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| Thread: Health Care in the Western World |  This thread is pages long: 1 2 · «PREV |
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mvassilev
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posted November 05, 2008 10:38 PM |
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Obviously, there's a role for government in the health care system. But that doesn't mean that we should have socialized medicine.
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JollyJoker
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posted November 05, 2008 11:06 PM |
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JoonasTo
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posted November 05, 2008 11:14 PM |
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I found this interesting passage about the Finnish healt care system in the wiki article:
"Finland's health care services are more highly socialized than the European average. The quality of service in Finnish health care is considered to be good and according to a survey published by the European Commission in 2000, Finland has the highest number of people satisfied with their hospital care system in the EU: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%.[2] Finnish health care expenditures are below the European average.
The main point here is the following: people seem to think that everyone in the health business is just REACTING on what you might call "the natural market". People get sick or injured, go to a doc get themselves a cured or repaired and that's it. But that's NOT it.
"Health" is much more than that. "Health" means for example prevention: a campaign for condoms to keep AIDS in check; mass vaccinations in school; mandatory newborn and baby checks; teaching the correct way to brush your teeth in kindergardens and schools; lectures in corporate offices about the right seating positions. All this things have to be researched before they can be put into action. And that's just to PREVENT sicknesses.
I don't see the point of this post. Care to elaborate?
And finnish healthcare system is being privatilised as we speak. Poor towns like mine are outsourcing it to cut down on the spending. And the finnish healthcare has been doing what you call money making for decades but not out of greed but stupididty, for example, if a guy had a condition that could be cured with surgery that's expensive but there are also meds available that'll help but cost less in a few prescriptions they'll point him to the meds. Now the guy's going to keep coming back for those meds for possibly years and it'll be much more expensive in the end.
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TitaniumAlloy
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posted November 06, 2008 12:43 AM |
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Europe, the US, Kanada, mostly. Israel, I suppose.
Capitalist countries with a high income per person NOT influenced heavily by other than Western medical culture. Japan doesn't count, since it's heavily Chinese influenced, medically.
As it happens the Japanese are the longest living people as well...
Actually Japan has a universal health care system, not dissimilar to the federal primary health care of Australia.
By the way, I wasn't calling Chinese medicine absurd, I was stating that if doctors only cured and didn't treat patients then that would be ridiculous nowadays as cancer patients would be left to die.
You then went on to contradict yourself and your confusion arose from the definition of the word cure so this point doesn't really matter.
However you didn't respond to my post in the other thread.
First you said
Doctor's do not cure.
Then you contradicted yourself by implying that that's what they were paid for in historic China:
doctors were paid only for CURING
??????
You argued over the semantics of the word "cure"
cure
n.
1. Restoration of health; recovery from disease.
2. A method or course of medical treatment used to restore health.
3. An agent, such as a drug, that restores health; a remedy.
4. Something that corrects or relieves a harmful or disturbing situation:
By this definition, doctors most definitely do cure people.
Treatment is treating the symptoms to aid the body in destroying the disease, which doctors do as well.
If a doctor applies antibacterial to a fungus infection that otherwise the body would not have destroyed, and hence restores the health of the person, the doctor has cured them of that fungus infection.
This is a fact.
The argument arose when Mytical made a statement that doctors will selectively choose to treat improperly or in preference to a possible cure in order to keep patients coming back for more income.
I rebutted it.
You joined in talking about something entirely different and irrelevant to the discussion, and also made the claim that doctors don't cure, which is relevant to the discussion, granted, but it is also wrong.
They do.
edit:
I agree with Joonas, I don't see the point of that post.
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mvassilev
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posted November 06, 2008 01:32 AM |
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Umm, why not, exactly?
Because that would just result in donut-eaters being treated at everybody else's expense, and also because costs would rise.
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del_diablo
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posted November 06, 2008 01:44 AM |
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And the finnish healthcare has been doing what you call money making for decades but not out of greed but stupididty, for example, if a guy had a condition that could be cured with surgery that's expensive but there are also meds available that'll help but cost less in a few prescriptions they'll point him to the meds. Now the guy's going to keep coming back for those meds for possibly years and it'll be much more expensive in the end.
We got a similar problem in Norway, but here its the lines for getting the operation. I mean, its forever and the goverment is still messing around telling hospitals to attempt saving money and killing local hospitals.....
But above example has happend several times...... Its a sin to sya itl ike that.
And there is a reason health care is not really thought of as a someting to farm money of, because its paid by taxes and thus its a yearly budget. Aka it will just be the payment for the hours of work and the cost of the work(meds, equipment, etc) that will cost money.
So its a job, but you will likely save peoples life and help them.
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Minion
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posted November 06, 2008 01:48 AM |
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Edited by Minion at 01:50, 06 Nov 2008.
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Quote:
Quote:
Umm, why not, exactly?
Because that would just result in donut-eaters being treated at everybody else's expense, and also because costs would rise.
That is so so funny coming from a person living in a nation with one of the most expensive (yet ineffective) healthcare systems in developed countries... 
@Joonas & TA: I think JJ meant that Finland is not a good example of European health care standards, because it is actually more socialiced than on average. And I talked about Finnsih health care, as I have experienes of it. It hasn't got much to do with JJ:s point really, it was just me having problems with him using Western World in the topic..
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mvassilev
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posted November 06, 2008 01:55 AM |
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Yes, but that is partially because, as JJ said, we are being overtreated. We go to the doctor for every little thing, and what is the doctor supposed to do? Say, "You don't need anything, just go home and drink plenty of fluids."? No, and not just because doctors are working for profit. If any doctor would tell people that, then some of his patients would go to a different doctor who would try to treat them in some way.
That's a cultural/social problem, not exactly a problem with the actual medical system.
Second, it is because the concept of insurance inhibits competition. Government intervention should increase competition, not stifle it even more.
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JollyJoker
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posted November 06, 2008 08:31 AM |
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Ok, one thing after another.
Minion answered JoonasTo already, and I think I can answer this and mvassilev in one go.
So let's see, if there is no general public health care system, there is the problem, that people with low or no income can only hope not to get sick, because as a rule they cannot afford a private health insurance. This, as we see in the US, leads to appalling differences in life expectancy between rich and poor, due to a generall lower health, especially teeth and so on.
A private health insurance works like any other insurance, since the contract is actually stating what is exactly is covered by the insurance, and - naturally - it is geared to make a ptofit for the insurance company. As with every insurance that means that Joe Average is paying more for the insurance than he would pay for his actual medical bills - but then no one knows whether someone is the Average Joe or not, so this is a case where not having an insurance and making a gamble out of your health is problematic, to say the least.
Now, for private health insurance, the company actually doesn't care about costs, because it simply adjusts the premiums each year - which means, it gets more expensive all the time, since there actually is no one who checks on prices or something. And as soon as you are insured, YOU aren't checking on prices either - it's covered, after all, so why should you?
That leaves the system wide open, obviously. In general, every doc knows what the insutance is covering or not, and if you come to a doc because of some problem, of course the docs will do anything they possibly can do to earn a maximum of money with their patients, while the patient doesn't care for costs - except that they get a feeling of being cared for.
You have to realize that the question is not anymore, what treatment is right for that patient. The question is, what treatment is possible, can be justified and will be paid for by the insurance.
A public health care has an obvious advantage for the poor, therefore there is no way around it.
Here the costs explode as well, and whether this is paid for from general taxes or from special health taxes, it seems to create a big whole.
Basically the reason is the same as with private health care. However, there are other factors: care for elderly people and costs for the treatment of the terminally ill and old-aged are rising fast. You can spend any amount of money for it, actually, and it becomes, of course, an ethic question of how much care in terms of value can a society afford to spend on those. In other words: do we have the money to do for everyone everything that is possible to keep them alive as long as possible?
Not in acapitalist system with socialized costs, it seems.
Of course the government is trying to keep the costs in check, but the main instrument is taking things out of coverage. In most countries, I think, the last years have seen dental care taken out of general health coverage - something we've been proud of to put INTO the general healt care not two full generations before. Another thing they try to get a lid on costs with are the prices for drugs, but that doesn't work as it should, for different reasons, depending on the country.
Now MOST of the measures to reduce the costs are on the expense of the patients - or the sick, to be more specific, because they are treated not as well as they should be treated: the docs will earn more with the privately insured patients. (I am a privately insured person and some things you will see are really appalling.)
Anyway, the bottom line is this: if you are publicly insured there will be tendency for undertreatment for several reasons depending on the actual limits of the insurance situation of the country. If you are privately insured there will be a tendency for overtreatment.
The reason for this is in both cases the potential and actual money that can be earned with you AND YOUR AILMENT. I wouldn't go as far and say that a doctor is rubbing their hands when they are examining a real expensice case... but heck, you have to take them as they come, have you?
For sure, the hospital board will be happy when their beds are fully covered, because that means that they work with 100% efficiency.
As mentioned, health is not just the costs for the actual sick - if you are the government, you'll have to think about methods of prevention (and I've named a few). There will be studies for lots of things - the last one I heard was the effect of toner cassettes of laser printers and xeroxes on the body, and the fine dust that will saturate the air when refilled or changed is extremely dangerous for your health, so people working in large offices with lots of those that are heavily used are living dangerous.
Moreover there are treatments that are dangerous or considered dangerous or not ok - which often comes with additional costs: an example for this is dental amalgame. Note, that this not only has a toxic effect on those who have the Mercury in their fillings - it has an effect on everyone - as with lead in the gasoline - since there are no regulations for filtering dental waste, and dentally used mercury is responsible for ONE THIRD of the mercury that's circling around in the water and the food.
Anyway, since health is such a sensible issue, it's actually pretty difficult to tell wrong from right and misspending from necessary costs. Which of course works FOR the people who spend the money, if you know what I mean. It's fairly difficult to actually rule a treatment definitely out as waste of money, and if someone does, you can bet that some doc will offer the service anyway - and will have patients all over the place.
The underlying reason is of course that most people have no idea about their health and how things work, what a treatment does and so on - they have to trust someone.
We wouldn't live in capitalism, if that wasn't taken advantage of. Health is a Seller's business - you have to sell people things. This has been always so - people would make the sales tour with a wonder tonic curing all kinds of stuff, from a bad stomach to a cold and a tight nose, getting no air, and people would buy it - you never know. However, no joke, about 125 years ago, chances were said tonic would indeed do what it promised. It would be cocaine - which was legal and cheap at that time and was in, you guessed it, Coca Cola (and three guesses, when the company had to decide on which part of the name to protect legally they decided on "Coca"  ) as well - in water, and it did everything it promised to do. A lot of people used to have some of that stuff at home - so many and with such success that the actual business of the doctors in that time was declining very much. Which is the real reason why it got illegal: the docs wanted it. The actual reason was some grotesque thing about how blacks on cocaine would rape wjite women and stuff, but the real reason behind it was the fact that it cutted on the profits of doctors, and this no joke.
Anyway, health is something to still sell to the people, and it's easy because people's fear is on their side. Today most everything is a reason to to to the doctor. Everything has to be found as early as possible, checked and rechecked for, examined and re-examined. In earlier times people would just KNOW when it was time to visit a doctor because they would listen to their body. Today people run to the doc because they need reassurance. No, it's not terminal, a harmless infection, no problem, it will go. 30 $, please.
Now, @TA
Let me make it clear, that when you came in the discussion was already on and overtreatment was the issue, but you decided to pick on a certain statement of Mytical who said that docs wouldn't want cures because then they couldn't treat anymore. Of course that's wrong. It's wtong because of many reasons, not the least of which is that there will be always money to make from, cure or treatment, and prefarably both. Because it looks like every cure comes with a price.
But one thing is clear: it's not the DOCTORS that are responsible for the cures, it's medical science. A recent example is Alzheimer disease; it's looks like a cure may have been found by medical science. Now let's wait how this will translate into treatment and costs. But again: it's not like a doctor invented this or something. If you ARE treated, it's because the doc just KNOWS there is such a possible treatment. The actual job of a doctor is the EXAMINATION, that is, they listen to you and your health problems, then try to pinpoint the problem, then suggest the best possible treatment depending on the knowledge about possible treatments they have. Ideally money should not be a factor, but quite obviously it is.
Should a doctor say I cannot treat you? Of course! If he does not, the time he wastes on that person is time lost for the examination of others. Too many people are treated that don't actually need or are beyond any treatment.
So, is Mytical's statement wrong? Yes, of course, but only because the system is a bit more subtly working.
Now for the curing thing. I agree, that there was a semantic problem.
Chinese docs would be paid if they could solve the health problems of a patient. Note, that this has been an incentive to actually try and understand exactly what the problem of the patient is, and to try and develop medical procedures that actually work. Which is the reason why the Chinese medicine was so advanced (and Japan has been heavily influenced by it, so the whole medical scene on street level is very different from the scene in the west, no matter their health system and who pays what).
The actual situation between a doctor and a sick person can be one out of 3:
a) the doc is pretty certain, the patient will eventually become healthy again, with or without his or her help.
b) the doc is not certain
c) the doc is pretty certain he can not help.
In case a the doc will get money for sure. He will do something for the patient. In general - we are not talking of modern times - the doc will get from the patient, what the patient feels is worth the while/can afford.
In case b the doc risks something, but it's a chance on actually earning something. He is in the same situation than a lawyer who accetps a compensation case for a percentage of the compensation: it seems to be no problem either, not for a good doc at least.
In case c he will say so. There may still be an arrangement between doc and patient about payments to be made for his (probably in vain) efforts. The patient may try his luck with someone else.
The bottom line is that today you wouldn't get money for UNSUCCESSFUL treatment: A botched operation; half a year of chemo therapy with the patient dying on month 7. I don't think it would be bad. And don't come with something like, without the chemo the patient may have died in month 2; that may well be, but if you ever have seen a terminally ill person shuffling through chemo only to die a couple of weeks later you might have second thoughts about it.
So there is nothing absurd about it because it would make people concentrate the costly efforts on those with a chance. Those without a chance would have to pay themselves, and living in a capitalist system it would be absurd if it wasn't so (and in fact it is so anyway).
The alternative is a completely socialized system with frozen prices for supplies and drugs and fixed salaries in the health business (which didn't have to be low, of course; as it is, hospital staff is being underpaid in capitalism as well), with the saved money going into research.
Lastly, TA, docs HERE IN WESTERN CIV are not curing, as I said. Because they don't NEED to. They are paid, no matter what: for treatment, no matter how successful. Curing is like an afterthought. "Being in medical care" is the important thing, and it's not success oriented, since there is no incentive to be successful in the interest of the patient. Sure, if someone has a heart failure and someone tries to bring him back, success is rather easy to see. But in the majority of cases - the bread and butter of the business - it's not that clear. Try people who have "a bad back".
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JoonasTo
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What if Elvin was female?
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posted November 06, 2008 12:32 PM |
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Yes, but that is partially because, as JJ said, we are being overtreated. We go to the doctor for every little thing, and what is the doctor supposed to do? Say, "You don't need anything, just go home and drink plenty of fluids."
That's exactly what they say here most of the time. Or at least they used to. Not sure if the privatising has affected it. The doctors are still the same though so I think they'd still act the same.
I've been to doctor only four times. Once for a broken arm. They didn't believe it was broken and would have just sent me home but my father (physiotherapist with enough specialisations to make the right term unpronounceable) insisted on taking X-rays.
Once for a flu that lasted for three weeks. I protested against it but my father dragged me there. The answer was just take it easy and drink enough warm juice. Got to snap my father about it. 
And once for a broken toe but that was kinda too obvious for them to sent me home without taking a look. Plus my mother would have probably butchered the poor guy on his next day of work. 
And once for an ankle that had achilles tendon damaged. Again they would have just sent me home without any help. Luckily there was a familiar nurse there who gave me walking sticks and a bond to my ankle. Next school week would have been a pain without the sticks. I wouldn't have been able to get to school since it's on top of a hill and it was winter. My injured leg couldn't carry any weight at all. 
So in three cases out of four the docs would just sent me home without delving any further. That's mostly lazyness the way I see it.
I'll read JJs reply after I get back from work.
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Moonlith
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posted November 06, 2008 12:36 PM |
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"When my doctor tells me my kidney has to come out, I don't know wether he is trying to pay off a yacht, or wether my kidney has to come out. It is very hard in a monetary system, to trust people. Because in a monetary system, you have profits."
~ Jacque Fresco
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JollyJoker
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posted November 06, 2008 01:10 PM |
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So in three cases out of four the docs would just sent me home without delving any further. That's mostly lazyness the way I see it.
I'll read JJs reply after I get back from work.
I take it, you are not privately insured.
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del_diablo
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posted November 06, 2008 04:40 PM |
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Quote:
So in three cases out of four the docs would just sent me home without delving any further. That's mostly lazyness the way I see it.
I'll read JJs reply after I get back from work.
I take it, you are not privately insured.
Hes not living in America, insurance is for when you crash and your bike breaks.
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JollyJoker
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posted November 06, 2008 05:04 PM |
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I thought, he was Scandinavian at least.
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JoonasTo
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What if Elvin was female?
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posted November 06, 2008 05:08 PM |
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Edited by JoonasTo at 17:14, 06 Nov 2008.
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I don't see any thing worth pointing out in your long post JJ. It's mostly a good analysis. And points out most of the capitalist health system.
I see you do not know anything about finnish healthcare though. It's very different from Germany(I am familiar with the German healthcare system btw.). We do not have private insurances for the healthcare like you do. I am insured privately in every kind of way including health but it's a different from germany where the docs get payed more from private insurances than public and might actually only take the privately insured ones.
The finnish healthcare system is "free". Everyone must pay the public health insurance and they get free treatment in exchange. You may choose to go to private doctor but then it won't be covered by the insurance so it's your stupidity. The public doctors treat everyone and they get monthly pay that doesn't depend on their patients. (and is way too big if you ask me)
Any questions?
EDIT: There's the profile button under the post from where you can check from where the people are.
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mvassilev
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posted November 07, 2008 01:46 AM |
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JJ:
Indeed the fact that the poor can't afford health care is a problem. This is why I'm suggesting my "proportional pay" health care plan.
As for describing the insurance system, you're right on the spot. There is little incentive to cut costs, and considerable incentives to raise them. But the problem is not the fact that health care is private, but because there is little competition. Government intervention should serve to increase competition, not stifle it.
Not covering things is indeed a solution, but where does one draw the line?
On the other hand, the US has much better cancer detection because the people are more vigilant and aware, and are more concerned about it.
Though I agree with your analysis, I don't see why total government control of the health care system is a solution.
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TitaniumAlloy
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posted November 07, 2008 02:47 AM |
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Of course that's wrong
Good. Glad we cleared that up.
However I disagree that doctors do not cure.
While medical scientists invent the cures, doctors in alot of cases will administer this cure, which is what is meant by the doctor curing you.
It doesn't mean that the doctor invented the cure, no, but doctors still cure patients of alot of diseases.
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JollyJoker
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posted November 07, 2008 08:33 AM |
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Though I agree with your analysis, I don't see why total government control of the health care system is a solution.
Because there can be no competetion in Health care:
1) While in every other sector things cannot be cheap enough - IF it's cheap enough and it's trash you can always throw it away and go for something new -, this obviously doesn't work in the Health department because here everybody wants QUALITY for obvious reasons; and as everybody knows, quality doesn't come cheap. So you might say, that too low prices in the health department may have the opposite effect, keeping people away, since cheap may be too cheap.
2) There is no objective way to compare medical services. The first problem is that cases are always individual. While an appendix is an appendix, there are still differences, and just because a doctor managed well until now doesn't mean, they will manage well with you, which is actually all that counts for you. With everyday medical work like dentists the only way to go is to test a couple of them personally - different people like different styles. Note again, that price is not that important here: if you cannot stand a dentist, you won't go to him just because he works cheaper than the nice guy 2 streets away who has this cool assistant.
3) There are practical reasons as well: if you have to drive an hour to and an hour from you don't save anything, just because you get the same service a bit cheaper. Which means that, for example, the doctors in a suburb, where there aren't so many, will be frequented, no matter what.
Moreover the government is involved anyway:
1) Laws have to be made governing a plethora of things, for example the conditions, when and how to clear a new drug for public use, what to teach in school, what you have to do to become a doctor, who is allowed to be called so.
2) Public health issues like containing plagues (which means organising vaccinations and making sure that the poor quarters arenÄt too ramshackle and so on). All in all this is one of the reasons for public health care anyway.
3) Laws on how to proceed with abortions, terminally ill and so on. What has to happen with severely handicapped without any next kin.
4) Campaigns, like with aids, polio and so on.
5) Whether someone, if ill, has a right to be treated, even if they can pay for it - which would be covered by public money anyway.
I'm probably forgetting a lot.
So. The business is pretty delicate. It involves drugs. It involves a lot of blind spots with people. It involves more fraud and corruption than everywhere else (for example, wrong claims to the public health insurance by doctors; the insurances cannot check with every patient whether they were served like the doctor claims or even served at all). And it involves a lot that is government responsibility anyway. That means, for me, you have to socialize the whole system.
Another necessary step would be to enforce ONE medical system for ALL cizizens, including doctors.
Now, I'm not blind to the disincentive nature of getting a fixed pay for everything or having to pay nothing for services.
However, insurances, have long solved that problem with the deterrent fee (and an apt name it is). I'm all for a general health insurance, but I'm all for a deterrent fee for the SMALL stuff as well. Small stuff is no problem anyway. Moreover, doctors should be paid for their work, but they shouldn't be paid for the "amount" of work (the number of treatments, so-to-speak, since that has obvious negative consequences): they should be paid depending on the satisfaction of their patients. It seems to work well in general - everything is rated nowadays and in fact something like ebay is based upon it - and a satisfied PATIENT is a thankful patient. Which would mean a payment system that would be a mix between fixed salary and satisfaction bonus per satisfied patient.
The same could be done with drugs. If someone is treated for something with a drug and gets a rash then, that is worse than what he was initially treated for, he won't be satisfied. Consequently for HIM the company manufacturing the drug should get LESS money: actually only the money the druf actually cost them to make.
So I don't see anything wrong with the government taking full control
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