I keep getting that feeling that something must be done.
Any suggestions HN readers?
Any suggestions HN readers?
However, naive grass-is-greenerism is more of what I was railing against.
"The social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s.... Health policies mainly promoting equal financial access to healthcare have little chance of abating health inequalities. "
It also appears to not look at ethnicity at all in that study.
It is basically saying that it isn't enough to make healthcare available, you also have to get people to use the service in other ways than mere affordability as even if something is affordable a lot of people will still not bother and claim that they think it will be unaffordable.
Results: After making adjustments for numerous individual socio-economic and health characteristics, we observed a higher occurrence of reported forgone healthcare among people who have had financial worries during adulthood, a life-course experience of physical, sexual or psychological abuse; who have experienced childhood difficulties; who have expressed a low degree of sickness orientation, a high worry/concern about and a low self-esteem
I happen to believe the french system is better than the US system (as the US system is right now) but I don't personally believe that it is fundamentally the best system or in any way fundamentally better than a free market system (to include medical charities). But what I think is completely misguided is to think that the French system is absolutely equitable, infallible, or transposable to the US.
You started with a comment about killing off 90% to achieve ethnic homogeneity and when pressed on the point said that the French health system can't possibly manage to treat poor people of Arabic extraction. Forgetting ethnicity for a moment would seem to be to remove the prior context that people were replying to.
Also, you then after saying to forget ethnicity start saying that we know socio-economic is a codeword, presumably meaning that you have no intention of leaving the subject of ethnicity.
Also you are claiming systematic avoidance of the French healthcare system and that it has failed in it's attempt to treat people fairly. Now, it obviously is not perfect, nothing is, however to paint that study as evidence of systematic avoidance and failure, rather than room for improvement seems churlish.
Failure is when you spend the most money, but still rank thirty eighth, rather than when you are the fourth biggest spender and rank first.
Personally I just think that you are an ideologue on this. Show me a country that gets good results from unregulated private medical care plus charities. Who builds the network of A&E departments in that case?
I am also not convinced that the French medical system is sustainable. We are getting a snapshot in time, and since no economy today is based on a system that doesn't borrow money on interest, (versus spending only what it takes in through taxes), kicking payments to the future could mask unsustainability, ultimately resulting in a spectacular collapse of the system. In other words, today's French citizens could be living in borrowed luxury that will absolutely slaughter tomorrow's. Again, this is not to say that the US system is sustainable (it obviously isn't).
Either of those people could get hit by a bus at age 20 and need life saving surgery and massive help learning to walk again. This isn't particularly about morals of ownership, this is about pragmatic ways of spreading risk.
I don't personally care what the political setup is and I think there are numerous ways to achieve spreading medical risk, but I have yet to see a country that is getting good results from just private industry plus charity.
If you think you know how it could work and that there would be an improvement in medical outcomes and general equitability from your plan over the other systems now in effect, then that is excellent news and you should detail it in an academic paper and tell the world.
However, given that you are stating that you are an ideologue on this, then you are starting with the answer you want to end up with and just trying to work out how to argue it.
If you want to say that is all I am doing as well, then fair enough, all I can say is that I am fairly certain that is not where I am coming from on this, while noting that you openly admit it.
Funnily enough, medic in French is an Arabic loanword, toubib.
Also, I am not sure how you think the French health system works, but at every level through it there are enough people of Arabic background in it that your idea of there being massive differences in health care for people of Arabic background in France seems unlikely. It is true that there will be instances of racism, however I think that you are pretty far off the mark here in general.
"Ultimately, different ethnicities get different diseases, too, so the bureaucrats in charge of deciding what gets covered and to what extent are basically institutionalizing racial privilege."
There is some variation in susceptibility to disease between different ethnicities, sure, but there is such a large and established Arabic population in France that it would make no sense for the health service to be acting in the way you are suggesting.
Also what particular diseases are you talking about? As far as I am aware there has been so much mixing between Arabic populations and European ones over history that the differences are not really all that great, especially when you look at the differences in care required anyway for two individuals from the same ethnic background.
At the end of the day, given that the French health system gets some of the best ratings in the world and that France also has a very large amount of people who are not of European ancestry, it would be very hard for there be a vast gulf in care based on the ancestry of such a sizeable percentage of the population, otherwise France simply would not hold those ratings.
Out of interest, how much time have you spent in France? I have been there a few times, some of my family have lived there for several years and I am currently sharing a house with someone French, who is not of European background.
This is easier said than done. The link between socialism, still a profane political philosophy, and municipal health care is too strong—the time it would take to switch it over is be on the order of election cycles, not years. Granted, we are already on that road, but it's going to be a long time before any mainstream politician embraces it.
Absolutely not, and and "socialist" is not the same thing as "socialism" at any rate. The only people who hate the idea are the hardcore capitalists, most notably those who profit from the current regime (industrialists and drama-fed parasites like the media and politicians), but the fact remains that nationalized health care is a feature of pretty much every single country with a higher standard of living than the US.
Well, them and voters.
End the idiotic "billed rate" vs. the "negotiated rate" nonsense.
Include patient transportation in the equation. If singular pricing isn't attainable, a local hospital's care is too expensive, and the patient can receive similar care at an alternate location in a cost-effective way - cover the transportation cost under their insurance.
Tort reform. Liability insurance premiums for health care professionals is as crazy as the price for the care they provide. This is as big a problem as the price of a bag of saline.
I know these aren't the answers - but pricing of services is key to the problem, and the Affordable Care Act did little to get that under control beyond attempting to move more individuals under the umbrella of insurance and outside of emergency care.
Preferably with a lead pipe.
These are non-technical people, who went to school mostly for biology and chemistry, or for the lowly clerks, and secretaries in your doctor's office, maybe two years of community college, with an associates degree in communications maybe. On average, take a random sample of the people who do the paper work for the lofty, priest-like physicians. Ask them what AES is, or what a SHA hash is, or even what SSL and TLS are. I guarantee you, that you'll get a blank stare.
They know how to use the systems they're provided with, like they know how to open a bag of Oreo cookies. The doctors know how to pay IT professionals for services, like they know how to write a check, and know to procure electronic systems like they know how to make down payments on their Mercedes. You can be sure that they know how to shred all those e-mails that they print out and read over their morning coffee.
It's only as private insofar as no one is supposed to look. This protects people under the law, in that, as a rule, certain information is not to be used as criteria for making certain business decisions. But this is merely a bureaucratic honor system, and it doesn't mean that people aren't aware of things they aren't supposed to know about. The information itself, frequently, isn't particularly "secure" according to more strenuous information security standards. Your credit card transactions are safer than your HIPAA information by a longshot, but mostly because there really isn't any sort of criminal profit motive behind obtaining and using that sort of information.
Perhaps a similar approach could work for IVs.
Even if one is willing to accept them into one's general worldview... First principles - like "government is wasteful" - only go so far in the face of conflicting data. And there is a lot of it on the topic of healthcare systems.
Don't simply blame "regulation" either. Many industries are regulated, some heavily so, and still manage to produce companies that are profitable and efficiently deliver good products.
I don't think we'll see a real solution to the healthcare system in America until we stop treating it like it's just like any other industry.
Politics is the art of figuring out when to burn the extra resources on the government method because all of the other available methods are even worse.