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Socialist Healthcare is Fundamentally Flawed watch

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    (Original post by jesusandtequila)
    Surely though it's also been a terrible waste for you to have your money forcibly taken for eight years in order to cover health costs...with insurance, though, you'd be seen as relatively healthy and get charged a lower premium, it means that the externalities of an unhealthy lifestyle are generally internalised.

    Now, don't get me wrong, I do think hybrid systems are best, but there's two important points to make.

    1) America is not a good example of a free-market system.
    2) Socialised healthcare is not free, a fallacy you committed above.
    One thing you should consider is that costs are far lower than in the USA - I think the UK as a whole is around a third of the cost of the USA. Surely your point indicates that both systems have the same problem?

    And one thing you have to consider is that the tax system is being cut in the UK - almost by £3000 by 2015. So if you are paying less, the value you are getting is going up too.

    And another thing to consider is that we are NOT paying insurance premiums to government - we are paying tax, the government(s) decide how the spend that money (a large proportion goes to the NHS), and that goes to the NHS.

    And one thing you have to consider is that I don't work (through no fault of my own - I put in 50+ CVs last year alone within the space of 2 days), so how would private healthcare be an option for me? By all means, if I get the specific job I want, I would probably go private. But as it stands, the NHS is a good system. I am no Socialist, but the system works. I have barely had to attend hospital or the doctor's in most of my life, so isn't that a justification for the current system?
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    (Original post by Stanley Baldwin)
    One thing you should consider is that costs are far lower than in the USA - I think the UK as a whole is around a third of the cost of the USA. Surely your point indicates that both systems have the same problem?
    As I said, the USA is *not* a good example of a free-market system. It has huge swathes of regulation that stifle competition and grant monopolies to drug and health companies, the prices are driven up because of government, not despite it.

    And one thing you have to consider is that the tax system is being cut in the UK - almost by £3000 by 2015. So if you are paying less, the value you are getting is going up too.
    Taxes are going up in the UK. While income tax is falling due to the increase in the personal allowance, other taxes are rising, such as VAT, National Insurance, indeed, overall tax is rising by about £30bn over the course of the parliament.

    And another thing to consider is that we are NOT paying insurance premiums to government - we are paying tax, the government(s) decide how the spend that money (a large proportion goes to the NHS), and that goes to the NHS.
    Exactly, whilst I think it's much more efficient to allow people how much of something they want to purchase, some people may want to spend more on other things and have less health cover, while others may be willing to shell out even more for further amenities in hospitals, or a particularly expensive treatment. You don't get the variation or the choice with the NHS.

    And one thing you have to consider is that I don't work (through no fault of my own - I put in 50+ CVs last year alone within the space of 2 days), so how would private healthcare be an option for me? By all means, if I get the specific job I want, I would probably go private. But as it stands, the NHS is a good system. I am no Socialist, but the system works. I have barely had to attend hospital or the doctor's in most of my life, so isn't that a justification for the current system?
    As I was saying, a hybrid system works best, but not in the style of the US. An actual free market system with subsidies from government for the poorest is a far better idea, since you have multiple provision, you have choice for all, not just for the richest, you have people able to choose their level of healthcare provision, you have competition driving standards up and prices down. Indeed, the Euro Health Consumer Index suggests that the biggest difference between outcomes on the continent and here is not cost (since the funding gap has closed hugely since 2002, but the outcomes gap hasn't), but the plural provision of health, and the competition and choice generated.
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    I have a large amount of family living in both the US (Michigan) and the UK. Many of those living in the US have dual-nationality and perhaps the single most useful example of the weaknesses of the US healthcare system as stands was made to me by my borther a while back, shortly after his wife had lost her job and his was looking shaky.

    "If I lose my job then we'll have to move back to the UK because I won't be able to afford to pay for my wife's medical bills (she has a chronic condition)".

    Now my brother earns quite a few dollars, is fairly high up the management chain of Ford North America and is surrounded by folk who believe that Obama and his healthcare reforms are the thing of the Devil. Even my brother, who has in the past benefitted from the NHS when seriously injured as a youngster, decries 'socialist healthcare'. Yet when his job was on the line his first thought was to jump ship.

    This though isn't an option for millions of who don't have the benefit of being dual-nationals. When they lose their jobs, possibly as a result of reckless speculation by the banks that hold the purse strings of their businesses (as happened during the recent financial downturn in the US) they will very swiftly thereafter lose their access to decent healthcare.

    But thats alright eh? Jack can pull up the ladder.....
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    (Original post by jesusandtequila)
    As I said, the USA is *not* a good example of a free-market system. It has huge swathes of regulation that stifle competition and grant monopolies to drug and health companies, the prices are driven up because of government, not despite it.
    Care to offer a good example of a free market system then?
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    (Original post by jesusandtequila)
    As I was saying, a hybrid system works best, but not in the style of the US. An actual free market system with subsidies from government for the poorest is a far better idea, since you have multiple provision, you have choice for all, not just for the richest, you have people able to choose their level of healthcare provision, you have competition driving standards up and prices down. Indeed, the Euro Health Consumer Index suggests that the biggest difference between outcomes on the continent and here is not cost (since the funding gap has closed hugely since 2002, but the outcomes gap hasn't), but the plural provision of health, and the competition and choice generated.
    I'm sure I ripped apart that paper a few weeks ago...

    If you're going to cherry pick a paper to fit with your a priori assumptions, at least choose a good paper.
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    (Original post by Captain Crash)
    Care to offer a good example of a free market system then?
    Britain before the advent of the NHS.

    But as I said, I'd support a hybrid system - I just think it's extremely faulty to critique the USA when many of its problems are caused by it not being a free market in healthcare.

    Indeed, sconzey is more illustrative than me:

    (Original post by sconzey)
    The US is an interesting place. It is certainly *NOT* a good example of a free market in healthcare.

    1. Each State imposes it's own "mandates" on what health insurance in that state must cover; sometimes incl. homeopathy and acupuncture.
    2. Because of #1, Americans are not allowed to buy health insurance from another state, so there's very little price competition between both insurers and providers.
    3. Hardcore regulation of the insurance industry actively discourages innovation from small players.
    4. Tax incentives heavily favour workplace-provided healthcare insurance over personal healthcare insurance, making unemployment in the states doubly ****.
    5. Because of #4, healthcare packages are bought in bulk by big companies so individuals are unable to pick and choose something specific to their own needs (and thus get a good deal).
    6. Medical costs themselves are high because the AMA has a monopoly on the certification of doctors to practice in the US, and so maintains artificially high wages by decertifying for minor and medically unrelated infractions.
    7. Because of #4, the tendency is to try to get insurance to cover all medical expenses (seeing a doctor and paying out-of-pocket is *not* tax deductable)
    8. The FDA's messed up incentive structure makes inventing new drugs doubly expensive (if the FDA certifies a drug and people die, there's outcry and heads roll. if the FDA doesn't certify a drug and people die (who could have been saved by the drug) then no-one notices -- for more on this effect see Hazlitt -- Economics in One Lesson).
    9. Let's not forget that inventing drugs is expensive to start off with, with countries like Britain imposing heavy price controls on new medications, companies often over-charge Americans to recoup the cost. You heard it: America subsidises British healthcare.

    There's more, but I can't remember it offhand. The killer is #2 -- chaps cleverer than I have estimated that if Americans were able to shop across state lines for healthcare insurance, one million more Americans would be able to afford it.

    I'm not saying that a solely privatised system would be perfect according to every metric, but I'm tired of people saying "privatised healthcare doesn't work; look at America!"
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    (Original post by Captain Crash)
    I'm sure I ripped apart that paper a few weeks ago...

    If you're going to cherry pick a paper to fit with your a priori assumptions, at least choose a good paper.
    I certainly wouldn't call that ripping apart the paper. Certainly it is not perfect and there are information problems, but it's well documented that European counterparts have better medical outcomes, and despite the closing of the funding gap, the outcomes gap hasn't closed. Pluralistic models with competition have driven up standards - no matter what you think of who should be paying.

    Furthermore, you belittle the consumer experience, why?
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    (Original post by pomme de terre)
    Even as someone who generally agrees with free market, privitisation etc. I find this completely ridiculous. No person should have the contents of their wallet checked before they have their injury checked.

    If someone is so inclined to want a different alternative to government healthcare for whatever reason, there is always private healthcare. So what's the problem?
    I find the Republican argument of 'death panels' completely ridiculous. I thought I broke my foot (couldn't stand on it, found out that I had sprained it to the worst possible extent), and a single Doctor took me through three steps of treatment without saying "Right, money" and "I am going to report to central bureaucracy to find out what you should get".
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    "This is America,"

    Stopped reading there.
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    (Original post by jesusandtequila)
    As I said, the USA is *not* a good example of a free-market system. It has huge swathes of regulation that stifle competition and grant monopolies to drug and health companies, the prices are driven up because of government, not despite it.


    Taxes are going up in the UK. While income tax is falling due to the increase in the personal allowance, other taxes are rising, such as VAT, National Insurance, indeed, overall tax is rising by about £30bn over the course of the parliament.


    Exactly, whilst I think it's much more efficient to allow people how much of something they want to purchase, some people may want to spend more on other things and have less health cover, while others may be willing to shell out even more for further amenities in hospitals, or a particularly expensive treatment. You don't get the variation or the choice with the NHS.


    As I was saying, a hybrid system works best, but not in the style of the US. An actual free market system with subsidies from government for the poorest is a far better idea, since you have multiple provision, you have choice for all, not just for the richest, you have people able to choose their level of healthcare provision, you have competition driving standards up and prices down. Indeed, the Euro Health Consumer Index suggests that the biggest difference between outcomes on the continent and here is not cost (since the funding gap has closed hugely since 2002, but the outcomes gap hasn't), but the plural provision of health, and the competition and choice generated.

    Just going to pick apart your points,

    1) Your tax point is just wrong - if tax is going up by £3000ish, and VAT is going to add an equivelant of an extra £200 per family, then you have more than £2800 more than under the Labour Government. Is that not more money? Even with NI, you are getting a hell of a lot of money back from tax.

    2) You miss the point on choice - the NHS is given a budget (like any major corporation) for a year to pay for wages, treatments, etc. A good thing about the NHS is access - you don't need to have £5000+ in reserves to get treatment. While, yes, this allows drug users to waste NHS money, it does allow the deserving (such as myself, and others who seldom have to use the NHS) to be treated. Also, those who are dependent upon the NHS for survival (such as those who are terminally ill and of special needs) benefit from the NHS because their lives are not prolonged depending on how much money they have. That compassionate point is a reason alone why the NHS is a good thing - because those who seriously need the NHS on a daily basis are given that help through the system we have.

    3) And on choice, the NHS does have quite a bit now due to Public-Private elements of healthcare. For example, my Dental practice was purely NHS, but now it is mainly private. I could have went purely with NHS treatment, yet I opted for the Private treatment. Same waiting time, but I got a slightly different treatment.


    That reminds me, why the term 'Socialist Healthcare'? We are not Reds, my son. Why don't you call it 'State-financed healthcare'? It seems far more neutral.
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    (Original post by Stanley Baldwin)
    Just going to pick apart your points,

    1) Your tax point is just wrong - if tax is going up by £3000ish, and VAT is going to add an equivelant of an extra £200 per family, then you have more than £2800 more than under the Labour Government. Is that not more money? Even with NI, you are getting a hell of a lot of money back from tax.
    http://cdn.hm-treasury.gov.uk/2011budget_complete.pdf

    Firstly, you're not getting £3K, the personal allowance is aimed to rise by £2.5K over the parliament, which is a £500 windfall. Se table 1.1, total discretionary consolidation down to tax: £30bn. The tax burden is rising over the parliament, not falling, as we can also see from point 1.15: "tax receipts are projected to rise from 36½ to around 38½ per cent of GDP over the same period".

    2) You miss the point on choice - the NHS is given a budget (like any major corporation) for a year to pay for wages, treatments, etc. A good thing about the NHS is access - you don't need to have £5000+ in reserves to get treatment. While, yes, this allows drug users to waste NHS money, it does allow the deserving (such as myself, and others who seldom have to use the NHS) to be treated. Also, those who are dependent upon the NHS for survival (such as those who are terminally ill and of special needs) benefit from the NHS because their lives are not prolonged depending on how much money they have. That compassionate point is a reason alone why the NHS is a good thing - because those who seriously need the NHS on a daily basis are given that help through the system we have.
    This makes little sense. A system of Medical Savings Accounts that are topped up for the poor would mean that instead of the money form your pay packet going to government for them to decide how to spend it, it goes to you. It's the same money, so I don't know why you're talking of needing to magically *find* £5K in reserves.

    Certainly it is easy enough to ensure universal coverage and access while reducing the burden on government introducing choice and competition, and incentivising healthy lifestyles through internalising the externality.

    3) And on choice, the NHS does have quite a bit now due to Public-Private elements of healthcare. For example, my Dental practice was purely NHS, but now it is mainly private. I could have went purely with NHS treatment, yet I opted for the Private treatment. Same waiting time, but I got a slightly different treatment.
    Sure, but that's only because of efforts to try to bring in competition into the NHS. Tell me, why do they bother, if it's not beneficial, and if it is beneficial, wouldn't you rather have that in far more areas?

    That reminds me, why the term 'Socialist Healthcare'? We are not Reds, my son. Why don't you call it 'State-financed healthcare'? It seems far more neutral.
    I haven't referred to it as 'socialist' healthcare, that was the OP. I wouldn't even refer to it as 'state-financed' - since that would include state-financed, privately-provided models such as Holland, France etc. which work far better then the NHS. Indeed, I either refer to the NHS (as I have in this thread), or to state-provided healthcare.

    This is the Health Bill we proposed, I think it's brilliant, and ensures the best of all worlds: http://www.thestudentroom.co.uk/show....php?t=1484835
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    (Original post by Aj12)
    So why is the UK healthcare rated higher than the US? None of the best healthcare systems are fully private. Most tend to be hybrid.
    This, I used to think that the NHS could do with full on privatisation but perhaps a hybrid system would be better... amazing how views change once you need to start using the NHS to the full
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    (Original post by Aj12)
    So why is the UK healthcare rated higher than the US?
    Because they make value judgements based on access and so forth. If you have decent insurance, the American healthcare system really is probably the best in the world.

    (Original post by jimbo139)
    In the USA, most people are weighed down by exhorbitant health insurance. Why? Because you are parasitized to fuel the profits of amoral health insurers and health providers. Your litigation culture is so out of control that your doctors have to order whole-body scans at the drop of a hat. In the UK, health services are not run for profit. Whether a patient gets a certain test or treatment is based on whether it offers reasonable health benefits, not on whether it happens to be profitable.
    Claiming that healthcare providers are amoral, and only citing an example of how they are forced to contend with ridiculous litigation from customers, hardly forms an argument. The 'exorbitant health insurance' they pay is the cost of providing treatment; here we simply pay it through taxation.

    As for treatment being based on medical need: it isn't. As an NHS patient, you simply won't get certain treatments because of cost.
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    Its quite amusing how accepting of certain state-financed institutions many in the US are but how anti-Universial Heathcare they can be.

    Perhaps if there weren't so many snouts in the private healthcare trough it'd be different.

    The 'exorbitant health insurance' they pay is the cost of providing treatment......
    Plus profit for insurance broker, medical service administrators, medical service providers and a whole list of other middle men between payment and service.

    As for treatment being based on medical need: it isn't. As an NHS patient, you simply won't get certain treatments because of cost.
    But you'll get some treatment. In the US, no money = no treatment, unless of course you can get yourself thrown in jail, then you can have all the treatment you need.

    A small example of the huge expense small injuries can cause in the US, even with medical insurance.

    Whilst mountain biking near Walled Lake, just NW of Detroit the other year a guy I was riding with came off his bike and popped his collarbone. As he was in great pain we did as you'd normally do, phone 911 and get the professionals on the scene.

    To cut a long story short, guy ends up having to go to a hospital in Ann Arbor as that is the one his HMO deals with, a pretty long journey from Walled Lake. As an extra kick in the teeth though the ambulance ride wasn't covered as it wasn't pre-booked and on top of that it was an operator that wasn't one of his HMOs approved operators. Ker ching, $7500 bill that his HMO wouldn't cover.

    Whilst there is waste within any state run healthcare system a purely profit driven one is far more dangerous.
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    (Original post by jesusandtequila)
    Indeed, sconzey is more illustrative than me:
    Thanks for the quotage. An aspect of #4 I missed is that were insurance bought by individuals, rather than groups, there would be strong incentives for the individual to maintain their own good health, to not go to the doctors unless necessary -- but when necessary, go, before it becomes more serious.

    As it is, you get very strong free-rider problems, but unlike a totally-socialised healthcare system, there's no social pressure on those who "game" the system. In many ways the poor yanks have the worst of both worlds.
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    (Original post by sconzey)
    .........were insurance bought by individuals, rather than groups, there would be strong incentives for the individual to maintain their own good health, to not go to the doctors unless necessary -- but when necessary, go, before it becomes more serious.
    But that is the issue. Such is the cost burden of actually using private medical insurance (hiked up insurance premiums) that many fear using their insurance at all and as a result it could actually be "too late" rather than the "go before it becomes too serious" you suggest.
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    (Original post by Martyn*)
    Maybe there should be a healthcare whereby you give what you can. If you are unemployed and need surgery or need medication to treat something you give a donation based upon what you can afford. If you are employed you give what you can. There should be some onus on people to keep healthy and fit as well. As a nation we are so unhealthy.
    Yeah.. it's called income tax
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    (Original post by jesusandtequila)
    Britain before the advent of the NHS.
    Because healthcare pre-NHS was a golden age right? :rolleyes:
    (Original post by jesusandtequila)
    But as I said, I'd support a hybrid system - I just think it's extremely faulty to critique the USA when many of its problems are caused by it not being a free market in healthcare.

    Indeed, sconzey is more illustrative than me:
    I am aware of the reasons why the US isn't a complete free market. However, this is like saying the motor industry isn't free market because it is constrained by regulations, insurance is mandatory, certain features are required on all cars etc. As a rough approximation, US is as close to a free market system as you can get in the Western world.

    With regards to specific points:
    i)I'm a bit concerned about the opposition to the AMA and licensing. No country in the western world allows practice with a license because quackery is so easy and common without it.
    ii)I never understand the opposition to the FDA in the US. FDA approval just means that the drug is deemed safe. It isn't mandatory for it's use, but the doctor would be liable if the drug caused problems. Individuals can request drugs off-licence. In any case, most drugs qualify for FDA approval from the initial trials that show it is effective anyway.
    iii)As for the US subsidising the UK for drugs, that's a load of *******s. Drug companies make a tidy profit from the UK - why would they do it otherwise? Are you suggesting they make a loss from selling drugs to the UK? They charge more in the US because they can, simple as.

    (Original post by jesusandtequila)
    I certainly wouldn't call that ripping apart the paper. Certainly it is not perfect and there are information problems, but it's well documented that European counterparts have better medical outcomes, and despite the closing of the funding gap, the outcomes gap hasn't closed. Pluralistic models with competition have driven up standards - no matter what you think of who should be paying.
    It's well documented that European medical outcomes are better than UK ones in the 90s. It is also well documented that the UK is improving at breakneck speed way ahead of all other european countries:



    Of particular note, we are set to overtake France heart disease survival rate (currently the best in europe) in 2012



    And our cancer survival ratings are closing too (although the data used to compare that - the Eurocare/Concord study - is decidedly dodgy and misleading anyway)

    With regards to your assertion that competition drives up standards in healthcare, the evidence for that is extremely mixed

    (Original post by jesusandtequila)
    Furthermore, you belittle the consumer experience, why?
    I don't dismiss it entirely, but basing the quality of healthcare on consumer indices alone (especially if flawed) is somewhat misleading. In any case, most other studies show that the UK performs very well in studies that take this into account.
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    (Original post by L i b)
    As for treatment being based on medical need: it isn't. As an NHS patient, you simply won't get certain treatments because of cost cost-effectiveness.
    Corrected.

    The NHS funds a number of expensive treatments, provided they have a proven benefit. Contrast this with other countries without the same cost controls and greater expense is incurred with minimal benefit. There's a reason many other countries are seeking to implement their own version of NICE to control medical costs.
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    (Original post by jesusandtequila)
    Sure, but that's only because of efforts to try to bring in competition into the NHS. Tell me, why do they bother, if it's not beneficial, and if it is beneficial, wouldn't you rather have that in far more areas?
    They bother because of ideology, not evidence. The NHS has improved drastically in recent years, but only because of increased funding. Competition was introduced in the early 80s under Thatcher but ended up producing some of the worst outcomes in the western world by the mid-90s.
 
 
 
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