Letting off steam about the Health System

[room305]

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.

- The positive component is a function of the increment of one animal. Since the herdsman receives all the proceeds from the sale of the additional animal, the positive utility is nearly +1

- The negative component is a function of the additional overgrazing created by one more animal. Since, however, the effects of overgrazing are shared by all the herdsmen, the negative utility for any particular decision-making herdsman is only a fraction of -1

Adding together the component partial utilities, the rational herdsman concludes that the only sensible course for him to pursue is to add another animal to his herd. And another; and another ... But this is the conclusion reached by each and every rational herdsman sharing a commons. Therein is the tragedy. Each man is locked into a system that compels him to increase his herd without limit - in a world that is limited. Ruin is the destination toward which all men rush, each pursuing his own best interest in a society that believes in the freedom of the commons. Freedom in a commons brings ruin to all.

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.

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.

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?

 

[Complainer]

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.

 

[room305]

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?

 

[Purple]

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 :





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.



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



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?

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

 

[diarmuidc]

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!!

 

[shnaek]

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?

 

[becky]

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.

 

[room305]

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.