Should Private Health care exist in a democratic society/ Pros and Cons of PMI

Don Keypunch

Should Private Heath care exist in a democratic society/ Pros and Cons of PMI

I think this might be an interesting topic to explore, Should ones ability to pay have an influence on the type and the ease at which they receive medical care.

Sitric

Good topic,

Personally, I think the entire notion of private medicine (as organised in ireland) is almost by definition undemocratic.

There are countries in Europe where everybody has private insurance and it seems to work well (Holland) and where almost nobody has it and it also works very well (Norway).

Here, without insurance you can have a really bad time accessing treatment.

Sitric

Does anyone believe that without the interference of the church (and of the medical authorities) in the Mother and Child scheme that we might have gone in a better direction socially as a country in the delivery of medical care?

This is not off topic and was central to development of the local "two tier" system we have in Ireland. (Mods, if you think this will mess up the discussion, please split it into another thread)

Big_G

Let's look at this from a different angle. Should there be a universal entitlement to health care? If the answer is yes, then how should this be provided in a fair and ethical manner?

The way the system is run right now, somebody who can afford to pay in some situations is being treated unfairly and the same is true for those who cannot afford to pay.

I think most people would say that there should be a universal entitlement to healthcare. This is an easy statement to make without understanding how this is to be funded.

The fact is that the people who can least afford healthcare are the ones who need most care, according to socioeconomic studies. So therefore, those who can afford to pay are often subsidising those who can't, either by taxation or risk equalisation or by some other economic mode of balancing inequity.

This may seem unfair to those who can afford to pay.

This stems back to a fundamental question in a democratic society: do we choose freedom or equality. You cannot have both, they are mutually exclusive. The more equality you have, the less freedom and vice versa.

The truth is that not everyone is equal, either in ability, or socioeconomic status or other ways. Some will make a net contribution to society, some will make a net demand on society. We choose as a society to balance this by taxation and social welfare programmes.

So really what I am saying is this is not a question of democratic or undemocratic ideas but is more a question of economics. Who pays, who doesn't pay? Because in the end of the day, healthcare costs money, and a significant amount of money.

In my opinion healthcare should ideally be universal. The mode of paying for this should be universal social insurance with risk equalisation. This privatises the current biggest problem in Irish healthcare which is the administration. People who can't afford the insurance should be subsidised. The only determinant of treatment options should be the patient and the doctor, no other factor should determine treatment or outcome.

This is the ideal. In reality, if there is a third party involved (an insurance company) they will try to bottom line treatment cost which will limit the patient's options. Therefore, people should have the option of paying privately, or bumping their insurance premium in order to access more expensive treatment.

imported_guy

unless you live in a proper socialist or communist state (and we dont have those in this world they are only pseudo socialist communist states) every thing should be private, including healthcare.

socialism is pretty cool until you run out of other people's money to spend like in greece, then you have no healthcare basically

N8

Don Keypunch wrote: »

Should Private Heath care exist in a democratic society/ Pros and Cons of PMI

Not to put too fine a point on it what has private health care got to do with democracy?

Why would there be a correlation?

The US (reputed to be a democracy) has a much lower level of health than Cuba.

In the US the freedom to pursue those actions and activities that they believe will bring them happiness is protected by their constitution. Note, it does not give the right to happiness, just the right to pursue it. That makes sense because happiness may be different for different people. The important thing is that they may pursue it; it is not given to them nor is the government obliged to provide it.

It’s the same with health. Some people believe that they have the right to be healthy and they are owed health despite their lifestyles and lack of attention to themselves. They are not owed healthcare, they are however entitled to pursue health and seek healthcare.

If we say health is a right that government bestows, then it only logically follows that they must decide what health is. Even the thought of that is pretty scary. If they cannot decide when life begins, how can they decide what health is?

Will they outlaw cigarettes, alcohol, automobiles, chocolate, vitamins, skateboards and motorcycles? Frankly, I would not want to live in a country that told me what health is and forced me to pursue their model of it. It’s bad enough as it is. I do not even like the idea of paying the cost of healthcare in this country given how (other than the emergency health) it has become monopolized, mismanaged and cost wise, out of control.

In short health care provision should all be private and so allow real health care and health care maintenance to rise to the top.

imported_guy

N8 wrote: »

The US (reputed to be a democracy) has a much lower level of health than Cuba.

someone watches too much michael moore, tbh america has too much cutting edge technology in terms of doing complex procedures in fields of neurological surgery and CVT surgery etc etc and most people would prefer being treated by american trained (or even 1st world trained) physicians than 3rd world trained physicians. (say harvard or john hopkins trained neuro surgeon rather than someone trained in a cuban hospital lol)

N8

imported_guy wrote: »

someone watches too much michael moore, tbh america has too much cutting edge technology in terms of doing complex procedures in fields of neurological surgery and CVT surgery etc etc and most people would prefer being treated by american trained (or even 1st world trained) physicians than 3rd world trained physicians. (say harvard or john hopkins trained neuro surgeon rather than someone trained in a cuban hospital lol)

yes your reply sounds good until you find out many american doctors are actually trained in the Latin American School of Medicine in Havana

You might even notice if you travel there how unhealthy in general americans are in comparison with cubans

imported_guy

N8 wrote: »

yes your reply sounds good until you find out many american doctors are actually trained in the Latin American School of Medicine in Havana

You might even notice if you travel there how unhealthy in general americans are in comparison with cubans

im on about residency training not pre-med/medschools, im sure medschools in africa teach the same as john hopkins medschool, but john hopkins hospital probably has much better residency training than an african hospital which trains doctors

and americans being unhealthy, its a lifestyle choice, im a bodybuilder, i live a healthy lifestyle, people who eat at mcdonalds 3-7 times a week live unhealthly, its their choice, people choose to be fat.

N8

imported_guy wrote: »

im on about residency training not pre-med/medschools, im sure medschools in africa teach the same as john hopkins medschool, but john hopkins hospital probably has much better residency training than an african hospital which trains doctors

probably but perhaps not

imported_guy wrote: »

and americans being unhealthy, its a lifestyle choice, im a bodybuilder, i live a healthy lifestyle, people who eat at mcdonalds 3-7 times a week live unhealthly, its their choice, people choose to be fat.

so if its their choice why should you be forced to pick up their health care costs?

also
http://www.boards.ie/vbulletin/showthread.php?t=2055942370&page=4

lonestargirl

I firmly believe in equal access to medical treatment for all. I don’t think private healthcare should be done away with in Ireland as I don’t think that’s possible. However I favour a complete separation of public and private facilities. I do think it acceptable for a public hospital to offer private rooms for an additional fee but access to medical services within a public hospital should be equal. I do think in a public system there should be a small fee for each use of the system, akin to the US system of a co-pay, for example €5 for every doctor’s visit and prescription with a cap on the monthly amount of €50. This is purely as a reminder to people that public facilities are not ‘free’ that the money must come from somewhere and to encourage people not to abuse the system.

I worked in a public radiotherapy facility in Ireland where there is a single queue for treatment. Private patients can be seen in private clinics and get private rooms but the queue for treatment spots is the same. However many of these private patients benefited from their private healthcare in terms of getting initial their diagnosis and referral (the biggest differences in public and private care in Ireland seem to be in ‘elective’ procedures, i.e. colonoscopies).

I currently live in the US and healthcare is one of the issues that would make me reluctant to stay here in my old age. Every year ordinary American families end up bankrupt because of healthcare bills. I have great insurance (@ $3000 per year) through my husband’s job which I think is great value for what I get. I am currently pregnant and the total cost to us of the pregnancy will be around $1000. However not all Americans have access to this type of employer group plan, if you are self employed you can expect to spend $1-2K per month for insurance for a family. This leads to people opting for minimum cover possible, for example with a $10,000 deductible. If you are an ordinary working family with a couple of kids $10,000 is a lot of money and could easily be the point that tips you over the edge. If you are illegal no matter how much you earn you probably can’t buy health insurance even if you wanted to (remember that although many adults may be illegal their children are often US citizens). There is also huge waste in the US system, it encourages over-diagnosis and over-treatment as reimbursement is per procedure and everyone is scared of litigation.

My local county hospital offers ‘compassionate’ dialysis. The hospital cannot refuse emergency treatment to those in need so they have a clinic specifically for those with no insurance / illegal who can come in when they feel like they need dialysis. The doctors hate it as they cannot give the care that they would like to their patients just do the minimum to keep them alive. Nobody can claim that this is first-world healthcare.

In summary I don’t think you can ever get rid of private health insurance, however it should be about private rooms, appointments when you want them etc. I think it’s wrong in a democratic society for a person’s access to healthcare to be based on their income and ability to buy insurance.

N8

Hi Lonestar - the question I would hazard is why is the insurance so expensive?

drzhivago

Don Keypunch wrote: »

Should Private Heath care exist in a democratic society/ Pros and Cons of PMI

I think this might be an interesting topic to explore, Should ones ability to pay have an influence on the type and the ease at which they receive medical care.

Think to really look at this you need to look at how health service developed

Dont claim to have encyclopaedic knowledge but

Public Health care (Care provided free) was initially provided in hospitals by religious agencies and voluntary charities as far as I know there was very little or none provided by Any Public Bodies/Government agencies

This care was provided by Consultants who WERE NOT paid, the deal was they were allowed to admit private patients and charge fees for that in the particular hospital the payback for the hospital was they had to provide services to public patients for free.
There were very small time requirements for this and they could do it at any time which meant there would have been very uncoordinated care

THUS PRIVATE SYSTEM ALLOWED A PUBLIC SYSTEM TO DEVELOP -- NOT THE OTHER WAY AROUND

Over time the amount of time required increased and increased until Consultants now become contracted for 37 hours and can do little private work

So When we had a one tier system, public got little or no care

Witha two tier system they get a lot more, like it or not most of the care is provided by Junior Doctors who may not be permanent fixtures and we see hospitals like Dundalk closing emergency rooms because they cant find docs to staff it

My feeling is we should have Universal healthcare

ALL ARE PRIVATE-- not because I want to make loads of money because I work in an area that wont necessarily make massive money with every one private

IF EVERYONE BECOMES PRIVATE THEN MONEY FOLLOWS THE PATIENT

THE HOSPITAL THAT DOES A LOT OF WORK AND IS EFFICIENT GETS MORE INCOME TO PROVIDE SERVICES AND THUS CARE IMPROVES OVERALL

What happens now is the hospital that treats a lot of people in one year, more than planned goes over budget and gets penalised so for being efficient they lose out

For a financial controller the incentive is to slow down medical work, reduce productivity to minimum required and thus come in close to budget. the hospital may have massive excess capacity/closed wards/empty theatres but doesnt lose money

In a UNIVERSAL healthcare system hospital doing more work gets more money

Patients would be able to use their CARECARD in whichever facility (obviously certain hi tech things may be regulated) but for the poorest group of patients Government pays, for the rest of us we pay something in Taxes and we get care as well

Waiting lists should improve as some hospitals will be able to concentrate on X procedures, develop protocols like in Canada and reduce admission times thus turning beds around quicker.

Food for thought

Black Swan

You don't want to be without medical insurance in the USA where private health care dominates:

"The survey found that 46.3 million people had no health insurance in 2009, a bit up from 43.8 million in 2008. This included more than 6 million children under 18."

Source: http://www.reuters.com/article/idUSN1617452220100616

Azy

Introducing a purely PHI model will not ensure equity of access and access based on medical need. Our welfare state is based on the beveridge system where benefits are paid for through taxation and social insurance. If we go down the PHI model, does that mean we wont have to pay existing rates of tax and the Government will deduct the amount of social insurance payable - unlikely.

Public hospitals do make money out of private health insurance. 20% of their bed allocations are private and several reports have highlighted that private patients have for many years been encroaching on public beds.

If we do go down the PHI model, we will still have a difference between those who can afford and those who cannot. PHI has been on the increase year on year and health costs increase with each advance in medical science and new treatments. So, what safeguards will our esteemed government introduce to ensure that PHI will be affordable to all? We could still find ourselves with those who can afford and those who cannot and for those who cannot there would be a government funded and provided system which equates with our existing public health system.

If we refer to the US model, providers of PHI only cover certain illnesses that are inexpensive to treat. So within the US you've got certain conditions that are not covered by the PHI market and those patients therefore have to depend on medicare - the state funded system. Is this model our future?

lonestargirl

Azy wrote: »

If we refer to the US model, providers of PHI only cover certain illnesses that are inexpensive to treat. So within the US you've got certain conditions that are not covered by the PHI market and those patients therefore have to depend on medicare - the state funded system. Is this model our future?

This statement does not make any sense

(a) this is not my experience of health care in the US, both as a patient and as a healthcare worker

(b) Medicare is only for those aged over 65