Privatise the HSE

Master and commander

The HSE is an inefficient, unwieldly monster controlled by union. There is far too much red tape in the health sector and it needs to be opened up. It is a massive burden on the Taxpayer. The beauraucracy is huge, i mean you have Dept Health>HiQua>HSE.
If all this was privatised it would allow huge swathes of beauraucracy to be cut loose and we'd be left with the Dept of Health to lay down rules, then its up to the private operators to make plans for efficient operation. Since private free enterprise is results driven, massive chunks of lazy and unproductive laour could be cut free and a slimmer whittled down private health service could meet health demands more efectively.

The notion of getting healthe care for free is left wing bonkers policy. I get noting for free, no med card, no GP card, nothing . I have to pay insurance AND pay taxes into an inefficient public system. I think all state supports should be abolished and it would be up to individuals to aquire the nessecary cover to get their heath care if needed. This would also ease the tax burden and allow the government to reduce tax rates and so stimullate a favourable environment for business and growth.

Benny_Cake

Master and commander wrote: »

The HSE is an inefficient, unwieldly monster controlled by union. There is far too much red tape in the health sector and it needs to be opened up. It is a massive burden on the Taxpayer. The beauraucracy is huge, i mean you have Dept Health>HiQua>HSE.
If all this was privatised it would allow huge swathes of beauraucracy to be cut loose and we'd be left with the Dept of Health to lay down rules, then its up to the private operators to make plans for efficient operation. Since private free enterprise is results driven, massive chunks of lazy and unproductive laour could be cut free and a slimmer whittled down private health service could meet health demands more efectively.

The notion of getting healthe care for free is left wing bonkers policy. I get noting for free, no med card, no GP card, nothing . I have to pay insurance AND pay taxes into an inefficient public system. I think all state supports should be abolished and it would be up to individuals to aquire the nessecary cover to get their heath care if needed. This would also ease the tax burden and allow the government to reduce tax rates and so stimullate a favourable environment for business and growth.

OK,so a person loses their job through no fault of their own and can't afford to continue paying health insurance.They,or one of their children fall ill.What happens to them?

Chuck Stone

Benny_Cake wrote: »

OK,so a person loses their job through no fault of their own and can't afford to continue paying health insurance.They,or one of their children fall ill.What happens to them?

The state could purchase health services off the private sector for the poor instead of providing it.

Benny_Cake

Chuck Stone wrote: »

Benny_Cake wrote: »

OK,so a person loses their job through no fault of their own and can't afford to continue paying health insurance.They,or one of their children fall ill.What happens to them?

The state could purchase health services off the private sector for the poor instead of providing it.

That's an alternative model alright although it might not work out any more efficiently than a fully-public system.But the OP mentioned abolishing all state supports so it didn't sound like state purchased insurance was something he envisioned.

Pat Mustard

Master and commander wrote: »

If all this was privatised it would allow huge swathes of beauraucracy to be cut loose and we'd be left with the Dept of Health to lay down rules, then its up to the private operators to make plans for efficient operation. Since private free enterprise is results driven, massive chunks of lazy and unproductive laour could be cut free and a slimmer whittled down private health service could meet health demands more efectively.

If the private sector was really going to provide these services at cheaper rates, then why has it not done so already?

I agree that the HSE is incredibly inefficient. But how can privatisation guarantee an affordable health service for ordinary people? And what do you suggest should happen to people with medical cards? (Perhaps a treatment purchase scheme of sorts?)

Has what you have suggested worked in any other country? Maybe, rather than privatisation, we should be looking at PROPER health service reform.

thebman

The Mustard wrote: »

If the private sector was really going to provide these services at cheaper rates, then why has it not done so already?

I agree that the HSE is incredibly inefficient. But how can privatisation guarantee an affordable health service for ordinary people? And what do you suggest should happen to people with medical cards? (Perhaps a treatment purchase scheme of sorts?)

Has what you have suggested worked in any other country? Maybe, rather than privatisation, we should be looking at PROPER health service reform.

Well at the moment we have public hospitals and some private and an insurer that is largely state owned it seems VHI and a bunch of private operators.

I think it kind of removes any likelihood of competition TBH to have the state heavily influencing the sector like this.

And that is before we even talk about risk equalization.

At the moment we appear to be following about 3 different strategies with public health care, private health care and risk equalization all been controlled by the state like it can't make its mind up on what one is the right way to proceed.

I think the last 10 billion deficit is in there on its own TBH.

Master and commander

I would be against state subsidised health care as it puts too much of a burden on the taxation system and pushes up rates. I think it migh work if medical cards and supports were phased out over 6 or 7 years, that would give people time to get their act together in terms of insurance.
Also since the taxes could then be lowered, people will have more take home pay and be better able to afford insurance. Whay should those who work hard and make alot of money have to pay their own insurance and be forced to pay for an inefficient service for those who won't get private insurance. Thats totally warped imo, and its no wonder business is so since all its profits are robbed by extorsionate tax rates to pay for inefficient services for those who can't be bothered.
The sale of state owned property from the HSE would also raise a good deal of capital that could go to paying the national debt. Same goes for other state property like CIE and ESB.

VHI definitely should be hived off to a private operator, and then with many insurers in the market the cost tot he punter will gradually come down. The over strict regulation on carpital reserves for insurers should be reduced, as not everyone is going to claim at the exact same time.

Benny_Cake

Master and commander wrote: »

I would be against state subsidised health care as it puts too much of a burden on the taxation system and pushes up rates. I think it migh work if medical cards and supports were phased out over 6 or 7 years, that would give people time to get their act together in terms of insurance.
Also since the taxes could then be lowered, people will have more take home pay and be better able to afford insurance. Whay should those who work hard and make alot of money have to pay their own insurance and be forced to pay for an inefficient service for those who won't get private insurance. Thats totally warped imo, and its no wonder business is so since all its profits are robbed by extorsionate tax rates to pay for inefficient services for those who can't be bothered.
The sale of state owned property from the HSE would also raise a good deal of capital that could go to paying the national debt. Same goes for other state property like CIE and ESB.

Again,what if someone loses their job and can't get another,through no fault of their own?Health insurance isn't cheap you know,and it would be even more expensive in a fully privatised system where people would need their insurance to cover absolutely everything.

Permabear

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Pat Mustard

Master and commander wrote: »

I would be against state subsidised health care as it puts too much of a burden on the taxation system and pushes up rates. I think it migh work if medical cards and supports were phased out over 6 or 7 years, that would give people time to get their act together in terms of insurance.
Also since the taxes could then be lowered, people will have more take home pay and be better able to afford insurance. Whay should those who work hard and make alot of money have to pay their own insurance and be forced to pay for an inefficient service for those who won't get private insurance. Thats totally warped imo, and its no wonder business is so since all its profits are robbed by extorsionate tax rates to pay for inefficient services for those who can't be bothered.
The sale of state owned property from the HSE would also raise a good deal of capital that could go to paying the national debt. Same goes for other state property like CIE and ESB.

VHI definitely should be hived off to a private operator, and then with many insurers in the market the cost tot he punter will gradually come down. The over strict regulation on carpital reserves for insurers should be reduced, as not everyone is going to claim at the exact same time.

This idea would be politically unworkable. It would be too unpopular.
Also, you cannot be sure that the private healthcare providers and the hospitals (who might very possibly invest heavily in each other) would have sufficient competition to prevent profiteering at the expense of the consumer. There would have to be enough players in the industry for it to work, and Ireland is a small place.

Pat Mustard

Permabear wrote: »

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This is a very good point.

Health care services should not be free. They should be subsidised. I can't point to a relevant study to back this up right now, but I understand that when services cost something, even something which is relatively nominal, people tend not to abuse the system - like in the case of some public transport systems.

Also, there are a whole load of old people who are in need of nursing home care who are taking up hospital beds. These people could be moved to nursing homes, which would cut costs.

In relation to nursing homes, I think that care costs approximately €800-€1,000/week. In my view, this figure should be much lower, but it is kept artificially high by the amounts paid by the HSE. In my view, the HSE is in a position to negotiate much lower rates than that, but this is not being done. It should be.

gandalf

The problem with the HSE is not the front line staff it is the vast numbers of totally unnecessary admin staff behind them. It is the large numbers of the different management levels that have been allowed build up by successive governments and upper management with the HSE and Dept of Health. It is just as much of a disservice to the staff who are actually treating patients.

What is needed is to cut down on admin staff numbers dramatically, streamline processes and duplication, flatten out management structures, make people responsible for their actions and performance and have consequences including dismissal if they do not perform as expected.

Privatisation of the whole edifice isn't the answer, it may be for portions of it but not everything.

Pat Mustard

gandalf wrote: »

The problem with the HSE is not the front line staff it is the vast numbers of totally unnecessary admin staff behind them. It is the large numbers of the different management levels that have been allowed build up by successive governments and upper management with the HSE and Dept of Health. It is just as much of a disservice to the staff who are actually treating patients.

What is needed is to cut down on admin staff numbers dramatically, streamline processes and duplication, flatten out management structures, make people responsible for their actions and performance and have consequences including dismissal if they do not perform as expected.

Privatisation of the whole edifice isn't the answer, it may be for portions of it but not everything.

I think that you are right.

Many people believe that just because a service is provided by the public sector that it will be inefficient. Unfortunately, this is true in many cases. However, this need not necessarily be the case.

There are a few aspects of public service that are run efficiently. If only this could be done with the HSE.

Chuck Stone

Permabear wrote: »

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The counter argument is that it's better to have people go to the doctor too often rather than too little because small inexpensive problems don't become big expensive ones.

In an ideal free market health insurance providors would probably demand that people go for comprehensive yearly health examination.

Overweight? Price goes up.
Smoking? Price goes up.
Breathless after a 30 seconds on a treadmill? Price goes up.

Boskowski

I don't think privatisation alone is the answer to everything. For starters a private organisations objective would be profit first of all, not necessarily value for money and effectiveness. The latter only comes through competition.
Are we getting value for money where a private, state lead monopoly is in place? I don't think so, one only has to look at things like Eircom or the ESB.
Health care is a community service and has to be paid for by the community. It's just that wherever there is a huge cake to be had all sorts of vested interests are homing in on it. If we could keep them at bay and find the political will to reform the organisational structures we'd be on a winner.

Delancey

Having once worked in the HSE I can say the most important people there are the staff - patients come a very distant second.

In a privatised health service the most important people will be the shareholders , followed by the staff and then the patients who will now be a distant third.

karlitob

Chuck Stone wrote: »

The state could purchase health services off the private sector for the poor instead of providing it.

The state already does this.
GP's - GPs are trained in the public system at the expense of the public system and then they go into the private sector. Last year the government spent E500m in fees to GPs. There are approx 2500 GPs. Thats an average of E200k per GP. Whats more, they should (and often don't) refer to the public system for everything else they don't provide, yet are paid for ie Physio, OT, PHN, ALL specialities in hospital, Xrays.

The NHS Trust model is the way to go. Large hospitals, communtiy areas and GP in primary care all within a defined area with an aggregated budget offering effective service to a large community.

cavedave

Chuck Stone

In an ideal free market health insurance providors would probably demand that people go for comprehensive yearly health examination.

Do you have any evidence for this?

It is claimed that teeth should be checked regularly. But mandatory checks seem not to stand up to evidence

[T]he authors of the only study that found differences in gingivitis scores (at 6, 12 and 22 months) deemed those differences clinically irrelevant….

Some checks may be dangerous in and of themselves such as CT scans

we probably test for breast cancer too much at the moment

On the surface there’s the fact that it seems women tend to test for breast cancer too often, so that encouraging more testing does net harm

Prostate cancer tests seem to be fairly useless

The blood test that millions of men undergo each year to check for prostate cancer leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men, and it remains unclear whether the screening is worthwhile for younger men, a federal task force concluded yesterday.

I can go on with more examples but it seems we check for illness too much already.

BTW i do think sponsoring good behaviour would be a very cheap way to improve health and reduce crime. For example how much would you have to pay a woman breastfeed? This would have about a 3 point increase in IQ. Or if you dislike IQ as a measure school performance would improve

The test score advantage of breastfeeding was largest amongst the most socially disadvantaged, where it averaged seven percentage points on reading and four percentage points on maths.

.

Permabear

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opinion guy

Master and commander wrote: »

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The major flaw in your logic is in bold italics. Private free enterprise is NOT results driven. Its profit driven.

Basically - this:

Delancey wrote: »

In a privatised health service the most important people will be the shareholders , followed by the staff and then the patients who will now be a distant third.

You can already see this. American healthcare has bloated to extortionate costs on the back of private enterprise. There is an element of this in the private healthcare market here. Private patients are more likely to ahve unnecessary tests done for example.

In essence private healthcare leads money being skimming from services and patients to produce profit. it is morally indefensible.

Permabear wrote: »

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Break them. Perhaps outlaw them. Like private shareholders would become in turn, the unions themselves have become self-interested entities whose primary focus is on the needs of the union ahead of the needs of patients or the workers.

Chuck Stone

cavedave wrote: »

Do you have any evidence for this?

Nope. You can't have evidence for something that hasn't happened yet. It just seems reasonable that people who lead bad lifestyles would be a greater risk for an insurance company and therefore would be charged accordingly.

It is claimed that teeth should be checked regularly. But mandatory checks seem not to stand up to evidence

That piece seems to be about regular professional teeth cleaning rather than a check-up for teeth maintenance.

Some checks may be dangerous in and of themselves such as CT scans

we probably test for breast cancer too much at the moment

Prostate cancer tests seem to be fairly useless

I can go on with more examples but it seems we check for illness too much already.

I read thru some of the articles and they don't seem too conclusive and are disputed by some. I take the point though.

BTW i do think sponsoring good behaviour would be a very cheap way to improve health

Disincentivising unhealty lifestyles I would agree with.

and reduce crime.

I disagree with this. Deeming soemthing criminal, such as drug use, is more about the opinions, the interests and the values/immorality of people in power.

For example how much would you have to pay a woman breastfeed? This would have about a 3 point increase in IQ. Or if you dislike IQ as a measure school performance would improve .

I find these IQ studies reductive personally.

From the article.

Some others suggest that the link is based on the fact that well-educated, wealthier women breast-feed far more than poor and less educated women. Consequently, breast-fed children will be found to test better for all the reasons that wealthier children from high social classes test better on standardized tests.

Points taken though. I guess best practice as regards preventative medicine is an ongoing field of study.

cavedave

Chuck Stone
From the article.

the next paragraph deals with these variables

Some others suggest that the link is based on the fact that well-educated, wealthier women breast-feed far more than poor and less educated women. Consequently, breast-fed children will be found to test better for all the reasons that wealthier children from high social classes test better on standardized tests.

Therefore Anderson's group weighed and eliminated 15 factors from their study, such as maternal smoking and education, birth weight, birth order and family income. After all these factors were removed, the researchers still found that breast-fed babies tested 3.1 IQ points higher than formula-fed babies!

My point is that it may well be cheaper to deal with the health issues with preventitive bribing. As evidence Stickk.com says people who commit to losing money if they do not reach their weight or smoking goals are 30% more likely to reach those goals than people who just make public commitments.

If we actually cared about health we would carry out actions that make people healthier. But we don't we carry out actions to signal that we care about people. This signaling argument is discussed in Cut medicine in Half by Robin Hanson


As another example of how we can prevent issues before they start. Ireland has the highest rates of cystic fibrosis in the world. All new borns are tested to see if they have the disease. Why are we not also tested to see if they are carriers of the gene? The test is very cheap. If two carriers laer decide they want to have children naturally and accept the risk of a child having cyctic fibrosis fair enough. But the evidence from Tay–Sachs suggests screening would reduce occurrences by more than 90%

In the year 2000, Michael Kaback reported that in the United States and Canada, the incidence of TSD in the Jewish population had declined by more than 90% since the advent of genetic screening.[8] On January 18, 2005, the Israeli English language daily Haaretz reported that as a "Jewish disease" Tay-Sachs had almost been eradicated. Of the 10 babies born with Tay-Sachs in North America in 2003, none had been born to Jewish families. In Israel, only one child was born with Tay-Sachs in 2003, and preliminary results from early 2005 indicated that none were born with the disease in 2004

If we actually cared about preventing people suffering CF we would implement a testing program which would reduce suffering by more than 90% cheaply. But we dont because we just care about looking like we provide care for the sick.


*actually for ethical reasons [url="http://www.genetics.ie/molecular/cystic-fibrosis/']genetic testing[/url] for carrying a disease seems to only be done on 16 year olds +. Still why arent late teens tested to see if they are carriers the way at risk groups of Tay-Sachs are?

Boskowski

Permabear wrote: »

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Is it supposed to generate a profit? There are things in society that don't evolve around making money you know?

Permabear wrote: »

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What makes you think with the HSE it would be any different?

Permabear wrote: »

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Fair enough, it's just something I feel strongly about.
I mean where do you draw the line? Would you concede there is anything at all that should be a public/community service? And if yes, what would it be and why would health not be one of them?

Permabear wrote: »

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I didn't actually exclude them. I totally agree as it happens. But of course there is others like the pharmaceutical industry for example.

Look, I'm not opposed to privatisation per sé. All I'm saying is privatisation is not the answer to everything. In fact I dare say unless there was actual competition a privatisation - even if done properly, not ala Eircom/ESB - wouldn't improve anything from a customer perspective. Chances are it would make things more expensive because on top of all the creaming off that goes on another party now wants to make a profit from it all.

Which of course means we're doomed because if one was playing devils advocate one might say the country is just not capable of organizing anything bigger than a charity raffle without keeping people's fingers out of the honeypot. And I'd have my doubts over certain charity raffles even.

Victor

thebman wrote: »

Well at the moment we have public hospitals and some private and an insurer that is largely state owned it seems VHI and a bunch of private operators.

Actually, the HSE owns relatively few hospitals - most are owned by charities and receive a proportion of state funding.

djpbarry

Master and commander wrote: »

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Can you demonstrate that this would be the case? Is there a fully privatised health care system in operation anywhere in the world offering health care comparable to (or better than) that provided by the HSE at lower cost than that charged by the HSE?

Master and commander wrote: »

I think all state supports should be abolished and it would be up to individuals to aquire the nessecary cover to get their heath care if needed.

And if an individual cannot afford said cover? What then?

Permabear wrote: »

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That’s the only option? Really?

gandalf wrote: »

The problem with the HSE is not the front line staff it is the vast numbers of totally unnecessary admin staff behind them.

Ireland has more nurses per capita than most, if not all, countries in the world. What’s more, Irish nurses are among the best paid in the world. I’m not necessarily disagreeing you about the admin behind the scenes, but it would be foolish to think that the so-called “front-line” staff cannot be trimmed.

Permabear wrote: »

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It’s not supposed to. That’s not to say that management of the service cannot be improved.

cavedave

djpbarry

Can you demonstrate that this would be the case? Is there a fully privatised health care system in operation anywhere in the world offering health care comparable to (or better than) that provided by the HSE at lower cost than that charged by the HSE?

This is not exactly what you are asking but here are two interesting pieces of evidence

Irish public healthcare spending is well over the odds for our age profile


Ireland and Costa Rica have nearly identical life expectancy (as shown here). Costa Ricas health care is public and costs 353.0 dollars in 2006 compared to 3,888.0 in 2006 for us

Costa Ricans have better diets and take more exercise and many other factors. If we actually cared about health rather than signalling that we care about other people we would change these preventitive things rather then spend so much on medicine

Valmont

djpbarry wrote: »

And if an individual cannot afford said cover? What then?

Then they deal with the consequences of their actions and take responsibility for not taking out health insurance or they can hope that a charity will help them out. Your question is only indicative of the exorbitant cost of healthcare under government monopolies - prices would invariably be cheaper if there was an actual marketplace in effect.

djpbarry

Valmont wrote: »

Then they deal with the consequences of their actions...

Even if that means dying? There should be absolutely no safety net?

Kinski

djpbarry wrote: »

And if an individual cannot afford said cover?

Valmont wrote: »

Then they deal with the consequences of their actions and take responsibility for not taking out health insurance

So your response to the question "What if someone can't afford cover?" is to say "They face the consequences, taking responsibilty for not taking out the cover that they couldn't afford."

I see...

murphaph

The Mustard wrote: »

Health care services should not be free. They should be subsidised. I can't point to a relevant study to back this up right now, but I understand that when services cost something, even something which is relatively nominal, people tend not to abuse the system - like in the case of some public transport systems.

The German system is insurance based, with insurance being compulsory and purchased by the state for those unable to afford it.

They also changed the system a while back to try to prevent frivolous waste of the doctor/dentist's time by introducing a €10 charge per quarter. If I see my doctor or dentist I have to pay €10 but this is then valid for the next 3 months. Personally I think it could be reduced to a one month period as I'm sure many people still scuttle to the doctor for something a chemist (or common sense) could treat.

Anyway, there's definitely a load of room for improvement within the HSE, even without abolishing it, though I would be in favour of abolition and the introduction of a system similar to Germany or the Netherlands, with nominal charges to discourage abuse of the system.

murphaph

Valmont wrote: »

Then they deal with the consequences of their actions and take responsibility for not taking out health insurance or they can hope that a charity will help them out. Your question is only indicative of the exorbitant cost of healthcare under government monopolies - prices would invariably be cheaper if there was an actual marketplace in effect.

The US does not have cheaper health care. It has the best health care in the world....if you can afford it. There is a better way that doesn't allow people to die because they couldn't afford insurance.

Master and commander

Chuck Stone wrote: »

The counter argument is that it's better to have people go to the doctor too often rather than too little because small inexpensive problems don't become big expensive ones.

In an ideal free market health insurance providors would probably demand that people go for comprehensive yearly health examination.

Overweight? Price goes up.
Smoking? Price goes up.
Breathless after a 30 seconds on a treadmill? Price goes up.

and what would be wrong with it? at least it would be an incentive of sorts to encourage people to lead a healthier lifestyle.
A yearly comprehensive check up would also be no harm. Think of the amount of conditions like cancer that could be caught early and not be allowed to snowball until its too late. Rater than a negative thing as you suggest, this would be an enourmous benefit to people, even if they grumble about having to do it.

. Why are we not also tested to see if they are carriers of the gene? The test is very cheap. If two carriers laer decide they want to have children naturally and accept the risk of a child having cyctic fibrosis fair enough. But the evidence from Tay–Sachs suggests screening would reduce occurrences by more than 90%

there absolutely should be testing for being a carrier. There should be some system put in place that attempts to "breed out" CF, its for the better. Carriers of the disease should be strongly discouraged from having children of their own by strongly incentivising them to adopt instead. CF and all its suffering could be eliminated in a generation. But they won't do it because 1)eugenics is taboo even though it is positive and 2) nobody has the spine to implement it.

BluePlanet

murphaph wrote: »

The US does not have cheaper health care. It has the best health care in the world....if you can afford it.

USA is ranked just 37th in World Health Organization country rankings.

Anyway, this privatise the HSE is the most daft of arguments.
Have a look at our successful neighbours with quality health care:
France, Germany, Switzerland, Netherlands etc.
Some of those countries make purchasing "private" health insurance compulsory but here's the kicker: All of those "private" providers are either NON-PROFIT organizations or they are legally barred from making a profit from health insurance.
I can't speak for all, but in the Netherlands the government even dictates the premium (the cost of the plan).

The only reason people would look to the USA's healthcare system, is Ideology. They are Libertarian ideologues. Be Warned!

Master and commander

..........they are legally barred from making a profit from health insurance.

I don't get it, if a private company is barred from making a profit, then what is the point in even existing. Just pack up. Don't private hospitals make all their income from health insurers?

Chuck Stone

Master and commander wrote: »

and what would be wrong with it? at least it would be an incentive of sorts to encourage people to lead a healthier lifestyle.
A yearly comprehensive check up would also be no harm. Think of the amount of conditions like cancer that could be caught early and not be allowed to snowball until its too late. Rater than a negative thing as you suggest, this would be an enourmous benefit to people, even if they grumble about having to do it.

I actually think costing unhealthy lifestyles might be a good thing FWIW.

djpbarry

Master and commander wrote: »

A yearly comprehensive check up would also be no harm. Think of the amount of conditions like cancer that could be caught early and not be allowed to snowball until its too late.

It’s extremely unlikely that a check-up will catch cancer - specific screens are required. Screening everyone every year for even the most common forms of cancer is totally impractical and there’s no way a private enterprise would back such a plan.

Master and commander wrote: »

there absolutely should be testing for being a carrier. There should be some system put in place that attempts to "breed out" CF, its for the better.

Presumably you would advocate the same policy for all genetic disorders? You don’t see any potential problems with such a policy?

Master and commander wrote: »

eugenics is taboo even though it is positive...

See above.

Master and commander wrote: »

I don't get it, if a private company is barred from making a profit, then what is the point in even existing.

There are plenty of privately-funded non-profit organisations and the world would be worse off without them.

cavedave

Master and commander
there absolutely should be testing for being a carrier. There should be some system put in place that attempts to "breed out" CF, its for the better. Carriers of the disease should be strongly discouraged from having children of their own by strongly incentivising them to adopt instead. CF and all its suffering could be eliminated in a generation. But they won't do it because 1)eugenics is taboo even though it is positive and 2) nobody has the spine to implement it.

Tay-Sachs did not need a 'system' in place people of their own free will did actions to prevent having kids with Tay-Sachs. That could be IVF and only implanting non disease carrying cells or it could be that two carriers decide they are not suited to having kids together. But it is peoples own choice. Carriers of the gene that requires both parents to be carriers of should not be 'strongly discouraged from having children' like with Tay-Sachs just informing people of their risks achieves massive amounts without draconian rules and without the cloven hoof of eugenics popping out.

Master and commander

Presumably you would advocate the same policy for all genetic disorders? You don’t see any potential problems with such a policy?

why not? we have the knowledge and technology to wipe out most forms of inherited genetic diseases. I think it is a folly that mankind would pass up the chance to vastly reduce suffering from these conditions for the sake of keeping the PC brigade happy.
It just makes sense, and those who have a genetic flaw and would like children can have IVF pregnancies thus keeping them happy too.

We have the knowlegde and the technlogy, we should use it.

opinion guy

Master and commander wrote: »

why not? we have the knowledge and technology to wipe out most forms of inherited genetic diseases.

Not by a long shot. Nor could we afford it. Hell we don't even know with certainty which ones are inherited and which ones are environmental

djpbarry

Master and commander wrote: »

why not? we have the knowledge and technology to wipe out most forms of inherited genetic diseases.

As opinion guy says, you're seriously overstating the current state-of-the-art. But ignoring that for a second, if everyone with any kind of genetic defect is "discouraged" from having children, which is going to be a lot of people considering how broad a term "defect" is (who decides what is a defect and what is not?), you're going to place potentially serious limitations on the gene pool. Then you end up with lack of genetic diversity becoming an issue.

Anyways, this isn't really suited to the Politics forum.

opinion guy

djpbarry wrote: »

As opinion guy says, you're seriously overstating the current state-of-the-art. But ignoring that for a second, if everyone with any kind of genetic defect is "discouraged" from having children, which is going to be a lot of people considering how broad a term "defect" is (who decides what is a defect and what is not?), you're going to place potentially serious limitations on the gene pool. Then you end up with lack of genetic diversity becoming an issue.

Anyways, this isn't really suited to the Politics forum.

Indeed, what Master and Commnaders is suggesting is basically Eugenics. But then I think he knows that. His post seemed kinda ......subterranean to me if I'm honest

Mucco

BluePlanet wrote: »

I can't speak for all, but in the Netherlands the government even dictates the premium (the cost of the plan).

I'm not sure this is quite correct. The government sets the basic package (quite comprehensive), and mandates that the premium offered by an insurance company must apply to everyone, regardless of age/medical history. Insurers can then compete with each other on price if they want to.
Insurance is compulsory, so young,fit,healthy can't opt out.

cavedave

opinion guy

Not by a long shot. Nor could we afford it. Hell we don't even know with certainty which ones are inherited and which ones are environmental

The cost of genetic screening is not that high and it is falling rapidly. 23andme do genetic tests for $209 for example. This is for around 97 different disorders. Many of these disorders are known to be almost entirely genetic (CF for example is genetic, though how bad it is is influenced by environment). Many diseases like alzheimers we have very limited knowledge of how genetics and environment interplay. I agree we should not test for these.

For Cystic Fibrosis the test is not always accurate, no test is, but testing for carriers will still reduce incidences of people suffering from the disease by a huge extent.
"One in nineteen Irish people
is a carrier, and approximately 35-40 children (one in 1,461) are born each year with cystic fibrosis"

If a test cost 100 euro and all it tested for was Cystic fibrosis and not the 90+ other disorders that could be tested for. There are circa 60,000 babies born in Ireland each year. And if CF carrier testing reduced occurrences of the disease by 90%. Again this should be based on people choice of who with and how they want to have childrenas has worked in Israel for Tay-sachs not some system of enforcement.

That is 60,000 tested * 100 cost / 36 people not born with CF = 166 666 euro per child born without CF*.

Add the Huntingtons (400 people in Ireland), Fragile X (similar levels) and a few of the other rarer but not really nasty genetic disorders and these tests start to become really cost effective.

This is politics and it is health. I am completely against eugenics. I am for letting people be tested for free to see if they carry some relatively common gene mutations. Mutations that if they choose to have children with someone else who also has the mutations has significant (usually 1 in 4) chance of having a very nasty disease.

The public/private bunfight can keep going but as long as we are not getting the right kind of medicine it does not matter who is paying for it, it still wont be much use.

166k might sound expensive to prevent Cf but if you look at the costs of CF here table 2. You can see that prevention is cheaper than treatment. Not even taking into account how much you would pay to avoid someone having to suffer such an awful condition at all.

sarumite

Chuck Stone wrote: »

In an ideal free market health insurance providors would probably demand that people go for comprehensive yearly health examination.

Overweight? Price goes up.
Smoking? Price goes up.
Breathless after a 30 seconds on a treadmill? Price goes up.

In some ways I agree with this idea that if people have the right to healthcare (as is often the argument made) then they have the obligation to take care of their health. Our society seems to be all about our rights and never our responsibilities. The fact that a person chooses to drink, smoke and eat junk food and then expects the state to pick up the tab for his/her bad decisions just doesn't seem right to me.

Hayte

Permabear wrote: »

This post had been deleted.

The whole point of a publically funded healthcare system is that it does not have to run at a profit, thus eliminating profit motive under any circumstance where it could conflict with quality of care.

Valmont

Hayte wrote: »

The whole point of a publically funded healthcare system is that it does not have to run at a profit, thus eliminating profit motive under any circumstance where it could conflict with quality of care.

And how, pray tell, does the profit motive conflict with quality of care? What does that little soundbite even mean? I'm guessing it's the old profit=evil argument in a more glossy form.

opinion guy

Valmont wrote: »

And how, pray tell, does the profit motive conflict with quality of care? What does that little soundbite even mean? I'm guessing it's the old profit=evil argument in a more glossy form.

Not all medical treatments are profitable. Private hospitals clinics are generally only interested in doing stuff thats profitable, not stuff that people need.

For example alot of private places are pushing whole body CT scans as a screening mechanism to people with insurance. These make them lot of profit, but they are generally viewed medically as unnecessary and harmful (alot of radiation in a whole body CT scan).

Boskowski

Valmont wrote: »

And how, pray tell, does the profit motive conflict with quality of care? What does that little soundbite even mean? I'm guessing it's the old profit=evil argument in a more glossy form.

How coyld you even pose that question without seeing the contradiction.
It opposes it in so far as the money that is now taken out of the system as profit could otherwise increase service levels or make the service cheaper.

MizenHead

Master and commander wrote: »

The HSE is an inefficient, unwieldly monster controlled by union. There is far too much red tape in the health sector and it needs to be opened up. It is a massive burden on the Taxpayer. The beauraucracy is huge, i mean you have Dept Health>HiQua>HSE.
If all this was privatised it would allow huge swathes of beauraucracy to be cut loose and we'd be left with the Dept of Health to lay down rules, then its up to the private operators to make plans for efficient operation. Since private free enterprise is results driven, massive chunks of lazy and unproductive laour could be cut free and a slimmer whittled down private health service could meet health demands more efectively.

The notion of getting healthe care for free is left wing bonkers policy. I get noting for free, no med card, no GP card, nothing . I have to pay insurance AND pay taxes into an inefficient public system. I think all state supports should be abolished and it would be up to individuals to aquire the nessecary cover to get their heath care if needed. This would also ease the tax burden and allow the government to reduce tax rates and so stimullate a favourable environment for business and growth.

If privatization of the HSE would make it so efficient - why not privatize it (as non profit making business, with well paid jobs); the savings would make an affordable and free to use health service for everyone? -