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mvassilev
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posted March 02, 2013 09:57 AM |
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JJ:
It "works"? What does that mean? I assume the NHS doesn't pay for every treatment someone wants, otherwise costs would spiral out of control. That means they have to make decisions what to treat and not treat. But what motivation do they have to make correct decisions? Especially without a free-market price mechanism.
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JollyJoker
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posted March 02, 2013 10:07 AM |
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Not in the sense that the government would operate them - like the police, for example, or the tax office.
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artu
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My BS sensor is tingling again
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posted March 02, 2013 10:11 AM |
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Quote:
But what motivation do they have to make correct decisions? Especially without a free-market price mechanism.
Well, call me naive but how about something called the Hippocratic Oath?
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JollyJoker
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posted March 02, 2013 10:11 AM |
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Quote:
Quote:
The problem is, that in the health "business", people are paid for doing something, not for SUCCESSFULLY doing something.
I see the problem with that, but consider the problem with the opposite situation - suppose you're sick and it's likely that you won't get better (but recovery is still possible). What doctor would treat you, knowing that even if they do everything as well as they can, you'd likely still get worse (and so they wouldn't get paid)? At least with health care being paid for in terms of procedures rather than outcomes, people who are sufficiently unlikely to recover wouldn't get any treatment.
I wrote that this kind of treatment should make NO PROFIT.
The general difference - and this is now a GENERAL remark rather than an answer to you - is whether you see the "health system" as a SERVICE or as a BUSINESS.
I think, it's both, but TREATMENT is SERVICE and should be paid as such, while SUCCESSFUL treatment is good business and deserves profit.
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mvassilev
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posted March 02, 2013 11:00 AM |
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artu:
Bureaucrats don't take the Hippocratic Oath, and even if they did, how would it help in this case? The only relevant part I see is "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone", which doesn't give much guidance as to whether to treat a 60-year-old cancer patient.
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Eccentric Opinion
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artu
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My BS sensor is tingling again
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posted March 02, 2013 11:25 AM |
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Edited by artu at 11:30, 02 Mar 2013.
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Quote:
artu:
Bureaucrats don't take the Hippocratic Oath, and even if they did, how would it help in this case? The only relevant part I see is "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone", which doesn't give much guidance as to whether to treat a 60-year-old cancer patient.
Bureaucrats wont be the ones making the medical decisions, will they. And the boards of management will surely include people who are doctors. I don't know the details of the US system on this, I am not specifically talking about US. But in general I can tell you this, health care is business in the sense that it should be self sufficient and shouldn't go bankrupt and of course doctors should make a living. But it is certainly not a field that can work as it should with the dynamics of free market capitalism which only and only aims HIGHER profit. As JJ pointed it out, health care is also a BASIC SERVICE that any government owns to its people. Think of roads, can you say I have a jet so I don't have to pay taxes for highway construction? Are bridges collapsing because governments aren't structures purely based on profit?
Since we wont go back to "elder woman of the village boiling herbs" as health care, modern medicine is something everybody is dependent on and not capable of producing themselves. So the state should give at least minimum health care to all of its citizens at a modest cost.
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mvassilev
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posted March 02, 2013 11:41 AM |
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It's easy to say "the government owes citizens health care". How would the government determine the correct amount and quality of health care? As I explained above, "the Hippocratic Oath" isn't an answer - the Ancient Greeks didn't think of having a clause about cost management in it. Who should be able to get certain surgeries? Should an 80-year-old man be able to have a taxpayer-funded surgery that prolongs his life by a month? A year? What if he's 70 and it would prolong his life by 10 years? Does it matter how difficult the surgery is, and how many surgeons there are who can perform it? If the government is paying with taxpayer dollars, what's the incentive to get these numbers right?
Quote:
Think of roads, can you say I have a jet so I don't have to pay taxes for highway construction?
You should be able to opt out of paying taxes for government roads. You could have tolls instead.
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Eccentric Opinion
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Zenofex
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posted March 02, 2013 11:41 AM |
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The concept is really simple: bad health = bad productivity = lower (or no) profit. It's not hard to understand now, is it?
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artu
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My BS sensor is tingling again
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posted March 02, 2013 12:01 PM |
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Edited by artu at 12:03, 02 Mar 2013.
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Who should be able to get certain surgeries? Should an 80-year-old man be able to have a taxpayer-funded surgery that prolongs his life by a month? A year? What if he's 70 and it would prolong his life by 10 years? Does it matter how difficult the surgery is, and how many surgeons there are who can perform it? If the government is paying with taxpayer dollars, what's the incentive to get these numbers right?
These are questions for the people whose job is to manage these things, they are the details and I won't pretend I have the answer to them. But that doesn't mean there is no answer to them. Once you see health care as basic service, you'll have the qualified staff to decide.Hippocratic Oath is rather a symbol of decency in our age, that's why I mentioned it.
And okay, take roads out of the budget, use tolls instead. I'll give fire department as an example then, the point is basic services are not scaled on the demands of this or that tax payer, they are scaled according to the general population. Or you can always go back to the crawling days of modern democracy where only people who had property and business had the right to vote.
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JollyJoker
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posted March 02, 2013 12:02 PM |
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Quote:
JJ:
It "works"? What does that mean? I assume the NHS doesn't pay for every treatment someone wants, otherwise costs would spiral out of control. That means they have to make decisions what to treat and not treat. But what motivation do they have to make correct decisions? Especially without a free-market price mechanism.
Mvass, that level of discussion is useless: we are not talking theory here, but practise. The British system IS WORKING like that (and the US has theirs). The Brits are at 10% costs of GNP, the US are at 19%, which is nearly double as much. Nearly half of that - which means practically the money paid privately in the US (47% of 19%) is in excess of that.
Now, if anything, all relevant statistical data in the UK about this are better than those of the US, and while that doesn't necessarily mean that the health care is better in Britain, what it does mean (very probably) is that a higher percentage of people gets ADEQUATE treatment. FOR LESS MONEY.
So that's facts - why would we debate of how people are to be motivated? I'll tell you one thing: the whole doctor's business reminds me of the highpriest business in ancient cultures. It's a lot of hocuspocus that profits from taboos. I mean, how do you motivate the police to do their job? Especially without a free-market price mechanism? Should we pay when we need the service of the police? "Officer, my house was burgled, while I was away." "Sure, we can investigate, but you will have to pay 500 bucks per officer and day."
It wouldn't take one day, until somewhere, anywhere you had the first racket of cops burgling and then get paid to investigate, direct consequence of a monopoly.
Now, with the health business, the really interesting things are "pressing". There isn't really a market mechanism involved - it's like with the fire department: if there's a fire somewhere you don't check prices of the various fire departments, the next one is coming. Same thing here. If you live in New York you won't fly to Texas to be treated. So that means, since health care is essentially A SERVICE needed everywhere and anywhere, there is no competition.
But I'm repeating myself here.
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JollyJoker
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posted March 02, 2013 12:18 PM |
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Quote:
It's easy to say "the government owes citizens health care". How would the government determine the correct amount and quality of health care? As I explained above, "the Hippocratic Oath" isn't an answer - the Ancient Greeks didn't think of having a clause about cost management in it. Who should be able to get certain surgeries? Should an 80-year-old man be able to have a taxpayer-funded surgery that prolongs his life by a month? A year? What if he's 70 and it would prolong his life by 10 years? Does it matter how difficult the surgery is, and how many surgeons there are who can perform it? If the government is paying with taxpayer dollars, what's the incentive to get these numbers right?
Quote:
Think of roads, can you say I have a jet so I don't have to pay taxes for highway construction?
You should be able to opt out of paying taxes for government roads. You could have tolls instead.
1) The difference is THE COST. If a surgeon is a government guy, he's paid by the hour. He may get a very good salary, let's say 100 bucks an hour, but that still means that a complicated heart surgery that takes 3 surgeons and 6 hours plus a couple of nurses and orderlies will still cost something like maybe 4000 bucks. What does it cost in the US, though? 100 grand? 200?
2) Toll system does NOT work, since there is no competition: you can't build an unlimited number of roads. So this works basically by competing for a government contract. The government decides, we need a highway from A to B. The contract will likely be coupled with some conditions, still, the corp that gets the deal will be interested in minimizing costs while maximizing profits, which means a minimum in (contractually obligated) maintainance and a maximum within the limits of what you CAN toll.
Ultimately this leads to a generally higher price level. Business people will simply add the toll their vehicles pay to their product prices, since the consumer will have to pay for the profit the tolling company is making.
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xerox
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posted March 02, 2013 01:04 PM |
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Edited by xerox at 13:10, 02 Mar 2013.
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I really don't think hospitals would do worse if they saw it as their job to provide healthcare instead of making profits. Of course, you can combine the two by providing better healthcare at a cost. Private hospitals will relieve state hospitals of some patients and that's good.
The point is that every citizen, no matter income, should atleast have access to basic healthcare. Or even more than basic considering that somehow American healthcare manges to be of a larger expense to tax payers than what the public healthcare is in many european countries. As Zenofex implied, the absence of healthcare for low-income people will also hurt their productivity and consequently, the economy as a whole.
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Over himself, over his own
body and
mind, the individual is
sovereign.
- John Stuart Mill
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markkur
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Once upon a time
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posted March 02, 2013 04:41 PM |
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@JJ
Quote:
I think, it's both, but TREATMENT is SERVICE and should be paid as such, while SUCCESSFUL treatment is good business and deserves profit.
There's a snag to this line of thought and that's something I bet most people do not consider today; healthcare is often no more than the old fashioned concept of "practice".
Practice implys to me far more I'll "try" to help you, than my old notion of medical gods I once visited. Usually, better doctors have been practicing the medical-arts for a longer time and have been exposed to more conditions & treatments. My 13 yr. health-issue has meant an incredible amount of money spent by myself & insurance (now Gov-disability) for very little success.
To your point; what little success has been purely the service of comfort-measures and nothing to do with a successful diagnois and treatment of my worsening disease.
@all
<imo> I think the real enemy regarding cost of health care that has to be dealt with 1st is the legal profession's dominence of the medical field. I know for a fact that many doctors left my state when mal-practice premiums and liabilities skyrocketed. Seriously, due to health-litigations; I think that many doctors look at poor patients more as a huge risk, than someone needing help.
i.e. In my case, as the patient and owner of my body, I should be able to sign a waiver of liability and "try something...anything" if it's my sound choice. However I can't, so medical science cannot learn from my misery and help others that follow in my path. Bad enough that an unknown-something can knock us out but this makes it much, much worse.
I realize that my illness is not the norm of health-care issues but this topic is all encompassing unless, as others have said, there is a division made; like only treatment of flus, infections, fractures etc.
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Elodin
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posted March 02, 2013 06:07 PM |
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Edited by Elodin at 18:07, 02 Mar 2013.
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The US has the best heath care in the world. Once Washington gets its filthy claws on it that will change. And anyone who thinks health care won't be rationed is living is some kind of loony-tunes cartoon land. And it will be rationed about by politically appointed bureaucrats.
Clicky
Quote:
In April, the British Medical Journal published an article about two studies conducted by the New York-based Commonwealth Fund. The studies compared the healthcare systems of 14 advanced countries, and on the 20 measures of comparison,Britain'scentralized National Health Service performed well in 13, indifferently in two and badly in five.
On several measures, the NHS came out the worst of all the systems examined. For example, it ranked worst for five-year survival rates in cervical, breast and colon cancers. It was also worst for 30-day mortality rates after admission to a hospital for either hemorrhagic or ischemic stroke. On only one clinical measure was it best: the avoidance of amputation of the foot in diabetic gangrene.
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Traditionally, the NHS has been inexpensive compared with most healthcare systems. But this reality is changing quickly. The NHS was inexpensive in part because it rationed care by means of long waiting lists. I once had a patient who had waited seven years for a hernia operation. The surgery was repeatedly postponed so that a more urgent one might be performed.
Such rationing has become increasingly unacceptable to the population. This was the ostensible reason for the Labor government's doubling of healthcare spending from 1997 to 2007. To achieve this end, the government used borrowed money and thereby helped bring about our current economic crisis. Waiting times for operations and other procedures fell, but they will probably rise again as economic necessity forces the government to retrench.
But the principal damage that the NHS inflicts is intangible. Like any centralized healthcare system, it spreads the notion of entitlement, a powerful solvent of human solidarity. Moreover, the entitlement mentality has a tendency to spread over the whole of human life, creating a substantial number of disgruntled ingrates.
And while the British government long refrained from interfering too strongly in the affairs of the medical profession, no government can forever resist the temptation to exercise power. Eventually, it will dictate, because that is what governments and their associated bureaucracies do. The government's hold over medical practice in Britain is becoming ever firmer; it now dictates conditions of work and employment, the number of hours worked, the drugs and other treatments that may be prescribed and the way in which doctors must be trained. Doctors are less and less members of a profession; instead, they are production workers under strict bureaucratic control.
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bixie
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my common sense is tingling!
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posted March 02, 2013 06:28 PM |
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Elodin is entirely right on this. I've been waiting on the NHS for a cure to homosexuality, and it hasn't come through yet.
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Vlaad
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ghost of the past
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posted March 02, 2013 08:44 PM |
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Edited by Vlaad at 20:45, 02 Mar 2013.
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Salamandre
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Wog refugee
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posted March 02, 2013 08:48 PM |
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JollyJoker
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posted March 02, 2013 09:31 PM |
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Quote:
@JJ
Quote:
I think, it's both, but TREATMENT is SERVICE and should be paid as such, while SUCCESSFUL treatment is good business and deserves profit.
There's a snag to this line of thought and that's something I bet most people do not consider today; healthcare is often no more than the old fashioned concept of "practice".
Practice implys to me far more I'll "try" to help you, than my old notion of medical gods I once visited. Usually, better doctors have been practicing the medical-arts for a longer time and have been exposed to more conditions & treatments. My 13 yr. health-issue has meant an incredible amount of money spent by myself & insurance (now Gov-disability) for very little success.
To your point; what little success has been purely the service of comfort-measures and nothing to do with a successful diagnois and treatment of my worsening disease.
@all
<imo> I think the real enemy regarding cost of health care that has to be dealt with 1st is the legal profession's dominence of the medical field. I know for a fact that many doctors left my state when mal-practice premiums and liabilities skyrocketed. Seriously, due to health-litigations; I think that many doctors look at poor patients more as a huge risk, than someone needing help.
i.e. In my case, as the patient and owner of my body, I should be able to sign a waiver of liability and "try something...anything" if it's my sound choice. However I can't, so medical science cannot learn from my misery and help others that follow in my path. Bad enough that an unknown-something can knock us out but this makes it much, much worse.
I realize that my illness is not the norm of health-care issues but this topic is all encompassing unless, as others have said, there is a division made; like only treatment of flus, infections, fractures etc.
Exactly my point. You got "treated" unsuccessfully and a lot of highly paid people cashed in for it. For what? Not killing you? When it was actually the much worse paid practicioner who had at least a small effect.
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del_diablo
Legendary Hero
Manifest
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posted March 03, 2013 02:46 AM |
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Quote:
So in my opinion, THE GOVERNMENT should control the health system. It should operate on a non-profit base. Profit should be made with SUCCESS only.
The only comment I have is that well, modern medical science is not exactly very good. There is a few diseases and problems we can cure and fix, but most of the diseases involve either suppressing it to not be troublesome or trying everything to make it suppressed while not exactly succeeding.
I just wanted to point that out, and its just semantics, because I am well aware of what you actually mean.
mvassilev:
Quote:
I see the problem with that, but consider the problem with the opposite situation - suppose you're sick and it's likely that you won't get better (but recovery is still possible). What doctor would treat you, knowing that even if they do everything as well as they can, you'd likely still get worse (and so they wouldn't get paid)? At least with health care being paid for in terms of procedures rather than outcomes, people who are sufficiently unlikely to recover wouldn't get any treatment.
And that would be trolling 101. Getting enough money to maintain wages, facilities, education and etcetera is a quite a large amount of profit.
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Elodin
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posted March 06, 2013 12:59 AM |
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Please read the full article. This is merely a brief snippet.
clicky
Quote:
To justify more government control of America’s health care, ObamaCare supporters frequently assert that access to and quality of health care in the United States are poor. However, the facts from source documents and medical journals show that Americans enjoy superior access to care compared to nationalized systems, the very systems put forth as models for ObamaCare — whether defined by wait-times for diagnosis, treatment, or specialists; timeliness of surgery; access to screening; or availability of medical technology and drugs. The separate issue of quality of care also demands analysis of objective data – and that means data from peer-reviewed medical journals, rather than subjective “rankings” and surveys by advocacy groups.
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