Health care rights and responsibilities.

On my previous thread on Republicanism, access to health care was raised a few times as an important right in a modern society. It is hard for any sensitive person to witness the suffering of someone who is sick and suggest nothing should be done. But how far does our moral obligation extend, and what responsibilities lie on the individual? The argument is often framed in the terms that quality of health care provision should be independent of ability to pay. The first thing to point out is that this is unrealistic. Even if private medicine was outlawed, those with enough money would be able to travel elsewhere for better treatment. The only way that it could achieved is if the government spent so much on health care that the marginal impact of any extra spending was effectively nil. But not even rich Western nations have those kind of resources to spend even if they had the will to do so. Even at current growth rates, health care spending may become prohibitive. In the US, it is projected that health care may account for 20% of its economy within the next decade. Every dollar, pound or euro spent on health care is one not spent on other things which may have equal claim or greater utility. The NHS may cost much less than the private system in the US, but it effectively rations care through waiting lists.

So when health care is claimed as a right, how far does it extend? Do we mean that a certain minimum standard of health care should be provided? Some democratically agreed level of provision, or a best effort at matching the best private care? Is the right equal over different types of care – acute such as heart surgery, and chronic such as dementia? How do we draw the line, without seemingly uncaring or arbitrary?

The second thing to consider is what responsibilities an individual has, and how it interacts with their other rights. Imagine if a pill was developed that, if taken regularly, could produce large and measurable weight loss. Regardless of expense, there would be an outcry to get it available on the NHS. If a patient then did not take the medicine regularly and had complications as a result, many people would feel that it would be justified to refuse further treatment due to negligence of the patient. But if the doctor proscribed regular exercise and a better diet, and then suggested refusing other treatment if the prescription was not followed correctly, there would likely be a public outcry at an overbearing state (or doctors) invading the rights of the individual to live life as they choose. Should the government have the power of coercion to produce better health outcomes? If not, what can they do?

These are more than just an academic debate. The UK is justifiably proud of the NHS; access to health care remains a hot button issue in the Republic and the US. But attitudes can often be reflexive and unthinking, particularly on the left. How we develop policy depends largely on the answers to these questions. This might have been egalitarian, but did it make sense?

  • slug

    “Every dollar, pound or euro spent on health care is one not spent on other things which may have equal claim or greater utility.”

    As we get richer so we attach more importance to health and education. These services are best provided publically and it is fundamentally civilised that they are free at the point of use. That is why the share of GDP attached to the public sector should be high, and financed via a tax system that takes most from the rich.

  • Kensei

    slug

    If the rate of increase in the cost of health care and education is greater than the growth of the economy, then on a long enough timescale the cost of universal, absolute provision will outstrip the amount of money available. So what do we do?

    I also tend to agree that the provision should be public, as I do not want the profit motive interfering with decisions on my health. But that’s another issue.

  • slug

    “If the rate of increase in the cost of health care and education is greater than the growth of the economy, then on a long enough timescale the cost of universal, absolute provision will outstrip the amount of money available. So what do we do? ”

    It cannot increase faster than the economy forever but there is still room for it to grow and I would be happy for the % to be higher than it is now. Health is part of the economy-just as much as food, housing, tourism, etc. Its share can rise to a higher level. One positive is that patent protection eventually runs out for all drugs. So, long term, there are also savings to be had on these expensive drugs. Progress is made all the time in health outcomes.

    You are right when you ask about “Should the government have the power of coercion to produce better health outcomes? If not, what can they do?”

    One of the most shocking statistics that should trouble a republican (and I think you seem to define republican in such a way that I am one) is that a person in Glasgow can add 10 or more years to his life expectancy by being born in the right part of town. That’s even when both are covered by the health service. This shows that health service isn’t everything but people’s lifestyle, and the inequality of income, make a difference too. That’s where education comes in and where things that make society more equal: a progressive system of tax with good public services, come in. Things like making swimming free in all leisure centres would help. I don’t think that coertion is realistic here but doing things that change the cost of exercise does see realistic.

  • Kensei

    Slug

    It cannot increase faster than the economy forever but there is still room for it to grow and I would be happy for the % to be higher than it is now. Health is part of the economy-just as much as food, housing, tourism, etc. Its share can rise to a higher level. One positive is that patent protection eventually runs out for all drugs. So, long term, there are also savings to be had on these expensive drugs. Progress is made all the time in health outcomes.

    It can keep on growing for a very long time: patents do run out but there is a constant supply of new and better drugs or treatments made available. The 100% example is simply an extreme example to illustrate the point — but suppose it grew to 40% of the economy and plateaued. That is still extremely high, and the people involved in that research aren’t involved in say, education or in inventing the internet 3.0, or developing nuclear fusions to solve the energy crisis.

    More money can help, but it will reach a limit. The NHS rations at the moment – you’ll get seen but you may have to wait. You might not be able to get quite the newest drugs. Is there any way to draw that line without being callous?

    One of the most shocking statistics that should trouble a republican (and I think you seem to define republican in such a way that I am one) is that a person in Glasgow can add 10 or more years to his life expectancy by being born in the right part of town. That’s even when both are covered by the health service. This shows that health service isn’t everything but people’s lifestyle, and the inequality of income, make a difference too. That’s where education comes in and where things that make society more equal: a progressive system of tax with good public services, come in. Things like making swimming free in all leisure centres would help. I don’t think that coertion is realistic here but doing things that change the cost of exercise does see realistic.

    Is pumping money in enough? The cost to go swimming is quite small. The cost to go walking is even less. Surely there are social and cultural factors that are more important in getting people to do more exercise. The current Tory big thing is the “nudge”. Can we nudge people to do more exercise?

  • Pete Baker

    I was wondering why the focus was on expenditure via tax-payers’ funding.

    I think the problem is encapsulated here..

    “The only way that it could achieved is if the government spent so much on health care that the marginal impact of any extra spending was effectively nil.”

    There’s an assumption in that comment that increased over-all expenditure equals better health care.

    Now that may, or may not, be true in regards to specific medical treatments, but to confuse it with general health care – particularly when discussing whether or not governments should have the power of coercion [not defined] – is just misguided.

    And that’s before separating treatment costs from administration costs.

    If you want to assess general health care then the criteria should only be outcome – in terms of a population’s general health. Provided there is the availability of additional specific treatments.

    If you want to argue that public health provision should include every medical treatment, regardless of cost – which is where the majority of privately available treatments exist – then you need to address the current role of ethics panels who make decisions about whether or not any particular treatment is worth pursuing – as in this case.

    Now there’s coercion, via publicly funded media, that resulted in a ill-advised medical treatment being publicly funded.

  • Reader

    slug: is that a person in Glasgow can add 10 or more years to his life expectancy by being born in the right part of town.
    No – correlation isn’t cause. I could take years off my life expectancy by smoking, or by drinking more than I do. I could add years to my life expectancy by eating less and exercising more.
    It seems that all of the above life choices are correlated with education (which is another life choice), and with wealth (which isn’t). Now – untangle the causes and effects…
    By the way – swimming in a pool isn’t free – but it is cheaper than smoking and drinking. (Bangor Castle leisure centre – £1.60 concession (JS40))

  • RepublicanStones

    Its only a matter of time before John Q comes true.

  • slug

    Kensei

    “It can keep on growing for a very long time: patents do run out but there is a constant supply of new and better drugs or treatments made available. The 100% example is simply an extreme example to illustrate the point—but suppose it grew to 40% of the economy and plateaued. That is still extremely high, and the people involved in that research aren’t involved in say, education or in inventing the internet 3.0, or developing nuclear fusions to solve the energy crisis.

    More money can help, but it will reach a limit. The NHS rations at the moment – you’ll get seen but you may have to wait. You might not be able to get quite the newest drugs. Is there any way to draw that line without being callous? “

    Probably not. I feel the current restrictions on Altzeimers drugs are callous. I’d be prepared to pay more in tax for an NHS that provides them. But I agree that there is an element of bottomless pit.

    I think the broader question of whether helthcare will be a drain on our economy depends on how much healthcare will result in people living longer productive lives versus just living longer but unproductive (and increasingly frail) lives. If the latter then we will be poorer because there will be more and more old people needing caring. It is only civilised to spend resources on caring. But it will indeed mean that we sacrifice other things. In that sense we will have a bigger public sector and a smaller private sector.

    “Is pumping money in enough? The cost to go swimming is quite small. The cost to go walking is even less. Surely there are social and cultural factors that are more important in getting people to do more exercise. The current Tory big thing is the “nudge”. Can we nudge people to do more exercise? “

    How do you do it? There are massive forces encouraging us not to bother exercising. I don’t think you can nudge but making things free and dropping financial and psychological barriers will be key. So free swimming is part of that.

  • ulsterfan

    There is a lot of talk about how the Health Service should be funded and by agreement the public purse should pick up the Bill.
    It is also suggested the percentage of GDP should be increased.
    Lets also think of reducing waste and being more efficient and the Government exercising more control over the cost of drugs rather than give drug companies a free hand to set their own charges.

  • kensei

    Pete

    You missed what I was getting at. I must not have been clear enough, I apologise. I am not at this junction talking about improving health care or otherwise. The issue is how far does the right to medical provision extend? How you improve outcome depends on the outcome you want.

    There’s an assumption in that comment that increased over-all expenditure equals better health care.

    No, I don’t think I have. I started with the presumption that “Provision quality should be independent of ability to pay”. What I’m saying is that the best health care currently available, in the UK at least, is private health care. Private health care costs more than public health care. The government could increase spending to that level, but that would drive up the price of private care. To achieve parity, you’d have to increase spending to the point where the marginal utility of the next pound added is 0. That doesn’t necessarily say you’ve improved health care from its current highpoint — just now it is equal for everyone.

    If you want to argue that public health provision should include every medical treatment…

    I’m not arguing anything here Pete, I’m asking. Where do you believe the limit should be? Why? Where do we draw the line and deal with the consequences. As useful as input on my errors are, I’d rather hear a few ideas on that. I might disagree, but it might be interesting.

    Do we run solely on outcome? What if a treatment with low success affects a large number of people. It might save a lot of people, but be horribly inefficient and costly. What do you do?

  • kensei

    slug

    Probably not. I feel the current restrictions on Altzeimers drugs are callous. I’d be prepared to pay more in tax for an NHS that provides them. But I agree that there is an element of bottomless pit.

    Okay, you are happy to pay a bit more now. So would I. But suppose that you are the point where losing another £20 in tax causing you big financial headache, because things have got that tight. You are just at that point where there’s not a lot else to trim. What should I do, as a government funding the NHS. Does someone’s right to medicine trump your difficulty?

    If no, what do I do? Suppose I know I can cut costs if I can get more obese people to exercise. Should I restrict treatment if they don’t do it (giving an equivalent saving) in order to pay for Altzeimers or cancer drugs, or is that in violation of their other rights?

  • New Yorker

    I agree with Ulsterfan about lowering the cost of drugs. For all countries I’d like to see a price set per drug and if the pharmaceutical companies cannot meet that price, a state company should be set up to do so. In the US something like over 30% of the price of a drug is due to marketing and much of that could be eliminated. The 30% is what the pharmaceutical companies admit to. What is needed is an accurate cost of the actual chemicals and direct production of each drug. We might find out that a cholesterol lowering drug could be made in a ‘bare bones’ operation for several pennies but the pharmaceutical companies charge the NHS several pounds for the chemically identical drug. Today essentially all important research discoveries are made by universities and other public research facilities. Research by pharmaceutical companies is mostly for marketing purposes. Countries should review what is the most efficient way to produce drugs for their health systems. The way we are doing it today is an outdated and very inefficient system.

    Regarding the Glasgow study, how do you factor in genetics? We know genetics is a major factor in longevity.

  • LURIG

    A lot of hot air and piss and wind on here. ANY government that can afford to pump billions into illegal wars in the Middle East AND to prop up crooked financial systems can afford to fund the healthcare for it’s citizens. I am prepared to pay more in taxation to finance good healthcare BUT asking me to pay £20 – £30 to visit a doctor or £100 to visit casualty is taking the piss. No wonder those pensioners in the South have taken to the streets at losing their health cards. A greedy Fianna Fail government, in hock to dodgy builders and financiers, has been left exposed by their greed and expects the over 70’s to bear the brunt. Most of them have worked and paid taxes and Insurance contributions all their lives and should expect the state to help them when they need it. Quite rightly these citizens have told Fianna Fail “Go f**k yourselves” and I for one am taking great glee at Fianna Fail’s fate as they had it coming for decades. The people are rebelling, at last at last. The working man and woman have had their fill of these corpulant corporate fraudsters, both in politics and business. The French had the right idea for these unemotional, immoral, Marie Antionette, Gordon Gekko scavengers. The next time a banker, economist or politician tells us to expect a period of sacrifice and hard times we should bring back capital punishment and wheel out the guillotine. I’ll pull the lever…..GLADLY & FOR NOTHING.

  • kensei

    LURIG

    Governments can indeed spend more more on health rather than war. But if health is a “right”, and rights are trumps, health spending must trump all other spending. Is that sensible or sustainable in the long run?

    If education a right also? If there are limited resources, which gets first dibs?

    I am prepared to pay more in taxation to finance good healthcare BUT asking me to pay £20 – £30 to visit a doctor or £100 to visit casualty is taking the piss.

    What if you spend less in charges taxation than you did in taxation over your lifetime? Would you still find it to be “taking the piss”? Why — greater security in the taxation model, or the negative incentive to go to casualty in the charging model or some principle?

  • frustrated democrat

    Sadly we have a grossly inefficient NHS, the first thing we should do is figure out is how to make it more efficient and less wasteful. By just walking round a hospital I can see waste and practices that would not be tolerated in a commercial company.

    I suspect if we can do that then we will have enough money to pay for many more drugs without increased expenditure.

  • Average Earner

    Many (if not most) people in NI are fat, lazy, smoking, binge drinking, fry eating wasters who are either on the dole or dla or some other form of hand out.

    I’m tired of subsidizing these fat, work-shy bastards’ lifestyles while barely scraping by myself.

    This probably disqualifies me from being republican.

    That’s all I have to add.

  • LURIG

    kensei

    Education and healthcare are indeed a right and must be the priorities of any moral government (do they exist?). Spending (wasting!!) billions on illegal wars and bailing out crooked/corrupt bankers and financiers are NOT a right. Indeed it is bad government and hypocrisy of the worst kind. It is drummed into us by politicians, economists, bankers and the media that the capitalist Western system is the best way, right way and ONLY way. They tell us that the economic market must find it’s own true level and consequently millions were dumped on to the dole queues by Thatcher and Reagan as a consequence of the RIGHT way. The social fall out and misery were “inevitable” and “unfortunate consequences” we were lectured. It was all for “the greater good”……..until the nasty greedy sinsister fatcats started to devour each other and cried out for government intervention and help. Well well the worm has certainly turned. Western governments are now propping up the GREAT capitalist system and socialism and nationalism have taken over the financial markets. The capitalist system is now bobbing about at a false level because of governments interventions and money. Where is the mantra now of ‘letting the market find it’s own level”?
    Most people know that taxation and National Insurance contributions are part of life and we moan and shout about it but put up with it BECAUSE we expect our money to go to those facets and institutions that we need and depend on. My taxes are not for bailing out greedy b*****ds who spend £10000 on a bottle of wine during their boozy lunches or to disappear down a black financial hole in Iraq and Afghanistan. I EXPECT to pay taxes, and don’t mind paying higher taxes for decent quality of life; indeed we budget for this throughout our lives. When we hit pension age we should quite rightly expect that our working lives have paid for our public needs and health care and a decent pension are those basic requirements. I will NO longer take ANY lectures or demands from these financial clowns, they are only interested in profit, share and dividend price for themselves and investment groups AND how much of a bonus they can make. They are no better than punters who have backed the wrong horse. They can go and whistle Dixie and hang their heads in shame as can those in Westminster, Dublin and Washington who have done their bidding for decades. I am delighted at this global financial crash as it was a deck of cards built on foundations of sand in a wind tunnel. As far as I am concerned enough of them couldn’t throw themselves out of their 15th floor windows in the City.

  • LURIG

    Average earner,

    Take if from me, you will find as many DLA/ Income Support/Incapacity Benefit claimants on the Shankill, Newtownards Road, Tigers Bay as you will on the Falls, Ardoyne and Markets. Incidentally DLA is also claimed in great numbers in places like Larne, Carrick, Ballymena, Newtownards too. Go look at some statistics before you spout that stereotypical pish.

  • average earner

    LURIG:

    What is your point? Are you suggesting I was claiming only Catholics/nationalists are spongers?

    Where did I say that?

    Do you automatically assume people who vent about spongers are having a go at Catholics? Whay is that?

    I stand by my views.

  • Reader

    LURIG: Go look at some statistics before you spout that stereotypical pish.
    What are you on about? Average Earner didn’t say where the “fat work-shy bastards” were located. Or what foot they kicked with.
    And it was Kensei (in all innocence) who linked republicanism with a concern with health care.
    So, aren’t you just a wee bit hyper-sensitive? As my gran would have said – “squealing before you’ve been bit”

  • Dave

    On the contrary, Average Earner, it designates you as a republican. A republican would hold that political and economic policies should be at the sole discretion of the people via their elected government. That’s democracy. On the other hand, you have a group (predominantly socialist) who advocate that specific political and economic policies should be removed from that democratic process by the expedient of reclassifying them as positive rights. These positive so-called ‘rights’ then impose an obligation on government to implement predetermined policies, removing the discretion of the people to determine appropriate policies via the democratic process. That’s a perversion of democracy – and it’s also an abuse of the constitutional process as a document of negative rights that no true republican would tolerate.

    People have a right to keep as much of their earned income as possible. The State has no right to regard the taxpayers as the means by which it raises funding for the pet projects of political elites and vested interests, arbitrarily declaring how much of their money that they will be ‘allowed’ to keep. There is an underclass in society who believe that they have a ‘right’ to live off the labour of others. This underclass undermines the work ethic of the productive members of society who see that they are only marginally better off for working hard than those who have no intention of working at all. The dole in the Republic of Ireland is 3 times higher than it is in the UK, along with a plethora of other benefits. Is it any wonder that 150,000 of this underclass decided to migrate to Ireland and enjoy this dole lifestyle at the expense of the Irish taxpayers?

    Contrary to the myth, no one has been ‘let down’ by the State. The State never promised that free health care for all in perpetuity. And unless it was sitting on vast reserves of oil, no one expected that it could. Any policy is subject to change upon change of government or due to other pressures, so even if this government announced ‘free’ health care for all, the people understand that doctors have not agreed to work for ham sandwiches and the drug companies have not found a way of developing new drugs that doesn’t eat up tens of billions in R&D;costs, etc, so they should not expect that the policy will remain until they reach retirement age in decades hence.

    The only ‘guarantee’ of affordable health care is for the individual to assume responsibility for his own welfare. Every working individual in this State could afford private health insurance. Even those who are now retired could have afforded it and were well aware of the need to make such provision. They chose not to make that provision. This country, poor as it was, was never Zambia. Instead, they chose to spend their income on cigarettes, booze, holidays, etc, and to become a burden on others when they retired. They are responsible for the consequences of their own actions, and their own mistakes.

    There is absolutely no excuse for this generation not to make provision for their retirement. If they fail to do so, fu*k them. And if you think that attitude is hard, just wait until you see how hard the next generation will be.

  • LURIG

    Average earner/reader,

    If I have misinterpreted your comments I humbly apologise, I hold no grudges. I can sympathise with some of your comments AV, yes there are those who expect something for nothing in this life AND the benefit system is too easily manipulated. I wouldn’t argue against that but if governments put a tenth of the zeal into going after the corporate and financial criminals as they do going after ‘benefit scroungers’ I would have more sympathy. It’s far easier for us to go for the easy targets as it is to go for others. I would love to know how much is lost to the British Exchequer every year through off shore tax accounts and dodgy financial deals compared to benefit fraud. I would say the City types would win hands down. I despise the ‘world owes me a living’ brigade as much as anyone but I won’t point the finger at them as the sole blame for all our ills. That is a total nonsense.

  • average earner

    I fear you have just over taken me on the right with that post Dave.

    I can live with the idea of ‘universal’ health care to a certain extent. I’d just make fat people and smokers pay more.

  • Dave

    Sorry, AE. But I do tend to lean just a tad right of the proverbial centre.

    One other point: introduce an ‘option’ tax that each individual taxpayer can elect to tick if he or she agrees to pay an extra 5% of his earnings toward health care. Let them put their own money where their mouths are. If that every happened, and if it was ever possible to compare the mouths to the ticked boxes, I’m sure those most vocal in their demands for handouts would be the least likely to tick the box – mainly because they want to get stuff for free rather than to give stuff for free.

  • LURIG

    Dave,

    There is an “OVERCLASS in society who believe they have the right to live off the labour of others” and it is THEY who have determined government policy as we can see with this global financial meltdown. FFS what do we pay taxes and NI contributions for if not for health and pensions? Wasn’t it Lloyd George who introduced compulsory contributory payments from people’s wages towards old age and state pensions AND Attlee and Bevin who further developed National Insurance contributions towards the NHS? Tell me, if the government has NO obligation to pay towards health and pensions what are NI contributions for, are these NOT specific? OK, I might agree with you if ALL taxation was scrapped, then we might be expected to provide for ourselves but WE have EVERY right to demand that the State provides towards our old age provisions while we pay 1000’s of pounds per year towards them. It is NOT our fault if the sleazy, slimey fatcats in the City f**k up OUR money and pension investments with stupid, corrupt, ill advised practices. I have no sympathy, indeed the ordinary citizen must now demand that Westminster introduces a Public Inquiry into financial mismanagement within the City of London and Banking world. I won’t hold my breath.

  • Dave

    Well, Lurig, why should someone who pays for health care provided by the private sector also have to pay for public sector health care that he will never use? That is a double charge on those who assume responsibility for their own needs, thereby sparing the taxpayer the expense. State health care provision (if folks insist on the overpriced butcher shops) should be paid for by an optional tax where those who intend to use the service pay the tax and those who don’t intend to use it don’t.

  • Rory

    A business is driving down a country lane running close to late for an important meeting where he must sign closure on a million pound deal by a deadline. If he’s one minute late he loses the contract.

    Rounding a bend, he sees a car that has crashed; inside a mother and child seriously injured and in great distress. If he stops to give aid and comfort he will be late. His dilemna is, do I stop and use my mobile phone to call for an ambulance and stay till it arrives and give what aid and comfort I can or do I drive on, calling for an ambulance as I drive, and promising myself that maybe I will later make a donation to a local hospital after the deal’s gone through?

    What a dilemna for the poor man. Here is wanting to do the right thing and stop, which is the first choice, but also needing to morally justify driving on to save the contract, which would be the second choice if he plumps for that.

    Society’s role is to relieve him of that dilemna by taking the choice away from him so that he has no choice but to do the right thing. In terms of this discussion that means the provision of all necessary medical care free at the point of use to be funded through taxation levied according to one’s income. Any alternative that would deprive any individual of treatment for any illness because of their lack of wealth would be simply barbarous (with apologies to the Barbarians among whom such barbarism would not have been countenanced).

  • Comrade Stalin

    Dave,

    Well, Lurig, why should someone who pays for health care provided by the private sector also have to pay for public sector health care that he will never use? That is a double charge on those who assume responsibility for their own needs, thereby sparing the taxpayer the expense.

    Because it’s not a charge, it’s a tax, which implies redistribution. Fundamentally, for whatever reason, some people in society will require more health care than others. Some people are born with problems, or have genetic defects, or just happen to get hit by a car one day; or they have other lifestyle circumstances (not necessarily bad habits) which mean they are more likely to get sick. You may very well argue that it’s not your problem and that such people just have to pay their own way. Reality tells us that even people who live a careful and prudent existence, with no wish to leech off the state, can happen upon bad luck and hard times.

    This state of affairs also exists in the USA, in a more clandestine way. Many hospitals do not turn the uninsured away, and by law, emergency rooms also cannot turn the uninsured people away. The costs incurred by providing those people with treatment have to be met, and that is done by loading those costs onto the charges paid by those who are able to pay.

    Those who wish to peruse the private sector in the UK ultimately benefit from the NHS, as it provides a baseline for the private hospitals to compete against.

    I’d point out that people who damage their health through smoking or drinking (for example) are already heavily taxed for their sins. I’m sympathetic to the principle, but I’m concerned that this argument that people who knowingly take risks with their lives should pay more to reflect the increased risk. Where do you stop ? Do you start taxing unhealthy foods ? What do you do with people who pursue any kind of sport ? Cycling, for example, is a good way to improve your general health – but if you’re in an accident with a car you’re likely to end up requiring some degree of medical care.

    State health care provision (if folks insist on the overpriced butcher shops)

    People in the UK will defend the NHS to the death, and there used to be a time (perhaps there still is ?) when the charge of attempting to damage the NHS would be a very serious one in UK politics. I don’t believe the UK public perceive the NHS as “overpriced” or “butcher shops” and, by most statistical measurements, it works quite well.

    should be paid for by an optional tax where those who intend to use the service pay the tax and those who don’t intend to use it don’t.

    An “optional tax” is a contradiction in terms. You’re talking about a service charge. Service charges can’t work for any healthcare system in a country that has certain basic human values that require a certain basic level of health care treatment. Ultimately all of them, including the ones in the USA, involve some degree of redistribution, and I don’t believe it will ever be possible to escape from that without completely abandoning our humanity and compassion.

  • consul

    If we’re going to talk about the state’s obligations as regards healthcare then we’re talking about public health system. First of all I have no problem with private health. I think it’s a great thing in fact. If you’ve got the means to pay and you want the best, then the best of luck to you, no problem.

    So lets talk about public health which the state in my opinion has a responsibility to provide. The aim in this republic should be to stop the hemorrhaging of funds i.e. exorbitant salaries for consultants and advisors, less regions, less red tape etc. Basically an end to the gravy train culture. There’s to many people in the HSE, and the output does not match the input. This leads to unequal service depending on where you live where for example there are significant differences in response times of ambulances. Also depending on location some people face much more challenging travel arrangements than others in order to access vital services. These are some of the problems that I see at the moment.

    Now as regards medical bills, everything should be means tested and not because we’re facing into a tougher period, this should always be the way in good times and bad. Anyone who’s able to pay should pay, anyone who’s not in a position to pay but needs medical attention should receive it.

  • RepublicanStones

    ‘State health care provision (if folks insist on the overpriced butcher shops) should be paid for by an optional tax where those who intend to use the service pay the tax and those who don’t intend to use it don’t.’

    Unless you have some sort of spider sense or third eye and can see into the future, the above would be a risky choice. Im willing to bet that there have been some people who pay for private healthcare have ended up in an A&E;or two.
    But if you wanna go down that road, hows about an optional tax for those who want to use the police or take the law into their own hands, and one for those who want their country to have armed forces and one who doesn’t (a la Patricia McKenna).

  • kensei

    Rory

    You’ve ignored the initial point. What if he’s not on the way to a contract, but to deliver food to relieve starvation?

    What happens when there is insufficient resources to meet you description? What if meeting it means 505 unemployment? You might claim that these scenarios are unrealistic, but we’re talking hypothetically to try and establish the principle.

    consul

    On unequal service — we could push power down the system and give people more say in how their health services at run either at board or council level. We could offer more individual choice in where you go. Completely equal treatment implies a degree of central control. Is that worth it, even if the average health care was bette rin a devolved system?

  • Rory

    “What if he’s not on the way to a contract, but to deliver food to relieve starvation?

    Shame on you for asking, Kensei. What the hell do you think a man should do? Ask yourself the damn question!

  • Harry Flashman

    How did we as a society allow ourselves to be so infantilised that we now regard free health care provided by the state as a right?

    Are there any other “rights” that the state needs to deliver? I only ask because I see millions of adults who are capable of providing a home for themselves and their families, to provide heat and light to those homes and to feed and clothe themselves and their children and they seem to manage this complex balance of first rate necessities very much on their own without having to wait cargo-cult like for the gub’mint to hand it to them.

    Do you think that just maybe, left to their own devices (and with that massive proportion of their hard earned income which the government forcibly confiscates from them to fund a clappped out apparatus supporting more index-linked civil servants than the Red Army and which in return kills tens of thousands of sick people every year) the average families throughout the country might just be able to manage their own health care provisions same as they do their food and shelter?

    Someone above spoke in outrage at the concept of paying 100 quid to visit an A&E;unit. Why? You may only have to visit such a unit three or four times in your lifetime and in return for receiving excellent care from well trained and dedicated professionals in a clean and comfortable clinic you will only be expected to hand over such a paltry sum.

    This is a country remember where people think nothing in spending thousands of pounds to follow football teams or take holidays in Florida or drink themselves insensible every weekend but being asked to pay for your healthcare causes outrage.

    The last time I visited an A&E;unit it was inundated with drunks seeking relief from their self inflicted stupidity. Is it too much to expect that they might be asked to pony up a small proportion of the cash they regularly piss against walls to pay for the damage they do to their health?

  • kensei

    Shame on you for asking, Kensei. What the hell do you think a man should do? Ask yourself the damn question!

    Why is it shame? I am simply trying to see how people respond to a tricky moral problem. I can reframe again if you’re not satisfied with the setup. But I was asking you, and you are still ignoring the question.

    Harry

    The Government certainly sets up the system whereby you can have those things.

    It is also clear from the American example that a lot of people don’t manage their health care priorities well, and in the right circumstance can be pushed under by the cost. People on lower incomes can buy lower cost foods or substitute in other ways but if you need expensive medicine then it is unlikely (though possible) you will able to make such a substitution. I don’t believe it can be trivially compared to buying your shopping, or arranging your heat.

    And moreover, if people started finding they couldn’t get food or heat, I think you’ll find the government beginning to take a lot of flack. A bit like, well if your banking system starts to melt, the government might just be called to bail it out.

  • It;s not so much that in the US they don’t manage things that well – it’s that the insurance companies won’t take them on at all, or only at outrageous prices. I love the notion that wanting an NHS is infantilised. Lex talionis is of course the mature and civilised approach to society.

  • Harry Flashman

    “A bit like, well if your banking system starts to melt, the government might just be called to bail it out.”

    Yes, and more fool the government, or more precisely the taxpayer, for doing so.

    I do take aboard the point that many people cannot afford the best of healthcare (although I utterly reject the notion that food and shelter are “trivial” concerns), but to use this situation to orientate society such that the government gets to be the primary arbiter of every citizen’s health care and of their right to live or die is utterly absurd.

    Government funded healthcare should be an insurance scheme, a safety net as it were, designed to intervene only in desperate cases and allowing the rest of society, the vast majority, the liberty to make their own conscious, free and informed decisions regarding their own life choices.

    Gerald Ford famously said that the government big enough to give you everything you wanted was big enough to take away everything you own. So it is if you go down the route of government organised healthcare for everyone. Not only the eyewatering waste and inefficiencies which alone would justify scrapping the idea, but in principle the idea of conceding your right to organise your own and your own family’s affairs to government officials, no matter how benign they might claim to be, is very dangerous.

    When I am seventy years old and in need of important surgery I want the decision to do so or not dependant on me, my family and our resources and not on the whim of some faceless bureaucrat who has to decide spending targets that day.

    I wish to remain a free citizen, not a number in a government book.

  • So Harry is private healthcare banned at the minute because of the NHS? Is it likely to be when you are 70, thus preventing you from using the choice you value so much? Of course, you are likely to be able to afford this. What about those who are not? Fuck them?

  • kensei

    Harry

    I do take aboard the point that many people cannot afford the best of healthcare (although I utterly reject the notion that food and shelter are “trivial” concerns), but to use this situation to orientate society such that the government gets to be the primary arbiter of every citizen’s health care and of their right to live or die is utterly absurd.

    The thing with health care is that “the best of health care” often means “getting something that you need you otherwise wouldn’t get” rather than “getting something a bit better”.

    Second, it’s not that food or heat is trivial, it is simply that there are much more widely available and have many substitutions. Prices, despite recent ticks up have tended to fall relative to income. It is not a fair comparison.

    Government funded healthcare should be an insurance scheme, a safety net as it were, designed to intervene only in desperate cases and allowing the rest of society, the vast majority, the liberty to make their own conscious, free and informed decisions regarding their own life choices.

    Define a “desperate case”. If someone squandered money they could have spent on health insurance partying and now have cancer, do you allow them to die?

    And if people refuse to have health insurance, they may well push costs onto the rest of society. Classic freeloading. Should they really be allowed?

    So it is if you go down the route of government organised healthcare for everyone. Not only the eyewatering waste and inefficiencies which alone would justify scrapping the idea, but in principle the idea of conceding your right to organise your own and your own family’s affairs to government officials, no matter how benign they might claim to be, is very dangerous.

    The cost of health care in the US versus Europe will kill any argument based on “efficiency”. Moreover, have you used the NHS, ever? It’s hardly Soviet Russia, and it is hardly a threat to your freedom.

    When I am seventy years old and in need of important surgery I want the decision to do so or not dependant on me, my family and our resources and not on the whim of some faceless bureaucrat who has to decide spending targets that day.

    I’m sure private care will always be available. If you are skint you might want the option of free care.

  • Greenflag

    kensei .

    ‘the cost of health care in the US versus Europe will kill any argument based on “efficiency”. ‘

    And that more than any argument based on ‘morality ‘ is the reason why there is crisis in US ‘ free market ‘ private insurance only based health care in the USA and why next to the economy and quite possibly also because of the economy it is a huge issue in the Presidential election.

    Paul Krugman the American Nobel Prize economist details the ‘economic’ insanity of the present Private Health Care system in the USA which costs twice as much per person and delivers the USA shorter life expectancy than any other major developed country . The World Health Organisation rates the USA as 37th in the world .

    The American Health care system is unravelling because of basic ‘economics’ and the huge waste in administrative costs annually estimated by McKinsey Global and others as up to 400 billiob dollars (i.e two years of Iraqi War costs at present expenditure levels )

    In the ‘real world’ as opposed to the theoretical world of the Chicago School of Economics (Milton Friedman -a.k.a high priest of fundamentalist neo conservatism – the truth is seen in the detail of how thousands of individuals are personally bankrupted through needing a serious operation . Every year a minority of Americans will incur huge medical expences – they’ll need a heart bypass, chemotherapy , dialysis etc . The Pareto principle will as usual apply with 20% of the population (mostly elderly ) accounting for 80% of costs . The sickest 1% of the population will need more than 150,000 dollars worth of medical care .

    Only a very small number of Americans can afford to pay 150,000 dollars out of pocket . And even fewer if and it often does, such costly medical care goes on for years . Modern medical care is available to middle class Americans only because someone else pays most of the bills if and when the need for expensive care arises .That some else is of course the private health insurers through the premiums of millions of others and also post age 65 very often by ALL of the taxpayers

    Private insurance companies in the USA have little incentive to pay for preventative care treatment even if such care saves large amounts in future medical costs . The most notorious example is diabetes where private insurers won’t often pay for treatment that would control the disease in its early stages but will pay for expensive foot amputations that are often the consequence of diabetes getting out of control.

    Beyond all the direct pragmatic reasons for having a system of universal health care there are of course indirect but equally valid economic reasons as to why such a system is mmore in tune with today’s ‘economy’. First it’s become abundantly clear that ‘competition’ in Health care provision has not reduced costs but actually increased them more than anything else .

    People nowadays change their jobs more frequently than in the past . Most Americans in any event could not afford private health insurance if their employers did not contribute anything form 100% to 50 % of the cost . The number of American companaies who can afford this expence (or say they can’t afford it ) has reduced in recent years and at the same time the number of Americans without health insurance has increased . Labour mobility is also impacted because employees are very often reluctant to leave a job with health benefits for one where the ‘benefits ‘may be somehow different and not suitable for their individual circumstances.

    Of course the Bush/Cheney neo cons don’t ever want to see Universal Health Care ‘working ‘ in the USA . That would be tantamount to having to admit that the ‘mixed ‘ economy works and that Government intervention which is anathema to the extreme right can actually work to everybody’s benefit .

    Britons should defend their NHS with their lives and the rest of us in the EU should make sure that nothing remotely similar to what passes for health care in the USA at this time.

  • Harry Flashman

    “Of course, you are likely to be able to afford this. What about those who are not? Fuck them?”

    I have answered that by my point that government health care should be available as a last resort, kensei asks what constitutes a desperate case? A fair question and one that I’m prepared to use as the basis of a government health care policy rather than the current one of just flinging money at a hopelessly mismanaged state run NHS.

    I have a philosophical antipathy to government control; usually government controls are brought in for the best of reasons, invariably that control grows like topsy until the benefits of the citizen are overturned in order to assist the government to control the citizens.

    I am not saying the NHS is like the Soviet Union but I am making it very clear that the rationale behind universal, government controlled, state run health care is the identical rationale behind Soviet style rule and as such should be challenged at every step. To lazily accept such arguments for health care is to concede the principle and when the state says it wants to control food distribution, employment, housing, child care and the other multiplicity of “rights” how can you argue against them when you’ve already accepted the basic premise?

    So I am not some sort of “let them eat cake” merchant who airily dismisses the problems of health provision but my hackles rise when the only solution put on the table is more state control and less individual liberty. It’s a slippery slope, concede the bastards nothing, make them prove that they need the powers and freedom of choice that they demand you surrender to them, at all time remain sceptical of governments seeking more control and examine whether you and your neighbours are actually well enough equipped and educated enough to handle the problems on your own without eroding any more of your hard won liberty.

    They only wanted to tax you, then they only wanted to educate your children, then they wanted to look after your health, then they wanted to examine your emails and phone conversations to protect you, now they want to serve you better by giving you a number on a card with your personal details and in order to look after you better you must show it to any government official who demands it or go to jail.

    They are nice people who seek to control you, give in to them and they will look after you and if you are over eighty and blocking a hospital bed that could be used for someone else or a handicapped child that might use up too many precious state resources, well no one will mind if the government takes the necessary actions now will they?

    It’s all for the common good, isn’t it?

  • Greenflag

    to finish above ,

    Britons should defend their NHS with their lives and the rest of us in the EU should make sure that nothing remotely similar to what passes for health care in the USA at this time ever sees the light of day in Europe .

  • kensei

    Harry

    I am not saying the NHS is like the Soviet Union but I am making it very clear that the rationale behind universal, government controlled, state run health care is the identical rationale behind Soviet style rule and as such should be challenged at every step. To lazily accept such arguments for health care is to concede the principle and when the state says it wants to control food distribution, employment, housing, child care and the other multiplicity of “rights” how can you argue against them when you’ve already accepted the basic premise?

    Harry, this is principle beyond reason. There are a number of ways to box in government to this particular issue, rather than accepting the whole principle. Health care is fairly unique as regards 1. expense 2. consequence if left to its own devices. Principle is all very fine and I respect that, even if I don’t buy the Reaganesque “socialised medicine is the passport to serfdom” nonsense, but in the real world it must bend to an extent with pragmatism.

    Second, public health care doesn’t necessarily have to mean government control; the UK runs that way and seems happy with it, but it does not mean that it must happen that way. It does mean a lot of public money though, whichever way you cut it. What we are effectively talking about is how to best insurance against risk — in the model you are talking about, health insurance is like car insurance. You are assessed individually, rated for risk and charged accordingly. So a 19 year old new driver will pay heavily for insurance on a fast car. But translate that to health, and a 50 year old with a family history of heart conditions and poor lifestyle will pay through the nose. Effectively the most charge heads to those that are most vulnerable. The sensible solution seems to be to socialise the risk — because we have little control over our genetic makeup and well, who knows what will happen to us to tomorrow. But as I pointed out originally, we run into the problem of limited resources.

    You accepted the question, but I notice you didn’t answer it. Should people dying for freedom mean they die for want of cancer drugs that a socialised solution could afford?

  • Greenflag

    harry flashman ,

    ‘So I am not some sort of “let them eat cake” merchant who airily dismisses the problems of health provision but my hackles rise when the only solution put on the table is more state control and less individual liberty.’

    The USA has experimented with a ‘free market ‘ for the under 65’s and Medicare (State control ) for over 65’s . The former spends 15% of it’s funds on administration the latter 2% .

    The extra administrative costs of the ‘free market ‘ for under 65’s as opposed to medicare is some 85 billion dollars a year in 2003 – probably closer to 100 billion today .

    The ‘they ‘ you refer to in to above is the government you elect .

    The Milton Friedman school of neo conservative economics is and has been proved to be destructive as regards health care for individuals and for access to education throughout the world . It has destabilised countries and led to military dictatorships such as Pinochet in Chile and the Argentinian Generals to mention just two .

    It’s also the basis of the fundamentalist ‘free market ‘ ideology which has led to the present worldwide economic crisis .

  • Harry Flashman

    Kensei, the discussion of fine tuning the provision of healthcare by the state is an excellent debate and one which you and I could probably bat back and forth for hours and at the end of which you might find I was more generous than you.

    However I approached this thread from the philosophical tone set by your opener and that seemed to me to be conceding the right [i]a priori[/i] to the government to decide how medical provision should be distributed and that philosophical angle was what immediately set off my alarm bells.

    I am more than happy to fine tune the way government handles health care but under no circumstances will I concede the right of a government official to decide how I lead my life.

    If I were to put it in crude terms of Irish history, at the Treaty negotiations I might have been happy to allow the British to hold on to their ports, I might have conceded the Commonwealth connection, who knows what more I might have given but an oath of allegiance, which from basic principle, gave the King of England sovereignty over Ireland I would never allow.

    So it is with state run health care; if the government stands on a policy of increasing it, I can grudgingly go along but under no circumstances will I concede that the taxes I pay towards the state run system gives them ownership over me or that government officials will dictate to me how I live my life, how much I drink, what my children eat or whether I am allowed to live past eighty and I’m afraid there are just far too many people who would actually give the government those very powers.

    Not me, no sir, never.

  • Greenflag

    ‘as I pointed out originally, we run into the problem of limited resources.’

    If the vast majority of the people other than the top 2% who can actually afford full private health insurance are part of a universal system then everyone pays a premium based on earnings with an upper and lower limit . The cost of prescription drugs would go down because of single buyer power .

    Limited resources will always be a problem . In the USA this is becoming the major reason why the present privatised system is unravelling and ‘eating ‘ up the real economy apart from the huge waste of time and administrative expense incurred .

    As for those who ‘abuse’ a universal health care system in disregarding or failing to follow doctor’s orders then some disincentives have to built into a system to encourage people taking more personal responsibility for their ‘health’ where that is practically possible .

    As it is many people go to the doc for no good ‘medical ‘ reason up to as many as a third according to some estimates . Health education needs to be taught not just in the home but perhaps in primary school as a means to reduce obesity levels and point out the dangers of smoking and excess drinking to private health .

    As resources will always be limited the objective for our politicians in the interest of fairness has to be the greatest amount of basic health and emergency live saving care at the least cost .

    BTW – Messrs Robinson and McGimpsey have to be commended on their move re drugs for cancer patients . People facing a probable terminal illness should not have extra ‘stressors ‘ imposed on them .

  • kensei

    Harry

    However I approached this thread from the philosophical tone set by your opener and that seemed to me to be conceding the right a priori to the government to decide how medical provision should be distributed and that philosophical angle was what immediately set off my alarm bells.

    There is a certain element of that because that is current how it runs in Northern Ireland. But I think the point stands whether the system is run by the state or not — to get to the point where health care is equal regardless of ability to pay requires a lot of state money no matter what. Once the state (or society, if you like) has committed funds, it’s right to ask what is required what the expectation in return is.

    I am more than happy to fine tune the way government handles health care but under no circumstances will I concede the right of a government official to decide how I lead my life.

    Okay – so should treatment be refused then? How do you deal with freeloaders?

  • Harry Flashman

    @kensei

    “Okay – so should treatment be refused then? How do you deal with freeloaders?”

    If you create a system which gives a universal free service to all comers you are going to get “freeloaders” as sure as the sun wil rise tomorrow. The solution therefore lies in not creating such a system in the first place.

    If however the only solution you can envisage is universal free health care provided to all comers then “freeloaders” as you call them are an intrinsic part of the package. As the Kerryman said when asked for directions; “well now I wouldn’t be starting from here in the first place sir”.

    @Greenflag

    “Health education needs to be taught not just in the home but perhaps in primary school as a means to reduce obesity levels and point out the dangers of smoking and excess drinking to private health.”

    You obsess so much about the system of society and governance in the US it seems you lose track of what is being debated.

    I have no opinion one way or the other about the benefits or otherwise of the US health care system, and as it is extremely unlikely I will ever avail of their services I couldn’t care less.

    However freedom and liberty mean a lot to me and your post above amply demonstrates why I have such a visceral distrust of government taking over control of me and my family’s health.

    You can just see how this “health education” in the home would take place can’t you? The humourless lady from the government coming into your home to question you on your drinking and smoking habits. You sitting nervously on your sofa with your wife as she goes through a lengthy questionnaire before going into your kitchen to look in your fridge, check through your bin and then heading up to your children’s bedrooms to see what is of interest to her there, tsk-tsking as she goes through her clipboard and reducing your state provided health care provision with every click of her ball point pen.

    Of course now that she’s inside your house she can maybe check a few other things out, the council suspect you aren’t recycling enough and frankly they think your back extension should qualify for a higher council tax band but they haven’t been able to check it out yet. And your oldest son’s rather extensive collection of World War II books might indicate a militaristic obsession which needs watching as well as your daughter’s obsession with boy bands indicating a need to discuss sexual awareness issues no doubt even though she’s only eight years old.

    Yes the joys of state run health care, an unalloyed blessing, no one could object, it’s all for the children after all. Government is always benign, Nanny always knows best.

    Form an orderly line there, it’s only a shower, to delouse you, it’s for your own benefit, it’s healthy.

  • Harry,

    I know you’re indulging in rhetorical flourishes, but really – from the NHS to the Nazi death camps is plain silly. Similarly with suggesting its logic extends to executing old people and sick children. Let’s not forget the NHS is to save lives, not take them. So that kind of falls down there. We live in a world where wealth determines life expectancy. The NHS helps to even out the playing field somewhat. The reckless taking of lives lies not in the principle of universal health care provided by the state, but in a world where you get only what health care you can afford.

  • kensei

    Harry

    If you create a system which gives a universal free service to all comers you are going to get “freeloaders” as sure as the sun wil rise tomorrow. The solution therefore lies in not creating such a system in the first place.

    You’ll find similar problems in any system that gets any government money or subsidy, unless it is shockingly clever.

  • Harry Flashman

    “Similarly with suggesting its logic extends to executing old people and sick children.”

    You think so Gari?

    Really?

    I can point you to numerous instances when the case for abortion and euthanasia has been made by high minded individuals entirely on the utilitarian basis that it’s better to kill off useless humans than allow them to waste the precious resources of the NHS.

    I suspect you too are familiar with such things.

    Like I say, it’s a very slippery slope.

  • I can honestly say I’ve never seen anyone advocate abortion to spare the NHS. Nor euthanasia. That is usually made as a quality of life issue. There are though suspicions that this happens in Holland, which is a very good reason for opposing euthanasia.

  • lamh dearg

    Re USA

    40% of population have no cover,
    illness is commonest cause of personal bankruptcy
    average cost of health insurance in 2006 – $3000 per individual ($1000 per month for average family)
    two recent people I met who had to use American Healthcare while on holidays, a man with a minor transient stroke – bill $500000, young woman with simple bladder infection $11500

    Re NHS

    15% of patients fail to turn up for appointments,
    estimated up to 30% of treatments (drugs, physio, therapy etc) not complied with.
    rationing by stealth (by waiting list, by postcode) and by regulation (NICE Guidelines)

    Or we could try the European model with co-payments and compulsory Social Insurance with the insurance market managed to prevent cherry picking of healthy patients by Insurance companies (as Mary Harney tried to do in the South). The theory being that the co-payments encourage responsibility and an appreciation of the value of the service while the compulsory insurance stops unfortunate people with expensive illnesses losing everything. No proof it works though.

    Some problems do not have a solution and health provision is one such. A health service could spend 100% of GDP if it was allowed to and still have gaps and deficiencies.

    A balance with fairness, protection of the vulnerable, tough business dealings with drug companies (who are as entitled to reasonable profits as anyone else and do have huge R&D;costs) along with a ceiling or cap resulting in explicit, up front rationing seems the reasonable goal and sounds very like the NHS (with less political interference and a stronger version of NICE). Of course the rich will get around the cap and rationing by going abroad but we will at least do the best we can for the resources we commit.

  • Greenflag

    lamh dearg ,

    Ironically the present financial crisis in the USA looks like it could be the final straw that breaks the back of resistance of the Insurance Industry , the Drug Companies and many in the Medical Profession to ‘universal health care ‘ or a one payer system as per this article -author quoted below.

    ‘The huge increase in the federal debt that these bailouts will entail intensifies the pressure to rein in health-care costs. This favors comprehensive rather than incremental reform.

    Before the financial crisis, the most likely options for controlling government health-care costs involved tinkering around the edges–striking a new deal between Medicare and physicians on their pay, initiating more demonstration projects in paying for performance and efficiency, and assessing comparative effectiveness of new tests and treatments.

    While absolutely valuable, these policies are far from certain to control health-care costs–and it will be five or 10 years before they are likely to generate savings. Paradoxically, only more radical changes in the health-care system are likely to actually save money and improve care–and more quickly. For instance, the Wyden-Bennett health-care bill–which proposes more extensive changes than either Barack Obama’s or John McCain’s proposals–is the only health-care legislation scored as budget neutral by the Congressional Budget Office. The CBO said that in the first year of full implementation, the expenditures would equal revenues, and in subsequent years the Wyden-Bennett bill would generate a surplus because it would save the health-care system money. The Lewin Group, a health-care policy research and management consulting firm, estimated that within a decade this plan could save as much as $1.4 trillion. No other health-care legislation comes close.

    Some will find this comprehensive reform unpalatable because it removes employers from health care altogether. As the economy stagnates, this may be absolutely necessary to keep employers afloat. Facing a rising deficit, more comprehensive reform that can really control costs begins to look more realistic than a few untested adjustments here or there.

    The dean of health-care economists, Victor Fuchs of Stanford, has long maintained that we will get health-care reform only when there is a war, a depression or some other major civil unrest. It’s beginning to look like we might just have all three.

    While the financial crisis has appeared to knock health care off the national agenda, in the strange chemistry that is American politics, it may in fact make comprehensive health-care reform more politically feasible, indeed maybe even absolutely necessary for fiscal stability.

    Ezekiel Emanuel is an oncologist and chair of the Department of Bioethics at the National Institutes of Health. He is the author of Healthcare, Guaranteed: A Simple Secure Solution for America.

  • kensei

    lamh

    The problem with explicit rationing is that you have to refuse drugs to people who are very, very worthy.

    How about this for “up front rationing” though — where there is a generic drug that is reasonably effective but has been superceded by a newer, better drug, the public purse will pay for the generic, but require co-payments to meet the cost of the new drug?

  • Harry Flashman

    “I can honestly say I’ve never seen anyone advocate abortion to spare the NHS. [b]Nor euthanasia[/b].”

    Gari you haven’t been paying attention of late.

    Dementia sufferers have a ‘duty to die’

    Some juicy quotes:

    “The veteran Government adviser said pensioners in mental decline…should be allowed to opt for euthanasia even if they are not in pain.”

    “…there was “nothing wrong” with people being helped to die for the sake of…society.”

    “Lady Warnock goes further by claiming that dementia sufferers should consider ending their lives through euthanasia because of the strain they put on their families and [b]public services[/b]”

    Welcome to Nurse Ratchett’s Brave New World, it’s for your own good, drink it up, all of it.

  • Fair enough Harry. Never saw that, and never heard anyone else said it. I don’t think she’s representative, and – and here is the important part – she is not calling for other people to be able to make the decision to kill someone when they become a burden, but rather for people who feel they have become a burden to have the right to opt for suicide.

  • Harry Flashman

    It’s a slippery slope Gari.