Public health care

[opebo]

Why on earth cover only emergency room care?  What a waste.  Provide a full health package that keeps the people as healthy as possible and you reduce the expensive emergency room visits.  Mainly poor people need regular doctors visits, and treatment and medications for chronic ailments.

[opebo]

'Public' bureaucracy is often just as efficient as 'private' business.

[opebo]

I meant more in a structural sense.  I think the emphasis placed on 'incentive' in selling us on the design of institutions/organizations in capitalist society is really over done. 

In fact what motivates most people in an organization is 1) security and 2) fear (of getting fired/caught/yelled at).  Very few people in even a 'private' organization have significant opportunities for financial gain.  No, the cogs in the machine, whether nominally 'public' or 'private' - are kept in line with a combination of penal threats and 'assurational' security - alas in our particular society mostly the former and very little of the latter.

Anyway the point of this is that the balance is a bit better in a government bureaucracy - the cogs have more security and a little more defense against abuse.  Contrary to capitalist rhetoric this means they are enormously happier.. whether this translates into better functioning of the organization I don't know.  But in neither case does incentive in the sense of irregular or performance-based reward above salary have much to do with said better functioning.

Of course the big argument in favour of 'private' incentive is innovation..  but what we demand from most of the institutions that make up our health-care system is care, and in fact care of a rather basic nature.  Housing people, giving them already-designed treatments, drugs, cleaning them, etc.  Yes, the doctor on the ground has to diagnose, but I would still argue that this is a more bureaucratic function than entreprenourial.  As Ebowed points out the profit motive can be counterproductive in basic care situations - I shudder to think that the persons caring for me in my old age and/or infirmity will be motivated by reducing costs. 

It seems to me that the only areas in which the 'profit' motive might lead to a better functioning of the health care system would be development of new drugs and treatments. 

[opebo]

What you're neglecting is that in a market where there is free competition, the consumer is free to penalize bad services by simply going somewhere else, whereas there is an incentive to provide good care. In a government monopoly, there is no incentive whatsoever since the patient has no alternatives, the only incentive is to perform a bad service so there will be problems and funding will be increased.

And I'm afraid what you're neglecting is that fifty percent of americans cannot afford any health care, and thus are not 'free to penalize bad services by simply going somewhere else'. 

The government 'monopoly' will provide better service than the the 'private' one does, for the very large number of people who get no service at all currently.

[opebo]

The fundamental problem with health care in America is that its too expensive. Even huge companies like GM are struggling under the weight of health care costs for employees and retirees. The reason it is so expensive is that it doesn't operate as a competitive free market. Fix that problem and the costs will come down by themselves. Then it will be more affordable for everyone.

Is that really the reason?  It is the sort of thing that is just not going to be all  that cheap, given the training and technology involved.  I suspect the main reason it costs a lot in the US is patent enforcement.

[opebo]

The fundamental problem with health care in America is that its too expensive. Even huge companies like GM are struggling under the weight of health care costs for employees and retirees. The reason it is so expensive is that it doesn't operate as a competitive free market. Fix that problem and the costs will come down by themselves. Then it will be more affordable for everyone.

Is that really the reason?  It is the sort of thing that is just not going to be all  that cheap, given the training and technology involved.  I suspect the main reason it costs a lot in the US is patent enforcement.

There are a few areas of medical care which still operate as a competitive free market. In those areas costs are reasonable or even decreasing. Vision correction surgery is not usually covered by insurance or Medicare so it still operates as a free market. 20 years ago that process cost about $3000 per eye, but today it is frequently advertised for less than $1000 per eye. I understand breast augmentation has undergone a similar price reduction. (You should appreciate that    )

Over the counter drugs are another example. Walk into any drugstore and you see a wide assortment of products for various conditions. Competitive products are displayed side by side with prices shown. And they are all relatively inexpensive. Want pain relievers? If Tylenol is too expensive how about Advil instead? And if that's still too costly how about aspirin? And if Bayer is too much you can buy the generic brand dirt cheap. The thing is that customers can make cost comparisons and pick whatever meets their need and fits their budget. If the manufacturers want to sell their product they must offer it at a competitive price or customers will buy something else. Competition drives low prices. It really works.

Yeah, like I said  about the patents.

[opebo]

Yeah, obviously the point was that the US legal system imposes a monopoly which creates extremely expensive drugs.  As you pointed out generic drugs - those upon which patents have expired or never existed - are very cheap.  Of course 'drug development' may cost money, and a system may be required to fund this... but the general point that patents greatly increase costs is a valid one.

[opebo]

Rather than eliminate patent rights, a better solution for government might be to streamline the approval process so it doesn't cost so much to get a drug approved.

Is it really necessary to use poor people as guinea pigs just to save a few bucks?

[opebo]

Rather than eliminate patent rights, a better solution for government might be to streamline the approval process so it doesn't cost so much to get a drug approved.

Is it really necessary to use poor people as guinea pigs just to save a few bucks?

Number one - no one said that. But despite the rigorous procedures required for FDA approval, drugs still get approved which later prove to have dangerous side effects. There is no such thing as 100% safe. But you can spend an unlimited amount of money trying to make them 100% safe, and you end up making drugs extremely expensive. Lets have reasonable safety procedures but not procedures that make drugs unaffordable.

Number two you were just complaining about the high cost of drugs, but you don't want to do anything to reduce the cost. Although I suspect you are going to propose something like murdering all the rich people and using their money to pay for prescription drugs.

Actually we're currently murdering poor people to pay for everything that the rich get, so turnabout would be fairplay.

Anyway I suspect blaming the FDA is just another right-wing red-herring.

But no, my proposal is not to 'make drugs affordable', since for the lower half of the population this would be virtually impossible.  When you have no disposable income, it doesn't matter how cheap something is.  No, I propose that we tax the owners to pay for the health care of the commoners, David S. 

[opebo]

The people who allegedly can't afford health care (you're providing that figure absolutely proof-free, as if it were an obvious fact everyone knows) can always use credit or other means, such as charity or even pay in cash.

Pay in cash?  They have NO MONEY, you simpleton.   As for credit, who will give them credit?  The Payday Loan shop?  Sure, it will advance them the paltry few hundred from their paycheck, while they have one, at several hundred percent interest.  How does that help with tens of thousands in medical bills.  And finally regarding charity - patently absurd.  The fact that you mention it shows you understand nothing.  That's precisely like me saying regarding the problem of mugging - 'oh perhaps if the mugger is kind he will let you keep something'.

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Why would an employer keep someone onthe payroll who cannot work?  Ridulous - anathema to your system. 

'Trapped', you say.  No one is trapped like the working class in the US - they have no way out of a lifetime of insecurity.   They would gladly trade a position on a waiting list that takes at most a few months for the certainty they currently have of never getting any health care.

[opebo]

How many people really have "no money"? Very few I'd expect. Certainly not 50% of the american people. Credit cards are widely available. As for charity, do you deny its existence? I'd like to see you offer any evidence of that.

Millions have just enough to pay rent, buy food, get transportation to work.  that's it.  They certainly don't have tens of thousands of dollars sitting around for health care.

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And yet, this happens all the time. An employee carries with himself significant know-how and human capital that is not simple replaceable--that is why originally companies elected to pay for health care of their workers even before it was the practically required mandate it is today--they wanted him healthy and back at work. That doesn't mean he'd be on the payroll, obviously, tough many companies have a form of sick pay, but he wouldn't be fired.[/quote]

If he is not making his meager paycheck, he cannot pay for his health insurance, which will be looking for any way possible to terminate him now that he has become a cost.  As for health care being a 'required mandate', what are you talknig about?  Most workers in the US do not have it - only the very fortunate elite minority are offered decent health care - mostly those who remain in unions.

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How do you know that? Did you ask them? Do you even know anyone on the amerian working class? Stop pretending that you understand the "workers" you so completely despite and fear. All that fake concern that fools nobody cannot mask the fact that you are nothing but a moton wallowing in your own intellectual feces.
[/quote]

What 'concern'?  I'm just talking politics here, Bono.  You may be right - the working class do seem to be a bunch of masochists, so maybe they like being used, abused, and consumed.  But I'll also wager that some of them may not actually like it - they simply have no choice.  That's the hallmark of the system you embrace - Force.