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Mannahnin wrote:This is a classic false dichotomy.

The world isn’t divided into just two groups of people or two possible outcomes.

Well no gak but we are talking in general terms here. We don't have 500 pages to go into a nuanced report about American political feelings on government spending. Generally, most Americans will lean toward one or the other in varying degrees. They only don't seemed crushed to you perhaps, but tell most Americans how much they pay in taxes and they will be flabbergasted and think it is to much.

Mannahnin wrote:
Part of the function of government is indeed to redistribute some of the burden from people who can’t take care of themselves onto people who can afford more. It’s the price we pay if we don’t want to see our poor, sick, elderly, and disabled dying in the streets. And if we want to avoid a lot of other less dramatic forms of suffering.

There is a monstrous assumption on your part and a total opinion presented as fact. If I look government up in different reference guides I doubt it will list government as a mechanism of wealth redistribution for the poor and elderly. It is not a function of the government to take care of these people. You can believe that it is important and that it should be a role of the government, but it isn't an inherent part of the definition of government. You seem to fall to the same misunderstanding of basic opposing ideas that Karl Popper writes about. You seem to contrast the individual against altruism when the opposite is the collective. You forget that an individual can be altruistic and help, yet remain fully free in their choices; you confuse individualism with egoism and collectivism with altruism. You are so myopic in your own vision of how things ought to be that you can't see the difference between that and the way things are. There are no garuntees. All these assumed ideas are like seat belts on an aeroplane. Old people die, children die before their parents, some people are poor. Government spending won't change this. That does not mean it should do nothing, but it is really more up to communities and individuals to help and they would have a far greater impact. We've gone from no one having health care to it being some sort of fundamental birth right. Here is another radical idea. Families and friends take care of each other. You don't need a government mandate to care.

Even with all this, there are still programs that do cover people now, all they have to do is look. Forget the federal programs the states and counties have different programs set up but they aren't going to come to the person. You have to do a little work and fill out some forms or talk to people.

Mannahnin wrote:
There is obviously a lot of real, legitimate disagreement about how much and to what degree we should do this. Obviously no one wants any elderly poor people dying in the streets. But how much medical assistance are we obligated to provide? Is it going too far to use the collective bargaining power of the over 36 million people who are on Medicaid and/or the more than 40 million people on Medicare to get lower prices for prescription drugs? Saving money both for the needy and for the taxpayers who are supporting them? I don’t think so.

Ewww, collective bargaining power. Those numbers are off for one. Almost 1/3 of the country is not on Medicaid/Medicare. Saving money is fine and there shouldn't be regulations that keep the companies from competing. If Canada is cheaper then so be it. It shouldn't cost me (that much more) money because they aren't allowed to compete with their pricing. Also, there is no garuntee of medication in our existence. Grandma may need $200 a month to stay alive at 84, but she's still going to die. Modern medicine spends more time keeping people alive well past there expiration date then saving people from accidents and such. Our feeble attempts at immortality only cost us more and more.

With GW's fans using collective bargaining power we can lower the price of a box of terminators. It hasn't yet but what the hell. You can get them cheaper but the MSRP hasn't changed.

Mannahnin wrote:
Right now our profit-centered model of healthcare results in a great deal of waste and inefficiency, and a lot of very tragic situations where people lose their lives or their livelihoods because they can’t afford the care they need. That, to me, is a problem. That’s not a healthcare system I’m inclined to be proud of.

That statistical comparisons of quality of life and healthcare across different countries seem to show is that a lot of countries which do work along a more socialized model have happier, and healthier populations than we do. IMO, purely on pragmatic grounds, we should be looking at how we can achieve their results, even if we have ideological issues with the means they use.

OMG profit, so evil! You talk of waste and inefficiency but then want more government involvement. You want waste and inefficiency look no further. I hope you are never successful so you don't have to know the horror that comes with it. It's, it's like being next to Satan himself really.

Yeah it sucks that some people have a rough time of it. Government spending won't change that. That is up to people, not the government. What is healthy changes and measuring happiness is a difficult prospect at best. Most of our health problems stem from our success. We are more sedentary because we don't have to do as much manual labor and our disposable income allows us to eat gakky food that tastes good and kills us. That isn't a government problem, if anything it is a sign of success and we seem pretty happy generally. They also have smaller populations then we do and it is much easier to herd smaller populations.

Europe as a whole has a much higher population density than the US. (Not Ireland though, we still haven't recovered to pre-famine levels)
But cheers for using the term "herd". That's just a wonderful choice. I'll not get into mudslinging but I find that usage laughable.

I come from a country where the government used to own things like telecommunications, transport, the airline and a few other things. Over the last decade, a party that espouses the kinds of veiws you have got into power as part of a coalition with a larger party. They negotiated the privatisation of all of these services.
Since privatisation these services have unilaterally gotten worse. Broadband penetration and line quality is laughable, the newly privatised airline is closing unprofitable runs in economically deprived areas, furthering their decline. The list is pretty long.
The party in question was decimated by "the herd" in the recent elections, losing 66% of their seats. Unfortunately, they are still part of the coalition, and are trying hell for leather to ruin the health system with the same bs. Pretty much everyone is opposed to it, and I can't see them surviving much longer.

Believe it or not, government spending can and does have and effect on quality of life. I posted concrete examples of that. And most people I've spoken to over here would gladly take another tax hike if it meant a better health service. I find the common objection to tax increases in the US baffling. Different strokes for different folks I suppose.
Mannahnin: Cheers for the quick rundown on medicaid and whatnot.

US Population: 303,175,000
US Population Density: 31/km²
EU Population: 495,128,529
EU Population Density: 114/km²

Da Boss wrote:US Population: 303,175,000
US Population Density: 31/km²
EU Population: 495,128,529
EU Population Density: 114/km²

Which is part of the reason why Europe's public transit systems to be much better than those in North America. Greyhound is often the only service linking Canadian cities for those without cars, and there's a large part of the country you can't get to without a car or snowmobile (or course no one lives in those places, so you can't mind too much).

I suppose the US and Europe just have differences of opinion and philosophy on these things.

Practical experience is also a fine teacher.

Dealing with the locality I'm most familar with (California and Southern California area counties and municipalities) poor fiscal planning and overexpansion have left governments in well nigh uniformly perilous conditions. Expanding their reach into more areas at this point would just give them something new to fail at. Until these entities can demonstrate a capacity for structural reforms and overcoming problems with a solution that is not "spend more money" . . . it's hard to take them seriously in that regard. The federal government is really no better at this point.

The European experiments in medicine are also not without risk. I know that it is the worst of the lot, but the British healthcare system seems to spin out plenty of horror stories that are on par or worse than the failings I've heard of within the US system (based on comparing The Economist/Financial Times coverage of said systems to US news sources such as the Los Angeles Times/New York Times that certainly pull no punches in this regard).

I think you'll find our own press rarely pulls any punches when it comes to health controversy.
But you are right, the health service is something that can go badly wrong.
Our government recently instituted a Health Service Executive which has total power but no accountability, against the advice of health service proffessionals. The litany of scandals and complaints, and their drive to privatise against the wishes of the populace certainly lend credence to your worries. But the party responsible is dead on it's feet politically, and the constant uproar and votes of no confidence are a good thing (in a way, obviously it would be better to have a totally efficient service), as it means that health is very much in the public conciousness, which means if a government wants to get voted in it has to make funding the health service a priority.
It's also easy to look at those problems and dismiss public healthcare, but keeping it under control of the government also keeps it under the control of the voting public, to a degree.

"To a degree" being the key qualifier, and something that all must judge for themselves.

One can also judge the value of keeping things under the voting public differently. To use a key point of contention: right now, medical science has advanced to the point of life sustaining and general excellence that a voting public could easily prefer to radically reduce the costs of current health (basically price/wage controls in the industry) at the expense of future health (decreased interest in the profession, reduced research expenditures, etc.). Individuals may have rather different opinions on the value of that proposition, no?

So wait, are we talking about a universal government system that is supposed to work for everyone everywhere? I know what Europe does, but that does not mean it will work here and vice versa. Not every country can use the same systems and have success. Making B like doesn't mean that B will actually turn out anything like A at all, or even last.

As far as population goes China has Europe and the US beat, does that mean we should all adopt Chinese Communism?

*Rolls eyes*
No that's not what I meant and not why I posted the population stats. Brilliant twisting of my words though.

I'm interested in the arguments for and against both kinds of government. As I stated in my first post, this is not meant as an attack on the US system, I just interested in why people think it is better. I will then make arguments as to why I like the system I'm in, while pointing out weaknesses.
For example Ahtman, if you could outline some of the differences between the US population and structure and the EU one, and why you think this would lead to a failure of socialist type government in the US, that would be really interesting to read.
I posted the population stats to point out the the EU actually has quite a large population, so it's not nessicarily down to the government "herding" them as you said.
Alpharius: This would be something I'd have to look into more, as I know little about it. But I will, and will answer you.

The interesting thing about that point as well is that it raises some free-rider/risk management issues. To my mind, as long as certain markets are profitable enough (basically the US home market for many pharms) there will be enough revenue generation to fund research to a point that is more or less adequate-so others can adopt differing systems that create less profitable ancillary markets and everyone is happy enough. Now if the "core" market spinning off the profitability goes south, how does that impact global research trends and spending, and what are the collateral impacts on all nations? One reason to watch what happens in the US very closely . . .

Certain price liberalization may have ironic secondary impacts on other nations as well. For instance, were drug reimportation from Canada to the United States legalized and widely used, which of the following would be more likely:

a) Global pharms accept radically reduced profit in the market of their core operations (the US) and drug prices fall without ill effects

b) The aforementioned companies greatly increase prices to the Canadian health care system to match US pricing structure in order to eliminate the discount-keeping profits in the US mostly stable but greatly increasing pharm costs for the Canadian system

Just some things to consider.

lifeafter wrote:Mannahin, thank you for clarifying the difference between the two programs for me.

All the countries you mentioned have much higher taxes than the U.S. Instituting a national healthcare plan similar to what those countries have will require a huge increase in the amount of taxes americans will pay.

When assessing the economic impact of taxes you also have to take into account the things those taxes are paying for. Right now my wife & I are in the 25% tax bracket but in real terms pay around 15% in income taxes, plus social security. Our health insurance costs me a bit over 10% of my gross pay each pay period. If health insurance were bundled into my taxes, it wouldn’t actually reduce my income unless it cost more than 10% of my gross pay. Remember that those countries have a lot of other services going into their taxes as well, so it’s not as simple as National Healthcare = Much Less Money in My Pocket.

lifeafter wrote:Government funded healthcare leads to a government regulated health industry. It'll drain the profit margins from the field and decrease both the amount invested in the development of new technologies.

It would definitely reduce the profit margin. Do we think that there needs to be a large profit margin in healthcare? Is it important for other services which keep us alive, like the fire department? Or the police?

Other countries still do research and come up with new technologies. The Berlin Heart EXCOR pediatric Ventricular Assist Device is an excellent machine and a real lifesaver for some kids. It was used for a 12 year old girl my company arranged the medical repatriation for last summer (from France where she fell ill on a school trip to her home in Colorado).

http://salesandmarketingnetwork.com/news_release.php?ID=2022084

Germany has what appears to be a pretty solid healthcare system:

http://www.medhunters.com/articles/healthcareInGermany.html

The WHO ranked them 25th for cost/effectiveness in their 2000 report (Canada was 30th and the US 37th).

lifeafter wrote:There are too many uninsured in the country right now and a sick population does have implicatoins for the economy. Keeping the uninsured healtheir should translate into a healthier, more productive work force.

Very good point. The statistical evidence shows that uninsured people get less care, and lower quality of care. They get virtually no preventive care, which results in greater costs because preventive care’s a lot cheaper than emergency room care.

http://www.nihp.org/Issue%20Briefs/Uninsured%20Issue%20Brief.htm

http://ideas.repec.org/p/fal/wpaper/06001.html

http://www.commonwealthfund.org/newsroom/newsroom_show.htm?doc_id=223595

lifeafter wrote:We should see how state models such as Massachusetts and California work out before we take the responsibility of healthcare from the free market.

How can the free market be responsible for healthcare? If the free market were the best way to handle public health and safety, wouldn’t we privatize fire departments, police, and highway maintenance?

Alpharius Walks wrote:The interesting thing about that point as well is that it raises some free-rider/risk management issues. To my mind, as long as certain markets are profitable enough (basically the US home market for many pharms) there will be enough revenue generation to fund research to a point that is more or less adequate-so others can adopt differing systems that create less profitable ancillary markets and everyone is happy enough. Now if the "core" market spinning off the profitability goes south, how does that impact global research trends and spending, and what are the collateral impacts on all nations? One reason to watch what happens in the US very closely . .

It’s a very good question. For all the free market fans, it’s also an interesting question whether it’s worthwhile for the US to effectively subsidize the rest of the world in research.

http://www.phrma.org/news_room/press_releases/r&d_spending_by_u.s._biopharmaceutical_companies_reaches_a_record_$55.2_billion_in_2006/

I have to admit that all the marketing of prescription drugs nowadays makes me a bit uncomfortable as well. In 2005 they spent around $30 billion just on marketing.

http://answers.google.com/answers/threadview?id=781742

On the flip side, without profit motive there's no motive for drug companies to develop new products.

Ahtman wrote:Generally, most Americans will lean toward one or the other in varying degrees. They only don't seemed crushed to you perhaps, but tell most Americans how much they pay in taxes and they will be flabbergasted and think it is to much.

Really? And when you tell them all the things they get for their taxes? Like healthcare, child care, and other services? “Most Americans”, IME, haven’t a clue about how their own health insurance works, so they’re not usually in a good position to comment on other systems without actually putting in some work and study. As for whether the citizens of those countries "seem" crushed by taxes to me, they're perfectly capable of speaking for themselves. Ask them. Lots of them are on these forums.

Ahtman wrote:

Mannahnin wrote:
Part of the function of government is indeed to redistribute some of the burden from people who can’t take care of themselves onto people who can afford more. It’s the price we pay if we don’t want to see our poor, sick, elderly, and disabled dying in the streets. And if we want to avoid a lot of other less dramatic forms of suffering.

There is a monstrous assumption on your part and a total opinion presented as fact. If I look government up in different reference guides I doubt it will list government as a mechanism of wealth redistribution for the poor and elderly. It is not a function of the government to take care of these people. You can believe that it is important and that it should be a role of the government, but it isn't an inherent part of the definition of government.

This is not an assumption or opinion. It’s a couple of facts, which perhaps I did not phrase clearly enough for you. Let me rephrase slightly.

Part of the function of government in GENERAL is to allow us to do some things and provide some services as a collective group, instead of having to do it for ourselves. These include things like making and enforcing laws, building highways, protecting our nation with an army and our local neighborhoods with police and fire departments. Can you agree with that?

In the SPECIFIC case of our government, generations prior to ours have already decided that another function is some wealth redistribution. This is what Social Security is. We as a nation instituted it after old people’s savings were wiped out in the Great Depression, and we decided that it would be wrong to leave them destitute to die in the streets or as unbearable economic burdens to their families.

Ahtman wrote: You forget that an individual can be altruistic and help, yet remain fully free in their choices; you confuse individualism with egoism and collectivism with altruism. You are so myopic in your own vision of how things ought to be that you can't see the difference between that and the way things are. There are no garuntees. All these assumed ideas are like seat belts on an aeroplane. Old people die, children die before their parents, some people are poor. Government spending won't change this. That does not mean it should do nothing, but it is really more up to communities and individuals to help and they would have a far greater impact. We've gone from no one having health care to it being some sort of fundamental birth right. Here is another radical idea. Families and friends take care of each other. You don't need a government mandate to care.

Let me give you a little background. I was raised by Libertarians, and my mother’s favorite aurhor when she was young was Ayn Rand. I was named after a character in Atlas Shrugged and I still get a thrill when I re-read Anthem. I grew up glorifying the freedom of the individual, and distrusting the government.

That said, as I grew up, I met people who genuinely need assistance, and whose families are unable or unwilling to provide it. And I decided that the greater evil is not to help. I worked in homeless services for three years, and I still donate money to charities, but healthcare is too big a problem for individuals.

I don’t try to fix a badly laid-out traffic intersection in my city myself, or expand a highway with a shovel and a wheelbarrow full of asphalt. Roads and highways work a lot better when done collectively through the mechanism of government. From what I can tell so far by comparing the US healthcare system with those of some other countries, it appears that this is something that might work a lot better if it wasn’t run by a lot of competing private companies whose primary responsibility is to their shareholders and their profit margins.

Ahtman wrote:

Mannahnin wrote:Is it going too far to use the collective bargaining power of the over 36 million people who are on Medicaid and/or the more than 40 million people on Medicare to get lower prices for prescription drugs? Saving money both for the needy and for the taxpayers who are supporting them? I don’t think so.

Ewww, collective bargaining power. Those numbers are off for one. Almost 1/3 of the country is not on Medicaid/Medicare. Saving money is fine and there shouldn't be regulations that keep the companies from competing. If Canada is cheaper then so be it. It shouldn't cost me (that much more) money because they aren't allowed to compete with their pricing.

Go ahead and look up the numbers. I won’t expect an apology or even an admission of error, but it is interesting that you didn’t even bother to look it up before posting.

Collective bargaining power is the reason we don’t have a seven day work week. Or a 12 hour standard workday. Don’t sneer at the thing that got you a lot of the quality of life you take for granted now.

Collective bargaining power is also a part of free market economics. It’s why a big company can get lower individual health insurance premiums for its employees than a small company can. The health insurance company has an incentive to cut the rates because of all the business they’re getting. It’s the same reason why you get cheaper prices when you buy in bulk, or some companies give free shipping for orders over a certain amount. If a big corporation can get lower prescription premiums for its employees, why on earth shouldn’t our government negotiate the same way? Why shouldn’t they save the taxpayers the money?

Ahtman wrote:

Mannahnin wrote:Right now our profit-centered model of healthcare results in a great deal of waste and inefficiency, and a lot of very tragic situations where people lose their lives or their livelihoods because they can’t afford the care they need. That, to me, is a problem. That’s not a healthcare system I’m inclined to be proud of.

OMG profit, so evil! You talk of waste and inefficiency but then want more government involvement. You want waste and inefficiency look no further.

What a ridiculous argument. Are you trying to look foolish? No one said profit is evil. But if a system forces people (like Dr. Linda Peeno) to choose profit at the expense of human life, there’s something wrong.

http://www.thenationalcoalition.org/DrPeenotestimony.html

As for waste and inefficiency, I reiterate: Do you think the police and fire departments would work better if those services were provided by competing profit-based private companies? HINT: New York City had fire brigades like this once upon a time. You can look it up and see how well it worked.

Ahtman wrote: I hope you are never successful so you don't have to know the horror that comes with it. It's, it's like being next to Satan himself really.

Wanting our country to have as good healthcare as the UK, France, or Sweden makes me Satan? Really? Wanting to reduce our infant mortality rate is evil? Did you know that we have more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but our newborn mortaility rate is higher than any of those countries?

http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html

jfrazell wrote:On the flip side, without profit motive there's no motive for drug companies to develop new products.

Because the products they're coming out with now are much better than, for example, the Polio Vaccine? Jonas Salk might beg to differ with your premise.

How can the free market be responsible for healthcare? If the free market were the best way to handle public health and safety, wouldn’t we privatize fire departments, police, and highway maintenance?

These are different services. One of the purposes of government is to provided services the market fails to. There's not a profitable market for fire service, and basic tenants of government (government having final say and authority of enforcement of laws) make privatization of law enforcement not practical. Still, many of these services have elements of free markets in them. Managed competition and outsourcing have led to governments using markets for all sorts of functions. For example, many cities hire contractors to do meter reading. Many cities have contractors perform meter maid functions instead of their police departments. Governments are even chartering schools to private companies. But I'm digressing. The reason we don't privatize fire, police, and highway maintenance is because the market would fail to provide these services. However, healthcare is different, because the private market has not failed in the supplying of these services. It's certainly not going as well as some would ideally like it, but it's not yet failing to the point that it needs to be axed and completely replaced. Government replacement of a service that is supplied in a free market should always be a last result.

Mannahnin wrote:

jfrazell wrote:On the flip side, without profit motive there's no motive for drug companies to develop new products.

Because the products they're coming out with now are much better than, for example, the Polio Vaccine? Jonas Salk might beg to differ with your premise.

The drugs used to (hopefully) free my father from stage 3 cancer were developed by a private drug company. they were not developed at a publicly owned facility. The point stands.

Its a simple system. The substantial majority of drug manufacturers are for profit companies, not public companies. You didn't see a lot of medical breakthroughs coming out of the Soviet bloc.

On the flip side I agree that the US is effectively a protected market for drug manufacturers. That should not be tolerated.

lifeafter wrote:

How can the free market be responsible for healthcare? If the free market were the best way to handle public health and safety, wouldn’t we privatize fire departments, police, and highway maintenance?

These are different services. One of the purposes of government is to provided services the market fails to. There's not a profitable market for fire service, and basic tenants of government (government having final say and authority of enforcement of laws) make privatization of law enforcement not practical. Still, many of these services have elements of free markets in them. Managed competition and outsourcing have led to governments using markets for all sorts of functions. For example, many cities hire contractors to do meter reading. Many cities have contractors perform meter maid functions instead of their police departments. Governments are even chartering schools to private companies. But I'm digressing. The reason we don't privatize fire, police, and highway maintenance is because the market would fail to provide these services. However, healthcare is different, because the private market has not failed in the supplying of these services. It's certainly not going as well as some would ideally like it, but it's not yet failing to the point that it needs to be axed and completely replaced. Government replacement of a service that is supplied in a free market should always be a last result.

I think you're building on an unproven assumption.

Who says you can't make a profit on firefighting? People did it in the US as recently as the 19th century. But we moved away from that model as it wasn't the most effective way to do it.

I think a number of other countries are demonstrating right now that there's a more effective way to handle healthcare. One that allows them to have less human suffering than we do.

jfrazell wrote:

Mannahnin wrote:

jfrazell wrote:On the flip side, without profit motive there's no motive for drug companies to develop new products.

Because the products they're coming out with now are much better than, for example, the Polio Vaccine? Jonas Salk might beg to differ with your premise.

The drugs used to (hopefully) free my father from stage 3 cancer were developed by a private drug company. they were not developed at a publicly owned facility. The point stands.

Its a simple system. The substantial majority of drug manufacturers are for profit companies, not public companies. You didn't see a lot of medical breakthroughs coming out of the Soviet bloc.

I hope they work and your father makes a full recovery. I don’t often pray for strangers, but I hope you don’t mind that I offer one up for him.

Your example doesn’t prove your point. The fact that private companies have a profit motive to do research doesn’t support your statement that WITHOUT a profit motive there’s NO incentive to do research. My example of Jonas Salk disproves your generalization.

Your argument about the Soviet Union is more interesting. Naturally as Americans born and raised in a culture which saw the Soviets as the enemy, we didn't grow up hearing a lot of good things about them. Do you have any statistical or historical comparison studies showing a contrast between how many "medical breakthroughs" they made in comparison to the US during the period when the Soviet Union existed?

Mannahnin wrote:

lifeafter wrote:

How can the free market be responsible for healthcare? If the free market were the best way to handle public health and safety, wouldn’t we privatize fire departments, police, and highway maintenance?

These are different services. One of the purposes of government is to provided services the market fails to. There's not a profitable market for fire service, and basic tenants of government (government having final say and authority of enforcement of laws) make privatization of law enforcement not practical. Still, many of these services have elements of free markets in them. Managed competition and outsourcing have led to governments using markets for all sorts of functions. For example, many cities hire contractors to do meter reading. Many cities have contractors perform meter maid functions instead of their police departments. Governments are even chartering schools to private companies. But I'm digressing. The reason we don't privatize fire, police, and highway maintenance is because the market would fail to provide these services. However, healthcare is different, because the private market has not failed in the supplying of these services. It's certainly not going as well as some would ideally like it, but it's not yet failing to the point that it needs to be axed and completely replaced. Government replacement of a service that is supplied in a free market should always be a last result.

I think you're building on an unproven assumption.

Who says you can't make a profit on firefighting? People did it in the US as recently as the 19th century. But we moved away from that model as it wasn't the most effective way to do it.

I think a number of other countries are demonstrating right now that there's a more effective way to handle healthcare. One that allows them to have less human suffering than we do.

Control over the firefighters was one of the big ways that Roman patricians established debts of obligations and showed their benevolence on the plebes.

One of the first things Augustus did when he took control was to nationalize Rome's firefighters so that he alone controlled them.

It's tangential, but it's too interesting not to mention.

That "unproven assumption" is what has been taught to me in both undergraduate (BA in Public Policy Studies) and graduate (Masters of Public Administration) school. Governments should only take up the provision of a service if the market is failing to provide it. The market is not currently failing to provide healthcare to this nation therefore complete getting rid of it is not the appropriate action. Doing so would not only place a huge financial burden on the tax payers in this country, it would also cripple elements of our current system that provide for the current standards of medical development and medical provisions in this country. Furthermore, the evidence is not in yet that the socialized health systems in this world are the best alternative. For proof, look at how the rates of people turning to private practice in those countries has increased. People with means aren't paying for different treatment because they're satisfied with the current government offering. What's great about our private medical system is that even government supplied insurance utilizes our free healthcare market. Our private practice, specialist care, and emergency staff are all top notch in this country because of the healthcare market that exists in this country.

Mannahnin wrote:

jfrazell wrote:

Mannahnin wrote:

jfrazell wrote:On the flip side, without profit motive there's no motive for drug companies to develop new products.

Because the products they're coming out with now are much better than, for example, the Polio Vaccine? Jonas Salk might beg to differ with your premise.

The drugs used to (hopefully) free my father from stage 3 cancer were developed by a private drug company. they were not developed at a publicly owned facility. The point stands.

Its a simple system. The substantial majority of drug manufacturers are for profit companies, not public companies. You didn't see a lot of medical breakthroughs coming out of the Soviet bloc.

I hope they work and your father makes a full recovery. I don’t often pray for strangers, but I hope you don’t mind that I offer one up for him.

Your example doesn’t prove your point. The fact that private companies have a profit motive to do research doesn’t support your statement that WITHOUT a profit motive there’s NO incentive to do research. My example of Jonas Salk disproves your generalization.

Your argument about the Soviet Union is more interesting. Naturally as Americans born and raised in a culture which saw the Soviets as the enemy, we didn't grow up hearing a lot of good things about them. Do you have any statistical or historical comparison studies showing a contrast between how many "medical breakthroughs" they made in comparison to the US during the period when the Soviet Union existed?

Thanks Manny. We're sitting on a three month wait period which hopefully will come out good-all signs point to yes though.
I think it would be easier to cite advances that did occur in the Soviet bloc. I can only think of assembly line eye surgery.

Mind you, I'm not against some modified system per se. I don't know about the German system. The Canadian system draws more positive scrutiny-I have more positive anecdotal opinions of it from Canadians then against it (I work with them). I don't think that an English/government system works on its face however.

Well the headline in today's paper was that an alarming number of people were dying in the emergency room waiting rooms because it can take hours to be seen even if you have a life-threatening condition, so make of that what you will.

One major thing that came out of the Soviet Bloc was the distribution of hospitals. Many rural areas that would not have had them because of economic reasons got them under the Soviet systems.

Jfrazell, I hope your father heals as well.

Asmodai, what country, state, city was the headline talking about?

lifeafter wrote:One major thing that came out of the Soviet Bloc was the distribution of hospitals. Many rural areas that would not have had them because of economic reasons got them under the Soviet systems.

Jfrazell, I hope your father heals as well.

Asmodai, what country, state, city was the headline talking about?

Ontario, but also Canada more generally. It's not an everyday thing, but there's been a few high profile cases of sympathetic and photogenic people dying while awaiting care, so it's all over the media.

Asmodai wrote:
Ontario, but also Canada more generally. It's not an everyday thing, but there's been a few high profile cases of sympathetic and photogenic people dying while awaiting care, so it's all over the media.

It's a pretty sad situation. In the U.S., our emergency rooms are crowded, but people will see a Doctor within hours for the least life threatening cases and immediately with life threatening cases. What's more, this service is essentially free for our poorest, because in any emergency room in this country, you will be treated regardless of your ability to pay for it. The doctor treating you will never say "This man needs an appendectomy now! Wait, is he insured?" because the law requires that doctor to do whatever it takes to save your life.

I will give you an example from my personal experience. When I was 18, I broke my arm very badly. I was not insured. It was a compound fracture. My friends drove me to a hospital Emergency room that usually would not accept breaks, but because the law forbid them to turn away critically injured patients, they had to call in a orthopedic surgeon to fix arm. I was stabilized, operated on, and hospitalized for 2 days without any question of whether or not I had insurance. I did, but the point is that this was beside the point when I was first admitted to the hospital. All my financial information was taken care after my hospital stay (cause I didn't have my information when the incident happened). Regardless of my ability to pay for it, the hospital took me in, a surgeon operated on me, ad I received all sorts of drugs and nursing care before any question of my finances was brought up. If I had been dirt poor, I'd be in debt, but I'd still have my arm.

lifeafter wrote:

Asmodai wrote:
Ontario, but also Canada more generally. It's not an everyday thing, but there's been a few high profile cases of sympathetic and photogenic people dying while awaiting care, so it's all over the media.

It's a pretty sad situation. In the U.S., our emergency rooms are crowded, but people will see a Doctor within hours for the least life threatening cases and immediately with life threatening cases. What's more, this service is essentially free for our poorest, because in any emergency room in this country, you will be treated regardless of your ability to pay for it. The doctor treating you will never say "This man needs an appendectomy now! Wait, is he insured?" because the law requires that doctor to do whatever it takes to save your life.

I will give you an example from my personal experience. When I was 18, I broke my arm very badly. I was not insured. It was a compound fracture. My friends drove me to a hospital Emergency room that usually would not accept breaks, but because the law forbid them to turn away critically injured patients, they had to call in a orthopedic surgeon to fix arm. I was stabilized, operated on, and hospitalized for 2 days without any question of whether or not I had insurance. I did, but the point is that this was beside the point when I was first admitted to the hospital. All my financial information was taken care after my hospital stay (cause I didn't have my information when the incident happened). Regardless of my ability to pay for it, the hospital took me in, a surgeon operated on me, ad I received all sorts of drugs and nursing care before any question of my finances was brought up. If I had been dirt poor, I'd be in debt, but I'd still have my arm.

Actually they had the same story about the US. Average wait times for heart attack victims have increased from 6 or 8 minutes to 20 minutes. Its a function of uninsured flooding the E rooms now for emergency and non-emergency care. This has caused 1) a decline in the number of emergecy rooms as hopsitals can't afford to treat people who can't pay; 2) overcrowding in the remaining rooms. The unwritten note on the story is the impact of illegal immigration on emergency healthcare and cost. Understandable. If you have 20MM illegal immigrants here, on top of the existing uninsured (who have to compete with them FYI as they have similar skills) then your emergency system and medical system in toto is going to be pressured.

I think it's great that emergency or lifethreatening injuries are treated without question, but for someone like my niece, who was born with a heart condition to a poor family, it would be a really sucky situation. She needed expensive (I mean really expensive) drugs to alleviate the symptoms and reduce her risk of heart attack. By my understanding (please correct me if I'm wrong) my sister would have had to pay for these in the US. Also, because of her pre-existing condition, wouldn't insurance be much harder for her to get in future? That seems unfair, as it wasn't anything that she did that caused her to have this heart defect.
So though I can see that the US system isn't the complete failure some would make it out to be by any means, I believe state sponsored healthcare is better at catching people who slip through the cracks.

Da Boss wrote:So though I can see that the US system isn't the complete failure some would make it out to be by any means, I believe state sponsored healthcare is better at catching people who slip through the cracks.

That recognized potential weakness is why creative market reform in states like Massachussets (enacted) and California (proposed) focuses on requiring individuals to enroll in group health insurance (basically, you have to at least pick up some kind of catastrophic coverage to handle such eventualities) while using existing health-care related subsidy money and other revenue streams to purchase/subsidize those whose income makes purchasing coverage unrealistic. There will be important variations as more states experiment and switch to these systems. California will be different than Mass. simply because our state has a larger pool of uninsured and poor residents relative to our population, Mass. is better off which gives them more flexibility.

This combines some imposition by the government (basically being forced to devote some portion of your income to health care spending) with retaining flexiblity in the market and alleviating the need for a systematic government take-over of the system and the risks that would entail.

The nice thing about the US system is that even with extensive regulation of the medical business there is enough flexiblity for change. For instance, in California at least, the Kaiser Permanente managed care system is becoming extremely popular amongst recent med-school graduates. Instead of a traditional practice model, individual doctors are salaried employees of the Kaiser corporate entity which handles the "practice" side of medicine. This means they earn somewhat lower wages than owning their own practice, but don't have to worry about malpractice and other things and can enjoy set work hours/schedules and other quality of life benefits.

At the same time, a great deal of the push for healthcare reform in many states is being driven by corporations who are tired of seeing their bottom line burdened by double-digit cost increases year over year in trying to provide a basic benefit to employees.

Although there will always be tensions between the need to provide services and generate profits to fund research and innovation, this new evolving consensus seems to pave a middle ground. There will be pitfalls and challenges, but many in the US would view it as less risky then wholesale nationalization.

This is particularly true in light of the laws of unintended consequences that accompany any industry of such complexity. To use another California example-after the Northridge earthquake in the 1990's, the state decided it would be a brilliant idea to require all hospitals to retrofit their facilities to exacting earthquake-safety standards. They, however, declined to provide any funding stream for this endevour. Suffice to say that retrofiting such large structures is exceedingly expensive, and in many cases it has proven cheaper to simply build a new facility.

Some larger corporations (Kaiser as an example) have the fiscal resources to absorb that hit. Many local and community hospitals do not. Some will survive thanks to community support (local redevelopment agencies providing no interest loans, etc.), many others will go out of business. In a few years a wave of local hospital closures will hit the state unless regulatory relief is granted, and everyone will shake their heads and wonder how it happened. This will of course only increase pressures on the remaining service providers.

Now imagine this same level of business acumen and rigorous weighing of consequences being applied to the entire health industry-and you can see why a country of 300 million may be skeptical of a one-size-fits-all solution.

Just some more food for thought.

Thank you very much for that post (and everyone else for theirs) this is exactly sort of thing I wanted to learn.
(Yeah I could go and research it, but an evolving discourse is more fun!)

We have a private healthcare system over here too, and opinion is divided on it. Some believe it should be there, and having two tiers of service is okay as long as the bottom tier looks after those who need it. Others hate the idea of a two tier system which is determined by income.
I'm currently undecided, but I disagree with any plans to run private practices from state owned hospitals.