How should a healthcare system be organised?

tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
edited January 2011 in Discussions
Article taken from the Swedish healthcare privatisation debate
This is a quick translation of a text on the debate of the Swedish healthcare system and the changes it's going through with the new right-wing government. After the text there is a youtube clip of the American Democratic congressman Dennis Kucinich on the issue of the vote to repeal the recent healthcare reform in the USA. The page ends with a text out of the UN declaration of human rights.

I assert that the only way to ensure the equal access and quality of health care and social services is through a publicly funded and owned health care system.

I would appreciate it if you skipped on commenting the bad language as this is assuredly a hack-job of a translation. The references mentioned in the translated article can be found in the link to the source at the bottom of the web page. If asked I will attempt to help you find further sources or references, or translate ones that happen to be in Swedish. And without further ado:

"
Private and public healthcare

A familiar thought within the civil society and in media is that private healthcare gives easier access, is more effective and of higher quality than the healthcare of a public system. It is seen as close to a fact that privatisation and adjusting the healthcare system to the market will improve the system as a whole. With this as starting point for the public debate, large privatisations, deregulations and strategic changes of legislation has been driven through. The fact of the matter, however, is that with a basis in the literature there is no support that for-profit healthcare is more favourable concerning healthcare economy, quality or patient access.

In a study of 317 articles which analysed different modes of operation it is established that none of these studies has results that point towards for-profit healthcare being more cost efficient [1]. The European Observatory on Health Systems (financed by the World Bank Group, London School of Economics and the WHO) also establishes that the idea of private ownership entailing increased efficiency is proven to be an ideological credo without any empirical support what so ever [2]. Likewise, a EU-financed report draws the conclusion that the increased productivity that has been observed in healthcare did not depend on increased market orientation [3,4]. Even if the quality aspect of healthcare privatisation is sparsely studied the evidence seems to go against privatising healthcare leading to higher quality.

The debate of accessibility within heatlhcare has largely revolved around opening hours and queues to see care, but accessibility also includes geographical accessibility. Publicly funded private healthcare providers are, since new legislation has been passed, allowed to establish their presence where they see most profit. There is a tangible risk that this will lead to a redistribution of care givers and resources to locales with a high socio-economic standing and a lesser need of healthcare. This despite the knowledge of an already existing imbalance in healthcare usage where individuals in neighbourhoods of weak socio-economic standing already under-use the health care. Private healthcare financed through private health insurances inherently lacks access to those without such an insurance. In the long run this will lead to an increasing part of the population with private insurance (who thusly "pay double" for their health care) and also a decreased interest in financing public health care through taxes. This could lead to decreased intake through taxes and lower budgetary allocations.

Thus the scientific literature speak against for-profit healthcare. But since the health care systems of different countries, and their situations, differ it is difficult to generalise the results of international research to the Swedish situation. It is, though, plain that the positive claims regarding private healthcare is being gratitiously treated without criticism. It is also obvious that the remodelling of the health care system that is now being implemented is founded neither in science, reason or proven experience but in ideological dogma. Our fear is that the principles of dignity, cost efficiency and need [editors note: direct translation of the principles stated in Swedish law that are to direct health care practice] will be abandoned as health, instead of being seen as a human right, now is to be viewed as a commodity. The public health care is wrestling with real problems, both as care givers and as work places. But everything does not work poorly, and neither is every problem a direct or necessary consequence of public ownership. We therefore want to influence the debate way from political dogmatism and towards a more serious discussion that focuses on long term and constructive solutions."


*Original article in Swedish, also containing the references stated above: http://www.socialistiskalakare.se/?page_id=104#1

.Dennis Kucinich (1 minute)


QUOTE
Article 25
1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
2. Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.


***edited for readability
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Comments

  • juicejuice Members, Constellation Join Date: 2003-01-28 Member: 12886Posts: 1,044
    edited January 2011
    So... the government builds a mammoth health care system with public funds, then profits are privatized?

    Wow, I'm so surprised.

    That debate is like choosing between getting stabbed with a spoon, or getting stabbed with a spork.

    ___


    Guarantee of goods and services cannot be a "right", because it places claims on others to provide those goods and services by obligation. Last time I checked, people had an actual right to spend their time and effort as they choose, perhaps providing for others, or perhaps not, by their own free will.

    ___

    Also, research funded by WHO and the World Bank promotes public programs which give them both more political and financial power? Shocked. Really, I am.

    ___

    Sweden is one of those countries who is supposed to have a perfect public health care system, at least that's the story here in the U.S. Don't go bursting our bubble.
  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    QUOTE (juice @ Jan 23 2011, 10:15 PM) »
    Guarantee of goods and services cannot be a "right", because it places claims on others to provide those goods and services by obligation. Last time I checked, people had an actual right to spend their time and effort as they choose, perhaps providing for others, or perhaps not, by their own free will.

    I see a fallacy here. You do NOT have a right to spend your effort as you choose, not in any modern society. Not without limitations. You spend a significant amount of your waking life working for money, I need not explain why. That's your effort, converted into currency. Part of that money is taken by the state via taxation. The state takes your money, which is a direct product of your effort. The state doesn't force you to build a highway, but it forces you to pay for it through some of the money your effort has made you.

    So the state takes some of your "effort" and uses it as it sees fit. That is how basic goods and services can be a right, because the state shoulders the burden of providing them, in exchange for taking some of your money.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
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  • AlignAlign Remain Calm Forum Moderators, Constellation Join Date: 2002-11-02 Member: 5216Posts: 8,207 mod
    I don't know if it's me being useless and inattentive, but what does juice mean with
    QUOTE (juice @ Jan 23 2011, 09:15 PM) »
    So... the government builds a mammoth health care system with public funds, then profits are privatized?

    this? As in, where'd you see that?
  • MOOtantMOOtant Members Join Date: 2010-06-25 Member: 72158Posts: 416
    tjosan: why write so much text when it has so little information in it? Study of studies related to healthcare that didn't find studies being in favor of private health care. Did I miss anything? Referencing Marx/Smith/Friedman/Mises/Keynes would be of bigger value.

    If you like nationalized health care go to North Korea. You might say that I'm exaggerating but it's country where basic incentive to get anything right is non-existent. Greed that makes people work in sectors that pay the most - where work is most demanded.

    The really, really old argument saying no to private health care because private health care won't pay $10M a year to heal expensive rare patient makes no sense. Whether it's nationalized or private, health care has specific amount of money (resources) available to it. It only changes people who decide who can live or not when there's not enough money. In nationalized system they are government officials. In private health care it's more distributed.

    Now on the downside of nationalized health care: everyone belongs to the society. If society pays for healing your drug/alcohol/computer/tobacco addiction, society has right to prohibit it. It sums up to basic question: safety or freedom? I think that everyone knows what Franklin said about it.

    BTW I'm not in favor of insurance. It weakens the connection between patient's money and doctor's payment.
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  • tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
    edited January 2011
    QUOTE (MOOtant @ Jan 23 2011, 10:47 PM) »
    BTW I'm not in favor of insurance. It weakens the connection between patient's money and doctor's payment.


    I'm just going to skip over the first few paragraphs since the translated article is directly aimed at dispelling such myths. I suggest you actually read the article before commenting again.

    Now this last sentence though. Are you actually proposing that direct cash payment is the best way of health care financing? I'm going to do something that's pretty rude but here goes: go actually read up on this. What you are proposing is ridiculous.

    Here is a good place to start for some basic information around national health expenditures, ways of financing, how they affect accessibility and other things such as resistance to antibiotics and consumption of prescription drugs among other things:

    http://www.who.int/research/en/
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  • tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
    edited January 2011
    QUOTE (Align @ Jan 23 2011, 10:05 PM) »
    I don't know if it's me being useless and inattentive, but what does juice mean with

    this? As in, where'd you see that?


    The changes that have been made during the last five years and those proposed has put a mandate on the public health care managements to write contracts with any private practice that so wants, where the Landsting has to pay for care but has no say in what care or where this private practice is being established. The direct consequence of this in Stockholm in specific (which has had this system in place longer than national legislation has required them to) is irrefutably that health care providers have established themselves in locales with high socio economic standing and a high demand but low need of health care, taking resources from places with lower socio economic standing and a lower demand but higher actual need of such services.

    Basically the right wing government has passed legislation that forces local politicians to pay for private health care from the public funds but has taken away their ability to choose when and where. This goes directly against the portal paragraphs in the law that governs public health care in Sweden, which puts dignity, efficiency and need first. It goes against this because suddenly those who need to follow these laws can't affect what publicly funded but privately owned and for-profit health care actors actually do. If you want to I can PM you the details (in Swedish) of these laws, and a link to some great reading material in the Scandinavian Journal of Social Medicine I will be glad to do so.

    [edit] Actually I'll comment on what juice said in that quote as well. The Swedish public health care "mammoth" actually spends only a fraction of what the American system does per capita, and still provides universal health care. It provides not perfect but adequate access to all those things that representative Dennis speaks of in the youtube clip.

    Here is some data from WHO organised through www.gapminder.com:

    Health expenditure and life expectancy
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  • juicejuice Members, Constellation Join Date: 2003-01-28 Member: 12886Posts: 1,044
    QUOTE (lolfighter @ Jan 23 2011, 03:59 PM) »
    I see a fallacy here.


    I must concede. You're correct - "the state takes some of my 'effort' and uses it as it sees fit". So I don't own the capital (means of production) of my own body. It's more like I'm renting it. In that case I guess it makes sense for the government to pay for the upkeep on my body (healthcare), like a landlord takes care of the upkeep of his property.
  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    Essentially correct, even if we make it sound kind of callous. I'd prefer calling it "enforced charity." Whether financially or otherwise, we all enjoy the benefits of the society we live in, and we are all responsible for its upkeep.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
    - George Carlin
  • tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
    QUOTE (juice @ Jan 24 2011, 01:58 AM) »
    I must concede. You're correct - "the state takes some of my 'effort' and uses it as it sees fit". So I don't own the capital (means of production) of my own body. It's more like I'm renting it. In that case I guess it makes sense for the government to pay for the upkeep on my body (healthcare), like a landlord takes care of the upkeep of his property.


    Perhaps cooperating with those closest to you and appropriating the means of production directly might be the best way to go about it, instead of having a government as a representative of the community. But I haven't read up on syndicalism lately, perhaps you can start a new thread on that subject and inform the rest of us on it?

  • MOOtantMOOtant Members Join Date: 2010-06-25 Member: 72158Posts: 416
    QUOTE (tjosan @ Jan 23 2011, 11:13 PM) »
    I'm just going to skip over the first few paragraphs since the translated article is directly aimed at dispelling such myths. I suggest you actually read the article before commenting again.

    Then quote what dispells it. I haven't noticed anything. Swedes can believe in any bull###### they want they are rich enough not to notice. BTW why is this article mentioning "research" not published in English? Is it some kind of local knowledge that doesn't apply anywhere else? I believe this one is most interesting in Africa: Heteronormativity in a nursing context: attitudes toward homosexuality and experiences of lesbians and ###### men

    QUOTE (tjosan @ Jan 23 2011, 11:13 PM) »
    Now this last sentence though. Are you actually proposing that direct cash payment is the best way of health care financing? I'm going to do something that's pretty rude but here goes: go actually read up on this. What you are proposing is ridiculous.

    Imagine you own all cars or trucks in your country (hypothetically). Would you buy insurance for them?

    QUOTE (tjosan @ Jan 23 2011, 11:13 PM) »
    Here is a good place to start for some basic information around national health expenditures, ways of financing, how they affect accessibility and other things such as resistance to antibiotics and consumption of prescription drugs among other things:

    http://www.who.int/research/en/


    I don't trust a single world that any UN organization says. It doesn't mean that all they say is false. You simply have to be very careful.

    It's obvious that Africa can't develop if EU/USA have tariffs and subsidize their production. Everything else follows from that, giving them temporary money or even worse - forcing them to spend more on healthcare won't change anything.

    http://www.who.int/mediacentre/factsheets/...1/en/index.html This one either agrees with me or is unrealistic. (given choice people choose job that pays the most even if it requires moving to different country) It's too vague for me to decide which one it is.

    Coverage - I don't know what that is. What does it consists of? Subsistence or fancy dentist services or maybe plastic surgery. If there exists drug that costs $1000 that works but has side effects that make use of it uncomfortable for the patient should "government" (all patients) pay $10000 for better one? Who makes the decision how much we can spend and why?

    If coverage doesn't have real definition then graph of expenses per person in different countries makes no sense either. There's also different purchasing power.
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  • tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
    "Coverage" does have a definition. You're simply not educated enough on the subject.
  • RobRob Unknown Enemy Members, NS1 Playtester Join Date: 2002-01-24 Member: 25Posts: 2,604 Advanced user
    QUOTE (tjosan @ Jan 24 2011, 10:02 AM) »
    "Coverage" does have a definition. You're simply not educated enough on the subject.


    Well, the general definition of coverage is "the extent to which something is covered." So, by that definition, coverage does not imply a specific set of provided benefits or services. It's a term to describe your particular "package" of those things, and what's in your package could vary depending on any number of factors.

    I would imagine that any study must first define specifically what this implies. As MOOtant has said, what "strategies" were used to govern patient care ('lowest cost solution first' vs 'most statistically successful solution first' vs something else). Beyond that, you'd need to define performance factors to make any real conclusions. Are you most successful when the patient fully recovers and returns to the same quality of life? Or are you most successful when the patient doesn't die and you spent the least money?

    Those would actually be interesting problems for a mathematical or computer scientist. We're always on the look out for a good heuristics trial.

    The bottom line in health care is that it's emotionally charged by champions on all sides taking morale high ground and using it to pry at the everyone else. It's very difficult for anyone to look at the matter objectively.
    -Rob
  • juicejuice Members, Constellation Join Date: 2003-01-28 Member: 12886Posts: 1,044
    QUOTE (juice @ Jan 23 2011, 07:58 PM) »
    "the state takes some of my 'effort' and uses it as it sees fit". So I don't own the capital (means of production) of my own body. It's more like I'm renting it. In that case I guess it makes sense for the government to pay for the upkeep on my body (healthcare), like a landlord takes care of the upkeep of his property.
    QUOTE (tjosan @ Jan 24 2011, 06:23 AM) »
    appropriating the means of production directly...syndicalism...


    If I don't own my body, but I control the means of production of it, why can't I just "own" it? Why do I have to share it in a syndicate, or rent it from my corporeal-landlord, the government? Is it just a psychological game?

    On ownership: say I offered to sell you my new car for $1. Sounds like a good deal. But what if the conditions were that you couldn't drive it, modify it, turn it on, sell it, touch it, you don't get the keys, and I retain full control over how it is used and by whom, and I retain the papers. Suddenly it's not a very good deal. In fact, it's just a semantic ownership, of no consequence.

    It's awfully creepy to think that someone else owns my body, whether or not I get to decide how to use it. But it's especially disturbing to imagine a syndicate that would own my body, but that I would own shares in, so I have some input into how it is used.

    In any case, not owning my own body seems pretty backwards. At least it's not a monarchy where King Bush or whoever owns me, but still, I'd like to at least own myself. I understand that then I might have to pay for the upkeep on my body (healthcare), but it might be worth it. Ah, to own one's own self. That would be nice.
  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    QUOTE (juice @ Jan 24 2011, 07:49 PM) »
    If I don't own my body, but I control the means of production of it, why can't I just "own" it? Why do I have to share it in a syndicate, or rent it from my corporeal-landlord, the government? Is it just a psychological game?

    On ownership: say I offered to sell you my new car for $1. Sounds like a good deal. But what if the conditions were that you couldn't drive it, modify it, turn it on, sell it, touch it, you don't get the keys, and I retain full control over how it is used and by whom, and I retain the papers. Suddenly it's not a very good deal. In fact, it's just a semantic ownership, of no consequence.

    It's awfully creepy to think that someone else owns my body, whether or not I get to decide how to use it. But it's especially disturbing to imagine a syndicate that would own my body, but that I would own shares in, so I have some input into how it is used.

    In any case, not owning my own body seems pretty backwards. At least it's not a monarchy where King Bush or whoever owns me, but still, I'd like to at least own myself. I understand that then I might have to pay for the upkeep on my body (healthcare), but it might be worth it. Ah, to own one's own self. That would be nice.

    It's all a matter of quid pro quo. Let's take an example, protection: There's the police force/justice system (please let's not debate whether they're doing a good job or not, let's just assume that the number of robberies, thefts, muggings etc. would go up a lot if the chance of being arrested and punished for it was zero percent and leave it at that), and for external threats the military. You can't "opt out" of the protection they afford (and if you think you should be able to I challenge you to find a practical way of doing that), and they have to be financed somehow. We can't rely exclusively on volunteers and charity, so taxes are pretty much the only workable approach.

    There is a way to be entirely your own master, beholden to no-one, and that is to start your own nation. Find an attractive piece of land owned by no-one (good luck!) and stake a claim, or buy land from another nation. It smells of the old "if you don't like it here you're welcome to leave" cop-out though. But unless you're willing to, for example, get special license plates that show that you are not allowed to drive on any publically funded roads (in other words, virtually all of them), you're gonna have to pay taxes.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
    - George Carlin
  • juicejuice Members, Constellation Join Date: 2003-01-28 Member: 12886Posts: 1,044
    edited January 2011
    QUOTE (lolfighter @ Jan 24 2011, 02:19 PM) »
    There is a way to be entirely your own master, beholden to no-one, and that is to start your own nation.


    So, don't like it, leave?

    Ok, how much does it cost to buy-in to ownership of my body so I can take it with me? Or maybe I can pay for it in labor, like a serf.
  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    Don't like it, leave, yeah. Or try to change it. Your nation claims to be a democracy, which means that purportedly the people have the power to shape it to their wishes. Of course, being a democracy also means that you won't always get your way. Always getting your way is called despotism, and it only works for one person at a time.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
    - George Carlin
  • locallyunscenelocallyunscene Feeder of Trolls Members, Constellation Join Date: 2002-12-25 Member: 11528Posts: 4,022 Fully active user
    There is a quote that basically sums up my views on the subject:
    "I like paying taxes, they buy civilization".

    Of course when I don't think my taxes are buying civilization I don't like paying them. I consider access to healthcare a part of civilization.
    QUOTE (Flayra @ Mar 28 2007, 09:21 PM) »
    It's not an easy balance to achieve, but we do want to make a game that will be both the best competitive game since Starcraft and also one that many people can enjoy casually without being in a clan or an experienced or knowledgeable NS player. That's the goal at least!


    - NS in game name - tilde - My Steam Id Page - .
  • juicejuice Members, Constellation Join Date: 2003-01-28 Member: 12886Posts: 1,044
    edited January 2011
    The government should pay for everything that is a part of civilization? Wow.

    Let me know when you've calculated the bill for civilization itself. I'd like an itemized list, for income tax purposes, of course.
  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    I think we can safely ignore a request like "list everything that is part of civilization and how much it costs."

    Let's be more specific. I'm sure all of us have our particular government-financed program that we consider nothing but a money-sink. Or at least too much of a money-sink. And no, government shouldn't pay for everything. But to repeat an earlier point, without government we wouldn't even have roads. There are things government needs to pay for because nobody else will, and doing without is not an option.

    It has been quite a while since this thread was about healthcare.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
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  • tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
    I like this development of the discussion though. As the article shows there is scant proof of private health care being better in any way than public health care if the goal is universal health care access.

    Now we can get past those fallacies and start discussing the heart of the matter: is universal and equal health care something we want? Do we think that health care should be considered a commodity like any other or do we think there are some things that just shouldn't be bartered with in that way, if the have the ability to organise the matter differently? This is where values and appended values come in. Perhaps someone has heard all their life that universal health care is socialism, and socialism is being imprisoned in Sibiria. Then perhaps what we're arguing isn't health care in itself, but the fear of the wolf.
  • MOOtantMOOtant Members Join Date: 2010-06-25 Member: 72158Posts: 416
    QUOTE (lolfighter @ Jan 27 2011, 07:06 AM) »
    But to repeat an earlier point, without government we wouldn't even have roads. There are things government needs to pay for because nobody else will, and doing without is not an option.


    That's not true. You can privatize roads (toll booths on highways) and even smaller roads - you require every car on it to have GPS and upload it (WIFI/GSM) to road owner's billing system. Once a month you send bill for how many kilometres that car travelled on private road system and everyone is happy. You can limit government to making sure that every car owner has this billing thing installed and working.

    tjosan: They're linearly dependent. In simpler terms they have the same direction but not length. What you're trying to say is that because they aren't exactly the same (length) they must be totally different (length and direction) which is obviously false.

    I don't even know why you're talking about the article, no one understands Swedish and the piece you posted contains no information.

    And the wolf is scary but you haven't ever seen effects of it in your life so you're underestimating it.
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  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    QUOTE (MOOtant @ Jan 27 2011, 04:59 PM) »
    That's not true. You can privatize roads (toll booths on highways) and even smaller roads - you require every car on it to have GPS and upload it (WIFI/GSM) to road owner's billing system. Once a month you send bill for how many kilometres that car travelled on private road system and everyone is happy. You can limit government to making sure that every car owner has this billing thing installed and working.

    tjosan: They're linearly dependent. In simpler terms they have the same direction but not length. What you're trying to say is that because they aren't exactly the same (length) they must be totally different (length and direction) which is obviously false.

    I don't even know why you're talking about the article, no one understands Swedish and the piece you posted contains no information.

    And the wolf is scary but you haven't ever seen effects of it in your life so you're underestimating it.

    The "pay by GPS" system is used with trucks in Germany. Among other things, it requires the driver to leave the Autobahn at the next exit if it loses connection or risk fines. But that's an issue with the technology, and could conceivably be fixed. A bigger issue is that a lot of roads that aren't profitable are still necessary. While high-traffic roads can probably pay for themselves, low-traffic roads can't. A road that has five cars per hour costs just as much as a road that has ten cars, but it would have to be twice as expensive to drive on to pay for itself. If you want to talk about neglect of the rural population, look at this system, because they'll be paying a lot more to drive than the city-dwellers will, while also having a bigger need to drive because there is less public transport available.
    What it comes down to is that private companies will look at the site of a potential road and say "is it profitable?" Government will say "is it needed?" I prefer the latter approach, it seems more fair.

    I don't know what the linear dependence thing is about, so I'll just skip that.

    As for the swedish article, tjosan could try to run it through google translate, then fix the crasser mistakes. That should be a lot faster than translating it all manually. tjosan, could you take a stab at that, see if it doesn't take too long?

    As for the "wolf" of socialism, tjosan lives in Sweden, a country that is more socialist than the countries of most people in this thread. tjosan has not only seen the effects of the wolf, he's keeping it as a pet. And it seems a lot less scary once you have played fetch with it.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
    - George Carlin
  • juicejuice Members, Constellation Join Date: 2003-01-28 Member: 12886Posts: 1,044
    They key problem in this entire discussion including the article presented is that public funding is assumed. Then the comparison entails only the use of those funds through government managed entities or private entities. A private entity using funds taken from working taxpayers to fulfill a government contract is NOT a "private" system, it is still a public system.

    I actually agree that there is no evidence that a public system in which private corporations are awarded contracts is any better than a public system in which the funds are managed by government bureaucracy.

    It's like the U.S. war in Iraq. It's a government project, but with no-bid contracts awarded to private companies like Halliburton, tied back to the Vice President Dik Cheney, previous head of the company, who made millions of dollars off of the privatization. The money is supposed to go to building roads and bridges. Instead it gets lost and lines the pockets of "G"-men. Or, back to healthcare, it's like Donald Rumsfeld's connections with Searle and big pharma, buying billions of dollars of products proven to be worthless.

    This is how this works. You create your own market for something by making the public pay for it. Then, you privatize the system, taking all of the profits. It happens in every sector: military, financial(wall street bailouts, FED), pharma, and agri. (Big-agri will fulfill the future "right to food." First you have to kill small family farms, though, with bills like Food 'Safety' Act, just like private low cost health care was killed with bills mandating certain properties of health insurance and employment) Eventually there is no more wealth left in the common people's hands, and you get economic collapse. Forget universal care, there is NO care, for no one, except those like Cheney getting fat on a "public" system. And soon no food. At least none at a reasonable price.

    So I argue not only should universal government programs be public, they shouldn't even be created in the first place, because their corruption is inevitable. The only true vote must happen with the money people work for, money paid for goods and services they value, because those votes are always counted, down to the penny.
  • tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
    edited January 2011
    QUOTE (MOOtant @ Jan 27 2011, 03:59 PM) »
    That's not true. You can privatize roads (toll booths on highways) and even smaller roads - you require every car on it to have GPS and upload it (WIFI/GSM) to road owner's billing system. Once a month you send bill for how many kilometres that car travelled on private road system and everyone is happy. You can limit government to making sure that every car owner has this billing thing installed and working.

    tjosan: They're linearly dependent. In simpler terms they have the same direction but not length. What you're trying to say is that because they aren't exactly the same (length) they must be totally different (length and direction) which is obviously false.

    I don't even know why you're talking about the article, no one understands Swedish and the piece you posted contains no information.

    And the wolf is scary but you haven't ever seen effects of it in your life so you're underestimating it.


    "Thus the scientific literature speak against for-profit healthcare. But since the health care systems of different countries, and their situations, differ it is difficult to generalise the results of international research to the Swedish situation. It is, though, plain that the positive claims regarding private healthcare is being gratitiously treated without criticism. It is also obvious that the remodelling of the health care system that is now being implemented is founded neither in science, reason or proven experience but in ideological dogma. "

    I don't see how this is difficult to read. As for those claims they're basically what a summary of what we actually know about the subject. People have studied health care to see whether or not private and for-profit actors do a better job. Not a single study published has shown that private for profit heath care is more efficient, provide better health care or gives better access to those who really need that health care. If you want the source there is a reference readily available, and the results are EASILY replicable. I actually did a similar quick search through the scientific literature and published articles a few months ago to see if anything had changed since that summary was published, and got the exact same results [edit for clarification: I didnt actually redo the review but I checked if any more studies of note had come out since then and if they said otherwise].

    Despite this I constantly hear it said that the private is more effective, that it gives better accessibility and that private enterprise and greed forces better solutions and therefore also a higher quality. But there is NO substance to those claims. I challenge you to prove otherwise, the results of your tries would be interesting. If you came to a different conclusion than me and presented the results I could change my stance but as it is:

    If you look at the difference in public health and health care availability on different levels (direct, indirect) between different countries, those countries that have wholly or mostly public systems with either mandatory insurance policies through state controlled actors or financing through taxes show by far the best results. This information was implied when reading the article considering the target group (doctors and medical students) and I should have provided it in the topic of course. I did do so later though but you dismissed source of the international statistics provided.

    Conclusion: empirical evidence points towards public non profit health care and science cant say otherwise. How does that say nothing?


    As for the linearity thing I have no idea as to what you are refering to.
    Post edited by Unknown User on
  • tjosantjosan Members, Constellation Join Date: 2003-05-16 Member: 16374Posts: 1,335
    edited January 2011
    QUOTE (juice @ Jan 27 2011, 06:04 PM) »
    They key problem in this entire discussion including the article presented is that public funding is assumed. Then the comparison entails only the use of those funds through government managed entities or private entities. A private entity using funds taken from working taxpayers to fulfill a government contract is NOT a "private" system, it is still a public system.


    This is false. The studies referenced and summarised are not comprised solely of actors of the VERY recently changed Swedish system.

    As you for your later train of thought I want a clarification: do you meant that public projects are bad because sooner or later they will be privatised? As for corruption of public projects I could argue that private for-profit projects are corrupt by their very own nature, that the goal of them is not to provide for example the service of health care, but to make as much money as possible. But this is a different discussion. The topic at hand is the organisation of health care and whether or not there is anything real pointing towards private health care being a better option other than assumptions and ideology. Because reality speaks of public health care as being the one option that so far has worked best.
  • RobRob Unknown Enemy Members, NS1 Playtester Join Date: 2002-01-24 Member: 25Posts: 2,604 Advanced user
    I agree with juice here. We can keep talking about public vs private, but the truth is that they can be one in the same just as easily as they can be completely different. What matters is the degree to which corruption exists. United States government is by design sluggish and petty. We don't want it to move quickly, if at all, which is why we've pitted every single branch against each other. When you look at the organization of government entities, it's very much the same. It could take months to get contracts approved because the finance department refuses to approve the contract based on a single ethereal "problem." Mostly just because they can.

    We see every day how high level people in our government advance pet programs and this is not unlike the corruption we've seen in the Soviet Union.

    Most of us see this as a necessary, if ugly, part of our government structure. We allow it, but it's also the primary reason a lot of us worry when it's proposed to give more responsibility to government. If we know it's that bad with something as simple as plowing the snow off a road, why would we want it taking care of our health?

    We take corporations, as we see them as the lesser of two evils. As much as some fantasize about the ability of corporations to influence and own government, we know it's not really true. Enron did some bad, bad things. But then it was exposed, and a few of the big wigs there committed suicide. But the lobbyists and government employees that directly conspired with them to do all that bad are still where they are, and probably still conspiring with other companies.

    Corporations die, but the might corruption of the United States government lives on.
    -Rob
  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    QUOTE (juice @ Jan 27 2011, 07:04 PM) »
    This is how this works. You create your own market for something by making the public pay for it. Then, you privatize the system, taking all of the profits. It happens in every sector: military, financial(wall street bailouts, FED), pharma, and agri. (Big-agri will fulfill the future "right to food." First you have to kill small family farms, though, with bills like Food 'Safety' Act, just like private low cost health care was killed with bills mandating certain properties of health insurance and employment) Eventually there is no more wealth left in the common people's hands, and you get economic collapse. Forget universal care, there is NO care, for no one, except those like Cheney getting fat on a "public" system. And soon no food. At least none at a reasonable price.

    So I argue not only should universal government programs be public, they shouldn't even be created in the first place, because their corruption is inevitable. The only true vote must happen with the money people work for, money paid for goods and services they value, because those votes are always counted, down to the penny.

    Their corruption is inevitable because privatization is heralded as the best possible option. We agree that this furthers corruption. But your answer to that is... privatization? That's an odd conclusion to draw. I would expect the very opposite to be the solution - don't privatize government programs. And why should you? A government program is owned by the government, or as the U.S. constitution so beautifully puts it, "we the people." Why should the people give their property away? Madness.

    You suggest a system where, and I paraphrase you, "the only true vote must happen with the money people acquire." I left out "work for" because the system you propose would give even greater power to thieves like Bernard Madoff than they already have. Such a system is blatantly undemocratic, and a contravention of the "one man, one vote" principle. In ancient rome, only the wealthy were allowed a say in politics. The early U.S. constitution codified this, according a vote to a man only if he had a certain minimum of wealth. Later amendments rectified this and took steps toward more democracy.
    The wealthy have always sought to subvert the "one man, one vote" principle (consciously or not) by seeking power through other means. The solution is not to throw up your hands and yell "fine, we'll do it your way" in frustration. Our corporate overlords are neither wise nor benevolent.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
    - George Carlin
  • RobRob Unknown Enemy Members, NS1 Playtester Join Date: 2002-01-24 Member: 25Posts: 2,604 Advanced user
    Remember that the subprime mortgage crisis was caused in large part by our government allowing banks to bundle mortgage's together and through "statistical analysis" declare them as safe as government bonds and sell them as such to other banks.

    Private corporations leverage changes on the government all the time. The real corruption is that government supports and encourages such behavior, and when things go bad, government movers and shakers don't get tossed out.
    -Rob
  • SpoogeSpooge Thunderbolt missile in your cheerios Members Join Date: 2002-01-25 Member: 67Posts: 1,531 Fully active user
    edited January 2011
    You really shouldn't use the sup-prime mortgage fiasco as a tool to convince others that government involvement makes things better.
    From your link:
    QUOTE
    In 1995, the GSEs like Fannie Mae began receiving government tax incentives for purchasing mortgage backed securities which included loans to low income borrowers. Thus began the involvement of the Fannie Mae and Freddie Mac with the subprime market.
    In 1996, HUD set a goal for Fannie Mae and Freddie Mac that at least 42% of the mortgages they purchase be issued to borrowers whose household income was below the median in their area. This target was increased to 50% in 2000 and 52% in 2005. From 2002 to 2006, as the U.S. subprime market grew 292% over previous years, Fannie Mae and Freddie Mac combined purchases of subprime securities rose from $38 billion to around $175 billion per year before dropping to $90 billion per year, which included $350 billion of Alt-A securities. Fannie Mae had stopped buying Alt-A products in the early 1990s because of the high risk of default. By 2008, the Fannie Mae and Freddie Mac owned, either directly or through mortgage pools they sponsored, $5.1 trillion in residential mortgages, about half the total U.S. mortgage market. The GSE have always been highly leveraged, their net worth as of 30 June 2008 being a mere US$114 billion. When concerns arose in September 2008 regarding the ability of the GSE to make good on their guarantees, the Federal government was forced to place the companies into a conservatorship, effectively nationalizing them at the taxpayers' expense


    The government sets a goal for itself to get more lower income families into their own homes and to meet that goal creates incentives for banks to offer these loans. When the system inevitably gets overwhelmed, the magnanimous government turns around and blames the banks for dangling these loans in front of people who couldn't possibly have known that they shouldn't be in a mansion while working a fast food job.


    And I thought this was an interesting bit of info about the Bhopal disaster:
    QUOTE
    UCIL was the Indian subsidiary of Union Carbide Corporation (UCC). Indian Government controlled banks and the Indian public held 49.1 percent ownership share.
  • lolfighterlolfighter Snark, Dire Members Join Date: 2003-04-20 Member: 15693Posts: 9,006 Advanced user
    Very well, the U.S. government leading up to the subprime mortgage crisis shares the blame with the financial institutions and should not have cooperated with a partner that had different goals from itself, and the indian government and its banks held a non-controlling share in the Bhopal plant (the controlling majority of 50.9% being owned by UCC until ten years after the disaster). What about everything else I wrote? I hope we're not going to ignore that.
    But let's take cues from the subprime mortgage crisis - government and free enterprise shouldn't mix. But perhaps there's room for both. Let's look at healthcare (that's what the thread is about at any rate). For everyone but the very wealthy who can pay for any treatment out of pocket, serious illness can be financially ruinous if uninsured. But cost considerations are a factor. Bear with me while I snip quotes from an earlier post:

    QUOTE (MOOtant @ Jan 23 2011, 11:47 PM) »
    [...]The really, really old argument saying no to private health care because private health care won't pay $10M a year to heal expensive rare patient makes no sense. Whether it's nationalized or private, health care has specific amount of money (resources) available to it.[...]

    It's undeniable that resources are limited, and not everyone can be treated for ten million a year. And luckily those expensive treatments are rarely needed. But this leaves room for different tiers of healthcare. Just like a more expensive house (that pays out more in insurance if it burns down) will cost you more to insure than a two-bedroom trailer with a weed-grown front lawn, people with more money to spare will want better insurance coverage. If you get dental caries, you'll want the cosmetically camouflaged filling, not the dental amalgam one. If you get pneumonia you'll want the antibiotic with the 99% success rate, not the one with the 95% success rate. And so on. All of this creates a niche for private insurance to compete with public insurance because private insurance is allowed to jack up the rates since it doesn't have to be all-inclusive, while public insurance will more often have to settle for cost-efficiency because it needs to (be able to) insure everyone. And if private insurance thinks it can offer equal coverage at lower rates or better coverage at equal rate than public insurance, people will switch to private insurance instead.
    Sounds like best of both worlds to me. Both sides get to put up or shut up.
    Military cemeteries around the world are packed with brainwashed, dead soldiers who were convinced God was on their side.
    - George Carlin
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