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Government Run Healthcare- Good or Evil

Discussion in 'General Issues and Discussion Forum' started by drsarbes, Aug 26, 2009.

  1. drsarbes

    drsarbes Well-Known Member

    Members do not see these Ads. Sign Up.
    As I'm sure most of you are aware, the US of A is in a heated debate concerning the future of healthcare, with emotional stances on each side of the argument.

    For those of you that practice in areas that have managed, Government run healthcare, I'd be interested in knowing what you think of it, as a provider and as a patient.

    Also, I'd like to know if you have anything to compare it to, i.e., have you experienced NON government health care?


  2. Craig Payne

    Craig Payne Moderator

    Despite all the whinges and grizzles that Australians have about our system of health care, the last thing most Australians would want would be the system that the USA has.

    I see two issues with the USA system:
    1. The costs to administrate the system as a % of the health care costs is double in the USA compared to any other country.
    2. The lobbyists rule. They good at running scare campaigns that the public fall for to protect their vested interest. That happens no where else on a scale anywhere close to what happens in the USA.

    The lobbyists love to point out and highlight problems in other countries, which may or may not be real problems; BUT, those problems are NEVER as big as the problems in the USA system!
  3. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Craig - good reply.

    As an outsider, the US system appears to be a shambles, and sending the nation broke.

    The outrageous lies that are bantered about by the insurance industry about the 'communist' nature of countries with blended or government run insurance is just a scandal.

    I feel for any American who is unemployed, or down on their luck etc, with a mental illness.

    No health system is perfect, but I think our 'blended' Australian system of Medicare and private health insurance has a lot to be admired. No matter how poor or disadvantaged you are, there is always a safety net to care for you. However, if you are wealthy (or just prefer to spend more money on your health), you can access the best of world class private services.

  4. Craig Payne

    Craig Payne Moderator

    I have been following the rubbish about Obama's 'death panels'.
  5. phil

    phil Active Member

    as a podiatrist working in public system i see the great value of goverment funded health services. we have rather strict criteria for service, but it means we catch those who really need us. my days are mainly filled with high risk diabetic clients with/without lesions and frail aged unable to access or afford other services.

    i know for sure i'd rather be sick with a chronic disease in australia than in the US.
  6. Comming from Australia But then moving to Sweden. Where all health is ment to covered by your tax ( which work out to be 78 % of what you earn when all said and done. That´s income. moms which is gst plus a whole lot of hidden tax ) I can now say having worked here for 3.5 years this utopia system does not work.

    The Austrailan system is much better with blended and a safety net for those who cannot pay for health insurance.

    What happens as with all Government dept. is that the bureaucracy goes crazy. I have a Dr patient who stopped seeing patients because she spent 70 % of her time doing paperwork to be payed and only 30 % of her time seeing patients. Waiting list are months long. Things like MRI can only be presricbed by a Ortopeadic surgeon and the patient much go thru a referral process which can take 5 months.

    I also have found that when people have the governemnt contract the patient becomes less important because there is more comming from the system so it does not mater if you get better.

    Lots more to say but a heath care system that helps those that cannot afford to pay for insurance and encourages those that can to be private insured such as the Australian system is the best Ive been involved in. The full government controlled is a nightmare.

    Michael Weber
  7. lusnanlaogh

    lusnanlaogh Active Member

    Everywhere I go at the moment this is being discussed and there seems to be some serious disinformation being spread, which I find a worry.

    But, back to your query -

    As a practitioner the main plus for a governemnt controlled healthcare system are:

    * Relative parity of treatment for all patients/clients - meaning you don't get many really nasty clinical surprises.

    * You don't have to adapt your treatment to the client/patient's available money.
    And, you don't have to wait for insurance approval.

    The negatives are -

    * It depends upon government policy, but high levels of seemingly unecessary paper work.

    * Depending upon the department you work for, there's less autonomy in clinical practice. But, having said that many departments are excellent.

    * You can be limited by funding. However, in the UK, if you can prove that treating the clinical need is cost effective and doable you can apply for more funding.

    Although there are lots of irritations to a government funded healthcare system, I feel that the positives far outweigh the negatives. In the UK our insurance system isn't as developed as in the US, so if we adopted your way of funding healthcare many people (more than your current 20%) would fall through the healthcare net.
  8. An interesting question, Steve, and pertinent, given the media-fuelled transatlantic debate on the merits or otherwise of state delivered healthcare. It is regrettable that the debate has become so polarised – not helped, in my opinion, by the Republican arguments citing the UK NHS as a doomsday example. A better question would have been; “What is the best way to deliver all aspects of healthcare in a developed country?” rather than argue the failings and successes of the current UK and US models of delivery. But what else do we expect from an adversarial system of politics?

    I guess the key is about balance. What level of state or governmental involvement in healthcare is optimal or desirable? What system provides equitable care – so that those who experience hardship are not denied essential treatment? What system promotes innovation in treatment and R&D? Which model rewards good and effective practice? Which care should be paid for by the state (either directly or by contract) and which costs should be borne by the individual?

    The problem is that healthcare has very much become a political yardstick by which to measure the success or failures of an administration. In that sense, politicians will always seek to control the delivery and management of healthcare to some degree or other – usually in the wrong areas. Over the last 10 years, the UK spend on the NHS has increased six-fold as a percentage of GDP, yet still front line clinical services are perceived as failing – some critically - and if anything, access to appropriate care is becoming even more difficult and inequitable than it was 20 year’s ago. http://www.telegraph.co.uk/health/h...care-of-one-million-NHS-patients-exposed.html

    It is just a pity that the legislators and politicians cannot work together with the professions and providers to work out the best system of care for all aspects of health delivery. For what it’s worth, I think that state involvement in the delivery of healthcare should be restricted to the areas which socialised health does best – the acute and specialised hospital based medical and surgical practice – for instance. Most other areas of health delivery – podiatry included – are best delivered by independent contractors and providers, and funded by some degree or another by government procurement (for essential and specified care), individual contributions and/or health insurance.

    The challenge will be designing a system of care that provides value for money; rewards good and innovative practice; is accessible to all regardless of the ability to pay; inhibits exploitative and fraudulent practice; and is sustainable.
  9. drsarbes

    drsarbes Well-Known Member

    Hi all:
    very enlightening responses, thank you. I look forward to more.

    One thing I should note: some of the opinions concerning the US healthcare system in the posts are quite "interesting" -
    I'm fairly certain that most of what you hear concerning our healthcare system from the US media is slanted in an ANTI direction (the media here is VERY liberal), especially the numbers that are thrown around concerning uninsured.
    Most of the time these numbers include the 20 million or so illegal immigrants living here that do not have health insurance (for obvious reasons)!

    Also, a law passed in 1983 (I think) makes it mandatory for an Emergency Room to treat EVERY patient who presents himself, regardless of the ability to pay or the condition presented. Yes, the hospitals "absorb" these costs, i.e., pass them along.

    Which brings up an additional question:

    In any of the Government run healthcare systems, are NON citizens covered?
    Every version of the new Obama Healthcare bill wants to cover EVERYONE - US citizen, immigrant, illegal immigrant - everybody.
    We have a LOT of non US citizens living here. MILLIONS! Of course us tax paying types are not overly happy with this since WE are the ones actually paying.

  10. Xenophobia rules! I thought the USA was a country of migrants and took pride in its multicultural make-up. Many of the NON US citizens also provide essential low-paid labour throughout many sectors of the economy and will no doubt contribute through some of the indirect taxation. But the whole issue of taxation paying for state services is spurious anyhow - do you seriously think taxes pay for everything your government spends?? A stronger argument would be the impact non-residents have on service capacity in areas of high demand.

    The answer to your question is, Yes. For the most part, non-residents can and do access health services, particularly in acute and trauma led care. As far as I am aware, access criteria to other services - such as podiatry - is health scored rather than domicilled status.
  11. drsarbes

    drsarbes Well-Known Member

    "do you seriously think taxes pay for everything your government spends"

    OK------ I'll bite!

    Where else do they get money besides taxes and other "fees" that are really user tax?



    You could write for the NY Times!
  12. Taxes account only for a minority of funds spent by government. Monies raised by bonds, gilts, securities, stocks - not to mention loans from the Fed and the creation of monies from fractional reserve supply, provide the vast bulk of funds for government expenditure. Actually, if it so desired, the US government could abolish all personal taxation without any real major impact on total revenues - but of course it would never consider this....and why would it? It helps perpetrate the myth that government is simply an extension of, and is run for the benefit of the electorate it puports to represent - i.e. the taxpayer. Which, of course, is bullsh!t.

    Anyhow, here's a personal reason why government involvment in delivering healthcare should be carefully considered. I was reasonably active in podiatry politics several years ago. I recall speaking with a junior Health Minister regarding preventative care - hoping to promote the benefits of early podiatric intervention in MSK problems - when the subject of full body scanners came up. The argument was that these scanners would aid early detection of potentially life-threatening conditions and would be a major cost benefit in primary care. Not so- argued the Minister. The corollary position being that although not (that)expensive to purchase and install (cost factor #1), these scanners would result in a sharp increase in the demand for specialist care (cost factor #2) and would probably improve adult morbidity and prolong life substantially (cost factor #3). In other words, in the greater scheme of things, it would not be cost effective in having a better diagnostic and screening programme - if the outcome was to prolong life in the elderly population. Similar arguments can be had with the tobacco industry's relationship with government - you could even argue that the tobacco industry is simply government supported euthanasia! It receives substantial revenues from an industry that supplies addictive products that kill people. Nice!

    Less government involvment in every aspect of our lives would probably be a good thing otherwise we may very well find ourselves at this place after the store closes down....

    Attached Files:

  13. drsarbes

    drsarbes Well-Known Member

    **** CREEK! VERY GOOD!!!

    Hey Mark - I really didn't want to have this thread migrate from the original question....but I will say this in response to your tax income budget proposition:

    I'm not sure what country you are referring to, but for the USA - here are the 2008 numbers

    total Government revenue = 4,824
    from income tax = 1832
    from Soc Sec tax = 984
    "other Gov Taxes = 1072
    Gov Fees = 368
    Other (like BONDS) = 550

    AND BTW: When the government does sell bonds, where did the BOND money come from????
    Big Ponzi scheme that one!

  14. Now look at the expenditure and think where did all the rest of the monies come from to pay for the differential? There's more than one ponzi scheme in operation, Steve.
  15. efuller

    efuller MVP

    Very good point. In which system do the people get the most for their insurance/tax ( insert your unit of money). If the media in the US were liberal this would be the more talked about question. Now the media debate is framed in terms of whether the current proposals are "on the road" to socialized medicine. The implied assumption is that socialized medicine is worse than our current system. What is not being debated is whether or not socialized medicine is better than our current system.

    Here is a podiatry story that we can use to compare the various systems.

    A patient shows up in my treatment room with an infected ingrown toenail. I check his insurance and note that the procedure should be covered by his insurance. My office staff neglected to check whether or not he had a referral from his primary care doctor. I treated him and got a letter syaing they will deny payment for treatment unless I can provide a record of the referral.

    So, if a patient, who is not aware of the ins and outs of his insurance coverage, with an ingrown toenail calls your office directly what do you and he have to do to get treated. In the situation above, I would have to have told the patient to go to his primary care provider to get a referral and then wait a week for the next available appointment to see me. (Insurer pays primary care physician and me to treat this ingrown toenail. The insurer is also paying someone to check if I had a referral.) Or he coud go to the emergency room (Much more expensive than an in office procedure.) So, in terms of efficiency and amount of paperwork how does your system compare.

    Eric Fuller
  16. Eric

    I am rather fortunate now insomuch as I practise wholly in the private sector and not constrained by the bureaucratic and overly onerous rigours of public podiatry care. I have, however, worked in the NHS in the past.

    In the public arena - patient goes to their primary care doctor who refers patient to podiatry department whilst treating the condition initially with a course of antibiotics. Referal gets to podiatry department and enters the appoinmtne system. Patient may be seen anytime from 6 days to 6 months, in which latter case multiple courses of antibiotics may be prescribed. Patient is seen and may or may not be treated by a podiatrist - depending on the Health Authorities qualifying access criteria. This differs from one Authority to another.

    In private practice - the patient contacts my office and is scheduled for an emergency appoinment. They are seen usually within 24 hours - treatment options and fees discussed and appropriate treatment scheduled within 1 week maximum. The fees are paid directly by the patient who may be reimbursed partially or wholly by one of the health insurance carriers - if they have cover.

    It's much easier to administer from a practice management perspective. Good for the cash-flow too. So I guess in that respect it is much more efficient than your system and a great deal less paperwork too. And my patients seem to like it. They get the appropriate treatment quickly and effectively. At a cost, of course. The only problem I have is that some people may not be able to meet my fees and have no insurance cover. They may also not be able to access state care for any number of reasons. If these people who have financial hardship, cannot afford essential care, I believe it appropriate for the state to pay for their care where the state is unable to provide that care directly. That is the inequitable position in the present UK system.

    Direct Insurance contributions accounted for only 18% of my income last year - and most of that related to the Football Association Medical Scheme - so not really relevent to the vast majority of my patients.
  17. Alank

    Alank Member

    What is fascinating about the current US debate is:
    1- the incredible ignorance about the proposals and even the current system (signs by opponents to "keep the governments hands off my Medicare" - a classical govt. run ins. program)
    2 - the outright lies about the proposals
    3 - The death panel rumor was started by a Republican proposal to allow the plans to pay for end of life discussions between the patient and their physician. It somehow was morphed into death panels by our resident political genius Sarah Palin (she who was tired of the press "just making stuff up"). The irony is that we probably SHOULD have an intelligent discussion about how much we want to pay for and far we want to go in providing endless care to terminally ill patients. But that is not on the table.

    The 3 most popular (if imperfect) health plans in the US today are Medicare, VA system and the Health program for American Indians - all federally run.

    Also, the idea that all Americans have access to health care by just showing up in an ER is preposterous and disingenuous to be kind. Most patients seen in our offices for annoying and painful problems are seen by a nonspecialist in the ER, told it is nonurgent and to follow up with their physician. Try getting your tendonitis, plantar fasciitis, bunion, Haglund's deformity etc treated in the ER. HA!
  18. efuller

    efuller MVP

    Mark, I wonder what the average time is. 6 days to 6 months is a pretty wide range. Would that include a diabetic with PVD?

    Under government run Medicare, in my example, the patient could go directly to the podiatrist and probalby get an appointment in less than 3 days.


  19. carolethecatlover

    carolethecatlover Active Member

    This thread wandered off point a bit.
    altho' I am now a 43 year old student of podiatry and Australian, I used to be British and Austrian, In Britain, you go thru hoops of referrals, I had eczema, and saw a lot of dermatologists, (I have such a low lower than a snake's belly, opinion of dermatologists,) and you went to a doctor GP and then waited and waited.....In Austria, I could, and did, go direct to a specialist, all doctors have their plate up on the door 'Hautarzt' 'Augenarzt' etc....and all were connected to the state scheme, but you had to pay for your meds, (or the material for fillings in your teeth, if you wanted gold, you paid for the gold. 30 years on, my gold fillings are still perfect.) also the Austrian, and German, and I think, Swiss system is good, in that alternative medicine is part of mainstream medicine. So, if your doctor thinks a course of Buyko breathing lessons will help your asthma more than a prescription for ventolin, you get the lessons. As a wannabe podiatrist, and had I known about this profession years ago, I would have jumped at it, I think the waiting lists both in Australia, and in the UK could be freed up a lot by letting people go to a specialist without a referral.
    I won't go on about the 'getting into medical school' issue which forces up the price of medical practice. Let's just say, it's a real pity that Australia is going down the US path of medicine as a post graduate degree. The Unis are rubbing their hands...fees...fees...fees..
  20. efuller

    efuller MVP

    Another interesting part of the debate is the conservatives who are opposed to both changes in the health care system and entitlements in general are attacking the proposed changes by saying that the changes will reduce benefits under medicare. I wonder if they are willing to raise taxes so that there will be no decrease in benefits? I hope we get to the part of the debate where we discuss what care we do want to cover. There are probably a few very expensive items that aren't providing much improvement in health that we could cut.


  21. Hylton Menz

    Hylton Menz Guest

    Dear colleagues,

    This is a difficult area to debate rationally, as it is driven as much by ideology as evidence. However, an analysis by the Commonwealth Fund (link), a US philanthropic foundation, indicates that the US healthcare system performs significantly worse than Australia, Canada, Germany, New Zealand and the UK, despite being the most expensive system in the world.

    Contrary to the demonisation of the NHS by some parts of the US media, the report concludes that overall, the UK has the best health care system of the six nations studied.
  22. For me, I guess this has overtures of the custom -v- prefabricated orthosis discussion. Published research says one thing whilst anecdotal clinical evidence tells another story altogether. If the UK has the "best" health care system in the G6, pity the residents in the other five nations!
  23. drsarbes

    drsarbes Well-Known Member

    Hi Alan:

    Well you have an interesting take on things.

    First, Mediare "popular" (whatever that means)?????
    Ask Medicare patients in most non retirement areas how easy it is for them to get to see a doctor?
    Second, medicare runs at a deficit EVEN THOUGH SO MANY pay into it that do not benefit from it (every worker in the United States with a Social Security number). How can you even suggest this is a successful program?

    3rd: Death Panel? A rose by any other name. What do YOU call it when Government officials (not your doctor or your family) decides what treatment you should or should not get (by panel)?
    If it's a life and death descion I guess "death panel" is pretty accurate. By the way - EVERYONE of the Health Care reform bills contains this provision. Emanual went on record as saying the biggest problem with the present state of costly medical care "is the Hippocratic oath"!!!!! Why? Because we treat patients as though life was precious. THat's the way it should be. Maybe it's not cheap, but it's the way I would want to be treated.
    How about YOU? Seriously, who do YOU want making these decisions concerning YOUR health. ANd don't say that is not what the Government is proposing because it is EXACTLY what they are proposing. Read them.

    VA! Now I know you're just egging us on!!!!!!!!!!!

    ER care? Persons with NO insurance, NO medicaid, NO medicare, NO VA, No state run care, no job, choose not to have insurance, illegal..........well, the ER isn't so bad is it.

    BTW: IF one of your POPULAR Medicare patients needs an orthotic for Plantar Fasciitis, who's paying for it? Not Medicare. Who? The same for someone with NO insurance I would imagine.

  24. efuller

    efuller MVP

    It's probably easier for someone with medicare to see a doctor than someone who has no insurance. There are some underserved areas. Anywhere where there are more than enough doctors, Medicare patients will probably be seen. It's not the fact that it is a government run program. I remember reading that more people were happy with medicare than with their insurance company.

    Yes I agree that Medicare will be spending more on care than it takes in. There is a problem if nothing is done. However, it's success should be measured in comparison to the alternatives. Where do you feel Medicare is failing? If there were no Medicare, old people would either be dying because they could not afford care or going bankrupt and losing their houses to pay for care. Now people who get sick before they reach the age where they qualify for medicare, and are unable to work, lose their job and health insurance, do go bankrupt.

    There is a problem with medicare, income will be less than expenditures. We can either raise taxes or reduce expenditures. Maybe we should get some smart people together and look at where we get the most health for our dollar and perhaps cut some benefits. Just don't call this group of people a death panels, because if we do we will either have to raise taxes or let the system collapse because we will never be able to have a rational discussion on how to cut expenditures.

    Now, we should be having the discussion of what things should be covered. The state of Oregon has done something very interesting by ranking various diagnoses and then looking at the money that they have and making a cut off point where things will not be covered. For example a subdural hematoma was ranked number one because, if left untreated it could kill someone. I don't think that onychomycosis made the cut off. Now we can ask the question of what we as a society we can pay for and are willing to pay for. If my 15 year old son had a subdural hematoma, I would give my house to treat him. On the other hand, my mother who said many times that she did not want to live as a vegetable had a massive stroke. I would not give my house to keep her alive in a permanent vegetative state. You might make a different choice. However, not everyone would like their taxes or insurance premiums increased to keep people in a permanent vegetative state alive. Insurance premiums are a voluntary tax that some healthy people choose not to pay in the hope that they stay lucky.

    Death Panels: Right now we have death panels and they are run by insurance companies whose motives are to make money for their shareholders. A government run "death panel" that would have to answer to elected officials would be an improvement.

    There was an interesting bit on the Daily Show with Jon Stewart who was interviewing the person who has been a source of the death panel concept. It appeared that she was misinterpreting the text of the proposal. Steve, have you read the "death panel" proposals?

    Life is precious. However we should be talking specific situations. The generic death panel argument really misses the point. There is a big difference between a subdural hematoma and keeping someone alive who has a flat line EEG. Would you rather have an insurance company bureaucrat or a government bureaucrat making those life or death decisions to spend else's money for that care. If you were willing to pay, I'm sure the hospital would take your money. You can't simultaneously complain about how so many people have pay into Medicare and about how benefits might be reduced.


  25. Julian Head

    Julian Head Active Member

    Hi all

    Having worked in the NHS and now in private practice in the UK I can say that our NHS is a good system, but with faults. Is there such a thing as a perfect healthcare system anywhere?

    The NHS provides care for all, no matter who they are, depending on need, free at the point of delivery. The care provided is great for accident and emergency (even includes ambulance, helicopter rescue, paramedics if needed....how many in the US know that I wonder?). It is also great for the serious healthcare problems, although there are delays in some services (not all!) due to the numbers of people accessing those services. This explains why we have lower survival rates for various cancers but excellent orthopaedic care.

    It is not that we do not have the technology or skills, it is that we choose (as a government) to spend approximately half (gdp) of what the US spends on health care. If we spent more we would have faster access and higher survival rates.....

    This is the crux of the argument you should be having in the US - access to all, free at the point of delivery and you can decide (as a nation) how much you spend and thus the waiting times/number of access points, etc for treatment.

    There is still an excellent private *(separate) healthcare system here, which you can access using health insurance you purchase independently or just pay-and-go! You do not have to use the NHS.

    How's that for choice......?

  26. That is simply not true. The oft spouted mantra of politicians regarding the NHS may have been a principle during the time of Bevan, but sadly, today, it no longer the case. You may qualify the "depending on need" to suit what you think is "need", but as we have seen in the podiatry service "need" really means what the service is actually able to deliver on a very limited budget. I haven't read the finalised report from SoCaP - but the commissioned paper on demand for foot health services illustrated there was indeed an enormous unmet need for podiatry care. If there wasn't, why is private practice flourishing?
  27. Julian Head

    Julian Head Active Member

    Did you not read the rest of my post?

    Finances limit the choices we make, more money=more services. Simple.

    As I clearly said, government decide how much they want to spend and that determines the service level....each country can decide this for themselves. The fact that people want more than is provided will always prevail. People will want more no matter what.

    The fact is that most people do receive essential healthcare services here....i.e. life and death services....not so in the US

  28. drsarbes

    drsarbes Well-Known Member

    I really didn't want to discuss US health care, just Government run programs and whether or not you were happy with them.
    Over 60% of US citizens are "happy" with their health are, but apparently we need to Overhaul the entire system because 5% of the citizens are without (15%-5% illegals and 5% who choose not to purchase).

    Personally I'm VERY happy with my present coverage, I'd like to keep it.



    Medicare patients happy: I'd be happy (happier) too if someone else was paying for the bulk of my coverage!!!!! That's not the point is it?
  29. efuller

    efuller MVP

    Aren't you curious about whether or not the public option could provide you the same coverage at less cost? Other countries cover all of their citizens for a smaller percent of their GDP than we spend to cover a portion of our population.

    You have to admit that the title of the thread seems to be related to the current US healthcare debate. I wish more U.S. citizens would show interest in the relative merits of private versus government run health care.


  30. Atlas

    Atlas Well-Known Member

    This is a generalisation, but closer to accurate than inaccurate; the good old US have been brainwashed about government intervention.

    The US Government has been hampered to regulate and reform the health industry (for memory Hillary was trying to do it during her husband's reign) because of the web-of-lies spread by the pharmaceutical companies and their anti-regulatory rhetoric.

    The US Government can't even regulate against advertising in children's viewing hours because of anti-regulatory rhetoric. The advertisers basically have free reign.

    The faith in free-enterprise and small government has been laughable...and has finally caught up with them. The irony for me is that the father of capitalism, Poulson, used vast government intervention at the height of the GFC to save the free-market from imploding.

    The other irony is that a left-wing outfit in Hawke and Keating, set Australia up fundamentally:
    - with the 4-pillars banking policy that leaves our 4 banks positioned in the worlds top 10 today.
    - with a health system and safety net the envy of the world. Yes we have our elective surgery waiting lists etc., but Medicare has been eroded over a decade of conservative rule in Australia.

    From across the pacific, the US are dogmatic and gullable, and sadly Australia isn't that far behind. We still think there are weapons of mass destruction hidden under Saddam's cousins bed!:rolleyes:

    Pre-Obama particularly, the US went from the envy of the world, to the basket-case, in a generation. Where the 3rd world dies of poverty, the first will die from affluence. Our diets have never been worse. The rubbish our kids eat. Even the utopic health system won't have the capacity to save us.

    The US have a lot of sour medicine to ingest before the carcass starts beating again. But if they maintain their lunacy about free-enterprise and small government, not only will they be hypocritical, but all hope will be lost for them...and by extension us.

    Physiotherapist (Masters) & Podiatrist
  31. Alank

    Alank Member

    By my count 10 non Americans have responded to the question posed at the beginning of this thread. There was one firm negative, another straddling the fence and the rest positive. A tiny sample to be sure. Still, do you think that will change the minds of those right wingers opposed to major reform in the US health system one iota? The lesson learned in the US is that for this group of right wingers, beliefs will trump facts and logic has little place. Arguments that support their beliefs will be trotted out, while their beliefs make it important for them to ignore, misunderstand or misstate evidence that does not support their beliefs. Sorry to say but further discussion with folks like that is pointless.

    FactCheck.org has a nice list of some of the kinds of things passed around as facts by this group that are groundless. What is most disturbing is the degree to which even after these "facts" are thoroughly debunked they are repeated - not just by the ignorant masses but by well educated people who, having their errors pointed out, should now know better. At that point they are simply old fashioned lies. Can you imagine if we practiced medicine like that?
  32. W J Liggins

    W J Liggins Well-Known Member

    Hi Steve

    An apparently simple question to which the answer is anything but. I can only answer with knowledge of the situation in the U.K., although I think the ethical philosophy is mirrored in the various European models as well as those in Australasia and other parts of the world. I trust that you will forgive a rather extended answer but for the background, it is necessary to note the history of healthcare over here.

    Way back in medieval days everyone was required to pay a tithe (10% of assets and income) to the Church. A proportion of this was used to treat the sick and hospitals in France are still called 'Hotels de Dieu'. Such (limited) available treatment was extended to the poor who could not pay the tithe. As an example, the Knights of St.John (the Hospitallers of Malta) who learned much of their health knowledge from the Arabs, who in turn had improved on knowledge that they gained from Greek and Roman medicine, treated all people, Christian or Moslem, rich or poor at no cost. The Knights themselves were required to minister to the sick and they had a working knowledge of cleanliness and antisepsis 500 years ago, long before Semmelweis. They also created 'Nightingale wards' 400 years before Florence Nightingale. Thus, over the years, medicine was seen to be in parallel with religion and in the following centuries hospitals were built on the basis of charitable contributions and endowments. Self help associations such as the Buffalos and the Foresters sprang up in the 18th/19th centuries to care for their members, thus continuing the charitable philosophy. As the U.K. population expanded, laws such as the Poor Laws were passed requiring local parishes and authorities to provide healthcare and these became interested in running hospitals. Some of the hospitals were associated with Universities and others of international renown were supported purely by charitable donations. In all cases, many doctors and surgeons gave their services freely. This cannot be compared to, say, legal 'pro bono' work, as the junior doctors or 'housemen' were paid appointments but the most senior, or consultant grades gave freely of their skills. The consultants' income was derived from private work. During the 19th century and into the 20th century medical knowledge advanced; it became clear that the system could not cope and in 1920 Lord Dawson was requested to write an investigative paper by the then government. A workman's medical scheme was already in place but this excluded wives and children. In the 1930's a series of similar papers were provided by the British Medical Association, various 'think tanks' and The Hospitals Association. On the outbreak of World War II in 1939, an emergency medical service was instantly created and during the war, in 1944 the Conservative party produced the first formal paper on how a National Health Service (NHS) might work. The Labour party won the 1945 election and the Minister of Health, Bevan, presented a different approach, which, after numerous changes was accepted as the NHS. It is important to note three points: i) that 87% of the population were in favour of the NHS ii) on the day after the establishment of the NHS no new hospitals were built and no new doctors were employed iii) the system had cross party support and was in no way 'communist'. It was a huge acheivement, built as it was at a time of economic austerity, a dollar economic crisis, a shortage of fuel and food and exhaustion after 6 years of war. It worked because everybody wanted it to work, at least in part because it continued the ethical and even spiritual values that had always been involved in health care.

    So the answer to your question is a definite "Good" since it cannot possibly be Evil as the conception was above all noble. Perhaps better questions may revolve around effectiveness and efficiency. Bevan believed that once all existing sickness had been dealt with, the NHS would actually shrink - an excellent example of putting 2 and 2 together and making 22. The service has of course grown and continues to do so. Certain elements of health care delivery, the Hospice organisation (for the terminally ill) for example, still rely on charitable status and the bureaurocracy associated with heathcare delivery is irksome to all of us who have delivered healthcare within the system. However, the fact of the matter is that anyone on these islands, whether it be the oldest taxpayer, the President of the United States when visiting (although one imagines he has his own arrangements!), or an illegal immigrant is entitled to the best medical treatment that can be offered, free at the point of delivery. This is something of which the British people are intensely proud (although they will unremittingly criticise that which requires criticism) and to which even an old cynic like me can feel an emotional tie. I do not think that the model is ideal, nor would it work in every country in every situation, but it is worthy of consideration. Given the above, I am sure that you will understand when we laugh at the nonsense that some Americans are regurgitating concerning 'socialised' healthcare eg. "Americans have been fed...a diet of ludicrous untruths: that the astrophysicist Stephen Hawking, for instance, would have been abandoned to die of his motor neurone disease had he been unfortunate enough to live in Britain." (The Economist) He does, he is British, he is a professor (Chair of department) at Cambridge University. On receiving the Presidential Medal of Freedom in Washington Hawking said "I wouldn't be here today if it were not for the NHS".

    I would not presume to offer advice to the American taxpayer; I do not know enough about the subject, nor the particular forces at work across the pond. I would though, just make a general comment that it is invariably unwise to throw the baby out with the bathwater.

    All the best

    Bill Liggins
    Last edited: Aug 31, 2009
  33. drsarbes

    drsarbes Well-Known Member

    "Aren't you curious about whether or not the public option could provide you the same coverage at less cost?"

    Well, I don't think wanting to satisfy my curiosity is enough motive to revamp the entire health care industry, and once done you can never go back.

    I have never seen capitalism as a bad thing, in fact capitalism has made the USA the richest, most powerful, most industrial, affluent country on the face of the earth in only 200 years. Pretty impressive and one that you just can't argue against. Like my Mom says, you shouldn't argue against success. Capitalism is what allows the individual to realize their highest potential.

    The main thing that has changed here in the US in the past decade is that those "receiving" is starting to out number those "giving" -- not a healthy situation. We're turning into a country of entitlements, even for non US citizens. It's crazy.

    Once a "people" realize that they are working but not receiving, and others realize that they can receive without working, then capitalism and democracy are doomed.

  34. W J Liggins

    W J Liggins Well-Known Member

    Hi Steve

    A little off thread but an interesting one nonetheless. As far as believe in any 'ism', like you, I believe that capitalism is the one that works.

    Having said that, historically the USA has had the advantage of being in the right place at the right time. Two world wars fought well outside the borders of the country have incontovertibly contributed to American affluence, whilst the knowledge gained from their allies (and captured German engineers) provided the means for industrial and scientific breakthroughs. However, it should be noted that the capitalist USA is already in debt to communist China, and China is making great strides in industrialisation.

    I certainly agree with your last sentence and we should know in the U.K. There are large camps set up in Calais (the nearest point of France to England) packed full of 'refugees' waiting to enter the U.K. illegally, although France should be able to offer them a 'safe refuge'. This does not impinge on my view that it is the responsibility of any civilised country to provide healthcare to all within it's shores. It just means that I disagree with my government's tardiness in dealing with illegal immigration.

    Bill Liggins
  35. efuller

    efuller MVP

    A better reason to revamp the system is that it is not currently sustainable. I was just trying to appeal to your economic self interest.

    One of the problems with the current system is that the young, healthier individuals are not paying into the insurance pool because in their self interest the odds of needing health care are lower than older people. If you have just the older, and more sick, population buying insurance it will get a lot more expensive. Insurance, at its heart, is a socialist concept. A group of people pay money into a pool and those that get sick will have their health care paid for out of that pool. The group is taking care of those that get sick. Some people will be paying and not receive any service. The question to ask is whether you want profit siphoned off the top of that pool. Does that make the system more efficient? In terms of disbursement to health care providers the insurance industry makes money by being inefficient. See my example above about the ingrown toenail.

    Democracy and capitalism are different things. They are both in trouble when spending money on getting politicians elected is considered free speech. (One dollar = one vote versus one person = one vote.) The attempts at reforming the causes of the current banking crisis is an excellent example. The banking system making risky loans nearly toppled capitalism. Yet, the banking industry is resisting any regulation that would prevent the banks from doing the same thing all over again. There was a survey a while back that said that 80% of the US population supported having a public option for health insurance. Democracy is in trouble when 80% of the population cannot get what they want.


  36. W J Liggins

    W J Liggins Well-Known Member

    Interesting Eric, that the figure for the U.K. population in favour of the public option in 1948was 87% whilst that of the U.S. a very similar 80% in 2008.

    Bill Liggins
  37. drsarbes

    drsarbes Well-Known Member

    Thank Bill for the thoughtful and rather in depth history lesson. I learned a lot. I think understanding Black Holes is a bit simpler though.

    And thanks to Eric and Alan as well. I appreciate you taking the time to educate us.

    One point you make, Bill, is the timely and conscious effort put forth in developing your British system as it now works.

    I think one thing that has most Americans concerned is the SPEED at which our administration wants to push legislation through at. I, like most, feel that any revamping of a system that accounts for 25% of our national budget and is as important as our health should be done prudently.

    Any time something you are comfortable with (and in this case, financially dependent upon) is "threatened" or is confronted with impending change...... it is "stressful"

    Do you change something that the majority are happy with for a possibility of a better system in the future or do you continue with the status quo not knowing if this road leads to an implosion?

    It's like the Hawking Paradox!!!! haha


    BTW: Alan - You use "right winger" as though it's a dirty word.
    As a conservative (which I guess makes me a right winger) I (we) are always open for a debate using ideas and truths.
    I have always felt it is the liberal minded that "think" with their emotions rather than their intellect that are the first to abandon factual dialog in favor of personal attacks. I thought this was an accepted truth.
  38. Alank

    Alank Member

    <<You use "right winger" as though it's a dirty word. As a conservative (which I guess makes me a right winger) I (we) are always open for a debate using ideas and truths. I have always felt it is the liberal minded that "think" with their emotions rather than their intellect that are the first to abandon factual dialog in favor of personal attacks. I thought this was an accepted truth.>>

    Conservative and right winger are not the same. I apply the term to those on the far right who seem wedded to their beliefs and immune to logic. The liberals have far left wingers who are equally immune to logic. This health debate is too serious to let it get hijacked by ideology. I like the Walter Cronkite definition of liberal whom he thought of as those always keeping an open mind, always questioning the status quo and not reflexively defending it. That was what he said he meant when he said reporters should all be liberals.

    There are reasonable arguments that could be made in favor of strongly regulating our current system only rather than also having a public option (AKA government run). There is no need to raise bogus issues. I am personally in favor of the former though for different reasons than you. There is also no question that the current system is extremely costly, getting worse and is unsustainable. We pay about twice as much as other comparable western countries for the care that we do get. Yet, for all that money we are falling progressively further behind in international measures of care and an unconscionable number of our residents are getting little or no care. Unfortunately this country is too often unable to respond to problems except in a crisis.
  39. Lawrence Bevan

    Lawrence Bevan Active Member

    Hows that "capitalism" thing working in Detroit or in Lehmans ?? ;)
    The US federal budget is unfathomly overspent and borrows trillions.
    One could say that the USA has made itself the most "affluent" country by being the most indebted. Debt is not wealth, what would healthcare spending be with a balanced budget?

    Most of healthcare budgets get spent on salaries. Thus if a country pays more as a percentage of GDP is because they are employing more personnel or paying them more. The beauty (to the state) of state-controlled healthcare is that it establishes a monopoly over the pay of the clinicians.
  40. In regards to the decision of whether the United States of America should begin to provide healthcare to it's citizens in the plan proposed by President Obama, I think it would be wise to use the method proposed by one of our founding fathers, Dr. Benjamin Franklin (and one of my all-time favorite scientists) of making two lists to compare pros and cons to see how this important decision should be made. Maybe we could start a list of pros and cons on nationalized healthcare to see if Dr. Franklin's method would allow us to make more rational and objective decisions on how we, as a nation, should proceed (I'll let someone else start the list of pros and cons).

    Here is Dr. Franklin's letter to his good friend, Dr. Joseph Priestley, a British scientist who is given credit with first discovering oxygen, for inventing soda water and starting the Unitarian religion, on how Dr. Priestley should proceed in regard to making an important decision in his life.


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