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Fine Gael's "Dutch Model" for Healthcare

  • 01-02-2011 06:01AM
    #1
    Dr. Baltar
    Registered Users, Registered Users 2 Posts: 1,252 ✭✭✭


    I can't exactly understand the Dutch model in practice. What I gather of the model is that it is a crime to not have Health Insurance (unless for religious reasons) and that this Health Insurance is bought from your own wages.

    A number of questions:

    1. What happens if you cannot afford your Health Insurance?
    2. Does everyone pay the same amount for their Health Insurance?
    3. How exactly does privatising Health make it a "better" service?
    4. Will this be cheaper on the taxpayer than the current HSE?
    5. What will happen to those people currently employed by the HSE?

    Thanking you in advance.


«1

Comments

  • #2
    bonkey
    Registered Users, Registered Users 2 Posts: 15,443 ✭✭✭✭bonkey


    Dr. Baltar wrote: »
    1. What happens if you cannot afford your Health Insurance?

    Not quite answering the question, but...
    From the Dutch healthcare site wrote:
    If your income is under a fixed minimum level, you are entitled to a health care allowance to help pay part of the cost of the contribution

    (Aside - in Switzerland, if your income is judged too low, Social Welfare can pay your insurance).
    2. Does everyone pay the same amount for their Health Insurance?
    No. There is a minimum "universal" package which all health insurers are obliged to offer. They can compete with each other on price. This is monitored by a government "watchdog" for price-fixing etc.

    (Aside - in Switzerland, the compulsory universal package also has a government mandated maximum cost)
    3. How exactly does privatising Health make it a "better" service?
    Its a fair question, to which I don't think there's an easy answer. I would say, however, that the Dutch are considered to have the best system in the world, and the Swiss aren't that far behind...and they have extremely similar systems.
    4. Will this be cheaper on the taxpayer than the current HSE?
    Supporters of the system will tell you that its a very efficient way of running things, so yes, the average cost will come down.
    Detractors of the system will tell you that in the Netherlands (and Switzerland) health-care costs are rising, so no, its not.

    IIRC, some years ago there was much noise about how the Irish paid per capita more on healthcare then anyone else in Europe, but had nowhere near the best system.

    My best guess is that if the Dutch model were properly implemented, then yes, average costs would come down and quality would rise. If, however, an "Irish model" were implemented instead, with pandering to cronies, and compromises to various concerns....then there's no telling what will happen.
    5. What will happen to those people currently employed by the HSE?
    No idea. That's a question for the policy makers alright...


  • #3
    femur61
    Registered Users, Registered Users 2 Posts: 1,588 ✭✭✭femur61


    bonkey wrote: »
    My best guess is that if the Dutch model were properly implemented, then yes, average costs would come down and quality would rise. If, however, an "Irish model" were implemented instead, with pandering to cronies, and compromises to various concerns....then there's no telling what will happen.

    QUOTE]


    I agree with you with on that, we fought 800 years so we could get independence, and all we put in the English's place are another bunch of people who abuse the minions who put them in power.


  • #4
    munchkin_utd
    Registered Users, Registered Users 2 Posts: 7,960 ✭✭✭munchkin_utd


    I agree with you with on that, we fought 800 years so we could get independence, and all we put in the English's place are another bunch of people who abuse the minions who put them in power.
    abuse the minions????

    My hole.

    - 37% of Irish WORKERS dont pay tax. Not a cent. The irish low paid minions are the most lucky minions in the western world. Even low tax ecomomies like the USA dont let so many people pay NOTHING towards running the country.
    - The Dole! 200 euros a week. Plus all the other perks and your rent almost fully covered. The low paid minions have it great, but the ones on the dole even better. (compare german dole of means tested max 370 a MONTH to what you get in Ireland, and germany is allegedly a far more socialist minion friendly country)
    - the pensioners have a massive tax credit, so most can live well on what income they have, and over 70s have a blanket blank cheque of a medical card to look after whatever medical ailments they have


  • #5
    Sulmac
    Registered Users, Registered Users 2 Posts: 1,021 ✭✭✭Sulmac


    Dr. Baltar wrote: »
    I can't exactly understand the Dutch model in practice. What I gather of the model is that it is a crime to not have Health Insurance (unless for religious reasons) and that this Health Insurance is bought from your own wages.
    That's it in a nutshell. Only a tiny number of people are exempt from it as their religious beliefs see insurance as a form of gambling which is forbidden.
    A number of questions:

    1. What happens if you cannot afford your Health Insurance?

    If you are unemployed you get a voucher to pay for it, and if you are on a low income it is paid for on a 'sliding-scale' (so the less you earn, the less you pay - it may be fully paid for). Other groups such as all children and those who are disabled also get vouchers to have it paid for.
    2. Does everyone pay the same amount for their Health Insurance?

    Yes (and no!), and companies cannot refuse to insure you. The government sets the maximum price for a 'basic' package that includes hospital care, GP care, prescription drugs, ambulance care and some dental and optical care, among other things (although long-term care and end-of-life care remains in the 'public' sector). In the Netherlands the current maximum price is around €90-100 per adult per month, and companies compete by setting prices below this (which they cannot change depending on the person, so if person A buys it from company A for €85, person B must also be allowed buy it from company A for €85).
    3. How exactly does privatising Health make it a "better" service?

    The biggest change is that 'money follows the patient', rather than hospitals getting a single block grant every year as they do now. This means that patients are an 'income' rather than an 'expense' and hospitals and insurance companies compete for their 'business'. The theory goes that this reduces waiting lists and speeds up the process of being 'in' the health service, generally.
    4. Will this be cheaper on the taxpayer than the current HSE?

    Well Fine Gael say it can be delivered within current budgets, but they also want to abolish the HSE organisation itself. I'd imagine a lot of savings can be made within the health service through greater efficiency.

    Also, the Dutch model is designed to be 'future-proof' for an aging population. This is more important to the Dutch than it is to us as we have a relatively young population (for now), although it is designed to keep costs low as the number of elderly people rises.
    5. What will happen to those people currently employed by the HSE?

    Thanking you in advance.

    Depends on their job, I suppose. Quite a lot of unnecessary staff (especially in administration) will be let go of, and I don't think Fine Gael make any secret of this.

    Most other staff, including frontline staff, would retain their jobs but would be employees of a hospital (or group/trust of hospitals) rather than the HSE. Fine Gael at the moment don't want to privatise all hospitals, like they have in the Netherlands, but keep them in the public sphere - although important decision making would be delegated down to local hospital boards, rather than made by the HSE.

    You can read more about the plan here and an FAQ here.

    Hope it helps!


  • #6
    [Jackass]
    Closed Accounts Posts: 9,193 ✭✭✭[Jackass]


    I'd love if FG got a majority somehow, as unlikely as it looks now.

    They'll have to compromise on a lot with labour, but I really feel stringent implimentation of FG policies, uninterupted and without despute, could really whip this country into shape, and I am a very firm believer in how they are looking to reform the public services and public sector.


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  • #7
    HappyHouseWife
    Closed Accounts Posts: 97 ✭✭HappyHouseWife


    [Jackass] wrote: »
    I'd love if FG got a majority somehow, as unlikely as it looks now.

    They'll have to compromise on a lot with labour, but I really feel stringent implimentation of FG policies, uninterupted and without despute, could really whip this country into shape, and I am a very firm believer in how they are looking to reform the public services and public sector.

    Well then, spread the word! make sure you inform your friends/family of FG's policies and don't just assume they know already. Maybe that's whats bloody wrong with this countries political system? we need a single govt instead of any coalition, There's a saying, "a camel is a horse designed by a committee"
    I suppose a coalition acts like a committee insofar as it has to make compromises on all of it's decisions to suit all the parties.


  • #8
    munchkin_utd
    Registered Users, Registered Users 2 Posts: 7,960 ✭✭✭munchkin_utd


    [Jackass] wrote: »
    I'd love if FG got a majority somehow, as unlikely as it looks now.

    They'll have to compromise on a lot with labour, but I really feel stringent implimentation of FG policies, uninterupted and without despute, could really whip this country into shape, and I am a very firm believer in how they are looking to reform the public services and public sector.
    Fianna Fail (aka Michael Martin) said they would support Fine Gael if they had a minority government. **
    as mad as this sounds, it may happen.

    Germanys two main parties formed a unity government a few years back.
    The idea was to bring stability AND to sideline the looney left/ greens who are normally needed in a coalition and are great lads for compromising necessary legislation.

    In Ireland ye didnt notice that germany was going through the wars, (everyone was too busy collecting a portfolio of houses or counting their 6 figure salary pusing a wheelbarrow ;).)
    But germanys dire state was why the interest rates that fueled irelands boom were so low.
    The SPD and CSU parties, which are as trenchent opponents as FG/ FF , decided to put historical bickering aside and get legislation through together to fix the country.
    Crazy stuff, but sometimes politicans DO put the factional politics to one side and row in for the good of the nation

    Could FF/ FG do the same to fix the health system etc to get Ireland back on the road for the future?
    Its far from impossible.

    (AND - neither FF/ FG want to see Labour prosper and grow which might be as much of a reason to go into a pact as the good of the nation)

    ** EDIT: or did i pick up something wrong? Im pretty sure I heard/ read it over the week.


  • #9
    [Jackass]
    Closed Accounts Posts: 9,193 ✭✭✭[Jackass]


    FG have ruled out accepting any support from FF as FF said they would support a minority FG Goverment as long as they implimented the failed FF policies.

    It's basically a trick to try and tarnish FG with FF failings and more or less giving the FG carrot of having a Government, but endoursing FF's sh*t storm they created...


  • #10
    Magi11
    Closed Accounts Posts: 240 ✭✭Magi11


    The difference is that the parties in Germany joined for the good of the country. FF want this alliance for (as always) the good of FF, the country comes a distant second as usual.


  • #11
    RachaelVO
    Registered Users, Registered Users 2 Posts: 3,108 ✭✭✭RachaelVO


    The main problem with how Fine Gael are thinking is this. The Dutch hospitals and healthcare system were already a million times better than in Ireland. Then the insurance companies took over.

    Basically here an adult pays nearly e150 per month (there is a plan that accepts less but that's not really worth it, you can also pay more). You then have what they call eigen risico (own risk so it's an excess) and depending on what insurance company you're with it from 150 per year. Not to mention the fact that you are also paying a type of social insurance. Even if you are unemployed you have to pay quiet a percentage of the insurance. You don't have a choice, social welfare will only pay towards it depending on the type of social welfare you're receiving!

    However to go back to the standard of the dutch healthcare system, here is an example. I broke my foot not so long ago. I went to my own doctor, she sent me straight up for an xray. I waited 20mins for that. They said that if I broke a bone they would send me to first aid, and if not they would tell me what I needed to do.

    I did break a bone, they sent me to first aid to get my foot set, I waited another 20 minutes and I was in a private room getting my foot set.

    Then there are other standards in care when you've had a baby (you get a nurse for 40 hours, which you contribute a very small fee towards and the insurance pays the rest) that the Irish system can't even come close to claiming!

    So until the Irish system can get up to scratch they can't expect people to pay for it. As it is anyone in Ireland who has health insurance is already paying for it twice!


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  • #12
    the groutch
    Closed Accounts Posts: 16,096 ✭✭✭✭the groutch


    this won't work unless they make the unpopular decision and introduce means testing for OAPS.


  • #13
    Sulmac
    Registered Users, Registered Users 2 Posts: 1,021 ✭✭✭Sulmac


    RachaelVO wrote: »
    The main problem with how Fine Gael are thinking is this. The Dutch hospitals and healthcare system were already a million times better than in Ireland. Then the insurance companies took over.

    Fine Gael's plan is basically a three-stage plan, with insurance companies being the last stage (after around five years). They'd first reform the current system by adopting practices in other places (such as Northern Ireland for waiting lists) and then bringing in 'money follows the patient' before handing it over to insurance companies.
    Basically here an adult pays nearly e150 per month (there is a plan that accepts less but that's not really worth it, you can also pay more). You then have what they call eigen risico (own risk so it's an excess) and depending on what insurance company you're with it from 150 per year. Not to mention the fact that you are also paying a type of social insurance. Even if you are unemployed you have to pay quiet a percentage of the insurance. You don't have a choice, social welfare will only pay towards it depending on the type of social welfare you're receiving!

    So most people purchase supplementary insurance? Interesting. What does it cover that the 'basic' package doesn't?

    On the excess, isn't there something that if you don't make a claim in a year you get some sort of refund (albeit a small one) worth the value of the excess?
    However to go back to the standard of the dutch healthcare system, here is an example. I broke my foot not so long ago. I went to my own doctor, she sent me straight up for an xray. I waited 20mins for that. They said that if I broke a bone they would send me to first aid, and if not they would tell me what I needed to do.

    I did break a bone, they sent me to first aid to get my foot set, I waited another 20 minutes and I was in a private room getting my foot set.

    Then there are other standards in care when you've had a baby (you get a nurse for 40 hours, which you contribute a very small fee towards and the insurance pays the rest) that the Irish system can't even come close to claiming!

    So until the Irish system can get up to scratch they can't expect people to pay for it. As it is anyone in Ireland who has health insurance is already paying for it twice!

    This is the system we should be aiming towards, without a doubt. Hope your foot is healing well.


  • #14
    RachaelVO
    Registered Users, Registered Users 2 Posts: 3,108 ✭✭✭RachaelVO


    Sulmac wrote: »
    Fine Gael's plan is basically a three-stage plan, with insurance companies being the last stage (after around five years). They'd first reform the current system by adopting practices in other places (such as Northern Ireland for waiting lists) and then bringing in 'money follows the patient' before handing it over to insurance companies.



    So most people purchase supplementary insurance? Interesting. What does it cover that the 'basic' package doesn't?

    On the excess, isn't there something that if you don't make a claim in a year you get some sort of refund (albeit a small one) worth the value of the excess?



    This is the system we should be aiming towards, without a doubt. Hope your foot is healing well.

    Well if that if Fine Gaels plan the are a bit optimistic with 5 years. But I do like the idea. There is virtually no MRSA here, about 6 years ago the instigate what is translated as Seek and Destroy. If you were in ANY hospital outside the country you were isolated and treated as if you had it until it was proven you didn't. That one thing will take time in Ireland, not to mention all the other problems as I see them.

    All packages have the basics. Doctor, hospitals, most medical prescriptions etc; Going up from that plan you get the above and dental care, lower excess, more private care, paying for your kids at a later age, all medical prescriptions, better maternity care. However there is very little in the way of competition. All the policies are pretty much the same from the MANY companies offering insurance.

    There used to be a rebate on the excess, but that is LONG gone, and of course the costs went up when they got rid of it.

    The foot is all good now, thanks for asking. And yes that is most definitely is what the Irish system should be aiming for. The idea of people on trolleys in corridors would horrify even the worst hospitals here!


  • #15
    D'Peoples Voice
    Registered Users, Registered Users 2 Posts: 1,698 ✭✭✭D'Peoples Voice


    Dr. Baltar wrote: »
    I can't exactly understand the Dutch model in practice. What I gather of the model is that it is a crime to not have Health Insurance (unless for religious reasons) and that this Health Insurance is bought from your own wages.

    A number of questions:

    1. What happens if you cannot afford your Health Insurance?
    2. Does everyone pay the same amount for their Health Insurance?
    3. How exactly does privatising Health make it a "better" service?
    4. Will this be cheaper on the taxpayer than the current HSE?
    5. What will happen to those people currently employed by the HSE?

    Thanking you in advance.
    The Dutch system?
    Excellent idea, clearly Inda thinks that by extension we can have the same number of hospitals per capita as Holland rather than hospitals based on geographical spread like we do in Ireland at the minute.
    There may be some people in underpopulated areas that might freak at this thought:eek:


  • #16
    Pete_Cavan
    Registered Users, Registered Users 2 Posts: 7,391 ✭✭✭Pete_Cavan


    RachaelVO wrote: »
    All packages have the basics. Doctor, hospitals, most medical prescriptions etc; Going up from that plan you get the above and dental care, lower excess, more private care, paying for your kids at a later age, all medical prescriptions, better maternity care. However there is very little in the way of competition. All the policies are pretty much the same from the MANY companies offering insurance.

    It was also mentioned earlier in the thread that health-care costs there are rising. Does this simply mean that the market has become as efficient as possible, ie. that the level of competition between the private companies has lead to them reducing the costs as low as they can possibly go? Or am I just reading too much into that? If that is the case then it is a very good thing for consumers and strengthens the case for such a system being introduced here.


  • #17
    femur61
    Registered Users, Registered Users 2 Posts: 1,588 ✭✭✭femur61


    munchkin_utd wrote: »
    abuse the minions????

    My hole.

    - 37% of Irish WORKERS dont pay tax. Not a cent. The irish low paid minions are the most lucky minions in the western world. Even low tax ecomomies like the USA dont let so many people pay NOTHING towards running the country.
    - The Dole! 200 euros a week. Plus all the other perks and your rent almost fully covered. The low paid minions have it great, but the ones on the dole even better. (compare german dole of means tested max 370 a MONTH to what you get in Ireland, and germany is allegedly a far more socialist minion friendly country)
    - the pensioners have a massive tax credit, so most can live well on what income they have, and over 70s have a blanket blank cheque of a medical card to look after whatever medical ailments they have

    My mistake was in a hurry 3 kids to get to school on time. Maybe I shouldn't have used minions. But the long and short is we as a nation have destroyed by electing candidates who have abused the system. First the church not the politcians.


  • #18
    Jolly Red Giant
    Registered Users, Registered Users 2 Posts: 3,434 ✭✭✭Jolly Red Giant


    Private health insurance is compulsory in Holland. The current cost for the basic package is €1197 per person per year. To have full cover you have to pay in excess of €3000 per year. Furthermore premiums are set to double by the end of 2014 (the deficit in 2010 between funding and expenditure was in excess of €2.4 billion).

    Health care costs in Holland are increasing far faster than had been predicted when the universal insurance scheme was launched in 2006. Income for consultants increased by 25% last year alone. Hospitals earn income on a per service basis and this has led to a situation where large numbers of hospitals (over 50) are now on the verge of bankruptcy.

    The insurance companies are losing significant amounts of money on the basic packages and as a result are cutting back on the services available for basic insurance holders leading to a widening two-tier system.

    Despite claims to the contrary - insurance companies are dumping patients with long-term and chronic illnesses off the basic package as the risk equalisation payments are insufficient to cover their health care costs. This is leading to large numbers of patients having to take out the second tier of insurance at a much higher cost.

    Many insurance companies are now only covering patients treatment in certain hospitals leading to many patients having to travel long-distances to receive basic care.

    The government has limited the subsidy for many treatments and drugs leading to patients having to pay extra on top of their insurance premiums.

    Over 300,000 people in Holland have now defaulted on their health insurance payments and are being hounded by debt collectors. Patients have to be treated whether they are insured or not - but debt collection agencies are bringing defaulting people to court and getting the equivalent of warrant sales issued against them.

    The Dutch health system has had massive investment in comparison to Ireland over the past 50 years - costs were falling in the period up until 2006 and have started to rise since the private insurance system has come into operation. Similarly the previously very high standard of quality of care in Holland has been falling consistently since 2006.

    The Dutch government are only too well aware of all these problems - their solution is to further de-regulate the system to allow for greater 'competition'

    Duke University carried out an in-depth study on the new Dutch universal health insurance system and concluded that any health care system that currently existed where there was a massive variation in the provision of care, disparaging levels of access, long-waiting lists, poor investment etc would suffer negatively from the introduction of the Dutch universal health insurance system. I would argue that from the findings of this report, Ireland is one of the last places this system should be introduced.

    Finally in relation to the Euro Health Care Index. This index is operated by Health Consumer Powerhouse - which is a privately owned and funded and begins with the starting point of treating the patient as a 'consumer'. The operators behind Health Consumer Powerhouse have a history of promoting the private healthcare industry. Its director, Johan Hjertqvist, was one of the prime movers in the promotion of private healthcare in Sweden. It is very closely linked with the Centre for a New Europe - a right-wing neo-liberal pro-privatisation think-tank in Brussels. Health Consumer Powerhouse have consistently avoided publishing who funds them and how much funding they receive. HCP are members of the Stockholm Network which receives funding for dispersal from pharmaceutical companies, private health care providers, insurance companies among others. The Stockholm Network promote 'flat taxes, the termination of social protection systems and privatisation of healthcare' (among other things).


  • #19
    Eliot Rosewater
    Registered Users, Registered Users 2 Posts: 3,745 ✭✭✭Eliot Rosewater


    I like the sound of the Fine Gael model. It seems to be a good compromise: bring in the efficiencies of the market but provide a safety net for those on the bottom.

    However, I was a little surprised with O'Reilly on Prime Time the other night. Firstly, he said the that bottom 40% of people would be subsidised, which seemed a lot. Secondly he said that it would only cost people €400 a year. Healthcare is bloody expensive - the equivalent of two Panadol Extra tablets in drip form costs hospitals €80 - so quoting the price so low seemed like populist pandering, much like their "Free GP Care" ads.

    There's going to be no free GP care: the cost to the insurance companies of providing that will be passed on through premiums. I wonder will FG continue to subsidise hospitals, thus making premiums cheaper and giving the illusion that they have made healthcare uber-cheap.
    Sulmac wrote: »
    In the Netherlands the current maximum price is around €90-100 per adult per month, and companies compete by setting prices below this (which they cannot change depending on the person, so if person A buys it from company A for €85, person B must also be allowed buy it from company A for €85).

    One might ponder whether that should be the case. I'm 20 years old - I drink very moderately, I don't smoke or take drugs, I eat relatively healthily, I cycle for about 35 minutes 5 times a week, and play the odd game of squash here and there. Clearly I'm less of a health risk than other 20 year olds who go out on the tear 2 times a week, smoke, eat junk food while they're at it, and get little exercise in between. Why should I have to subsidise their healthcare?

    Forbidding companies to discriminate on the basis of age and gender has a good justification, but I wonder whether people think they should be able to discriminate on the basis of lifestyle choices (assuming those choices could be objectively judged).


  • #20
    takun
    Registered Users, Registered Users 2 Posts: 173 ✭✭takun


    Eliot Rosewater wrote: »
    I'm 20 years old - I drink very moderately, I don't smoke or take drugs, I eat relatively healthily, I cycle for about 35 minutes 5 times a week, and play the odd game of squash here and there. Clearly I'm less of a health risk than other 20 year olds who go out on the tear 2 times a week, smoke, eat junk food while they're at it, and get little exercise in between. Why should I have to subsidise their healthcare?

    No matter whether it is provided by the state (and paid for by some kind of tax/levy) or paid for by insurance the young and healthy always pay in more than they claim.

    However in a sense you are subsidising your older self, because no matter how unlikely it may seem now, you will not always be young and healthy. And nothing in your lifestyle exempts you from being in a catastrophic car accident or getting a long term illness - or even cancer or a heart condition, which have been known to afflict people who lead exemplary lifestyles.

    It may seem deeply unfair, but it is a certainly that some of the young people who currently drink like fish and smoke like chimneys while slouched with a pizza in front of the TV will outlive some of the young people who do neither and are out keeping themselves fit.

    Nobody is guaranteed lasting health.


  • #21
    Eliot Rosewater
    Registered Users, Registered Users 2 Posts: 3,745 ✭✭✭Eliot Rosewater


    Well, I wasn't really taking issue with my age. I live a life that is relatively healthy, and so I would basically be helping to pay for the healthcare for people who make voluntary choices, like smoking, which negatively impacts their health.


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  • #22
    BOHtox
    Registered Users, Registered Users 2 Posts: 4,314 ✭✭✭BOHtox


    Dr. Baltar wrote: »
    I can't exactly understand the Dutch model in practice. What I gather of the model is that it is a crime to not have Health Insurance (unless for religious reasons) and that this Health Insurance is bought from your own wages.

    A number of questions:

    1. What happens if you cannot afford your Health Insurance?
    2. Does everyone pay the same amount for their Health Insurance?
    3. How exactly does privatising Health make it a "better" service?
    4. Will this be cheaper on the taxpayer than the current HSE?
    5. What will happen to those people currently employed by the HSE?

    Thanking you in advance.

    1. It is paid out of tax AFAIK. The less unemployed, under 18s, students and OAPs s get it for free.
    2. No. Everyone gets the same for €300 they pay. But you can pay more for things like a private room , higher end medicines etc.
    3. It makes it more efficient, less bureaucracy meaning it costs less and cost can go on front-line services instead.
    4. It is said that for a family of 2adults 2kids it will be the same. And more kids it will cost less, for singles it will cost more. Efficiency savings will save €500 million approximately.
    5. They will be redeployed into the new health service. But there will be people losing their jobs. These will mostly be people retiring though. There will be 8,000 jobs lost in the health service I think.


  • #23
    takun
    Registered Users, Registered Users 2 Posts: 173 ✭✭takun


    Smoking is a particularly bad example, because as awful as it seems, non-smokers are more of a cost to the exchequer. In fact smokers may well be subsidising you. For two reasons:

    1. They die young, which saves a lot of money in not just their health care when they are older, but in pensions, housing, nursing home care etc.

    2. They pay a LOT of tax - the biggest percentage in a break down of the cost of a packet of cigarettes is tax and duty.

    Funnily enough the most important research on this was done in by the Dutch at Erasmus University Department of Public Health in Rotterdam. They found that non-smokers over their lifetime cost about 12-15% more than smokers.

    It's not unlikely that on purely monetary basis, other unhealthy choices have a similar benefit to society.

    A government keen to maximise income would encourage smoking - though even those who attribute the most Machiavellian impulses to our governments would probably not think they were doing that. But then again, no additional tax was put on cigarettes in the budget,......[FONT=Arial, Helvetica]
    [/FONT]


  • #24
    meditraitor
    Closed Accounts Posts: 5,207 ✭✭✭meditraitor


    The real truth is that the Dutch solution is the most expensive system per capa in europe outside of the super rich (l Luxemburg's,swiss and norway) and is not fit for purpose. FG as usual are the political party equivalent of bertie aherne..... and anyone who falls for their wiki COPY AND PASTE AND CUT POLICIES SHOULD BE ASHAMED OF THEMSELVES.

    We do not have the money for this system, we need to cut our cloth to measure...


  • #25
    meditraitor
    Closed Accounts Posts: 5,207 ✭✭✭meditraitor


    Eliot Rosewater wrote: »
    Well, I wasn't really taking issue with my age. I live a life that is relatively healthy, and so I would basically be helping to pay for the healthcare for people who make voluntary choices, like smoking, which negatively impacts their health.

    and the children of a smoker or drug addict?


  • #26
    Eliot Rosewater
    Registered Users, Registered Users 2 Posts: 3,745 ✭✭✭Eliot Rosewater


    meditraitor wrote: »
    and the children of a smoker or drug addict?

    I don't get you?


  • #27
    meditraitor
    Closed Accounts Posts: 5,207 ✭✭✭meditraitor


    Eliot Rosewater wrote: »
    I don't get you?
    Your a libertarian, of course you wouldn't get me! How do you treat the children of drug addicts and smokers? Who pays for them?


  • #28
    bluewall
    Registered Users, Registered Users 2 Posts: 28 ✭bluewall


    The dutch model in theory is a great model. In practice it is becoming increasingly costly and the fact that it has been in place less than 10 years means that we don't really know how things are going to turn out.

    When Obama was getting stuck into his health reform policies in the US, several universities were enlisted to carry out research on the actual effectiveness and success of the dutch model. Ultimately, the findings were that the model sounds better than it looks in reality hence the US did not opt to employ something similar to it.

    So, for FG to implement such a model in this country without any real research or proof of such a system actually working over time leads me to think that FG are just as incredibly short sighted as Fianna Fail. Don't get me wrong, I am all for health system reform but just do it in a bloody sensible way!!

    Secondly, FG are forgetting the main people in the picture for such a model to work - the doctors!! In all fairness, who are FG to tell doctors how to run their businesses?? If you think about it, FG as part of the model want to offer wider access to GP's for little or no cost. How does this impact on the GP's? Well frankly nobody knows because FG have told us nothing about this. All I can say is that seeing as the majority of GP's own their own practices, unless this 'fair care' model is mutually beneficial to all involved they are going to be met with a lot of resistance from the GP's.

    And don't be fooled by Dr. Reilly... If you want my two cents - he owns a shopping centre down the country and also spent years making his fortune in general practice during the Fianna Fail free for all. In other words, he's made his money which he can sit on happily now which in turn allows him to jump on his magic carpet of altruism and push this 'fair care' model at absolutely no odds to himself.

    So in my opinion, it nearly doesn't matter who we vote for at this stage, they're all the same at heart e.g. "as long as I look after number 1, I couldn't care less about the sh*t storm that happens around me".

    The sad thing is, this is a huge opportunity for our country to start from scratch on a political level, right all the wrongs of the past, put in place laws and reforms to prevent them in the future and allow us to become a self-sustaining and efficient country that could be leaders again in the future. But no, not a chance that will happen. Why? Because, they're all too afraid they'll put themselves out of a job.

    14/2/10 - Proof is in the pudding

    Irish independent 10th June 2010 - TD's top up their pay with rental income

    "On the opposition benches, Dr James Reilly and Alan Shatter top the Fine Gael leader board.

    As well as almost 240 acres over various farms and plots of land in north Dublin, Meath and Offaly, Dr Reilly has a holiday home at the Doonbeg five-star golf and spa resort in Clare.

    In addition to his quarter-share of a nursing home in Tipperary, he would see a sizeable monthly rent roll from the block of surgery rooms, offices, shops, a supermarket, a restaurant and apartments he owns in Lusk, north Co Dublin"


  • #29
    Eliot Rosewater
    Registered Users, Registered Users 2 Posts: 3,745 ✭✭✭Eliot Rosewater


    meditraitor wrote: »
    Your a libertarian, of course you wouldn't get me! How do you treat the children of drug addicts and smokers? Who pays for them?

    The government. :confused: Have you read Sulmac's post?


  • #30
    nkay1985
    Registered Users, Registered Users 2 Posts: 6,975 ✭✭✭nkay1985


    Fine Gael's healthcare plan sounds good but my problem with it is that it'll have to be implemented in Ireland. I'm sure the idea behind our healthcare system isn't then worst thing in the world, yet we've managed to implement it very, very poorly. The way the health service is run may change but there will need to be a fundamental change in how we deliver health at the front line.

    I also have a feeling that this may be a point where a FG/Labour coalition will clash so it'd be interesting to see what the compromise would be and whether that would see the idea fudged beyond all recognition.


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  • #31
    HQvhs
    Registered Users, Registered Users 2 Posts: 313 ✭✭HQvhs


    I too have mixed feelings about this proposed system. In theory it sounds great, but I'm not sure how it would work in practice.
    I think the health debate is focussing on the wrong issue in the first place - we should be asking the question 'why do people fall ill in the first place?', and try to put more action there, rather than wait for them to fall ill. Prevention is a lot cheaper than cure across the board, and there are many areas where Ireland falls behind (obesity, drinking, drugs, cancer screening), and others where we have made huge gains (road safety, and smoking cessation come to mind).
    If the government (not just the health service) put more resources into prevention and primary care we would reap huge gains in the long-term.


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