The Gaming Den

PhoneLobster wrote:

cthulhu wrote:Works great.

Compared to the US mess it is a damn miracle working system.

But in practice the good bits are the public system and collective public bargaining power for drug purchases. The private system is just free money for corporate shills at the expense of the public system.

Of course this article is over 5 years old now.

NOW we subsidize over 4 Billion per year on the completely corrupt and unproductive "Private health rebate" alone. And royal commissions are warning us that we are creating an unfair two tiered environment that is damaging the public health system.

And in the end the basic concept that rich people deserve better health is foul and disgusting, even in a "hybrid" system where the bottom isn't as far down.

Sure - but the french system works the same way (Okay the details a different the plans are more structured but the concepts are the same) and gets a good rap from all parties involved - and here to.

Australian implementation here is a bit ho hum and can definately be improved (so can everything! I can link you to articles about the crippling problems experienced by every health system - except the ones operated by ultra rich city states like Hong Kong and Singapore), but the concept and direction is probably the right one. I could have used france and denmark as the examples if you'd like. It's the same idea - public healthcare minimum with public/private hybrid topup programs. France and Germany? I'm pretty sure hong kong works the same way too. It is a pretty common structure.

As for the rich thing - look, you can essentially spend any amount on medical care. The dollars that can be thrown at the task are unlimited. Rich people will want to spend dollars on medical care. It would require massive social and economic changes to prevent that, which are probably out of scope of the discussion. Given that, its just part of the landscape.

You can crack down on it - like Canada and the UK - but I'm not sure that actually makes things better. Those two systems are probably the cheapest deliveries of effective healthcare globally, and honestly deciding that the NHS is the way to go with health (and it sounds like the system you'd support) is quite a rational decision.

I've lived under the NHS and while it is a cheap and excellent system, and the end of the day I'm not sure it is my preferred.

But at the end of the day, whether you go france, Australia, Canada or the UK all of them are wildly superior to the US model in every respect.

Disclosure: I make a living on the administrative overheads of the current US system.

mean_liar wrote:The cost reductions you're talking about are basically unachievable in the US: France and Italy have 50% more doctors per person than what the US does. They don't appear overnight. In absolute terms that's roughly an additional 300k doctors. POOF.

You can import health professionals. That's what the UK did when it increased spending on the National Health Service. Worked fine.

PhoneLobster wrote:And in the end the basic concept that rich people deserve better health is foul and disgusting, even in a "hybrid" system where the bottom isn't as far down.

Perhaps. Regardless, it's a necessary compromise to get/keep the middle classes on board.

MartinHarper wrote:Perhaps. Regardless, it's a necessary compromise to get/keep the middle classes on board.

Public health care is massively and unrelentingly popular with the middle class. Even in backward hell holes like the USA. So I have no idea what you think you are talking about.

As for Cthulhu.

The problem with the two tiered system in Australia and elsewhere is several fold.

1) It is a waste of money. We can get more an better health care by throwing the same money at public health. And that includes the money rich people might want to personally throw at it.

2) The money thrown at private health in these countries is diverted from public tax payer funded government coffers. We are paying taxes right into fucking subsidizing the undermining and destruction of our own public health system. That private health rebate? It isn't some fucking rich guy's personal money desperately being spent on placebos. It's our fucking money being given to a bunch of snake oil salesman as a subsidy to further con individuals out of their private funds.

3) It is utterly unjust to say "If you can just pay some more we will save your life". You are a bad person for repeatedly defending it.

Now. As a thought exercise.

What government subsidized private/public two tiered system do you envisage as being acceptable? For one to exist you have to answer the following question...

What medical procedures actual simultaneously are acceptable to offer only to those who can buy them but also simultaneously deserve government subsidizing paid for by everyone, including poor people who cannot buy those services?

I can't think of even one.

Because private health isn't really private it's just a stupid way to spend our money on buying yachts for health fund executives.

PhoneLobster wrote:Public health care is massively and unrelentingly popular with the middle class.

To ensure that rich people don't get better healthcare, you would need to ban private healthcare. That is unpopular with the middle class.

PhoneLobster wrote:What medical procedures actual simultaneously are acceptable to offer only to those who can buy them but also simultaneously deserve government subsidizing paid for by everyone, including poor people who cannot buy those services?

Suppose that I have a life-threatening heart condition. There are three relevant procedures:
* Slice and Dice. Costs £2,000. Cures heart condition, but causes scarring.
* Keyhole Magic. Costs £11,000. Cures heart condition, with no scarring.
* Scar-B-Gon. Costs £10,000. Cures scarring caused by Slice and Dice.

Slice and Dice is life saving, and should be state-provided.
Scar-B-Gon is cosmetic, and should be private.
Keyhole Magic should be subsidised by between £1,000 and £2,000.

Frank made a good point on one of these debates: When you give everyone the best care you have tons of trained professionals even for somewhat rare conditions. Given the enormous amount of money currently wasted in the US health system it might actually be feasible to give the current state of the art treatments to everyone. Then, when someone has rare skin disease 43 odds are you will already have multiple doctors who have dealt with it. If you desperately need a system where rich people can pay more to distinguish themselves from the peasants let them pay for private rooms and personal nurses.

Murtak wrote: If you desperately need a system where rich people can pay more to distinguish themselves from the peasants let them pay for private rooms and personal nurses.

Sorry, that reminds me of a porn I once saw. Although if I'm sick enough to actually admit that I need a doctor, I'm not going to feel amorous at all.

Draco_Argentum wrote:You attended the protest. You mightn't like the name but you attended and agree with the protest. As PL points out the tea bagging language is used by your fellows, its not just a media attack.

Once again, I'll try to make it as simple as possible. I attended a "Tea Party." Tea parties often used "tea bags" (NOUN) as a symbol. The link provided by PL states "Poll: Who Would You Send a Tea Bag to in Washington?" ("Tea Bag" is a noun, "Send" is the verb.) While some of the comments do use "Tea Bag" as a verb, that can hardly be called an offical endorsement of "Mailing a tea bag" (which is actually different from attending a "tea party" but it's not worth going there) being defined as the verb "tea bagging" to having those who mailed tea bags called "teabaggers."

Many members of the Tea Party movement were up in arms the moment the word "teabagging" was heard. (By the way, the only reason bags were used in the first place was because people were thinking loose tea would really freak the government out. They didn't have tea in bags back in 1773.)

In one sense I think we are mixing apples and oranges here. In one sense it is not the system that ensures adequate coverage, but the economies of scale. In this sense we have to look at the system from the opposite direction. Some problems are commonplace, distributing the means to solve those problems makes the most sense. Some problems are rare, and often very expensive to do right. In between is a complex sliding scale. In the case of rare problems, not only is there the matter of finding the right expert, but there is the matter of getting to that expert, and this is something that in general health insurance doesn’t consider. If done right, on the Continental United States, the quality of life would be significant not because of the system, but because of the numbers involved.

It takes a national dialogue to suss out how and what we want for care and we basically can't do that in the US, at least according to how swimmingly it went with Clinton. We especially can't do it when slightly less than half the nation are crazy.

We’ve never had one. Seriously, most health care “dialogue” starts off with one person who has a “plan.” You first need a dialogue as to what the problem is first, only then can you come up with a plan. Secondly, everyone (who is anyone) has their own “plan” and the only purpose of the plan is to benefit their special interest. Thus nothing gets done.

Riddle me this, it is generally considered a high social priority that Emergency Rooms treat everyone, regardless of whether or not they have a plan. But who actually provides the funds to pay for the expenses? Those who actually have plans? Basically speaking emergency rooms should be paid for by all of us, the people, through the general federal budget since it is the general federal government that requires them to treat everyone; a perfect example of the most evil federal institute of an “unfunded mandate.”

While we are at that, consider something that is funded by the states, poison control centers. Right now a call to a poison control center could mean the difference (in cost) between going to the store for a “bottle of milk” and going to the ER and getting the insurance company billed a thousand dollars for that same “bottle of milk.” But since the benefit doesn’t get applied to the state (but to the insurance company) there is no pressure to keep such poison control centers operational in times of budget problems.

MartinHarper wrote:Suppose that I have a life-threatening heart condition. There are three relevant procedures:
* Slice and Dice. Costs £2,000. Cures heart condition, but causes scarring.
* Keyhole Magic. Costs £11,000. Cures heart condition, with no scarring.
* Scar-B-Gon. Costs £10,000. Cures scarring caused by Slice and Dice.

Slice and Dice is life saving, and should be state-provided.
Scar-B-Gon is cosmetic, and should be private.
Keyhole Magic should be subsidised by between £1,000 and £2,000.

The thing is... in the real world, Keyhole is like half the cost of slice-and-dice, but instead uses a machine and a trained operator and doctor which have a one-time cost 100x the expensive procedure. So it is cheaper, but needs money now.

So then, which do you support? That's why, at times, Canada lags behind the US, because these big burst costs weren't supported by the system. But in the US, getting money up front is no problem - to the point that we buy so many of these machines that many of them aren't being used, but they still need to be paid for, so all the procedures cost the upper cost, never to be reduced.

-Crissa

Why do conservatives keep going off about how bad the Carter Administration was?



-Username17

tzor wrote:Riddle me this, it is generally considered a high social priority that Emergency Rooms treat everyone, regardless of whether or not they have a plan. But who actually provides the funds to pay for the expenses? Those who actually have plans? Basically speaking emergency rooms should be paid for by all of us, the people, through the general federal budget since it is the general federal government that requires them to treat everyone; a perfect example of the most evil federal institute of an “unfunded mandate.”

Do you really have to ask whether or not it is a "high social priority" that emergency rooms provide treatment for everyone? This is The Gaming Den, not Red State. I think the evil of letting poor people bleed to death in hospital waiting rooms FAR outweighs the evil of "unfunded mandates". Did you even read what you wrote before you posted this?

The reality is if ER rooms had to check your insurance plan before treating you, you'd die before they got the answer back.

cthulhu wrote:The reality is if ER rooms had to check your insurance plan before treating you, you'd die before they got the answer back.

And that's exactly the kind of shit that was happening before federal laws were passed to prevent that sort of thing. We wouldn't need "evil federal mandates" if we all treated each other with human decency and respect. But that's just not how some people roll.

Look, we had tzor arguing for funding ERs. That's pretty awesome, if you think about it.

Anyhow, the problem with the dialog is that it looks like this.

-Crissa

MartinHarper wrote:\

Suppose that I have a life-threatening heart condition. There are three relevant procedures:
* Slice and Dice. Costs £2,000. Cures heart condition, but causes scarring.
* Keyhole Magic. Costs £11,000. Cures heart condition, with no scarring.
* Scar-B-Gon. Costs £10,000. Cures scarring caused by Slice and Dice.

Slice and Dice is life saving, and should be state-provided.
Scar-B-Gon is cosmetic, and should be private.
Keyhole Magic should be subsidised by between £1,000 and £2,000.

Um, no. Let people take Slice and Dice. This is public. It is the option. If anyone then wants Scar-B-Gon afterwards, they pay the full 10K out of their own pocket for the cosmetic surgery. This is not private health insurance, nobody else is paying a cent towards it. Perhaps alternately, if people want to pay, up front, out of their own pocket, for Keyhole Magic they can do that. Again, without anyone else ever being charged for it.

This is ignoring the bit about Keyhole being individually cheaper with a more expensive start-up. Under the method you showed, the bit that everyone pays for is S&D, which is there for everyone, and if they want to be scar-free they pay the entire cost of being scar-free without anyone else being charged.

MartinHarper wrote:Suppose that I have a life-threatening heart condition. There are three relevant procedures...
Slice and Dice is life saving, and should be state-provided.
Scar-B-Gon is cosmetic, and should be private.
Keyhole Magic should be subsidised by between £1,000 and £2,000.

Your example is confusing.

Starting with it's incorrect assumptions, some of which are highlighted by Crissa, but which extend to the "scarring" you are talking about being a lot worse than a minor cosmetic issue. Indeed we are talking life threatening differences and quality of life differences between open heart and keyhole surgery.

All in all the example is highly contrived and revolves around false assumptions about the nature of medical treatment.

But overlooking that and pretending that it's a magical scaling tree where the upper branches are no better than the basic procedure and a snazy fashionable haircut...

The keyhole and the scar be gone are subsidized by government, heavily so. The very fact the government is spending millions on training doctors that are then removed from the public system to perform these private procedures makes that unavoidable.

So why is the poor bastard who can only afford the "cosmetic" scarring procedure paying for training doctors AND providing a cash discount to rich bastards getting the "better" version of the procedure with "their own money"?

If rich people were honestly using their funds to simply pay out of their own pocket for something beyond the capability of the public system then why are they using public resources at all?

If it's some terrible Randian fantasy of uber-rich entitlement and merit by wealth then they had damn well better pay all the damn way and not be leaching off the taxpayers with some "cash back" scheme for opting out of the basic surgery.

After all the most basic procedure is actually none at all so why doesn't the poor man opt out of the whole thing for HIS cash back and give it to his family on his death bed? Same principle!

The reality is that any public healthcare system is going to pay for keyhole, and the examples here are moronic. Martin Harper is looking at it like a health insurance company, not someone who owns the System end to end

Consider the NHS. No matter what happens to you, the NHS has to pay to fix you. So you can be really damn sure they:

A) Want to keep you out of hospital. Hospital is really really really really really expensive. Anything that can humanly be done to make sure you don't darken that doorway will be done, because it makes your treatment cost up to 75% less

B) Really want to stop you getting sick in the first place. At all costs. It's so much cheaper to stop you smoking that it is to intervene when you get lung cancer that you wouldn't belive it. If you never get measels or maralria, they don't have to fix it. If they can stop you from smoking, they don't have to fix that either.


Given that context, the NHS pays for keyhole. Why? Bed days cost to much money and are your biggest resource, and keyhole gets you out of hospital faster. The cheapest option is whichever one gets you out of the system quickest.


In Acute care the cost drivers are so clear than whatever treatment option results in the least bed days for the patient, and then the least physio treatment required is always the cheapest option. Despite the treatment cost of keyhole it is still way cheaper than the other options for the healthcare system as a whole because you get out of hospital and free up a bed which they need to handle something else.

Chronic illness is the really big problem for them. If you keep going to hospital, the NHS is fuxxored. That is why the NHS also has a massive immunization drive, a massive drive for electrionic health records and a big focus on primary care. Satisfaction with primary care is 90%+ Why? Because they care deeply about making sure you don't go to hospital because it costs the NHS to much damn money if you do, and all those things make you less likely to go to hospital and that is all they care about.

Going to hospital once costs about as much as 10 years of GP visits.

Ganbare Gincun wrote:Do you really have to ask whether or not it is a "high social priority" that emergency rooms provide treatment for everyone? This is The Gaming Den, not Red State. I think the evil of letting poor people bleed to death in hospital waiting rooms FAR outweighs the evil of "unfunded mandates". Did you even read what you wrote before you posted this?

You missread. He was saying ER should be funded by federal tax rather than making the states cough up the cash.

---

What medical procedures actual simultaneously are acceptable to offer only to those who can buy them but also simultaneously deserve government subsidizing paid for by everyone, including poor people who cannot buy those services?

Ones that won't work but which the richies want to get anyway out of desperation. Even then only if they won't use a hospital bed/doctor's time that could be used on someone who can be cured. So if some rich tool wants to cough up the full price of a drug treatment that won't cure their cancer, I don't have a problem with that.

There are loads of ones that don't deserve government subsidies, but do have measurable clinic benefits.

Health insurance in two tier systems picks up shit like massage therapies that have a quantifiable clinical benefit, but aren't worth the investment by the central body which has a responsibility to spend its money in whatever gives the biggest reduction (increase really) in DALYies per dollar invested.

It also gets stuff like extra sports physio, or getting a TV in your ward. If you're rich and want to pay for your own TV in your hospital bed, you can just do that for all I care.



As for the other stuff.. look, their are 2 dimensions to this

A) You can have public, privatised or hybrid delivery of care (who owns the hospitals)

B) You can have public, private or hybrid payment for care (who pays when you to to the GP or have an operation).

No OECD country has a completely public healthcare system. Some component is delivered by private practioners. In the NHS its the GPs. In canada, it is pervasive.

Payment however can be public. In canada, if you are a doctor and get 1 cent through the government insurance scheme it is illegal for you to work privately, but hospitals etc are owned privately sometimes, just do public work according to the funding schedule.

PhoneLobster wrote:All in all the example is highly contrived and revolves around false assumptions about the nature of medical treatment.

Yes. Slice and Dice, Scar-B-Gon, and Keyhole Magic are not real medical procedures. I'm not qualified to discuss efficient healthcare decisions for real medical procedures.

Koumei wrote:Let people take Slice and Dice. This is public. It is the option. If anyone then wants Scar-B-Gon afterwards, they pay the full 10K out of their own pocket for the cosmetic surgery. This is not private health insurance, nobody else is paying a cent towards it. Perhaps alternately, if people want to pay, up front, out of their own pocket, for Keyhole Magic they can do that. Again, without anyone else ever being charged for it.

So, under that plan, people who want to avoid scarring will choose Slice and Dice followed by Scar-B-Gon, because it is cheaper to them than Keyhole Magic. This means that the state pays £2,000 and the patient pays £10,000. Total healthcare cost: £12,000.

If the state subsidised Keyhole Magic by £1,500 then people will choose that procedure instead. This means that the state pays £1,500 and the patient pays £9,500. Total healthcare cost: £11,000. Same outcome.

If the metric of a good healthcare system is achieving the best health outcomes for the lowest total cost, the subsidy is a good idea in principle. This should be something decided by the managers of the state health service, based on what they decide is the best use of their resources.

cthulhu wrote:There are loads of ones that don't deserve government subsidies, but do have measurable clinic benefits...

And then you go on to effectively suggest things which are defined by their inefficiency.

But the important thing here is that "private" health in basically every incarnation in the modern western world in fact eats public funding.

So while we can sit here and say that rich suckers can pay for voodoo and suicide by chiropractor without government funding and that would be fine...

It doesn't fit the criteria I gave of a medical procedure OK for the wealthy only that ALSO deserved government funded subsidy.

And that's the point because here in Australia for instance the government really DOES subsidize private plans that include voodoo and chiropractors in their coverage!

And THAT is not OK. Not OK at all. It costs us well more than 4 Billion in tax dollars a year that could be spent to greater efficiency in the public system on stuff that isn't voodoo and chiropractors.

And that isn't counting the private funds individual suckers are pumping into it which theoretically could be pumped into a public system instead.

Mehhhhhh, you're going to have a hard time arguing about things like drugs that help treat end stage meso. That got *added* to the PBS despite clear evidence that it was inefficent.

I mean, you're welcome to the reform crusade, but people actually want this stuff as part of public healthcare. Remember, as Frank loves to point out the french system scores the highest on patient satisfaction - and they offer all the stuff that you've just called "voodoo and suicide by chiropractor" in a very dismissive way, which means I assume that you don't want it.

Anyway, clearly you want the NHS or Canada. Both systems meet your criteria. That's a rational choice. Get on the soap box and start pushing the cause politically - the time is actually ripe for the formation of the NHS in Australia, so it might even do something.

But lots of people don't and the decisions their are entirely rational.

Are you going to defend Chiropractors?

Really?

They are evil sons of bitches. Stone cold killers.