The great debate of healthcare, private or public?

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Originally Posted by Sonic

I can see your position but I don't agree. At present I have private health cover because I am fortunate enough to afford it. However if my luck changed and I found myself unemployed and therefore insuranceless through no fault of my own I would still want to be treated should I suffer from a serious illness.

By getting me well and back to work the gov regains a tax paying worker. Whereas without the public health service I couldn't recovered an therefore would become a drain on other public services without being able to work and contribute towards their costs.

All hypothetical, granted, but I still feel happier knowing whichever way my life works out my health is as well protected as it can be.

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I understand your points completely and for most of us it boils down simply to a cultural bias. I can easily understand how someone who has been raised with a NHS in place would be reluctant to give it up, even if as you are, they are only using it for a safety net. But as you introduced a "what if" to the equation I'll expand on that.

If you found yourself unemployed and unable to land another job within 60 days or so then I'd guess that there are not too many jobs in your chosen field, or unemployment is high in general, or you are a really sorry hand and the word is out on you, or all of the above. In other words, there may not be a tax paying position available suited for rushing you back into. Depending on your age and condition the NHS may decide that providing you with maximum care simply isn't cost effective. Thats their choice, not yours. But here again, some treatment is probably better than none at all.
I do applaud your willingness to provide, at additional expense to yourself, better or more health care as opposed to sitting back and screaming that someone owes it to you.

Best of luck to you.

Mark, I just read your last book at the end of page one. Nicely done and well put.

Along with better administration of government programs, I feel we should be much, much more hard hearted in dealing with the people using them. Especially aid and poverty programs. Call me Max but I think anyone caught abusing the system should lose their benefits for 30 days on the first offence and lose them for life upon a second offense.

Nobody knows America's professional poor like Americans. When construction companies started cleaning up and rebuilding New Orleans after Katrina they ended up having to recruit and import laborers from other parts of Louisiana and other states. Of course they had to import skilled labor and craftsman too, but you should never have to import basic pick up debris labor. They were paying guys $12.00 an hour plus $50 per diem and providing lodging for their crews that were filling wheelbarrows with debris and dumping it into dumpsters. You see, all those angry black men you saw on the news standing around demanding help, were drawing government benefit checks and couldn't be bothered to work for a living. The work paycheck would have put 3 times the money of the benefit check in their pocket and they would have started learning skilled crafts that would have moved them into higher paying jobs. Nah, don't want it. They did supplement their benefit checks by robbing some of the workers early on but gave that up when they started getting shot for their efforts.

Mark my words, if Obama gets his "health insurance" down to the professional poor, the very first and most lucrative abuse wil be these people wandering in complaining of horrible pain in hard to dispute areas like the lower back and then skipping merrily on out to sell on the street that new bottle of perscription painkillers they got for free.

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Originally Posted by Mark in Oshawa

What people have to remember always is the public system, no matter how well intended is run by government, and government can do less with 1000000 dollars than the private sector can.

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Really?

In the UK the private sector can compete to supply services to GPs against NHS hospitals in particular sectors.

One area they tried to get into was hip replacements. Problem was, none of the private suppliers could match the price the NHS hospitals routinely did it for, and that was with the private suppliers merely cherrypicking the healthiest least complicated patients. I believe private suppliers promised the whole service for about £2800 a patient whilst NHS hospitals did it for £2200 or so with a proven track record.

The problem got so bad for the government which had essentially promised private suppliers contracts if they bid for them, that orders were sent directly from Whitehall to local hospitals to defer to the private suppliers in their locality regardless of the cost involved. This ensured business for the private suppliers and took it away from the NHS hospitals, reducing their income.

In fact if you look at some of the sweeteners the government has included in contracts to entice private suppliers, they have clauses you simply wouldn't believe, including no penalty for failing to deliver what has been promised in the contract. Essentially these private suppliers can't compete with publicly owned and run establishments without government subsidies. Thats private efficiency for you.

Unfortunately this whole thing about private being better than public doesn't hold true in many countries. I can think of quite a few places where public owned hospitals are a guarantee of first rate care whilst private is less secure.

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Originally Posted by Dylan H

Unfortunately this whole thing about private being better than public doesn't hold true in many countries. I can think of quite a few places where public owned hospitals are a guarantee of first rate care whilst private is less secure.

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Such as the US, where the best health care package is the government funded offering to the US Army. :p

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Originally Posted by Brown, Jon Brow

Such as the US, where the best health care package is the government funded offering to the US Army. :p

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The package may be good, but...well, every system has it's little problems.

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Originally Posted by Dylan H

Really?

In the UK the private sector can compete to supply services to GPs against NHS hospitals in particular sectors.

One area they tried to get into was hip replacements. Problem was, none of the private suppliers could match the price the NHS hospitals routinely did it for, and that was with the private suppliers merely cherrypicking the healthiest least complicated patients. I believe private suppliers promised the whole service for about £2800 a patient whilst NHS hospitals did it for £2200 or so with a proven track record.

The problem got so bad for the government which had essentially promised private suppliers contracts if they bid for them, that orders were sent directly from Whitehall to local hospitals to defer to the private suppliers in their locality regardless of the cost involved. This ensured business for the private suppliers and took it away from the NHS hospitals, reducing their income.

In fact if you look at some of the sweeteners the government has included in contracts to entice private suppliers, they have clauses you simply wouldn't believe, including no penalty for failing to deliver what has been promised in the contract. Essentially these private suppliers can't compete with publicly owned and run establishments without government subsidies. Thats private efficiency for you.

Unfortunately this whole thing about private being better than public doesn't hold true in many countries. I can think of quite a few places where public owned hospitals are a guarantee of first rate care whilst private is less secure.

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Dylan, let me ask you something? Do you think government spends the tax dollars you give it in an efficient manner? If you say yes, then there is no point in debating you on this, because I likely will say nothing that will change your mind. If you say no, then ask youself WHY governments who routinely waste and make billions disappear into a giant mass of bureaucracy would all the sudden make a system to provide the most vital services financially efficient?

Dylan, I live with public healthcare. IN the Province on Ontario, close to half of the provincial expenditures in the budget are for healthcare. At last count, I believe it was in the 47% range. This in one of the most highly taxed jurisdictions in North America. Yet we are short of doctors, short of some of the things Americans can get to and have waiting times issues in our emergeny wards, and for a lot of procedures. There is a shortage of GP's and this is completely due to the Province cutting back on the funding of medical schools because of budget issues from the mismanagement of the budget when the left wing NDP was in power. We have to face the reality. You have a giant bureaucracy that pays lipservice to efficiency, but the hospitals are forever fundraising for equipment that would already be in use in smaller centers of the same size in the US. We are not in the 3rd world, you sometimes wonder.

I see shortages in lab techs, I see shortages in services, often due to bureaucratic bunglling. You don't see this in a the US. THere, the services are often created through private healthcare companies reacting to the demand and opening up the door to new treatments. You have new technologies being developed because someone realizes their idea could make them RICH and therefore have a great incentive to provide them. That R and D pressure to make money creates new treatments and no ideas. No bureaucrat will do that.

Is private healthcare perfect? No...likely not, but spare me this fiction that the government can run an effcient excellent healthcare system. They run one that chews through a lot of money to get the effciency up to just ok. OK is fine for most countries, but in my mind should NEVER cut it. Canada has a pretty good or "ok" system. We have no worries as citizens about getting treatment, but we are going to wait for certain procedures, we may have to search high and low for a few years to find a new GP if we don't like the one we have, and there is a general sense by many who have sat in an hospital ward that the system is broke. We have ambulances being shuttled to hospitals farther away often because there is a lack of beds or a shortage of doctors available at certain hours. This is NOT a system that should be tagged as world class...but I can tell you when I saw my paycheck, I know I was paying for one when I saw what I was paying in provincial taxes, and with a special levy that was put on my pay to go for healthcare. I wasn't given a choice either.....

The instances you state are something I cannot comment on, but I do know this much: I have public healthcare, it is run by the government of Ontario, and it chews through one hell of a lot of money to give me ok service at best. I have no options if I don't like it because they outlawed private care. My best healthcare option if I have money is to go to the US if I don't like what is offered here. Many RICH Canadians do.....

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Originally Posted by Brown, Jon Brow

Such as the US, where the best health care package is the government funded offering to the US Army. :p

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It isn't the best package at all. And how much does it cost per patient? None to the patient, but the money spent to provide that service is likely more and yet 60 minutes and other US news programs have done scathing reports about the conditions in VA hospitals. Spare me the fiction about how it is the best system....it has bureaucratic bumbling all over it...

On paper, the package looks great. Active duty people wouldn't be in the VA system for the most part. They would be treated at on base facilities.

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Originally Posted by Mark in Oshawa

Dylan, let me ask you something? Do you think government spends the tax dollars you give it in an efficient manner? If you say yes, then there is no point in debating you on this, because I likely will say nothing that will change your mind. If you say no, then ask youself WHY governments who routinely waste and make billions disappear into a giant mass of bureaucracy would all the sudden make a system to provide the most vital services financially efficient?

Dylan, I live with public healthcare. IN the Province on Ontario, close to half of the provincial expenditures in the budget are for healthcare. At last count, I believe it was in the 47% range. This in one of the most highly taxed jurisdictions in North America. Yet we are short of doctors, short of some of the things Americans can get to and have waiting times issues in our emergeny wards, and for a lot of procedures. There is a shortage of GP's and this is completely due to the Province cutting back on the funding of medical schools because of budget issues from the mismanagement of the budget when the left wing NDP was in power. We have to face the reality. You have a giant bureaucracy that pays lipservice to efficiency, but the hospitals are forever fundraising for equipment that would already be in use in smaller centers of the same size in the US. We are not in the 3rd world, you sometimes wonder.

I see shortages in lab techs, I see shortages in services, often due to bureaucratic bunglling. You don't see this in a the US. THere, the services are often created through private healthcare companies reacting to the demand and opening up the door to new treatments. You have new technologies being developed because someone realizes their idea could make them RICH and therefore have a great incentive to provide them. That R and D pressure to make money creates new treatments and no ideas. No bureaucrat will do that.

Is private healthcare perfect? No...likely not, but spare me this fiction that the government can run an effcient excellent healthcare system. They run one that chews through a lot of money to get the effciency up to just ok. OK is fine for most countries, but in my mind should NEVER cut it. Canada has a pretty good or "ok" system. We have no worries as citizens about getting treatment, but we are going to wait for certain procedures, we may have to search high and low for a few years to find a new GP if we don't like the one we have, and there is a general sense by many who have sat in an hospital ward that the system is broke. We have ambulances being shuttled to hospitals farther away often because there is a lack of beds or a shortage of doctors available at certain hours. This is NOT a system that should be tagged as world class...but I can tell you when I saw my paycheck, I know I was paying for one when I saw what I was paying in provincial taxes, and with a special levy that was put on my pay to go for healthcare. I wasn't given a choice either.....

The instances you state are something I cannot comment on, but I do know this much: I have public healthcare, it is run by the government of Ontario, and it chews through one hell of a lot of money to give me ok service at best. I have no options if I don't like it because they outlawed private care. My best healthcare option if I have money is to go to the US if I don't like what is offered here. Many RICH Canadians do.....

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Mark, as I've mentioned Canada is not the centre of the universe and what applies to Canada does not necessarily apply to the rest of the world. The reverse is also of course true. We differ in our opinions because you appear to see things in plain black and white, in this case public bad private good.

I'm aware of the shortages of staff you have there, in my field a large proportion of that shortage is because of a migration of doctors and other staff to the US next door where they can earn more. Of course the Americans pay for that, they pay more overall for their healthcare than you do.

Also, regarding healthcare advances, why is it that a significant proportion of medical advances in current use are/were developed in Britain with a state funded healthcare system (depending upon your definition up to half of medical patents over the past century were registered in the UK)? Why is it that Japan is a leading power in medical technology despite again having an entirely publicly reimbursed system?

Again, comparing public systems in different countries is an exercise in futility. The American governments both at federal and state level spends more on healthcare (proportionately) than is spent on the NHS in the UK yet the latter provides pretty good universal healthcare while the former can only patchily provide care for the most vulnerable segments of American society. How are the two comparable in any way, whether looking at efficiency, funding or even organisationally?

I'm afraid that until you realise that your gripes with your local public funded system are not necessarily universal then there isn't any point carrying on this 'debate' either.

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Originally Posted by Dylan H

Mark, as I've mentioned Canada is not the centre of the universe and what applies to Canada does not necessarily apply to the rest of the world. The reverse is also of course true. We differ in our opinions because you appear to see things in plain black and white, in this case public bad private good.

I'm aware of the shortages of staff you have there, in my field a large proportion of that shortage is because of a migration of doctors and other staff to the US next door where they can earn more. Of course the Americans pay for that, they pay more overall for their healthcare than you do.

Also, regarding healthcare advances, why is it that a significant proportion of medical advances in current use are/were developed in Britain with a state funded healthcare system (depending upon your definition up to half of medical patents over the past century were registered in the UK)? Why is it that Japan is a leading power in medical technology despite again having an entirely publicly reimbursed system?

Again, comparing public systems in different countries is an exercise in futility. The American governments both at federal and state level spends more on healthcare (proportionately) than is spent on the NHS in the UK yet the latter provides pretty good universal healthcare while the former can only patchily provide care for the most vulnerable segments of American society. How are the two comparable in any way, whether looking at efficiency, funding or even organisationally?

I'm afraid that until you realise that your gripes with your local public funded system are not necessarily universal then there isn't any point carrying on this 'debate' either.

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Well Dylan, We can all use our local public healthcare or lack thereof as an example, but UN healthcare surveys were putting Canada on a pedestal for years. Yet all the issues I raised have been around. So someone isn't accurate.

Also, the Americans pay more for healthcare directly, but they pay much less in taxes, so it is a wash except they have more choice in how their dollars are spent. So I hardly say the true cost of healthcare in any nation is honestly appraised when the cost of public healthcare is masked in political smoke and mirrors. The much vaunted NHS has had all sorts of horror stories said about that in the press, so What is real? What is just myth? If the NHS is so wonderful, why would anyone take private healthcare? I would wager you do have a good system, but I am not there to judge. I am also going to say you are not here to judge our system either. I can just say this: IF the Canadian system was rated so highly by the UN not long ago, then why am I finding fault with it? Trust me, I have no desire to start paying for private insurance unless my taxes get cut, but I KNOW There is no going back.

As to your record of the UK and Japan's public system doing such wonderful innovation, understand this: Americans have provided most of the Nobel prize winners in Medicine in the last few decades. They must be doing something right there also.

I am not against the public system, but I refuse to by the myth it is BETTER. I am for a system that supports both, but the public system must never be bloated and run to the favour of those who work in it, as opposed to the patients.