# Letting off steam about the Health System



## bradfield (16 Apr 2008)

Doing precisely what the post prescribes letting off steam!!!

I have a health issue which requires an ultrasound as part of the diagnosis. 

It causes me practically constant pain which is bearable but not ideal. 

My doctor referred me to the hosp for the test, I told the hosp that I would be going private and wanted to pay as l thought that this would mean that I could maybe get the test a bit sooner! After 6 weeks I today received an appointment for SEPTEMBER! It was going to cost me 115euro. 

I got an appointment for next week in a private clinic for 135euro!!!!!!!! 

What can you say!!!!!

B


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## GeneralZod (16 Apr 2008)

*Re: Health System*

I can understand why that would be frustrating. The quality of service seems to be a lottery. Did you ring up the clinic on your own initiative or did your GP or someone in the hospital tell you about it. Is the private clinic covered by private medical insurance?


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## bradfield (16 Apr 2008)

*Re: Health System*

I found the clinic on the internet it specialises in ultrasounds. They do Sat and Sun appointments. An ultrasound is an outpatient procedure which is not covered by the VHI anyway so that wasnt relevant! I just cant believe that it takes that long to get an appointment for an ultrasound that will only take about 15 mins to do! I am hoping that there is nothing seriously wrong but if there is then I want to know as soon as possible! Very frustrating!

B


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## michaelm (17 Apr 2008)

*Re: Health System*



bradfield said:


> After 6 weeks I today received an appointment for SEPTEMBER! It was going to cost me 115euro.


What you needed there was a letter from your doctor for A&E to rule out something or other - also letter negates the €66 A&E charge.  You probably would have had to spend half the day (or all day) there but the A&E doctor would say 'we'll need to get an ultrasound' which you'd get - no charge - and then you'd be sent off home with an outpatient appointment to see a relevant consultant. 

It must be uniquely Irish where one is forced to pay 2% of salary into a public health system but said system is so unreliable that, if one can afford it, one also pays for private health insurance.  Then there's a shortage of beds because, amongst other reasons, public hospitals rent beds to the private system.  This increases waiting lists so to ease those, the Treatment Purchase Fund uses public money to pay for procedures in private hospitals for public patients; and the same consultants are working in both systems.  You couldn't make this stuff up, if it wasn't so serious it would be funny.


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## csirl (17 Apr 2008)

*Re: Health System*



> I got an appointment for next week in a private clinic for 135euro!!!!!!!!


 
You can get up to 41% of this refunded from Revenue, which makes it even cheaper.


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## Purple (17 Apr 2008)

*Re: Health System*



bradfield said:


> Doing precisely what the post prescribes letting off steam!!!
> 
> I have a health issue which requires an ultrasound as part of the diagnosis. It causes me practically constant pain which is bearable but not ideal. My doctor referred me to the hosp for the test, I told the hosp that I would be going private and wanted to pay as l thought that this would mean that I could maybe get the test a bit sooner! After 6 weeks I today received an appointment for SEPTEMBER! It was going to cost me 115euro.
> 
> ...


You’re making a very good argument for privatised healthcare.


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## bradfield (17 Apr 2008)

*Re: Health System*

I am not against private health care being available as an option as long as along side it everyone can have confidence in a public health system that they are paying for a few times over!!!

In this instance I dont really care where I get the test done as long as I get it done!!!!! My peace of mind is shot and my back is constantly sore and painful! Hopefully its nothing serious but it could be and I am one of the lucky ones that I can actually afford to think this way for this particular test, I dont know what I would do if it were something like an MRI as I would not be able to afford that!


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## Purple (17 Apr 2008)

*Re: Health System*



bradfield said:


> I am not against private health care being available as an option as long as along side it everyone can have confidence in a public health system that they are paying for a few times over!!!
> 
> In this instance I dont really care where I get the test done as long as I get it done!!!!! My peace of mind is shot and my back is constantly sore and painful! Hopefully its nothing serious but it could be and I am one of the lucky ones that I can actually afford to think this way for this particular test, I dont know what I would do if it were something like an MRI as I would not be able to afford that!



Rest assured that all of the problems of the health service, at both a policy and operational level, are the fault of Mary Harney. Once she is gone it will be back to the great service we had before she took over.


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## room305 (17 Apr 2008)

*Re: Health System*



bradfield said:


> I am not against private health care being available as an option as long as along side it everyone can have confidence in a public health system that they are paying for a few times over!!!


 
I don't see how the country would be any worse off, either from an economic prospective or overall health service provision, if we just scrapped the public health system in its entirety.

Let the private sector handle the health needs of everybody, with the government purchasing some form of basic health insurance to meet the needs of those without the means to purchase their own.

The role of the HSE then could be reduced to that of regulation rather than provision.


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## Complainer (18 Apr 2008)

*Re: Health System*



room305 said:


> Let the private sector handle the health needs of everybody, with the government purchasing some form of basic health insurance to meet the needs of those without the means to purchase their own.
> 
> The role of the HSE then could be reduced to that of regulation rather than provision.


This sounds remarkably like the Labour policy for Universal Health Insurance, but it seems like a cop-out to me. Why go for a system where the state is destined to pay a significant profit margin on top of the real cost. Why not address the underlying issues.

The private hospitals aren't without their faults, e.g. MRSA in Blackrock Clinic, cancer misdiagnosis in Barringtons etc.


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## room305 (18 Apr 2008)

*Re: Health System*



Complainer said:


> This sounds remarkably like the Labour policy for Universal Health Insurance, but it seems like a cop-out to me. Why go for a system where the state is destined to pay a significant profit margin on top of the real cost.


 
What's the difference between paying an extra margin in profit to a private supplier and an extra margin in inefficiency to a public supplier? 

I think Labour's policy is designed to remove "inequality" from the health system, as though everybody enjoying the same crap healthcare will solve all our problems. I say we need greater inequality in healthcare, so that the high end, high margin services can subsidise the low margin side, in the same way that business class seats on a British Airways flight will subsidise the economy seats.

My belief is that the state should only supply a basic health service to everybody. Every whim cannot be catered for and cruel as it may seem, every radical new treatment cannot be purchased. Nobody argues that individuals on social welfare should be able to dine in Shanahan's every night but we don't expect them to go to bed hungry either.

I think it will be more cost effective for the state to provide a basic, efficient, clean and timely healthcare system for all by purchasing a basic insurance policy for every citizen in the state than to actually try and provide a health service itself.

Nobody would suggest that it is a "cop out" that the government doesn't take on Tesco in the food distribution game to ensure nobody in the state goes hungry. I fail to see how this is any different for health service provision.



Complainer said:


> Why not address the underlying issues.


 
Are you suggesting that nobody has tried? Does anybody know even know what they are? Resources are finite, we already spend more per head of population on health than the French, yet I hear very few suggestions for reform that don't involve throwing even more money at the existing problems.



Complainer said:


> The private hospitals aren't without their faults, e.g. MRSA in Blackrock Clinic, cancer misdiagnosis in Barringtons etc.


 
Indeed, but at least in a private healthcare system if you don't like one hospital you can take your business elsewhere.


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## zag (19 Apr 2008)

*Re: Health System*

I think a public health system is something fundamental that should be provided by the state.  Just like roads, sewerage treatment and drinking water there are some things that just should not be left up to the market to provide.

I agree with michaelm that we seem to have a very curious and illogical setup.  Since I started earning over 20 years ago a portion of my salary each and every week or month has gone to contribute to PSRI, and also to the associated health levy.

I realised long ago that even though I was paying this money to at least partially fund a public health system, this system was unlikely to provide *a timely response* in the case of any number of medical situations that I might find myself in.  Sure, it might provide a response, but I might be dead or have to endure months or years of pain and be out of work while I was waiting.  So I also pay for private medical insurance just in case I might need it.

The galling thing is that if I ever needed to avail of this cover I might well find myself in a public hospital, being attended to by public employees.  The same public hospital and public employees who couldn't see me publicly for months.  How can this be ?  How can these scarce resources be made available for private use when the primary employer of them (i.e. the public) can't use them ?  Don't get me wrong - my complaint is not with the hospitals or with the employees, but with the system of governance of our public health system that has allowed this situation to arise.  I have no problem with private practitioners using public resources (at a price) when these resources are surplus to requirements.  I cannot accept that they can use the resources in their private capacity while there are long waiting lists for their primary users.  Again, I have no problem with private clinics with nice flowers, fancy food, 24 hour professional cover, etc . . . if the market will bear the cost.  Just don't use my public contributions to faciliate it.  Keep the public and private seperate.

I don't think just throwing more money at the system is the solution - I could be wrong but we have been throwing money at some parts of the system for a long time now, and I don't think this has worked.

z


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## Complainer (19 Apr 2008)

*Re: Health System*



room305 said:


> What's the difference between paying an extra margin in profit to a private supplier and an extra margin in inefficiency to a public supplier?


There is at least an opportunity to eliminate that margin in the public sector. If you opt to privatise, you choose a system that will inherently and always include the margin.



room305 said:


> I think Labour's policy is designed to remove "inequality" from the health system, as though everybody enjoying the same crap healthcare will solve all our problems. I say we need greater inequality in healthcare, so that the high end, high margin services can subsidise the low margin side, in the same way that business class seats on a British Airways flight will subsidise the economy seats.




If the business class seats create this generous subsidy, why would AL have cut them out on everything except transatlantic? Why would Ryanair not be using these seats to subsidise passengers further? I'd love to see some backup for this claim? If (and its a big if) such a subsidy exists, surely the great panacea of the free market competition is bound to eliminate this subsidy over time?




room305 said:


> My belief is that the state should only supply a basic health service to everybody. Every whim cannot be catered for and cruel as it may seem, every radical new treatment cannot be purchased. Nobody argues that individuals on social welfare should be able to dine in Shanahan's every night but we don't expect them to go to bed hungry either.
> 
> I think it will be more cost effective for the state to provide a basic, efficient, clean and timely healthcare system for all by purchasing a basic insurance policy for every citizen in the state than to actually try and provide a health service itself.



Do you consider the expectation that when your wife goes into hospital to deliver twins, both she and the twins will come out alive to be a 'whim'? [Check out last week's inquiry into the Tania McCabe case in Drogheda? Do you consider the expectation that when your elderly parents go into hospital in Ennis they will come out in a more healthy state than they went in to be a whim? [Check out the reports of the fatal C.Diff infections in Ennis]. We are a long, long, long way from dealing with whims in the public health system.




room305 said:


> Nobody would suggest that it is a "cop out" that the government doesn't take on Tesco in the food distribution game to ensure nobody in the state goes hungry. I fail to see how this is any different for health service provision.


I don't want to bring my children up in a more Boston than Berlin society where the healthcare they receive depends on their wealth. Basic healthcare provision is a basic human right.




room305 said:


> Are you suggesting that nobody has tried? Does anybody know even know what they are? Resources are finite, we already spend more per head of population on health than the French, yet I hear very few suggestions for reform that don't involve throwing even more money at the existing problems.


 Regrettably(and unsurprisingly), I don't have all the answers. Is there any international evidence that privatisation of health care actually works for ALL the population (instead of just the privileged few).




room305 said:


> Indeed, but at least in a private healthcare system if you don't like one hospital you can take your business elsewhere.



You don't need a private system to be able to choose your hospital. Many public patients choose what hospital to go to based on discussions with their GP, or recommendations from family/friends, or simply by ringing up and asking how long the queue in A&E is.


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## room305 (21 Apr 2008)

Complainer said:


> There is at least an opportunity to eliminate that margin in the public sector. If you opt to privatise, you choose a system that will inherently and always include the margin.


Yes but how difficult is it to eliminate such a margin in a public sector organisation and how little incentive is there to do so? I say it is better to privatise, pay the profit margin of the private supplier and let the private supplier drive down costs and increase efficiency in the pursuit of profit. Where they fail to do so you can always switch to a new supplier.

I believe the weight of history backs this assertion.


Complainer said:


> If the business class seats create this generous subsidy, why would AL have cut them out on everything except transatlantic? Why would Ryanair not be using these seats to subsidise passengers further? I'd love to see some backup for this claim? If (and its a big if) such a subsidy exists, surely the great panacea of the free
> market competition is bound to eliminate this subsidy over time?


This particular aspect of microeconomic theory is known as price discrimination. If I am a business I want to charge people according to their willingness to pay, as long as I can do so profitably. If Bill Gates walks into my shop with a headache, it probably makes little difference to him whether he pays €1,000 or €1 for aspirin. However, it might make a big difference to my business.

One means of discoverying what a customer is willing to pay (and some economists do not regard this as "true" price discrimination) is to offer some small additional frippery to your core product at an inflated cost over and above the worth of said frippery. Stewardesses that smile, a few inches of extra legroom and free drinks are not worth an extra €4,000 to most people - but "most people" are not the target market segment to which business class seats are sold.

One reason perhaps that Ryanair do not engage in such price discrimination (although they engage in plenty of other forms of it - see what it costs to buy a Ryanair ticket at the last minute) is that the people who fly BA 1st class would probably never be caught dead flying Ryanair anyway.



Complainer said:


> Do you consider the expectation that when your wife goes into hospital to deliver twins, both she and the twins will come out alive to be a 'whim'? [Check out last week's inquiry into the Tania McCabe case in Drogheda? Do you consider the expectation that when your elderly parents go into hospital in Ennis they will come
> out in a more healthy state than they went in to be a whim? [Check out the reports of the fatal C.Diff infections in Ennis]. We are a long, long, long way from dealing with whims in the public health system.


 
You seem to be intent on working yourself up into a fit of self-righteous indignation without actually reading my post properly.



Complainer said:


> I don't want to bring my children up in a more Boston than Berlin society where the healthcare they receive depends on their wealth. Basic healthcare provision is a basic human right.


 
I would argue that basic healthcare provision is on a par with not going hungry regardless of economic circumstances. Are you suggesting that the government should start producing and distributing food?



Complainer said:


> Regrettably(and unsurprisingly), I don't have all the answers. Is there any international evidence that privatisation of health care actually works for ALL the population (instead of just the privileged few).


 
Well the current system works for no-one, don't forget that. I could just as easily question if you have any evidence that an efficient health care system can be run by the public sector? 

No industrialised nation currently has a health care system that the majority of people are satisfied with. Also, since you specifically mentioned the American healthcare model as one you would wish to avoid, it is worth noting that 84% of Americans have health insurance, either privately-funded or employer-funded. So the only industrialised nation that does not offer government-sponsored healthcare to all its citizens, with the world's most expensive healthcare, still does not leave access to health in the hands of the "privileged few".


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## diarmuidc (21 Apr 2008)

room305 said:


> I believe the weight of history backs this assertion.


Which country's health system do you wish to emulate? (ie which one has the "weight of history" behind it)?

Where does one draw the line between services that the should be public and private? Why not privatise the police force, the fire brigade, the road traffic controllers etc..? Your house fire could be put out faster if you pay the "comprehensive" premium ...


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## Purple (21 Apr 2008)

diarmuidc said:


> Which country's health system do you wish to emulate? (ie which one has the "weight of history" behind it)?
> 
> Where does one draw the line between services that the should be public and private? Why not privatise the police force, the fire brigade, the road traffic controllers etc..? Your house fire could be put out faster if you pay the "comprehensive" premium ...


While your at it room305 what's your favourite colour? (Since we are dragging the whole thread off topic and ignoring the substance of the points you made)


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## The_Banker (21 Apr 2008)

It gets better....

Reading this morning that a kid with a problematic kidney when into Crumlin Childrens hospital to have it removed. Guess what..? They removed the wrong kidney!!!!

I don't think it matters who is Minister For Health when dealing with stupidity like this.


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## Purple (21 Apr 2008)

The_Banker said:


> I don't think it matters who is Minister For Health when dealing with stupidity like this.


That's where you're wrong. She has to be liable for any and all errors by the 120'000 odd people who work for the public health service. If she can't keep on top of a few thousand clinical decisions each day, as well as set and implement policy, then she should not be in the job! 

at least that's what the opposition seem to think...


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## cork (21 Apr 2008)

Purple said:


> She has to be liable for any and all errors by the 120'000 odd people who work for the public health service.


 
People who make errors are responsible and should be dealt with.

The Minister is not responsible for every employee.

The opposition are all over the place on health - they favour centres of excellence while maintaining small local hospitals.

Centres of excellence are the way to go.


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## room305 (21 Apr 2008)

diarmuidc said:


> Which country's health system do you wish to emulate? (ie which one has the "weight of history" behind it)?


 
I'd prefer if you didn't misquote me. I said that the weight of history backs the assertion that the pursuit of profit leads to lower costs and increased efficiency. Is this an assertion you have a major problem with?

I also mentioned that no industrialised nation has a health care system the majority of people are satisfied with. This would indicate they all have major flaws. Of course arguments regarding public health care are generally fought on ideological rather than practical grounds.

Perhaps you'd care to mention the health care system you'd most like to see Ireland emulate?



diarmuidc said:


> Where does one draw the line between services that the should be public and private? Why not privatise the police force, the fire brigade, the road traffic controllers etc..? Your house fire could be put out faster if you pay the "comprehensive" premium ...


 
Where does one draw the line between public and private sector services indeed. Why not nationalise the banks, airlines, housing etc ... ?


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## ajapale (21 Apr 2008)

cork said:


> Centres of excellence are the way to go.


 
I heard Dr. John Crown on the LLS. He said that you only know that you have a _*centre of excellence*_ after the event. Up to that point the best you can strive for is a *centre of competence*.

Labeling a facility "*centre of excellence*" before it provides an excellent service is absurd!


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## Blueberry08 (21 Apr 2008)

ajapale said:


> I heard Dr. John Crown on the LLS. He said that you only know that you have a _*centre of excellence*_ after the event. Up to that point the best you can strive for is a *centre of competence*. Labeling a facility "*centre of excellence*" before it provides an excellent service is absurd!



Agree. As Crown put it: "You can no more say a centre will be excellent in advance than you can look in to your lover's eyes over a glass of champagne and say the baby we're going to make will be a piano virtuoso."

He has interesting things to say, although I could have done without him quoting Paris Hilton.


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## Complainer (21 Apr 2008)

room305 said:


> I believe the weight of history backs this assertion.


I believe in Santa Claus. Unfortunately, my belief doesn't make him real.



room305 said:


> This particular aspect of microeconomic theory is known as price discrimination. If I am a business I want to charge people according to their willingness to pay, as long as I can do so profitably. If Bill Gates walks into my shop with a headache, it probably makes little difference to him whether he pays €1,000 or €1 for aspirin. However, it might make a big difference to my business.
> 
> One means of discoverying what a customer is willing to pay (and some economists do not regard this as "true" price discrimination) is to offer some small additional frippery to your core product at an inflated cost over and above the worth of said frippery. Stewardesses that smile, a few inches of extra legroom and free drinks are not worth an extra €4,000 to most people - but "most people" are not the target market segment to which business class seats are sold.
> 
> One reason perhaps that Ryanair do not engage in such price discrimination (although they engage in plenty of other forms of it - see what it costs to buy a Ryanair ticket at the last minute) is that the people who fly BA 1st class would probably never be caught dead flying Ryanair anyway.


Thanks for the business 101 lesson. Now what the hell has all this got to do with healthcare? There is no evidence that privatised health care subsidises the public system, and even if it did, the free market economy would eliminate this over time (if we are to believe that stuff about the benefits of privatisation). You can't have it both ways.


room305 said:


> No industrialised nation currently has a health care system that the majority of people are satisfied with.


A very senior Dept of Health official referred me to Cuba as the ideal public health system. Apparantly they have a huge number of nurses. But I don't really know enough about this to answer definitively.


room305 said:


> No industrialised nation currently has a health care system that the majority of people are satisfied with. Also, since you specifically mentioned the American healthcare model as one you would wish to avoid, it is worth noting that 84% of Americans have health insurance, either privately-funded or employer-funded. So the only industrialised nation that does not offer government-sponsored healthcare to all its citizens, with the world's most expensive healthcare, still does not leave access to health in the hands of the "privileged few".


84% and dropping fast - see


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## Purple (22 Apr 2008)

Complainer said:


> I believe in Santa Claus. Unfortunately, my belief doesn't make him real.


Not quite the same thing...



Complainer said:


> Thanks for the business 101 lesson. Now what the hell has all this got to do with healthcare? There is no evidence that privatised health care subsidises the public system, and even if it did, the free market economy would eliminate this over time (if we are to believe that stuff about the benefits of privatisation). You can't have it both ways.


 If I pay for public healthcare through my taxes but consume it using my private health insurance then I have subsidised the public health system, i.e. I have paid for a public provision but chosen not to use it. BTW, the government still needs to regulate the health system, even if it is all privately delivered.



Complainer said:


> A very senior Dept of Health official referred me to Cuba as the ideal public health system. Apparantly they have a huge number of nurses. But I don't really know enough about this to answer definitively.


Do you advocate a system that sees consultants driving taxies in the evenings to supplement their income? If we paid professionals and nurses in the health system Cuban rates and closed our borders to stop them leaving then I'm sure we would have a great level of care. Personally I'd think that the totalitarian police state necessary for the Cuban model is not worth it.



Complainer said:


> 84% and dropping fast - see


The USA spends more per head on public healthcare than Ireland. My experience of their healthcare system has been excellent but I do agree that there is gross inequity there.
I am in favour of a public health system but I think that the waste is appalling and blaming the minister and using him or her as a whipping boy for all of the problems in a service that has enjoyed massive investment over the last 15 years (twice as much per person, adjusted for inflation, is spent on health than 10 years ago) is playing politics and ignoring the core problems.


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## Pique318 (22 Apr 2008)

Purple said:


> I am in favour of a public health system but I think that the waste is appalling and blaming the minister and using him or her as a whipping boy for all of the problems in a service that has enjoyed massive investment over the last 15 years (twice as much per person, adjusted for inflation, is spent on health than 10 years ago) is playing politics and ignoring the core problems.



I agree, but to get away from the sarcastic comments and thrust & parry of posters like the Complainer & room305 are enjoying, can we focus on the gist of the OPs thread ?

What are the core problems ?
Health system top-heavy with pen-pushers making decisions ?
Unions calling the shots on wage demands for underdeserving cases when junior doctors work 100hr weeks ?
Consultants telling the employer whet they can and cannot do ?
The whole public vs private fiasco where treatment can't be provided if you're public but the resources are 'suddenly' found if you've private health insurance.
Primary care not extensive enough leading to A&E overcrowded with simple issues such as sprains, breaks, cuts etc that a GP or nurse in a clinic/WestDoc/NowDoc setup could easily handle ?

Any more ?

Oh and please someone try to list them in order of importance, if you can !!


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## Complainer (22 Apr 2008)

Purple said:


> If I pay for public healthcare through my taxes but consume it using my private health insurance then I have subsidised the public health system, i.e. I have paid for a public provision but chosen not to use it.


Historically, there was no subsidy arising from private patients in public hospitals, as the insurance companies only paid the hospital the incremental cost of the private room, and not the real cost. So as well as subsiding private health care through tax breaks on the policy cost and tax breaks for investors, the state subsidised the private patients.


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## room305 (22 Apr 2008)

Complainer said:


> Thanks for the business 101 lesson. Now what the hell has all this got to do with healthcare? There is no evidence that privatised health care subsidises the public system, and even if it did, the free market economy would eliminate this over time (if we are to believe that stuff about the benefits of privatisation). You can't have it both ways.


 
You seem to be missing my point. This has nothing to do with public vs. private and everything to do with how private enterprise will seek to cater for all markets in the pursuit of greater profit and market share.

In Tesco they sell products that are essentially the same but placed in different packaging. More affluent consumers will choose the fancier packaging and the less well-off will choose that with the less appealing packaging. If some law was passed to prevent this practice and Tesco was forced to sell the product in the one type of packaging, the price would probably be placed somewhere between the two (i.e. cheaper for affluent consumers, more expensive for the less well-off). Hence in the first scenario, the affluent customers are subsidising the less affluent.

If health care was privatised you would see the same effect. Wealthier people seeking fancier packaging would subsidise those of us there for the 'plain vanilla' services. This would lead to better coverage and a more efficient service.



Complainer said:


> A very senior Dept of Health official referred me to Cuba as the ideal public health system. Apparantly they have a huge number of nurses. But I don't really know enough about this to answer definitively.


 
Now that is scary. Cuba's health system is the best in the world solely by virtue of the fact that Cuba says it is. They don't let foreign health inspectors in. I find it hard to believe that a system that sees surgeons routinely reusing latex gloves due to shortages can be all that great.

That said, I imagine quite a few senior administrators in the HSE would love to be able to kidnap the families of top consultants to prevent them leaving the country and force them to work for a pittance!


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## zag (23 Apr 2008)

room305 - the difference between the health system and Tescos is that people don't normally suffer for unreasonably long periods and sometimes die while waiting for the 'plain vanilla' product in Tesco.  They walk in, buy it, leave, consume it.  Health services are not comparable in any way.

If you walked in to Tesco, went to the fruit section and were about to pick up some apples when the staff told you to wait while they took your product away, wrapped them up in a new shiney bag and gave them to someone who was going to pay more than you, I don't think you would be happy.

z


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## shnaek (23 Apr 2008)

zag said:


> If you walked in to Tesco, went to the fruit section and were about to pick up some apples when the staff told you to wait while they took your product away, wrapped them up in a new shiney bag and gave them to someone who was going to pay more than you, I don't think you would be happy.



Or if you went to the fruit section and tried to put fruit in your trolley, but you were told that only union members could wheel the trolley, and you asked for a union member but they were all out sick, so you went looking for someone to wheel the trolley and it turned out that nobody would without the unions consent, which wasn't given. Oh, and you are in tremendous pain at the time.

Don't think they'd be in business too long.


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## Purple (23 Apr 2008)

shnaek said:


> Or if you went to the fruit section and tried to put fruit in your trolley, but you were told that only union members could wheel the trolley, and you asked for a union member but they were all out sick, so you went looking for someone to wheel the trolley and it turned out that nobody would without the unions consent, which wasn't given. Oh, and you are in tremendous pain at the time.
> 
> Don't think they'd be in business too long.



Very well put.


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## diarmuidc (23 Apr 2008)

shnaek said:


> Or if you went to the fruit section and tried to put fruit in your trolley, but you were told that only union members could wheel the trolley, and you asked for a union member but they were all out sick, so you went looking for someone to wheel the trolley and it turned out that nobody would without the unions consent, which wasn't given. Oh, and you are in tremendous pain at the time.
> 
> Don't think they'd be in business too long.


That's incidental. Having a public health care system does not imply you have to have unions and all that baggage. The discussion is whether universal healthcare funded by social insurance is a right or not. The details of implementing it should be separate.


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## room305 (23 Apr 2008)

diarmuidc said:


> That's incidental. Having a public health care system does not imply you have to have unions and all that baggage. The discussion is whether universal healthcare funded by social insurance is a right or not. The details of implementing it should be separate.


 
No, the discussion is whether healthcare should be provided by the public or the private sector. Is there some reason why the private sector cannot supply universal healthcare?


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## diarmuidc (24 Apr 2008)

room305 said:


> No, the discussion is whether healthcare should be provided by the public or the private sector. Is there some reason why the private sector cannot supply universal healthcare?


Ok, I wasn't clear. I am saying healthcare should be provided for everyone with equal treatment, paid for by social insurance charges. I don't care who provides the service.


> If health care was privatised you would see the same effect. Wealthier people seeking fancier packaging would subsidise those of us there for the 'plain vanilla' services.


Can you spell out what *exactly* you mean by plain vanilla service? What I understand from this is "if you can afford it you get to the top of the queue for your MRI." If not, what is a fancier service? Filet steak for dinner in ward 3?


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## shnaek (24 Apr 2008)

diarmuidc said:


> Can you spell out what *exactly* you mean by plain vanilla service? What I understand from this is "if you can afford it you get to the top of the queue for your MRI." If not, what is a fancier service? Filet steak for dinner in ward 3?



Exactly! Fillet steak in ward 3, which has a flat screen TV and a thousand channels, rakes of porn on satellite, big leather couches for visitors etc. If some idiot is willing to pay big bucks for all this, then why not let them pay for it? Those big bucks could then be spent on medical equipment and staff for the benefit of all. I can't see a problem with this.

Now if it were to affect quality of treatment, that would be a different matter.


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## Complainer (24 Apr 2008)

shnaek said:


> Exactly! Fillet steak in ward 3, which has a flat screen TV and a thousand channels, rakes of porn on satellite, big leather couches for visitors etc. If some idiot is willing to pay big bucks for all this, then why not let them pay for it? Those big bucks could then be spent on medical equipment and staff for the benefit of all. I can't see a problem with this.


The problem with this is that, if the free market economy works in the way that the proponents of privatisation and outsourcing tell us, there will be no subsidy. The big bucks will pay for the fillet steak and the flat screen TV and nothing more. There will be nothing left over 'for the benefit of all'.

The problems in the Irish health service have little to do with fillet steaks and flat screen TVs


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## shnaek (24 Apr 2008)

Complainer said:


> The problems in the Irish health service have little to do with fillet steaks and flat screen TVs


That comment has more to do with getting a nice sound bite in there than getting a point across methinks


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## Complainer (24 Apr 2008)

shnaek said:


> That comment has more to do with getting a nice sound bite in there than getting a point across methinks


That comment has more to do with getting a nice sound bite in there than getting a point across methinks


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## Purple (24 Apr 2008)

shnaek, the bottom line is that you will never convince anyone with a "private sector=bad, public sector=good" mindset that competition of any sort is a good idea.


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## shnaek (24 Apr 2008)

And with the sound bites and parrots around, I think we may have politicians in our midsts - so the prospect of a decent debate appears to be out the window too!


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## Complainer (24 Apr 2008)

Purple said:


> shnaek, the bottom line is that you will never convince anyone with a "private sector=bad, public sector=good" mindset that competition of any sort is a good idea.


Pots and kettles come to mind. I think the mirror image of that statement would well apply to Mr Purp!

For the record, my mindset it not that 'private sector=bad, public sector=good" or that 'competition of any sort is a good idea'. My mindset is that the Pavlovian response of 'public sector bad, private sector good' without any evidence or detailed analysis is facile.


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## room305 (24 Apr 2008)

diarmuidc said:


> Ok, I wasn't clear. I am saying healthcare should be provided for everyone with equal treatment, paid for by social insurance charges. I don't care who provides the service.


 
Okay now I understand better. You don't care who provides the healthcare so long as the cost is socialised. Socialisation of costs means abuse by participants. An effect known as the tragedy of the commons. Think of a typical buffet lunch - people eat more than they need to because it's "free". Or as Hardin puts it so eloquently :



> The tragedy of the commons develops in this way. Picture a pasture open to all. It is to be expected that each herdsman will try to keep as many cattle as possible on the commons. Such an arrangement may work reasonably satisfactorily for centuries because tribal wars, poaching, and disease keep the numbers of both man and beast well below the carrying capacity of the land. Finally, however, comes the day of reckoning, that is, the day when the long-desired goal of social stability becomes a reality. At this point, the inherent logic of the commons remorselessly generates tragedy.
> 
> As a rational being, each herdsman seeks to maximize his gain. Explicitly or implicitly, more or less consciously, he asks, "What is the utility to me of adding one more animal to my herd?" This utility has one negative and one positive component.
> 
> ...


 


diarmuidc said:


> Can you spell out what *exactly* you mean by plain vanilla service? What I understand from this is "if you can afford it you get to the top of the queue for your MRI." If not, what is a fancier service? Filet steak for dinner in ward 3?


 
What do you want me to do - draft up a contract? There are people who can afford whatever they want whenever they want it and there are people who can only afford what is necessary when it is necessary. Even if the profit margins are fattest on the former, there are always more people in the latter group, so it is unlikely their needs will ever be ignored. 

Yes, the service supplied to those who aren't wealthy won't be as good as the one supplied to those who are. Wealthy people can hire better lawyers, wear better clothes, eat in fancier restaurants, buy bigger houses and drive nicer cars than we can. That doesn't mean the markets for lawyers, clothing, dining, housing and cars are exclusively occupied with the predilections of the wealthy elite.

In the end you either accept reality and support a system that will work, or you continue to propose a fantasy health service in which no doctor would dream of bumping his sick daughter to the top of a waiting list.



Complainer said:


> The problem with this is that, if the free market economy works in the way that the proponents of privatisation and outsourcing tell us, there will be no subsidy. The big bucks will pay for the fillet steak and the flat screen TV and nothing more. There will be nothing left over 'for the benefit of all'.


 
You have made some variation on this point about five times now and I still don't understand what you are saying.



Complainer said:


> The problems in the Irish health service have little to do with fillet steaks and flat screen TVs


 
You're not on the pulpit at an ICTU convention - why not chance coming down here where the air isn't so thin and engage in the debate?


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## Complainer (24 Apr 2008)

room305 said:


> In the end you either accept reality and support a system that will work, or you continue to propose a fantasy health service in which no doctor would dream of bumping his sick daughter to the top of a waiting list.


I dream of a system where no doctor would need to consider bumping his daughter to the top of the waiting list, because there would be no waiting list.


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## room305 (25 Apr 2008)

Complainer said:


> I dream of a system where no doctor would need to consider bumping his daughter to the top of the waiting list, because there would be no waiting list.


 
Do you have nightmares about the bill?


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## Purple (25 Apr 2008)

room305 said:


> Okay now I understand better. You don't care who provides the healthcare so long as the cost is socialised. Socialisation of costs means abuse by participants. An effect known as the tragedy of the commons. Think of a typical buffet lunch - people eat more than they need to because it's "free". Or as Hardin puts it so eloquently :
> 
> 
> 
> ...



One of the most logical, succinct and well crafted post I have read on AAM.


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## diarmuidc (25 Apr 2008)

room305 said:


> Okay now I understand better. You don't care who provides the healthcare so long as the cost is socialised. Socialisation of costs means abuse by participants.



Ok So let's not subsidise the fire service,the police force and the upkeep of the roads. Your house fire gets put out if you pay your fire insurance, otherwise tough. If you want the road passing your house maintained, then you pay for it out of your own pocket. 

How can you tolerate to have the costs for these services "socialised"? Think of all the people abusing the fire brigade service!!


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## shnaek (25 Apr 2008)

That's fair enough, diarmuidc - and there are separate arguments to be made about other services - but this topic is about the health service, and we are never going to come to any conclusions if we go off topic. 

So coming back to the health service - do you believe it should be an entirely public funded service, diarmuidc? And if so - do you believe we should be spending more than 15bn on it a year? How much more? Or do you think the service needs reform? Do you see any role for the private sector in health?


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## becky (25 Apr 2008)

I beleive it has to be a mix.

For routine procedures I have no difficulty with the private system but for expensive procedures like cancer treatment I would be using the public system where the experst are paid an excellent salary and are not concerned with the 'business' side of things.


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## room305 (1 May 2008)

diarmuidc said:


> Ok So let's not subsidise the fire service,the police force and the upkeep of the roads. Your house fire gets put out if you pay your fire insurance, otherwise tough. If you want the road passing your house maintained, then you pay for it out of your own pocket.
> 
> How can you tolerate to have the costs for these services "socialised"? Think of all the people abusing the fire brigade service!!


 
I have ideas and answers for all of these services but unless you are proposing that people should only ever have a choice between laissez-faire capitalism and communism with nothing in the middle, each should be debated on its individual merits.

Our public health system is a failure. It costs more to fund per head of population than the French healthcare system and yet over fifty percent of the population still chooses to purchase private health insurance. People wouldn't pay for something they can get for free unless they felt they were getting a vastly superior product, so it follows that the private health care system in Ireland is the one with which more people are satisfied.

Yet your solution involves shutting down the successful system in favour of the failing system. I don't see the logic in that myself.


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