all get to the top. Even though statistically this is of course nothing more than a lie that is promulgated as it's in no one's interests to reveal the truth.

If your parents aren't clever, chances are, you'll not be that bright either. if they have no interest in schooling chances are the kids will get this attitude. If the parents drink and smoke, chances are the kids will get it second hand from a young age and will themselves start soon. If the parents have an army of kids at a young age, the chances are that the kids will do so as well.

Unless society intervenes to levels that would stagger China, this isn't going to change.

The NHS does, most of the time, to most people provide effective treatment. It provides treatment that was unheard of 50 years ago.

You seem to wish to get rid of private institutions, yet provide no way of achieving this.

There should be many more than two tiers. A multi tier system that gives to all what society can afford and then people topping up with what they wish.

Private hospitals in the NHS are a disaster. They do simple work, and when (and they do) screw things up it gets dumped on the NHS. So their numbers seem good, as they don't look for problems. And they get a steady number of patients which obviously means that the "proper" NHS hospitals suffer.

I'm surprised that you've bought the government take on PFIs hook line and sinker like this - especially when so many think they are a bad idea.

Oh, for the record the American system is appalling.

~:smoking:

I have not taken the government line hook line and sinker, merely looked around at the best system and seen that it is a sensible way of doing things if done properly. Tax heavily but balance that with significant benefits - benefits for everyone. Use an active private sector but only in terms of supporting public institutions. Manipulate the market and have government as a significant aspect of life in society, though that doesn't have to be central government, local government can be just as effective.

I don't want to get rid of private institutions just modify them, that can be done easily and I simply do not agree with your outlook on life in society for those from poorer backgrounds. It would be quite possible for those from poor backgrounds to have social mobility if the proper services were given to them. It is a lie that social mobility is easy in this capitalist system but only a lie because of the system, not because it is impossible.

If you tax private healthcare to much, two things are going to happen:

those that otherwise sacrifice for better treatment can't afford it at all, so have to go on the NHS

Others will go abroad for treatment where the tax isn't so high, and therefore the treatment.

In essence the usual "solution" to all problems of taxing everyone and then wondering why everyone doesn't go along with this and instead goes elsewhere.

What system is there where social mobility is so good? I am a firm advocate of a meritocracy where the poor but bright are elevated. In that case bring back Grammer schools and Assisted Places to help the gifted. My parents are both products of this system (father Grammer, Mother scholarship), and myself and siblings were on assisted places.

Grandfather: plumber
Parents Teachers
Myself Doctor

There! Social mobility from social class 4 to 1 in 3 generations.

~:smoking:

Great arguments on both sides. Please allow me to clarify the logic behind my reasoning:

I seek not an equalization of education, health care, nor pension. I do not desire, whatsoever, to provide undeserved benefits to the lazy nor punish the wealthy for their success.

I am a capitalist first and foremost. I fully understand that this will create a two-tiere system that will contribute to the perception of an already existing divide.

But from this perception of division, a concrete opportunity for advancement and achievement will be created. All individuals would have not only the freedom to succeed as currently exists, but also the essential resources to do so.

The logic is that there can be no more excuses. All citizens will have a basic guaranteed starting position in the rat race. The responsibility to excel will rest with them. Think about the following:

(1) An individual will recieve the essential care necessary to survive and the opportunity for exceptional care should they choose to pay for it. The affordability and quality of private care would encourage many to pay out of pocket.

(2) An individual will be empowered upon reaching adulthood to contribute to society with a specialized education based on their ambitions- be those ambitions grand or mediocre. The choice to "step up" to private education will also remain and so long as there is a demand for affordable private education, a supply will remain.

(3) The specifics of a public pension system do not necessarily include total public funding. Defined Contribution remains a viable option so long as these are backed by the federal government.


Finally, and only partially related, I would like to see further privatization of government administration. There is no reason that bureaucracies, such as the DMV, et al, cannot be privatized with mixed public/private funding of operations. The U.S. post office is as efficient as it is today because of the introduction of competition years ago. I do not recall, in my life, having something "lost in the mail".

Warm Regards. You leftist liberals. :wink2: ~D

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Originally Posted by rory_20_uk

We are told that we can all get to the top. Even though statistically this is of course nothing more than a lie that is promulgated as it's in no one's interests to reveal the truth.

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There are three kinds of lies....I assume you know the rest. Besides, in your next post you say yourself you (and your parents) succesfully climbed the social ladder.
Even something only affects 1% of the population, that would still be 100 000 people in Belgium alone. You're a doctorn you should know how small an error rate a drug may have for it to be allowed. That's because even a small percentage often means a whole lot of people.

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If your parents aren't clever, chances are, you'll not be that bright either.

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This is often assumed, but I'm not sure how accurate this is (correlation sure, but how strong), regardless there a plenty of exceptions and it's hard to 'measure' intelligence.

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if they have no interest in schooling chances are the kids will get this attitude.

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My mother never finished HS, my dad often laughs how he fell asleep when 'studying' (he's an electrician). I'm working on my second Master's.

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If the parents drink and smoke, chances are the kids will get it second hand from a young age and will themselves start soon.

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My father used to smoke when I was a kid, I never smoked.

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If the parents have an army of kids at a young age, the chances are that the kids will do so as well.

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I know plenty of cases where this (or the opposite case) isn't true.

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Unless society intervenes to levels that would stagger China, this isn't going to change.

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Honestly, Rory, you're threating people like they were just statistics, while all you've said might be true for the majority, that doesn't mean the minority is negligable.

When approaching a topic concerning a society, one has to go with statistical generalisations. Using a single person as an example is pointless, as would lead to impractical and / or implausible policies.

The percentage of poor, who are bright and who want to work hard out of the total population is proobably less than 1%

In the UK, the system of grammer schools allowed the small but important children from poor but bright families to get a head start.

~:smoking: