But even here in the US, isn't the pay for MDs greatly exaggerated, considering the cost of malpractice insurance and medical school loans?
I'd be interested in seeing the figures for doctors' salaries adjusted for these effects.
Insurance costs are the bane of all healthcare systems. If you didn't have to pay absurd fees for that then the price of healthcare would be much more reasonable.
Perhaps, rather than nationalizing healthcare itself, we should nationalize the insurance of doctors and medical staff.
I'm happy with the NHS in the UK and the health system back home, in NZ, both of which I have used a fair bit (the latter more than the former).
So far as NZ goes:
GP/primary care is satisfactory - there is a two tier system - for the poor/youth/60+ it is nearly free*. For the rich it is a little more expensive, but it has got a little cheaper due to recent reforms (primary healthcare trusts). Prescription medication is very cheap generally (always exceptions if you have a horribly rare /new condition, or want fancy new medication). Dentistry is less well catered for - iirc free under 18, not so after that, although to be honest I don't fully know how the latter works fundingwise.
Consultations with specialists or consultants must be referred by a GP and delays can creep in here, but you will get to see one for free when that happens. I never had to wait too long (I had 6 monthly check-ups with mine), however since the initial referral is from your GP you have to rely on them to push it, rather than being able to do it yourself, which does disempower one somewhat.
For surgery - this varies depending on your area and your surgical problem. For acute (in my experience in two distinct health districts) waiting times are short. For elective, it can be worse, although i don't have a hard, verifiable reference point here. These operations are free if you can wait. I personally have only paid for one operation and that was a minor outpatient eye thing which I couldn't wait 3 weeks to have done. The same guy that would have done it for free did it for me as a paying customer (small town specialists often work in both private and public systems). The hospitals I've used have been clean and modern, with well trained staff that do appear to give a crap. I have no complaints on that score
Oh and one of the best things about New Zealand is there is no personal injury litigation. We have compulsory accident insurance administered by a state owned corporation that provides cover for all accidents regardless of where they occur (within NZ) or whose fault it is. If you hurt yourself on the road due to some dickhead without a licence or insurance you still get compensation and recovery costs. This is paid for by a variety of levies - and works on the basis that this regime ensures that all get coverage quickly rather than some getting it slowly through the courts.
* There is a threshold personal/household income test as to who falls into either camp. It doesn't take much for one to be rich by this, although numbers escape me.
Checking up on doctors wages in Denmark they make between 26,000 and 56,000DKK a month or about $5-10,000 a month, depending on position and senority, which is about the same as most engineering degrees or other top tier jobs pay.
NATIK on
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BobCescaIs a girlBirmingham, UKRegistered Userregular
Taxes vary from province to province in Canada and health care is a provincial thing.
I have a family doctor who I need to schedule visits with (normally about 2-5 business day wait) but don't have to wait more then 10 minutes or so to see normally. This guy is my personal doctor, he knows me, and he knows my family.
I can go to a walk in clinic if I'm in a hurry to get something seen to, these are really hit and miss. I've been seen immediately and once I had to wait 2 hours (I could have tried driving 5 minutes down the road and to a different clinic but I had a good book with me), you get a random doctor.
I can go to a specialist, but if your problem is not serious your looking at up to a 6 month waiting.
For the above 3 cases I get examined in a private room.
Hospital ER -this is not where you want to go if your problem is not immediate, you will wait, possibly for many many hours. You will get a screened off area, not a private exam room (unless you really need one, there are only a few).
Regardless of where I go, hospital/walk in/specialist/family doctor they have access to an electronic copy of my medical history. And regardless of where I go its covered (I pay nothing). Prescription meds and Dental are not covered, you need a plan (normally through your job) or to qualify as some sort of unfortunate.
If you have a real emergency, you get seen to right away. The triage people are good at their jobs.
Personally I am all for socialized health care. I would not trade our system for the US system. For most folks I'm pretty sure the difference in tax between the USA and here would be small (higher or lower depending on which state/province were talking).
Most people only see a Doctor if they need to, they would actually like it if more people went for yearly checkups because prevention and early diagnosis of stuff would more then offset the cost of the additional checkups. Not many people abuse the system.
Anyone who says they are "paying more then their share" for health care better be making 100,000 a year and have no dependants. Despite everything we hear about rich people and companies avoiding taxes, they still contribute by far the most in taxes.
I think overall, the Canadian system is more efficient then the USA system. More people get medical treatment for a smaller (socialized) cost. But I see not reason not to have a 2 tier system where people have the option to go to private hospitals, as long as its regulated. Those rich cats paying to go to private hospitals will still be paying tax which pays for the social hospitals.
The two tier system already exists in Canada but some people don't know this yet and are scared bad things happen to public health care if we allow it (sshhhh don't tell them!).
The danish wages get nowhere close to the american ones, but really the doctors aren't complaining because they are paid exactly what any sane danish person expect a top tier job to pay. Blame it on our socialist mindset. Practically everone in denmark is within that 20-50,000 DKK a month wage area depending on specific position and type of work.
It also has to be said that the danish work week is 37 hours for everyone, doctors included.
Only read the first page so far but I wanted to add something from the US point of view.
I make pretty good money. I have health insurance through work. But work only covers a certain portion of the cost of the premiums.
Even after my workplace contribution, I pay more than 2x as much for health insurance for my family as I do in taxes. Total. Even making 90K + bonuses per year, if the US government doubled my current total tax burden but provided health care in exchange I would still be taking home more money.
In the US, we have a system called COBRA where if you leave your employer or get fired, you can continue with the same health care plan for 18 months as long as you pay for it yourself.
If I were to COBRA off right now, assuming my income remained stable, my health care plan would cost about 5% of my gross income per month.
Feral on
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
The problem with nationalized medicine is that it doesn't care about your health, and shouldn't. It cares about the countries health, getting the most healthy people it can for the money it has.
The problem with for-profit health care is that the insurance companies are not concerned with your health, or the health of the nation, but the size of the executive's pay.
HonkHonk is this poster.Registered User, __BANNED USERSregular
edited October 2008
I live in Sweden and have a chronic liver disease. I never really thought about different medical systems before, but the one we have (much like in Denmark and the rest of Scandinavia) is as good as free. I have never noticed the "waiting in line" that some use as an argument against socialized medicine - I share a specialist with about 20 other patients, she has several people working under her. You get prioritized according to the severity of your situation, which seems like a good system. Excellent care, and if I'll need to get a transplant in the future the state run hospital here in Stockholm to which I belong has a survival rate slightly surpassing that of the Mayo clinic (Jacksonville).
One might argue this type of system brings higher taxes, but I'm biased in my situation... I think mostly everyone know enough people in need of expensive care to not care about a higher tax rate.
I bitch about the cost of medicine, which the first month of the year costs me about $200 and then nothing for the rest of the year (would otherwise cost me thousands). So not really much to complain about, all the more to rejoice about! Socialized medicine ftw, makes being sick awesome!
edit: Here health insurance is like insuring your house, you get sick - you get money.
Of course, the german system has its downs. As mentioned, we pay ridiculus amounts of taxes
How much?
Because apparently the UK's tax rate, described as "rape" by Willeh above, is comparable to what I pay here in the US.
From what I know, our income tax whilst similar to yours, is only different in that that is the majority of your tax whereas we pay VAT at 17.5% on EVERYTHING (bar children's clothes), we pay a 75% tax on petrol (your complaining about $4 a gallon, try $14 a gallon, or £1.50 a liter) God knows what other tax's im forgetting.
Of course, the german system has its downs. As mentioned, we pay ridiculus amounts of taxes
How much?
Because apparently the UK's tax rate, described as "rape" by Willeh above, is comparable to what I pay here in the US.
From what I know, our income tax whilst similar to yours, is only different in that that is the majority of your tax whereas we pay VAT at 17.5% on EVERYTHING (bar children's clothes), we pay a 75% tax on petrol (your complaining about $4 a gallon, try $14 a gallon, or £1.50 a liter) God knows what other tax's im forgetting.
Like so much else, you are wrong about this.
On top of federal income taxes just about every state has some extra form of taxation. Some, such as Washington where I live, have sales taxes. Some have an extra layer of income tax. Some have both. Nearly all have extra taxes on gas such as what you keep bitching about.
I wonder why in these discussions it's only the Canadian or British systems that get raised as potential alternatives to the American system. I know I keep harping on the "Sick Around the World" frontline, but it seemed like Japan had some damn interesting ideas.
I forgot about the joyous 17.5% VAT. Also, the cost of living is much more expensive here, so while I wouldn't swap my NHS for the US system, it is true that most people from the States would be worse off here as when comparing prices, generally just swap the $ for a £...there's no need to worry about exchange rates or anything like that.
We have 25% VAT here, but some stuff has a lower rate -- 12% on food, hotels and camp sites. Books/newspapers, conserts and various other culture is 6%.
No VAT on rent and medical fees (like seeing a doctor; dunno about medical supplies).
A broken bone usually takes several hours of waiting time before you see someone.
An "optional" surgery like a hip or knee replacement usually takes something absurd like 5-7 months before the surgery occurs.
On the other hand life-threatening things are treated quickly. If my sister who can have severe asthma attacks walks into a hospital with trouble breathing she's attended to immediately. Same would go for dealing with a heart problem or malignant cancer.
I'm not quite sure what our state of pharmacare is though...
Despite this, the Canadian government is able to run balanced budgets every year . Also I remember hearing that the U.S. healthcare system costs more per capita than the Canadian or British one which is both surprising and scary.
Hey, there, folks living in a country with national medicine
How do you feel about your system?
Its peachy-keen.
Would you trade it for the current US system of private insurance?
Hell no. Your system terrifies me.
What do you like about your system?
Cheap, diverse, easy to navigate, overall excellent professional standards. I've never had to wait long to see a doctor, even specialists. I do have to book well ahead to see a dentist; dentistry isn't covered in our public health system.
What do you hate about it?
The aforementioned lack of dental cover. Its actually a big public health issue, a lot of preventative healthcare is focused on the mouth.
Its got problems with aged care (although that's kind of tangential to medical provision and related to high demand), and it also struggles to meet the needs of people living outside the capital cities, although it has a fair stab at it. Facility and doctor provision is largely down to the states, so working condition variability is driving some doctors to certain locations at the expense of others.
The only other major problem is one common to most western countries - the admin and managers have taken over. Nurses have to spend a lot of time on fussy paperwork, but the real problems are when the managers don't do their jobs properly. We've had three cases in the last couple of years of dodgy surgeons in NSW and QLD, all of whom were complained about by both patients and nursing staff. The complaints were ignored far too long, and a number of people died or were mutilated in the meantime. Managers in all cases neglected to run proper background checks, and were so desperate to hire anyone that these people got in.
I suspect that besides managerial incompetence, the shortage of locally-trained doctors has contributed to that problem, but that's not happening because our healthcare is socialised - its happening because the AMA are raging dicks and are trying to keep their salaries high by not training enough people. Dicks.
In sum, the system has problems, but they're not directly related to the system being part-public.
I have heard criticisms of the Dreaded Socialized Medicine where things are bandied about like, "Everyone gets the same treatment no matter how much care they need" and "Do you want to wait to see a doctor?"
Usually put forward by people with one eye and four teeth, I presume.
I've also heard that there are sometimes not enough specialists to go around or that doctors don't make a fair wage under these systems.
There's a shortage of training spaces for new grads here, but again, that's the AMA being dicks. A lot of overseas students who get their medical degrees here are going to get shafted in terms of prac training in the next few years. Wages are pretty much fine, although the radiologists have been bitching about not being able to afford that second BMW the last couple of years.
I would really like a thread where people in nationalized healthcare systems tell the pros and
cons, without Ameri-centric debate of the current candidate's policies.
Of course, the german system has its downs. As mentioned, we pay ridiculus amounts of taxes
How much?
Because apparently the UK's tax rate, described as "rape" by Willeh above, is comparable to what I pay here in the US.
From what I know, our income tax whilst similar to yours, is only different in that that is the majority of your tax whereas we pay VAT at 17.5% on EVERYTHING (bar children's clothes), we pay a 75% tax on petrol (your complaining about $4 a gallon, try $14 a gallon, or £1.50 a liter) God knows what other tax's im forgetting.
Like so much else, you are wrong about this.
On top of federal income taxes just about every state has some extra form of taxation. Some, such as Washington where I live, have sales taxes. Some have an extra layer of income tax. Some have both. Nearly all have extra taxes on gas such as what you keep bitching about.
You pay $4 per gallon, we pay $14 per gallon. When I was in America I was told that New York was expensive and that I was advised to do my shopping in Florida or Seattle (holla PAX!) as Tax was a horrific 9% there.
If im wrong then fair enough, all im going on is my experiance.
40% on anything earned above £35k Vs ?
Feral already figured out he would be paying 33% vs 20% on earnings and god knows how much less on the Tax of goods.
Though I've never had any real need for medical care as an adult, I work for the NHS and speaking from the inside I wouldn't give it up for any other system. It has its problems - no mistake - but the sense of security, even for a healthy guy like myself is second to none. I know if my balls fall off overnight that there's a system in place to stick 'em back on.
Paperwork and admin could be considered a problem, but a lot of those problems are due to a lack of technical skills on the side of the clinical staff. For example, among other things I deal with waiting lists for elderly patients waiting to get hearing aids fitted. The paperwork is an absolute necessity for us to find out who is dropping off the bottom of the waiting lists and get them treated in time. Every problem that I've had with that data is directly because the people supplying it (i.e. clinicians and practices) suck balls at recording it.
You could make the argument that if they didn't record that information at all then they'd have more free time to treat people, but the risk of patients falling through the gaps is far too high to make it worth it, especially when you're dealing with cancer patients, where being forgotten for a week could literally be a life or death matter.
I wonder why in these discussions it's only the Canadian or British systems that get raised as potential alternatives to the American system.
That's a damn good question.
France, Germany, Switzerland, and Australia all have interesting ideas.
I'd still like to hear from somebody in one of those countries.
There are a lot of countries clearly doing something better than the US is, given that the US is #1 in per-capita costs but 34th in aggregate health outcome.
I wonder why in these discussions it's only the Canadian or British systems that get raised as potential alternatives to the American system.
That's a damn good question.
France, Germany, Switzerland, and Australia all have interesting ideas.
I'd still like to hear from somebody in one of those countries.
According to the source of all human knowledge (Wikipedia), Germany only pays Euro160/capita/year on administrative costs. This compares to more than $1000/capita/year for the US.
Considering Germany doesn't use a single payer system (there are hundreds of insurance companies), how do they do it? Anybody have the inside scoop?
Person A earns £235k a year, pays around £70k in tax on income tax alone.
Person B earns £20k a year, pays around £4k in tax on income alone.
Both get the exact same services from the NHS, throw in the idea that Person A is healthy and Person B smokes 20 fags a day. Is that fair, in my eyes its not.
I believe the traditional response is that person A is paying not entirely out of a sense of charity, but also because seeing the myriad examples of person B treated leads to greater social stability and safety for people like person A.
How about, everyone pays a flat rate for the services everyone uses on a day to day basis, similar to a Poll tax. Give a small tax break to the very poor, and tax earnings on anything above, around £60K a year. I'm no economical expert, but this seems allot fairer. It provides for the poor, gives necesary room for incentive to better ones self, rewards those adequately who have done well for themselves whilst taxing people who earn more than enough to live a well off life.
This way, everyone pays for what they use themselves, as an individual, which seems fair. There is an element of the rich paying for the poor, which of course is beneficial in many ways for society in general, but it isn't eliminating the middle class and punishing those who work hard and do well in life.
Someone quoted the great Prime minister Margaret Thatcher, 'there is
no such thing as society'. Just posting simply this is taking it way out of context and is kind of a cheap shot very similar to the abysmal attack ad's McCain is running against Obama at the moment , post the whole thing, even if you disagree with it.
I think we've been through a period where too many people have been given to understand that if they have a problem, it's the government's job to cope with it. 'I have a problem, I'll get a grant.' 'I'm homeless, the government must house me.' They're casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It's our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There's no such thing as entitlement, unless someone has first met an obligation.
(I am high on pain killers after just having surgery so please bare this in mind)
Person A earns £235k a year, pays around £70k in tax on income tax alone.
Person B earns £20k a year, pays around £4k in tax on income alone.
Both get the exact same services from the NHS, throw in the idea that Person A is healthy and Person B smokes 20 fags a day. Is that fair, in my eyes its not.
Someone quoted the great Prime minister Margaret Thatcher, 'there is
no such thing as society'. Just posting simply this is taking it way out of context and is kind of a cheap shot very similar to the abysmal attack ad's McCain is running against Obama at the moment , post the whole thing, even if you disagree with it.
I think we've been through a period where too many people have been given to understand that if they have a problem, it's the government's job to cope with it. 'I have a problem, I'll get a grant.' 'I'm homeless, the government must house me.' They're casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It's our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There's no such thing as entitlement, unless someone has first met an obligation.
No, that seems like exactly the context I think it would be in.
What a dumbass statement.
JebusUD on
and I wonder about my neighbors even though I don't have them
but they're listening to every word I say
Person A earns £235k a year, pays around £70k in tax on income tax alone.
Person B earns £20k a year, pays around £4k in tax on income alone.
Both get the exact same services from the NHS, throw in the idea that Person A is healthy and Person B smokes 20 fags a day. Is that fair, in my eyes its not.
In my eyes it is fair.
See, this is where we differ, I think that its unfair for one person to pay £70k thing for the same thing someone else has to pay £4k for....
Someone quoted the great Prime minister Margaret Thatcher, 'there is
no such thing as society'. Just posting simply this is taking it way out of context and is kind of a cheap shot very similar to the abysmal attack ad's McCain is running against Obama at the moment , post the whole thing, even if you disagree with it.
I think we've been through a period where too many people have been given to understand that if they have a problem, it's the government's job to cope with it. 'I have a problem, I'll get a grant.' 'I'm homeless, the government must house me.' They're casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It's our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There's no such thing as entitlement, unless someone has first met an obligation.
No, that seems like exactly the context I think it would be in.
Person A earns £235k a year, pays around £70k in tax on income tax alone.
Person B earns £20k a year, pays around £4k in tax on income alone.
Both get the exact same services from the NHS, throw in the idea that Person A is healthy and Person B smokes 20 fags a day. Is that fair, in my eyes its not.
In my eyes it is fair.
See, this is where we differ, I think that its unfair for one person to pay £70k thing for the same thing someone else has to pay £4k for....
Someone quoted the great Prime minister Margaret Thatcher, 'there is
no such thing as society'. Just posting simply this is taking it way out of context and is kind of a cheap shot very similar to the abysmal attack ad's McCain is running against Obama at the moment , post the whole thing, even if you disagree with it.
I think we've been through a period where too many people have been given to understand that if they have a problem, it's the government's job to cope with it. 'I have a problem, I'll get a grant.' 'I'm homeless, the government must house me.' They're casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It's our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There's no such thing as entitlement, unless someone has first met an obligation.
No, that seems like exactly the context I think it would be in.
What a dumbass statement.
Care to explain why its dumb?
Because this part right there? That is the definition of society. Looking out for our fellow citizens in their time of need. Because they would do the same for us. Our neighbours do not encompass the people living in our close proximity, but also people we have never met. In effect every person in the UK is your neighbour and you should be ready to help them out if they need it. You should also get help from the same people.
What is more effective? 1 person(you) trying to do everything, 5 people(your actual neighbours) cooperating or 40 million people(the UK) working in agregate? Wich is going to be able to give you adequate healthcare in any circumstances?
Kipling217 on
The sky was full of stars, every star an exploding ship. One of ours.
All of Sociology says different. Clearly there is more that just individualism to the max and your immediate social group.
I guess there are really two ways to read that quote. One says that the solution starts with you and social programs can't work unless you do it. The other says get rid of the social programs. Peoples agency is entirely internal and everything that happens to them is their fault.
I see it as the second and thereby think it is a load of bollocks.
JebusUD on
and I wonder about my neighbors even though I don't have them
but they're listening to every word I say
I'm wondering what the actual pay rates for the doctors are. I'm skeptical.
They may not be making $500,000 a year, but I don't think they're middle class.
It's the nurses and other people below the docs that really need a raise. At least here in Scandinavia they've started taking over a lot of the stuff doctors used to do during the last 20 years, but without an appropriate pay raise to compensate for that.
My mom's a nurse, and that was a pretty common rant from her.
The surgery was done immediately. There was no wait or hint of a wait.
I had peritonitis, and had a resection (cutting out bits) of my intestine. Later doctors, both in and out of the UK, have told me the surgeon did an amazing job and I'm very lucky to not have a bag.
After that, I saw a consultant/specialist regularly, who is world-famous. When I read up on Crohns his name comes up quite often, and even non-English-speaking doctors outside the UK have heard of him.
I received my medication, (which is extremely expensive) a very good standard of care, and rubbish food during my time in hospital. All together, I've been in hospital for over a year in a couple of different places. My family joked that I should publish a 'Good Hospital Guide'.
All my hospital treatment and doctor visits were free. I paid prescription fees (utterly nominal in comparison to the real costs) for my medication.
I've also been hospitalised for pneumonia and the treatment was similarly good.
Of course, during all this time I had no money. I was poor growing up, and chronic illness didn't make that any better.
I'm not exaggerating when I say I owe the NHS system, not just the people, my life.
Anyway, I think the NHS is the single best thing about living in the UK. Where I live now, Japan, has a hybrid system (state health insurance, private hospitals) which works very well, but that might be to do with cultural factors here.
Would you trade it for the current US system of private insurance?
What do you like about your system?
What do you hate about it?
Canadian:
*I feel that our system is good at some things, but is chronically and intentionally underfunded by our federal and provincial levels of government. While the Canadian constitution makes health care a provincial responsibility, much of the funding comes from the national government. The system here could also do with some organizational reform and some more access to private care being allowed. Various European countries do a much better job of delivering socialized health care than Canada does.
*Hell no. My family probably would have been bankrupt years ago under a US system due to some family member's conditions.
I wouldn't trade a socialized healthcare system for the world. Could the Canadian system be better? Certainly, but you could likely say that about every system. The U.S. system is just crazy, and I would fear it if I were a victim of a chronic health problem.
I've had one major run in with the healthcare system, about 8 years ago when the Canadian healthcare system was likely in worse shape than it is now. I had a regular family doctor, who I could get in to see with only two or three days notice, and who had prescribed me with a medication. I started having a bad reaction, and was able to get in to see him immediately, and it was severe enough that he had me in the hospital about an hour after seeing me. While in the hospital I was seen by a number of specialists, while they tried to determine what exactly was wrong with me. The whole experience was quick, efficient and the quality of care was quite good. Total cost of the entire episode? Under $50 dollars for the optional phone and television in my hospital room.
Now recently, I've had to make a number of visits to the doctor. I've not been in Newfoundland for a few years, but decided to run by my old family doctor to see if she could still see me. Had no problem, and managed to get in to see her the next day... shock of shock, she remembered who I was. She had me referred to a specialist for some ear problems, and I was in to see them within three days. Managed to get everything sorted with them, along with a hearing test, and have now been referred to another specialist for a surgical consult in early November. Now, after the consult it may take a while to get in for surgery should I need it, as my problem is in no way of dire consequence. However, total cost of the past week in medical visits? Nothing! Should I need surgery, my cost will also be nothing.
See, this is where we differ, I think that its unfair for one person to pay £70k thing for the same thing someone else has to pay £4k for....
The same thing is true for roads, police forces, and education.
I had this great quote that someone (sadly, I forgot to note who) wrote in one of the Ron Paul threads maybe six months back. Mildly off topic, so here's a spoiler.
A Libertarian willing to admit he doesn’t understand something? This is a rarity. There are whole dissertations written on this subject by people far more qualified than me, but I’ll hit some of the very basics of the question, and the fundamental idea behind the existence of government. Let’s start with this whole ”government of the people, for the people” idea: the essential, fundamental purpose of government is to solve collective action problems (I’m going to refer to them as ”CAPs” from here on). There are many things which aren’t traditionally thought of as CAPs which actually are: crime comes to mind as the big one. It’s good for a society to be crime-free. However, if you have something, and I don’t, it benefits me, personally, to take that thing, even though it hurts society as a whole. Without some other incentive not to steal it (either a personal system of ethics/morals, wanting to keep you as a friend, or government intervention), I have no reason to not take it if I’m strong enough to do so. Thus, collective action problem.
Another example (the classic example, really) would be something like roads. A new road going through a city to another city would create jobs, allow trade, allow travel, etc. Everyone in the city would see $300 in benefits from this new road (not necessarily $300 in money). The road, however, will cost $50,000. There are 1000 people in the city, so the city asks everyone to voluntarily contribute $50. Everyone realizes, however, that $50 is a lot of money to them, and whether or not they contribute, they’re still going to get the $300 worth of benefits, and $50 is quite a bit of money, and really, when you’re talking about a $50,000 road, $50 is nothing.
So, each and every individual acts rationally, and elects not to contribute (unless they get $50 worth of personal satisfaction out of ”doing their part,” which very few people will). The city, seeing that this whole ”voluntary” thing isn’t working, and seeing that the city would benefit tremendously from this road, decides to introduce a tax in order to pay for it. So, a $50 a person tax is implemented. Now, we run into another problem: Hobo Bob only makes $25 a year, and he’s really not going to get anything out of the new road (maybe an extra $10 from the additional people, but less than he puts in).
However, Richguy Robert owns the port in the city, and when the new road comes through, he’s going to start making an extra $1000 a year, in addition to the $3000 a year he already makes. So, the city decides, in its wisdom, that the people who benefit the most from the new road should probably pay some more. So, they tax Richguy Robert $300, and don’t bother asking Hobo Bob for anything. So, yeah, Hobo Bob gets some small benefit from the road, but Richguy Robert gets far more benefit from the road, even after paying way more in taxes for it. So, they should both be happy, right?
No, of course not, people are never happy. Richguy Robert is going to bitch incessantly about how he’s paying $300 for this new road, while Hobo Bob isn’t paying anything, and that doesn’t seem fair, now, does it? And of course, looking at it from a very basic perspective, with no consideration whatsoever for what is actually going on behind the scenes, and what the actual effects of the road are (externalities), Robert is right.
On a more complex scale, the city is representative of the Federal Government, the road is representative of all the government services they provide that allow Richguy Robert to become wealthy (everything from clean drinking water and safe food to keeping people from killing him and taking his stuff, and maintaining the economic security of his domestic and international investments), and Hobo Bob is representative of the people who get screwed by the system. If we were in Mad Max-land, Hobo Bob might be king, because maybe he’s way more of a badass than Richguy Robert. So, in order to compensate Hobo Bob for getting screwed, we help him out with social programs. Not only do these programs help him, they also help the rest of us, because they provide Hobo Bob with a disincentive to decide ”hey, y’know, my life sucks anyhow, I may as well turn to crime.” Social programs are also cheaper than law enforcement, so we see a net benefit from them, even if we aren’t consumers of the programs ourselves.
Is the system perfect? No, absolutely not, there’s all sorts of room for improvement. But to argue there’s some sort of fundamental flaw, meaning that the system needs to be thrown out, or that taxation is the worst violation of freedom which exists is, at best, totally ignorant. For what you receive in return, your taxation is an incredible deal. It’s probably the best deal you’ll ever get in your entire life.
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I'd be interested in seeing the figures for doctors' salaries adjusted for these effects.
Insurance costs are the bane of all healthcare systems. If you didn't have to pay absurd fees for that then the price of healthcare would be much more reasonable.
Perhaps, rather than nationalizing healthcare itself, we should nationalize the insurance of doctors and medical staff.
So far as NZ goes:
GP/primary care is satisfactory - there is a two tier system - for the poor/youth/60+ it is nearly free*. For the rich it is a little more expensive, but it has got a little cheaper due to recent reforms (primary healthcare trusts). Prescription medication is very cheap generally (always exceptions if you have a horribly rare /new condition, or want fancy new medication). Dentistry is less well catered for - iirc free under 18, not so after that, although to be honest I don't fully know how the latter works fundingwise.
Consultations with specialists or consultants must be referred by a GP and delays can creep in here, but you will get to see one for free when that happens. I never had to wait too long (I had 6 monthly check-ups with mine), however since the initial referral is from your GP you have to rely on them to push it, rather than being able to do it yourself, which does disempower one somewhat.
For surgery - this varies depending on your area and your surgical problem. For acute (in my experience in two distinct health districts) waiting times are short. For elective, it can be worse, although i don't have a hard, verifiable reference point here. These operations are free if you can wait. I personally have only paid for one operation and that was a minor outpatient eye thing which I couldn't wait 3 weeks to have done. The same guy that would have done it for free did it for me as a paying customer (small town specialists often work in both private and public systems). The hospitals I've used have been clean and modern, with well trained staff that do appear to give a crap. I have no complaints on that score
Oh and one of the best things about New Zealand is there is no personal injury litigation. We have compulsory accident insurance administered by a state owned corporation that provides cover for all accidents regardless of where they occur (within NZ) or whose fault it is. If you hurt yourself on the road due to some dickhead without a licence or insurance you still get compensation and recovery costs. This is paid for by a variety of levies - and works on the basis that this regime ensures that all get coverage quickly rather than some getting it slowly through the courts.
* There is a threshold personal/household income test as to who falls into either camp. It doesn't take much for one to be rich by this, although numbers escape me.
Is that better?
EDIT: yes
Yeah from what you've guys have said, medical school is covered nationally so there's no reason to have exorbitant paychecks.
I have a family doctor who I need to schedule visits with (normally about 2-5 business day wait) but don't have to wait more then 10 minutes or so to see normally. This guy is my personal doctor, he knows me, and he knows my family.
I can go to a walk in clinic if I'm in a hurry to get something seen to, these are really hit and miss. I've been seen immediately and once I had to wait 2 hours (I could have tried driving 5 minutes down the road and to a different clinic but I had a good book with me), you get a random doctor.
I can go to a specialist, but if your problem is not serious your looking at up to a 6 month waiting.
For the above 3 cases I get examined in a private room.
Hospital ER -this is not where you want to go if your problem is not immediate, you will wait, possibly for many many hours. You will get a screened off area, not a private exam room (unless you really need one, there are only a few).
Regardless of where I go, hospital/walk in/specialist/family doctor they have access to an electronic copy of my medical history. And regardless of where I go its covered (I pay nothing). Prescription meds and Dental are not covered, you need a plan (normally through your job) or to qualify as some sort of unfortunate.
If you have a real emergency, you get seen to right away. The triage people are good at their jobs.
Personally I am all for socialized health care. I would not trade our system for the US system. For most folks I'm pretty sure the difference in tax between the USA and here would be small (higher or lower depending on which state/province were talking).
Most people only see a Doctor if they need to, they would actually like it if more people went for yearly checkups because prevention and early diagnosis of stuff would more then offset the cost of the additional checkups. Not many people abuse the system.
Anyone who says they are "paying more then their share" for health care better be making 100,000 a year and have no dependants. Despite everything we hear about rich people and companies avoiding taxes, they still contribute by far the most in taxes.
I think overall, the Canadian system is more efficient then the USA system. More people get medical treatment for a smaller (socialized) cost. But I see not reason not to have a 2 tier system where people have the option to go to private hospitals, as long as its regulated. Those rich cats paying to go to private hospitals will still be paying tax which pays for the social hospitals.
It also has to be said that the danish work week is 37 hours for everyone, doctors included.
I make pretty good money. I have health insurance through work. But work only covers a certain portion of the cost of the premiums.
Even after my workplace contribution, I pay more than 2x as much for health insurance for my family as I do in taxes. Total. Even making 90K + bonuses per year, if the US government doubled my current total tax burden but provided health care in exchange I would still be taking home more money.
If I were to COBRA off right now, assuming my income remained stable, my health care plan would cost about 5% of my gross income per month.
the "no true scotch man" fallacy.
One might argue this type of system brings higher taxes, but I'm biased in my situation... I think mostly everyone know enough people in need of expensive care to not care about a higher tax rate.
I bitch about the cost of medicine, which the first month of the year costs me about $200 and then nothing for the rest of the year (would otherwise cost me thousands). So not really much to complain about, all the more to rejoice about! Socialized medicine ftw, makes being sick awesome!
edit: Here health insurance is like insuring your house, you get sick - you get money.
From what I know, our income tax whilst similar to yours, is only different in that that is the majority of your tax whereas we pay VAT at 17.5% on EVERYTHING (bar children's clothes), we pay a 75% tax on petrol (your complaining about $4 a gallon, try $14 a gallon, or £1.50 a liter) God knows what other tax's im forgetting.
the "no true scotch man" fallacy.
Like so much else, you are wrong about this.
On top of federal income taxes just about every state has some extra form of taxation. Some, such as Washington where I live, have sales taxes. Some have an extra layer of income tax. Some have both. Nearly all have extra taxes on gas such as what you keep bitching about.
That's a damn good question.
France, Germany, Switzerland, and Australia all have interesting ideas.
I'd still like to hear from somebody in one of those countries.
the "no true scotch man" fallacy.
We have 25% VAT here, but some stuff has a lower rate -- 12% on food, hotels and camp sites. Books/newspapers, conserts and various other culture is 6%.
No VAT on rent and medical fees (like seeing a doctor; dunno about medical supplies).
A broken bone usually takes several hours of waiting time before you see someone.
An "optional" surgery like a hip or knee replacement usually takes something absurd like 5-7 months before the surgery occurs.
On the other hand life-threatening things are treated quickly. If my sister who can have severe asthma attacks walks into a hospital with trouble breathing she's attended to immediately. Same would go for dealing with a heart problem or malignant cancer.
I'm not quite sure what our state of pharmacare is though...
Despite this, the Canadian government is able to run balanced budgets every year
Hell no. Your system terrifies me.
Cheap, diverse, easy to navigate, overall excellent professional standards. I've never had to wait long to see a doctor, even specialists. I do have to book well ahead to see a dentist; dentistry isn't covered in our public health system.
The aforementioned lack of dental cover. Its actually a big public health issue, a lot of preventative healthcare is focused on the mouth.
Its got problems with aged care (although that's kind of tangential to medical provision and related to high demand), and it also struggles to meet the needs of people living outside the capital cities, although it has a fair stab at it. Facility and doctor provision is largely down to the states, so working condition variability is driving some doctors to certain locations at the expense of others.
The only other major problem is one common to most western countries - the admin and managers have taken over. Nurses have to spend a lot of time on fussy paperwork, but the real problems are when the managers don't do their jobs properly. We've had three cases in the last couple of years of dodgy surgeons in NSW and QLD, all of whom were complained about by both patients and nursing staff. The complaints were ignored far too long, and a number of people died or were mutilated in the meantime. Managers in all cases neglected to run proper background checks, and were so desperate to hire anyone that these people got in.
I suspect that besides managerial incompetence, the shortage of locally-trained doctors has contributed to that problem, but that's not happening because our healthcare is socialised - its happening because the AMA are raging dicks and are trying to keep their salaries high by not training enough people. Dicks.
In sum, the system has problems, but they're not directly related to the system being part-public.
Usually put forward by people with one eye and four teeth, I presume.
There's a shortage of training spaces for new grads here, but again, that's the AMA being dicks. A lot of overseas students who get their medical degrees here are going to get shafted in terms of prac training in the next few years. Wages are pretty much fine, although the radiologists have been bitching about not being able to afford that second BMW the last couple of years.
:^:
If im wrong then fair enough, all im going on is my experiance.
40% on anything earned above £35k
Feral already figured out he would be paying 33% vs 20% on earnings and god knows how much less on the Tax of goods.
Paperwork and admin could be considered a problem, but a lot of those problems are due to a lack of technical skills on the side of the clinical staff. For example, among other things I deal with waiting lists for elderly patients waiting to get hearing aids fitted. The paperwork is an absolute necessity for us to find out who is dropping off the bottom of the waiting lists and get them treated in time. Every problem that I've had with that data is directly because the people supplying it (i.e. clinicians and practices) suck balls at recording it.
You could make the argument that if they didn't record that information at all then they'd have more free time to treat people, but the risk of patients falling through the gaps is far too high to make it worth it, especially when you're dealing with cancer patients, where being forgotten for a week could literally be a life or death matter.
There are a lot of countries clearly doing something better than the US is, given that the US is #1 in per-capita costs but 34th in aggregate health outcome.
According to the source of all human knowledge (Wikipedia), Germany only pays Euro160/capita/year on administrative costs. This compares to more than $1000/capita/year for the US.
Considering Germany doesn't use a single payer system (there are hundreds of insurance companies), how do they do it? Anybody have the inside scoop?
How about, everyone pays a flat rate for the services everyone uses on a day to day basis, similar to a Poll tax. Give a small tax break to the very poor, and tax earnings on anything above, around £60K a year. I'm no economical expert, but this seems allot fairer. It provides for the poor, gives necesary room for incentive to better ones self, rewards those adequately who have done well for themselves whilst taxing people who earn more than enough to live a well off life.
This way, everyone pays for what they use themselves, as an individual, which seems fair. There is an element of the rich paying for the poor, which of course is beneficial in many ways for society in general, but it isn't eliminating the middle class and punishing those who work hard and do well in life.
Someone quoted the great Prime minister Margaret Thatcher, 'there is
no such thing as society'. Just posting simply this is taking it way out of context and is kind of a cheap shot very similar to the abysmal attack ad's McCain is running against Obama at the moment , post the whole thing, even if you disagree with it.
(I am high on pain killers after just having surgery so please bare this in mind)
No, that seems like exactly the context I think it would be in.
What a dumbass statement.
but they're listening to every word I say
See, this is where we differ, I think that its unfair for one person to pay £70k thing for the same thing someone else has to pay £4k for....
Care to explain why its dumb?
Do you feel that way about the fire department, too? Or police protection?
the "no true scotch man" fallacy.
He referred to Thatcher as "the great Prime minister". I think that's all we need to know really.
Because this part right there? That is the definition of society. Looking out for our fellow citizens in their time of need. Because they would do the same for us. Our neighbours do not encompass the people living in our close proximity, but also people we have never met. In effect every person in the UK is your neighbour and you should be ready to help them out if they need it. You should also get help from the same people.
What is more effective? 1 person(you) trying to do everything, 5 people(your actual neighbours) cooperating or 40 million people(the UK) working in agregate? Wich is going to be able to give you adequate healthcare in any circumstances?
All of Sociology says different. Clearly there is more that just individualism to the max and your immediate social group.
I guess there are really two ways to read that quote. One says that the solution starts with you and social programs can't work unless you do it. The other says get rid of the social programs. Peoples agency is entirely internal and everything that happens to them is their fault.
I see it as the second and thereby think it is a load of bollocks.
but they're listening to every word I say
It's the nurses and other people below the docs that really need a raise. At least here in Scandinavia they've started taking over a lot of the stuff doctors used to do during the last 20 years, but without an appropriate pay raise to compensate for that.
My mom's a nurse, and that was a pretty common rant from her.
The surgery was done immediately. There was no wait or hint of a wait.
I had peritonitis, and had a resection (cutting out bits) of my intestine. Later doctors, both in and out of the UK, have told me the surgeon did an amazing job and I'm very lucky to not have a bag.
After that, I saw a consultant/specialist regularly, who is world-famous. When I read up on Crohns his name comes up quite often, and even non-English-speaking doctors outside the UK have heard of him.
I received my medication, (which is extremely expensive) a very good standard of care, and rubbish food during my time in hospital. All together, I've been in hospital for over a year in a couple of different places. My family joked that I should publish a 'Good Hospital Guide'.
All my hospital treatment and doctor visits were free. I paid prescription fees (utterly nominal in comparison to the real costs) for my medication.
I've also been hospitalised for pneumonia and the treatment was similarly good.
Of course, during all this time I had no money. I was poor growing up, and chronic illness didn't make that any better.
I'm not exaggerating when I say I owe the NHS system, not just the people, my life.
Anyway, I think the NHS is the single best thing about living in the UK. Where I live now, Japan, has a hybrid system (state health insurance, private hospitals) which works very well, but that might be to do with cultural factors here.
Would you trade it for the current US system of private insurance?
What do you like about your system?
What do you hate about it?
Canadian:
*I feel that our system is good at some things, but is chronically and intentionally underfunded by our federal and provincial levels of government. While the Canadian constitution makes health care a provincial responsibility, much of the funding comes from the national government. The system here could also do with some organizational reform and some more access to private care being allowed. Various European countries do a much better job of delivering socialized health care than Canada does.
*Hell no. My family probably would have been bankrupt years ago under a US system due to some family member's conditions.
I've had one major run in with the healthcare system, about 8 years ago when the Canadian healthcare system was likely in worse shape than it is now. I had a regular family doctor, who I could get in to see with only two or three days notice, and who had prescribed me with a medication. I started having a bad reaction, and was able to get in to see him immediately, and it was severe enough that he had me in the hospital about an hour after seeing me. While in the hospital I was seen by a number of specialists, while they tried to determine what exactly was wrong with me. The whole experience was quick, efficient and the quality of care was quite good. Total cost of the entire episode? Under $50 dollars for the optional phone and television in my hospital room.
Now recently, I've had to make a number of visits to the doctor. I've not been in Newfoundland for a few years, but decided to run by my old family doctor to see if she could still see me. Had no problem, and managed to get in to see her the next day... shock of shock, she remembered who I was. She had me referred to a specialist for some ear problems, and I was in to see them within three days. Managed to get everything sorted with them, along with a hearing test, and have now been referred to another specialist for a surgical consult in early November. Now, after the consult it may take a while to get in for surgery should I need it, as my problem is in no way of dire consequence. However, total cost of the past week in medical visits? Nothing! Should I need surgery, my cost will also be nothing.
Wouldn't change a god damn thing.
I had this great quote that someone (sadly, I forgot to note who) wrote in one of the Ron Paul threads maybe six months back. Mildly off topic, so here's a spoiler.
Another example (the classic example, really) would be something like roads. A new road going through a city to another city would create jobs, allow trade, allow travel, etc. Everyone in the city would see $300 in benefits from this new road (not necessarily $300 in money). The road, however, will cost $50,000. There are 1000 people in the city, so the city asks everyone to voluntarily contribute $50. Everyone realizes, however, that $50 is a lot of money to them, and whether or not they contribute, they’re still going to get the $300 worth of benefits, and $50 is quite a bit of money, and really, when you’re talking about a $50,000 road, $50 is nothing.
So, each and every individual acts rationally, and elects not to contribute (unless they get $50 worth of personal satisfaction out of ”doing their part,” which very few people will). The city, seeing that this whole ”voluntary” thing isn’t working, and seeing that the city would benefit tremendously from this road, decides to introduce a tax in order to pay for it. So, a $50 a person tax is implemented. Now, we run into another problem: Hobo Bob only makes $25 a year, and he’s really not going to get anything out of the new road (maybe an extra $10 from the additional people, but less than he puts in).
However, Richguy Robert owns the port in the city, and when the new road comes through, he’s going to start making an extra $1000 a year, in addition to the $3000 a year he already makes. So, the city decides, in its wisdom, that the people who benefit the most from the new road should probably pay some more. So, they tax Richguy Robert $300, and don’t bother asking Hobo Bob for anything. So, yeah, Hobo Bob gets some small benefit from the road, but Richguy Robert gets far more benefit from the road, even after paying way more in taxes for it. So, they should both be happy, right?
No, of course not, people are never happy. Richguy Robert is going to bitch incessantly about how he’s paying $300 for this new road, while Hobo Bob isn’t paying anything, and that doesn’t seem fair, now, does it? And of course, looking at it from a very basic perspective, with no consideration whatsoever for what is actually going on behind the scenes, and what the actual effects of the road are (externalities), Robert is right.
On a more complex scale, the city is representative of the Federal Government, the road is representative of all the government services they provide that allow Richguy Robert to become wealthy (everything from clean drinking water and safe food to keeping people from killing him and taking his stuff, and maintaining the economic security of his domestic and international investments), and Hobo Bob is representative of the people who get screwed by the system. If we were in Mad Max-land, Hobo Bob might be king, because maybe he’s way more of a badass than Richguy Robert. So, in order to compensate Hobo Bob for getting screwed, we help him out with social programs. Not only do these programs help him, they also help the rest of us, because they provide Hobo Bob with a disincentive to decide ”hey, y’know, my life sucks anyhow, I may as well turn to crime.” Social programs are also cheaper than law enforcement, so we see a net benefit from them, even if we aren’t consumers of the programs ourselves.
Is the system perfect? No, absolutely not, there’s all sorts of room for improvement. But to argue there’s some sort of fundamental flaw, meaning that the system needs to be thrown out, or that taxation is the worst violation of freedom which exists is, at best, totally ignorant. For what you receive in return, your taxation is an incredible deal. It’s probably the best deal you’ll ever get in your entire life.