That's far too simple a scenario. How old is the patient? How long have they had their cancer? What's the health region's budget? Is it 6 months of constant pain, or is it going to be relatively pain-free?
Dude, serving on a death panel is hard, you have to think about more than two things.
I'm not suggesting you were saying that. What I'm suggesting is that there are other ways to protect the poor from getting ripped off other than legislation. If you create a system that means those who need financial help don;t need to go to a less than reputable source then they won't, or if they then do anyway, then it's their own fault.
This goes for financial problems, obesity, health and even sex education. If you provide enough information, guidance and sometimes financial assistance then you can greatly reduce the general population's need and ability to make bad decisions.
Look at a company like McDonalds, they spend millions advertising their products, targeting specific markets and their food is cheap but tasty crap. Everyone knows it's not very good for you but it tastes a lot better than vegetables right? How many people knew exactly how bad McDonalds food was for you gram for gram when compared with something similar? Until they began publishing the calories on their products I had no idea it was so bad for you, it's very hard to estimate that sort of thing without being a nutritionist. is that fair? I would say not.
Why does *the best* option for a healthcare plan involve the government making those sorts of tough policy choices at all?
It's emotionally compelling to talk about people who died because they couldn't afford medical care, but under any system anywhere, there's always going to be someone who dies because the system does not pay for something that might cure them or keep them alive a bit longer.
Now to be fair in any sane policy, you'd set up something like Pal articulated that sets standards where if it's over a certain limit the answer is automatically no unless you can persuade someone to make an exception.
But we have a long developed and carefully studied mechanism for allowing people to figure out whether it's desireable to purchase large amounts of goods or services for minimum additional benefit. It's called "price."
We also have a well developed industry that prices catastrophic risks. You want 5 million dollars in coverage, 10 million? While the high cost individuals are a substantial driver in health insurance costs, another substantial driver is that so much of health insurance is "dollar 1" coverage. If they know they're just going to be on the hook for $10,000 in medicine on average a year, they just price that right into the policy.
If the goal of healthcare is to ensure a healthy populace, it ought to be far better to ensure through some mechanism universal "dollar 1" coverage up to a certain amount sufficient to satisfy the cost of routine care and up to moderate injuries or illness. That doesn't preclude also offering care beyond that, but it frees up a lot of options that otherwise might be off the table.
there's always going to be someone who dies because the system does not pay for something that might cure them or keep them alive a bit longer.
I don't understand how we are back at the beginning again. There are health care systems that cover more things and that keep more people alive in countries all over the world. They are all in some way run by the government. This is not virgin territory for the world. It's not like this concept has just been invented and now we are spit-balling exactly how it may or may not work. It already exists and it is already more successful that private health care. All you should be debating is which system to pick not whether private health care is better than universal health care.
universal "dollar 1" coverage up to a certain amount sufficient to satisfy the cost of routine care and up to moderate injuries or illness.
What is this American obsession with not wanting to contribute any money to something because you may not need it? Why is it always in the negative? Why is it:
"I don't want to contribute to a health care system I might never use."
rather than:
"I want to contribute to a health care system that I might need in future."
Routine care is not what puts families on the street, if you don't cover the expensive treatments you might as well not cover anything. Private health care doesn't work for exactly this reason.
In reply to BigBen, #4893: I don't understand how we are back at the beginning again. There are health care systems that cover more things and that keep more people alive in countries all over the world. They are all in some way run by the government. This is not virgin territory for the world. It's not like this concept has just been invented and now we are spit-balling exactly how it may or may not work. It already exists and it is already more successful that private health care. All you should be debating is which system to pick not whether private health care is better than universal health care.
That's not true at all. In fact I'd go so far as to say that's willfully dishonest unless you want to weasel out by saying that "in some way run by the government" doesn't imply any actual government control over doctors and how they treat patients. Which is the same point that you keep absolutely missing again and again.
Belgium has privately provided healthcare and a requirement to have some health coverage with the option to purcahse state provided coverage or private coverage. The model is fee for service and people then get reimbursement from their insurer.
Denmark and Finland, Sweden and Norway like the UK have public health systems.
In france most physicians are in private practice, and charge fees for service. However, there are publically financed hospitals where service can be obtained with lower or no up front front fees. The entire population has compulsory health insurance which is provided by non-profit agencies which work in coordination with the state. afterthe patient pays the doctors fee, this insurance reimburses 70% and more in some select cases.
Germany likewise has compulsory minimum level insurance , but it is multi-payer and provided through non-profit insurance companies operating under state regulation. Those insurance cooperatives separate negotiate with providers. About 80-85% of the population carries the minimum level while 15-20 carries private insurance that usually provides higher benefits. Physicians negotiate with these providers to pre-set fees, and people pay a percentage at the point of service but most of it is billed as in the American system.
In the netherlands, long term disability and permanent hospitalization are taken care of through a state service not unlike medicare, for short term treatment there is obligatory heath insurance which is purchased from private health insurance companies. Hospitals operate privately on a fee for service model.
In switzerland there is compulsory health insurance mandated at a minimum level but from private insurers. They are not permitted to make a profit off the compulsory portions, but may charge a premium for services above the compulsory portions. The insured pays a premium to the private company of up to 8% of their income. If the cost is higher than this, the government provides a cash subsidy to the individual to purchase this coverage.
Some hospitals in switzerland are publically owned, but the majority of physicians are in private practice.
Your argument that privately provided healthcare cannot work in any form is just wrong. Some of the best healthcare systems in the world are "more privatized" than the united states (with Medicare, Medicaid and the VA and a heavily regulated insurance sector), but in very different ways.
Belgium has ... a requirement to have some health coverage with the option to purchase state provided coverage
Denmark and Finland, Sweden and Norway like the UK have public health systems.
In France ... there are publically financed hospitals where service can be obtained with lower or no up front fees
Germany ... has compulsory minimum level insurance
In the Netherlands, long term disability and permanent hospitalization are taken care of through a state service ... for short term treatment there is obligatory health insurance
In Switzerland there is compulsory health insurance mandated at a minimum level but from private insurers (sounds familiar) ... If the cost is higher than [8% of their income] the government provides a cash subsidy ... to purchase this coverage.
Now, the parts you left out:
In France, the government pays 80% of all health costs. The government of Lionel Jospin put into place the "universal health coverage" allowing the entire French population to benefit from Health care. For serious illness, regardless of the insurance regime, the national health system will assume the cost of long-term remedial treatment.
In Germany, the government pays 77% of all health costs.
In the Netherlands, children under 18 are insured by the government, and special assistance is available to those with limited incomes. The government pays 65% of all health costs.
When insurers in Switzerland started denying coverage for pre-existing conditions, and when the uninsured rate reached 5% they held a referendum to change how insurance works. They were the last for-profit insurance country in Europe, and as soon as it became clear that the insurers didn't have the best interests of their insured at heart, they went on the warpath to change things. That was in 1995. For the record, in 2010 the rate of uninsured people in the US was 16.3%.
Each of these plans has state-provided care in some way for the entire population, and some also have mandated minimum coverage for all in some government regulated way. All of them are better for the population than the US system, and all of them involve (at some level) universal health care.
Yes, they have compulsory insurance, What's your point? That's decidedly not the same thing as the state taking over all medical care and operating those medical facilities as an arm of the state and providing taxpayer financed care as a public benefit.
Likewise with non-profit insurance carriers. It's reasonably fair that if you're going to mandate, as a matter of law, that people purchase certain coverage, that insurance companies don't get to make substantial profits off that.
In the United States the Federal and State Governments provide coverage to children, the elderly, and the disabled. They directly cover 28% of the population. There are numerous public hospitals operated by cities, states and public universities. The US government pays over 45% of all medical costs in the United States, cout in states and localities and other funding and that number is over 50%. Private insurance pays for 36% and the remainder goes to out of pocket or personal expenses.
That's decidedly not the same thing as the state taking over all medical care and operating those medical facilities as an arm of the state and providing taxpayer financed care as a public benefit.
One out of three ain't bad.
The state never takes over medical care, because only doctors are capable of providing it. The state takes over paying for medical care.
The state generally doesn't operate medical facilities - they are privately operated - they are financed by the state assuming certain regulations and guidelines are met (just like every other state-financed institution).
Your entire argument here is based on a strawman you don't realize is a strawman. You're arguing against something that never happens.
The state never takes over medical care, because only doctors are capable of providing it. The state takes over paying for medical care.
The state generally doesn't operate medical facilities - they are privately operated - they are financed by the state assuming certain regulations and guidelines are met (just like every other state-financed institution).
Your entire argument here is based on a strawman you don't realize is a strawman. You're arguing against something that never happens.
That's not true and you know It.
If the state is just "financing" medical care, they can do it with insurance, or by giving people direct cash refunds, or any other methods that don't actually involved paying the operating expenses of hospitals out of taxpayer funds,
If the hospitals are operated by the state, and the doctors are paid out of taxpayer funds, even if that's through an "independent" hospital managed by an administrator (who is himself paid with taxpayer funds and was hired by the state) the state is not just "paying" for medical care, it is operating a hospital.
If I give a pro bono law firm $2,000,000 so it can take cases, and have no other communication with anyone in the company beyond making sure that all the cases really are being taken pro bono, does that mean I'm operating the law firm?
If you give a law firm $200,000 to buy offices, tell them that they're obligated to use this money to operate a law firm in the city of Toronto, and make them sign a 60 page contract that specifies how they're going to operate as an independent contractor? including goals for numbers of clients, the types of services offered, who else they're going to deal with to share services and numerous other factors?
yeah, I'd say that you're ultimately responsible for running the hospital. What you're arguing is like saying my state government isn't actually building and maintaining the roads in my state because when they decide to rebuild a section of road, they hire construction contractors to do it.
I disagree. I'm not running it, I'm telling them how I expect them to run it. That whole "regulation" thing. In cases of things like public works, there actually is a specialized government official on site to oversee things. In those cases, the government is running things. When it comes to hospitals, the government is hands-off.
You mean provisions in a contract like that LHIN is an agent of the crown (15.7) and that the hospital is to provide to LHIN all information it requires necessary for the performance of its duties?
The government gives my department £15,000,000 a year and lets us run things pretty much how we see fit, there are certain areas of accountability on how we are able to spend that money (which if we didn't have would actually make us less of a burden on the taxpayer but would also mean that somebody could accuse us of corruption where there is none, but that's a different story), We have certain things that has to be agreed upon officially but these are so broad in their scope as to not have an impact on us in any way shape or form that would be considered "running things".
Health is run exactly the same. There are tight checks and balances in place to ensure corruption doesn't occur but they are left to run things how they see fit. There just isn't the time, staff or money for the government to get involved in running such a huge area in any more than the broadest of ways.
So, what's up? Anyone feel it deep in their gut hole that the Supreme Court will release its ruling on PPACA tomorrow? Still thinking the mandate is going down.
I think it's going to get shot down (the individual mandate that is). I can only hope that this will lead to a greater push for a single payer system. I'm not optimistic.
SCOTUS blog have spent about $25,000 to try to keep that liveblog alive. I'm not sure they are getting any better odds of that than the individual mandate is of being upheld right now.
Interesting, the court affirmed the Stolen Valor Act 6-3 with kennedy writing the opinion. More fodder for the speculation that Roberts wrote the healthcare opinion.
The original specualtion for the healthcare opinion was that Kennedy would be key and would write the opinion as the deciding vote.
If Roberts writes the outcomes would likely either be 5-4 to overturn it and Roberts takes the opinion for himself, or 6-3 in favor with Roberts writing a narrow opinion to uphold it.
This is the result I was hoping for. Not just upholding the law, but Roberts being on the left of the court and making all the people describing him as a fascist version of Satan very, very confused.
