The great debate of healthcare, private or public?

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Originally Posted by Fiero 5.7

In my opinion, the cost of many medical services is way out of line. In addition take someone with say, prostrate cancer. Maybe after 5 years of treatment and removals with the cancer returning each time, it's time the medical profession quit charging this man for the privilege of being able to experiment on him and started paying him for using him as a test bed. Nobody gives the profession lab rats for free, they have to buy them.

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I'll assume that paragraph isn't a joke.

The problem there is that your expectation is too high. You are not a car, replacing a faulty part does not mean the problem goes away. You're lucky the prostate cancer disappeared in the first place, unlucky that it came back.

No you (or the hypothetical you) aren't being experimented upon, otherwise you'd have had to fill in a battery of ethical questionnaires and consent forms. You are merely being moved on to the next battery of treatments available now that the first line has failed.

Medicine isn't a precise science and neither is it as effective as anyone wants it to be. It is also far far more expensive to run than you give credit for, the cost comes from the expense of researching the treatments you receive, and the running costs of medical establishments with all the equipment they require.

In the UK it costs £500 a night for a stay in a normal ward with just basic monitoring, no treatment. There's no profit there, that is what it costs per patient. Stay in intensive care for one night and you're looking at £5000 per night, again no treatment, just staying there and being monitored with nothing on top. No profit there either, just cost price. American costs won't be much different.

Those drugs you get, someone has to pay for researching them and the approximately 1000 or so others that get some way along the research pathway before they end up proving useless or dangerous. How much do you think it costs to research those drugs? How much of the profit gets taken away by losing court cases when drugs end up being riskier than initially projected? Entire drug companies have disappeared over the past few decades or have had to be bought out because the market is so tough. And its getting tougher as drugs get more expensive to research and fewer and fewer governments are prepared to pay for them.

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Originally Posted by Fiero 5.7

I worked with a guy that had an irregular heartbeat. He had always had it. His doctor, mainly by working through horror stories to his wife, finally got him into a hospital for a week of tests. End result, after insurance he still had to pay $1500, the doctor still didn't know what was causing it, and hot dogs, cheetos, and cigarettes did not make for a healthy lifestyle. No sh!t Rick, I would have warned you about the cheetos for $100. You can bet your life that the data from all those tests Rick paid for is being used for free by all those that track that condition in search of a profit.

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Are you also willing to put your career on the line and face millions in damages if your opinion turned out to be wrong?

I have to say though that the case you presented is something that is wrong with private healthcare (and I speak as someone who practices it too). The doctor has an incentive to go for expensive tests or procedures because he will get paid some of that. Your friend probably had tests that are either marginally useful for detecting the cause of his problem or totally irrelevant and he doesn't know better, purely for profit. Thats human nature I'm afraid, and something you can't get rid of if you give doctors incentives for generating more expensive tests and procedures. If you want a private free market healthcare system you'll have to live with its side effects.

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Originally Posted by Fiero 5.7

You are correct about following the money and the same applies to medicine. If people didn't go running to the doctor for every littlt thing nowadays, the prices would fall as doctors tried to attract patients. I think the health industry has done a great job of selling itself as something far more knowledgeable and necessary than they truly are.

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You might reduce charges a little but you won't fundamentally change the fact that medicine is an incredibly capital intensive industry. If you want truly cheap healthcare then abandon any pretence at wanting cutting edge treatments and settle for stuff thats twenty years old.

Dylan, in my situation, you said follow the money. Well here, the money is all in the public funded system. The public sector unions that have all the workers in the system are the ones with the most to lose. They do not want any private care, because they assume they alone are capable of compassion in the system. Listen, my mother was a nurse, and worked in the hospital for a very nice wage, but she also worked free lance for a year or two part time (she was in the hospital part time as well) with a nursing service outside of the public system. She was paid maybe 80% of her wage from the hospital BUT when you factor in income tax, the take home pay was a lot closer. So how is it the private sector couldn't do the job cheaper? Sometimes I know they may not, because alas, I know they want a profit, but there is no accountability to the public sector unions. They accept no responsbility for trying to save the taxpayer money, and consider public healthcare a sacred cow, except if they are at contract time, then they consider that right to strike (not nurses, but the support staff) sacred.

You have done a lot to educate and make me think about some of the hitches and conventions in healthcare, but one thing I am sure on is there is still room for more efficiencies in public healthcare, at least here...but the conversation isn't really allowed to start because of the fear of "American style healthcare" AS I have explained, this threat is the 3rd rail of Canadian politics.

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Originally Posted by Jag_Warrior

What frustrates me is that my dental plan will not cover braces. I don't need braces. And I don't have a child that needs braces. But what if I marry a woman with crooked teeth, and we have a child with crooked teeth. What then?!

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Ask her why her mouth is open without a d!ck in it. stop now jag.

I once lived in an area where a state issued "certificate of need" had to be in hand before, I thought, a hospital could be built. It may have applied to government financing. It was a long time ago.

A local board was created and construction was begun on a 400 bed community hospital. Everybody was thrilled until the local doctors realized the new hospital was to be a nonprofit hospital. They quickly formed an association and started building their own 300 but expandable to 600 bed unit about 10 miles away. There is nothing like working within or in close proxcimity to a profession to realize there is no nobility in any of them.

The local doctors boycotted the nonprofit unit. If the doctor's hospital was full, patients were sent to a city 35 miles away. A few doctors ignored the boycott and used the nonprofit hospital but not very many. Working at a hospital meant I got to learn quite a bit about how they operate. Doctors were expected to fill x amount of beds a month to maintain their priviiges. Bonuses for exceeding that amount. If a supplier came up with a really good deal on sterile, pre-packaged surgical kits for tonsils, then tonsils was the surgery of the month and each doctor was expected to deliver x amount of tonsil surgeries. Mind you, the nonprofit hospital wasn't playing by those rules. The nonprofit never had enough business to get that cocky.

The nonprofit went bankrupt and closed within 2 years.

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Originally Posted by Fiero 5.7

I once lived in an area where a state issued "certificate of need" had to be in hand before, I thought, a hospital could be built. It may have applied to government financing. It was a long time ago.

A local board was created and construction was begun on a 400 bed community hospital. Everybody was thrilled until the local doctors realized the new hospital was to be a nonprofit hospital. They quickly formed an association and started building their own 300 but expandable to 600 bed unit about 10 miles away. There is nothing like working within or in close proxcimity to a profession to realize there is no nobility in any of them.

The local doctors boycotted the nonprofit unit. If the doctor's hospital was full, patients were sent to a city 35 miles away. A few doctors ignored the boycott and used the nonprofit hospital but not very many. Working at a hospital meant I got to learn quite a bit about how they operate. Doctors were expected to fill x amount of beds a month to maintain their priviiges. Bonuses for exceeding that amount. If a supplier came up with a really good deal on sterile, pre-packaged surgical kits for tonsils, then tonsils was the surgery of the month and each doctor was expected to deliver x amount of tonsil surgeries. Mind you, the nonprofit hospital wasn't playing by those rules. The nonprofit never had enough business to get that cocky.

The nonprofit went bankrupt and closed within 2 years.

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Your story tho tells all of those in Europe that everything they believe about the American system is true.

AS for the non-profit, well if the gov't subsidized it, you would have: Voila, a public healthcare system.

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Originally Posted by Jag_Warrior

What frustrates me is that my dental plan will not cover braces. I don't need braces. And I don't have a child that needs braces. But what if I marry a woman with crooked teeth, and we have a child with crooked teeth. What then?!

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Funny you should ask. My 33 year old wife got braces 6 months ago. (She had couple of wisdom teeth removed and her teeth started seperating). Adult Orthodontia is not covered of course, so we treated it like you might an addition on your house. We went to three different orthodontists with good references and took bids.

It was instructive, one mentioned that the prices also included the retainer she would need after they are removed, so we checked and found the others had not included that in the price and yes she would need them. On the basis of their thoroughness and a 15% discount for lump sum payment up front, we went with them.

Now, does that mean actual market competition is the solution for what ails medical costs? I don't know, but I believe that like the funeral industry, medical practitioners also count on you not knowing the costs, and not negotiating because it's "unseemly"

My daughter was born with a congenital heart defect (repairable, thank Goodness) and had heart surgery at 4 days old. I got bills for all sorts of things from doctors I never met, related to all of this. I started questioning a few things, but was told not to worry about it, I was already at calendar year maximum out-of-pocket, and everything was 100% covered. Now, it may have all been on the up-and-up (i.e. doctors on rounds would review her chart and send us a bill.), but I've always had my doubts.

That said, I still prefer private as opposed to government run health care. I would like to see insurance treated a more as an emergency type service not unlike home or auto insurance, where people would know costs and pay for basic services out of pocket. I would also like insurance de-coupled from work. I think it keeps people in jobs that sometimes don't like, but feel like they cannot leave because of the benefits they'll lose. It's complicated, and there are no easy answers.

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Originally Posted by Fiero 5.7

As a general rule, one shouldn't be allowed to purchase additional rights or a better set of them.

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Originally Posted by Fiero 5.7

Amongst that, you do not have a right to healthcare but you do have the right to attempt to get all the healthcare you want by purchasing it, begging for it, bartering for it, conning them out of it, and you name it.

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Which is it? How do you explain this paradox?

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Originally Posted by Rollo

Which is it? How do you explain this paradox?

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I don't see a paradox per se. If you believe it to be a right, then you believe that from cradle to the grave, regardless of what you do or don't do, some third party is obligated to care for your health needs even if you never contribute one penny to the system.

Is voting a right or a privilige? You have one vote and the rich guy you absolutely hate has one vote. Neither one of you can go to the government and buy extra votes. Both of you enjoy the privilige of aiding and assisting your favorite candidate beyond casting your one vote for him. But, even if you do volunteer work 40 hours a week for his campaign and contribute thousands of dollars, when you walk into the polls, you'll still only have your one vote.

If health care is a right and the system is obligated to provide for your needs (the very definition of "needs" is a can of worms in itself), then it will attempt to do so fairly. If somebody makes more money and ends up paying more NHS taxes, that doesn't qualify them for any better care than the poorer guy gets. In other words, the extra money he paid in didn't buy him anything extra. Of course, since I don't know how the NHS works and is funded, I could be just talking out my ass here. But, if a man pushed a little harder and made and saved more money and wants to use it to enhance his health care options and services outside the system, then thats his privilige to do so. He might even work out a barter arrangement for additional care.

There will always be people that want more and are willing to work more, save more, and risk more to achieve their goals. And there will always be people that want more and intend to get it by taking it away from you.

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Originally Posted by Mark in Oshawa

AS for the non-profit, well if the gov't subsidized it, you would have: Voila, a public healthcare system.

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In a way, that was the problem. Full control of the hospital was to remain with the non-profit board and not The doctors. So even though the doctors could still scam their patients on their personal charges, the hospital refused to play the bonus game and of course by law, no profit sharing. It was a wonderful hospital, state of the art and no patients were ever turned away. It died of greed all the way around, from the doctors that couldn't milk it to the former patients who felt like they didn't need to pay an honest bill once they were feeling better.

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Originally Posted by Fiero 5.7

There is nothing like working within or in close proxcimity to a profession to realize there is no nobility in any of them.

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Hmmm I'm getting a strong whiff of hypocrisy here.

Fiero, you've been arguing over and over again that healthcare isn't a right, it is something that should be bought. You've talked about the benefits of a market system and how profit motivates hospitals to be efficient.

Then you've seen doctors firsthand playing the game not only by its rules but by the spirit of the rules as you want it to be played and you don't like it.

Which is worse, the doctor who works the system as its meant to be or the guy who demands that the system is the way it is?