Questions FG and LP must answer on Health before you vote for them

Jolly Red Giant

Both Fine Gael and the Labour Party plan on introducing mandatory Universal Health Insurance after the next general election. Fine Gael’s ‘FairCare’ plan lauds the Dutch system of Universal Health Insurance. The Labour Party’ ‘FairHealthCare’ plan is similar but instead of using the Dutch system as a model, the Labour Party refer to the German system. In reality both systems face the same issues – issues that should be answered before anyone votes for Fine Gael or the Labour Party.

Twelve points that need to be addressed in relation to the Dutch model of Universal Health insurance –

Questions FG and LP must answer on Health before you vote for them

Both Fine Gael and the Labour Party plan on introducing mandatory Universal Health Insurance after the next general election. Fine Gael’s ‘FairCare’ plan lauds the Dutch system of Universal Health Insurance. The Labour Party’ ‘FairHealthCare’ plan is similar but instead of using the Dutch system as a model, the Labour Party refer to the German system. In reality both systems face the same issues – issues that should be answered before anyone votes for Fine Gael or the Labour Party.

Twelve points that need to be addressed in relation to the Dutch model of Universal Health insurance –

1. The Netherlands has gone from a two-tier health system to a three-tier health system. Almost half a million people are now uninsured or defaulting on the health insurance payments.
(Leu, R. E., Rutten, F. F. H.. Brouwer, W., et al., “The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets”, The Commonwealth Fund, (January 2009), p.5) http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Jan/The-Swiss-and-Dutch-Health-Insurance-Systems--Universal-Coverage-and-Regulated-Competitive-Insurance.aspx

2. Private health insurance companies are findings ways to circumvent the ban on ‘risk selection’.
(Maarse, H., “Testing Market Practices”, Health Care Cost Monitor, (8 June 2009) p.13)
http://healthcarecostmonitor.thehastingscenter.org/hansmaarse/testing-market-practices/

3. The current cost of the Universal Health Insurance basic package in the Netherlands is €1194 per person for this year. On top of that Employers deduct a further 6.9% of a workers income up to a ceiling (€2233 in 2009).
(Baxter, G., “Is going Dutch our best healthcare option?”, Irish Medical Times, (March 18, 2010))
http://www.imt.ie/opinion/guests/2010/03/is-going-dutch-our-best-healthcare-option.html

4. With annual income running at €53,000 per household, the annual cost of health insurance is somewhere between €4,525 and €5,625, or 8.6 to 10.7 per cent of household income.
(Baxter, G., “Is going Dutch our best healthcare option?”, Irish Medical Times, (March 18, 2010))

5. Since the introduction of Universal Health Insurance in 2006, premium costs have risen by 41% and could double from the current rates by 2014.
(Dutch News, “Health insurance rises 41% over five years” Dutch News, (dutchnews.nl, 9 Nov. 2010))
http://www.dutchnews.nl/news/archives/2010/11/health_insurance_rises_41_over.php

6. More than 50% of the hospitals in the Netherlands are facing bankruptcy as a result of the introduction of Universal Health Insurance in 2006.
(Maarse, H., “Testing Market Practices”, Health Care Cost Monitor, (8 June 2009) p.1)

7. There has been a significant and continuing increase in healthcare costs since the introduction of Universal Health Insurance in 2006.
(Rosenau, P.V., & Lako, C.J., “An Experiment with Regulated Competition and Individual Mandates for Universal Health Care: The New Dutch Health Insurance System”, Journal of Health Politics, Policy and Law, Vol. 33, No. 6, (December 2008) p. 1040)
http://jhppl.dukejournals.org/cgi/reprint/35/4/539

8. The necessity to negotiate and implement 30,000 Diagnosis Treatment Combinations (DBCs) between private health insurance companies and individual hospitals has led to a massive bureaucratisation of the system.
(Maarse, H., “Testing Market Practices”, Health Care Cost Monitor, (8 June 2009) p.12)

9. It is not known how many hospital beds there actually are in the Netherlands.
(Schäfer W, Kroneman M, Boerma W, van den Berg M, Westert G, Devillé W
and van Ginneken E., “The Netherlands: Health system review”, Health Systems in Transition, (2010) 12(1) p.117)
http://www.euro.who.int/__data/assets/pdf_file/0008/85391/E93667.pdf

10. The Dutch healthcare system has growing waiting lists and short-notice postponement of operations.
(Schäfer W, Kroneman M, Boerma W, van den Berg M, Westert G, Devillé W
and van Ginneken E., “The Netherlands: Health system review”, Health Systems in Transition, (2010) 12(1) p.133)

11. The Dutch healthcare system is no better than average in comparison with other wealthy countries.
(Schäfer W, Kroneman M, Boerma W, van den Berg M, Westert G, Devillé W
and van Ginneken E., “The Netherlands: Health system review”, Health Systems in Transition, (2010) 12(1) p.XX)


12. 41% of people say that the quality of the health system has worsened since the introduction of Universal Health Insurance in 2006, while 8% indicated that it had improved.
(Rosenau, P.V., & Lako, C.J., “An Experiment with Regulated Competition and Individual Mandates for Universal Health Care: The New Dutch Health Insurance System”, Journal of Health Politics, Policy and Law, Vol. 33, No. 6, (December 2008) p. 1047)


In Germany –

1. The public health insurance system has a projected deficit of €11billion in 2011
(Rainer Buergin – ‘Merkel Government to Raise Health-Insurance Premiums in Bid to Cut Deficit’ Bloomberg News, Jul 6, 2010)
http://www.bloomberg.com/news/2010-07-06/merkel-raises-german-health-premiums-to-15-5-of-gross-pay-to-plug-deficit.html

2. Older patients and those with chronic or long-term illnesses are dumped off of the private insurance system onto the public insurance system causing rising costs for public UHI.

3. Patients with private health insurance (rather than UHI) are automatically seen before UHI patients – even in a GP’s surgery.

4. As the crisis in the German healthcare system continues to grow those on lower incomes are being disproportionally hit by rising costs.

5. German Health Minister, Philipp Rösler, plans on switching from health premiums based on a percentage of income to premiums based on a flat rate charge, thereby further hitting those on low incomes.
(The Economist, 29th April 2010)
http://www.economist.com/node/16015443

6. Procedures covered in the basic UHI package are dropping and out-of-pocket payments by patients are increasing.
(Kaiser Family Foundation, Cost Sharing for Health Care: France, Germany, and Switzerland, (January 2009), p. 13-15)
http://www.kff.org/insurance/upload/7852.pdf

In terms of both systems of health care the issue are the same.

- Rising costs – despite claims from both FG and LP to the contrary

- Rising insurance premiums

- Rising deficits

telekon

Nice copy and paste from Politics.ie, "Making waves". Why change your name for Boards.ie?

WeeBushy

Do you have anything to back up these figures?

gandalf

OP have you got sources for any of these so called facts you have spouted? Links if you please.

syklops

Is this more lobbying from the Irish communist party? The nick Jolly RED Giant would be suggestive that it is.

Also the thread is Questions FG and LP must answer, but those are not questions they are just flaws of the Dutch system. For those of us who are lazy, would you mind adding the questions you want us to ask?

telekon

FYI, the OP is affiliated to the socialist party according to politics.ie. No source there either for claims.

gandalf

telekon wrote: »

FYI, the OP is affiliated to the socialist party according to politics.ie. No source there either for claims.

No sources for their claims, no sources for how they are going to solve the banking crisis. Its just more "It's not fair" politics then with no solutions at all.

Jolly Red Giant

I have references for each and every claim on this thread

telekon wrote: »

Nice copy and paste from Politics.ie, "Making waves". Why change your name for Boards.ie?

Not allowed use JRG on politics.ie

gandalf

Jolly Red Giant wrote: »

I have referecnes for each and every claim on this thread

Well post them.

telekon

Jolly Red Giant wrote: »

I have referecnes for each and every claim on this thread

Great. Post them ASAP.

And ensure you do it for all future posts too.

There's no problem as long as they're backed up with credible sources.

Dozen Wicked Words

One particular part of the FG manifesto could do with some clarification:

We will pay hospitals for the number of patients they treat rather than, as is currently the case, giving them block grants. This system, which is known as Money Follows the Patient, should increase hospital productivity by between 5% and 10%

My concern would be hospitals will make day cases and short stay cases their priority in allocating beds. Therefore increasing turnover of patients, and apparently, their income. This would be completely unfair to the large Regional and Dublin Referral hospitals who are asked to take on the more difficult/challenging cases who more often than not block their beds for a much longer time.

Would be very interested to see their criteria for what each patients stay, and their condition, is worth financially.

rumour

Jolly Red Giant wrote: »

Both Fine Gael and the Labour Party plan on introducing mandatory Universal Health Insurance after the next general election. Fine Gael’s ‘FairCare’ plan lauds the Dutch system of Universal Health Insurance. The Labour Party’ ‘FairHealthCare’ plan is similar but instead of using the Dutch system as a model, the Labour Party refer to the German system. In reality both systems face the same issues – issues that should be answered before anyone votes for Fine Gael or the Labour Party.

Twelve points that need to be addressed in relation to the Dutch model of Universal Health insurance –

1. The Netherlands has gone from a two-tier health system to a three-tier health system. Almost half a million people are now uninsured or defaulting on the health insurance payments.

2. Private health insurance companies are findings ways to circumvent the ban on ‘risk selection’.

3. The current cost of the Universal Health Insurance basic package in the Netherlands is €1194 per person for this year. On top of that Employers deduct a further 6.9% of a workers income up to a ceiling (€2233 in 2009).

4. With annual income running at €53,000 per household, the annual cost of health insurance is somewhere between €4,525 and €5,625, or 8.6 to 10.7 per cent of household income.

5. Since the introduction of Universal Health Insurance in 2006, premium costs have risen by 41% and could double from the current rates by 2014.

6. More than 50% of the hospitals in the Netherlands are facing bankruptcy as a result of the introduction of Universal Health Insurance in 2006.

7. There has been a significant and continuing increase in healthcare costs since the introduction of Universal Health Insurance in 2006.

8. The necessity to negotiate and implement 30,000 Diagnosis Treatment Combinations (DBCs) between private health insurance companies and individual hospitals has led to a massive bureaucratisation of the system.

9. It is not known how many hospital beds there actually are in the Netherlands.

10. The Dutch healthcare system has growing waiting lists and short-notice postponement of operations.

11. The Dutch healthcare system is no better than average in comparison with other wealthy countries.

12. 41% of people say that the quality of the health system has worsened since the introduction of Universal Health Insurance in 2006, while 8% indicated that it had improved.

In Germany –

1. The public health insurance system has a projected deficit of €11billion in 2011

2. Older patients and those with chronic or long-term illnesses are dumped off of the private insurance system onto the public insurance system causing rising costs for public UHI.

3. Patients with private health insurance (rather than UHI) are automatically seen before UHI patients – even in a GP’s surgery.

4. As the crisis in the German healthcare system continues to grow those on lower incomes are being disproportionally hit by rising costs.

5. German Health Minister, Philipp Rösler, plans on switching from health premiums based on a percentage of income to premiums based on a flat rate charge, thereby further hitting those on low incomes.

6. Procedures covered in the basic UHI package are dropping and out-of-pocket payments by patients are increasing.

In terms of both systems of health care the issue are the same.

- Rising costs – despite claims from both FG and LP to the contrary

- Rising insurance premiums

- Rising deficits

So in a nutshell.......are you saying they are in a mess also????

Whats the point????

Anyway seems to me we plough loads of money into the health service and get crap out in return.
The problem is not the minister or the government policy its the people within the health service. Its a vast empire where its only purpose is to serve the needs of the little kingdoms/fiefdoms within the empire. The end result is always give me more money.

So we get the highest paid consultants in western europe and what in return???
The highest paid nurses in western europe and what in return???

I think the job security and enormous pay levels should to be taken away, then you might see a better service.

Whatever FG & lab propose and may even enact, wait and see at the next election we'll have the same debate.........

jimmycrackcorm

What ever points are being made about the Dutch and German systems, they sure beat our existing system hands down (source - any system suggested at all is better than the HSE model).

costa

Dozen Wicked Words

gandalf wrote: »

OP have you got sources for any of these so called facts you have spouted? Links if you please.

All the references are there now, OP has updated original message.

Jolly Red Giant

rumour wrote: »

So in a nutshell.......are you saying they are in a mess also????

Whats the point????

Anyway seems to me we plough loads of money into the health service and get crap out in return.

A lot less than in Holland or Germany

rumour wrote: »

So we get the highest paid consultants in western europe and what in return???

in 2006 income for GP's in Holland increased by over €54,000 to over €250,000 a year - directly as a result of UHI. In 2008 salaries for consultants jumped by 50% in one year.

rumour wrote: »

Whatever FG & lab propose and may even enact, wait and see at the next election we'll have the same debate.........

The plan is to privatise anything that moves - including healthcare.

Eliot Rosewater

The references the OP have stuck in are basically useless, in fairness. Any chance he could put in links?

In the last week before the election we're probably going to have to go hard on posts like the OP's, as it could be construed as mud-slinging and general electioneering.

/mod.

Chucky the tree

Jolly Red Giant wrote: »

in 2006 income for GP's in Holland increased by over €54,000 to over €250,000 a year - directly as a result of UHI. In 2008 salaries for consultants jumped by 50% in one year.

Link? It seems GP's wages were always quite high in holland.

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

I think most people would mind the high salaries if it meant quality health care which seems to happen in holland.

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx.

Jolly Red Giant

Eliot Rosewater wrote: »

The references the OP have stuck in are basically useless, in fairness. Any chance he could put in links?

In the last week before the election we're probably going to have to go hard on posts like the OP's, as it could be construed as mud-slinging and general electioneering.

/mod.

Yes I can - however most can be got by simply googling the details provided. Some do require academic access - i.e. through Jstor etc.

I rushed the thread bacasue the issue was being discussed on Pat Kenny - I actually emailed them a study that I conducted into the Dutch UHI system, but unsurprisingly it was ignored despite the fact that their 'analyst' got nearly every fact she stated wrong.

Jolly Red Giant

Chucky the tree wrote: »

Link? It seems GP's wages were always quite high in holland.

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

Schäfer W, Kroneman M, Boerma W, van den Berg M, Westert G, Devillé W & van Ginneken E., “The Netherlands: Health system review”, Health Systems in Transition, (2010) 12(1), p. 58

Chucky the tree wrote: »

I think most people would mind the high salaries if it meant quality health care which seems to happen in holland.

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx.

The point being made was not rising salaries - but (along with other info) rising costs - both FG and LP claim that UHI will reduce costs, the opposite is actually the case.

Jolly Red Giant

Fine Gael praise the Dutch health service based on the rankings published on the Euro Health Consumer Index. Given the weight that Fine Gael place on the EHCI it is necessary to review what the EHCI is and where it comes from.

The EHCI is produced by a Swedish registered privately-owned European think-tank called the Health Consumer Powerhouse. In 2009 a study was carried out into the 2007 EHCI in the University of Twente. The report goes into detail in outlining the shortcomings of the EHCI. In concluding the author states:

“In the Index 2007 there are serious shortcomings in respect of quality. The most acute concerns are about the Index validity. The Index 2007 is neither transparent (does not elaborate on choice of indicators and their meaning) nor based on relevant information (limited sources of information, irrelevant to the reality statements). As the systematic process of indicators choosing is absent, the Index touches upon only specific services and particular groups of patients. Thus, standards of comprehensiveness are not met. There are concerns in respect of relevance and reasonable. The Index overlooks consumers because takes a high level of aggregation - national health care systems, but not the level of hospitals.”

When you actually look into who the Health Consumer Powerhouse are then these conclusions of secrecy are not surprising. The Health Consumer Powerhouse was founded in 2004 by Johan Hjertqvist. He was previously the founder of a venture capital company that invested in private health care in Sweden and was among the foremost promoters of the expansion of private health care into the Swedish health system. Prior to establishing Health Consumer Powerhouse, Hjertqvist has developed a right-wing Swedish based think-tank called Timbro. Timbro's mission is to originate, promote and disseminate ideas and issues supporting the principles of free markets, free enterprise, individual liberty and a free society. Timbro's main research areas going into 2009 are wealth accumulation, health and welfare reform, and aid and global development.

In relation to Health Consumer Powerhouse, what can been seen from an analysis of their EHCI is that countries with privatized or semi-privatised health systems always perform better than state-run healthcare systems.

Health Consumer Powerhouse refuses to disclose who funds the group or how much funding it has available to it. Both Health Consumer Powerhouse and Timbro are members of the Stockholm Network.

Chucky the tree

From 2004 to 2007, health care expenditure grew in line with economic
development. The favourable economic growth in this period has ensured that
health expenditure as a proportion of GDP scarcely rose between 2004 and
2006 (Westert et al. 2008) (see also Table 3.1)....

The new financing
system of GP care (see Section 3.6 Payment mechanisms) also led to an increase
in expenditure of about 17% in 2006 (Te Brake et al. 2007; Westert et al. 2008).
A study revealed that GPs (in full-time equivalents) generated an extra income of
€54 257 in 2006. The higher revenue, 14% more than estimated, was mainly due
to the level of the tariffs for consultations and a higher number of consultations
than expected (Dutch Health Care Authority 2008f; Karssen, Schipper and
Jurling 2009). According to the National Association of General Practitioners
(LHV), this increase can be explained by the substitution of secondary care with
primary care, resulting in more work for GPs and savings in secondary care.

So how is the opposite the case? It seems the dutch have basically spent the same as always while imporiving there medical care. While I don't know if FG have claimed to redce cost but you can still do that while raising wage rates.

Jolly Red Giant

Chucky the tree wrote: »

So how is the opposite the case? It seems the dutch have basically spent the same as always while imporiving there medical care.

You quote from a study from 2007 that discussed up to 2006. The study by Rosenau & Lako goes into detail on the rising costs which have been increasing significantly since 2006.

Chucky the tree wrote: »

While I don't know if FG have claimed to redce cost but you can still do that while raising wage rates.

“It reduces costs and increases quality. The Irish State has a very poor track record in driving innovation in the health system and in making deals that generate value-for-money. Properly incentivised and managed insurance companies, by contrast, would have every reason to drive innovation as a way to maximise service and reduce costs.”
(Faircare p. 14)

The experience of the Dutch system is the opposite - poorer service with increasing costs.

gandalf

OK so you are saying that FG and Labour have it wrong. As you appear to be a supporter of the Socialist Party what is their solution?

Because from where I stand and having experienced our current Health System both from family illnesses, death and from dealing with segments of it from a business perspective it is broken and needs to be addressed and what FG are proposing to me makes sense and does look like it will work.

So what are your solutions to the problems and how will you make them work? Or is this just you pointing out negative points with another parties plans because you cannot positively present the case for your plans?

Chucky the tree

Jolly Red Giant wrote: »

You quote from a study from 2007 that discussed up to 2006. The study by Rosenau & Lako goes into detail on the rising costs which have been increasing significantly since 2006.


“It reduces costs and increases quality. The Irish State has a very poor track record in driving innovation in the health system and in making deals that generate value-for-money. Properly incentivised and managed insurance companies, by contrast, would have every reason to drive innovation as a way to maximise service and reduce costs.”
(Faircare p. 14)

The experience of the Dutch system is the opposite - poorer service with increasing costs.

Link to that study? I'm quoting studies you have referenced. You claimed the study said GP wages had risen from €54k to €250k in a year and I found no mention of that in the report. How is the dutch a poor system when it's one of the top ranked?

Jolly Red Giant

Chucky the tree wrote: »

Link to that study? I'm quoting studies you have referenced. You claimed the study said GP wages had risen from €54k to €250k in a year and I found no mention of that in the report. How is the dutch a poor system when it's one of the top ranked?

You quote from the study showing the increase in GP's salary - you further quote from a report dealing with issues prior to introduction of UHI in 2006.

As regards the ranking of Dutch healthcare - FG's claim comes from the ECHI which is produced by a pro-privatisation lobby group with major question marks over it's validity - other reports indicate that it is no better and no worse than other wealthy countries.

Chucky the tree

Jolly Red Giant wrote: »

You quote from the study showing the increase in GP's salary - you further quote from a report dealing with issues prior to introduction of UHI in 2006.

As regards the ranking of Dutch healthcare - FG's claim comes from the ECHI which is produced by a pro-privatisation lobby group with major question marks over it's validity - other reports indicate that it is no better and no worse than other wealthy countries.

Those quotes are from the same report. Ah right, you meant the increased was by €54k, not from. What about the commonwealth fund?

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx

Jolly Red Giant

Chucky the tree wrote: »

. What about the commonwealth fund?

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx

It is a study conducted into seven health services - hardly comprehensive in claiming the 'best'.

There is no argument that the Dutch healthcare system is not a good health system in terms of quality and care. The issue is that since the introduction of UHI in 2006 it has not improved, costs have increased, premiums have increased dramatically, people feel it has got worse.

The claims made by FG for the Dutch system have no foundation in fact and are based on reports from pro-privatisation lobby groups. Furthermore the Dutch government regard the introduction of UHI as a step towards the complete privatisation of healthcare inthe Netherlands.

Jolly Red Giant

The second group that Fine Gael use for arguing in favour of their mandatory universal health insurance is the REFORM think-tank.

So where do REFORM come from? It is based in London and was founded in 2001 by Nick Herbert (now a Conservative MP) and Andrew Haldenby (former head of the Political Section in the Conservative Party’s Research Department). It function is outlined on its website as follows:


“We believe that by liberalising the public sector, breaking monopoly and extending choice, high quality services can be made available for everyone. Reform would remove public services from the escalator of ever-rising costs. It would enable policy makers to aim for a lower level of taxation and public spending which would better suit the UK's current and future economic challenges.”

REFORM argue for cuts in welfare spending and the privatisation of health and education. Many of REFORM’s research publications have been heavily criticized. One report into falling standards of mathematics in UK schools was should to have incorrect calculations in the data (Goldacre, 2008). In 2009 REFORM produced a budget submission that argued in favour of cutting back what they call "pensioner gimmicks" such as the winter fuel payment and free TV licensing for the over 75s. and the introduction of market rates for student loans which would result in UK students paying an extra £1.2billion a year in interest payments.

REFORM are also a member of the Stockholm Network.

gandalf

gandalf wrote: »

OK so you are saying that FG and Labour have it wrong. As you appear to be a supporter of the Socialist Party what is their solution?

Because from where I stand and having experienced our current Health System both from family illnesses, death and from dealing with segments of it from a business perspective it is broken and needs to be addressed and what FG are proposing to me makes sense and does look like it will work.

So what are your solutions to the problems and how will you make them work? Or is this just you pointing out negative points with another parties plans because you cannot positively present the case for your plans?

Any chance you can answer these or is the Socialist Party engagement just going to consist of negative campaigning against other parties policies?

nesf

Jolly Red Giant wrote: »

Yes I can - however most can be got by simply googling the details provided. Some do require academic access - i.e. through Jstor etc.

I rushed the thread bacasue the issue was being discussed on Pat Kenny - I actually emailed them a study that I conducted into the Dutch UHI system, but unsurprisingly it was ignored despite the fact that their 'analyst' got nearly every fact she stated wrong.

This is not acceptable on this forum. The onus is on you to back up your points with material that is accessible to members of the forum (i.e. that means provide links, not tell people to google). Also JStor only references are not acceptable because the vast majority of people on here don't have JStor access and those that do (like myself) do not have the time to go through all your references by hand most likely.

If a journal paper has made a substantial finding about a health system it is almost certainly reproduced in a newspaper or magazine article somewhere. Use these as your references.


Also, finally and most importantly: it not sufficient to say X is true and provide a single journal reference. You need to argue the point and explain why it is true. E.g. why are there so many uninsured in the Dutch system? It is not sufficient to merely state X% are uninsured. Also you should be clear when these are estimates and how they were estimated. Also the group or people behind said estimate are also important.

Jolly Red Giant

gandalf wrote: »

Any chance you can answer these or is the Socialist Party engagement just going to consist of negative campaigning against other parties policies?

The Socialist Party position is clear - free universal health care for all funded by progressive taxation.

nesf wrote: »

This is not acceptable on this forum. The onus is on you to back up your points with material that is accessible to members of the forum (i.e. that means provide links, not tell people to google).

A study of the Dutch UHI and healthcare system has just been completed. Would you like me to forward you a copy and you can read the entire thing. The Pat Kenny programme were discussing this issue this morning and I posted parts of the information to provide an opportunity to discuss the issue. As I have had time today I have provided further information from this study. To be honest I have provided vastly more references for what I have posted than most threads on this forum and significantly more than Fine Gael have provided in their FairCare document. I will add links shortly but to be honest it takes about 10 seconds to compy and paste the title into google and that is what I have to do as I have a paper copy.

nesf wrote: »

Also JStor only references are not acceptable because the vast majority of people on here don't have JStor access and those that do (like myself) do not have the time to go through all your references by hand most likely.

If a journal paper has made a substantial finding about a health system it is almost certainly reproduced in a newspaper or magazine article somewhere. Use these as your references.

The British Medical Journal is only available by subscription and whether you like it or lump it that is what you have to work with - so in terms of your assertion I would say - tough.

nesf wrote: »

Also, finally and most importantly: it not sufficient to say X is true and provide a single journal reference. You need to argue the point and explain why it is true. E.g. why are there so many uninsured in the Dutch system? It is not sufficient to merely state X% are uninsured. Also you should be clear when these are estimates and how they were estimated. Also the group or people behind said estimate are also important.

Are you trying to tell me how I should go about writing or referenceing a post? - what I posted was a brief summary of a much longer document - it is fully argued and referenced. If I forward it to you will you make the entire document available on this forum? It will be made available shortly on the internet by the author and I will link it when that happens.

As I final point - it is interesting that none one from Fine Gael or the Labour Party nor anyone else who supports mandatory Universal Health Insurance has come on here to answer the points raised or to refute them. This is because the points are accurate and the issues raised cannot be refuted. Instead all we have is nonsense complaints about how material is argued and referenced - despite the fact that the referencing is extensive.

EDIT - links added to opening post

gandalf

Jolly Red Giant wrote: »

The Socialist Party position is clear - free universal health care for all funded by progressive taxation.

Hmmm nice and generic that. What are the Socialist Parties opinion on the chronic overpopulation in the HSE of Admin staff, some of whom actually no longer have a job even though they are still employed and paid by the taxpayer. Are the SP in favour of removal of these staff to free up funds that are needed to desperately back up the front line staff?

Laminations

The OP makes some good points, or at least relays some good information that should be considered by anyone thinking of following the Dutch system. However his points have not convinced me to not vote FG. Universal Health care is a good idea and whether this is provided through an insurance scheme (once the poorest are protected) or through progressive taxation, the problems of rising costs and lowering standards will still creep in. Highlighting these slippages exist in countries with universal health care is a good start but you need to try and pinpoint why problems of cost and quality have appeared. This will allow FG or whoever to recognise and tackle slippage in the introduction of their scheme, preventing the problems cited by the OP from occurring here.

A second point is on references. I find the OP satisfactory once the references were added as was done. The idea that peer reviewed scientific work in international journals shouldn't be acceptable as a reference unless it's been picked up by some easy to access red top is backward. Accessibility to papers is a problem in academia but to prescribe that all sources be accessible to all before they are deemed acceptable is wrong. If he cuts the source and quotes the relevant piece he shouldn't have to care whether it's pay per view once it's an accredited journal etc. Are we accusing him here of lying? He has backed up his points as well as reasonably possible and they are points worth considering in the implementation and evaluation of any system as introduce here but like I said, they are points to which I believe the socialist model is also not immune to

Jolly Red Giant

Laminations wrote: »

Universal Health care is a good idea and whether this is provided through an insurance scheme (once the poorest are protected) or through progressive taxation, the problems of rising costs and lowering standards will still creep in.

Universal Health Insurance is a stepping stone to the complete privatisation of Health Care. In relation to the Netherlands - to quote again -
“The current market reform is not only intended to introduce regulated competition in health insurance, but also in the provision of care.”
http://www.docstoc.com/docs/29472243/Private-Health-Insurance-in-the-Netherlands

We already have significant sections of healthcare in Ireland privatised - most noticably in terms of private nursing homes who receive massive tax breaks from the government.

Laminations wrote: »

Highlighting these slippages exist in countries with universal health care is a good start but you need to try and pinpoint why problems of cost and quality have appeared.

The problems are created by the 'market' - inevitably once you being this process there is only one place it will end up and that is with the 'free market' running wild. The drive is for profits and not health care. The REFORM group and the Health Consumer Powerhouse (the two lobby groups used by Fine Gael for their FairCare plan) are both lobbyists for the privatisation of healthcare.

Furthermore the current regulation in the Netherlands is under severe threat from the EU who could well force the Dutch government to open up healthcare to unbridled competition as part of the 'internal market'
http://healthcarecostmonitor.thehastingscenter.org/hansmaarse/testing-market-practices/ p.9

Laminations wrote: »

This will allow FG or whoever to recognise and tackle slippage in the introduction of their scheme, preventing the problems cited by the OP from occurring here.

Fine Gael's final objective is complete privatisation - their open use of pro-privatisation lobby groups to promote their UHI plan is ample demonstration of that.

Fine Gael will find it extremely difficult to introduce their plan as outlined for two reasons - 1 - the economic condition of the country will make it difficult to do what they say they are going to do prior to UHI being introduced (although the could simply go for it very early) - 2 - there will be widespread opposition from working class people (particularly as the Dutch system falls apart).

Laminations wrote: »

A second point is on references. I find the OP satisfactory once the references were added as was done. The idea that peer reviewed scientific work in international journals shouldn't be acceptable as a reference unless it's been picked up by some easy to access red top is backward. Accessibility to papers is a problem in academia but to prescribe that all sources be accessible to all before they are deemed acceptable is wrong. If he cuts the source and quotes the relevant piece he shouldn't have to care whether it's pay per view once it's an accredited journal etc. Are we accusing him here of lying? He has backed up his points as well as reasonably possible and they are points worth considering in the implementation and evaluation of any system as introduce here

I agree and thanks for the support

Laminations wrote: »

but like I said, they are points to which I believe the socialist model is also not immune to

By removing the 'private' aspect out of a universal health care system you remove a significant number of the reasons for issue such as rising costs and poorer quality. You create more stepdown beds to free up hospital places and re-open wards. You remove significant layers of bureaucracy that are needed for the 'negotiations' on fees, bill processing, making decisions on cost rather than necessity etc. For example one of the first things a socialised healthcare system would do is implement the mandatory production and use of generic drugs.

The Socialist Party will be dealing with this in far more detail in the near future.

two wheels good

nesf wrote: »

This is not acceptable on this forum. The onus is on you to back up your points with material that is accessible to members of the forum (i.e. that means provide links, not tell people to google). Also JStor only references are not acceptable because the vast majority of people on here don't have JStor access and those that do (like myself) do not have the time to go through all your references by hand most likely.

If a journal paper has made a substantial finding about a health system it is almost certainly reproduced in a newspaper or magazine article somewhere. Use these as your references.

Also, finally and most importantly: it not sufficient to say X is true and provide a single journal reference. You need to argue the point and explain why it is true. E.g. why are there so many uninsured in the Dutch system? It is not sufficient to merely state X% are uninsured. Also you should be clear when these are estimates and how they were estimated. Also the group or people behind said estimate are also important.

Jeez, Give the guy a break will ya! I heard the Pat Kenny debate and I was left thinking "since when is the Dutch Health System the ideal model for Ireland".

Some additional reading on the Dutch system is welcome. Thanks. I haven't read any of the links in detail yet but I'm keen to take a look.

nesf

Jolly Red Giant wrote: »

The Socialist Party position is clear - free universal health care for all funded by progressive taxation.


A study of the Dutch UHI and healthcare system has just been completed. Would you like me to forward you a copy and you can read the entire thing. The Pat Kenny programme were discussing this issue this morning and I posted parts of the information to provide an opportunity to discuss the issue. As I have had time today I have provided further information from this study. To be honest I have provided vastly more references for what I have posted than most threads on this forum and significantly more than Fine Gael have provided in their FairCare document. I will add links shortly but to be honest it takes about 10 seconds to compy and paste the title into google and that is what I have to do as I have a paper copy.


The British Medical Journal is only available by subscription and whether you like it or lump it that is what you have to work with - so in terms of your assertion I would say - tough.


Are you trying to tell me how I should go about writing or referenceing a post? - what I posted was a brief summary of a much longer document - it is fully argued and referenced. If I forward it to you will you make the entire document available on this forum? It will be made available shortly on the internet by the author and I will link it when that happens.

As I final point - it is interesting that none one from Fine Gael or the Labour Party nor anyone else who supports mandatory Universal Health Insurance has come on here to answer the points raised or to refute them. This is because the points are accurate and the issues raised cannot be refuted. Instead all we have is nonsense complaints about how material is argued and referenced - despite the fact that the referencing is extensive.

EDIT - links added to opening post

Thanks for adding the links.

Issues are: The mods don't have the time to proof read people's references and there's a big possibility for abuse if people start referencing papers. So we rely on crowdsurfing to do it for us (i.e. this is why references need to be as much as possible publicly accessible).

FG and FF official types don't come on here and honestly what you're talking about would need expertise in the area to deal with (i.e. understand the academic papers and any possibly biases or methodological issues within them etc). I do have the expertise to do this due to my academic background but bluntly, I've a mental illness and am in a poor concentration phase of it so am not in a position to analyse those papers and references properly. So I'm not sure if your position can be properly challenged on here unless someone with a background in the area takes an interest.

I'm not telling you how to post rather I'm asking you to provide some idea of the background behind the stats to allow people to get a better idea of your position.

nesf

two wheels good wrote: »

Jeez, Give the guy a break will ya! I heard the Pat Kenny debate and I was left thinking "since when is the Dutch Health System the ideal model for Ireland".

Some additional reading on the Dutch system is welcome. Thanks. I haven't read any of the links in detail yet but I'm keen to take a look.

Eh, we require people to support these kinds of posts with publicly accessible links in general. Rule is there for a reason and has been around almost since this forum was founded in the early years of this site. One could say it's one of the key differences between this forum and others to be found online.

Jolly Red Giant

Finally it is necessary to look at the Stockholm Network. This is a London based privately-owned company that operates as an umbrella group for over 130 right-wing think-tanks. The Stockholm Network outlines it strategy as follows:

• Reforming European welfare states and creating a more flexible labour market
• Updating European pension systems to empower individuals
• Ensuring more consumer-driven healthcare, through reform of European health systems and markets
• Encouraging an informed debate on intellectual property rights as an incentive to innovate and develop new knowledge in the future, whilst ensuring wide public access to such products in the present
• Reforming European energy markets to ensure the most beneficial balance between economic growth and environmental quality
• Emphasising the benefits of globalisation, trade and competition and creating an understanding of free market ideas and institutions.
• www.stockholm-network.org

Among its prominent supporters is former President of the European Parliament and member of the Progressive Democrats, Pat Cox. Among its prominent clients are pharmaceutical companies Pfizer, Merck Sharp & Dohme. The Stockholm Network, while disclosing the names of its sponsors, does not disclose the amount of cash it generates for its activities. In effect the Stockholm Network is a lobbying group for among others, pharmaceutical companies, private healthcare providers and private health insurance companies.

In 2010 the Stockholm Network was accused of being responsible for the removal from the National Institute for Health and Clinical Excellence in the UK of its remit to purchase certain drugs for the NHS. The new method to replace the NIHCE was for drugs to be purchased not on the basis of necessity but on the basis of ‘assessed value. Following the publication of a further report in 2010 a number of groups left the Stockholm Network citing its ‘promotion of particular business interests’.

(Harkins, S., & Jones, M., “The Stockholm Network”, British Medical Journal, (10 Nov. 2010) http://www.bmj.com/content/341/bmj.c6413.extract )

Given the background and nature of the groups that Fine Gael has used to promote it mandatory Universal Health Insurance system, voters in Ireland should be more than a little sceptical about the proposal being offered.

Laminations

JRG, like I said there are definite concerns there but I think the privatisation argument is a scare tactic. The Scandinavian health system is mostly privatised but it remains universal- very different from medical insurance in the States. It also remains amongst the best in the world. Your solution of having a state funded care system does not surmount the problems of waste, drop in quality, increased costs - all of which we currently have with the HSE. UHI while having private interests involved creating competition is still overseen and regulated by the state. Could the problems you cite in relation to the Dutch model be dealt with through regulation? I, by no means want to see an unregulated free Market healthcare system but that's not the plan, and framing your argument with that consequence on the end of a slippery slope is scaremongering (you described this as a stepping stone to full privatisation). I'll read the fleshed out SP proposals on state funded universal health care when they become available but I'm doubtful they will address the issues of rising costs and slipping standards.

Jolly Red Giant

Laminations wrote: »

JRG, like I said there are definite concerns there but I think the privatisation argument is a scare tactic.

I have already provided evidence that the strategy of the Dutch government is to proceed with the full privatisation of the dutch healthcare system. The inevitable consequence of mandatory UHI is creeping privatisation. the insurnace companies in the Netherlands are already pushing for increased de-regulation and are banking on the EU to rule against the 'social' element of UHI.

Laminations wrote: »

The Scandinavian health system is mostly privatised but it remains universal- very different from medical insurance in the States. It also remains amongst the best in the world.

The privatisation of the Sewdish healthcare system was driven by Timbro - the same people who produce the ECHI - and the Swedish healthcare system is falling apart at the seams.

Laminations wrote: »

Your solution of having a state funded care system does not surmount the problems of waste, drop in quality, increased costs - all of which we currently have with the HSE.

You are assuming that any state funded system proposed by the Socialist Party would be run by a bureaucracy like the HSE - it would not - it would be run on a planned democratic basis with input from health professionals, patients and communities and it would have full democratic accountability.

Laminations wrote: »

UHI while having private interests involved creating competition is still overseen and regulated by the state. Could the problems you cite in relation to the Dutch model be dealt with through regulation? I, by no means want to see an unregulated free Market healthcare system but that's not the plan, and framing your argument with that consequence on the end of a slippery slope is scaremongering (you described this as a stepping stone to full privatisation).

Once a public service operates within the restrictions of the market and is run on the basis of the market all the regulation in the world won't mean diddly-squat. Inevitably those who hav so much to gain from free market activities will force de-regulation or wreck the system in the process. A booming economy can cover-up the anarchy of the market by simply throwing money at the problem - a crashing economy will wreck any healthcare system no matter how much regulation you have.

Laminations wrote: »

I'll read the fleshed out SP proposals on state funded universal health care when they become available

I will make sure you get a copy

Laminations wrote: »

but I'm doubtful they will address the issues of rising costs and slipping standards.

Be warned it will require you think outside of the (market) box.

Laminations

Jolly Red Giant wrote: »

I will make sure you get a copy

thanks for that

Be warned it will require you think outside of the (market) box.

I can definitely do that, look up my arguments against the libertarians of this site.

You say that I assume the SP proposal will be like the HSE but you assume that the UHI will end up like the Swedish or Dutch model. Now granted that it's based on the Dutch model but what im saying is that we can see where they went wrong and not make the same mistakes. You can base a system on another without having the same end goal, or is your point that this result is inevitable, that these problems are inherent in the UHI system.

If so do you not concede that waste and dry rot will be the consequence of any state funded system or is there any working examples in the world of what the SP is proposing. Knowing that your preferred system is state funded I could point to similar examples that are failing apart, but of course you'd argue that 'we'd do it differently' but you don't afford that excuse to the implementation of UHI.

And just to clarify, I fully agree with your OP, that FG/Lab need to answer on those points, they need a plan to avoid making similar mistakes

Jolly Red Giant

Laminations wrote: »

You say that I assume the SP proposal will be like the HSE but you assume that the UHI will end up like the Swedish or Dutch model. Now granted that it's based on the Dutch model but what im saying is that we can see where they went wrong and not make the same mistakes. You can base a system on another without having the same end goal, or is your point that this result is inevitable, that these problems are inherent in the UHI system.

The problem is that every attempt to introduce UHI has ended up the same way and over time progressed in the direction of the 'unregulated' American system. It is a physical impossibility to regulate the anarchy of the market - the chaos caused by the market can be side-stepped during a boom, but inevitably comes crashing down. This is why the Dutch, German and Sewdish health systems are on the verge of collapse.

Laminations wrote: »

If so do you not concede that waste and dry rot will be the consequence of any state funded system or is there any working examples in the world of what the SP is proposing. Knowing that your preferred system is state funded I could point to similar examples that are failing apart, but of course you'd argue that 'we'd do it differently' but you don't afford that excuse to the implementation of UHI.

The entire basis of a socialised healthcare system begins with preventative measures to primary care to polyclinics to generalised hospitals to specialised centres to step-down facilites to elderly care. Current state funded systems operate within the confines of the market and are structured on the basis that they were market orientated (every state and semi-state service operates on that basis). There have been initial discussions on developing a comprehensive healthcare policy (detailed rather than simply 'universal free healthcare' but to be comprehensive will take time and in my view will be necessary to counter-act the plan of FG and LP to introduce UHI.

Laminations wrote: »

And just to clarify, I fully agree with your OP, that FG/Lab need to answer on those points, they need a plan to avoid making similar mistakes

FG and LP are not really concerned with 'mistakes' - they are already making a whopper by backing the bailout - they are concerned with opening up public services to the (almighty god of the) market.

Hector Mildew

Does anyone know how our total healthcare cost per person compares with Holland and Germany?

Annual HSE funding is about €16 billion which is roughly €4000 + any private health insurance per person.