Private vs. public healthcare

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.
 
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.

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.

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?).

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).

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.

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.
 
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.
 
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.
 
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.

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.

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?

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

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

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.

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.

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.

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

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.

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.

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.
 
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].
 
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?
 
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.
 
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:)
 
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.
 
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