Healthcare for Profit

[Spot261]

What do you think rights are or should be based on? Or laws/policies should be based on?

Yes, I think what people get should be based not on their morality but on their actions and whether or not those actions were moral or immoral (harmless or harmful).

As a health professional I can't help but be horrified by that idea. A doctor takes an oath to do no harm and that includes that caused by inaction. We are not here to judge the morality of individual choice or to decide who does or does not require treatment. We educate the public and as you say that has mixed results. Nonetheless it does have results and is a fundamental part of the role of a universal healthcare system.

Ironically I was tasked only the other week to deliver a presentation on geographical health inequalities in the UK and they definitely do exist (I actually live in one of the areas associated with lowest life expectancy, which was a lovely point to throw in for light relief), but those inequalities stem far more commonly as a consequence of other demographics than inequalities of provision, regardless of what sells newspapers.

We do not make the decision that someone, anyone is undeserving of our help. Period.

At least not here.

I am a nurse (albeit one whose current duties are more academic than practical), not a judge or jury and in forensic practice many of my patients have been people who would have received the death penalty in some countries. That I can separate the person requiring my help from a value judgement about them is a point of professional pride and one shared by thousands of others in my profession.

This may sound naive but consider the fact that we actually pay significantly LESS per head on average than US citizens for the privilege of having a healthcare system which not only delivers everything to everyone, every time.

In addition that system (along with others like it) pours money into research, both in terms of that purely funded from the public purse and in terms of subsidising drug companies where there is sufficient doubt as to the profitability of that research. The fruits of that research are borne globally.

 

[Spot261]

Have you read the preamble of the Constitution of the United States of America?



Edit: You share the allusions of our current Mr. Trump. We don't have a PRESIDENT right now.

Would that be the one with the bit about all men being created equal?

 

[J.T.B.]

To equate universal healthcare with a lack of individual responsibility is to completely miss the impact made by public spending in health education and preventative care.

Universal health care also has the proven advantage of most efficiently providing the best outcomes for the most people.

Ah, see, what's happening is that he's turning a right into a moral choice, which is how actual rights are withheld from people. It's the same reasoning that says by recognizing LGBT rights, we also condone their behaviors. That is how you start a war on gays, a war on drugs, a war on... well, whatever you want, because it reframes the issue as a moral choice instead of a recognition of one's rights.

And the other classic reframing: They're taking your money and giving it to people who don't deserve it. Don't deserve it because they make bad choices, or have too many babies, or don't do well in school, etc. etc.

Any big corperation must turn a profit to stay in business. I am not advocating they should be allowed, quote-unquote "obsecene profiteering". But where, exactly, do you draw the line? When does a reasonable profit turn into "obscene profiteering"? According to two different people up-topic, >ANY< profit made is unreasonable.

States regulate utilities providers so the public isn't unfairly gouged for services that they have no real alternative but to pay for. Since employer-paid insurance companies have become the de facto system of providing health care for the largest segment of (c. 47%) of Americans, it doesn't seem at all unreasonable that publicly-accountable government bodies be able to say how much profit is enough.

Emergency/lifesaving care is by law provided regardless of ability to pay. I don't think society has an obligation to otherwise fix health problems that individuals have caused to themselves.

But as you say, treatment will still be provided. So those costs, of medical facilities providing emergency or catastrophic care to the uninsured or underinsured, are passed on to those paying for insurance in higher premiums. So what is the most efficient and equitable way of covering those costs? Large insurance pools, with a lot of healthier people paying in and offsetting the costs. And which system has more leverage for changing people's unhealthy behavior, the system which provides them medical coverage, or the system where they are told "You're on your own"?

If one can remember back before Republicans decided that nothing mattered except opposing everything Barack Obama wanted to do, individual insurance mandates were a conservative idea. They were the party of "personal responsibility," the party that wanted to crack down on "free riders." That's why Mitt Romney went with mandated coverage in Massachusetts, hailed by the GOP as a success story, though by 2012 he seemed unable to recall much about it. And one that always cracks me up is Newt Gingrich, forgetting that the script had been changed, still advocating individual mandates on Meet the Press in May 2011.

 

[UncleRogi]

Would that be the one with the bit about all men being created equal?

No, That is the Declaration of Independence, the precursor to telling the Crown to "Fuck Off'

Edit: Most Conservative Americans are unaware that that is not in the Constitution.
So much for conservative literacy.

 

[suarezguy]

As a health professional I can't help but be horrified by that idea. A doctor takes an oath to do no harm and that includes that caused by inaction. We are not here to judge the morality of individual choice or to decide who does or does not require treatment.

I am a nurse (albeit one whose current duties are more academic than practical), not a judge or jury and in forensic practice many of my patients have been people who would have received the death penalty in some countries. That I can separate the person requiring my help from a value judgement about them is a point of professional pride and one shared by thousands of others in my profession.

I hope you don't think all of society should be bound by the same obligations as workers in the health care field. It seems not as you admit the criminal justice system does and I would hope you think should take into account individual behavior.

They're taking your money and giving it to people who don't deserve it. Don't deserve it because they make bad choices, or have too many babies, or don't do well in school, etc. etc.

Society does have limited amounts of financial resources, which indeed must be taken from people for the government to have it. It seems better to me to spend more of it on education for children and young people and infrastructure (for the whole society), including public transportation and cleaner energy, than trying to remedy specific health problems.

But as you say, treatment will still be provided. So those costs, of medical facilities providing emergency or catastrophic care to the uninsured or underinsured, are passed on to those paying for insurance in higher premiums. So what is the most efficient and equitable way of covering those costs? Large insurance pools, with a lot of healthier people paying in and offsetting the costs.

Yes, I said earlier that that system should greatly reduce the individual costs.

And which system has more leverage for changing people's unhealthy behavior, the system which provides them medical coverage, or the system where they are told "You're on your own"?

I don't know, both seem to have little influence in doing so.

If one can remember back before Republicans decided that nothing mattered except opposing everything Barack Obama wanted to do, individual insurance mandates were a conservative idea. They were the party of "personal responsibility," the party that wanted to crack down on "free riders." That's why Mitt Romney went with mandated coverage in Massachusetts, hailed by the GOP as a success story, though by 2012 he seemed unable to recall much about it. And one that always cracks me up is Newt Gingrich, forgetting that the script had been changed, still advocating individual mandates on Meet the Press in May 2011.

Since emergency care that eventually can/will be used is indeed mandated, mandatory health insurance also seems reasonable (indeed, obvious and probably necessary to avoid free riders passing costs to others). That's very different from having a single-payer system and/or prohibiting health insurers from making any profit.

 

[UncleRogi]

I would say it's to try to prevent people from harming others.



I agree we should have health education and we do, I don't know how much more health education or preventative care you have with single-payer health care but the results seem uneven rather than clearly better.



I don't see how you have a right or actual right to have society as a whole pay for all the doctors, drugs or medical equipment you use at least if your medical problem is due to individual behavior.



You should have the right to be treated equally by the government and employers. That is a moral choice, the right one, that people shouldn't be discriminated because you wouldn't want to be discriminated either so you shouldn't do it to others. There's nothing harmful about LGBT behaviors while there is a lot of harm from smoking, drugs, STDs, alcohol.

You are arguing against yourself.

Edit: might that clue you in as to your lack of empathy?
You would yell loudest when a poor folk got seen before your Band-Aid application.
Do unto others, it is said.
The Lesson is the best gift to give is your life.
Fiscal responsibities need not apply

I'm not particularly religious, but you seem to be. Therefore, in respect,

Amen

 

[Jedman67]

I haven't read the last 4 pages, so I'm going to some up my thoughts here:
For profit Insurance/healthcare in an open, transparent, consumer-protected regulatory market is not inherently a bad thing.
What we have now in the US is an extremely opaque market where insurance companies get favored regulations passed, have fairly little competition, and have a complete monopoly on price-fixing throughout every aspect of the industry. There's no easy way to unravel this beast; however passing laws mandating that insurance companies post their provider-reimbursement rates for each procedure/billing code; and that providers publicly post their charges for each procedure would go a long way towards fixing whats wrong - as that would give consumers the ability to price shop before committing to expensive procedures.
A few years ago, NY State passed a law requiring that insurance companies cover out-of-network providers and that any procedures done in-state would have to be covered and that the consumer would only have to pay the out-of-network copays; rather than being denied the claim in full. It's only a band-aid on a pretty expensive and nightmarish system, and I don't know the answer.
Here are a few links that are relevant:
http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/
https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem

 

[UncleRogi]

I haven't read the last 4 pages, so I'm going to some
http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/
https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem

Sir, I read the first link and say Thank you.

Edit: Read the second link; even better!

I'm just interested in what pretzels those folk tie themselves into, and
call it "moral."

Welcome to America in 2017
We are "exceptional."

 

[Jedman67]

^as i said, the theory is a far cry from the practice. When we get rid of cronyism, lobbying and kickbacks; maybe we can do something about this mess.

 

[Robert Maxwell]

Food is a basic necessity, too. Are you saying that restaurants, grocery stores, and farmers / ranchers shouldn't be allowed to make a profit selling food??????? No?? Well, it's the same principle.

Look, private companies are in business to make money. They have a fiduciary responsibility to their investors to turn a profit. They do so by selling a product or providing a service at a reasonable price. No company can afford to sell health insurance without investors buying into the company on the stock market, and nobody will invest if they don't get a fair return on their money.

And as I said before, the problem isn't health insurance, but rather the run-away costs of health care itself: what the doctors and hospitals charge. Part of that cost is due to the price of malpractice insurance, which is driven up by stupid juries awarding obscene amounts for frivolous lawsuits. If you truly want to "fix health care", you have to address the entire system. Forcing heavy-handed regulations on the insurance side of the equation doesn't deal with the root cause of the problem.

So you're saying we should abolish health insurance and just have a single-payer system. Sounds good.

 

[Spot261]

I hope you don't think all of society should be bound by the same obligations as workers in the health care field. It seems not as you admit the criminal justice system does and I would hope you think should take into account individual behavior.

Not sure what you mean with the word "admit" here, possibly you're assuming a dichotomy between the two where an overlap might be closer. The Mental Health Act contains significant provision for facilitating provision in partnership with the criminal justice system. There are several iterations on the theme with each placing legal powers variously in the hands of the courts, the medical profession or the local authorities. Some treat forensic services to treat concurrently with a prison sentences, others to detain someone in place of those sentences. Some require us to return people to prison after a period of assessment, others to take on the responsibilities of the prison at a proxy. Some require us to liaise with outside agencies to safely monitor patients post discharge. In all instances the decisions are made either by judges or psychiatrists based on reports written by someone like me.

My role is not to judge those people or moralise about their actions, it is to provide appropriate physical and psychiatric care and make recommendations based on my professional judgement as regards to public safety. Or at least it was.

Society does have limited amounts of financial resources, which indeed must be taken from people for the government to have it. It seems better to me to spend more of it on education for children and young people and infrastructure (for the whole society), including public transportation and cleaner energy, than trying to remedy specific health problems.

Was anyone suggesting taking money from education? Healthcare for many countries is considered part of that infrastructure and public bodies are frankly much better suited to this than private ones.

Yes, I said earlier that that system should greatly reduce the individual costs.

But not as much as removing the insurance component altogether and replacing it with not for profit taxation.

If you genuinely do see the world that differently than I to the point where the ethics of saving a human life have dollar signs consider this analogy of a homeless person.

You might walk past said person without offering spare change, you might well believe that their choices have led them there and you have no responsibility to help them. Many would consider you heartless but your own numerical sense of ethics would have guided you, even if by doing so you had denied them the chance to eat that day.

However, would you go one stage further though and prevent them buying the last loaf of bread by outbidding them on it? Would you decide that their lack of personal responsibility weighed so heavily on your mind that you would not only fail to help them, but actively hinder them even if it cost you more to do so?

That is essentially what you are suggesting with your free rider argument. you are accepting a private insurance system which costs you more than public taxation would and arguably delivers a weaker end product on the principle that it prevents others who haven't paid from also benefiting.

You aren't paying to see a doctor, you are paying to prevent someone else doing so.

That's a really difficult principle for me to equate as "moral"

 

[suarezguy]

I'm not particularly religious, but you seem to be.

I'm not religious but I do follow the golden rule and especially the silver rule (don't do to others what you wouldn't done to you) and think that's pretty basic to morality and reasonableness.

But not as much as removing the insurance component altogether and replacing it with not for profit taxation.

That's hard to believe when for-profit insurance companies make very little profit, that profit is very small compared to the overall costs of the health care system.

If you genuinely do see the world that differently than I to the point where the ethics of saving a human life have dollar signs consider this analogy of a homeless person.

You might walk past said person without offering spare change, you might well believe that their choices have led them there and you have no responsibility to help them. Many would consider you heartless

I don't think so, I believe many people regardless of political views, even those charitable in other ways, would feel uncomfortable about and not feel obligated to directly help an individual they randomly see.

However, would you go one stage further though and prevent them buying the last loaf of bread by outbidding them on it? Would you decide that their lack of personal responsibility weighed so heavily on your mind that you would not only fail to help them, but actively hinder them even if it cost you more to do so?

Of course I wouldn't hurt or hinder people, try and personally punish them when they're already in a bad condition, let alone if it cost me more.

That is essentially what you are suggesting with your free rider argument. you are accepting a private insurance system which costs you more than public taxation would and arguably delivers a weaker end product on the principle that it prevents others who haven't paid from also benefiting.

These are certainly bold claims. It's true that other advanced countries with health care by taxation spend less without having worse outcomes but that doesn't mean mean for the U.S. it wouldn't increase costs, overall and for many individually, and/or lower the quality.

 

[UncleRogi]

I'm not religious but I do follow the golden rule and especially the silver rule (don't do to others what you wouldn't done to you) and think that's pretty basic to morality and reasonableness.



That's hard to believe when for-profit insurance companies make very little profit, that profit is very small compared to the overall costs of the health care system.



I don't think so, I believe many people regardless of political views, even those charitable in other ways, would feel uncomfortable about and not feel obligated to directly help an individual they randomly see.



Of course I wouldn't hurt or hinder people, try and personally punish them when they're already in a bad condition, let alone if it cost me more.



These are certainly bold claims. It's true that other advanced countries with health care by taxation spend less without having worse outcomes but that doesn't mean mean for the U.S. it wouldn't increase costs, overall and for many individually, and/or lower the quality.

A question: the Trolley paradox:

If you saw train out of control, and you are the switchman, five strangers are tied to one track
and YOUR child is tied to the track that would be the other choice, what would you do?

Such is the choice of health care in America today
You could pull a Kirk, and have the train derail, killing a third of the passengers.
Who would you choose to die? And what would be the criteria?

America

Answer: save as many as possible. Remove an option?
Change the rules

 

[Spot261]

That's hard to believe when for-profit insurance companies make very little profit, that profit is very small compared to the overall costs of the health care system.

There are several ways a universal health care system saves compared to a private provider besides simply being not for profit. Bulk buying in a market where they have both a near monopoly on purchasing and are a subdivision of the very government which regulates the market are also factors. But crucially the price per head is based on income, yet none are excluded.

Literally no one can't afford the service and whilst those in higher tax brackets do pay more, their loss is in terms of relative luxury rather than life saving operations.

Of course I wouldn't hurt or hinder people, try and personally punish them when they're already in a bad condition, let alone if it cost me more.

Yet that is exactly what you are advocating. You are literally referring to people who can't afford healthcare but need treatment as "free riders". You have repeatedly referred to the idea of providing them that treatment as being immoral on financial grounds.

Thus your argument is that private healthcare is better because it excludes those who can't afford it from getting that treatment and that (assuming you are of middle income) you would rather pay more for that exclusivity.

 

[MacLeod]

The US spends roughly double what some other developed nations spend on Healthcare in terms of per capita spending. Yet has a lower lfe expectancy than those some countries. Of course the US healthcare system will perform better in some areas than others.

Sure healtcare provision isn't the sole factor in a lower life expectancy but it might factor in to it.

https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita


But even though emergency care is covered in the US regardless of ability to pay, someone still pays that bill likley throuigh higher insurance premiums.

But once again the biggest argument against for profit healthcare is you don't know what the future will hold. You might be able to pay your medical bills easily today, can you say that will definatly be the case for the rest of your life?

Are you sure you won't be diagnosed with a medical condition in the future that will be classed as a pre-existing condition should you need to change your health insurer in the future?

If you have children in the future can you be sure they wo't be born with what in the future would be classed as a pre-exisiting condition?

 

[Snaploud]

Let's keep in mind that universal healthcare does not necessarily mean single payer or preclude elements of for-profit healthcare.

 

[Leviathan]

What is a sound moral argument for rationing healthcare by financial prosperity?

I don't do 'sound' or 'moral'....but the thought occurs that if the prosperous are healthier they can be taxed more so you get more total health care to spread around.

Presumably healthier people contribute more money/tax to the system? If not, instituting cannibalism for the wealthy-but-untaxed is advisable.

 

[Tenacity]

The US spends roughly double what some other developed nations spend on Healthcare in terms of per capita spending. Yet has a lower lfe expectancy than those some countries.

Life expectancy in Japan is higher than in the European Union, what is the EU doing wrong?

 

[Robert Maxwell]

Life expectancy in Japan is higher than in the European Union, what is the EU doing wrong?

The EU isn't doing anything "wrong" in that regard, you are by comparing a large collection of substantially different countries to a single and highly homogeneous country.

Try comparing France and Japan, then you see they have almost identical life expectancies (within about a year of each other.) Same with Germany (though there is still a slight lag as the East is almost but not quite caught up with the West).

 

[Spot261]

Life expectancy in Japan is higher than in the European Union, what is the EU doing wrong?

Japan does an admiral job on healthcare.

Hospitals are legally required to be run on a not for profit basis, must be owned and run by health professionals, cannot be subsidiaries of profit making corporations and cannot legally deny treatment.

The government provides a national health insurance scheme which automatically covers 70-90% of the cost of any treatment required depending on individual need and is open to anyone. Said government also stipulates the price of private healthcare and insurance for those who choose it. Uninsured patients are never required to pay at all if they are on government subsidies .

All this whilst paying less than half the amount the US does per capita and completely outstripping it on life expectancy