Is health insurance immoral?

Dorakman

I hear a lot of people harp on about the 2 tier health system. How is private practice coexisting with public healthcare such a bad thing?

mickdw

No.
You spend on what you chose. Some spend their last penny on health cover while others might spend it on a holiday.
It should however be priced at a level where people with average wage / pension should be able to afford it.

alphasully

No, it's essential. Also we dont have a 2 tier health service, we have up to 5 tiers.

Edgware

mickdw wrote: »

No.
You spend on what you chose. Some spend their last penny on health cover while others might spend it on a holiday.
It should however be priced at a level where people with average wage / pension should be able to afford it.

There are several levels of insurance which will give different levels of benefit and are affordable to average wage/pension. People who smoke 40 a day could get some very good cover if they cut back to 20 a day and use the saving for health insurance.
Thats the system. You might as well say that every house should be priced at a price that all can afford.

mikhail

I have no problem with private healthcare and private health insurance so long as the public system provides a good baseline cover. The ****e US system can't be allowed creep in.

piplip87

We have a highly subsidised public health system. The maximum anybody can pay publicly for approved treatment in a hospital is 800(may have changed since I worked on HSE accounts).

Where as if a private patient presents at the public hospital this subsidy is no longer exists. So by having private healthcare you are saving the state money on your healthcare.

Fred Cryton

Dorakman wrote: »

I hear a lot of people harp on about the 2 tier health system. How is private practice coexisting with public healthcare such a bad thing?

It's not a bad thing. it's just petty jealousy and envy from the SF & welfare dependents who want middle classs people to have to wait in line with them. They can't see that public sector inefficiencies are what is causing the problem in health in the first place.



They want to bring the rest of us down to their level. The word spiteful comes to mind.

Dorakman

Fred Cryton wrote: »

It's not a bad thing. it's just petty jealousy and envy from the SF & welfare dependents who want middle classs people to have to wait in line with them. They can't see that public sector inefficiencies are what is causing the problem in health in the first place.



They want to bring the rest of us down to their level. The word spiteful comes to mind.

I did always think that’s it’s really screwed up that employer provided health insurance is taxed as BIK. Shouldn’t the government be happy with less burden on the public system?

ForestFire

I'm hearing these government parties talking about setting up universal health care system (is this full public again?)

When was this part of the election campaign??

As someone else's says, if you're willing to pay health insurance and forego other things like, holidays, meals out etc then why should you not be able to have private heth insurance?

It's community based and cost about 20euro a week.
It also heaving funds the public system.

What happens when they take the private hospitals into the public sector.... It will not improve anything for anyone currently on public, it will just make things worse for all....

I think there are some 7nivetsal systems that work well like Canada and Holland, if I remember correctly, but could we replicate that here? I believed there is a large clean out at the middle and upper levels require to get a good system we can fund, but unions will resist all...

Rodney Bathgate

I assume we get rid of all forms of medical card if we have a ‘1 tier’ system.

Yellow_Fern

The idea of a one tier or two tier health system to some extent is just codology. All countries have a second private tier. The only difference between Ireland and say the UK or a typical other country in Europe is that we are more reliant on private than elsewhere.

What is the other option?

Everybody treated in the public system with no private care allowed? You've just got a lot more people using the Public system. So, those that weren't paying for Health Insurance would have to pay for it through taxes to support a larger public need. Those that were paying Health Insurance would be paying less. So, instead of me paying for Health Insurance, those not currently paying would have to pay higher taxes.

I'd be okay with you paying more for my health care, OP, but I fear paying more money into the HSE (we pay more per capita that the UK for the NHS as it is) will not raise the Public sector up to the Private sector.

What do you think, OP?

Dorakman

[Deleted User] wrote: »

What is the other option?

Everybody treated in the public system with no private care allowed? You've just got a lot more people using the Public system. So, those that weren't paying for Health Insurance would have to pay for it through taxes to support a larger public need. Those that were paying Health Insurance would be paying less. So, instead of me paying for Health Insurance, those not currently paying would have to pay higher taxes.

I'd be okay with you paying more for my health care, OP, but I fear paying more money into the HSE (we pay more per capita that the UK for the NHS as it is) will not raise the Public sector up to the Private sector.

What do you think, OP?

I’m for a 2 tier system, perhaps I wasn’t clear. I’ve got health insurance, and I’d never go public unless there’s no other choice.

suicide_circus

Fred Cryton wrote: »

It's not a bad thing. it's just petty jealousy and envy from the SF & welfare dependents who want middle classs people to have to wait in line with them. They can't see that public sector inefficiencies are what is causing the problem in health in the first place.



They want to bring the rest of us down to their level. The word spiteful comes to mind.

I cant believe you went there

Geuze

ForestFire wrote: »

I'm hearing these government parties talking about setting up universal health care system (is this full public again?)

When was this part of the election campaign??

As someone else's says, if you're willing to pay health insurance and forego other things like, holidays, meals out etc then why should you not be able to have private heth insurance?

It's community based and cost about 20euro a week.
It also heaving funds the public system.

What happens when they take the private hospitals into the public sector.... It will not improve anything for anyone currently on public, it will just make things worse for all....

I think there are some 7nivetsal systems that work well like Canada and Holland, if I remember correctly, but could we replicate that here? I believed there is a large clean out at the middle and upper levels require to get a good system we can fund, but unions will resist all...

It's called Slaintecare, there is cross-party agreement on it.

It wasn't really an issue in GE2020.

It means the removal of private practice from public hosps.

It doesn't directly involve private hosps.

It would mean the HSE would move closer to the NHS.

Geuze

Yellow_Fern wrote: »

The idea of a one tier or two tier health system to some extent is just codology. All countries have a second private tier. The only difference between Ireland and say the UK or a typical other country in Europe is that we are more reliant on private than elsewhere.

Yes, there is private practice in the UK, and AFAIK some takes place in public NHS hosps.

In many countries provision is left to many operators, while everybody has insurance.

Geuze

Deleted User wrote: »

I'd be okay with you paying more for my health care, OP, but I fear paying more money into the HSE (we pay more per capita that the UK for the NHS as it is) will not raise the Public sector up to the Private sector.

What do you think, OP?

This is my fear also.

We start Slaintecare, we pay more tax, the idea is we drop our insurance.

OK.

But then, for various reasons, the new Slaintecare doesn't meet the targets for waiting times.

LoughNeagh2017

Insurance is legal robbery, you pay your car insurance and if you have no accidents you are just paying for other peoples car repairs. Then they have the nerve to increase your insurance price if you ever do eventually have to claim yourself. It makes you want to drive into a wall just so you can get your moneys worth.

Montage of Feck

Insurance is a form of gambling so therefore immoral.

rob316

The state own the largest private operator. That sits uncomfortably with me. If you fixed the hse what would be the need for a private healthcare system?

Dravokivich

Montage of Feck wrote: »

Insurance is a form of gambling so therefore immoral.

No it isn't. Insurance is about protecting assets and minimising losses.

noodler

And I thought everyone was in favour of slaintecare

mickdw

Edgware wrote: »

There are several levels of insurance which will give different levels of benefit and are affordable to average wage/pension. People who smoke 40 a day could get some very good cover if they cut back to 20 a day and use the saving for health insurance.
Thats the system. You might as well say that every house should be priced at a price that all can afford.

I think you took slightly wrong meaning from my post. I should have explained better. Im agreeing that there is a place for health insurance and nothing wrong with providing better service to those who pay hard cash.
May be more accurate to say it should be at a price that those on average wages could afford if they chose to put their money in that direction and sacrifice other things.
It should never be affordable to all otherwise, it will be just a tax on public health care.
I also agree with loading prices for late comers.

AllForIt

No.

People who contribute more to the economy deserve better health care.

It's called being responsible and not expecting everything to be handed to you on a plate.

piplip87

noodler wrote: »

And I thought everyone was in favour of slaintecare

All parties in theory are in favour of Slantiecare. It's how it's implimented is where the differences lie.

FG want to gradually introduce it. By negotiating contracts with consultants to keep them working in the public hospitals and not see private patents.

FF want the same except to pump money into the Treatment Purchase Fund to reduce waiting times, which has plenty of merit as it dramatically decreased waiting times between the late 90s to mid 2000s.

SF & PBP want to roll in seize private hospitals, American pharmaceutical companies, Insurance companies and employ hospital consultants while Increasing Thier tax liability because you know consultants are highly paid and that's not allowed in the utopia. They also want to introduce free health care for all. Which again has merit but we need thousands of healthcare professionals before it can be implemented.

L1011

Rodney Bathgate wrote: »

I assume we get rid of all forms of medical card if we have a ‘1 tier’ system.

Yes and no

In a true single payer system there would be no need for a medical card equivalent because there would be no payments made ever by anyone


In many single tier European systems there is some form of user contribution for primary care costs - a damn sight lower than the average GP cost here currently - and for prescriptions; but there would still be exemptions available. These would be a lot less common than the medical card and would never have political interference in the issuing of them. Clean cutoffs and hard cases are ignored.

There was such extreme corruption in the issuing of discretionary medical cards in the past here that if we end up with a system like above your holding or not of a medical card previously should be entirely irrelevant; with the exemptions granted anew.

Geuze

L1011 wrote: »

In many single tier European systems there is some form of user contribution for primary care costs - a damn sight lower than the average GP cost here currently - and for prescriptions; but there would still be exemptions available. .

Yes, AFAIK in France most GP charge 25 euro.

The compulsory insurance covers 70%.

You pay the 30% yourself.

You can buy optional insurance to cover the 30%.

Yellow_Fern

piplip87 wrote: »

All parties in theory are in favour of Slantiecare. It's how it's implimented is where the differences lie.

FG want to gradually introduce it. By negotiating contracts with consultants to keep them working in the public hospitals and not see private patents.

FF want the same except to pump money into the Treatment Purchase Fund to reduce waiting times, which has plenty of merit as it dramatically decreased waiting times between the late 90s to mid 2000s.

SF & PBP want to roll in seize private hospitals, American pharmaceutical companies, Insurance companies and employ hospital consultants while Increasing Thier tax liability because you know consultants are highly paid and that's not allowed in the utopia. They also want to introduce free health care for all. Which again has merit but we need thousands of healthcare professionals before it can be implemented.

Yes the parties but there are plenty of intelligent people who don't agree with Slaintecare.

Ireland's jumbled health service is a suitable case for treatment — but not at any price: cormac lucey


Waiting times are an inevitable feature of a universal free on entry healthcare.

sheep26

mickdw wrote: »

No.
You spend on what you chose. Some spend their last penny on health cover while others might spend it on a holiday.
It should however be priced at a level where people with average wage / pension should be able to afford it.

I totally agree

No, nor are fee-paying schools, or living a five-bed house by yourself.

There should be equality of access to health care based on medical needs but if someone is using their insurance to get a more convenient appointment time, a nicer ambiance, a modern ensuite private room, more convenient all-round experience I don't see any harm in that.

Yellow_Fern

Healthcare is what is termed a positive right. It requires others to provide you with this service. Nature does not provide it. What relies on others will always be at the whims of others and the state can only try to provide the service insofar as all the highly specialised doctors and nurses are willing and able to sell their labour to provide it. As medicine becomes more and more advanced it is becoming harder to offer and it seems to be more and more irresponsible to assume that the state will will simply provide it to you as desired. There are just too many actors at play. For that reason I would urge everyone to buy private health insurance.

Ticking and Bashing

I think if people want to spend their money on health insurance then so be it.

What's immoral about health insurance is the high degree of confusion surrounding health insurance. (1) vast number of products with confusing titles, (2) difficulty to make direct comparisons with competitor products, (3) difficulties in understanding products including policy, cover, excesses, and waiting periods. I believe there's a significant number of people who don't fully understand the level of cover they have at the point of sale / renewal and subsequently when it comes to making a claim.

Sean.3516

Dorakman wrote: »

I hear a lot of people harp on about the 2 tier health system. How is private practice coexisting with public healthcare such a bad thing?

It isn't a bad thing at all. Private healthcare is a tremendous thing. When it comes to healthcare the three things we want to maximise are: (1.) accessibility, (2.) affordability and (3.) quality. Neither the public system or the private system alone can give you all three but a mixed system might be the best we can do.

If the system were fully public, we would have (1.) but not (2.) or (3.). Affordability is an issue because in a fully public system, you pay through your nose on taxes. Middle class tax rates in Denmark are upwards of 60%. Quality is an issue because in public systems healthcare rationing is inevitable hence waiting lists. You also don't have access to the most cutting edge medicines and procedures due to lack of innovation in the sector when the profit motive has been eliminated.

If the system was fully private, you would have (3.) but not (1.). With (2.) affordability, it's hard to say for sure. If the only way to get healthcare is through private companies, then those companies will inevitably lower their prices in order to compete for customers. But there may always be a minority of people who are left without healthcare or with substandard healthcare because they can't afford the plan they need.

If we're looking at this purely in terms of efficacy, both systems have their flaws and advantageous but a system combining the two may be the best.

There's also the basic libertarian argument in favour of private healthcare. ie. I have a right to my own labor therefore if I wish to invest my labor in building a healthcare service and if others wish to invest their labor in using my service on a voluntary basis then we should be able to do that.

Sean.3516

mikhail wrote: »

I have no problem with private healthcare and private health insurance so long as the public system provides a good baseline cover. The ****e US system can't be allowed creep in.

The US has brilliant healthcare but a bad healthcare (system). The reason healthcare is linked to your employer is thanks to a holdover from World War Two, believe it or not, when wage controls meant that employers started paying for people's healthcare because they couldn't give them a pay rise.

In terms of the quality of the care itself the US is one of the world's leading countries. If you have cancer, you don't want to be anywhere else.

There's a case to be made that we could improve our overall quality if rather than having the government being the one administering care in the public system through the HSE, we instead just had the government subsidise the private companies for the care of people who can't afford healthcare as is done with MediCare/MedicAid. The premise being that private companies are just better at doing healthcare. AFFORDABILITY is the main issue.

cython

piplip87 wrote: »

We have a highly subsidised public health system. The maximum anybody can pay publicly for approved treatment in a hospital is 800(may have changed since I worked on HSE accounts).

Where as if a private patient presents at the public hospital this subsidy is no longer exists. So by having private healthcare you are saving the state money on your healthcare.

That's a slight but significant oversimplification. If a patient with private insurance is receiving the same treatment/facilities (i.e. public ward, etc.) in public treatment as a public patient, then hospitals have to ask patients with insurance to waive their treatment being publicly funded. There is no obligation on patients to do this, and in the event that they don't, then the insurer only has to cover the outpatient levy (which is the capped fee you outlined), while the HSE foot the rest of the bill as they would for a public patient.

Health insurers have, for the last few years, been actively canvassing their customers to not sign this waiver, citing it leading to increased premiums. Personally I'm of two minds on the matter; on the one hand someone with insurance could unburden the system financially, but on the other hand they're likely paying their share of taxes and just as entitled to the treatment. The insurers, either way, will nail both sides with impunity when they can!

The real benefit of insurance is in non-emergency cases anyway. If you attend A&E in a public hospital, you'll be treated under the same system regardless. If, however, you need a referral for something less urgent, going private funded by insurance is a godsend.

blackbox

Spend your money how you choose.

Health insurance
Children's education
Cigarettes
Betting
Holidays

It's your money, your choice.

SEPT 23 1989

Heart attack stroke and certain children's A & E

They have the treatment of these running perfectly

If they could only extend this success out to the rest of the system

boombang

As long as the freedom to buy healthcare with your own resources (directly or through insurance) remains, then at least some element of two tier will remain. I don't see that freedom going anywhere, so, in my view, anybody that said we're going to a single tier is naive or lying. Despite that, I think as close to a single tier is desirable.

Regarding the comment "I thought everyone was for Slaintecare", I think the plan is vague enough to allow everyone to agree. If they really got down to making a realistic, detailed plan then there'd be no consensus. Expect the consensus to vanish once any hard questions emerge.

Regarding the notion that healthcare has been effectively nationalised: that's as about as meaningful as saying I own villa in the South of France because I rented one for a holiday.

jimmycrackcorm

Fred Cryton wrote: »

It's not a bad thing. it's just petty jealousy and envy from the SF & welfare dependents who want middle class people to have to wait in line with them. They can't see that public sector inefficiencies are what is causing the problem in health in the first place.



They want to bring the rest of us down to their level. The word spiteful comes to mind.

It's the same ideology that suggests that private school fees should be banned as it gives some people prepared to pay an advantage. It does give richer people an advantage, but equally, it gives people of ordinary lesser means a chance to prioritize their children's education over paying for brand new cars.

A ban on private healthcare would create a negative effect like banning private schools fees. In the latter case, it means bringing everyone down to the same level but does not bring anyone up. So no improvement for anyone, and particularly in the education sector, it means the state has to pay more in pupil capita payments, so costs us all more.

Spiteful is accurate because it pulls down everyone.

boombang

School fees aren't a good analogy in the Irish case as the state pays for education in private schools and private payments top up. I've no problem with private payments, once you're fully outside a public system.

Sean.3516

boombang wrote: »

School fees aren't a good analogy in the Irish case as the state pays for education in private schools and private payments top up. I've no problem with private payments, once you're fully outside a public system.

To what extent does the state fund private schools? I never knew this was the case.

the_syco

mickdw wrote: »

It should however be priced at a level where people with average wage / pension should be able to afford it.

It can be. But I've found health insurance to have several tiers itself.

Health insurance can cost €30 or it can cost you €100. The €30 was through the company I worked with at the time, but reading through it didn't really get you that much. The VHI plan that I was paying €100 a month for had a load of benefits.

I view it like retirement funds. Everyone gets a state pension, but those who put money aside for it can get to retire better.

boombang

Sean.3516 wrote: »

To what extent does the state fund private schools? I never knew this was the case.

As far as I know the state pays teachers' wages (the majority of the cost of running most schools). I think this is grossly unfair and can only persist because Irish middle classes somehow never seem to raise in policy discussions. I think that tells us a lot and about the likely prospects of a significant single tier health system.

boombang

Plenty of tiers within private health insurance. There currently are 307 different adult health insurance packages on sale in Ireland, each with a different cost and level of benefits.

Sean.3516

boombang wrote: »

As far as I know the state pays teachers' wages (the majority of the cost of running most schools).

But I thought that the reason private schools do better is because of superior teachers (who are payed more). Does the private fee pay them on top of their state wages?

ILoveYourVibes

Its unfair some people don't have access to the best healthcare. We are all human.

But i dont think if you go get health insurance you are a bad person. I have it and I am grateful. I would like if it just wasn't even questioned that everyone had it though.

the_syco

Sean.3516 wrote: »

Does the private fee pay them on top of their state wages?

Mostly no. Some are even paid less; https://www.irishtimes.com/news/education/private-school-teachers-are-treated-like-second-class-citizens-1.2594344

L1011

the_syco wrote: »

It can be. But I've found health insurance to have several tiers itself.

Health insurance can cost €30 or it can cost you €100. The €30 was through the company I worked with at the time, but reading through it didn't really get you that much. The VHI plan that I was paying €100 a month for had a load of benefits.

I view it like retirement funds. Everyone gets a state pension, but those who put money aside for it can get to retire better.

€100 plans these days are surprisingly sparse in what they cover.

The state charging insurers for their patients hospital costs was something they never really expected and really ramped up premiums.

jimmycrackcorm

boombang wrote: »

School fees aren't a good analogy in the Irish case as the state pays for education in private schools and private payments top-up. I've no problem with private payments, once you're fully outside a public system.

Sean.3516 wrote: »

To what extent does the state fund private schools? I never knew this was the case.

boombang wrote: »

As far as I know the state pays teachers' wages (the majority of the cost of running most schools). I think this is grossly unfair and can only persist because Irish middle classes somehow never seem to raise in policy discussions. I think that tells us a lot and about the likely prospects of a significant single-tier health system.

Sean.3516 wrote: »

But I thought that the reason private schools do better is because of superior teachers (who are paid more). Does the private fee pay them on top of their state wages?

I don't want to sidetrack this into a discussion about private schooling. Only to make an analogy as we have a similar comparison given the base public system in both. But it seems a lot of people don't understand how private schools work. The government pays teachers salaries in both systems. This is correct because there is a duty on the government to provide schooling for all children regardless of status. But private schools don't get per capital payments to fund buildings/gymnasiums etc. so private money from parents funds that. Parents are also basically funding extra teaching hours and other curricular activities. That's their choice.

If we banned private schooling then the government would be on the hook for this extra expenditure and there would be none of those extras. So no one would get any benefit.

Likewise in public health, banning private healthcare does not improve anything one iota. Private hospitals add extra capacity where private patients can take advantage of them instead of clogging up the public system. If, for example, we had banned private hospitals form the start to only have a single-tier system, then we'd have much less bed capacity than we have now. We'd have longer queues, because there is a false narrative in believing that private patients are somehow less sick than public patients.

Theres also an imaginative belief that the money paid to the private system will somehow go toward the public system to compensate. But this is a ridiculous idea. It will simply go to pay for ski holidays, or maybe, for private schooling, if we don't ban that also.

jimmycrackcorm

L1011 wrote: »

€100 plans these days are surprisingly sparse in what they cover.

The state charging insurers for their patients hospital costs was something they never really expected and really ramped up premiums.

I refused to sign the wiaver form that the hospital gave me to allow them to charge my insurer 800 per night instead of the public fee of 80. It's a rip-off and as a taxpayer, let alone a citizen, I should be equally entitled to state services without being overcharged.

Geuze

Sean.3516 wrote: »

To what extent does the state fund private schools? I never knew this was the case.

Just be careful with language here.

All primary schools are private, typically owned by churches.

(There are a few State-owned VEC/ETB primary schools)

Most secondary schools are private, excl VEC/ETB.

The State pays the wages of all teachers in all schools.