This Will Hurt A Bit
It seems you can't fart these days without someone passing comment on the great US healthcare debate. There are clearly two sides to this issue and I have to say, as a dispassionate observer, that they both appear to be fucking clueless. Now I say this having lived for many years under the UK national health care system (the NHS) as well as the US system. Let me summarize the difference for the hard of thinking:
In the UK everyone has access to healthcare but it's pretty crap, so many employers offer supplementary private insurance as a benefit; in the US the healthcare system is great if you're insured but you're buggered if you're not. The merit of the UK system, at least as far as consumers are concerned, is that should you ever need urgent care you'll get good treatment and won't have medical bills bankrupt you. The downside is that for the less urgent stuff you might be waiting a while. Oh, and you might die in hospital from a MRSA or C-Diff. infection.
I clearly remember on the few occasions I went to my primary care physician (GP) in the UK the advice was always "Take two aspirin and come back in a week if it's no better". Didn't matter what was wrong with me - sore throat, broken bone, strange skin disease - it was always two aspirin and come back in a week. I was brought up on the "Don't Go Unless You Need To" philosophy, so by the time I'd decided to go I would have waited a week and taken loads of aspirin, but that didn't matter. I still had to wait another week and then come back again. And in the meantime I'd probably come down with something else, contracted from the dozens of wheezy, infected, spluttering bastards who clog up waiting rooms in the UK. The NHS worked on the principle of attrition - care was rationed according to your willingess to put up with their shit.
Contrast this with the US: here parents take their whiny brats to the doctor for every tiny fucking thing. Kid's got a temperature: let's go to the doctor. Kid fell over: let's go to the doctor. Kid threw up: let's go to the doctor. Kid threw up twice: let's go straight to the emergency room for IV fluids. I puked my ring up for two days solid in the UK and my mum never took me to the fucking emergency room, but here I've lost count of the number of times I've heard about IV fluids for some kid who just had a bug.
And this is perhaps the crux of the whole debate: if something is free, people will use it like crazy. Without some disincentive (and in the UK it's crap service) people trot along to the doctor for every little thing. Now combine this with the other bane of the medical world - litigation. In the US juries of tiny-minded halfwits will throw out multi-million dollar sympathy verdicts to just about anyone who ended up in bad shape, never mind if medical science had a hand in it or not; someone has to pay, and it's only a faceless insurance company, right? So doctors practice defensive medicine, ordering endless tests, and insurance pays for them so the consumer doesn't mind. The hidden costs of all this waste get rolled into health insurance premiums; employers get stung every year for increases and private buyers are priced out of the market completely.
Here's the problem: if you want to have limitless, unrationed healthcare for all it will bankrupt the country. The cost of healthcare in the UK is astronomical, and it rises every year out of all proportion to the cost of living. It's the largest drain on the UK treasury and it's out of control. If the whole US population starts showing up at their doctor for a sore throat and ordering MRIs for a stiff knee it won't matter what the world economy does, the resulting tax rate on income will stifle growth like a stranglehold and the dollar will sink like a stone with the massive borrowing.
So where's the middle ground? How do you have a safety net so that people can get treatment if they fall badly ill, while not creating a sudden and massive new "entitlement" that everyone else has to pay for. Because you know damn well that what starts out as "Don't Let Poor Cancer Patients Suffer Without Morphine" will soon become "Gastric Bands For Fat Fuckers, Transgender Surgery, Breast Enhancement, Hair Removal, Fertility Treatment, Boner Pills, Insemination For Lesbians and New Livers For Alcoholics are a right for all".
This is where the wankers on the right, like that mental pygmy Sarah Palin, have it wrong. If you want to provide the maximum benefit to society as a whole (a humanist perspective that I kind of like) you have to ration healthcare. This means that not every operation should be performed, not every life should be extended and not every condition should be treated as a right. You have fertility issues? I sympathize. Now save up for treatment or have your insurance pay if you're lucky - we're not short of babies in this world and the population is exploding; your problem does not equal my obligation to help pay for it. A safety net health service should be just that - for serious health problems, not lifestyle issues. Think that's harsh? It's just practical common sense, a commodity which appears to be in very short supply on either side of this debate.
Republicans seem to want limitless healthcare, but only for people with insurance; Democrats want limitless healthcare but have no fucking clue how to pay for it. And neither side should, under any circumstances, be trusted to set up a national healthcare system. Let's face it, Congress couldn't run a lemonade stand. Not without running up a million dollars in debt to lemon suppliers, failing to deliver any actual lemonade and pocketing half a million in campaign contributions from the lemon industry.
One thing of which you can be very sure: neither the left or the right has YOUR interests at heart. If the Democrats wanted to fix healthcare the first thing they'd do would be remove the massive cost imposed by meritless litigation, but to do so would hurt their friends in the tort industry (trial lawyers) who bankroll their campaigns with donations, so it doesn't matter what is in your interest, it will never happen. If the Republicans wanted to fix healthcare they would insist that the prices offered by hospitals to large insurance companies are the same prices you and I would pay if we bought the procedure ourselves (rather than the poorest users having to pay the highest prices). Fair and equal pricing is not a new principle in business - that's why we have the Robinson-Patman Act. And the religious right would have to grow up and realize that at some point we need to stop extending worthless life so that we can do real and practical good for more people.
At this point I'd make some comment on the Obama "plan" but he doesn't actually have a plan. Most of the details are "to be defined later" meaning that no-one figured it out yet (or, possibly, that it's figured out but the public would shit a piano if they knew the facts). In the meantime all I know is that the current system is fucked, the new system will be worse, it will cost a fortune, benefit everyone but the working taxpayer and be larded with right-on new lifestyle entitlements that the rest of us will have to bankroll. Just see if I'm wrong.
Copyright © 2009 Edward Bison
In the UK everyone has access to healthcare but it's pretty crap, so many employers offer supplementary private insurance as a benefit; in the US the healthcare system is great if you're insured but you're buggered if you're not. The merit of the UK system, at least as far as consumers are concerned, is that should you ever need urgent care you'll get good treatment and won't have medical bills bankrupt you. The downside is that for the less urgent stuff you might be waiting a while. Oh, and you might die in hospital from a MRSA or C-Diff. infection.
I clearly remember on the few occasions I went to my primary care physician (GP) in the UK the advice was always "Take two aspirin and come back in a week if it's no better". Didn't matter what was wrong with me - sore throat, broken bone, strange skin disease - it was always two aspirin and come back in a week. I was brought up on the "Don't Go Unless You Need To" philosophy, so by the time I'd decided to go I would have waited a week and taken loads of aspirin, but that didn't matter. I still had to wait another week and then come back again. And in the meantime I'd probably come down with something else, contracted from the dozens of wheezy, infected, spluttering bastards who clog up waiting rooms in the UK. The NHS worked on the principle of attrition - care was rationed according to your willingess to put up with their shit.
Contrast this with the US: here parents take their whiny brats to the doctor for every tiny fucking thing. Kid's got a temperature: let's go to the doctor. Kid fell over: let's go to the doctor. Kid threw up: let's go to the doctor. Kid threw up twice: let's go straight to the emergency room for IV fluids. I puked my ring up for two days solid in the UK and my mum never took me to the fucking emergency room, but here I've lost count of the number of times I've heard about IV fluids for some kid who just had a bug.
And this is perhaps the crux of the whole debate: if something is free, people will use it like crazy. Without some disincentive (and in the UK it's crap service) people trot along to the doctor for every little thing. Now combine this with the other bane of the medical world - litigation. In the US juries of tiny-minded halfwits will throw out multi-million dollar sympathy verdicts to just about anyone who ended up in bad shape, never mind if medical science had a hand in it or not; someone has to pay, and it's only a faceless insurance company, right? So doctors practice defensive medicine, ordering endless tests, and insurance pays for them so the consumer doesn't mind. The hidden costs of all this waste get rolled into health insurance premiums; employers get stung every year for increases and private buyers are priced out of the market completely.
Here's the problem: if you want to have limitless, unrationed healthcare for all it will bankrupt the country. The cost of healthcare in the UK is astronomical, and it rises every year out of all proportion to the cost of living. It's the largest drain on the UK treasury and it's out of control. If the whole US population starts showing up at their doctor for a sore throat and ordering MRIs for a stiff knee it won't matter what the world economy does, the resulting tax rate on income will stifle growth like a stranglehold and the dollar will sink like a stone with the massive borrowing.
So where's the middle ground? How do you have a safety net so that people can get treatment if they fall badly ill, while not creating a sudden and massive new "entitlement" that everyone else has to pay for. Because you know damn well that what starts out as "Don't Let Poor Cancer Patients Suffer Without Morphine" will soon become "Gastric Bands For Fat Fuckers, Transgender Surgery, Breast Enhancement, Hair Removal, Fertility Treatment, Boner Pills, Insemination For Lesbians and New Livers For Alcoholics are a right for all".
This is where the wankers on the right, like that mental pygmy Sarah Palin, have it wrong. If you want to provide the maximum benefit to society as a whole (a humanist perspective that I kind of like) you have to ration healthcare. This means that not every operation should be performed, not every life should be extended and not every condition should be treated as a right. You have fertility issues? I sympathize. Now save up for treatment or have your insurance pay if you're lucky - we're not short of babies in this world and the population is exploding; your problem does not equal my obligation to help pay for it. A safety net health service should be just that - for serious health problems, not lifestyle issues. Think that's harsh? It's just practical common sense, a commodity which appears to be in very short supply on either side of this debate.
Republicans seem to want limitless healthcare, but only for people with insurance; Democrats want limitless healthcare but have no fucking clue how to pay for it. And neither side should, under any circumstances, be trusted to set up a national healthcare system. Let's face it, Congress couldn't run a lemonade stand. Not without running up a million dollars in debt to lemon suppliers, failing to deliver any actual lemonade and pocketing half a million in campaign contributions from the lemon industry.
One thing of which you can be very sure: neither the left or the right has YOUR interests at heart. If the Democrats wanted to fix healthcare the first thing they'd do would be remove the massive cost imposed by meritless litigation, but to do so would hurt their friends in the tort industry (trial lawyers) who bankroll their campaigns with donations, so it doesn't matter what is in your interest, it will never happen. If the Republicans wanted to fix healthcare they would insist that the prices offered by hospitals to large insurance companies are the same prices you and I would pay if we bought the procedure ourselves (rather than the poorest users having to pay the highest prices). Fair and equal pricing is not a new principle in business - that's why we have the Robinson-Patman Act. And the religious right would have to grow up and realize that at some point we need to stop extending worthless life so that we can do real and practical good for more people.
At this point I'd make some comment on the Obama "plan" but he doesn't actually have a plan. Most of the details are "to be defined later" meaning that no-one figured it out yet (or, possibly, that it's figured out but the public would shit a piano if they knew the facts). In the meantime all I know is that the current system is fucked, the new system will be worse, it will cost a fortune, benefit everyone but the working taxpayer and be larded with right-on new lifestyle entitlements that the rest of us will have to bankroll. Just see if I'm wrong.
Copyright © 2009 Edward Bison
posted by Mr Bison at
6:23 PM
1 Comments:
You make some interesting points.
I'm one of those people who only uses the doctor's office as a last resort, but I never thought about how much of a necessity health care is until we were just a couple of months away from maxing out our COBRA benefits.
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