the poll thread

[Senethro]

Yes, doctors are part of a conspiracy theory to end the harmless practice of tobacco smoking.

Yes, selling a health service that runs at a loss to profit-driven entities won't result in the complete loss of a health service.

[exnihilo]

How does it run at a loss? It costs money to run, sure, but that money comes from taxation. It's not a profit or loss situation.

[Dave the Explosive Newt]

Quoting exnihilo from 23:04, 4th Jul 2007
hopefully resulting in major improvements in service.

I'm really not sure it does... I can think of so many cases where provision has been taken out of the government's hands and things have sharply gone downhill (Private Finance Initiatives in London that have spiralled immensely over budget or the NHS IT system which has been outsourced to numerous people who have cocked it up royally).

Alright, I will grant you that perhaps health is not a right. But by the same token it's also quite dangerous to treat it as a commodity - a lot of the normal rules of business simply don't apply.

For one thing, the problem with a wholly privatised healthcare system is that the poorest people, who are least able to afford healthcare are those that need it the most. This is why you see so many NHS centres of excellence for treating heart disease, lung cancers, etc etc in some of the most deprived parts of the country - because it is these people who, thanks to numerous social and economic factors (diet, smoking/alcohol use, quality of housing, stress, etc) need these services the most. With increasing privatisation, services cluster around more affluent areas and cater more for the different spectra of disease that affects them.

As for NICE - while a PCT could, if they really wanted, ignore guidance such a decision would be open to court challenge, which the trust would almost certainly lose - so it's really in their interest to follow advice.

[hr]

Mmmmmmm, cake.
http://standrews.facebook.com/profile.php?id=37102114

[LonelyPilgrim]

Quoting novium from 14:28, 4th Jul 2007
I wasn't suggesting any bans or anything. it was just the point; the health risks of smoking are well documented and are on the whole very costly.

There are many other things, as you have pointed out, where individual decisions may lead to costly health related problems. And given that cost, I think you eventually hit the point of either providing state-funded healthcare for those problems...which then leaves you quite justified in regulating what was formally an individual choice (because the individual isn't footing the bill, their bad choices are costing the state)... or you don't make health care a state concern, and thus the consequences fall on those who made those decisions (smoking, etc) (as well as the unlucky)... but this does mean that an individual is free to choose.

Now of course those are simplified extremes, but in essence I think those are examples of the underlying logic for both camps.

Sorry, novium, but your example is more than just simplified. It's simplified to the point of being patently incorrect. In a private healthcare system the individual who has chosen to engage in lifestyles injurious to their health does not, in many cases, foot the bill of their own later health problems. If they are poor and can't afford insurance, they don't get treatment and there is no bill. If they can and do have insurance, the cost of their treatment is paid for by other persons who have insurance through rises in premiums.

The point is that regardless of whether you have a state run or private run health system, unhealthy lifestyles have their costs passed on to the larger society. Whether it's taxes or higher insurance premiums is irrelevant. Consider, however, that with higher insurance premiums more and more people are priced out of being able to afford insurance, lowering the revenue base for the insurers, and driving up premiums even higher in a vicious cycle. With a tax supported system, at least the revenue base stays pretty much the same and that cycle can be broken.

I'm not saying that you are wrong about the dangers inherent in government run healthcare. I am saying that a serious look at the alternative may very well reveal that on some of those issues government vs. private is irrelevant. And in the end, would you rather have a healthcare system that is politically accountable to the people or a system run by HMOs and other insurers that is not accountable to the people?

I have not made up my mind on this issue because it is very complicated. I do get very skeptical of people who have come to a decision though, especially if I think they've reasoned or argued themselves to their position through false pretences or misundertandings.

[hr]

Arma virumque cano...

[LonelyPilgrim]

And now to weigh in on Rights...

Rights are a confusing subject, but for purposes of politics they are things which no one gives you and which no one can take away but which can be violated or ignored.

These are also known as negative rights. The Founders of the US called them 'inalienable' rights: Life, Liberty, Pursuit of Happiness (which really means the right to own property - which is a highly questionable right). Over the years others have been defined - free speech, liberty of conscience, etc etc.

Health care, per se, is not a right. However, an argument can be made that universal health care falls under the Right to Life, particularly for non-elective procedures and therapies.

That said, there are serious philosophical issues with the whole concept of Rights. Which Rights trump which when they come into conflict? How broadly should Rights be defined? How do we know that a Right is really a Right and not just a Liberty?

The whole concept of Rights and Liberties and Freedoms and all that comes from the Enlightenment obsession with discovering the Natural Laws that govern human social relations. That idea, that there are Laws of Nature that dictate human society, has been pretty well discarded, but we keep on talking about Rights as though they are things independent of ourselves; universal and immutable.

I personally feel that a government that only upholds negative rights, the so-called Natural Law, is a failure as a government. Government is supposed to be responsive to the needs and wishes of the people that it governs, and if those people want universal health care they should have it. The People have a Right to govern their own society, through their government. To me, this is the only real Right. The rest are derivative and dependant upon the exercise of this one political Right.

[hr]

Arma virumque cano...

[Jono]

Professor Gow's interpretation from his lectures in SA1001. "You can't get given rights; You have to take them, through armed insurrection!"

In regards to healthcare;
http://www.workingforchange.com/comic.cfm?itemid=22429
c.cfm?itemid=22429

[hr]


Exclusive to The Sinner, and all other fora.

[David Bean]

Quoting LonelyPilgrim from 18:45, 5th Jul 2007
I personally feel that a government that only upholds negative rights, the so-called Natural Law, is a failure as a government. Government is supposed to be responsive to the needs and wishes of the people that it governs, and if those people want universal health care they should have it. The People have a Right to govern their own society, through their government. To me, this is the only real Right. The rest are derivative and dependant upon the exercise of this one political Right.

What you're describing is an illiberal democracy. If 99% of the people wanted the other 1% to be enslaved, they wouldn't have the right to do so; why then should the whatever percentage of people who want universal healthcare have the right to insist that everyone else (as well as themselves, of course) should have to pay for it, on pain of imprisonment?

And jumping back to your previous remark, I don't believe in rights precisely because, apart from what I said on the matter earler, there are two many Mehmsys around who want to make 'rights' into some kind of political trump argument. I remember recently when there was all that (perfectly correct) furore about councils that insist on spending their ratepayers' money on translation services to support non-essential services for people who steadfastly refuse to learn the English language. One of the news reports I saw on television featured a Turkish woman sitting smugly on her sofa, being asked to justify why the ratepayers should have to fund a translator to come into her home and provide her with smoking cessation councelling. "Because is my human rights", she responded. Hah. The bitch couldn't even form a proper sentence, but she knew how to use the expression 'human rights' when she thought she could get something from it. Says it all, in my opinion.

So as far as I'm concerned, 'rights' can go hang. Liberties are all that I'm interested in.

[hr]

Psalm 91:7

[novium]

I believe you are wrong, Lonelypilgrim. It was simplified, but it was also the extreme; carrying things out to their logical conclusion. Sure as hell, if I were running a government with full public heath care, I'd ban smoking and quite a few other things. When you make health care a public concern, and something paid for by taxes, then people's bad decisions- previously only hurting themselves- suddenly are hurting the entire community. (the right to swing your arm, etc etc etc).

That was solely an argument around public health care. As to private health care, I said, yes, it sucks if you've made bad decisions *or are unlucky*. But your bad decisions hurt only yourself. As to insurance; you insurance rates go up if you're a smoker, overweight, etc. So the costs of your bad decisions are laid at your door. As I said, this is not advocating the whole health insurance private health care or HMO route. I hate the insurance companies, etc, they make absurd amounts of money and then refuse to pay out.


BTW, I am saying that BOTH systems suck, and I sure as hell do not want to replace one with the other. Either way.

But you know, I don't think there are only two options. I don't think people/governments/companies can stomach actual and real from-the-bottom-up reform, so they just keep with the same system they've got, making small changes here and there, letting the mess get worse and worse.

Quoting LonelyPilgrim from 18:32, 5th Jul 2007

Sorry, novium, but your example is more than just simplified. It's simplified to the point of being patently incorrect. In a private healthcare system the individual who has chosen to engage in lifestyles injurious to their health does not, in many cases, foot the bill of their own later health problems. If they are poor and can't afford insurance, they don't get treatment and there is no bill. If they can and do have insurance, the cost of their treatment is paid for by other persons who have insurance through rises in premiums.

The point is that regardless of whether you have a state run or private run health system, unhealthy lifestyles have their costs passed on to the larger society. Whether it's taxes or higher insurance premiums is irrelevant. Consider, however, that with higher insurance premiums more and more people are priced out of being able to afford insurance, lowering the revenue base for the insurers, and driving up premiums even higher in a vicious cycle. With a tax supported system, at least the revenue base stays pretty much the same and that cycle can be broken.

I'm not saying that you are wrong about the dangers inherent in government run healthcare. I am saying that a serious look at the alternative may very well reveal that on some of those issues government vs. private is irrelevant. And in the end, would you rather have a healthcare system that is politically accountable to the people or a system run by HMOs and other insurers that is not accountable to the people?

I have not made up my mind on this issue because it is very complicated. I do get very skeptical of people who have come to a decision though, especially if I think they've reasoned or argued themselves to their position through false pretences or misundertandings.

[hr]

Arma virumque cano...

[hr]

tamen ira procul absit, cum qua nihil recte fieri, nihil considerate potest.

[exnihilo]

Quoting Dave the Explosive Newt from 13:56, 5th Jul 2007
I'm really not sure it does... I can think of so many cases where provision has been taken out of the government's hands and things have sharply gone downhill (Private Finance Initiatives in London that have spiralled immensely over budget or the NHS IT system which has been outsourced to numerous people who have cocked it up royally).

We can argue about whether it would result in improved service, but as it's not being done we can't discuss whether it is. I'm also not convinced your examples of failings apply, as they aren't examples of service provision by private companies, they're examples of largely government funded (and fiddled with) services being wildly inefficient, which is exactly what the NHS is currently.

[Dave the Explosive Newt]

What PFI is: http://www.dh.gov.uk/en/Procurementandp ... /index.htm

Cocking it up: http://news.bbc.co.uk/1/hi/health/4997232.stm

Although technically not service provision I grant you. However an interesting development along that line was the opening of a Boots-run walk-in centre within a branch of Boots... which I think is doing alright. There are, I think, one or two GP practices which are privately managed that run ok so far (although I think I heard a report of one of their contracts needing re-writing after they refused to train students), although I'm not as convinced of the outlook on a larger scale should the creeping privatisation creep further.

[hr]

Mmmmmmm, cake.
http://standrews.facebook.com/profile.php?id=37102114

[LonelyPilgrim]

Quoting David Bean from 20:06, 5th Jul 2007

What you're describing is an illiberal democracy. If 99% of the people wanted the other 1% to be enslaved, they wouldn't have the right to do so; why then should the whatever percentage of people who want universal healthcare have the right to insist that everyone else (as well as themselves, of course) should have to pay for it, on pain of imprisonment?

Actually, you are giving me rather more credit than I deserve. I wasn't necessarily referring to democracy at all. If a People is happy with a king and don't mind abiding by his absolutist decisions, that falls under my reasoning as well. The People of any society always ultimately hold the power, regardless of whether they conceive of it as such or not. That was my point.

Liberal democracy, concerned with minority rights and privileges, is not natural or inherent, as I'm sure you'd agree. It only exists when the majority decides that they want A) a democracy and B) feel like being nice to the minority, for whatever reason (and there are some very good practical reasons to respect minority liberties and promote equality, BUT they *can* be disregarded and frequently have been for a whole host of reasons).

Liberty and freedom are given out of the benevolence, or the interest, of those who hold power. Rights, arising out of some Natural Law, are non-existant. In nature all that exist are capabilities. The whole philosophical attempt to 'discover' Natural Laws to complement scientific laws was and is a fool's errand. There is no cosmic referee to call fouls and enforce the 'rules' that the Enlightenment thinkers deduced.

If there is a Higher Power concerned with justice, and I for one believe there is, He is strictly involved in post-game analysis. Here in the world, at the very least, we are all on our own. The concept of Rights is therefore misleading, because as a facet of the Natural Laws they imply a natural enforcement mechanism which does not, never has, and never will exist.

[hr]

Arma virumque cano...

[exnihilo]

Quoting Dave the Explosive Newt from 23:37, 5th Jul 2007
What PFI is: http://www.dh.gov.uk/en/Procurementandp ... /index.htm

Gosh. Really? My word. I also have an egg here, perhaps you could teach me to suck it?

Key words "without immediate recourse to the public purse".

[LonelyPilgrim]

Quoting novium from 21:24, 5th Jul 2007
I believe you are wrong, Lonelypilgrim. It was simplified, but it was also the extreme; carrying things out to their logical conclusion. Sure as hell, if I were running a government with full public heath care, I'd ban smoking and quite a few other things. When you make health care a public concern, and something paid for by taxes, then people's bad decisions- previously only hurting themselves- suddenly are hurting the entire community. (the right to swing your arm, etc etc etc).

That was solely an argument around public health care. As to private health care, I said, yes, it sucks if you've made bad decisions *or are unlucky*. But your bad decisions hurt only yourself. As to insurance; you insurance rates go up if you're a smoker, overweight, etc. So the costs of your bad decisions are laid at your door. As I said, this is not advocating the whole health insurance private health care or HMO route. I hate the insurance companies, etc, they make absurd amounts of money and then refuse to pay out.


BTW, I am saying that BOTH systems suck, and I sure as hell do not want to replace one with the other. Either way.

But you know, I don't think there are only two options. I don't think people/governments/companies can stomach actual and real from-the-bottom-up reform, so they just keep with the same system they've got, making small changes here and there, letting the mess get worse and worse.

But, novium, the government is already legislating to reduce health care costs. Look at seatbelt laws, for example. Look at the rash of public smoking bans that are sweeping the country. The primary argument in the adoption of mandatory seatbelt laws was healthcare costs. Healthcare costs are also the primary or secondary argument employed as justification of banning smoking in restaurants, bars, and public places. Some places are banning smoking in private automobiles on the grounds of healthcare costs.

There is constant talk of a 'fat tax'. The gradual banning of trans-fats which started in New York City is another example of legislation aimed at cutting healthcare costs.

And you are wrong about people with unhealthy lifestyles paying for their own care through their own higher premiums. The rise in premiums that they pay does not even come close to covering the increased cost. The difference is passed on to those of us who are healthier in our own premium rate hikes. The US is less insured than ever, due to the rate hikes precipitated by increased healthcare costs of smokers, the obese, and the otherwise unhealthy lifestyles (and the general aging of the population, of course... but many of the aging are less healthy than they should be, if they changed their lifestyles: old and fat is still fat).

The only solution for private insurance is for the insurance companies to decide not to insure smokers or the obese or otherwise at all. Perhaps the development of a situation like exists in home lending institutions: a division between low risk and high risk insurers, which would permit a sharper division in rates. I believe the problem then would be that many of the overweight/smokers, etc. would not be able to afford their premiums and would go totally uninsured - an almost certain death sentence.

My preference would be to see a massive government investment in preventative measures. Some of which may not be intuitive: a higher tax on private petrol consumption; massive subsidies for urban renewal projects; an excise tax on foods lacking in nutritional value; etc.

Any plan, government or private, that only addresses the effects of a heavier and older population is going to fail.

[hr]

Arma virumque cano...

[raheli]

This is a debate that is only of interest to people who have never faced a serious illness. Let me assure you, that the minute you have a suite of symptoms with a strong indication of being brain cancer, you too will be a rabid supporter of health care that is free at the point of use.

"You should have bought health insurance", I hear you cry. I had. It covered me for a year (the maximum amount of time one could buy it for) after which I had to buy another plan. Any sickness that I already had would be defined as a pre-existing condition, and ineligble for further coverage. If this problem had been cancer (and it was not, for any interested parties who may be reading this)I would have been unisurable for the rest of my life.

Private health insurance is a business, and it is not good business to insure cancer patients. It is good business to get rid of them as fast as possible, either by revoking their coverage or (and this actually happens, although not often) by denying them expensive treatments in the hope that they will die quickly. Imagine ENRON running a health insurance business. Do you seriously think they would do a better job than the NHS?

Lots of people here have said that the situation is complicated. What are your arguements against national health care? That it violates your philosophic integrity; that it might result in a slight increase in your taxes; and that it creates too much security, which you feel is incompatible with your personal freedom. In the face of the kind of suffering and the kind of pain and the kind of fear that private health care allows (and encourages) to exist, to pretend that these are vital, policy-deciding arguements is discompassionate to the point of immorality.

[hr]

Intelligence is good. I'm not very intelligent myself, but I think it's a nice idea.

[exnihilo]

As is so common with generalisations, you're wrong. I am intimately familiar with the situation you describe in your opening paragraph - I still stand by what I said.

[Midget]

Libertarians, lets go the whole hog don't stop with a health service only for those who can afford it:

Obviously abolish public education, cool idea in the 19th century, implemented in 20th, bit old fashioned now.

Transport -thanks to Tories and Tony we're already halfway there, get rid of buses and trains -they're publicly subsidsed. How much fun would the M1 be?

Then abolish prison, the law courts and the police force, if you want protection from the criminals pay for bodyguards (and if you think you're bad pay for your own jail sentence).

What next oh yeah all OUR money wasted on politicians, the houses of Parliament would make a nice stately home for some London billionaire.

Its great that university education gives you these great libertarian ideas, but just remember subsidised further education is thanks to oh god not the welfare state.

[hr]

IMAGE:img9.imgspot.com/u/04/241/18/160019.jpg new shite
http://standrews.facebook.com/profile.php?id=37100090

[exnihilo]

Oh dear, the slippery slope? For shame, Mr Ewin!

[Midget]

Ok some of its slippery. But I do like my analogy, which every ignored earlier in the thread and I have displayed more blatantly here, about disease and crime.

[hr]

IMAGE:img9.imgspot.com/u/04/241/18/160019.jpg new shite
http://standrews.facebook.com/profile.php?id=37100090

[bdw]

Quoting LonelyPilgrim from 23:39, 5th Jul 2007

If there is a Higher Power concerned with justice, and I for one believe there is, He is strictly involved in post-game analysis.

I shall start sacrificing virgins to Dougie Donnelly forthwith.

[Jono]

THis whole thing seems to be based on a load of truisms that, as of yet, haven't been challanged.

Does the private sector, actually "Out-compete" the public?

An NAO report produced in 2005 (but buried, and later published in Private Eye), shows that the PFI success in hospitals is overblown. it shows maze-like buerocracy, poor hygene, over-occupancy of beds, and evidence that projected savings made compared to the public sector alternative are more to do with account fiddling (the "Risk Factor") than any real streamlining. Hardly evidence of the private sector being any better.

The standard response here seems to be that this only comes about because of the public sector restricting free-marketism. Funnily enough; the blame here is laid squarely at the door of the company.

I don't know about you, but if someone can't manage one hospital adequately, I wouldn't put them in charge of the whole shebang.

[hr]


Exclusive to The Sinner, and all other fora.