SENATE BILL: Reforming Atlasian Public Health Act of 2014 (Debating)

[bore]

Aye, on the assumption that the final version will be simplified.

[bore]

I have to say, speaking as someone from Britain, this whole debate bemuses me. For one thing the costs of the NHS are, while by no means low, cheaper than in almost every other developed countries. The other point I'd make is people don't not drink beer or not smoke because they think they'll have to pay for it. No one thinks lung cancer is worth smoking but 100 grand in hospital fees are not. As well, a comprehensive, free at the point of delivery healthcare service does not preclude private insurance. In Britain a bit more than 10% of people have private insurance, because it gets you a slightly nicer room, and it's a status symbol, among other things.

I do recognise though that I'm out of the mainstream on this issue, in that I'd prefer to nationalise hospitals, and pay for it out of general taxation, in a similar way to the NHS operates, so I'm not going to try and push that.

[bore]

I have to say, speaking as someone from Britain, this whole debate bemuses me. For one thing the costs of the NHS are, while by no means low, cheaper than in almost every other developed countries.

This is not the first time I had to contend on the "British Perspective" whilst having a debate over healthcare. Afleitch was rather forcefull in defending NHS as I recall. It is not just a question of cost, but also cost relative quality. I also recall a substantial controversy surronding some recent reforms to NHS proposed by Cameron. Did these pass and what were they and why was he pushing them?

Have you ever wondered why both me and afleitch, despite him being a torie and me a labour supporter who disagree on almost everything, both support the NHS so strongly

The Cameron reforms basically made GPs like businessman who bought their own services, and generally marketized the NHS. They were initially far more radical, but public outcry watered them down at least twice. As for why he supported them, my answer would be because he's an idealogue who is emotionally attached to the idea of a free market.

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Then why have taxes worked so well over the last thirty years to reduce smoking? Again you missed my point, it is not so much just about discouraging or incentivizing the use, but also defraying the cost to the general healthcare inflation and to the treasury, since any system we adopt would in effect have substantial government subsization. This way we avoid the risk of reduced access for one person on the account of the actions of another they have nothing to do with. [/quote]
Taxes work well because they are an immediate cost to the buyer, increasing the cost of healthcare doesn't because it is a possible cost 30 years down the line, so people don't factor it in. I'd be willing to bet that the people less able to afford the costs of risky health habits are those most likely to have risky health habits- people aren't rational accountants.

I accept that if there was a real shortage of medicines or services then single payer is basically subsidising some people over others- although I think that's true for any system, it's just different people get discriminated against. Besides, I don't think that's it's all that big a problem anyway- certainly in Britain there is not really a problem of "deserving" people losing out on treatment to "undeserving" people.

 

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Then NHS is not a pure single payer system by definition, regardless, no?
[/quote]

It depends how you define single payer. Wikipedia seems to think it is, because the government is the single payer for all healthcare, but I think this is more a semantic dispute than anything.

[bore]

What would Afleitch say about why Cameron was pushing them? or Cameron himself?

You'd have to ask him Although IIRC afleitch was against the reforms. Cameron claimed he was doing them for the usual reasons, to improve patient care, cut costs etc.

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I suppose I just don't think that abstract insurance premiums or possible costs in the future actually effect how people live their lives. If that were true, wouldn't you expect there to be a negative correlation between, say, smoking and income? Our problems with regard to that sort of thing seem to me to be far deeper social ones. Besides a punitive insurance scheme will also end up costing lots of people who are just plain unlucky.

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Maybe. I guess that means I'm pushing a market dominating public option then

[bore]

I often find that whilst a party is necessitated to adapt to get with the times (Get Gubermint out of Medicare), there is still a core that has never adapted. This was especially the case once the Republicans took over Congress 1990's and began pouring over various stuff going back decades and even back to the Depression. The British system discourages this, but in your "biased" opinion, how many Conservatives deep down want NHS abolished?

There are a few people like this guy who want something more like an american system. But, as Ike said "Their number is negligible and they are stupid". Almost everybody torie or not, supports a free at the point of use system, though tories tend to prefer things like competition in the service and private providers bidding for services.

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I don't think we actually disagree on that much, then. My preferred system, the NHS system, works because the rich (of whatever health status) subsidises it, your's seems to be similar, except it's a different way of execution. Again though, I don't see insurance costs being a massive deterrent to people smoking or drinking, if we're going to get people who take risks with their health to pay more, a tax on fast food or cigarettes (though IIRC smokers actually end up costing less because they die sooner) seems much more effective. What I meant by unlucky is people who are born with higher chances of illness.

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All private healthcare does is guarantee you a nicer room when you go to hospital, and maybe things like plastic surgery or very expensive but only slightly beneficial medicines. The vast, vast majority of doctors in the UK work for the NHS, and if your disease is in any way serious (cancer or whatever) insurance or not, you will be treated by the NHS, in exactly the same way. It's a two tier system in the same way as an education system where there were only public schools, but anyone could hire private tutors or buy books.

[bore]

If we're doing one giant omnibus bill, could we take the opportunity to repeal all of our current statute on the record?

A quick scan of the wiki produces these healthcare related bills:

Comprehensive Drug Reform Act
TRICARE Reform Act of 2013
Equality in Healthcare Act
The Duke-Yankee Mental Helath Care Reform Proposal Part 1
Healthcare Reform Act of 2004
Repeal of the Prescription Drug and Medicare Improvement Act of 2003
Addition to the Prescription Drug Reimportation Act
Senior Care Act
and, of course,
The New Atlasian Healthcare Act

[bore]

Again, this could be my British parochialism speaking, but I'm deeply uncomfortable with people having to pay directly for any type of essential healthcare, whether they can afford it or not. The same is true for education.

If it were the case that the cost of the government providing healthcare for all was far more expensive than the alternative, I could get behind some sort of graded payment system, but I just  don't think that's the case. An atlasian NHS  would not be any more expensive, in fact it would probably be cheaper, and it just seems so much fairer.

[bore]

I should probably re emphasize what private healthcare is like in the UK. It means you get a nicer room in the hospital, and access to very very expensive but not incredibly effective drugs and a fast track for non essential operations. It's not a case of the rich surviving at the poor's expense. If you have cancer or a heart attack or anything serious, you will be treated by the NHS, private insurance or not. There is no private A and E just to take one example.

If that seems a bit aggressive, I apologize, but you have to remember that the NHS is Britain's national religion

[bore]

Healthcare is not, and never will be, like selling paperclips, the market is not particularly well equipped to supply it.

For one thing, insurance plans are very very complicated, by launching a brave new world where consumers (horrible word) choose their own care policy you'll leave behind the vulnerable, who'll be preyed upon by used car salesman who sell flashy but useless schemes. People don't want choice, they just want not to have to worry about paying for healthcare when they're suffering serious illnesses, and not be crippled with huge costs.

For another, a lot of healthcare is a natural monopoly- you'll only have one general practitioner in a remote town, you'll only have one A and E in a city, you'll only have one local oncology department. Most of the time choice is illusory.

The experience of almost all developed countries around the world is that the cheapest way to provide quality healthcare is not a pure market system, but comes through the economies of scale that one buyer provides.

Finally the idea of loosening regulations seems to me incredibly dangerous. I know enough about the NHS in both England and Scotland, and they are very different systems, to know that there is bureaucracy and waste. In Scotland, incidentally, the waste and bureaucracy is far less because there is almost no market in healthcare. No one is opposed to reducing that, but the idea of allowing vested interests to certify doctors is insane. I can guarantee that it would not be long before there was a scandal because an incompetent doctor ended up killing a patient due to lack of training.

[bore]

Maybe I'm reading this wrong, but it seems to me that to say the Singapore government spends a lot less on healthcare is a bit misleading. If Medisave is compulsory, it's a tax in all but name.

[bore]

Yes, but the point is to promote personal responsibility.

But if it's a percentage of your income which you have to pay regardless of your lifestyle, it does nothing of the sort.

[bore]

The idea is that if you are pputting in money into an account with your name on it that you can check and feel is really yours, one will choose to avoid wasteful spending as opposed to being the beneficiary of "free money" from the government that isn't really free.

See, I'm inclined to think that a doctor is far better placed to decide what is and what isn't wasteful care. This system would likely lead to the poor scrimping on operations or scans because they worry they can't afford it, even if they need it, and the rich getting every operation and scan even if they don't need it.

I'm not sure what the health system is like in other countries, but in britain you get the treatment a doctor thinks you need and that's it, you, being unqualified, don't make that decision, and that's how it should be.

[bore]

Surely the answer to having too few doctors is to accredit more schools, not to throw the baby out with the bathwater?

I can guarantee that if we allow anything to go in the training of doctors in a few years there will be countless scandals involving poorly trained doctors killing their patients.

[bore]

Surely the answer to having too few doctors is to accredit more schools, not to throw the baby out with the bathwater?

I can guarantee that if we allow anything to go in the training of doctors in a few years there will be countless scandals involving poorly trained doctors killing their patients.

Certainly there is some middle ground between too few and too many, one that preserves that academic rigor, yet meets our needs.


I think we are moving too far afield though and will need several bills to deal with some of these other aspects, important though they may be.

Yeah, there will be a middle ground.

I might introduce a bill to deal with accredition, so we can deal with that seperately...

[bore]

How is medisave is in any way different to putting a few more per cent on income tax?

[bore]

Abstain ftr.

[bore]

The new bill doesn't seem to explicitly repeal anything, so where does it leave these bills?

If we're doing one giant omnibus bill, could we take the opportunity to repeal all of our current statute on the record?

A quick scan of the wiki produces these healthcare related bills:

Comprehensive Drug Reform Act
TRICARE Reform Act of 2013
Equality in Healthcare Act
The Duke-Yankee Mental Helath Care Reform Proposal Part 1
Healthcare Reform Act of 2004
Repeal of the Prescription Drug and Medicare Improvement Act of 2003
Addition to the Prescription Drug Reimportation Act
Senior Care Act
and, of course,
The New Atlasian Healthcare Act

[bore]

Considering the transition has already been done, unless started otherwise, nothing in this legislation would reverse that transition. Also Part III, specifcally establishes programs for seniors, vets and the like anyway. Even when Tricare was passed in early 2013, I warned Nix and others that it would be a mistake to insert a new item into a previously completed transition.

The reason for that bore, was the decision made a few pages back to staff out the semi-releated stuff or stuff not directly connected to the public healthcare system to seperate bills because of how big this was going to get as it was. I went through your list but none was related 100% to public health like the big cajuna the New National Healthcare Act, and none of it was problematic as it relates to what we are doing here.

I was going to insert "Healthcare Reform Act of 2004"  but then I realized that only clause 1 was really applicalbe and the rest was tort reform and therefore I decided to leave that for a later bill.

The Drug Acts are likewise a seperate issue that should be consolidated and dealt with in a single seperate bill on prescription drugs.

DYCOY is our Mental Health project, there is no reason to repeal it. If anything we can no proceed with Part II of that now. And you had your chance at a consolidated mental health bill. People wanted piecemeal and that is what they have gotten.

End of Life care was left in the new ANHC in our act, and once again the rest of the Senior Care Act (80% of the text) was an amendment to the CSS, not ANHC. Considering the size of the bill, it would have been impractical to dive into that mess as well and attempt to alter that.

Thanks for the detailed answer yankee