4 ms·

EU systems get much better outcomes for a fraction of the cost, and you think that's 'unsustainable'? 'lobbying' can be dealt with a either side of the pond, th

by cortic 10y ago

EU systems get much better outcomes for a fraction of the cost, and you think that's 'unsustainable'? 'lobbying' can be dealt with a either side of the pond, the only thing you are arguing for is making profit from the poor and sick.

ThomPete 10y ago
Better outcomes doesn't shield you from in-sustainability if your cost still is bigger than the money you can afford to put into it. The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlepayer system. In a system more driven by market you can actually make money. It's finding the right balance between those two I consider the most interesting part of this discussion. Unfortunately it's impossible to have this discussion because people either see you as a singlepayer proponent or a 100% marketdriven proponent.
- cortic 10y ago
  "cost still is bigger than the money you can afford to put into it." - so spending even more would be super sustainable, so long as it enriches the wealthy shareholders? "you can never spend enough money on it" - i say again, 'enough' is defined differently, a 'socialist enough' is enough to please the people; where a 'capitalist enough' is the smallest number that can sustain profit. these 'enough's are radically different. "In a system more driven by market you can actually make money." - only by denying treatment. this is the cornerstone of the market model, those who can't pay don't matter. "It's finding the right balance between those two" - In the UK, we are bringing private companies into contracts within the NHS, its always been a disaster, costing much more money that the services needed to cost, the inefficiency inherent in private companies (from bloated wages of CEOs to dividends) drag the whole system into financial crisis. The people who pay for the profits at the top are always the poor users of the service.
  - ThomPete 10y ago
    Spending even more is whats unsustainable you can't keep spending more and more money in a single payer system as it will either affect other areas or you will have to tax the citizens even more. There is a limit to that. If you get more and more treatments available and what people consider being part of healthcare and you are running a cost center then your system gets more and more expensive. No enough here is meant as there will always be things you can spend to make your system better than it is. It's not a matter of opinion it's a matter of what kind of treatments are available compared to how many you can offer. The single payer system is also denying treatment exactly because it can't pay if everyone used it. It's just another way to say some people don't matter enough. In the UK system is also deciding which drugs it will prioritize and which it wont. You are mixing two things together. Yes there are plenty of issues with the US system but the single payer system have issues too and they are not the same.
    - cortic 10y ago
      "Spending even more is whats unsustainable" - nationalized healthcare spends less for the same or better outcome, if your problem is price, then your problem is private healthcare. 'cost center' Vs 'profit center' <why would the profit center be cheaper? its the same as a 'cost center' with an added money drain and incentive to inflate prices.. '[denying treatment] because it can't pay if everyone used it' - This is just false, moneys going into a countries nationalized health system is high return (due to taxes), its also cheaper (due to group union prices). So long as its a healthy part of a healthy GDP (12%) it should have capacity for everyone in the country. compared to the US system which costs over 40% of your GDP and still does not have capacity for all your citizens. 'which drugs it will prioritize' - true, but this is done mostly on evidence of usefulness, not price. I largely agree with your last statement, but whatever problems a socialist system has, they pale in comparison to the misery caused by Laissez-faire in our health system.
      - ThomPete 10y ago
        I am not sure why you talk about socialist system vs. Laissez-faire. Single payer doesn't mean socialist neither does private mean Laissez-faire. Those kind of oversimplifications doesn't really add anything useful to this discussion. Switzerland has universal healthcare but it's based on private insurance. In other words it's not that simple. In general I find this discussion hard to have because you are assuming so many things about what I say or mean, that simply aren't true. I am not saying that a profit center is cheaper than a cost center I am saying that its able to make money which gives it flexibility. The incentives that drives the US healthcare system are pretty shitty but they aren't incentives which are unique to a private system. On top of that in the public healthcare systems you see more and more new public management to hold down cost, which itself is expensive. But it's not something that's set in stone. It's not a property of the system it can be changed. Changing the US healthcare system to patient outcomes incentives would do a lot to fix the incentives and there is an active program trying to do that. And no it's not false that there are limits to a public healthcare system. Believe me I have lived in one and it doesn't only get realized by not doing certain treatments it also reflect in waiting time for operations, to see a specialist etc. In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in. In Denmark my biopsy had to be done at the hospital. In the US they made it right away at the dermatologist the same day. With regards to drugs it's actually based on the cost, the rarity of the decease etc. I think it's in the UK where they have a list in order to prioritize.

by cortic 10y ago

ThomPete 10y ago

Better outcomes doesn't shield you from in-sustainability if your cost still is bigger than the money you can afford to put into it. The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlepayer system. In a system more driven by market you can actually make money. It's finding the right balance between those two I consider the most interesting part of this discussion. Unfortunately it's impossible to have this discussion because people either see you as a singlepayer proponent or a 100% marketdriven proponent.

cortic 10y ago
"cost still is bigger than the money you can afford to put into it." - so spending even more would be super sustainable, so long as it enriches the wealthy shareholders? "you can never spend enough money on it" - i say again, 'enough' is defined differently, a 'socialist enough' is enough to please the people; where a 'capitalist enough' is the smallest number that can sustain profit. these 'enough's are radically different. "In a system more driven by market you can actually make money." - only by denying treatment. this is the cornerstone of the market model, those who can't pay don't matter. "It's finding the right balance between those two" - In the UK, we are bringing private companies into contracts within the NHS, its always been a disaster, costing much more money that the services needed to cost, the inefficiency inherent in private companies (from bloated wages of CEOs to dividends) drag the whole system into financial crisis. The people who pay for the profits at the top are always the poor users of the service.
- ThomPete 10y ago
  Spending even more is whats unsustainable you can't keep spending more and more money in a single payer system as it will either affect other areas or you will have to tax the citizens even more. There is a limit to that. If you get more and more treatments available and what people consider being part of healthcare and you are running a cost center then your system gets more and more expensive. No enough here is meant as there will always be things you can spend to make your system better than it is. It's not a matter of opinion it's a matter of what kind of treatments are available compared to how many you can offer. The single payer system is also denying treatment exactly because it can't pay if everyone used it. It's just another way to say some people don't matter enough. In the UK system is also deciding which drugs it will prioritize and which it wont. You are mixing two things together. Yes there are plenty of issues with the US system but the single payer system have issues too and they are not the same.
  - cortic 10y ago
    "Spending even more is whats unsustainable" - nationalized healthcare spends less for the same or better outcome, if your problem is price, then your problem is private healthcare. 'cost center' Vs 'profit center' <why would the profit center be cheaper? its the same as a 'cost center' with an added money drain and incentive to inflate prices.. '[denying treatment] because it can't pay if everyone used it' - This is just false, moneys going into a countries nationalized health system is high return (due to taxes), its also cheaper (due to group union prices). So long as its a healthy part of a healthy GDP (12%) it should have capacity for everyone in the country. compared to the US system which costs over 40% of your GDP and still does not have capacity for all your citizens. 'which drugs it will prioritize' - true, but this is done mostly on evidence of usefulness, not price. I largely agree with your last statement, but whatever problems a socialist system has, they pale in comparison to the misery caused by Laissez-faire in our health system.
    - ThomPete 10y ago
      I am not sure why you talk about socialist system vs. Laissez-faire. Single payer doesn't mean socialist neither does private mean Laissez-faire. Those kind of oversimplifications doesn't really add anything useful to this discussion. Switzerland has universal healthcare but it's based on private insurance. In other words it's not that simple. In general I find this discussion hard to have because you are assuming so many things about what I say or mean, that simply aren't true. I am not saying that a profit center is cheaper than a cost center I am saying that its able to make money which gives it flexibility. The incentives that drives the US healthcare system are pretty shitty but they aren't incentives which are unique to a private system. On top of that in the public healthcare systems you see more and more new public management to hold down cost, which itself is expensive. But it's not something that's set in stone. It's not a property of the system it can be changed. Changing the US healthcare system to patient outcomes incentives would do a lot to fix the incentives and there is an active program trying to do that. And no it's not false that there are limits to a public healthcare system. Believe me I have lived in one and it doesn't only get realized by not doing certain treatments it also reflect in waiting time for operations, to see a specialist etc. In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in. In Denmark my biopsy had to be done at the hospital. In the US they made it right away at the dermatologist the same day. With regards to drugs it's actually based on the cost, the rarity of the decease etc. I think it's in the UK where they have a list in order to prioritize.