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"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

by 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.
- cortic 10y ago
  There are outliers but most systems fall between two extremes of regulation, the heaviest regulation is basically a socialist system, owned by the people, run as a public service and so directly regulated. the lightest regulated is a private system, in a country that believes in free trade, unimpeded, Laissez-faire. As a general rule, the latter gives you worse outcomes at higher prices and is, from a patient perspective, unsustainable. the former gives you better outcomes at lower prices and scales with the countries needs (along side GDP) and is very sustainable. Switzerland has very heavy regulations, everyone is covered by a national insurance system like other EU countries, but the very fact that its private companies that carries out the health care show in the stats, they pay almost twice the GDP of the UK for about the same outcomes, same with Germany, which has a similar system, its about 18% of GDP (and their GDP is higher per person). "I am saying that its able to make money which gives it flexibility" - if this is really what you are trying to say, then you should have started with "Private, profit driven health care is fine for rich people", which i would have agreed with. "waiting time for operations, to see a specialist" - this is a bad example, how many Americans wait all there lives for an operation, or never see a specialist because of the price. if you factored this in the average waiting times in a private unregulated system would dwarf a socialist waiting list(which by definition includes everyone). "With regards to drugs" - in England we have 'NICE' which is a public board mandated to approve drugs and procedures on the NHS, with the fist stipulation that the drugs or procedures are shown through proper trials to work. This system is not perfect, but its a hell of a lot better than a private board incentivized to approve any BS treatment on profit basis alone. "In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in." Try to put your personal feelings aside and look at the stats; http://www.nationmaster.com/country-info/compare/Denmark/United-States/Health http://www.nationmaster.com/country-info/compare/Denmark/Uni...
  - ThomPete 10y ago
    I am sure you don't notice it yourself but you are basically trying to argue through painting things into extremes. It's either socialist or Laise-Faire, Switzerland is heavly regulated, Public boards are based on rationality, private boards are based on greed alone. No a taxpayer paid healthcare system does not make it a socialist system anymore than a taxpayer police force or army does. And the US system isn't laissez faire just because it's broken in many ways. Most economies are mixed economies. So I am not sure what you are trying to prove here. The fact remains that public healthcare has it's own issues regardless of whether you personally think they are better issues to have and any honest dive into those the countries systems will show you that. You can't both have your cake and eat it. Switzerland is heavy regulated you claim (which is wrong) but they pay twice the GDP for about the same outcome. So what is it? A system governed by the state, a system that's private or something in between? With regards to Germany most of their insurance is covered by public healthcare 80% if not more. So why is that? Furthermore the US is a huge country with hundreds of millions of citizens and millions of illegal immigrants and spread out over a huge area. Based on it's circumstances it's not doing too shabby regardless of the statistics. It's just not as simply as you would like to paint it in those extreme corners. There is an interesting discussion around Medicaid vs. private insurance in the US you can read about here: https://www.forbes.com/sites/sallypipes/2014/08/14/no-really-employer-health-insurance-is-better-than-government-care/#3969b1883ca7 https://www.forbes.com/sites/sallypipes/2014/08/14/no-really... My point was never to say one thing was better than the other yet thats what we are really discussing here. My point was that there are tradeoffs in both systems.

by cortic 10y ago

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.

cortic 10y ago
There are outliers but most systems fall between two extremes of regulation, the heaviest regulation is basically a socialist system, owned by the people, run as a public service and so directly regulated. the lightest regulated is a private system, in a country that believes in free trade, unimpeded, Laissez-faire. As a general rule, the latter gives you worse outcomes at higher prices and is, from a patient perspective, unsustainable. the former gives you better outcomes at lower prices and scales with the countries needs (along side GDP) and is very sustainable. Switzerland has very heavy regulations, everyone is covered by a national insurance system like other EU countries, but the very fact that its private companies that carries out the health care show in the stats, they pay almost twice the GDP of the UK for about the same outcomes, same with Germany, which has a similar system, its about 18% of GDP (and their GDP is higher per person). "I am saying that its able to make money which gives it flexibility" - if this is really what you are trying to say, then you should have started with "Private, profit driven health care is fine for rich people", which i would have agreed with. "waiting time for operations, to see a specialist" - this is a bad example, how many Americans wait all there lives for an operation, or never see a specialist because of the price. if you factored this in the average waiting times in a private unregulated system would dwarf a socialist waiting list(which by definition includes everyone). "With regards to drugs" - in England we have 'NICE' which is a public board mandated to approve drugs and procedures on the NHS, with the fist stipulation that the drugs or procedures are shown through proper trials to work. This system is not perfect, but its a hell of a lot better than a private board incentivized to approve any BS treatment on profit basis alone. "In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in." Try to put your personal feelings aside and look at the stats; http://www.nationmaster.com/country-info/compare/Denmark/United-States/Health http://www.nationmaster.com/country-info/compare/Denmark/Uni...
- ThomPete 10y ago
  I am sure you don't notice it yourself but you are basically trying to argue through painting things into extremes. It's either socialist or Laise-Faire, Switzerland is heavly regulated, Public boards are based on rationality, private boards are based on greed alone. No a taxpayer paid healthcare system does not make it a socialist system anymore than a taxpayer police force or army does. And the US system isn't laissez faire just because it's broken in many ways. Most economies are mixed economies. So I am not sure what you are trying to prove here. The fact remains that public healthcare has it's own issues regardless of whether you personally think they are better issues to have and any honest dive into those the countries systems will show you that. You can't both have your cake and eat it. Switzerland is heavy regulated you claim (which is wrong) but they pay twice the GDP for about the same outcome. So what is it? A system governed by the state, a system that's private or something in between? With regards to Germany most of their insurance is covered by public healthcare 80% if not more. So why is that? Furthermore the US is a huge country with hundreds of millions of citizens and millions of illegal immigrants and spread out over a huge area. Based on it's circumstances it's not doing too shabby regardless of the statistics. It's just not as simply as you would like to paint it in those extreme corners. There is an interesting discussion around Medicaid vs. private insurance in the US you can read about here: https://www.forbes.com/sites/sallypipes/2014/08/14/no-really-employer-health-insurance-is-better-than-government-care/#3969b1883ca7 https://www.forbes.com/sites/sallypipes/2014/08/14/no-really... My point was never to say one thing was better than the other yet thats what we are really discussing here. My point was that there are tradeoffs in both systems.