# Private vs. public healthcare



## television (12 Jun 2008)

_Split by moderator from thread on Lisbon Treaty_.



Purple said:


> Points 1-4 make a strong argument against a public health system.


 
I dont think so.



Purple said:


> or a least show that massive reform is required.


 
Perhaps but not with a for profit agenda. 



> 1. An inability of european governments to pay for the hugh costs associated with modern health care.


Good quality and equitable health care costs. In a private system the middle classes will end up spending a large part of their disposable income on it. While the poor will be severly disadvantaged due to their inability to pay.

if you dont believe in the principle of equity of access regardless of income then this will not be important. Call me a marxist but i believe your ability/lack of to pay should not decide the quality of the health care you recieve. And all the evidence from private systems world wide suggests that it leads to an devide of access between those who can afford to pay and those who cant.


​


----------



## ubiquitous (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> One of the biggest areas of litigation in America is Health related issues.



Its naive to single out America in this regard. The same applies in this country, and probably all developed countries.


----------



## GeneralZod (13 Jun 2008)

*Re: The Lisbon vote*

According to this the US spends more public funds per capita on health than Ireland does. That doesn't seem to fit in with the picture we get of the situation there.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



GeneralZod said:


> According to this the US spends more public funds per capita on health than Ireland does. That doesn't seem to fit in with the picture we get of the situation there.


 
According to these figures America also spends far more on private health care than any other country.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



ubiquitous said:


> Its naive to single out America in this regard. The same applies in this country, and probably all developed countries.


 
Even if that is true. My point was refering to the fact that another poster was complaining about incompetence of the public system. I was making a point that in a country like america that has a very large private system there is still incompetence as can be seen in the amount of litigation.



ubiquitous said:


> Your comment would be outrageous and libellous if directed at a single individual. It is ridiculous when directed at a third to a half or more of our electorate. The notion that one sector in society are morally superior to another on the basis of their opinion on a particular political issue is absurd.


 
Very well said.


----------



## Purple (13 Jun 2008)

*Re: The Lisbon vote*



Mpsox said:


> I voted yes for a number of reasons
> 
> Firslty, I detest with a passion the majority of those campaigning for a no vote. If they are not the purveyors of a defunct political idealogy(Marxism), then they are incapable of saying anything other then No(Patricia McKenna) or have the blood of thousands on their hands
> 
> ...


Superb post (but havu=ing read Ubi's comment I can see where he's coming from)


----------



## GeneralZod (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> According to these figures America also spends far more on private health care than any other country.



That fact was is so well known I didn't think it was necessary to point it out. Combined the amount of health spending per capita is twice Ireland's figure.
I'm not advocating the American system BTW before you make that assumption.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



GeneralZod said:


> That fact was is so well known I didn't think it was necessary to point it out.


 
It is the balance between the two that is important. it shows that the American system has a greater relience on private. Health care costs in America are porportionally far higher  than in Europe which means America has to spend more proportionally to achieve the same outcomes. 

And i am talking about inequity within a private system. Sometimes statistics do not truly show up real inequity.


----------



## Purple (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> which means America has to spend more proportionally to achieve the same outcomes.


How do you know that the outcomes in America are the same? From my experience if you have the insurance their health system is much better than ours.
By the way I also agree that healthcare should be available free at the point of consumption for all citizens. I do not agree that these services should necessarily be provided by a public health system. Basically whomever can provide services (to the required level of quality), in the most efficient way, should do so.


----------



## room305 (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> The french heatlh care system is free at the point of access for all and where people do pay there is various rebate systems.


 
Like many of your friends on the left you seem to have great difficulty distinguishing between a public healthcare system that is privately provided and an entirely private health care system.

75% of the more than 4,000 hospitals in France are owned by and managed by private companies on a for-profit basis. The fact that the cost of treatment in these hospitals is heavily subsidised is a function of the French national healthcare and social security programme.



television said:


> There is plenty of evident for the fact that there is a great difference between the type and quality of health care in America between those who can afford to pay and those who cannot.


 
The US healthcare system has many problems but there is a lot of exaggeration in this area too. By and large, in an emergency I'd take my chances with the American public health system ahead of ours.



television said:


> One swallow does not make a summer and one private hospital does not make the swedish health system privatised.


 
I tell you that the largest hospital in a country with one of the best public health care systems in the entire world is run by its shareholders on a for-profit basis and you dismiss this in favour of anecdotal stories about US hospitals?

As we have seen with your Lisbon Treaty propaganda, you are never one to let the facts get in the way of your beliefs.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



Purple said:


> How do you know that the outcomes in America are the same? From my experience if you have the insurance their health system is much better than ours.


 
If you have insurance. What about the millions who dont? 




Purple said:


> By the way I also agree that healthcare should be available free at the point of consumption for all citizens. I do not agree that these services should necessarily be provided by a public health system. Basically whomever can provide services (to the required level of quality), in the most efficient way, should do so.


 
Thats fine in theory. The only problem is when the profit motive is used in Health there is tendency to place a greater emphesis on saving money and excluding those who cannot afford to pay. If i beleived, that in a fully privatised system, all regardless of income would have equal treatment and access then I would be happy to say yes to a private system.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



room305 said:


> Like many of your friends on the left you seem to have great difficulty distinguishing between a public healthcare system that is privately provided and an entirely private health care system


 
Two thinks, being on the "left" is not a term of derision for me. If being on the left means i believe every person regardless of income desreves equality of access and treatment in a health system than yes i am on the left. 

2. I aggree with you about the french system. 



room305 said:


> As we have seen with your Lisbon Treaty propaganda, you are never one to let the facts get in the way of your beliefs.


 
Thats just funny


----------



## Purple (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> If you have insurance. What about the millions who dont?


 Most of them have Medicare. The problem is that some earn too much for Medicare but too little to buy insurance. Both presidential candidates in the USA have said they will address this.



television said:


> Thats fine in theory. The only problem is when the profit motive is used in Health there is tendency to place a greater emphesis on saving money and excluding those who cannot afford to pay. If i beleived, that in a fully privatised system, all regardless of income would have equal treatment and access then I would be happy to say yes to a private system.


 There is no country in the developed world where the government is not the biggest purchaser of healthcare services. Their function should be to regulate and police the system and buy services from those providers who can meet the standards for the best price. 
It's hardly news that our public system is dirty, inefficient and very badly policed. All while our per capita spend, adjusted for inflation, has more than doubled since 1996. This is hardly the sort of universal service that we should strive for.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



Purple said:


> Their function should be to regulate and police the system and buy services from those providers who can meet the standards for the best price.


 
Give me a little time to think about that. But in theory I have no problem with that idea as long as all regardless of income have equal access to treatment. But America private spending on health ccare in america out weights public spending. And look what that has achieved for things like equity.


----------



## Purple (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> But America private spending on health ccare in america out weights public spending. And look what that has achieved for things like equity.


What it has given is a public system that is, on balance, better than ours, and a private system that is much better than ours.
By the way, no ER in America can turn a person away without treating them, regardless of whether or not they have health insurance. They may only stabilise them and ship them off to a public hospital but they can't turn them away.


----------



## csirl (13 Jun 2008)

*Re: The Lisbon vote*



> Two thinks, being on the "left" is not a term of derision for me. If being on the left means i believe every person regardless of income desreves equality of access and treatment in a health system than yes i am on the left.


 
You mean that your from the strata of society that believes it should get a free ride on the backs of everyone elses hard work. Why should everyone else pick up the tab for you? Health insurance is not expensive in Ireland - most working people can afford it. Why not get a job and pay for it?

Dont give me the what about old, kids, handicapped etc? Providing free health care to those who are unfortunate enough to be able to support themselves is an entirely different argument to providing free health care to those who are too lazy to get a job.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



csirl said:


> You mean that your from the strata of society that believes it should get a free ride on the backs of everyone elses hard work. Why should everyone else pick up the tab for you? Health insurance is not expensive in Ireland - most working people can afford it. Why not get a job and pay for it?.


 
Health insureance for me and my family is around 2 grand (not a big family!). you think this is affordable for some one with 3 or 4 kids on an average industrial wage where its probalbly doubled?



csirl said:


> Dont give me the what about old, kids, handicapped etc? Providing free health care to those who are unfortunate enough to be able to support themselves is an entirely different argument to providing free health care to those who are too lazy to get a job.


 
Tell that to the families of workers of companies in ireland who have gone bust in the last few months and who are unemployed through no fautl of their own.

And yes I believe in values such as community spirit, helping those who need it. giving people a helping hand if they are poor. and free health care to those in need who cant afford to pay. Those are values that are important to me and I hope remain important for the majority Irish people as I really think they still are.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



csirl said:


> Why should everyone else pick up the tab for you?


 
I have no problem picking up my share of the tab for universal free health. Its essentially about community and about looking after each other.


----------



## Purple (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> Tell that to the families of workers of companies in ireland who have gone bust in the last few months and who are unemployed through no fautl of their own.


 Ironically due in no small way to the wage inflation driven by benchmarking and the other massive pay increases that those in the health sector have received over the last few years.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



Purple said:


> Ironically due in no small way to the wage inflation driven by benchmarking and the other massive pay increases that those in the health sector have received over the last few years.


 
Funny. But more due to weakness of the Amerian economy, Global Oil  prices, etc to be fair.  What ever the reason, calling these people lazy is pretty crude.


----------



## Purple (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> But more due to weakness of the Amerian economy, Global Oil  prices, etc to be fair.  What ever the reason,


 But we can't do anything about global factors. We can do something about our relative efficiency (since global factors effect everyone).



television said:


> calling these people lazy is pretty crude.


 True


----------



## csirl (13 Jun 2008)

*Re: The Lisbon vote*



> Health insureance for me and my family is around 2 grand (not a big family!). you think this is affordable for some one with 3 or 4 kids on an average industrial wage where its probalbly doubled?


 
The average income in this country is not far of 40k per year. 2k is only 5% of this. 2.5% if both parents are working. Considering the importance of being healthy, this percentage spend on healthcare is very low. Even if the family has an income of only 30k per annum, it is still a small percentage of total income. People spend more money on holidays, beer, expensive consumer electrical goods etc. than they do on health insurance, but which is more important?



> Tell that to the families of workers of companies in ireland who have gone bust in the last few months and who are unemployed through no fautl of their own.


 
Even with the slowdown, we are still importing 10,000s of workers per annum. Go into most businesses in Ireland and you'll find imported workers. An unemployed person in Ireland should have no problems getting a job.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



csirl said:


> The average income in this country is not far of 40k per year. 2k is only 5% of this. 2.5% if both parents are working. Considering the importance of being healthy, this percentage spend on healthcare is very low. Even if the family has an income of only 30k per annum, it is still a small percentage of total income. People spend more money on holidays, beer, expensive consumer electrical goods etc. than they do on health insurance, but which is more important?


 
Average household income was 35000 in 2005 lets say its 40000 today.

So a family with three kids 2 parents working, with costs like creches cars morgages, food, fuel, etc etc etc,. Im sorry but a family on 30,000 a year who have to pay 2000 for health care and you dont think thats alot of money??? What planet are you on seriously. 



csirl said:


> An unemployed person in Ireland should have no problems getting a job.


 
Tell that to the 200000 spungers out there.


----------



## csirl (13 Jun 2008)

*Re: The Lisbon vote*



> Im sorry but a family on 30,000 a year who have to pay 2000 for health care and you dont think thats alot of money???


 
6.67% is a low percentage. As I said earlier, what % do they spend on luxuries?



> Tell that to the 200000 spungers out there.


 
You said it. How many of these are genuinely out of work? If a foreign person can arrive in Ireland with little more than some clothes in a suitcase and after a short time, be in regular work, able to support a family etc. with little or no support from the State, I see no reason why the 200k spongers cant.

e.g. there are c.100,000 Chinese people working in Ireland, doing some of the lowest paid jobs that exist here. All, as non-EU citizens, require private health insurance before being even allowed to enter the country. So if they can afford it, why cant you?


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



csirl said:


> You said it. How many of these are genuinely out of work?


 
I was being ironic. Really no talking to you on this one. We will have to agggree to differ.

6% for someone on a low income is a lot of money. and a person on a lwo income has some rights to things like a night out or a holiday once a year as well as affordable health care.


----------



## diarmuidc (13 Jun 2008)

*Re: The Lisbon vote*



csirl said:


> 6.67% is a low percentage. As I said earlier, what % do they spend on luxuries?



I looked on the VHI and for a family of 2 with level 1 day to day cover the yearly premium is 1816Euro. With an average wage of 40,000 that's 4.5% of  ones income. Sorry but that's a low percentage. If you want universal publicly funded health care, what increase in your social insurance are you willing to pay? Do you know how much the French pay for their system? Google it, you might be surprised.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



diarmuidc said:


> I looked on the VHI and for a family of 2 with level 1 day to day cover the yearly premium is 1816Euro. With an average wage of 40,000 that's 4.5% of ones income. Sorry but that's a low percentage. If you want universal publicly funded health care, what increase in your social insurance are you willing to pay? Do you know how much the French pay for their system? Google it, you might be surprised.


 

Sorry buy]t 4.5% for a family with 2 kids is not a low percentage. it is a very high persentage. it 1800E which is a hell of a lot of cash. And its not an average wage im talking about it the average househould income which is a completly different figure.

If I believed that there was a unoversally public system that counld be accessed by all equaly regardless of income then i would be willing to pay my fair share that is afordable to me based on my income. And yes that will mean the richer members of societly will pay more but im willing to pay a little more if it means helping those who cannot.


----------



## Purple (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> Sorry buy]If I believed that there was a unoversally public system that counld be accessed by all equaly regardless of income then i would be willing to pay my fair share that is afordable to me based on my income. And yes that will mean the richer members of societly will pay more but im willing to pay a little more if it means helping those who cannot.


I support a universal health insurance system where both private and public patients are seen as a source of income as opposed to the current system where public patients are a drain on hospitals resources but private patients are a source of income. 
In agree that those who can pay more should pay more. I also support a health system that is free (or close to free) at the point of consumption but that doesn’t mean that it has to be publicly provided.


----------



## diarmuidc (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> Sorry buy]t 4.5% for a family with 2 kids is not a low percentage. it is a very high persentage. it 1800E which is a hell of a lot of cash. And its not an average wage im talking about it the average househould income which is a completly different figure.



So I will ask again. What % increase in your social insurnace/tax/whatever are you willing to pay? Do you know how much the French pay for their system?


----------



## redstar (13 Jun 2008)

*Re: The Lisbon vote*

Isn't this all a bit vague, and is typical of arguing using generalities which sound good but don't stand up to scrutiny..



television said:


> Sorry buy]t 4.5% for a family with 2 kids is not a low percentage. it is a very high persentage.


High compared to what ?



> it 1800E which is a hell of a lot of cash. And its not an average wage im talking about it the average househould income which is a completly different figure.


What is the average household income ?



> If I believed that there was a unoversally public system that counld be accessed by all equaly regardless of income then i would be willing to pay my fair share that is afordable to me based on my income. And yes that will mean the richer members of societly will pay more but im willing to pay a little more if it means helping those who cannot.


OK, but what is 'a little bit more' - Less than 4.5% ? You say that 4.5% is very high, so does that mean you wouldn't pay that much. How much would a universally available healthcare system cost ?


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



redstar said:


> Isn't this all a bit vague, and is typical of arguing using generalities which sound good but don't stand up to scrutiny..
> 
> 
> High compared to what ??


 
 if you are paying a big morgage have one kid in a crech and one in a primary school. running a car, inlfation biting economy not going to well. 1800E is a hell of a lot of money. its the real world im talking about here. 



redstar said:


> What is the average household income ??


 
http://en.wikipedia.org/wiki/Median_household_income
   A useful guide to giving an idea of household incomes



redstar said:


> OK, but what is 'a little bit more' - Less than 4.5% ? You say that 4.5% is very high, so does that mean you wouldn't pay that much. How much would a universally available healthcare system cost ?


 
Very high for a family on the average industrial wage yes.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



diarmuidc said:


> So I will ask again. What % increase in your social insurnace/tax/whatever are you willing to pay? Do you know how much the French pay for their system?


 
What I would be willing to pay and what a guy with two kids earning 40000 a year should pay are very different.

I would be willing to pay porportanally more than him but porportanally less than someone who earns more than me. 

The french system is run through a serious of health insurance schemes. the fact about the frenc system is that level of income will not determine the kind of health care avalible. It is a equitable system. But it is under treat.


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



diarmuidc said:


> I asked *you* what percentage increase *you* on your hypothetical 40k/year with 2 kids is willing to pay. Can't you answer that question?
> 
> 
> 
> ...


----------



## S.L.F (13 Jun 2008)

*Re: The Lisbon vote*



Purple said:


> I support a universal health insurance system where both private and public patients are seen as a source of income as opposed to the current system where public patients are a drain on hospitals resources but private patients are a source of income.
> In agree that those who can pay more should pay more. I also support a health system that is free (or close to free) at the point of consumption but that doesn’t mean that it has to be publicly provided.



People who can't afford the VHI fees are not a drain on resources they have paid for the service through their taxes and PRSI.

People who pay for VHI have already paid once through their taxes and PRSI then pay a second time to jump the queue.


----------



## diarmuidc (13 Jun 2008)

*Re: The Lisbon vote*



television said:


> Actually for him it would be completly free health care for his children and a small contribution from his wages say 2% or perhaps nothing.



So to pay for 2 people + 2 kids health insurance some other poor schumck is going to have to fork out, what ? 20% increase in his tax contribution?


----------



## television (13 Jun 2008)

*Re: The Lisbon vote*



diarmuidc said:


> So to pay for 2 people + 2 kids health insurance some other poor schumck is going to have to fork out, what ? 20% increase in his tax contribution?


 

No a fair and equitable amount based on their level of income.


----------



## diarmuidc (14 Jun 2008)

*Re: The Lisbon vote*



television said:


> No a fair and equitable amount based on their level of income.


So you want universal healthcare but are refusing to say who will pay for it and  how much you will pay for it. Typical.


----------



## television (14 Jun 2008)

*Re: The Lisbon vote*



room305 said:


> That's hilarious. You voted no to the Lisbon Treaty in case it resulted in further privatisation of Irish health services but you _actually pay_ for private health care for yourself.
> 
> It is refreshing to see someone whose beliefs run so deep.


 
I am not like that woman who stayed on the public list and ended up dying of cancer because she didnt get treatment in time. Yes i am fortunate enough to pay for VHI but I believe in the principle that those who cannot afford to pay what i can should get the same kind of treatment as me. And i think that a not for profit health system is the best mechenism to deliver this. A for profit health system creates a divide between those who can pay and those who cant. that is unfair and immoral.


----------



## television (14 Jun 2008)

*Re: The Lisbon vote*



diarmuidc said:


> So you want universal healthcare but are refusing to say who will pay for it and how much you will pay for it. Typical.


 

Listen I could give you a arbetary figure but what would that mean exaclty. But if you want me to I will. Ok a extra % in the top rate of tax for all those earning 50 grand and one and a half% for those earning over 75 grand. with factors taken into account like number of children etc. However someone earlier mentioned the labour idea of a universal health insurance scheme akin to the french system. Where contributions would be based on income.


----------



## room305 (14 Jun 2008)

*Re: The Lisbon vote*



television said:


> A for profit health system creates a divide between those who can pay and those who cant. that is unfair and immoral.


 
Yet you continue to pay for said services despite your stated aversion to private health care. Why worry about Europe foistering private health care on the Irish public when you yourself are already driving the demand?

You believe that health care should only be provided by the public sector. No choice for the consumer. Yet when faced with the choice between public and private sector health care you find the public sector wanting and opt for the private sector intead. I am not condemning you for this in any way. If I had dependent children I'd probably purchase private health insurance as well. However, I do find it galling that you desire to deny others the same choice.

Anyway, I'm dragging this thread off-topic. There is discussion [url="http://www.askaboutmoney.com/showthread.php?p=622403#post622403]here[/url] concerning public/private healthcare which is probably more suited to a continuation of this discussion.


----------



## television (14 Jun 2008)

*Re: The Lisbon vote*

What is driving demand for me is the fact that the public health service is so underfunded people like me have no option but to get VHI etc. this does not mean that a far more equitable system should not be put in place. It creates a two tier system where those who can afforf to pay do and those who cant get left behind. this is wrong. And a publically funded not for profit system is the only equitable way forward.


----------



## television (14 Jun 2008)

*Re: The Lisbon vote*



room305 said:


> Yet you continue to pay for said services despite your stated aversion to private health care. Why worry about Europe foistering private health care on the Irish public when you yourself are already driving the demand?
> 
> You believe that health care should only be provided by the public sector. No choice for the consumer. Yet when faced with the choice between public and private sector health care you find the public sector wanting and opt for the private sector intead. I am not condemning you for this in any way. If I had dependent children I'd probably purchase private health insurance as well. However, I do find it galling that you desire to deny others the same choice.
> 
> Anyway, I'm dragging this thread off-topic. There is discussion here concerning public/private healthcare which is probably more suited to a continuation of this discussion.


 
And youtalk about consumars of health care like health care was the same as purchesasing a TV. This is what is wrong with privitisation of health care provision. People become consumars and doctors become health care providors. And a patient is called a "client". Using the languege of business will do nothing good for health care. Mark my words.


----------



## room305 (14 Jun 2008)

*Re: The Lisbon vote*



television said:


> What is driving demand for me is the fact that the public health service is so underfunded people like me have no option but to get VHI etc. this does not mean that a far more equitable system should not be put in place. It creates a two tier system where those who can afforf to pay do and those who cant get left behind. this is wrong. And a publically funded not for profit system is the only equitable way forward.


 
Under-funded? We pay more per-capita for our public health system than France. The problems are not money but general public sector incompetence and malaise exacerbated by a union strong hold.

It's hard to imagine how dismantling the private sector (the most successful part of the health system) will improve things. Would you be happy if the government announced tomorrow that private health care was evil and from now on everyone would have to rely solely on public health care.


----------



## television (14 Jun 2008)

*Re: The Lisbon vote*



room305 said:


> Under-funded? We pay more per-capita for our public health system than France. The problems are not money but general public sector incompetence and malaise exacerbated by a union strong hold.
> 
> It's hard to imagine how dismantling the private sector (the most successful part of the health system) will improve things. Would you be happy if the government announced tomorrow that private health care was evil and from now on everyone would have to rely solely on public health care.


 
where doyou get you figures from. Iam not saying dismantle the private sector. I am saying that if private sector health care is the only option then poor people who cannot afford it will suffer.


----------



## S.L.F (14 Jun 2008)

*Re: The Lisbon vote*

Our health service was seriously underfunded for 20 or so years.

Any money being put into it now is only helping to play catch up.

Playing catch up always costs more because you are not only upgrading but you also have running costs to deal with too.


----------



## Complainer (15 Jun 2008)

*Re: The Lisbon vote*



room305 said:


> That's hilarious. You voted no to the Lisbon Treaty in case it resulted in further privatisation of Irish health services but you _actually pay_ for private health care for yourself.
> 
> It is refreshing to see someone whose beliefs run so deep.


It's not funny at all. Many, many Irish people (including myself) who have deep reservations about the creation of a 2-tier health service have no choice but to take out private health insurance to protect their families given the atrocious state of the public system. 

The thousands of children born using IVF technology would not exist without the private healthcare system, given that the Dept of Health don't provide IVF services to public patients.


----------



## television (15 Jun 2008)

*Re: The Lisbon vote*



room305 said:


> Would you be happy if the government announced tomorrow that private health care was evil and from now on everyone would have to rely solely on public health care.


 
Yes if i meant a good quality service that has equality of access to all regardless of ability to pay.


----------



## Brianne (15 Jun 2008)

I think there are people arguing here who are throwing out huge statements about our health system which aren't necessarily accurate.

Everyone living in Ireland and certain visitors to Ireland are entitled to free maintenance and treatment in public beds in Health Service Executive (HSE) hospitals and voluntary hospitals. Some people may have to pay some hospital charges. Holders of [broken link removed] and certain other groups do not have to pay charges.
*There are daily in-patient charges, an out-patient charge and some long-term stay charges.*


The charge for in-patient/day services is €66 euro per day up to a maximum of €660 euro in a year (1 January 2008). The charge does not apply to the following groups:


Medical card holders
People receiving treatment for prescribed infectious diseases
People who are subject to "long stay" charges
Children up to six weeks of age, children suffering from prescribed diseases and disabilities and children referred for treatment from child health clinics and school board examinations
People who are entitled to hospital services because of EU Regulations
Women receiving maternity services
So basically everyone has the above. What would happen if all those in VHI etc. decided to drop their private insurance and use the system?
Well the system would collapse and maybe then people would realise that this health care system out of which FF government in the 1980's took three thousand beds, is not adequate . Yes we had that many more beds in 1980's Ireland when the population was up to half a million less , when people were not living as long and when many of the procedures which we now take for granted such as CAT Scans and MRI were either not around or in their infancy.
Then, if there was a revolution and the Irish people wanted an NHS situation would we, the electorate put in a government who said they'd increase taxes? The system was stripped , the private system developed and some would say took pressure off the public system but now hard decisions have to be made.
Will we allow any government to make them?
Will we allow our local hospitals to be downgraded and go further for certain treatments?
Health care is an endless demand curve and all this talk about the private system being efficient is  just that.........talk.
The private system doesn't deal with major accidents, old people with dementia and multi disease who are waiting on suitable nursing homes. The private system doesn't have the orthopaedic lists f.......d up for the next two days because joy riders or drunken drivers or plain road traffic victims need urgent operations and automatically jump the list.The private system can pick and choose, the public system can't.
They operate on you in the private system but if things go really wrong, where do you end up.......back in casualty at 3 am being looked after by the public system.
Futhermore we had clean hospitals, I remember them:we also had domestic staff,,,,,,yes the dreaded public servant who cleaned them. Now the cleaning is done by private companies employing people on low wages.We didn't value some of the most important people in the system.....yes the cleaners.......
I think people should be entitled to use private health care, I also think they have paid for the public system and should avail of both if it suits and there is no reason why if efficiencies in administration and management with extra funding were agreed on by the taxpayer , we couldn't have a good public system as well.
Incidentally the midwife who was not able to work the epidural machine could have been reported to the Chief Nursing Officer and also to An Bord Altranais; we have a highly regulated nursing profession  and surely a reprimand with further training or conditions attached to her/his registration would be a better result.


*
*


----------



## television (16 Jun 2008)

Brianne said:


> I think there are people arguing here who are throwing out huge statements about our health system which aren't necessarily accurate.
> 
> Everyone living in Ireland and certain visitors to Ireland are entitled to free maintenance and treatment in public beds in Health Service Executive (HSE) hospitals and voluntary hospitals. Some people may have to pay some hospital charges. Holders of [broken link removed] and certain other groups do not have to pay charges.
> *There are daily in-patient charges, an out-patient charge and some long-term stay charges.*
> ...


 
Brilliant post. Well informed. Well done.


----------



## csirl (16 Jun 2008)

> A for profit health system creates a divide between those who can pay and those who cant. that is unfair and immoral.


 
As a previous poster said, you are confusing 2 issues here - (1) whether or not there should be universally available public healthcare at taxpayers expense & (2) whether or not public healthcare should be provided by the private or public sector.

It is possible to have universally available public healthcare at taxpayers expense which is provided entirely by the private sector on a for profit basis.

Is your issue with the provision of healthcare by private companies or is your issue having equal level of healthcare for all citizens regardless of whether or not they can afford to pay extra for better service?


----------



## television (16 Jun 2008)

csirl said:


> It is possible to have universally available public healthcare at taxpayers expense which is provided entirely by the private sector on a for profit basis.
> 
> 
> 
> ...


----------



## csirl (17 Jun 2008)

> I dont believe it is possible because heath care sometimes costs more than is economically viable. Health is not about profit and trying to convince yourself that the free market economic eutopia will cure all ills (excuse the pun) does not take into account that sometimes proceedures that save lives may not balance the balance sheet.


 
Not true. If a hospital is getting paid solely on a usage basis, then the opposite is actually the truth - they are more likely to do procedures as they get paid for doing so. Doing the procedures is necessary to make a profit. You dont do procedures, you dont get paid.

Again you are confusing unrelated issues - in this case you are confusing the method of delivery of services (i.e. doing procedures) with how those procedures should be paid for (public purse, insurance etc.) and who should ultimately pay the cost.


----------



## Purple (17 Jun 2008)

csirl said:


> Not true. If a hospital is getting paid solely on a usage basis, then the opposite is actually the truth - they are more likely to do procedures as they get paid for doing so. Doing the procedures is necessary to make a profit. You dont do procedures, you dont get paid.
> 
> Again you are confusing unrelated issues - in this case you are confusing the method of delivery of services (i.e. doing procedures) with how those procedures should be paid for (public purse, insurance etc.) and who should ultimately pay the cost.


You are right but you are banging your head against an ideological brick wall.


----------



## redstar (17 Jun 2008)

If a publicly-funded, efficient, clean health-care system was provided in Ireland then there would be no debate about public V private care.

But because our health-care system is publicly-funded AND grossly inefficient/mismanaged, and dirty, people will pay extra to get private care.

People will search and pay for what they perceive as the 'best' way to get  health-care. i.e shop around, just like a consumer.


----------



## csirl (17 Jun 2008)

> If a publicly-funded, efficient, clean health-care system was provided in Ireland then there would be no debate about public V private care.


 
The only way this can possibly be achieved is by giving people a choice of hospitals in which to receive treatment with competition between the hospitals.

The other 2 publically funded models have failed miserably in Ireland.

In some parts of the country, you have publically owned hospitals providing the service without competition and its clearly not up to scratch.

In other parts e.g. Dublin, you have a "Railtrack UK" style nightmare - the worst possible situation from a level of service, cost and customer friendly point of view - the private sector monopoly i.e. privately owned hospitals, who never even tendered for the business, having a monopoly on public health provision. 

Look at newspapers reports in recent weeks and you'll see plenty of stories about hospitals saying that they will be closing wards, units, services etc. unless they get more money from the Government. This shows us how messed up this monopoly is. Could you imagine any other part of the private sector taking advance payment for a service and then refusing to provide it or asking for more money to provide it? They'd lose customers very quickly or get sued out of existance.


----------



## bullbars (17 Jun 2008)

deleted


----------



## bullbars (17 Jun 2008)

csirl said:


> Look at newspapers reports in recent weeks and you'll see plenty of stories about hospitals saying that they will be closing wards, units, services etc. unless they get more money from the Government. This shows us how messed up this monopoly is. Could you imagine any other part of the private sector taking advance payment for a service and then refusing to provide it or asking for more money to provide it? They'd lose customers very quickly or get sued out of existance.


 

Emotional bribery at its best. They know it will twig the response from the public that they need. The blame is shifted to the government.


----------



## bullbars (17 Jun 2008)

television said:


> Health is not about profit and trying to convince yourself that the free market economic eutopia will cure all ills (excuse the pun) does not take into account that sometimes proceedures that save lives may not balance the balance sheet. In a purely for profit system there is presures put on to do just that at the expence of patient care. And if you think that would not/does not happen your deluding yourself.
> 
> The untimate aim of universal health care provision should always be about patient care and never profit


 
I agree. Health care and profit should never be linked. However Health care and efficient use of public money is the issue.


----------



## Purple (17 Jun 2008)

Brianne said:


> Well the system would collapse and maybe then people would realise that this health care system out of which FF government in the 1980's took three thousand beds, is not adequate .


 And why did they do that? Do you not know what a state the country was in at the time?



Brianne said:


> Yes we had that many more beds in 1980's Ireland when the population was up to half a million less , when people were not living as long and when many of the procedures which we now take for granted such as CAT Scans and MRI were either not around or in their infancy.


... and a vast array of procedures that required 3-5 days in hospital are not done as elective day surgery. Many others that required weeks in hospital now require days. There was no such thing as keyhole surgery, stents and balloon catheters were crude and used for only a tiny number of the applications for which they are now. Don't tell half the story when you have read the whole book.



Brianne said:


> Then, if there was a revolution and the Irish people wanted an NHS situation would we, the electorate put in a government who said they'd increase taxes? The system was stripped , the private system developed and some would say took pressure off the public system but now hard decisions have to be made.
> Will we allow any government to make them?


 No, the first people to down tools when the government tries to sort out the health service are the nurses. This has been seen over and over again. The solution is good management that is allowed to manage. At the moment we have neither. 



Brianne said:


> Health care is an endless demand curve and all this talk about the private system being efficient is  just that.........talk.
> The private system doesn't deal with major accidents, old people with dementia and multi disease who are waiting on suitable nursing homes. The private system doesn't have the orthopaedic lists f.......d up for the next two days because joy riders or drunken drivers or plain road traffic victims need urgent operations and automatically jump the list.The private system can pick and choose, the public system can't.
> They operate on you in the private system but if things go really wrong, where do you end up.......back in casualty at 3 am being looked after by the public system.


 Agreed



Brianne said:


> Futhermore we had clean hospitals, I remember them:we also had domestic staff,,,,,,yes the dreaded public servant who cleaned them. Now the cleaning is done by private companies employing people on low wages.We didn't value some of the most important people in the system.....yes the cleaners.......


 I remember when nurses used to pick up the odd thing in hospitals. I remember when the ward sister used to make sure the cleaner did their job properly instead of chatting at the desk and then blaming the hospital management or the minister when the place was dirty. I even remember when nurses washer their hands and didn't spread MRSA.



Brianne said:


> I think people should be entitled to use private health care, I also think they have paid for the public system and should avail of both if it suits and there is no reason why if efficiencies in administration and management with extra funding were agreed on by the taxpayer , we couldn't have a good public system as well.


I agree but the consultants have accept change as well and nurses have to accept that just like any other group of people some of them are just no good at their job and/or lazy and should be sacked.



Brianne said:


> Incidentally the midwife who was not able to work the epidural machine could have been reported to the Chief Nursing Officer and also to An Bord Altranais; we have a highly regulated nursing profession  and surely a reprimand with further training or conditions attached to her/his registration would be a better result.


 Good luck with that one...


----------



## redstar (17 Jun 2008)

Purple;


> I remember when nurses used to pick up the odd thing in hospitals. I remember when the ward sister used to make sure the cleaner did their job properly instead of chatting at the desk and then blaming the hospital management or the minister when the place was dirty. I even remember when nurses washer their hands and didn't spread MRSA.



Indeed. My father is in and out of hospitals for years and said exactly that ! He recalled being in hospital sometime in the 70's, when the matron would come around and inspect the ward for cleanliness. The nurses were terrrified of her so  kept the place spotless !
I'm not advocating terror on the wards  but the lesson here was that the wards were managed properly. Cleanliness was checked daily and staff were held accountable if the wards were not looked after.

In recent years, external cleaning companies have been brought in and nowadays some hospitals are manky. Accountability has now gone as health service management 'outsourced' cleaning without managing the contractors performance.


----------



## csirl (17 Jun 2008)

> Quote:
> Originally Posted by *Brianne* http://www.askaboutmoney.com/showthread.php?p=649260#post649260
> _Health care is an endless demand curve and all this talk about the private system being efficient is just that.........talk._
> _The private system doesn't deal with major accidents, old people with dementia and multi disease who are waiting on suitable nursing homes. The private system doesn't have the orthopaedic lists f.......d up for the next two days because joy riders or drunken drivers or plain road traffic victims need urgent operations and automatically jump the list.The private system can pick and choose, the public system can't._
> ...


 
I dont know about this one. There is no reason why A&E couldnt be put out to tender on the basis that whoever wins the tender has to deal with whatever injuries present themselves on a given day. There is an element of risk in this given that there will be quiet times and peaks, but, there is a lot of data on the accident rates available and so a company can price the extra costs associated with the demand risk. This is not an impossible service for a private sector organisation to provide - remember that most of the public health service A&E departments in Dublin are privately owned (Beaumont, Mater, St James, St Vincents) and are already doing this job in the context of the aforemention "Railtrack UK" monopoly situation. These hospitals are already coping with whatever is thrown at them. I dare say that if there was competition and the business was tendered, we would probably get a more efficient service at cheaper cost.

The argument is always made that private A&E would cut corners to save costs. I dont believe this as people would die thus pushing their mortality rate above norms. If too many people die, they'd lose the contract, so it is more profitable in the long run for them to provide a high level of care in order to keep the lucrative contract. Using my "hospitals must do procedures to make a profit argument" earlier in this thread, if A&Es were paid on a volume related basis rather than a lump sum basis, it would be in their interests to give better care as it would earn them more money. In terms of medical costs, the main difference between A&E and any other type of medicine is the demand risk - you cant schedule A&E whereas you can schedule other injuries. And demand risk CAN be priced.


----------



## television (17 Jun 2008)

How would competition in this respect work. Lets see, there is a really serious car accident. I can picture the scene 3 competing ambulences attend to the scene who ever gets there first wins the "unit". Or if I break my leg I decide to go to the most efficent Aand E based on published mortality rates for a and es. Crazy. Trying to blindly fit what works as competition in the private sector does not take into account the complexity of providing quality free health care for people.


----------



## Complainer (17 Jun 2008)

csirl said:


> I dont know about this one. There is no reason why A&E couldnt be put out to tender on the basis that whoever wins the tender has to deal with whatever injuries present themselves on a given day. There is an element of risk in this given that there will be quiet times and peaks, but, there is a lot of data on the accident rates available and so a company can price the extra costs associated with the demand risk. This is not an impossible service for a private sector organisation to provide - remember that most of the public health service A&E departments in Dublin are privately owned (Beaumont, Mater, St James, St Vincents) and are already doing this job in the context of the aforemention "Railtrack UK" monopoly situation. These hospitals are already coping with whatever is thrown at them. I dare say that if there was competition and the business was tendered, we would probably get a more efficient service at cheaper cost.
> 
> The argument is always made that private A&E would cut corners to save costs. I dont believe this as people would die thus pushing their mortality rate above norms. If too many people die, they'd lose the contract, so it is more profitable in the long run for them to provide a high level of care in order to keep the lucrative contract. Using my "hospitals must do procedures to make a profit argument" earlier in this thread, if A&Es were paid on a volume related basis rather than a lump sum basis, it would be in their interests to give better care as it would earn them more money. In terms of medical costs, the main difference between A&E and any other type of medicine is the demand risk - you cant schedule A&E whereas you can schedule other injuries. And demand risk CAN be priced.



So is mortality rate the sole metric you'd use to measure success on the contract?


----------



## room305 (17 Jun 2008)

television said:


> How would competition in this respect work. Lets see, there is a really serious car accident. I can picture the scene 3 competing ambulances attend to the scene who ever gets there first wins the "unit". Or if I break my leg I decide to go to the most efficient Aand E based on published mortality rates for a and es. Crazy. Trying to blindly fit what works as competition in the private sector does not take into account the complexity of providing quality free health care for people.


 
There is no "free" health care, somebody has to pay for it at some point. The word you are looking for is "socialised". As has been pointed out numerous times to you on this thread to little avail, you can have a socialised medical system provided by the private sector (e.g. France or Sweden).

Yes and how crazy would you have to be to want to be treated in the hospital in which you are least likely to die.



Complainer said:


> So is mortality rate the sole metric you'd use to measure success on the contract?


 
Being facetious adds little to the thread. The poster was illustrating his point by way of example, not writing a contract. Many factors could be included - wait time for treatment/bed/doctor/transfer, satisfaction with service, mortality rates, infection rates all as measured against the expected averages in other industrialised nations.

Done transparently and competently, the privatisation of healthcare could lead to a better and more accountable service than that currently provided by the HSE for the same cost.


----------



## television (17 Jun 2008)

> Done transparently and competently, the privatisation of healthcare could lead to a better and more accountable service than that currently provided by the HSE for the same cost.


 
Why do you see transparency competence and accountability as something exclusive to the private sector. Plenty of examples from the private sector where there is anything but, by the way.


----------



## csirl (18 Jun 2008)

> How would competition in this respect work. Lets see, there is a really serious car accident. I can picture the scene 3 competing ambulences attend to the scene who ever gets there first wins the "unit". Or if I break my leg I decide to go to the most efficent Aand E based on published mortality rates for a and es. Crazy. Trying to blindly fit what works as competition in the private sector does not take into account the complexity of providing quality free health care for people.


 
This is not how the system works.

You would have 1 A&E service in each area (as you have now) and the operation of the A&E could be tender e.g. every 5 years. If an operater is not up to scratch, then they will have no hope of getting the contract renewed. This model actually works quite well in a lot of public service sectors around the world. People always use the German train service as an example as an efficient public service. In most German cities, the public trains are operated by a single private company (much in the same way as the Luas is operated by a private company, but on a much bigger scale) who tender for the business periodically e.g. Munich underground. Company isnt up to scratch, they lose the business to a competitor.

This mulitple ambulance argument is always used as a scaremongering tactic by socialists. They misinterpret competition as being on an indivudual e.g. road traffic basis and say it will cause confusion. They fail to see that the competition is to get the contract in the first place - when the contract is being placed.


----------



## television (18 Jun 2008)

csirl said:


> .
> This mulitple ambulance argument is always used as a scaremongering tactic by socialists.


 
Anything that goes against the blind religious zeal of nieve application of competition is seen as socialist scaremongering.


And its not just competition to get the contract in the first place its also competition over patients as as you said earlier under your systemits also about volume.



> This model actually works quite well in a lot of public service sectors around the world


 
You do not really understand the complexity of this situation if you are seriously trying to equate the provision of a transport to the provision of health care.


----------



## room305 (18 Jun 2008)

television said:


> Why do you see transparency competence and accountability as something exclusive to the private sector. Plenty of examples from the private sector where there is anything but, by the way.


 
You have misinterpreted my comment. I said that if the privatisation _process_ is performed transparently and competently (e.g. public tender process, properly specified terms and conditions, penalties for default, unambiguous contracts etc.) then an improvement upon the service provided by the HSE will result. This process will have to be carried out by the public sector.

Of course if you are unhappy with the service provided by the private sector you can always take your business to a competitor. An option always denied to you under the public sector monopoly you treasure so much.


----------



## shnaek (18 Jun 2008)

television said:


> Why do you see transparency competence and accountability as something exclusive to the private sector. Plenty of examples from the private sector where there is anything but, by the way.


And there are close to zero examples of where it applies to the public sector - certainly wrt accountability and transparency!


----------



## csirl (18 Jun 2008)

> You do not really understand the complexity of this situation if you are seriously trying to equate the provision of a transport to the provision of health care


 
People make out healthcare to be to complex and difficult to be run by the private sector. The reality is that a lot of the major public service hospitals in Ireland ARE private sector owned (Beaumont, St. Vincents, St James, Mater), so this statement has been disproven. Are you really trying to get us to believe that a private sector organisation can run a service better with a monopoly/cartel situation that it can without? Can you give any examples of where a private sector monopoly/cartel has given better service in any sector of business?

What particular aspects of healthcare delivery make it more difficult for a private sector organisation to deliver as opposed to a public sector organistion? Can you state them? Volume and demand is not the correct answer as the public sector also has to deal with them.


----------



## television (18 Jun 2008)

csirl said:


> People make out healthcare to be to complex and difficult to be run by the private sector. The reality is that a lot of the major public service hospitals in Ireland ARE private sector owned (Beaumont, St. Vincents, St James, Mater), so this statement has been disproven.


 
And according to anyone who asks not very efficently.



csirl said:


> Are you really trying to get us to believe that a private sector organisation can run a service better with a monopoly/cartel situation that it can without? Can you give any examples of where a private sector monopoly/cartel has given better service in any sector of business?


 
You see the proviision of health as a market place where the rules of profit and loss etc applies. If you dont then your not really talking about privatision in the sence I unnderstand it. In a privatised system, privately owned health care providers will charge insurance companies for services and insurance companies will levy the cost of this onto consumer in terms of policies. 

This would mean that those who cannot afford to pay the cost on health insurance will be left behind. Now if you are saying that in some way the government could pay private health care providers for the health needs of poor people who cannot afford it then this may solve the equity problem. But this is not pure privatisation as the government would be paying for certain people. 

I aggree with you that monolopies are bad for consumers. However you do not see that monolopies do not have to exist within the public sector. there can be competition between hospitals in the public sector. Along much of the saME CRITERIA that you are suggesting. the difference being that the ultimate motivation is making patients better not making profit.



csirl said:


> What particular aspects of healthcare delivery make it more difficult for a private sector organisation to deliver as opposed to a public sector organistion? Can you state them? Volume and demand is not the correct answer as the public (did you mean private)sector also has to deal with them.


 
I was making this comment in relation to you trying to compare running a health service with running a bus company.


----------



## television (18 Jun 2008)

Just to clarify one thing csgirl. do you believe the state should pay for the health care of those who cannot afford to pay?


----------



## csirl (18 Jun 2008)

> do you believe the state should pay for the health care of those who cannot afford to pay?


 
Depends on the reason they cannot afford to pay.

If someone has a genuine disability, then the State should pay, but I do not believe that the State should pay for people who are capable and able to work, but choose not to. People have to take a certain amount of personal responsibility for their circumstances. In most cases when you talk about paying for health care, you are really asking the question as to whether or not health insurance should be paid for. Its easy to state that very few people could pay for a complex operation costing €100,000's, its less easy to argue that very few people could pay a few hundred euro per annum for the insurance policy that would pay for such an operation. 



> Quote:
> Originally Posted by *csirl* http://www.askaboutmoney.com/showthread.php?p=651004#post651004
> _People make out healthcare to be to complex and difficult to be run by the private sector. The reality is that a lot of the major public service hospitals in Ireland ARE private sector owned (Beaumont, St. Vincents, St James, Mater), so this statement has been disproven._
> 
> And according to anyone who asks not very efficently.


 
Precisely - due to having a monopoly/cartel. Do you not think that these hospitals would up their game if they faced the prospect of losing their public sector contracts to a competitor if they did not improve?



> You see the proviision of health as a market place where the rules of profit and loss etc applies. If you dont then your not really talking about privatision in the sence I unnderstand it. In a privatised system, privately owned health care providers will charge insurance companies for services and insurance companies will levy the cost of this onto consumer in terms of policies.


 
2 points:

1. There are many forms of privatisation, some of which may be more suitable and efficient than the one you describe.
2. It may surprise you, but whether public or privately funded, economics do apply to healthcare. You argue that a private sector organisation may determine that it is not worth offering a particular service because it costs too much. A public sector organisation e.g. HSE, Dept of Finance, may also make the same decision and seem to be doing so with increasing frequency as the economy slows down. Public health is not immune from being shut down for budgetary reasons as the 1980s would prove. The public service always has to balance the additional charge to be passed onto the taxpayer in the form of higher taxes against the benefit of providing the service.



> However you do not see that monolopies do not have to exist within the public sector. there can be competition between hospitals in the public sector. Along much of the saME CRITERIA that you are suggesting. the difference being that the ultimate motivation is making patients better not making profit.


 
If you were going to get the same pay regardless of how hard you worked and you could never lose your job, what motivation do you have to work harder? Answer: None. This is just ideological claptrap - it goes entirely against human nature to suggest that people would go out of their way to work harder for no reward.

The only way you can have genuine competition between hospitals delivering public services is if those who are not up to scratch lose their jobs - this can only be achieved by competition with real benefits for those who perform well i.e. increased profits, and real penalties for those who dont i.e. no profits, job losses etc.


----------



## television (18 Jun 2008)

csirl said:


> Depends on the reason they cannot afford to pay.
> 
> If someone has a genuine disability, then the State should pay, but I do not believe that the State should pay for people who are capable and able to work, but choose not to. People have to take a certain amount of personal responsibility for their circumstances. In most cases when you talk about paying for health care, you are really asking the question as to whether or not health insurance should be paid for. Its easy to state that very few people could pay for a complex operation costing €100,000's, its less easy to argue that very few people could pay a few hundred euro per annum for the insurance policy that would pay for such an operation.


 
In your market driven eutopia there will always be a certain amount of unemployed people. That is an economic fact. Your solution is the complex responce of a famous tory "get on your bike" What about the children of those people who "choose not to work". What happens to them. But you do aggree that it is the governments responcibility to look after the health needs of certain sections of the community.



csirl said:


> Precisely - due to having a monopoly/cartel. Do you not think that these hospitals would up their game if they faced the prospect of losing their public sector contracts to a competitor if they did not improve?.


 
Even in your own example above you say that their should only be one And E per area. 


2 points:

1. There are many forms of privatisation, some of which may be more suitable and efficient than the one you describe.



csirl said:


> . It may surprise you, but whether public or privately funded, economics do apply to healthcare.?.


 
Yes economics applies of cource but if there is a decision to be made between cost and making someone better then the community have a responcibility to ensure the former. 



csirl said:


> . You argue that a private sector organisation may determine that it is not worth offering a particular service because it costs too much. A public sector organisation e.g. HSE, Dept of Finance, may also make the same decision and seem to be doing so with increasing frequency as the economy slows down. Public health is not immune from being shut down for budgetary reasons as the 1980s would prove. The public service always has to balance the additional charge to be passed onto the taxpayer in the form of higher taxes against the benefit of providing the service.


 
Whether thr cutting of essential health services happens in the publlic or private sector still makes it immoral and absolutly wrong. See I believe the provision of health care is also essentially a moral issue and responcibiliy for the community.


----------



## room305 (18 Jun 2008)

television said:


> In your market driven eutopia there will always be a certain amount of unemployed people. That is an economic fact.


 
Yes but usually a lower percentage than in your socialist utopia. 



television said:


> Even in your own example above you say that their should only be one And E per area.


 
With contracts for running the A&E renewed every five years. Poor performance against the competition (i.e. other companies competing for contracts, possibly running other A&E units in other areas) will result in a loss of existing contract and consequent job losses.



television said:


> Yes economics applies of cource but if there is a decision to be made between cost and making someone better then the community have a responcibility to ensure the former.


 
At any price? If that is the case why not assign every family in the country a live-in doctor? 



television said:


> Whether thr cutting of essential health services happens in the publlic or private sector still makes it immoral and absolutly wrong. See I believe the provision of health care is also essentially a moral issue and responcibiliy for the community.


 
_Basic_ healthcare is something that every citizen of the state should be able to avail of. It should be within the means of the state to provide this to everybody who cannot afford it. At the moment despite massive funding the public sector cannot guarantee a basic level of care. You yourself have admitted that you consider it necessary to purchase private health insurance to provide a decent health care service for your family. What makes you so confident that additional funding to the public health care system will allow you to happily no longer avail of private health insurance? How much extra tax will this require? Who will pay the extra tax and just how much damage to our already faltering economy will this do? Remember we have already flirted with high taxation in this country and the result was grinding poverty, widescale tax evasion and mass emigration.

Why is it so hard to imagine a completely privatised health system? The huge advances in medical technology, surgical procedures, drugs and treatments available today are almost invariably provided by private companies pursuing a profit-driven agenda. How much harder then can it be to run the hospital that provides these services?

What is so fundamentally different about healthcare that people feel it cannot be left to the private sector? Is it any more complex than other services that people every day entrust their lives to the private sector to provide such as air travel? I cannot help but feel that much of this is propaganda driven by unions trying to defend work practices that are no longer prevalent in the rest of society.


----------



## Purple (18 Jun 2008)

csirl, Room305; I 'aint posting 'cause you're saying it all.
Keep banging away and they might see logic trumps ideology.


----------



## television (18 Jun 2008)

room305 said:


> Yes but usually a lower percentage than in your socialist utopia. .


 
But your responce tothese unemployed peoples health care needs is to say "tough luck go get a job you lazy scrounger" (paraphrase) Great sound bite, but simplistic, and ignores the fact that unemployed people would loose out badly in a purely for profit health service. Your answer "get a job". Tell that too a lot of hard working people who have lost thier jobs over the last year or so. tell that to the 50 year old with 3 kids who has worked for30 years in the one company and now its closed down.  you see all unemployement as the fauth of the unemployed. And you call my stance ideological? I call it moral.




room305 said:


> With contracts for running the A&E renewed every five years. Poor performance against the competition (i.e. other companies competing for contracts, possibly running other A&E units in other areas) will result in a loss of existing contract and consequent job losses.


 
If the state is paying for private companies runnign these a A%E units this is far from the privatised Eutopia your calling for.



room305 said:


> At any price? If that is the case why not assign every family in the country a live-in doctor? .


 
That comment is unbecoming of your decent argument so far in this discussion.




room305 said:


> _Basic_ healthcare is something that every citizen of the state should be able to avail of. It should be within the means of the state to provide this to everybody who cannot afford it. At the moment despite massive funding the public sector cannot guarantee a basic level of care. You yourself have admitted that you consider it necessary to purchase private health insurance to provide a decent health care service for your family. What makes you so confident that additional funding to the public health care system will allow you to happily no longer avail of private health insurance? How much extra tax will this require? Who will pay the extra tax and just how much damage to our already faltering economy will this do? Remember we have already flirted with high taxation in this country and the result was grinding poverty, widescale tax evasion and mass emigration.


 
The key word here is _basic. Your admiting _here that you see a difference between the health care people who can afford it should recieve and people who cannot should recieve. That is fine up to a point, but when it comes to services like cancer, alsimers care, you believe those who can afford to pay have a greater right to these services simply because they can afford it. If you think that is a good way for society to devlope and tolerate good luck to you. I want QUALITY health care not BASIC health care for all. 



room305 said:


> Why is it so hard to imagine a completely privatised health system? The huge advances in medical technology, surgical procedures, drugs and treatments available today are almost invariably provided by private companies pursuing a profit-driven agenda. How much harder then can it be to run the hospital that provides these services?.


 
Even you see state funding for privatly provided service as a means of movign forward. SO where does this fit with your completly privitised health system?



room305 said:


> What is so fundamentally different about healthcare that people feel it cannot be left to the private sector? Is it any more complex than other services that people every day entrust their lives to the private sector to provide such as air travel? I cannot help but feel that much of this is propaganda driven by unions trying to defend work practices that are no longer prevalent in the rest of society.


 
I am not arguing that private sector cannot provide efficent health care. I am arguing that a purely privitised service cannot provide *equitable *care. If the only responce you can give this is the typical 





> propaganda driven by unions trying to defend work practices that are no longer prevalent in the rest of society


 argument, I suggest this is you being idological not me. What am I arguing for?Good quality health care avalible to all citizens regardless of thier ability to pay taking into account the complexity of issues of ppoverty, and the need for social justice and equity. Is essentially a question of morality.


----------



## television (18 Jun 2008)

Purple said:


> csirl, Room305; Keep banging away and they might see logic trumps ideology.


 
That line could have been written by Marx well done


----------



## television (18 Jun 2008)

room305 said:


> As has been pointed out numerous times to you on this thread to little avail, you can have a socialised medical system provided by the private sector (e.g. France or Sweden)..


 
Are you saying you favour this system as opposed to a purely privatised system? 



> All NHI funds are legally private organizations responsible for the provision of a public service. In practice, they are quasipublic organizations supervised by the government ministry that oversees French social security.


 
Taken from http://www.ajph.org/cgi/reprint/93/1/31.pdf makes interesting reading in regards public funding of health care from equitable social insurance payments and takes into account 1. equity 2. quality.

ONe final quote from artical.




> Smaller funds with older, higher-risk populations (e.g., farmers, agricultural workers, and miners) are subsidized by the CNAMTS, as well as by the state, on grounds of what is termed “demographic compensation.” Retirees and the unemployed are automatically covered by the funds corresponding to their occupational categories. In France, the commitment to universal coverage is accepted by the principal political parties and justified on grounds of solidarity—the notion that there should be mutual aid and cooperation between the sick and the well, the active and the inactive, and that health insurance should be financed on the basis of ability to pay, not actuarial risk.


 
Common sence i'd say.

Vive la France.


----------



## room305 (18 Jun 2008)

television said:


> Are you saying you favour this system as opposed to a purely privatised system?


 
No. If it were up to me we'd have a purely free market system with no social welfare and no state-funded education or healthcare. However, I am well aware that such a system would be unpalatable to many and that it probably appeals to the same tacit sense of perfectionism as Marxism.

So what I am saying is that if we must have a health system where the cost is socialised then it is better that it is run by the private sector than the public sector as it will deliver a better service for less of my taxes.

During much of this debate you appear to have had difficulty distinguishing between public/private healthcare provision and public/private healthcare funding leading to much confusion.

If I am following you correctly, you are now modifying your original argument somewhat and believe that private healthcare is fine so long as it is paid for out of public funds? Am I right? If not perhaps you could clarify matters.


----------



## television (18 Jun 2008)

> private healthcare is fine so long as it is paid for out of public funds?


 
No I am not the one with the confusion here, you are. This is a discussion between the merits of a public v private health system. A private system is funded by contributions by people into insurance policies and run by the private sector on a for profit basis . PERIOD. Anything else is not purely private. 

The only one that has modified an argument or has confused this is you.

The french system looks good to me. As it offers equity and effeciency which is essentially a publicly run service.  Now I am not ideologicaly fixed on publicaly fundeded and run hospitals. If I believed the private sector could offer more efficent, clean, people centred hospitals where there was equity of access and treatment for all regardless of an ability to pay. then lets run with the private sector. I just cant see this happening in the real world. for one thing those who do pay will resent those who pay nothing as being scroungers. And a divide will develop between what the government are willing to pay into the system for public patients and the money private patients pay. This will happen more and more as the cost of health care increases. leading todivision and inequity.


----------



## room305 (18 Jun 2008)

television said:


> But your responce tothese unemployed peoples health care needs is to say "tough luck go get a job you lazy scrounger" (paraphrase) Great sound bite, but simplistic, and ignores the fact that unemployed people would loose out badly in a purely for profit health service. Your answer "get a job". Tell that too a lot of hard working people who have lost thier jobs over the last year or so. tell that to the 50 year old with 3 kids who has worked for30 years in the one company and now its closed down. you see all unemployement as the fauth of the unemployed. And you call my stance ideological? I call it moral.


 
Please reference the post in which I said that those who are unemployed and in need of healthcare should "get a job". Given that some of my friends and family members have recently been made unemployed I find your assertion that I see unemployment as the "fault" of the unemployed individual questionable.



television said:


> If the state is paying for private companies runnign these a A%E units this is far from the privatised Eutopia your calling for.


 
Indeed it is but that doesn't stop it being an improvement on the present situation. 



television said:


> That comment is unbecoming of your decent argument so far in this discussion.


 
My comment about live-in doctors was admittedly flippant but the logic was sound. Where do you draw the line if healthcare is, as you have repeatedly asserted, "free"? Resources that are finite but provided free tend to become over-used. Unless of course you make the "free" health service so unappealing you'll only avail of it at point of death (now why does that scenario sound familiar?).



television said:


> The key word here is _basic. Your admiting _here that you see a difference between the health care people who can afford it should recieve and people who cannot should recieve. That is fine up to a point, but when it comes to services like cancer, alsimers care, you believe those who can afford to pay have a greater right to these services simply because they can afford it. If you think that is a good way for society to devlope and tolerate good luck to you. I want QUALITY health care not BASIC health care for all.


 
There is a prevailing theme among certain members of society that seems to involve working themselves up into an apoplexy of rage whenever it is suggested that rich people can buy better healthcare than poor people. It matters not a whit if the individuals themselves actively purchase private health insurance and thus avail of better healthcare than those less well-off than themselves. You appear to belong to this club.

Tell me where I suggested cancer services should only be available for the rich? Or Alzheimer's? Why do you suggest that the amount of services available should be _limited_ and auctioned off to the highest bidder? This is the public sector approach that you favour so highly (think air travel in the eighties). The private sector approach would be to provide healthcare to as many customers as possible and charge in a discriminatory fashion based on what customer's can afford (think air travel now).



television said:


> Even you see state funding for privatly provided service as a means of movign forward. SO where does this fit with your completly privitised health system?


 
As I said it's an improvement. There isn't a completely privatised system in existence anywhere that I know of so it's unrealistic to expect it to happen in my lifetime. Especially in a country that is beholden to trade unions and in which many essential services supposedly owned by the state and run for the benefit of the public, are in fact owned by trade unions and run for the benefit of the employees. 



television said:


> I am not arguing that private sector cannot provide efficent health care. I am arguing that a purely privitised service cannot provide *equitable *care. If the only responce you can give this is the typical argument, I suggest this is you being idological not me. What am I arguing for?Good quality health care avalible to all citizens regardless of thier ability to pay taking into account the complexity of issues of ppoverty, and the need for social justice and equity. Is essentially a question of morality.


 
What is the "typical" argument? I too would like to see good quality healthcare available to all citizens regardless of their ability to pay. We were arguing about the means to achieve this. If you now accept that we could completely privatise the healthcare system, with the proviso that the welfare system covers the costs of those who cannot afford to pay then that is a huge leap forward and something I would love to see put into practice.


----------



## csirl (19 Jun 2008)

> I am arguing that a purely privitised service cannot provide *equitable *care.


 
Why not. If it were written into the contracts of those private companies who successfully tender for the provision of the service that all patients get equal care, the private companies would lose their contracts and go out of business if they didnt treat every patient equally.

I do think you are still mixing up things here. The privatisation of health care = all health care being provided by private companies for profit. Were talking about the privatisation of the service here i.e. there being no public hospitals with public sector employees and best of all no HSE. The Dept of Health would just put alll the services it requires to competitive tender. 

How people are to pay for this healthcare and what mechanisms the Government puts in place for disadvantaged people is a different argument.


----------



## csirl (19 Jun 2008)

Here's an idea - any comments?


A&E Services:

The Dept of Health puts these out to competitive tender with contracts due for re-tender every 5 years. The country is divided up into different areas of appropriate size and 1 contract is given out for each area of the country. Contracts are on a volume related basis with the sucessful hospitals having to take demand risk and hit service delivery targets.

Non-A&E Hospital Services:

We have 2 choices here:

1. Fully refundable tax credit for private health insurance. This tax credit is sufficient to pay for the equivalent of Plan B VHI. People are free to choose whatever insurance company they like to give their tax credit to - the competition between them for customers will lead to greater value. Health insurance pays for all non-A&E care. [for those not familiar with taxation, a "fully refundable tax credit" is one like mortgage interest relief where you get the benefit even if you pay no tax.]

2. A modification of the above, only the Government pays the health insurance for disadvantaged people only. Everyone else is free to buy whatever health insurance they think they need or just pay in cash for whatever health services they avail of. Everyone else should be able to afford health insurance easily due to the huge reduction in tax rates and consequential higher take home pay that would occur if the Government did not have to pay for everyones health care.


----------



## room305 (19 Jun 2008)

television said:


> No I am not the one with the confusion here, you are. This is a discussion between the merits of a public v private health system. A private system is funded by contributions by people into insurance policies and run by the private sector on a for profit basis . PERIOD. Anything else is not purely private.


 
If you wished to make such a distinction you should have indicated this from the start. Certainly such a distinction in debates focusing on privatisation is not common. For example, in debates regarding the privatisation of bus transport services in Dublin, nobody was suggesting that the privatisation of some routes was not "proper privatisation". Nor did I hear Joe Higgins, Mary Lou McDonald or any of the trade unions argue that partial privatisation was fine so long as the whole system wasn't completely privatised.

This makes the reasons advanced by you for voting against the Lisbon Treaty even more suspect in my opinion, since no country in Europe has a purely privatised healthcare system so it can hardly be something that other countries will attempt to foister on us against our will.



television said:


> The only one that has modified an argument or has confused this is you.


 
No I have been consistent in my claims. I'd like if the healthcare system required no government funding at all but acknowledge this is extremely unlikely. However, I believe we could massively improve our existing system if the government restricted its role to one of regulation rather than actual service provision.



television said:


> The french system looks good to me. As it offers equity and effeciency which is essentially a publicly run service.


 
75% of French hospitals are privately owned and privately run on a for-profit basis. Again I reiterate, you are debating whether or not the cost of medical care should be socialised (like France) or not. Privatisation is irrelevant in this debate, as there is no reason why the service for which the cost has been socialised cannot be provided for privately, publically or through a mixture of both. 

If you owned a supermarket in an area of high unemployment, where all of your customers were in receipt of social welfare, would you claim that your shop was "essentially a publically run service"? In a debate with me about whether food distribution in this country should be publically or privately provided, would you claim that a "purely privatised" food distribution system meant those without jobs must starve?



television said:


> Now I am not ideologicaly fixed on publicaly fundeded and run hospitals.


 
Really? This doesn't sound consistent with some of your previous comments:



television said:


> Privitisation of health will lead to vast swathes of poor people not being able to afford health care. If you think thats morally right good luck to you. then again morality has nothing to do with the business ethic.


 


television said:


> Privitisation has been shown to benifit the rich and disadvantage the poor. That is a fact. In Ireland a two tier system is developing in health care already. The american system mainly privitised leads to millions not being able to afford basic health care and this is the way Europe is going.


 


television said:


> If I believed the private sector could offer more efficent, clean, people centred hospitals where there was equity of access and treatment for all regardless of an ability to pay. then lets run with the private sector. I just cant see this happening in the real world.


 
If you don't believe the private sector can deliver better healthcare than the public sector why then do you purchase private healthcare? Surely this is contradictory?

Also does the public sector currently offer anything even remotely resembling "efficient, clean, people-centred hospitals". Equity of access and treatment can be tackled in a number of ways without necessarily requiring the government to own and run hospitals.



television said:


> for one thing those who do pay will resent those who pay nothing as being scroungers. And a divide will develop between what the government are willing to pay into the system for public patients and the money private patients pay. This will happen more and more as the cost of health care increases. leading todivision and inequity.


 
Two points:

1. The cost of health care should be decreasing as a consequence of improvement in technologies, shorter recuperation times from surgical procedures, better treatments and increasing specialisation of nurses and doctors. This is the best way in the long term to ensure equity of access to all.

2. If this divide is going to exist then it exists already as a function of our welfare system. Individuals on welfare already have most of their medical costs subsidised. I fail to see how there will be any great increase in antagonisation especially if the PAYE sector is also availing of the lower medical costs and taxation that will result from privatisation.

The only real losers from privatisation of the health service will be inefficient HSE staff (mangerial, administrative and frontline).


----------



## room305 (19 Jun 2008)

csirl said:


> How people are to pay for this healthcare and what mechanisms the Government puts in place for disadvantaged people is a different argument.


 
Keep repeating it, it might eventually sink in.


----------



## csirl (19 Jun 2008)

> If you owned a supermarket in an area of high unemployment, where all of your customers were in receipt of social welfare, would you claim that your shop was "essentially a publically run service"? In a debate with me about whether food distribution in this country should be publically or privately provided, would you claim that a "purely privatised" food distribution system meant those without jobs must starve?


 
I love this argument. Could you imagine the Government deciding to scrap all welfare payments and instead opened up a chain of supermarkets, staffed by public servants, to distribute food/clothes to welfare recipients? These shops would only contain the basics - no luxury items - and you would have to queue for 10 hours in order to get served. And the Government would decide what stock the shops would sell. And off course, you could never suggest closing down these shops....all the welfare recipients would die of hunger if you did .

I seem to remember something similar existing in the not too distant past.........I have a strange memory of switching on current affairs programmes in the 1980s and seeing 1,000s of Soviet citizens queing for hours in state owned supermarkets with not much on the shelves.


----------



## room305 (19 Jun 2008)

csirl said:


> I seem to remember something similar existing in the not too distant past.........I have a strange memory of switching on current affairs programmes in the 1980s and seeing 1,000s of Soviet citizens queing for hours in state owned supermarkets with not much on the shelves.


 
No doubt the Soviet _apparatchik_ at the time claimed that the privatisation of Soviet supermarkets would result in only the very wealthiest getting fed.


----------



## Purple (19 Jun 2008)

television said:


> That line could have been written by Marx well done


Maybe Groucho but not Carl. Carl was all about the perfect ideology of a workers utopia, he ignored human nature much like those that suggest a publicly owned and delivered health system (or any other system) where there is little or no accountability or sanction can ever be efficient.  That’s what this boils down to: will a privately delivered health system deliver more bang for our buck? Discussion on this question should be free from ideological preconceptions and the assumption that the state (i.e. it’s Dept. of Health civil servants) is not competent enough to regulate either service. I think it’s quite clear where we all stand at this stage.


----------



## csirl (19 Jun 2008)

We havent heard back from "Television" yet today. Is it because like all good socialists, s/he is not into mornings?


----------



## Purple (19 Jun 2008)

csirl said:


> We havent heard back from "Television" yet today. Is it because like all good socialists, s/he is not into mornings?



Don't judge, he/she could be too busy working.


----------



## television (19 Jun 2008)

room305 said:


> If you wished to make such a distinction you should have indicated this from the start. Certainly such a distinction in debates focusing on privatisation is not common. For example, in debates regarding the privatisation of bus transport services in Dublin, nobody was suggesting that the privatisation of some routes was not "proper privatisation". Nor did I hear Joe Higgins, Mary Lou McDonald or any of the trade unions argue that partial privatisation was fine so long as the whole system wasn't completely privatised.).


 
You really ar eonly hearing what you want to hear/read. Again I am not idologically opposed to privatisation of anything. However health is something very specific within a community. It is not with due respect the same as running a shop or any other form of private enterprise. This is where you are being ideoligically blinkered. Using the rules that work in the wider business world and applying them simplictically to something as morally and structurally complexed as providing equitable health care for all citizens is ideologally blinkered. 



room305 said:


> This makes the reasons advanced by you for voting against the Lisbon Treaty even more suspect in my opinion, since no country in Europe has a purely privatised healthcare system so it can hardly be something that other countries will attempt to foister on us against our will.).


 
See this is where you are very wrong. A few things in what you say are interesting. i.e "foistering on us against our will" maybe you see this as a bad thing too subconsciencly? Again because there is blinkered ideologs at the heart of the european project who believe in treating health care as any other service they believe that there should be no distortion or unfair government interference in the market place. Now I seem to remember that some schools were forced to pay for thier own water etc recently because of this very reason. 

_it is not _difficult to see that at some future time that this argument could be put in place against government interference in the health market place.



room305 said:


> No I have been consistent in my claims. I'd like if the healthcare system required no government funding at all but acknowledge this is extremely unlikely. However, I believe we could massively improve our existing system if the government restricted its role to one of regulation rather than actual service provision.)


 
Even within a government regulated private system companies have to make a profit. This is fine in any other industry but in health it leads to inequity. 



room305 said:


> 75% of French hospitals are privately owned and privately run on a for-profit basis. Again I reiterate, you are debating whether or not the cost of medical care should be socialised (like France) or not. Privatisation is irrelevant in this debate, as there is no reason why the service for which the cost has been socialised cannot be provided for privately, publically or through a mixture of both. ).


 
Where do you get this figure from exactly? Well if this argument is not about purely privatised health care what it is about. Are you telling me that a system run by the private sector but payed for by the government is privatesed Health care in the classical sence of pure privatisation? And the french system is farmore complex than you are arguing in terms of its outward apperence of privatisation but the reality of government funding and regulation> I suggest you read the artical I cited in an earlier post to clear up your confusion.



> If you owned a supermarket in an area of high unemployment, where all of your customers were in receipt of social welfare, would you claim that your shop was "essentially a publically run service"? In a debate with me about whether food distribution in this country should be publically or privately provided, would you claim that a "purely privatised" food distribution system meant those without jobs must starve?


 
Equating food distribution with the health needs of people does not work I am afraid. See you believe that cost effective yellow pack health care can be given to the huddled masses while the rich can shop at the Harrods of heath care. Now this is fine if you believe in a service that is unequtable. Again I do not. Weather you like ot or not.

But in your lassez faire ideological free competition world these people would not get the dole so i suppose they would starve. NO Just leave it to the market place to take care of them?????



> If you don't believe the private sector can deliver better healthcare than the public sector why then do you purchase private healthcare? Surely this is contradictory?


 
When will you ever listen to what i am actually talking about. I want equitable health care for all. I believe the state should fund those who cannot fund their own health care. Those who can can look after themselves. I also believe that community run hospitals with a not for profit motive are the best mechenism to achieve this.



> Also does the public sector currently offer anything even remotely resembling "efficient, clean, people-centred hospitals". Equity of access and treatment can be tackled in a number of ways without necessarily requiring the government to own and run hospitals.


 
There are very good examples of the american system where community not for profit hospitals are the leading providers of quality health care. And Irish hospitals and the public system does by and large provide people centered care. As far as clean goes some one earlier commented on how the cleaning our hospitals way put out to tender to the private sector standards of cleanleness have decreased. 

Two points:

.[/quote] 1. The cost of health care should be decreasing as a consequence of improvement in technologies, shorter recuperation times from surgical procedures, better treatments and increasing specialisation of nurses and doctors. This is the best way in the long term to ensure equity of access to all..[/quote] 

Absolutly wrong. Health care inflation is many factors above ordinary inflation. And this is the way it is always going to be. Research new products drugs etc are hugely expensive. IN a private run system the government because of reduction in tax take may not be able to fund this expencive health care for people who cannot afford topay for insurance. Setting up the further inequity between those who can and those who cannot pay. 



> 2. If this divide is going to exist then it exists already as a function of our welfare system. Individuals on welfare already have most of their medical costs subsidised. I fail to see how there will be any great increase in antagonisation especially if the PAYE sector is also availing of the lower medical costs and taxation that will result from privatisation.


 
A person on welfare or those in work but on low incomes already are at a huge disadvantage when it comes to health care in ireland. For example I know of someone who had lung cancer on a medical card. Complained about painss in his chest to GP and was refered to a consultant. Took 9 months for him to see one. Died 6 months later. If he had seen consultant earlier he may have got 5 more years with his family. See you do not see the connect between the provision of quality health care and a sence of the morality that a community has for itself and those who are vunerable. YOu want to leave it to the whim of the market. We see in every aspect of life inequity. Some people can afford to buy a rollsroyce some a bycycle. Some people can afford to goon expensive holidays some cant. This is fine everyone in the world cannot have equity in this respect. That would be ridiculous. Because these are consumerable good and services. See the unmoral world of business creates winners and loosers. It must do so. I am not critizing this. It is, if you like commercial darwinism. Well sometimes the community must step in a set up supports for those who cannot help themselves. what you are advocating  in a purely privatised system is a form of social darwinism where the weak die and the strong survive.


----------



## csirl (19 Jun 2008)

> Even within a government regulated private system companies have to make a profit. This is fine in any other industry but in health it leads to inequity.


 
Can you explain how? Why is health different? I dont think anyone has any objections to private hospitals earning well deserved profits if they do a great job. There are many examples of private companies operating within government regulated systems, some providing essential services, where the private companies are run profitably.

Can you give a concrete real world example of any possible inequity? You keep on going on about inequity, but cant point to any examples. 

I think you've been taken in too much by the "we're special" brigade in the HSE. [This is an expression given to the HSE employees who justify incompetence or bad management with a reply that health is special and so normal rules of best practice, good management, economics, accounting, HR management and even the laws of physics do not apply].


----------



## csirl (19 Jun 2008)

> There are very good examples of the american system where community not for profit hospitals are the leading providers of quality health care.


 
A not for profit organisation in US terms is very very different from a public sector organisations - I once worked for an officially registered "not for profit" organisation registered in the US (though not in healthcare sector - was set up to earn funding for needy causes in Ireland). Not for profit organisations are often very commercial - they aim to make big profits out of their commericial operations and the CEOs are tasked with maximising these profits by the owners/trustees of the organisation. The reason being is that these profits are used for philantrophy. Dare I say that the organisations you refer to are in community health care for the profits and serve as proof that community health can be delivered profitably? A "not for profit" would not be involved if it could not make money for its philantrophy. 




> And Irish hospitals and the public system does by and large provide people centered care.


 
How does long waiting lists and poor outcomes equate to people centred care?


----------



## television (20 Jun 2008)

csirl said:


> Can you give a concrete real world example of any possible inequity? You keep on going on about inequity, but cant point to any examples. ].


 
Read my cancer example in my previous post. Health provision is essential a debate about ethics and economics. You are too ideologically blinkered to understand this duality. UNkess you seriously try to address the issue of the ethical issues brought about by purely private health care I dont see much point in adding further to this discussion.



> Here's an idea - any comments?


 
SO many holes I dont know where to start.


----------



## television (20 Jun 2008)

csirl said:


> We havent heard back from "Television" yet today. Is it because like all good socialists, s/he is not into mornings?


 
No its because I am busy. And whats this? Private sector employees/employers dossing on work time? Innificency? Surely not? Cheap shot I know but I just cant help it. Its too easy


----------



## Purple (20 Jun 2008)

television said:


> Read my cancer example in my previous post. Health provision is essential a debate about ethics and economics. You are too ideologically blinkered to understand this duality. UNkess you seriously try to address the issue of the ethical issues brought about by purely private health care I dont see much point in adding further to this discussion.


In a privately delivered system it is the function of the government or it's regulatory body to construct a system, and enforce compliance with that system, which requires those delivering the healthcare to operate in an ethical manner.
It's that simple, but not simple to implement, and works well in other countries. That's what this discussion is about. No poster has suggested that healthcare should be completely private at the point of consumption. I suggest that you may be the one with the ideological blinkers. 
Given that public hospitals have to operate within a budget they are subject to the same moral dilemma of service V cost that a private hospital is subject to. The difference is that a private hospital is usually in a better position to control costs because the managers are not subject to short-term political interference and what amounts to a trade union veto over their management decisions. They can also hire managers without limiting their reach to public sector pay scales.


----------

