5 ms·

Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic be

Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard. That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.

arcticbull 6y ago
Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.
- chordalkeyboard 6y ago
  > Private healthcare should be abolished entirely. Wouldn't this mean using the police to arrest people if, e.g. a person got a doctor to look at them or suggest a treatment for a condition and it wasn't something that had gone through government channels?
  - lazyasciiart 6y ago
    Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.
    - chordalkeyboard 6y ago
      But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?
      - arcticbull 6y ago
        This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison. Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.
        chordalkeyboard 6y ago
        > This situation exists today. If I'm an physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. I agree and this is terrible. > Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, it may not be a legal defense but it is absolutely a moral defense. > in my scenario, that would not change. I just want to make it explicit that you agree with the criminalization of healing people without permission.
      - arcticbull 6y ago
        Replying here because rate limiting, and I find this conversation interesting :) > it may not be a legal defense but it is absolutely a moral defense. I suppose that's so. > I just want to make it explicit that you agree with the criminalization of healing people without permission. By framing your reply as "criminalization of healing people without permission" you have baked in a lot of unstated assumptions: 1. The person doing the 'healing' has met your personal standard for a 'healer' - in this case foreign experience. Without licensing, I could, with no experience whatsoever, just cut you open and go to town. You would die, and then what? Who's liable? What if I get half way through and then realize that Milton Bradley's Operation is not a replacement for Grey's Anatomy and you are rushed to a real hospital? 2. You assume the 'healing' is successful. Does it become butchering if I fail to do so? So, to that end, while I may not agree with all aspects of licensing physicians (for instance, I'm with you on the foreign degree and experience limitations) I believe that on the whole it does more good than harm. I will therefore be explicit and say, yes, I do "agree with the criminalization of healing people without permission [of competent authorities]," even if I do not today agree with all of their requirements, however I reject your framing.
- vidarh 6y ago
  In the UK, about 10 percent has private insurance, but nearly all private plans are 'top up' type plans where the assumption is that you usually rely on the NHS first, but ask for a private referral if you need a specialist or procedure there's a wait for. As a result they're generally pretty cheap. In effect you're paying to jump queues for a limited resource.
  - uzakov 6y ago
    I don't know if you live in the UK but I can share my 2 cents: UK NHS systems isn't exactly what many Americans picture it.
- fraggle_sock 6y ago
  Thank you for the information - it is interesting to learn of a case where discouragement and disincentivisation, in lieu of abolishment, has turned out to be a reasonable and pragmatic secondary option.
  - arcticbull 6y ago
    Looks like I forgot to link you to the write-up (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/) but I suspect you'll find it interesting!
- refurb 6y ago
  Disagree on private healthcare being abolished. If people want to spend their own money outside the single payer system, why not let them? It doesn't absolve them of contributing to the public system, so the public system benefits when they decide to go outside it. And in Canada, there isn't much private healthcare because of the way Medicare is set up. A doctor has to choose - practice in the public system or the private system - they can't do both. As a result, you have a handful of doctors who do private with the majority in the public system. For certain procedures there is actually a lot of private healthcare in Canada. Take a look at MRI's. Instead of waiting 2 or 3 months for an MRI you can pay $300 and get one this week and send the results to your doctor.
  - arcticbull 6y ago
    It varies from province to province [0]. What you're saying is true in some provinces but not all. However, even in the provinces without material barriers, no private sector exists. The article actually provides some solid theories. Your information about MRI waiting times isn't accurate in general - or rather paints only part of the picture. Even with the COVID situation happening now, in Ontario... Patients who should be scanned immediately receive a scan, immediately. Patients who should be scanned within 2 days are in fact scanned within 2 days. Patients who have a target of 10 days for a scan wait closer to 18 (but 53% are scanned within the SLA). Patients who have a target of 28 days wait closer to 90. [1]. If you don't need one now, you're wasting capacity by getting one now. This capacity should be allocated 100% to the public sector on a need basis. That would reduce wait times for all priorities. This is in fact what the British Columbia government did [2] to excellent effect [3]. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ [1] https://www.hqontario.ca/System-Performance/Wait-Times-for-Diagnostic-Imaging https://www.hqontario.ca/System-Performance/Wait-Times-for-D... [2] https://globalnews.ca/news/4481951/b-c-to-purchase-two-private-mri-clinics-to-reduce-wait-times/ https://globalnews.ca/news/4481951/b-c-to-purchase-two-priva... [3] https://globalnews.ca/news/5256655/wait-times-mri-procedures/ https://globalnews.ca/news/5256655/wait-times-mri-procedures...
    - refurb 6y ago

arcticbull 6y ago

Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.

chordalkeyboard 6y ago
> Private healthcare should be abolished entirely. Wouldn't this mean using the police to arrest people if, e.g. a person got a doctor to look at them or suggest a treatment for a condition and it wasn't something that had gone through government channels?
- lazyasciiart 6y ago
  Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.
  - chordalkeyboard 6y ago
    But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?
    - arcticbull 6y ago
      This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison. Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.
      - chordalkeyboard 6y ago
        > This situation exists today. If I'm an physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. I agree and this is terrible. > Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, it may not be a legal defense but it is absolutely a moral defense. > in my scenario, that would not change. I just want to make it explicit that you agree with the criminalization of healing people without permission.
    - arcticbull 6y ago
      Replying here because rate limiting, and I find this conversation interesting :) > it may not be a legal defense but it is absolutely a moral defense. I suppose that's so. > I just want to make it explicit that you agree with the criminalization of healing people without permission. By framing your reply as "criminalization of healing people without permission" you have baked in a lot of unstated assumptions: 1. The person doing the 'healing' has met your personal standard for a 'healer' - in this case foreign experience. Without licensing, I could, with no experience whatsoever, just cut you open and go to town. You would die, and then what? Who's liable? What if I get half way through and then realize that Milton Bradley's Operation is not a replacement for Grey's Anatomy and you are rushed to a real hospital? 2. You assume the 'healing' is successful. Does it become butchering if I fail to do so? So, to that end, while I may not agree with all aspects of licensing physicians (for instance, I'm with you on the foreign degree and experience limitations) I believe that on the whole it does more good than harm. I will therefore be explicit and say, yes, I do "agree with the criminalization of healing people without permission [of competent authorities]," even if I do not today agree with all of their requirements, however I reject your framing.
vidarh 6y ago
In the UK, about 10 percent has private insurance, but nearly all private plans are 'top up' type plans where the assumption is that you usually rely on the NHS first, but ask for a private referral if you need a specialist or procedure there's a wait for. As a result they're generally pretty cheap. In effect you're paying to jump queues for a limited resource.
- uzakov 6y ago
  I don't know if you live in the UK but I can share my 2 cents: UK NHS systems isn't exactly what many Americans picture it.
fraggle_sock 6y ago
Thank you for the information - it is interesting to learn of a case where discouragement and disincentivisation, in lieu of abolishment, has turned out to be a reasonable and pragmatic secondary option.
- arcticbull 6y ago
  Looks like I forgot to link you to the write-up (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/) but I suspect you'll find it interesting!
refurb 6y ago
Disagree on private healthcare being abolished. If people want to spend their own money outside the single payer system, why not let them? It doesn't absolve them of contributing to the public system, so the public system benefits when they decide to go outside it. And in Canada, there isn't much private healthcare because of the way Medicare is set up. A doctor has to choose - practice in the public system or the private system - they can't do both. As a result, you have a handful of doctors who do private with the majority in the public system. For certain procedures there is actually a lot of private healthcare in Canada. Take a look at MRI's. Instead of waiting 2 or 3 months for an MRI you can pay $300 and get one this week and send the results to your doctor.
- arcticbull 6y ago
  It varies from province to province [0]. What you're saying is true in some provinces but not all. However, even in the provinces without material barriers, no private sector exists. The article actually provides some solid theories. Your information about MRI waiting times isn't accurate in general - or rather paints only part of the picture. Even with the COVID situation happening now, in Ontario... Patients who should be scanned immediately receive a scan, immediately. Patients who should be scanned within 2 days are in fact scanned within 2 days. Patients who have a target of 10 days for a scan wait closer to 18 (but 53% are scanned within the SLA). Patients who have a target of 28 days wait closer to 90. [1]. If you don't need one now, you're wasting capacity by getting one now. This capacity should be allocated 100% to the public sector on a need basis. That would reduce wait times for all priorities. This is in fact what the British Columbia government did [2] to excellent effect [3]. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ [1] https://www.hqontario.ca/System-Performance/Wait-Times-for-Diagnostic-Imaging https://www.hqontario.ca/System-Performance/Wait-Times-for-D... [2] https://globalnews.ca/news/4481951/b-c-to-purchase-two-private-mri-clinics-to-reduce-wait-times/ https://globalnews.ca/news/4481951/b-c-to-purchase-two-priva... [3] https://globalnews.ca/news/5256655/wait-times-mri-procedures/ https://globalnews.ca/news/5256655/wait-times-mri-procedures...
  - refurb 6y ago