The Commonwealth Foundation puts out a great PDF every year on international health system comparisons. Here is Table 1 which describes the many different ways industrial countries cover their citizens. There is no single way that works. Each pathway in these countries evolved from pre-existing institutions and constraints.
Just keep that in mind when there is a discussion about means and end and how we should not confuse means with ends.
Why is one of the tags (which I usually don’t notice) “I Hate All of You”?
Don’t blog angry, Richard.
@BGinCHI: I figured this would start a good pie fight introducing facts into an emotional discussion
I get the feeling, for some on the Left, the goal is as much to destroy private health insurance as an industry, as it is to achieve universal coverage.
Therefore it is government run single payer or bust.
@Richard Mayhew: Diabolical.
It’s like the opposite of being a referee.
@gene108: Is the question also: should there be profit in delivering healthcare services?
Maybe that’s too basic, but when that question is applied to, say, education, it’s very clear to me that the answer is absolutely NO.
Botsplainer, Cryptofascist Tool of the Oppressor Class
Let’s you and him fight….
No profit for anything to do with Justice system too seems obvious. Can’t understand how republican’s think.
On the other hand healthcare is more complicated because of medical research. We would like continuous advances in knowledge and profit has sometimes been a useful help in good results in the past, just not unlimited nor unmitigated. Pure academic research funded by government has also been a driver, especially for the early stages. It’s complicated. Endless patent’s for non significant improvements is not beneficial though. Smart regulation is hard but nessesary.
@BGinCHI: Richard’s been hanging around Cole too much.
@BGinCHI: So then you’re arguing for, not single payer like Canada, but for a British style NHS.
@BillinGlendaleCA: I was asking a question. I’m curious what role profit has, positively, in healthcare delivery. And by that I don’t mean paying people like doctors/nurses/admins for their work, but shareholder profit (or the like).
It makes no sense to me in education. Is it salutary in healthcare? This is a fundamental question.
@BGinCHI: If we are unwilling to tax ourselves as a society to pay for medicine, and we as a society want medical services, we need someway to get people who could be doing other things to be doing medical things….
And if we’re not going to fund with tax money MRI machines, the money to buy those MRI machines has competing opportunities.
Yeah, that is reductive and Econ 101ish but it is the basic reality.
Any chance of you passing this on to the Republicans in Congress?
Seems to me that a lot of different shit works.
And for the record I do not favor a single payer. Not yet anyways.
@BGinCHI: The problem is that you’re right, but what you’re asking for is an immediate and total realignment of our society, and I don’t think that’s possible without massive stresses. To me, the best path right now is to get to universal care, then move from there.
Blue in SLC
Keep in mind that non-profit does not mean “no-profit.” Private non-profit healthcare can make plenty of money, which may be used to purchase MRIs, drive innovation, etc., without the downside of being driven by shareholder value. Depending on their charter (or whatever the formal term is for such things), management will be driven by other goals (e.g., providing high quality and/or accessible healthcare).
Personally, I’d like to see healthcare restricted to non-profits. Don’t much care if they are private or public entities.
pseudonymous in nc
I think there’s an argument that profit can be made, but only in a very very tight sandpit. Cosmetic procedures, the number of cable channels in your hospital room, etc. Australia very definitely has room for that. And, y’know, doctors have to get paid.
The point being that the US has inserted profiteering and wheedling for profit where it is most exploitative and capricious and least likely to improve outcomes.
There are some common themes to that chart (ex-US): large risk pools, price controls, tight regulated sandpits, transparent costs for reimbursement, a recognition that it’s in a nation’s best interests to underwrite treatment for certain groups of people, and above all, a belief that providers and insurers are accountable to government and the people in a way they simply aren’t in the US.
There are those among us for whom “great PDF…on international health systems comparisons” may not sound like compelling reading. I suggest the T.R. Reid Frontline documentary of several years ago, “Sick Around the World.” Similar information but with moving pictures.
@Blue in SLC:
Secular non-profits. Catholic hospitals have got to go.
What Have the Romans Ever Done for Us?
That’s one thing that’s puzzled me about Hillary’s response to Bernie on the medicare for all plank – he’s proposing this as though that’s how everyone does it but Germany, France, the Netherlands, etc. have Obamacare-like insurance exchanges. I knew that’s how Germany did it but didn’t know Switzerland, France, and The Netherlands use a similar model.
@greennotGreen: Hey, I know how to have a good time… :)
The real problem isn’t any moral issue surrounding profiting from something so basic and essential to our lives. The problem is that the incentives for health care delivery (here, by “delivering”, I assume you mean providers) are all wrong. Basically, you’re paid to treat people, not to keep them well, and those two things aren’t the same. There’s also the huge problem that the people who decide on what to do are the same as the people who provide the service, the consumer-driven-healthcare-will-solve-problem idiocy notwithstanding.
So…health care is innately prone to severe market failure. Kenneth Arrow saw this a long, long time ago (I think back in the 1950s).
The real problem is that the incentive to e.g. develop new drugs is not via “profit,” in the economic sense, but by rent, as in “monopoly rents”.
Yeah…who’d want to destroy something that is a stupid way of doing things, front pagers with a conflict of interest on the issue notwithstanding?
pseudonymous in nc
@What Have the Romans Ever Done for Us?:
That’s stretching the ‘-like’ part a little more than it ought to be. There’s nothing like the tyranny of choice that’s forced on individuals by the ACA exchanges, where no matter which plan you’re choosing there’s going to be some way it fucks you over, whether it’s the network or the deductible or the coinsurance.
The other question may be, does competition and the profit motive help stimulate innovation? This applies both to medicine and education.
And I would say, yeah, probably.
As an aside, aren’t wages profits to some degree? I know good liberals who would like to fix the wages of doctors and nurses at a low, but appropriate level, and never permit raises, and justify this as part of the mechanism of controlling medical costs. And some of these same people would pay all teachers football player level salaries because educators are angels.
If it helps bring efficiency and innovation, I would say, yes.
ETA: An earlier attempt at a reply was eaten by the system, apparently.
@liberal: Please go fornicate with a rusty farm instrument and an amorous goat.
It’s worth noting that we do accept for profit companies to play a role in education. Text book companies, for better or worse, science lab equipment manufacturers, etc. But those who ensure access to education (school boards) are where we draw the line on accepting the profit motive as a driving force.
Another good look at options: Frontline had a really good show looking at Britain, Germany, Switzerland, Singapore and Japan. All different systems, all universal. Yeah, I pushed this yesterday, but it is good.
I don’t really get the single payer is the only way to go thing. Plenty of other countries have universal coverage without single payer. Obviously there have to be constraints like they have in those countries, but single payer isn’t the only option.
On the other side of the coin it would seem to me that smaller insurance companies would do pretty well under a medicare for all system. Medicare for all wouldn’t eliminate private insurers, because medicare does not cover everything. Insurance companies would still sell the companion policies, and I would imagine that because the gov’t picks up 80 percent of costs it would eliminate wild swings in costs that may come up anomalously that can ruin a smaller or midsized insurer. While revenue would drop, there’s no reason that profits would, and my guess is that profit margins may actually be better.