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You are correct sigma, and yes I was referring to the cost. It ends up costing all of us more in the long run because so many do not have any type of health insurance. I was one of those for a very long time, and simply never went to the doctor (for things I should have).
If it can be privatized and work, then I'm all for it. But I have my doubts in our sue-happy society. I think the right to Life, Liberty, and the Pursuit of Happiness would include access to basic health care. What we have now is an economic class system where the poorest are denied that access (yes, they can go to any emergency room to be treated, so it looks good on paper, but in actuality, they often do not get treatment when they need it out of fear of the financial impact, and the rest of us end up paying a much higher cost to treat them later on). Feel free to post your detailed plan here. You have piqued my interest.
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Originally posted by PDXSVT:
I'm neither a Canadian nor an expert on health care delivery and management. But I'm under the impression that Canadians can shop privately for additional/supplemental private health insurance on top of the governmental program.
Indeed Canucks can source supplimental health care insurance (through work or personally). This insurance is generally for Extended Health Coverage - coverage of prescriptions, dental, eye glasses etc. Not to be confused with "I'm sick, go to MD or hospital, drop your card on the counter and get treatment generally without any cost"
Have heard much adu about our failing Cdn system but have to say, in the few incidences where my senior mother was ill (or injured), she received first rate, immedate assistance without using 911 services to jump the queue. I think her 30 day stay in hospital a few years ago and the 3 weeks late this summer were an opportunity to get a little insight. Cannot speak for other people in other places (outside Ontario).
However, take this for what it's worth. My brother has lived in this area for 24 years and still cannot get a 'family doctor'. The Kawatha Lakes area has a population of 75000. Just recently a nurse practitioner became available so he can see her if it's nothing serious. Good thing we kept our family md's in the city even tho it can be a 2+hr drive.
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Originally posted by sigma:
I assume you mean the cost, but privatized basic health care can be provided at little to no cost. There are thousands of free clinics around the nation that provide these services and don't charge a dime.
There is no such thing as "free" or even "little cost" healthcare - nowhere. The point isn't really up for debate is it? Doctors get paid reasonably well, the technology is expensive and the administration is too; we all know how much healthcare costs - and the money comes just one place - the citizenry - what you refer to as "free" is really just a different way of covering the costs; a different way of distributing the necessary funds - in this case, I believe you mean that someone else is cutting the check.
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Note that our Founding Fathers didn't put into national healthcare plan into place even in a time when common illnesses were much more likely to be fatal than they are today. We got through almost 200 years without paying any sort of federal taxes for government-supported healthcare because we took care of our own.
The founding fathers couldn't have conceived of health care as we know it now - no more than they could have conceived of hanging chads having anything to do with the right to vote. They also couldn't have conceived of a universal, publicly funded educational system as we have now, but no one seems to have a problem with basic education being a right of citizenship.
Isn't the real question more fundamental than what it costs, how it's delivered, or who cuts the check? Isn't the question more along the lines of "is it the right thing to do - for individual citizens or for the country, or both?"
If you believe the answer is yes, the questions about how to do it and how much it costs become a lot more relevant. If you don't, then for you the debate probably ends there.
Try this little exercise: write down the top 5 things you believe about the right to basic education (assuming you believe it is a right - if not, you undoubtedly know exactly where you stand on universally accesible heathcare).
Then replace the word education with healthcare. Do you still believe the same and if not, what's different?
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I don't think you'll find many people to disagree that we all have a right to at least a fundamental level of basic healthcare. That's not really at question. The question is who is better-equipped to provide it.
And, while I agree with basic education also being a right, I will again pose the question of who is better-equipped to provide it.
The federal government is not supposed to be providing us with all these various programs unless private enterprise is refusing to do so (which brings up a whole 'nother set of questions). Their job is to ensure that our right to these fundamental rights is not intruded upon or inhibited in some way by individuals or corporations. Our Constitution explicitly states that government is to promote the general welfare, not provide it.
So, in terms of health-care this would mean enacting legislation that would protect private hospitals, doctors, and insurance companies from excessive litigation so that they can continue to provide us with cheap, efficient, and effective treatment. This might mean providing minimal incentives to companies in certain areas to ensure that areas that need adequate coverage have it. In some areas local government, through local taxation, might have to help subsidize some level of coverage. And the government should be setting and enforcing the professional standards for medical personnel -- again, not providing us with the healthcare, just ensuring that private enterprise is providing us with a safe level of service.
And all the same ideas can be appliedd to education.
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Originally posted by sigma:
I don't think you'll find many people to disagree that we all have a right to at least a fundamental level of basic healthcare. That's not really at question. The question is who is better-equipped to provide it.
As I said, if the answer is "yes, it's a right" then the "who, how, and how much" debate becomes a lot more significant. I'm not convinced, however, that the majority agrees that univeral access to basic healthcare is a right.
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The question is who is better-equipped to provide it. And, while I agree with basic education also being a right, I will again pose the question of who is better-equipped to provide it.
Who indeed? Does the record of providing basic healthcare to all (universal access is a right, right?) by private healthcare providers even come close to a minimum standard? Do kids today have better access to basic education or to basic healthcare? Millions without access to basic healthcare due to being uninsured, underinsured and unable to pay for it IMO doesn't meet any standards for success.
When this debate was waged in Canada in the 1960's two things became clear. 1) The vast majority of Canadians felt it was a right of citizenship to have universal access to basic healthcare ... and 2) private insurance companies wanted nothing to do with it because the profit potential wasn't there.
What happened in essence is that the Federal government was forced to become the insurer, and all Canadians became at the same time policy holders and share holders.
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And the government should be setting and enforcing the professional standards for medical personnel --
Isn't this already the case?
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again, not providing us with the healthcare, just ensuring that private enterprise is providing us with a safe level of service.
Doctors nurses and hospitals deliver healthcare, not the government (even in Canada) - if you believe in universal access as a right, then what happens if the private sector can't or won't provide it (and the evidence strongly suggests this is the case) how do you ensure that it happens?
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And all the same ideas can be appliedd to education.
Are you suggesting that public education be privatized? What other institutions would you apply this philosophy to ... law enforcment (FBI, CIA) or the military perhaps?
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Quote:
Doctors nurses and hospitals deliver healthcare, not the government (even in Canada) - if you believe in universal access as a right, then what happens if the private sector can't or won't provide it (and the evidence strongly suggests this is the case) how do you ensure that it happens?
The private sector can and will step-in if there's money to be made. If a company isn't making money, one first has to ask the question why not. As I said in my previous post uf the company is doing everything they can and still not making ends meet in a particular area, then the government, either local, state, and lastly federal should incent these companies to remain through whatever means it has at it's disposal. Government assistance should be the exception, not the rule.
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Are you suggesting that public education be privatized?
Yes. Although not overnight. The government should be ensuring that all areas have schools and that all schools meet educational standards, nothing more. No matter how you look at it, privately-operated schools do much more with much less than public ones do.
Just think of how great our primary and secondary school system would be, particularly in cities which now tend to fair the worst, if you had a choice of where you sent your child to school. How good your teachers would be if they were paid more, were better educated, and if the school didn't meet your standards you took your kids (and your money) and went elsewhere with it. Schools would have a vested interest in the teachers they hired, teachers would have a vested interest in the school they worked for. Without fail, competition yields higher levels of service at lower costs.
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What other institutions would you apply this philosophy to ... law enforcment (FBI, CIA) or the military perhaps?
The Constitution explicitly states that the government is to provide (rather than promote) us with some services, among these are national defense. So, no, I do not suggest privatizing the above groups.
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Good post - lots to think about.
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The private sector can and will step-in if there's money to be made. If a company isn't making money, one first has to ask the question why not. As I said in my previous post uf the company is doing everything they can and still not making ends meet in a particular area, then the government, either local, state, and lastly federal should incent these companies to remain through whatever means it has at it's disposal. Government assistance should be the exception, not the rule.
This doesn't sound realistic to me ... the only reason healthcare is profitable in America is because not everyone has access; and high-risk, heavy users are routinely dropped or excluded from coverage by those who need to generate profit for shareholders. I am however open to the possibility you suggest ... do you have an example of any program that features universal access and generates a profit for private enterprise?
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Just think of how great our primary and secondary school system would be, particularly in cities which now tend to fair the worst, if you had a choice of where you sent your child to school. How good your teachers would be if they were paid more, were better educated, and if the school didn't meet your standards you took your kids (and your money) and went elsewhere with it. Schools would have a vested interest in the teachers they hired, teachers would have a vested interest in the school they worked for. Without fail, competition yields higher levels of service at lower costs.
I have a bias here, my two kids go to private school and I agree that the standards are higher and they are also probably more efficient. I do however continue to pay school taxes.
But what makes the higher standards of a private school possible, is the existence of a universal access public school system - because private schools are relieved of the burden to meet societies obligation of universal access. If parents / students were able to decide for themselves where they went to school it would be chaos.
It is only because of the existence of the public schools that the private schools can operate differently ... they select who and how many students attend and the criteria on which those decisions are made - arbitrarily and without general oversight; they decide the curriculum and their location, and most importantly, they decide what their operating budgets are. Need/want a higher budget - charge more - no referendums, no accountability to elected officials, no need to worry about the impact of the next municipal election, no need to raise taxes.
How exactly do you educate millions of kids from destitute families within this system?
And how do you provide healthcare to millions of kids from destitute families with a comparable healtcare system?
Last edited by Mysti-ken; 10/18/04 07:35 PM.
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1.8 trillion..
Couple points..
1) A shockingly high % of hospital admissions are for heath/lifestye choices the patient made years before..obesity is a rampant contributer..Alcohol, Cigarettes, Drugs, unsafe sex practices. My "rough" guess based on >10 years of hospital ward experience is about 2/3 - 3/4 of ALL admissions have these as strong contributing factors or cause. These are all more common in US than other countries ranked "healthier" than us.
2) A few patients cause BIG BUX. We do heart surgery on 75 year olds, dialysis on 80 year olds...many other countries have age cuts-offs including the UK (as low as 60!). Renal failure at 61..= adious muchacho! Marrow & organ transplants, devise implants...big ticket items we do more than ANYONE. Personally, I think we go to far sometimes but expectations are enourmous in the US. Somebody abuses there body for years but if they have a bad hospital outcome, the family wants to know why the HOSPITAL SCREWED UP. Unfortunately, this means less money to pay for prevention..which is UNDERSTRESSED in the US.
3) Litigation...extending our last topic, we have more malpractice litigation in this county thant THE WORLD COMBINED. Combined with unrealistic demands and poor self care, malpractice costs are huge. And it does not stop at insurance costs and actually driving all doctors in some specialties in certain areas. It factors incalculably into DEFENSIVE medicine. Young Docs (and many veterens) today are less comforatble with a good history and physical ruling out some condition and want to do a test...CT, MRI, etc. Some of the labwork today is amazing as well...we have tests for many things that are RARE but serious, and tests get employed ALOT. Many other countries just do not routinely have thses specialized tests, and again...I think they are OVERUSED here.
4) Patient DEMAND...look no further than your TV. Is there an hour that goes by when a drug for erectile dysfunction is not on (Viagra, Levitra, etc.). "Ask your Doctor or Pharmacist"....and you can bet they do! And many docs will give patients what they want to keep them comming. This BS does not occur in many of these countries. And if they DID ask...it would not be on the RESTRICTED formulary.
I could go on...but we have
1) Unheathy folks
2) Unsafe lifestyles
3) Overemphasis on expensive care for older, end stage persons
4) Underemphasis on prevention
5) High consumer demand & expectations
6) MDs trained more in procedures than "art" of diagnosis (a big pet peave of mine)
7) Excess litigation costs
8) MD maldistribution (too many here, not enough here)
9) The US pharma industry bears an inordinate % of drug R&D costs..
You take THIS current problem list NOW to a "global heathcare" model with same level of benifits...we will bankrupt it so fast your head will spin. Kerry's plan is pure fantasy.
Now...it CAN be done if we all want..Nobody wants to lose weight. Nobody wants to be told "if I drink or smoke crack, I lose heathcare". Nobody wants their 80 year old dad to be denied dialysis. Nobody wants to have a resticted number of drugs available..and no "fancy extras".. Nobody will be happy when they are told "NO MRI of that knee, head"..."let's just watch it". Nobody wants to give up the right to sue docs into the ground if something goes wrong. I have cancer and want a marrow transplant NOW, not a waiting list...I want to pick my MD. Oh..and I want our pharm industry to start cranking out the miracle drugs...NAH!
If we all agree to this, we can cover everybody, and in SOME respects do a better job However, I do not believe that we as a people are ready for this. It will need to be implimented gradually. Tort reform is a good start and educating lifestyle changes and working on prevention..all of which are current initiatives. I think we can finf a middle ground on drug pricing without going to Canada to get drugs we developed HERE. I do not want French or Canadian heathcare, I want to borrow what is best in their systems and combine with the best of ours..for despite your WHO stats..it is the US to which the wealthly of nearly ALL countries come for care.
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Quote:
This doesn't sound realistic to me ... the only reason healthcare is profitable in America is because not everyone has access; and high-risk, heavy users are routinely dropped or excluded from coverage by those who need to generate profit for shareholders. I am however open to the possibility you suggest ... do you have an example of any program that features universal access and generates a profit for private enterprise?
Hmm. The only examples off the top of my head are non-profit or not-for-profit organizations -- which of course, by definition, are not making a profit. However they are very viable businesses and certainly could become businesses if need be.
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If parents / students were able to decide for themselves where they went to school it would be chaos.
I'm curious why you think it would be "chaos" in such an system. Different, yes. But I'm not seeing the possibility of 'chaos'. Perhaps you could elaborate on your viewpoint, I'm curious to hear it. You give some insight in your following paragraph, but I'm not seeing the level of problems that you are and I may just be missing something.
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It is only because of the existence of the public schools that the private schools can operate differently ... they select who and how many students attend and the criteria on which those decisions are made - arbitrarily and without general oversight; they decide the curriculum and their location, and most importantly, they decide what their operating budgets are. Need/want a higher budget - charge more - no referendums, no accountability to elected officials, no need to worry about the impact of the next municipal election, no need to raise taxes.
Now, correct me if I'm wrong, but private schools have their own body of accreditation, correct? I mean, you know that your children are getting a good, quality education that meets or exceeds state/federal requirements, because a body holds them to that, right?
Now take exactly what you describe -- the ability to set your own curriculum (as long as it meets accreditation), locations, operating costs, prices, etc -- why can't that be done on a much larger scale?
We're talking a fully-privatized system, not accountable to officials or referendums or anything of the sort. With rare exception, only accountable to the free-market. Exceptions being areas where only one school is operating poorly or at high cost and no others are willing to come in.
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How exactly do you educate millions of kids from destitute families within this system?
And how do you provide healthcare to millions of kids from destitute families with a comparable healtcare system?
The whole concept, and I admit that it's totally hypothetical, revolves around the premise that 1> the government will give my tax money back, and 2> people are willing to give their money to support charitable groups.
I picture a reversal of the roles we see today in education where public rather than private schools are the exception. And I'm not claiming to think my way is the best way; I just see a system we have that, frankly, isn't working and only shows signs of getting worse. I'm of the mindset that anything is better than what we've got now and I'm willing to give anything a shot.
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Wow, awesome posts everyone. From both sides, too! Obviously people know where I'm coming from, but I'd never learn anything if I closed my eyes and ears to the opposition. Thanks for the great input! A theraputics test hath fried my brain,  so I'm only going to comment on this one right now: Originally posted by Dan Nixon:
I want to borrow what is best in their systems and combine with the best of ours..for despite your WHO stats..it is the US to which the wealthly of nearly ALL countries come for care.
Dan - if we didn't take snippets from one country and snippets from another, we'd be fools. Very good post my friend! I agree, this country has the best possibilities, but it's availability that we're really lacking. And yes, cost is skyrocketing because of all our cool tests...that we imlement out of fear from getting sued.  Dan, our PA class has put a HUGE stress on the importance of Hx. The physical exam has been dubbed "that which confirms your diagnosis...that you made from taking a good history!" 
I would have a really really hard time knowing that my taxes went to a gastric bypass surgury for a person who was 80 lbs over weight. Prevention is common knowledge, but its importance somehow just isn't sinking in. It's our "fix it once it's a problem" kind of attitude that's getting us into trouble.
I think it's been well hashed, but I'm going to make a comment about urgent care, too. My friend from Idaho had a clinic that got gov't grants to run. It's mission - serve those w/o insurance who would normally have gone to the ER for things such as ear aches, stomach aches, etc etc. They also had regular patients, too. The estimated cost of care for these patients was ~ 1/4 the cost had they gone to the ER. Granted, I don't know all the details about this clinic or the patients, but it's a damn good idea, IMO.
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