Why not get rid of public healthcare?

A Primal Nut

For most people, private health insurance is around E1000 per person. Public spending on health insurance is much more than that, and is a weaker form of healthcare. Why don't we get rid of the public healthcare system, and use the billions we would save to for private insurance for the poorest, most vulnerable, unemployed, etc and force everyone else who can afford it to buy their own private health insurance? We would end up saving a lot of money and everyone would get a better form of healthcare.

thebman

Isn't that more or less what FG promised in the election campaign?

CrystalLettuce

A Primal Nut wrote: »

For most people, private health insurance is around E1000 per person. Public spending on health insurance is much more than that, and is a weaker form of healthcare. Why don't we get rid of the public healthcare system, and use the billions we would save to for private insurance for the poorest, most vulnerable, unemployed, etc and force everyone else who can afford it to buy their own private health insurance? We would end up saving a lot of money and everyone would get a better form of healthcare.

Because it doesn't work like that. Private Healthcare ends up with all kinds of overheads. Just look at America, they spend more than France on Healthcare yet before Obamacare only covered 80-90% or so of the population, as opposed to being universal.

Privatising things is often a bad idea. Some things work best private, and some things public. Health care is one of those that works best public. As are Trans Services, as the disastrous British rail system shows.

What FG were offering was a variation on this, similar to the Dutch model. The Dutch model is actually pretty good, but not as good as France or Sweden as far as I know. It bypasses a lot of these issues by having strong regulation, something the "privatise everything" crowd hate. We haven't exactly proven ourselves champs with the whole regulation thing before, so I'd be sceptical as to how this works out for us.

thebman

While we have failed at regulation in the past, the reason for that is mostly cosy regulation. In Ireland though, the one thing politicians fear more than a non-cosy arrangement is being blamed for peoples deaths so I think if there were one situation in which we can get regulation right, it is in this scenario.

GCU Flexible Demeanour

A Primal Nut wrote: »

Public spending on health insurance is much more than that, and is a weaker form of healthcare. <> We would end up saving a lot of money and everyone would get a better form of healthcare.

I don't think this is an accurate depiction of the situation.

Firstly, Irish health insurance typically doesn't cover primary care at all, where the public system covers a third of the population, and makes no contribution to universal health schemes like vaccinations.

Secondly, the more complicated procedures are undertaken in the public hospitals - the private sector, as you'd expect, do the stuff that you can do in volume and that turns a profit. 60% of inpatient stays by people with private health insurance are in public hospitals, so I think its fair to question which is the 'weaker form'.

Thirdly, private health insurance receives both direct subsidies through the tax system and indirect subsidies, by being able to dump the problems it doesn't want to handle on the public system.

Fourthly, health care is not a normal good. Leave it to private competition, and the market will not function as (inter alia) people don't make informed choices about what to consume; professionals decide on their behalf, so supplier induced demand is a significant problem.

The US has a largely private system. They spend more on health care than anyone else, and have not that much to show for it. We spend much less, but our life expectancy is much the same.

I wouldn't favour a greater role for private health care, as I think it would lead to the health sector consuming an even greater share of national income for no benefit. That's never a good thing, but its doubly bad when we need to get the best value from such resources as we can gather at present.

GCU Flexible Demeanour

CrystalLettuce wrote: »

What FG were offering was a variation on this, similar to the Dutch model.

What FG offered was an incompetent rendition of the Dutch model. FG don't seem to get the point of 'managed competition', which is that everyone (even people on low incomes) should face a price incentive in the hope that they'll seek cheaper insurance.

FG undertake to pay in full for Medical Card holders. That completely unseats the idea of the market determining costs - in particular, as medical card holders account for half of all health care activity.

Also, FG fudged on the local hospital issue. Managed competition should close unneeded health facilities, as health care providers only get paid per patient. But FG promised that no facility will close without Ministerial approval - although they haven't explained where all the money will come from to do this.

CrystalLettuce wrote: »

The Dutch model is actually pretty good, but not as good as France or Sweden as far as I know.

I think you have to distinguish two things. Dutch healthcare is pretty good. But that has nothing in particular to do with their current experiment with managed competition, which was really only put into effect in 2006. The Dutch experience is that managed competition hasn't delivered the benefits they hoped, which was (basically) to bring down costs.

beeno67

A Primal Nut wrote: »

For most people, private health insurance is around E1000 per person. Public spending on health insurance is much more than that, and is a weaker form of healthcare. Why don't we get rid of the public healthcare system, and use the billions we would save to for private insurance for the poorest, most vulnerable, unemployed, etc and force everyone else who can afford it to buy their own private health insurance? We would end up saving a lot of money and everyone would get a better form of healthcare.

One of the big differences however is that the public healthcare system in Ireland is far superior to the private one. Yes access is difficult (extremely difficult in places) but given the choice I would much prefer to be treated in a public hospital than a private one

thebman

beeno67 wrote: »

One of the big differences however is that the public healthcare system in Ireland is far superior to the private one. Yes access is difficult (extremely difficult in places) but given the choice I would much prefer to be treated in a public hospital than a private one

That problem disappears once you sell the public hospitals though surely?

Then the private ones have the better access and everyone has health insurance to get access to them.

beeno67

thebman wrote: »

That problem disappears once you sell the public hospitals though surely?

Then the private ones have the better access and everyone has health insurance to get access to them.

My point though is the only good point of private hospitals is the ease of access. On every other criteria I think public hospitals do better (well the major hospitals)

deirdremf

GCU Flexible Demeanour wrote: »

I don't think this is an accurate depiction of the situation.
...
I wouldn't favour a greater role for private health care, as I think it would lead to the health sector consuming an even greater share of national income for no benefit. That's never a good thing, but its doubly bad when we need to get the best value from such resources as we can gather at present.

Excellent post, and for those advocating private healthcare on the basis of efficiency, the bit I highlighted should sound a loud, long warning signal.
But the greedy in the healthcare sector would, of course, feel that that is a good thing. They would like more to come their way.

deirdremf

thebman wrote: »

That problem disappears once you sell the public hospitals though surely?

Then the private ones have the better access and everyone has health insurance to get access to them.

Yes, you are correct that the problem will disappear when the public hospitals are sold. That will leave no public system against which you can benchmark the private sector; and this being Ireland, we will quickly see the quality of the ex-public system drop to that of the present private system, if not actually further in the absence of the need to keep up.
You will then see a new private sector developing, with quality at a price, a very high price. So, a crap private system for the poorer part of society, a moderately good system for the better off, and probably a top tier (but not necessarily in Ireland) for the wealthy.

CrystalLettuce

deirdremf wrote: »

Yes, you are correct that the problem will disappear when the public hospitals are sold. That will leave no public system against which you can benchmark the private sector; and this being Ireland, we will quickly see the quality of the ex-public system drop to that of the present private system, if not actually further in the absence of the need to keep up.
You will then see a new private sector developing, with quality at a price, a very high price. So, a crap private system for the poorer part of society, a moderately good system for the better off, and probably a top tier (but not necessarily in Ireland) for the wealthy.

I'm pretty sure that's what they want.

In general, the political right wants more poor people to die, since it's morally right to them.

thebman

deirdremf wrote: »

Yes, you are correct that the problem will disappear when the public hospitals are sold. That will leave no public system against which you can benchmark the private sector; and this being Ireland, we will quickly see the quality of the ex-public system drop to that of the present private system, if not actually further in the absence of the need to keep up.
You will then see a new private sector developing, with quality at a price, a very high price. So, a crap private system for the poorer part of society, a moderately good system for the better off, and probably a top tier (but not necessarily in Ireland) for the wealthy.

That isn't really valid reason for thinking that will happen. What have the experiences being elsewhere when this has happened? The Irish are not so unique as we like to imagine.

CrystalLettuce

thebman wrote: »

That isn't really valid reason for thinking that will happen. What have the experiences being elsewhere when this has happened? The Irish are not so unique as we like to imagine.

Funny, since you don't seem to care about other examples of austerity measures and how they harmed the economies. You seemed to consider them wild and fantastical. Why do you suddenly care about other examples, facts and statistics now?

nesf

CrystalLettuce wrote: »

In general, the political right wants more poor people to die, since it's morally right to them.

Less of this kind of baiting please.

davoxx

A Primal Nut wrote: »

For most people, private health insurance is around E1000 per person. Public spending on health insurance is much more than that, and is a weaker form of healthcare. Why don't we get rid of the public healthcare system, and use the billions we would save to for private insurance for the poorest, most vulnerable, unemployed, etc and force everyone else who can afford it to buy their own private health insurance? We would end up saving a lot of money and everyone would get a better form of healthcare.

not sure i follow you there .. surely it makes more sense to scrap private health care (health care is for the sick not the rich) and use the money from taxes for an all inclusive health care? then no one needs to worry about health care as we will all have access to it by default.

also private health costs more that public, so i'm not sure what you mean by public costing more?? i mean how much is a ct scan privately vs publicly?

Head The Wall

CrystalLettuce wrote: »

Privatising things is often a bad idea. Some things work best private, and some things public. Health care is one of those that works best public. As are Trans Services, as the disastrous British rail system shows.

I would hardly call our state run transport system well run, the only time they seem to improve their services is when there is some private competition against them.

Mucco

A Primal Nut wrote: »

For most people, private health insurance is around E1000 per person. Public spending on health insurance is much more than that, and is a weaker form of healthcare. Why don't we get rid of the public healthcare system, and use the billions we would save to for private insurance for the poorest, most vulnerable, unemployed, etc and force everyone else who can afford it to buy their own private health insurance? We would end up saving a lot of money and everyone would get a better form of healthcare.

As mentioned, what you're suggesting is similar to the Dutch system. Everyone has private insurance, premiums are subsidised by the government for the poor. Insurers 'compete' for clients, leading to efficincies. Hospitals also 'compete' which should also lead to price reductions.
One of the biggest problems is that selective contracting between insurers and hospitals has not really happened as insurers are worried this will be seen as a race to the bottom with regards quality, and they will therefore lose customers. To persuade people that contracting is done on quality, clear quality indicators are needed. If I were in charge of the Irish health system, I would be developing good quality indicators, a lot of efficiencies follow from this.

The other issue is that your maths are wrong. In Ireland, private insurance is indirectly subsidised by the public system, some estimate by about 65%. Also, the poorest have medical cards, so are not in the private system. As ill health is concentrated among low income households, this means the insurers are, in essence, cream skimming the low risk clients - universal insurance would therefore be a lot more expensive than €1000.

There's a presentation on the Dutch system here:
http://tinyurl.com/3j94aa4

ChRoMe

Head The Wall wrote: »

I would hardly call our state run transport system well run, the only time they seem to improve their services is when there is some private competition against them.

Transport privatisation in the UK has been a disaster.

Head The Wall

I never said it wasn't, our state run transport services are a disaster as well.

Whats the solution when private and public are both crap?

snickerpuss

Where would this leave publicly funded residential and day services for people with intellectual and physical disabilities say? There's more to healthcare than hospitals.

A Primal Nut

beeno67 wrote: »

One of the big differences however is that the public healthcare system in Ireland is far superior to the private one. Yes access is difficult (extremely difficult in places) but given the choice I would much prefer to be treated in a public hospital than a private one

But aren't all the people on trolleys and long waiting lists using public healthcare? We hear about scandals in the public HSE all the time due to inefficencies, corruption, waste, poor service, etc.

I always thought private healthcare was better and we keep hearing about problems with public healthcare.

Mucco

A Primal Nut wrote: »

But aren't all the people on trolleys and long waiting lists using public healthcare? We hear about scandals in the public HSE all the time due to inefficencies, corruption, waste, poor service, etc.

I always thought private healthcare was better and we keep hearing about problems with public healthcare.

Here are a few stats (2009, WHO):
% GDP on health: 9.7%
% of Total health spending by Gov: 80%
% of Total health spending privately: 20%

Therefore, private insurance pays a max of 20% of the total bill.
The reason that the private system seems better than the public system is that:
a) it is subsidised by the public system (estimated ~65%)
b) it cream-skims the healthy people
c) it is limited to certain procedures/types of care, see snickerpuss, above, and http://www.vhi.ie/swiftcare/.

There may be an argument for a compulsory insurance system, a la Dutch, but they talked about it for a long time before implementation, and had a reasonably efficient system already in place.

RichardAnd

Head The Wall wrote: »

I never said it wasn't, our state run transport services are a disaster as well.

I can't speak for everywhere but here in Dublin, public transport is fine. I get the dart to and from work every day and with only a few exceptions, it arrives on time and gets me where I need to be within the same time frame every day. Irish people love to tell each other our country is a sh*thole but public transport and many other things really aren't all that bad. Nothing is remarkable but all in all, they could be worse.

Head The Wall

The country is more than 1 city.

RichardAnd

Head The Wall wrote: »

The country is more than 1 city.

I reiterate:


I can't speak for everywhere but here in Dublin

thebman

RichardAnd wrote: »

I can't speak for everywhere but here in Dublin, public transport is fine. I get the dart to and from work every day and with only a few exceptions, it arrives on time and gets me where I need to be within the same time frame every day. Irish people love to tell each other our country is a sh*thole but public transport and many other things really aren't all that bad. Nothing is remarkable but all in all, they could be worse.

The DART is okay, Dublin Bus is a national joke as is Bus Eireann. I've used all the services even commuter and intercity rail services and Luas over the years and the only one that is providing a reasonable service is Dart and Luas.

All the others are shockingly poor with regards to time tabling, service announcements, time of journey and cost.

In some cases, it can't even compete with cycling and that is in Dublin. I know two people who cycled to work rather than get the train because it was faster, cheaper and healthier and they lived near the train stations and were cycling beside the canal.

I think the reality is we generally have too many stops on our commuter lines into Dublin across all the services. In the case of trains, by the time they are anywhere near up to speed they are slowing down again for the next station except on the very fringes.

There is also very little outer transport around the circumference of Dublin. To get anywhere, you pretty much end up going into the city centre and then back out to where you want to go. When I was in college on work experience, it took me an hour and a half to get to work where if I could have afforded a car, I would have done it in about 20 minutes and I have a friend that does it now in a car in this time.

WooPeeA

Public transport, good or not, is a disaster for economy. They take away millions of millions of euros of our taxes and donate public transport with it, which at the end charges customers as much as the private carriers.

Why people can't understand that when the government gives them €100 it must first take away €140 . That additional 40 quid is a cost of the administration, bureaucracy, law enforcement, rent for the offices and wages for those fat bureaucrats.

Free healthcare, transport, postal services and education and all taxes can be almost banished.

CrystalLettuce

Head The Wall wrote: »

I would hardly call our state run transport system well run, the only time they seem to improve their services is when there is some private competition against them.

Have you ever familiarised yourself with the UK system? It's a nightmare. Having to change several times between rail operators etc. the whole thing is a mess.

Mainland europe has much better public transport than the UK or Ireland. Ireland's public transport is bad because we tend to fail at these things regardless.

keithclancy

CrystalLettuce wrote: »

Have you ever familiarised yourself with the UK system? It's a nightmare. Having to change several times between rail operators etc. the whole thing is a mess.

Mainland europe has much better public transport than the UK or Ireland. Ireland's public transport is bad because we tend to fail at these things regardless.

I would say it depends on where you live in Mainland Europe, mainly Irish people only visit major cities and think "wow, public transport is great here"

Not necessarily the case if you live in a city with a population of less than 500,000 people.

Generally speaking its perfect for a tourist because they are going where the bus is going. As a commuter though the bus/train can be a pain in the arse, with a 120km Journey with Rail only taking upwards of 3 hours.

ChRoMe

CrystalLettuce wrote: »

Have you ever familiarised yourself with the UK system? It's a nightmare. Having to change several times between rail operators etc. the whole thing is a mess.

Mainland europe has much better public transport than the UK or Ireland. Ireland's public transport is bad because we tend to fail at these things regardless.

The UK system is very expensive, however the service that is provided is very good. Its a world apart from the Irish standard.