Healthcare – need or wealth?

Written By: - Date published: 11:32 am, August 25th, 2009 - 41 comments
Categories: health - Tags:

I don’t know if you’ve been following the healthcare debate in the States. Obama’s trying to bring in a plan that gets their ludicrously backward and complicated system part way towards the universal system every other developed country has. The Right’s going nuts.

These next two clips prove that Jon Stewart is the smartest man on TV.

Can you imagine any journalist debating at this level? And that quote: “I don’t mind being taxed a little more to help people who are not in the position I am because it’s one way I can give back to the country helped me come this far”

To me, the healthcare issue is simple. There’s not enough, and never going to be enough, healthcare capacity to meet demand. So, as with any resource, use must be rationed. Usually, we use markets to ration. The price rises until enough people are cut out of the market that demand matches supply. But that’s not satisfactory for healthcare because access to health is a human right.

So, the only just solution is to ration by need. The resources go to those who need it the most. That can only be done through a universial, free system. There shouldn’t be any private paid healthcare, including GPs because they exclude people who have greater need while treating those with greater wealth. Only free provision based on need is just.

We’re still some way from that ideal but at least we’re not stuck in the rut the Americans are in where powerful industry interests have combined with every nutter in town to stop even a partial reform towards a fairer, more efficent public system of the type that every other developed country takes for granted.

[lprent: added a div’s to get the layout correct]

41 comments on “Healthcare – need or wealth?”

  1. ieuan 1

    Ok so who decides ‘need’?

    If I’m 70 and I need a replacement hip is that more or less important than if I’m 50 and need a replacement hip and then can go back to work and pay taxes?

    Also what is wrong with having a hybrid public/private system like we have? If you can afford it and it reduces the burden on the public health system then why not have a parallel private health system?

    New Zealand has a very good health system the only real issue is escalating costs and an aging population.

    • Bright Red 1.1

      medical professionals decide need. They do it now in the public system.

    • Bright Red 1.2

      The reason not to have a private system is the one that marty says. There’s only so much medical resource to go around, and the private system just lets some of that resource go to who can afford it rather than who needs it.

      • ieuan 1.2.1

        Oh please, you don’t actually believe that do you?

        You do know that we have a large sector of our economy that is ‘private’ i.e. people or companies, other than the state, use/pay for the goods and services.

        What, did I wake up and we are suddenly Cuba?

        • felix 1.2.1.1

          Oh please, you don’t actually believe that do you?

          Which part are you having trouble with? Do you think there’s some other criteria than ability to pay involved?

        • Bright Red 1.2.1.2

          iuean. The point is that healthcare is different from other things.

          Ration ipods on ability to pay but ration healthcare on need as decided by the professionals.

      • uroskin 1.2.2

        Then problem in the hybrid New Zealand health system is that the same health professionals (mostly specialists) work for both the public and private sector. So the total health care delivery output is split between the two systems rather than complementary, i.e. those that can afford it pay for “relieving” the public sector. But in reality, having private health insurance in NZ means you just jump the queue. None of the privately funded care is extra to the public health care provision. So there is really no rationing by need in NZ either.

        • ieuan 1.2.2.1

          So that new semi-private ultrasound place that just opened up down the road from where I live doesn’t add to the total health care services available?

          Because, following the logic of uroskin, there are only so many resources to go around and so some other place must have shut down, oh wait none of the other places have closed.

          I guess the whole philosophy of our free market economy where some ones sees a gap in the market and starts a business to take advantage of that is just plain wrong, silly me, doesn’t apply to health care.

          I guess none of you have ever heard of ‘dentistry’ because that sector of our health care is pretty much totally private in this country and no one seems to be complaining about that.

          • RedLogix 1.2.2.1.1

            You are sort of right when it comes to low to mid level services like ultra-sound.

            But the supply of top flight medical specialists is very inelastic. You cannot for instance decide that there is a lucrative gap in the neuro-surgery market and close up your corner dairy to go for it. It takes literally decades of a highly demanding career path to get to the top.

            So in this sense uroskin is right, that in reality most specialists work in both the public and private domain. Increasing the supply in the private domain simply takes away from the public sector… at least in the short to medium term.

          • Draco T Bastard 1.2.2.1.2

            Are you being purposefully dense?

            You can have an many buildings as you like – doesn’t much when you only have the people to man one though does it? And that was what uroskin was saying. Doctors working in both private and public doesn’t increase the number of resources but does allow those who can afford to to jump the queue.

            I guess the whole philosophy of our free market economy…

            The free-market doesn’t apply to a lot of things. Health just so happens to be one of them.

          • uroskin 1.2.2.1.3

            “I guess none of you have ever heard of ‘dentistry’ because that sector of our health care is pretty much totally private in this country and no one seems to be complaining about that.”

            Dentistry is unaffordable in NZ because it is totally market based – with tight controls on market entry. No wonder New Zealanders have bad teeth.

            Why are teeth the only part of your body exempt from the public health system?

            Captcha: bits

    • Ag 1.3

      In the US, an employee of your insurance company decides “need”. Unfortunately, their conclusions often have little correspondence with reality.

      • Bright Red 1.3.1

        yeah, their goal is to take in as many insurance payments as possible and pay out for as little care as possible.

        In fact, they spend a huge amount on lawyers etc to minimise their payouts, which just leaves even less money for actual healthcare. it’s an insane system

  2. Quoth the Raven 2

    Jon Stewart is usually pretty good, but sometimes he’s just a spineless liberal.

    • felix 2.1

      Agreed, that was pretty fucking weak.

      • bilbo 2.1.1

        Eh he’s pretty fucking weak because he reneged on his comment that Truman was a war criminal, perhaps he just realised it was a stupid thing to say.

        • felix 2.1.1.1

          The deliberate massacre of hundreds of thousands of innocent civilians is generally considered a war crime.

          Even a make-believe doctor like you should be appalled at such disregard for human life, dildo. Didn’t you take a make-believe oath?

          • bilbo 2.1.1.1.1

            Ummmmmm so it would have been a more sensible option to wage a land invasion ?

            Or perhaps continue firebombing Japanese cities ?

            Make believe Dr ? Are you a make believe twerp or do you actually believe some of the excrement that you dump on the internet ?

            • Pascal's bookie 2.1.1.1.1.1

              Bilbo, is there a bit in the geneva conventions that says ‘it’s a crime to target civilians, but not if you have an excuse’?

              Cause that’d be pretty lame.

            • bilbo 2.1.1.1.1.2

              Agreed PB – Truman’s situation was pretty stark however.

              A land based invasion which would have cost millions on both sides vs dropping the A bomb, was there another way to end the war abruptly without costing the lives of the civilians killed by the A bombs – no one will ever know for sure but I have my doubts.

              I’d also suggest that calling Truman a war criminal for making the decision is pretty stupid.

              Anyway this is probably the wrong thread for this discussion.

            • felix 2.1.1.1.1.3

              There is never a right thread for a discussion with you, dildo (or whatever you’re calling yourself today).

              No-one’s suggesting Truman’s situation was easy. And it doesn’t matter what you think the acceptable options were or how important you think his objectives were.

              All we can judge is what he actually did in the real world, not your imagination-land. And that was to murder (yep, it’s murder) over 200,000 innocent people.

              Now fuck off back under your rock and play fake doctors and nurses with yourself, you subnormal freak.

            • Pascal's bookie 2.1.1.1.1.4

              Could of done all sorts of things. japan’s navy was broke, The russians were freed up from the german business and threatening merry hell. Shit, a few months of blockade and some stories of what the uncle joe had in store and the emperor would’ve fold up like one of those little paper cranes I reckon.

              there’s some evidence the emp was looking for terms with the yanks anyway, on account of the hungry bear making threats.

              truman had options, he chose to drop nukes on cities. Any way you cut it that’s a war cime. Even if justifiable, which it may not have been, it’s a war crime.

          • Quoth the Raven 2.1.1.1.2

            God I’ve had this argument before. Suffice to say just look at the history you’ll find there are a lot historical facts against your argument. Which is neither here nor there when we are talking about the deliberate mass murder of hundreds of thousands of civilians in such a horrific manner. Absolutely nothing can possible justify those actions. Nothing. Get it? Got it? Good!
            Anyway here’s something to mull over from wiki:

            “The Japanese had, in fact, already sued for peace. The atomic bomb played no decisive part, from a purely military point of view, in the defeat of Japan.” Fleet Admiral Chester W. Nimitz, Commander in Chief of the U.S. Pacific Fleet.

            “The use of [the atomic bombs] at Hiroshima and Nagasaki was of no material assistance in our war against Japan. The Japanese were already defeated and ready to surrender because of the effective sea blockade and the successful bombing with conventional weapons… The lethal possibilities of atomic warfare in the future are frightening. My own feeling was that in being the first to use it, we had adopted an ethical standard common to the barbarians of the Dark Ages. I was not taught to make war in that fashion , and wars cannot be won by destroying women and children.” Fleet Admiral William D. Leahy, Chief of Staff to President Truman.[76]

            • Bright Red 2.1.1.1.2.1

              Just to play devil’s advocate, their use when the US was on the only power who had them and only had a couple may have avoided first use taking place between two powers with arsenals of the things. Probably helped keep Uncle Joe from keeping on rolling into Western Europe too – he had 140 divisions in Europe to the Western Allies’ 40.

            • Quoth the Raven 2.1.1.1.2.2

              The bombings were after Potsdam, but I don’t know about your point. Either way you either agree that nothing justifies such actions or you don’t. Learn this and learn it well: Violence begets violence

          • bilbo 2.1.1.1.3

            “Now fuck off back under your rock and play fake doctors and nurses with yourself, you subnormal freak.”

            Is it because you are retarded that you feel the need to abuse people who you don’t agree with ?

            Perhaps that’s why they allow you to flout the rules of the site

            “What we’re not prepared to accept are personal attacks, or tone or language that has the effect of excluding others. We are intolerant of people starting or continuing flamewars where there is little discussion or debate.”

            I’ve got no interest in debating the matter with an idiot like you.

            PB

            “Could of done all sorts of things. japan’s navy was broke, The russians were freed up from the german business and threatening merry hell. Shit, a few months of blockade and some stories of what the uncle joe had in store and the emperor would’ve fold up like one of those little paper cranes I reckon.”

            There is no compelling evidence that Japan was going to surrender – in fact the US was preparing a massive landing for the two main islands and could’ve expected the same kind of bloody mayhem as was seen on Okinawa.

            Feel free to call Truman’s decision a war crime if you like IMO it was a decision that brought an abrupt end to the war that was likely to drag on for many more months or years at the cost of many more Japanese and Allied lives.

            • Pascal's bookie 2.1.1.1.3.1

              You agreed it was war crime at 4.48 didn’t you?

              The US may or may not have been preparing for a land invasion, irrelevant. they knew as sure as shit that they were going to nuke them, they knew sure as shit that there were at the very least murmurings about surrender from high ups in japan, so I’d say they knew sure as shit that an iwo jima scenario was a fantasy.

              What the fuck would compelling evidence be bilbo? The yanks weren’t interested, they wanted to drop their bomb on a city to show ol’ joe that they had it in them.

              You can tell yourself what you like to justify that little event in your mind, but at least think about what you are justifying, and whether that justification stacks up in reality.

            • RedLogix 2.1.1.1.3.2

              The yanks weren’t interested, they wanted to drop their bomb on a city to show ol’ joe that they had it in them.

              Of all the explanations this is the one that makes sense in terms of the dates and the timing.

              Most people forget that it was the Russians who destroyed 90% of the German military, and who were poised to invade Japanese territory from the north. The last thing Truman wanted was to have to negotiate with Stalin over the surrender of Japan as well as Germany.

              War is of course never a simplistic one dimensional thing. Truman did indeed have some stark choices before him, but in the end, once the pink lenses of propaganda are set aside, history will judge his actions in a darker light.

            • felix 2.1.1.1.3.3

              Jesus dildo, you never did get the hang of stringing together a decent insult. A bit awkward reading them, can hear your gears grinding a bit too loudly.

              “Feel free to call Truman’s decision a war crime if you like IMO it was a decision that brought an abrupt end to the war…”

              Which has absolutely no bearing whatsoever on whether it was a crime. As Pb pointed out, you agreed to this upthread.

              Underneath all your waffling bullshit you agree he committed a horrendous war crime, but maintain that it would be stupid to call him a war criminal.

              Fair enough, it was only once after all. Oh hang on…

              No wonder you have to pretend to be a doctor.

            • bilbo 2.1.1.1.3.4

              Dear felix – clearly you are a bit dim.

              To clarify – Yes there is a bit in the geneva conventions that says ‘it’s a crime to target civilians.”

              No I don’t think agree that Truman is a war criminal

              Now go back to sucking your thumb.

            • Quoth the Raven 2.1.1.1.3.5

              Curtis LeMay said:

              Killing Japanese didn’t bother me very much at that time… I suppose if I had lost the war, I would have been tried as a war criminal.

              He’s willing to admit that he’s a war criminal, but Bilbo can’t admit that Truman was?????

            • felix 2.1.1.1.3.6

              Orwell’s neologism “doublethink” is defined as

              The power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them

              You do it very well. I haven’t yet mastered that skill so maybe I am indeed “a bit dim”.

  3. Ianmac 3

    But NZ does have the equivalent to Jon Stewart. Every time I see Jon in action I think Mark Sainsbury the same style and content in every way- except for the beard.

  4. Bright Red 4

    Wow. Marty calls for the abolishment of private healthcare and the right has no comeback. That’s informative. If the debate is focused on need vs wealth, they’ve got nothing.

  5. A Nonny Moose 5

    I’ve been following the American Healthcare debate quite closely, and both Stewart and Rachel Maddow have had some very insightful commentary.

    It’s made me realize how grateful I am for our system, which fundamentally can stand on it’s own two feet (despite our grumblings of wait times, lack of beds etc). I can not imagine being terrorfied of being one car accident or breast cancer away from bankruptcy.

    I see the horrible childish behaviour from the American right as barely veiled racism – they’re doing everything in their power to make Obama look like a failure.

  6. Bill 6

    From Paul Krugman “According to news reports, the Obama administration — which seemed, over the weekend, to be backing away from the “public option” for health insurance — is shocked and surprised at the furious reaction from progressives.

    Well, I’m shocked and surprised at their shock and surprise.”

    So the answer to the question posed in the header and which not shock or surprise anyone is of course that the unhealthy needs of the wealthy (profits) have priority. Or, just because I like the alliteration, that only the wealthy deserve to be healthy.

  7. The more honest view is instead of price you ration by bureaucratic/political criteria.

    That means that need is subjectively defined.

    It means you don’t get to choose GP, because they get rationed by bureaucratic/political criteria (guess who has the biggest say over that).

    Oh and banning private healthcare is saying an enormous “get fucked” to people who lose under the socialist system you advocate.

    So let’s see how I would have faired:

    I could have spent my 7th form unable to sit down because the public health system regards chronic haemmorhoids in a teenager (inherited condition) as not being a priority (was told it would be 6-9 months). I had 5 minor surgical ops before needing a seriously invasive one to clear it up. My parents paid for this, because the taxes taken from them wouldn’t.

    I could have spent 2-3 years unable to stand for more than a few seconds, or sit still for long in my early 30s due to varicose veins. Again another procedure I didn’t “need”. Had it for another leg.

    Why is it your business what people spend their own money on, and what people with the skills, experience and equipment to undertake the procedure do? What sort of screwed up control freak would ban private health care?

    All I have ever had done under private health care WAS extra, because while none of it was life threatening, it was debilitating.

    Oh don’t say I was “lucky” to have private health care. I chose to pay for health insurance as an adult, my parents chose to pay as I grew up, and given they were a couple of nearly penniless migrants from tenements in Scotland in the 1960s, I don’t think luck had anything to do with them becoming middle class.

    However, given many developed countries have insurance based models for health care, and provide universal coverage through either top ups or compulsory cover, you might find there is something to learn from opening your eyes beyond NZ, the UK and the US. Singapore in particular seems to ensure everyone is responsible for choosing a healthcare package that suits them, there is strong accountability, and those on lower incomes get their premiums topped up to ensure a basic level of care.

  8. Swampy 8

    You are advocating a complete State monopoly on health provision despite ample evidence it does not provide for people’s health needs adequately. We have private proivision alongside the public system because of the latter’s long waiting times and the fact that so much is now completely unfunded such as certain types of operations.

    Why is it that after nine years of a Labour government a charity hospital now operates in Christchurch to fill some of the gap in public health funding?

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