Split off discussion of differences in healthcare systems

[Storker]

The decisions are made to maximize profits, not patient care.

This is the reason that I'm strongly of the persuasion that some things shouldn't be left to private organizations. Some things - like police, firefighting, infrastructure, schooling and healthcare to name the most important - are better handled by the state. Of course, private businesses should often be allowed to deliver extra services for a fee, but core requirements at a minimum level can't be trusted to for-profit organizations. IMNSHO, of course.

So - again IMNSHO- the ideal model is somewhere between Ayn Rand's vision and Vladimir Ilyich Ulyanov's vision. If we can agree on that, the rest is just quibbling about details.

EDIT: What I find rather fascinating about the "Scandinavian model" for socialism/social democracy is its pragmatism. If you look at the political development in Scandinavia the last 100 or so years, its most striking feature is the absence of hard-core ideology and the strong reliance on actual, measurable facts. And a willingness to adjust the course according to how the waters actually look, regardless of what either Dr. Marx or Dr. Friedman had written in their charts.

 

[taimen]

You are? Despite the fact that every industrialized country with single-payer healthcare gets a lot more healthcare per € or $ or £ than is the case for private insurance-based healthcare?

With public health measures, that is true. Those measures hit you very hard when you have inequality in the system, with a fraction of people without covarage.
Leaving people without coverage is actually a completely different thing than the healthcare provider model.
The standard of care and service for those who are covered is completely a different thing and that is what I am talking about.
I am very familiar with the stats you are talking about and agree. But they don't put much weight on things like 4 month wait to see a primary care physician, several years wait to hip replacement surgery also for working age patients. Practically nonexistent public service in some fields like ophtalmology. The list goes on...
We pay full taxes for the service, yet 2/3 of families in urban areas decide to get private insurance for their children to get access to private care.
That is double pay for us, and probably something that even doesn't show in your €/infant mortality stat.

Then follow up care is left entirely to the patient with a phone number to a medial exchange where someone with no knowledge of you or your case tells you if you should go to the emergency room to address your problem.

That is very much a decription of our praised public healthcare. Once you are discharged from a hospital, you must fight your way back through the primary care, often with nonexistent appointments outside emergency rooms.

 

[BRT]

Good point, it's of course total tax revenue which is relevant, not whether it's income tax or sales tax. See below.


Red herring fallacy. The real difference in tax rate isn't between the different Nordic countries, it's between countries with proper single-payer healthcare (i.e. Europe) and the US. Just back in 2010, Finland and Iceland were the two Nordic countries with the lowest total tax revenues as % of GDP, and the tax level in a country goes up and down depending on whether the country has a conservative administration or a social democratic/Labor party administration. See Total tax revenues (% GDP) Also, Figure 4 in Revenue Statistics 2018: Tax revenue trends in the OECD (warning: PDF)

Kind of changes how you look at the US system, doesn't it?

 

[Storker]

Leaving people without coverage is actually a completely different thing than the healthcare provider model.

How do you avoid that if you don't have a single-payer system as a basis? In an insurance-based system, if you're out of a job (or other income, or wealth), you're basically screwed.

 

[Storker]

Kind of changes how you look at the US system, doesn't it?

Not immediately. Care to elaborate?

 

[BRT]

How do you avoid that if you don't have a single-payer system as a basis? In an insurance-based system, if you're out of a job (or other income, or wealth), you're basically screwed.

By reversing what happened under wage controls in WWII and getting employers out of the health insurance business.

 

[BRT]

Not immediately. Care to elaborate?

Just a lower tax burden. Which is what matters to me.

 

[taimen]

How do you avoid that if you don't have a single-payer system as a basis? In an insurance-based system, if you're out of a job (or other income, or wealth), you're basically screwed.

Obamacare? There are endless possibilities for covering that part.
A European insurance based system with universal coverage, look at Germany.

None of the systems is perfect, of course. But having lived (also as a mid level healthcare/hospital admistrator as you may already guess) through the endless rounds of savings and cost cuts, I don't believe in the universal public provider anymore. It is great as long as money pours in, but it's incentives to keep providing are weak once the cuts start.

Best healthcare (of the systems I am somewhat familiar with)? Probably Denmark, Netherlands (both have private primary care providers), possibly Norway yes. But I am not sure how they would fare in poor economic situation. Switzerland is great, but expensive. USA has a very high standard of care for an employed insured patient, but is expensive by all measures.

 

[Storker]

Just a lower tax burden. Which is what matters to me.

"Lowering the tax burden" isn't what matters to me. What matters to me is to deliver a civilized minimum of services (infrastructure, education, healthcare etc.) to the general population. As long as trade, industry and innovation isn't unduly affected by the taxes required to reach that goal, I, personally, am fine. Even if it means that I - being above the national median income - have to contribute more than the average Joe working the cashier in the local grocery store. Because I truly believe that a minimum welfare network isn't only good from a moral POV, but also beneficial for entrepreneurship and the willingness to leave one's job to start a new business.

YMMV, of course.

 

[BRT]

"Lowering the tax burden" isn't what matters to me. What matters to me is to deliver a civilized minimum of services (infrastructure, education, healthcare etc.) to the general population. As long as trade, industry and innovation isn't unduly affected by the taxes required to reach that goal, I, personally, am fine. Even if it means that I - being above the national median income - have to contribute more than the average Joe working the cashier in the local grocery store. Because I truly believe that a minimum welfare network isn't only good from a moral POV, but also beneficial for entrepreneurship and the willingness to leave one's job to start a new business.

YMMV, of course.

Probably we only disagree on the levels of services.