American Politics Discussion Thread

[Miguelito]

Curiously, in Germany lately there is increased talk of abolishing full private insurance. Private insurance patients often get appointments a lot faster, which has led to a sense of two class medicine for long, so the left has for long argued against it. The fun is that now business circles are joining in. Apparently between the aging populace and low interest rates, private insurance is increasingly unprofitable, so they would love to just transfer all their elderly cost generators into the general system.

For better understanding, even the "public" insurance here is operated by private companies, just on a heavily regulated market. For a long time, in particular the self employed, and, curiously, government officials, had difficult access to the public option (as the funding model works on keeping a share of employees' salaries - but importantly losing or changing your job does not affect your insurance status, and unemployed people are also included). Both publicly and privately insured people can get additional private insurance, of which I believe the most relevant one is dental replacement (regular dental care is covered by public insurance). Also single room hospital accomodation and such.´

Oh and being publicly insured I can choose my doctors freely, and also go directly to a specialist (there were some attempts to limit that some ten years ago, but it has been dropped). Waiting times for certain specialists can be pretty bad though.

[Mr. Cairo]

I am not 100% sure on definitions, but I don't think you could say that the UK has a nationalised health service even with the name: private healthcare exists here as well. I have, my wife has it, we use it, and we both work for the NHS.

Darrell, your points boil down to: who decides the care and treatment that a person received? What you are saying appears to be: I can have anything I can pay for and I think I need. This is true even of private healthcare in western Europe. What happens, at least in the NHS is slightly different: clinicians (not admin) offer clinically appropriate choices and then, if the individual has capacity, they choose from the provided options.

The NHS has some big flaws, but it seems to me that this is a system that actually fits what the USA needs, with some tweaks.

Yeah, there's private options in the UK, but the "public" service is nationalised because the "public" providers are owned and run by the government and mostly staffed by government employees. But yeah, I know what you mean, when I lived in England I used a private dentist because lack of NHS funding meant wait times were around 2 years for NHS dentists in Cornwall.

Here in Canada at least, most practitioners aren't government employees, and most smaller facilities and many larger ones (ie hospitals) aren't owned by the government.

[Krill]

I'm not sure if the idea of a "public" service has anything to do with nationalization?

FWIW the NHS sells services to other organizations.

[darrelljs]

Long video, short story is insurrection denial by Michigans top Republican...

Darrell

[darrelljs]

The thing is, America and Americans do spend like a drunken sailor on healthcare, both themselves through private insurance and out-of-pocket costs, and through their taxes. Per capita America spends far more than any other country on healthcare. Even if you take out private spending, the US government still spends more per capita on healthcare than Canada and most European countries. And yet vast swathes of your population are unable to get adequate care, or are forced to bankrupt themselves to get it.

It’s always annoyed me that studies which compare US health outcomes with other nations looks at the entire population. This overstates how ineffective the system is for those on the inside, and drastically understates how ineffective it is for those on the outside.

Anyway I believe (without any evidence to back it up) that we have better trained, equipped and talented doctors in the US because the financial incentives attracts the best & brightest, the education system is geared towards only elite outcomes, and the hospitals are in a race to have the latest & greatest equipment to capture as much market share as they can. So again, drunken sailors...but I’m okay with that.

Darrell

[Mr. Cairo]

I'm not sure if the idea of a "public" service has anything to do with nationalization?

FWIW the NHS sells services to other organizations.

I'm not entirely sure what you're trying to argue here. The NHS is "nationalised" because it's owned and run by the government, and it's employees are government employees. That isn't the case here in Canada for example. But that doesn't mean that healthcare in Canada isn't "public". "Public" in this case just means publicly funded.

When I go and see a GP, they are self-employed, and they receive payment for my visit. It's just that they're paid for that visit by the taxpayer, via the government, not by me directly. NHS GPs are employed by the government directly.

[Krill]

Ok, that last hit is not true Mr Cairo, but I'll start from the top.

Yes the NHS is nationalized, but healthcare as a whole is not in the UK. I think the only part of the system in the UK which is not available privately is A&E and 999, and this is always a loss maker so I'd argue doesn't really matter. What I didn't understand is what you mean by the would public, but yes, NHS services are free after the point of contact as they are funded by taxes. Other private services are occasionally commissioned by the NHS as and when needed, on either a one off or block booking or time limited manner, so can be publicly funded as well. This is a decision that is made by senior individuals in clinical commissioning groups, not by elected officials. CCGs are given tax money commission most services that provider trusts provide, other than services which NHS England and Improvement commission (healthcare for armed forces personnel, prisons, secure services for mental health and children's mental health services).

You are wrong about GPs in the UK. Whilst there are private GPs who can be paid be individuals either via insurance or out of pocket, these are few and far between. The majority of GPs are employed by private partnerships. The private partnerships are not part of the NHS, and the employees are not paid by the agenda for change pay deal or have access to NHS pensions. The private practices are commissioned by NHS England and Improvement to provide specific care and treatment, on a per head basis with additional funding for complex patients, so they are funded by taxes but they are public not nationalised.

I will note that some GPs are employed by NHS trusts, for example to work in A&E departments, to work for out of hours services, and these professionals are therefore able to get the benefits and pay of public sector workers, but a key point to remember is this: no NHS worker is a government employee, we do not work for HMG. We are public sector workers, and you might say this is splitting hairs but I'd argue it is an important distinction.

Source: this is my job.

[darrelljs]

That's just splitting hairs Krill.

Darrell

[Krill]

Look, the whole point of private healthcare is to have the money to go to someone who knows more than you and has access to testing whenever you want, and get them to do what you want whether it is needed or not, need defined by the person with money. The whole point of every other healthcare system is to have access whenever you need it, with the need defined by some third party, regardless of what the individuals views of their own needs are.

Everything after this is splitting hairs and none of us are going to change it.

[darrelljs]

That's the most succinct assessment I've yet read .

Darrell