Well, there are differences, but I think the particular difference you point to is spurious.

People want to be <i>eligible</i> to receive health care for life, but they only want to actually receive it, by and large, when they are sick. On the whole, over our lifetimes the amount of time we spend in hospitals and clinics is usually much less than the amount of time we spend in schools, and few of us want to spend more time there than we need to.

Yes, there are hypochondriacs. There are “perpetual students” too; people who would stay in college forever if they could. Ways are found to cope with them; the public education system doesn’t break down.

In any event, to the extent that this is a problem, it’s not a problem that is solved by a user-pays healthcare model. User-pays models deny healthcare to those who need it,b but cannot afford it, while providing healthcare to those who can afford it, but do not need it. Plus, most user-pays models are at least supplemented with a free-at-deliver model for the very poor, and the free-at-delivery model will suffer from this problem whether it covers the entire population or only (say) the poorest 25%.

http://www.dailytelegraph.com.au/news/f ... 5834072353

Would you pay to jump the queue?

Peregrinus,

Besides their being a cutoff for education, not education forlife. "Free" public education isn't free. The taxpayer is footing the bill. And there are complaints about the tax bite from singles. childless, and older taxpayers who feel they are being forced to pay for a service they can't/don't use.

Peregrinus, I was tempted to reply to your entire thread but gave up. The U.S. didn't exist before independence but we didn't have socialized education until fairly recently and our present socialized education system is not something on which I'd want to base a healthcare system.

Most bankruptcies in the U.. are caused by people spending too much money on things that aren't essential. The "research" you're referring to is sometimes based on self-reporting which is ludicrous or based on research using a fixed, and quite low, amount of medical debt to explain the bankruptcy. In short, they cooked the books.

You apparently don't understand the difference between net worth and income. But, you're right, people can choose to ride the subway or the taxi but they pay for the use of both, unless they're poor. If they have the ability to pay for the subway, they do. In many places, if they're poor, they get to ride the subway for free. And, I don't know anywhere that has eliminated, by law, taxis to force people to use subways or that denies people the right to use a subway if they've taken a taxi.

According to Cuba's self-reporting, they have the lowest infant mortality in the world and no one is in prison. And, the U.S. has 70 million people with no access to healthcare. A recent poll in the U.S. said that 10% of those surveyed believe government statistics.

I still think a system that helps those who need help but expects those who can take care of themselves to do so is a desirable goal. Forcing people into a system they don't want is not desireable.

Patrick
Lets look at this from another perpective.

Heres a hypothetical.

You work hard all your life and provide for your family.
Just before retirement you get striken with a severe illness.
Treatment costs all your assets.
You pay for the treatment and live on welfare.
You have come back to square one. Wasn't your life of hard work completely wasted?
How is this depressing and demoralising situation justifiable?
Why not surf or sunbake on the beach for your entire life?

As a community we all work, pay tax, and decide what to spend those tax dollars on.

I think health and education should be top priority.
What do you think?

Hi Kookaburra


I know. In what I wrote I was at pains to emphasis free-at-delivery. The service is free to the user; you can use it without paying for use. Of course somebody pays for it, but that is true of the roads, the police, the army, the fire brigade, . . . We pay through taxes to have these services available. We don’t pay a second time when we actually need to use them. There is no inherent reason why healthcare can’t be provided on this basis.


There are. But despite these complaints, all developed countries provide public education which is taxpayer-funded, and free to the user. Those who object to the system are everywhere in a minority; no democratic government has ever put an end to free public education, or seriously considered doing so.

Similarly, free-at-delivery health services, wherever introduced, have proved enduring popular. If people complain about them, the complaint is usually that they want more free-at-delivery services, not less.

The United States has had publicly-provided schools from its foundation and, prior to that, the colonies provided public schools. These were not all free to the user – some charged tuition - but most were at least subsidised, and many were free, right from the start, being supported by local taxation. The colonies/states were providing free-to-user schools more than a century before the practice became widespread in Europe. “Socialised education” is an American invention, copied by Europeans. All that has changed since colonial times then is the scale and scope of free-to-user public education – e.g. the provision of education for girls as well as boys, the provision of high schools as well as elementary schools - not the principle.


What makes you say that? Of course I understand the difference. I mention both because means tests for various public services can be based either on capital assets, or on income, or on some combination of both. The point is that for many taxpayer-provided public services there is no means test based on either; the service is subsidised, or free, on the same terms for everyone who uses it, regardless of what assets or income they have. There is no eternal principle written in stone which says that healthcare services cannot be among those provided in this way.


But those who pay for the subway, even those very wealthy people who pay for the subway, typically benefit from a substantial taxpayer subsidy (to which, of course, as taxpayers, they contribute). So, I ask again, why single out healthcare as a service which cannot be provided in a similar way? If the very wealthy have the same access to subsidised or free-to-user government-provided trains, roads, police, fire brigades, national defence, schools, parks, museums, etc, as the rest of us, why cannot they have similar access to government-provided healthcare? Why is healthcare different?


And I don’t know anywhere that, by law, has forced people to use publicly-provided healthcare, or forbidden them from obtaining and paying for their own healthcare, if they want to, from anyone (competent and licensed) who is willing to provide it.


If your defence of the US healthcare system is going to be based on the assumption that the US Census Bureau is lying, and that the US actually enjoys better life expectancy, infant mortality, etc than it admits to, it’s not going to be a very convincing defence, is it? At the very least, you need to produce some evidence that the Census Bureau statistics are false. You’ll also have to explain why the insurance offices, who produce their own mortality statistics from their own substantial databases are in on the conspiracy, given that they would have a powerful vested interest in talking up the outcomes of the present US healthcare system. Yet, embarrassing as they are, they don’t dispute the Census Bureau figures.

No, I’d drop this line of argument, if I were you. Odds are that the Census Bureau figures are correct.


Where have I advocated forcing anybody to use publicly-provided healthcare? On the contrary, I have pointed out in relation to education that people who don’t want to use the public schools are free to attend and pay for private schools, and a substantial number do; why should you assume that I don’t favour a similar approach to healthcare?

Christine O wrote:

..Here's a hypothetical.

You work hard all your life and provide for your family.
Just before retirement you get striken with a severe illness.
Treatment costs all your assets.
You pay for the treatment and live on welfare.
You have come back to square one. Wasn't your life of hard work completely wasted? ... ... What do you think?

I think the aim of life is not to have more assets than others. The aim of life is ??? about being good and happy etc. If the person in your hypothetical did a lot of good, nice stuff (ethical stuff) for others during his/her life, I reckon their life was definitely not wasted. When anyone dies, we are at square zero, where we started. Unless you follow the Buddhist faith and then if you have been good, in your re-incarnation you will have moved closer to the ideal.

Peregrinus wrote:

Well, there are differences, but I think the particular difference you point to is spurious.

People want to be <i>eligible</i> to receive health care for life, but they only want to actually receive it, by and large, when they are sick. ...

Not so, people are now requesting health services that were not available previously. Simple things like mammograms, x-rays and ultra sounds for the same problem, annual dentist checks, annual eye examinations, prostate checks, 'flu injections, hospitalisation for giving birth, ... all of these can be before any illness is apparent. As more tests become available, people want them as insurance. And this is supported by the Government and generally the health industry. Some are probably appropriate, some not.

There is the well documented issue of ultrasound machines, which were very expensive and in order to get a return, these machines required regular and frequent use. So, the owners of these machines (generally Doctors) referred their patients for ultrasounds instead of or in addition to x-rays and in effect, the health care system paid for these machines and the owners made a very healthy profit.

Not a good model.

Peregrinus wrote:

... Similarly, free-at-delivery health services, wherever introduced, have proved enduring popular. If people complain about them, the complaint is usually that they want more free-at-delivery services, not less. ...

You have stated clearly exactly the problem with free to end user health services. many people want more and more and more and society pays more and more and more, and the healthy members of society subsidise the unhealthy. There must be limits. I reckon the current system is reasonable effective, but probably too generous to those who are unhealthy due to their own past abuse of themselves.

I would support the reduction of funds for the obesity area to pre-natal health care for example, or a reduction of funds spent on treating lung cancer for smokers and an increase on treatments for health problems caused by environmental pollution (e.g. asbestosis).

There’s truth in what you say. People who don’t have to pay for them may well want procedures, particularly diagnostic procedures, when they don’t have sufficient clinical value to justify the cost, or indeed any clinical value at all.

My point is, though, that this is a problem which affects insurance-funded healthcare systems just as much as taxpayer-funded healthcare systems. After all, insured patients also don’t pay for the specific treatments and procedures they receive, just like public patients in a taxpayer-funded system, and they have just the same incentive to demand more and more procedures, which they perceive as free.

If, as seems to be the case, the practical alternative to tax-funded healthcare is insurance-funded healthcare, you don’t avoid this problem by not having tax-funded healthcare. In fact, the US suffers from this problem very badly. There is evidence to suggest that the insured patient feels an even stronger sense of entitlement than the tax-funded patient, because he has paid his premium, dammit, and he chose to insure when he didn’t have to, and he chose this company when he could have chosen another, and so they owe him. Plus, they have some incentive to concede his demand, because if they don’t he may go elsewhere, or persuade others to do so by badmouthing them.

It seems to me the issue is, which system is more effective at making treatment decisions on clinical grounds? There is no a priori reason to assume that it will be the insurance-based system; if anything, the reverse. Apart from the sense of entitlement just mentioned, insurers do actually have a long-term vested interest in ramping medical costs up to the maximum that society can be made to pay. Their income is essentially a margin of what is spent on (insured) healthcare; the more money that is devoted to healthcare, the more profit for them. You make much more from insuring somebody against a $10,000 cost than you do from insuring them against a $1,000 cost. I don’t think it’s a coincidence that the US spends far more of its national wealth on healthcare than most other countries with a similar level of prosperity.


Leaving aside the question of whether those would be good things, there is no reason to think that an insurance system would be better at rebalancing expenditure as you want than a taxpayer system. Insurance-based systems tend to skew healthcare expenditure towards the well-off, since they are more likely to have insurance, and more likely to have higher levels of cover. They have no tendency to skew expenditure towards the virtuous.

Christine



I'm not an expert, on the health system in the Great Satan, the United States, but i do know they have MEDICAID and MEDICARE, that are government programs for health care. The former is a welfare type insurance, and the latter is funded by mandatory payroll deductions as part of the social security system. They also have programs for military retirees, and even non-retirees as long as they were honorably discharged veterans.

I wonder how much of these "uninsured" are uninsured by choice as opposed to by necessity

Patrickt, the US spends twice as much on healthcare than Australia does every year (per capita) and yet you still have a quarter of your citizens who don't have access to any kind of healthcare, so don't even try to argue that yours is a better system. If anything the US healthcare system is the most disgraceful of all OECD countries. I think every US citizen should be ashamed at how their country treats those most vulnerable. Disgraceful.

Australia, like every OECD country (except the US) offers a level of state provided healthcare. Obviously that is limited because of budget limitations, and is balanced against other necessary costs. Airzone, that problem exists with every government department- how much should be spent on each? Governments make those kind of decisions all the time, this is nothing new.

I would like to see GPs and dentists to be freely accessible to the public, other than that, I think everything is ok with our health system.

arry,



You are being disingenuous with that statement. I'm pretty sure in the US if you show up at the emergency room of a hospital you can't be turned a way even if you don't have insurance. That would seem to contradict your claim of people not having access to any kind of healthcare. In fact just because someone doesn't have insurance doesn't mean they have no access to healthcare.

I advocate being good and happy but do not advocate making their quest an excuse to avoid contributing to society via the workforce. One does not engage in employment purely for enjoyment purposes, who are we kidding? Some are lucky enough to enjoy their job but a lot are more are of the " one powerball and I'm out of here" persuasion.
"Completely wasted" is a black and white statement, and an exaggeration, however, if one is reduced to homelessness because of sickness after a life of contributing tax I don't think that is fair and reasonable at all.

If the health of taxpayers is not a priority for your so begrudgingly given tax dollars may I ask what is?

hi Christine O,

We all have choices. Some choose to try to collect as many goodies as possible, others work enough to support themselves and focus on non-income earning activities. Some work as volunteers in remote countries, helping others in more need, definitely not for the money. We all have choices and I am finding that many people do not understand they have these choices. They lock themselves into a lifestyle they actually dislike, working hard for the ability one day to be able to do all the things they really want to do.

I don't give my tax dollars begrudgingly. I think tax dollars are well spent on such things as most health care, roads and footpaths, maintaining a government, maintaining a defence force, being used as a means of applying monetary policy to keep most people's living standards reasonably stable, subsidising some parts of our education system etc. ... I do somewhat begrudge my tax dollars being spent on supporting car manufacturers who have got themselves into financial difficulty, sending drug abusers overseas for medical treatment when they have already received a liver transplant and then abused it, putting on fireworks displays at New Year and a few other things. But overall, I accept my tax dollars being spent as is. If I really reckoned something could be done a lot better, I would try to do something about it.

Health care is a priority, but which priority is the real ethical dilemma. There is no ethical dilemma saying something should be a priority because there is no dilemma. What proportion of the budget should be spent on health care? And if it is to be increased, what service is to be reduced? Now that is a dilemma. I would support no Governement sponsored on New Year and a reallocation of that budget into health care for example. Preferably into some form of preventative health care and not fertility clinics. Ethics is about difficult conflicting choices, and trying to make the best possible choice. Not the right choice because there is no such thing as a choice which is right for everyone.

If you believe the health services budget should be increased, what expenditure do you believe is ethical to reduce?

I think this topic has been debated so many times in so many different contexts and I think it comes down to the simple basic principle that people are entitled to have access to healthcare in a society that is wealthy enough to provide it (such as Australia). This is a belief that is practiced in every OECD nation except the US.

Where you fall on the question of public healthcare can pretty much be determined by whether your ethical belief system results in you agreeing or disagreeing with the above principle.

Obviously, I have very strong views on the matter, and wonder how anyone in good conscience can argue against providing healthcare for the sick in a wealthy nation such as Australia. It takes selfishness to new levels. At its most basic, I don't believe that if you were sitting with someone who was sick, and you had the spare medicine in your hand to save them, you would choose not to help them because you wanted to trade that medicine for (let's say) a chocolate chip cookie that you wanted to eat because it was yummy and sweet. Yet that is, in effect, what you would be doing if you removed universal healthcare. You would be saying, 'it's ok that we spend all this money on frivolities such as BMWs etc., i don't care that money could be used to save a person's life... I just don't care'... that kind of attitude would make me really question a person's humanity.

Hi Airzone,
Not everyone works to "buy themselves goodies", and its perfectly possible to give to charity, volunteer, spread joy, and work in a low paid job all at the same time. Only getting the luxury of a lap top when Kevin Rudd sent a cheque for $ 900.00!

Everyone can't be living in the dreamtime, some people have to do the hard yakka!
Then they should get their health care paid, end of story.

I resent my tax dollars being spent on anything to do with sport.
I resent tax dollars being spent in the form of grants to idiotic artists.
I resent tax dollars being spent to fund an election.
I resent tax dollars being spent on propping up banks and then seeing it handed to a CEO as a bonus.
I resent tax dollars being spent on travel and other perks for politicians.

Just playing devil's advocate...

True, but universal access does not necessarily imply direct government provision.
Can we trust the government with our health?

101



NO

The Government and the politicians who run it can't be trusted to do anything but act in their own self interest and the public be damned.

The government is elected by the people and accountable. If you don't like what the govt is doing with health, vote for the other guy.

When i look at how incredible our health system is at the moment, the number of professional people with expert knowledge, the number of hospitals and the technology in them, it really is quite impressive and amazing. Things of course can always be better, but they could also be a whole lot worse. We don't have to trust them, we just have to have a mechanism to hold them accountable if they stuff up, which we do, elections.

I understand you're wondering if there is a 'better way'. Personally I don't think there is because only the govt will run healthcare in the interests of the people. I suppose when it comes to healthcare, I subscribe to the view, 'If it ain't broken, don't fix it'. The last thing we want is some trial of some new way of delivering healthcare that stuffs everything up. Healthcare is too important for political experiments.

arry





it sounds like you are making the argument that a lot of people in the United States are making.