Letting off steam about the Health System

cork said:
Centres of excellence are the way to go.
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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!
 
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!
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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. :)
 
room305 said:
I believe the weight of history backs this assertion.
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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.
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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.
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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".
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84% and dropping fast - see
 
Complainer said:
I believe in Santa Claus. Unfortunately, my belief doesn't make him real.
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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.
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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.
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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
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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.
 
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.
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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 !!
 
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.
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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.
 
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.
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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.
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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!
 
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
 
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.
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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.
 
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.
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Very well put.
 
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.
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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.
 
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.
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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?
 
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?
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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.
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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?
 
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?
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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.
 
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.
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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
 
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.
 
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!
 
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.
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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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