6 ms·

Absolutely true. As a doc, the US problem boils down to a cultural issue that can be summarized as: "there is no reason my money should pay for the care of oth

by rscho 8y ago

Absolutely true. As a doc, the US problem boils down to a cultural issue that can be summarized as: "there is no reason my money should pay for the care of others, but if I personally need care, then it should be of the absolute best quality and should be provided until my last breath no matter what" The people maintain the system themselves by insisting on that, and that is the root of every other problem. Before alleviating restrictions for med school, US people should think about pulling the plug on the legions of evidently terminal patients receiving maximal care that just prolongs their intense suffering every day around the country. Why do you think your doc does every exam under the sun as soon as you step foot in the office? 1 - if solo, more money; if networked, makes you look better for the "employer" (insurance company/hospital/HMO, etc.) 2 - if you have too many exams, you will complain on the internet. If you have too few exams and something goes wrong, you will drag the doc into court. Weigh the incentives and I think even the most conservative person should see a problem.

arethuza 8y ago
"there is no reason my money should pay for the care of others" Isn't the cultural issue largely a idealogical issue - things like the UK NHS are avowedly socialist? In the words of Aneurin Bevan, founder of the NHS: " A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society." https://en.wikipedia.org/wiki/Aneurin_Bevan https://en.wikipedia.org/wiki/Aneurin_Bevan Personally, at least when it comes to healthcare, I'm a socialist: "The collective principle asserts that ... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means."
- rscho 8y ago
  Indeed, I think so too. Ironically, people essentially tend to ask for freedom of choice above all in the US healthcare system (I want complete price info, yada yada...) when the US system is evidently already the one offering the highest level of patient autonomy, probably worldwide (regarding the ethics principles of beneficence, nonmaleficience, Justice and autonomy). But guess what? That has a price, who would have thought?! Another point is that IMO, you can't go extreme on one principle without impacting the others. Nonmaleficience is clearly a problem in the US.
  - DennisP 8y ago
    People want complete price information because we don't have price controls, like they have in Germany, France, and Japan. Having a "free market" in healthcare without showing prices in advance of providing services is sort of obviously the worst way to get a reasonably priced healthcare system. That's somewhat mitigated by negotiations between insurers and providers, but not entirely given out-of-network charges.
    - rscho 8y ago
      Agreed, however there is a solid base of evidence (as solid as medical evidence can be, which is not saying much) that health can't humanely be handled as a commodity. Plus, providing complete price info itself is not free. Talk about administrative inflation!
      - DennisP 8y ago
        So then, go with price controls. We have multiple examples of that working just fine. The answer cannot be that we make people responsible for payment before telling them what the price will be, and it's unsurprising that by doing that, we have the most expensive healthcare system in the world.
  - arethuza 8y ago
    Indeed, its why I dislike ideological based arguments - once people commit to an ideology they will stick with it way past the point where it is clearly not effective (and this goes for right wing and left wing ideologies).
- tim333 8y ago
  Kind of. As a Brit I don't think the UK is especially socialist. Also we don't generally think of the NHS as socialist more than Americans would talk about having a socialist army or police force. The fact that the above are funded by the government from tax in my view doesn't really make them socialist. It's more just a common sense way of funding some stuff. The dictionary has socialism as "means of production, distribution, and exchange should be owned or regulated by the community as a whole" and I've never thought of health care as a "means of production". Now if the government tries to own all the factories that's socialism.
  - entity345 8y ago
    Healthcare is broadly a service and thus what hospitals, GP surgeries, etc. produce in the economy. The NHS is a socialised system based on socialist ideas and indeed can be seen as a socialist construct within a capitalist overall economy. Nothing inherently wrong with that, that's just objectively the way it is. Bevan just said it the way it is. Now, the military and police are regalian functions of the state. The government and regalian functions cannot really be labelled 'socialist', that would make much sense.
    - fsloth 8y ago
      "regalian functions of the state" Sorry to nitpick, but does "regalian" mean something else than emblems or insignia of royalty? A credible sovereign state generally needs some force projection capability within it's political domain, hereditary monarchy or not. Hence military is definetly in a different category than healthcare.
      - entity345 8y ago
        The etymology of the term indeed comes from the prerogatives of the sovereign. "Regalian functions of the state" is a common term that means the basic powers of the state (monarchy or not) that used to be the prerogative of the sovereign. I.e. law & order, military, and taxation. You could also call these "inherent powers of the state".
- cm2187 8y ago
  Paying for the care of others is also the insurance model, which is not socialism. I think where you lose support from part of the population is when the system is being abused. I understand France for instance has an abnormally high number of depressions, as it is a common way for a lazy employee to take some time off at the expense of the system. In the US I understand there is an abnormally high number of people on disability benefits. The hostility I think comes not from the fact that it is mandatory, but from the fact that if it is managed by the state, it will be badly managed, abused by a minority, and you end up over-paying while getting a bad service yourself the day you need it.
  - telchar 8y ago
    Fact, you say? I think you're right about the psychology here but if you're going to assert that state management is factually bad please provide some support to that.
  - dalore 8y ago
    > but from the fact that if it is managed by the state, it will be badly managed, abused by a minority, and you end up over-paying while getting a bad service yourself the day you need it Fact you say? Sounds like an opinion to me.
- dalore 8y ago
  I think have a socialist healthcare improves the capitalist opportunities for people in those countries. Having your job tied to your health insurance means people are less likely to change jobs, thereby not giving their true optimal output to a capitalist society. A worker who is free to offer his labour to whomever he wants knowing that his healthcare is not tied into their employment has more options and choice to them then someone who can't change jobs. A point on your last point, people would argue that even in the US you can still access the emergency room when you have no money so no one is turned away due to lack of means.
edoloughlin 8y ago
You: "if I personally need care, then it should be of the absolute best quality and should be provided until my last breath no matter what" Your healthcare industry: "if you personally need care, then it should be of the absolute best quality and should be provided until your last cent no matter what"
- jbob2000 8y ago
  In America, cent and breath are the same. Your statements read the exact same.

by rscho 8y ago

arethuza 8y ago

"there is no reason my money should pay for the care of others" Isn't the cultural issue largely a idealogical issue - things like the UK NHS are avowedly socialist? In the words of Aneurin Bevan, founder of the NHS: " A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society." https://en.wikipedia.org/wiki/Aneurin_Bevan https://en.wikipedia.org/wiki/Aneurin_Bevan Personally, at least when it comes to healthcare, I'm a socialist: "The collective principle asserts that ... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means."

rscho 8y ago
Indeed, I think so too. Ironically, people essentially tend to ask for freedom of choice above all in the US healthcare system (I want complete price info, yada yada...) when the US system is evidently already the one offering the highest level of patient autonomy, probably worldwide (regarding the ethics principles of beneficence, nonmaleficience, Justice and autonomy). But guess what? That has a price, who would have thought?! Another point is that IMO, you can't go extreme on one principle without impacting the others. Nonmaleficience is clearly a problem in the US.
- DennisP 8y ago
  People want complete price information because we don't have price controls, like they have in Germany, France, and Japan. Having a "free market" in healthcare without showing prices in advance of providing services is sort of obviously the worst way to get a reasonably priced healthcare system. That's somewhat mitigated by negotiations between insurers and providers, but not entirely given out-of-network charges.
  - rscho 8y ago
    Agreed, however there is a solid base of evidence (as solid as medical evidence can be, which is not saying much) that health can't humanely be handled as a commodity. Plus, providing complete price info itself is not free. Talk about administrative inflation!
    - DennisP 8y ago
      So then, go with price controls. We have multiple examples of that working just fine. The answer cannot be that we make people responsible for payment before telling them what the price will be, and it's unsurprising that by doing that, we have the most expensive healthcare system in the world.
- arethuza 8y ago
  Indeed, its why I dislike ideological based arguments - once people commit to an ideology they will stick with it way past the point where it is clearly not effective (and this goes for right wing and left wing ideologies).
tim333 8y ago
Kind of. As a Brit I don't think the UK is especially socialist. Also we don't generally think of the NHS as socialist more than Americans would talk about having a socialist army or police force. The fact that the above are funded by the government from tax in my view doesn't really make them socialist. It's more just a common sense way of funding some stuff. The dictionary has socialism as "means of production, distribution, and exchange should be owned or regulated by the community as a whole" and I've never thought of health care as a "means of production". Now if the government tries to own all the factories that's socialism.
- entity345 8y ago
  Healthcare is broadly a service and thus what hospitals, GP surgeries, etc. produce in the economy. The NHS is a socialised system based on socialist ideas and indeed can be seen as a socialist construct within a capitalist overall economy. Nothing inherently wrong with that, that's just objectively the way it is. Bevan just said it the way it is. Now, the military and police are regalian functions of the state. The government and regalian functions cannot really be labelled 'socialist', that would make much sense.
  - fsloth 8y ago
    "regalian functions of the state" Sorry to nitpick, but does "regalian" mean something else than emblems or insignia of royalty? A credible sovereign state generally needs some force projection capability within it's political domain, hereditary monarchy or not. Hence military is definetly in a different category than healthcare.
    - entity345 8y ago
      The etymology of the term indeed comes from the prerogatives of the sovereign. "Regalian functions of the state" is a common term that means the basic powers of the state (monarchy or not) that used to be the prerogative of the sovereign. I.e. law & order, military, and taxation. You could also call these "inherent powers of the state".
cm2187 8y ago
Paying for the care of others is also the insurance model, which is not socialism. I think where you lose support from part of the population is when the system is being abused. I understand France for instance has an abnormally high number of depressions, as it is a common way for a lazy employee to take some time off at the expense of the system. In the US I understand there is an abnormally high number of people on disability benefits. The hostility I think comes not from the fact that it is mandatory, but from the fact that if it is managed by the state, it will be badly managed, abused by a minority, and you end up over-paying while getting a bad service yourself the day you need it.
- telchar 8y ago
  Fact, you say? I think you're right about the psychology here but if you're going to assert that state management is factually bad please provide some support to that.
- dalore 8y ago
  > but from the fact that if it is managed by the state, it will be badly managed, abused by a minority, and you end up over-paying while getting a bad service yourself the day you need it Fact you say? Sounds like an opinion to me.
dalore 8y ago
I think have a socialist healthcare improves the capitalist opportunities for people in those countries. Having your job tied to your health insurance means people are less likely to change jobs, thereby not giving their true optimal output to a capitalist society. A worker who is free to offer his labour to whomever he wants knowing that his healthcare is not tied into their employment has more options and choice to them then someone who can't change jobs. A point on your last point, people would argue that even in the US you can still access the emergency room when you have no money so no one is turned away due to lack of means.

edoloughlin 8y ago

You: "if I personally need care, then it should be of the absolute best quality and should be provided until my last breath no matter what" Your healthcare industry: "if you personally need care, then it should be of the absolute best quality and should be provided until your last cent no matter what"

jbob2000 8y ago
In America, cent and breath are the same. Your statements read the exact same.