We have on occasion, on this board, spoken of nationalizing, or subsidizing, or socializing, health care in this country. One of the peripheral topics of discussion has been that people don't want to subsidize others' choice of unhealthy lifestyles. For instance, smoking and drug use.
For the sake of argument, let's say that obesity falls in the category of unhealthy lifestyle.
My question is, if medical care is socialized, why shouldn't I have the option, through the state, of putting pressure on those who are sucking up an inordinate amount of the medical resources to stop engaging in their unhealthy lifestyles? Why should the majority of the country who thinks of their fellow man, and doesn't burden him with unnecessary medical bills, pay for those who choose to be selfish and burden the rest of society?
quote:Originally posted by Storm Saxon: ... the majority of the country who thinks of their fellow man and doesn't burden him with unnecessary medical bills, pay for those who choose to be selfish and burden the rest of society?
On the whole, it might not be a bad idea. But some nit-picks: A) I doubt many people choose to be healthy to spare other people money B) The majority of the country is hardly in a healthy weight range
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Smoking is easy to regulate as it's something you either do or don't do, and it's obviously unhealthy for everyone.
Weight is harder, because some people are naturally much heavier than others. Some people can be "overweight" with minimal or no health problems, while other people can put on just a little weight and start to have the common weight related problems.
Besides, food is something everyone needs to eat, and it can be expensive to eat healthy. Have you seen the prices on organic food?
I think for this to work, it would require a lot of new ways of doing things.
Rather than try to regulate weight, encourage healthy lifestyles.
Include a rebate program for buying sporting or exercise equipment, gym memberships, sports programs and the like. Offer coupons for healthy, fresh food.
You have to encourage people to have a healthy lifestyle, and make it financially available to people who don't have the money to go skiing or join a gym or eat organic produce.
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quote:Originally posted by Storm Saxon: My question is, if medical care is socialized, why shouldn't I have the option, through the state, of putting pressure on those who are sucking up an inordinate amount of the medical resources to stop engaging in their unhealthy lifestyles? Why should the majority of the country who thinks of their fellow man, and doesn't burden him with unnecessary medical bills, pay for those who choose to be selfish and burden the rest of society?
I see these as 2 very different questions. You shouldn't have the option of telling me what to eat, because it's none of your business. You shouldn't have to pay for my angioplasty if I go for the bacon, because it's none of your business. (Although you might decide to pay for the angioplasty, or warn me about the bacon, out of generosity.)
Admittedly, when everything becomes the state's business, everything becomes the state's business. But when we don't, generosity can flourish.
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I would have no problem paying for free health care for the country because it's the humanitarian thing to do. I haven't been to the doctor in probably 8 years--but if I needed to, I like the idea that my health care is covered by the state rather than a privatized corporation whose interest isn't the people, but profit.
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posted
It does work differently if it is a state-run insurance system as opposed to the state running the health care itself. (e.g., Canada v. England)
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quote:Originally posted by Storm Saxon: My question is, if medical care is socialized, why shouldn't I have the option, through the state, of putting pressure on those who are sucking up an inordinate amount of the medical resources to stop engaging in their unhealthy lifestyles? Why should the majority of the country who thinks of their fellow man, and doesn't burden him with unnecessary medical bills, pay for those who choose to be selfish and burden the rest of society?
If you're concerned about subsidizing bad lifestyle choices, shouldn't you be more upset about all your tax money that goes towards the penal system?
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quote:My question is, if medical care is socialized, why shouldn't I have the option, through the state, of putting pressure on those who are sucking up an inordinate amount of the medical resources to stop engaging in their unhealthy lifestyles?
Hmm, if it ever came to this I'm not sure how you could effectively put pressure on them, short of making the information public or depriving them of some other government benefit.
posted
Smoking is an easy thing to regulate? How? Based on how people answer all those questions the doctor asks? Because I know plenty of people who consider themselves nonsmokers who will have a smoke or two on the weekends. I don't see any way of preventing that, unless you're willing to invest in the Health Police, with subdivisions for the Smoking Police, the Drinking Police, the Sex Police, and the Food Police.
Edit: But I will volunteer for the Cake Detail of the Food Police, if we get to confiscate people's cakes. Although some of them might not make it to the evidence room intact.
quote:Originally posted by ClaudiaTherese: It does work differently if it is a state-run insurance system as opposed to the state running the health care itself. (e.g., Canada v. England)
I really know nothing of this. Which is which, and what are some of the glaring differences in how they work?
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The only thing I can think of to do is provide a minimum of care, or, at least a set level of care.
Life decisions should be paid for out of pocket. If you get lung cancer because of your smoking, or heart disease from eating cheeseburgers, it's your choice, and I respect that, so pay the price for your choice, and pay, out of pocket, or through your own separate insurance, for the problems that arise for your choices.
Every day flu, or problems that arise due to bad genetics or what not, not from an unhealthy lifestyle, I'm okay with being part of the community when it comes to health costs. I think getting everyone on healthcare, and with a focus on preventative care, will lower the cost of healthcare for everyone dramatically anyway.
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quote:Life decisions should be paid for out of pocket.
I'm assuming you're not talking about all medical decisions that arise from life decisions. Otherwise, we need to start penalizing people for not exercising enough, exercising too much, exercsing in an unsafe manner, eating too much, eating too little, eating the wrong food, driving a car, riding a bicycle, working a streesful job, working at an easy job and thus being poor, using birth control, having abortions, or having children.
Who gets to draw the line between what is an acceptable health risk like, for example, driving a car, and which health risks are unacceptable, like you appear to consider eating cheesburgers?
posted
You can't just list life choices without demonstrating what cost they place on society. Well I guess you can, and I see the point you're trying to make. I don't really have an answer for you, honestly I don't think we'll ever come up with a treatment system that will make everyone happy. Too many people want to live their lives however, without thinking they should pick up the tab for their stupid decisions. And others, who lead responsible healthy lives don't want to pay for the former. Good luck with that. I agree with the second group, just don't have an answer to how to fairly make those who make poor choices own up to those choices.
Regardless, my focus would be a system that focuses on what happens BEFORE you have problems. Yearly checkups, teaching people about how to lead healthy lifestyles, how to exercise, about nutrition, etc. I think it would make the nation many times healthier, and would get rid of billions of dollars of expense from the system.
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Mucus (What's up with your nick, by the way? Curious. )
quote: On the whole, it might not be a bad idea. But some nit-picks: A) I doubt many people choose to be healthy to spare other people money B) The majority of the country is hardly in a healthy weight range
I'm not clear on how this addresses the article and what I wrote?
MightyCow--
Good ideas.
WillB-
quote: I see these as 2 very different questions. You shouldn't have the option of telling me what to eat, because it's none of your business. You shouldn't have to pay for my angioplasty if I go for the bacon, because it's none of your business. (Although you might decide to pay for the angioplasty, or warn me about the bacon, out of generosity.)
Admittedly, when everything becomes the state's business, everything becomes the state's business. But when we don't, generosity can flourish.
I'm exploring issues in nationalized/socialized/subsidized healthcare. If I'm paying for your healthcare, then doesn't your health become my business?
As to your second point, er, o.k.?
Launchy,
quote:
I would have no problem paying for free health care for the country because it's the humanitarian thing to do. I haven't been to the doctor in probably 8 years--but if I needed to, I like the idea that my health care is covered by the state rather than a privatized corporation whose interest isn't the people, but profit.
I like the idea of 'free' health care, too. A lot of this thread is inspired by recent reading of Misconceptions by Naomi Wolf, wherein she pushes for a more subsidized system.
The problem is that nothing is really free. This thread explores one issue of subsidized healthcare.
CT,
quote: It does work differently if it is a state-run insurance system as opposed to the state running the health care itself. (e.g., Canada v. England)
I am not clear on how the state paying through insurance is significantly different than the state just outright running things? Like Porter, I am curious as to the difference.
Jon Boy,
quote: If you're concerned about subsidizing bad lifestyle choices, shouldn't you be more upset about all your tax money that goes towards the penal system?
I'm calling this a straw man, as I believe there are seperate issues involved that will just muddy the waters.
Kirk,
quote: Hmm, if it ever came to this I'm not sure how you could effectively put pressure on them, short of making the information public or depriving them of some other government benefit.
That's a good question, and one of the central ones in this thread, I think. I can think of there being, along the lines of some of the anti-drug commercials the government subsidizes, there being 'get in shape' commercials. I'm pretty sure these already exist in the children's cartoon market. Perhaps signs like 'Nothing tastes as good as thin.'
That's just the nice way. The mean way might very well setting some kind of cap on how much each person can recieve in health care.
Lyrhawn,
quote: Life decisions should be paid for out of pocket.
Porter brings up good points. Another issue is the interplay of biology and environment that make some people's choices perfectly fine and other people's choices very bad for them. Another facet is people who have a biological or genetic component to, say, overeat.
I probably can't continue to answer everyone in this thread. From here on out, I'll probably be more choosy, depending on time.
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A) I thought this was obvious. You said that the majority of the country is healthy because they think about their fellow man, and don't want to burden his paycheck. I think thats a pretty bizarre idea. People are healthy because it directly benefits them, whether feeling better, living longer, or using less of their money. Pragmatically, you're never going to convince people to live better in order to use less of "your" money, you can convince them by saying how its better for *them.* People are inherently selfish that way.
B) mr_porteiro_head expanded on this idea. The majority of the country hardly makes healthy decisions. On average the US is the most obese country in the world and there are many other health risks as well. So who gets the high horse to decide who gets penalized and for what.
I just didn't feel like spelling it out because I thought it was kinda obvious.
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posted
A) O.K., I see. I did probably make a leap there. Nonetheless, it does work out under a socialized system that the healthier you are, the less you cost the state, which is payed for through taxes.
B) I don't think Porter said that the majority of the country doesn't make healthy decisions. He said (to paraphrase) that the line is difficult to draw.
Further, while I think that there are lots of 'unhealthy' people, it's not clear to me that the majority of people don't make healthy decisions. I grant you, this does go back to what is healthy or not, and how to measure unhealthiness and to draw the line between what is reasonably payed for, and not reasonably payed for. As
I said in my initial post, the idea that others shouldn't pay for unhealthy lifestyle choices is a distinction that people have made on this board before. This thread, in essence,attempts to explore that issue in relation to the article that I posted and subsidized health care. As other people have noted, under a completely private system, what you eat financially effects you and anyone else who decides to pay for you. So, it's a non-issue in that respect for the community.
So, I do think it is a factor in determining whether subsidized health care is doable or wanted. Certainly, insurance companies assign risk to people given their lifestyle, so the line can be drawn. Certainly we already see private companies pressuring their employees to, for instance, quit smoking and get in shape. I don't see that, when it comes to keeping costs down, that the state wouldn't do the same thing.
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quote:The mean way might very well setting some kind of cap on how much each person can recieve in health care.
Then you can just kill anyone with a number of different genetic diseases right now. No matter what your cap, the cost of monthly (and sometimes more often) injections of expensive artificial enzymes will exceed ANY cap, especially if it's a lifetime one.
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I'm just bringing up issues in relation to the article. I'm not saying that I want things to end up a certain way.
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My big worry is who decides what lifestyles are dangerous?
Unbiased science would be a great tool, but it is somewhat rare, especially when politics is concerned. Whenever we are talking about the government, politics are concerned.
While seat belts and motor cycle helmets seem to be no-brainers when it comes to healthy lifestyles (pun intended).
However, other choices could be considered healthy choices and may be influenced by politics.
Everything from Sexual Lifestyles to Gun Ownership will have proponents arguing that they are inheritantly unhealthy and those health consequences should not be paid for by the people.
Living on the coast, or in a flood plain, or in a mobile home could be an unhealthy choice. Should people with genetic illnesses be allowed to procreate at all?
If the power to tax is the power to destroy, what is the power to pay for medical expenses?
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posted
Dan makes excellent points. There is no realistic way to avoid having what SOMEONE considers an "unhealthy lifestyle" cost other taxpayers money. Attempts to do so will of necessity focus on the few issues that one particular person or group consider most unhealthy -- or most unlikely to affect them.
Oh, and unless you do not have medical insurance, or have insurance through a very small company, you are already paying for other people's genetic misfortunes and lifestyle choices.
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quote:The mean way might very well setting some kind of cap on how much each person can recieve in health care.
Then you can just kill anyone with a number of different genetic diseases right now. No matter what your cap, the cost of monthly (and sometimes more often) injections of expensive artificial enzymes will exceed ANY cap, especially if it's a lifetime one.
*nods* Not to mention some cancers, especially ones that recur, and conditions that require special food supplements (PKU, MSUD) or people who need constant pain medication for much of their lives...
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quote:Originally posted by ClaudiaTherese: It does work differently if it is a state-run insurance system as opposed to the state running the health care itself. (e.g., Canada v. England)
I really know nothing of this. Which is which, and what are some of the glaring differences in how they work?
On the one hand, the details would (and do) easily fill a two-semester course. On the other hand, I can probably sketch out the broad differences, so long as it is clear that this is a sketch at best.
Overview: Few countries have an entirely private-care health system. There are several (like the US) with the majority of care provided through private clinics and insurance (or out-of-pocket), but with a subsidized portion of care. For the US, this is via Medicare, Medicaid, the VA system, Public Health Departments/Districts, WIC funding, etc -- and if anyone wants an explication further for these, just ask. A substantial amount of care is provided in the US this way (IIRC, ~25-30%), but it is still a minority of care that is subsidized.
Most other industrialized countries have some form of subsidized system that provides the majority of health care for the population. This may or may not be accompanied by an alternative private care system (with or without private insurance). Examples are below, followed by general summary of how the differences play out.
Canada, "single payer system": This is a federally organized and publically funded health insurance program that is run province by province. Individual provinces have the option of opting out, although none currently do. The territories up north are covered separately.
Basically, the provincial government and the provincial medical association negotiate yearly the compensation for various services. The physicians are in private practice, but (within province) they each bill the same company (provincial insurance) at the same rate for whatever services they provide. Physicians are held to a maximum compensation of that agreed on with the province per given service, even if they are charging someone not covered out of pocket, unless they choose to opt out of the public system altogether. There is concern about provision of private services and the creation of a "second tier" system, and that is happening more frequently (quasi-legally) as the public funding continues to be decreased under more conservative leadership federally.
Great Britain, "National Health Service": This is a federally organized and publically funded entire health care coverage that is run at the federal level. Physicians are employees of the State and work in a "capitation" system; i.e., they are assigned a set number of patients and then are compensated at a flat rate, regardless of variations in providing those comprehensive services to all of those various people.
Basically, the State decides which services will be covered and what the compensation will be, along with the workload of each physician. If you are assigned 200 patients as a physician in the NHS, then you care for those 200 patients. You can't decide that you'd rather work fewer hours and cover only 150 patients, or that you'd rather live and work in this other area and with these other (rural, urban, what have you) people. There is a secondary private insurance set-up that runs alongside the NHS, but it is not extensively used. Most citizens seem to use it to fill in gaps in NHS coverage, not to supplant it.
Germany, Finland, Australia, Japan, and New Zealand all have their own unique versions of public health care systems, as do all modern industrialized nations other than the US. I am not going to detail them unless asked or it becomes relevant.
Primary differences: As I see it, the two primary differences between a state-run health care system and a state-run insurance system are:
1) Physicians as self-employed workers as opposed to State employees. This is not merely a semantic difference. Under state-run systems of provision, a physician cannot determine for him- or herself where to practice, how many patients to accept, what services (among those covered) to offer, etc. It is the State that signs the paycheck, and it is the State that holds all the cards. If you don't like the rules of the game, you don't get to play. At all. There isn't room for self-determination as a small businessperson.
2) Following from #1, there is a provision of so-called checks and balances to the system when physicians and the State must negotiate on coverage and compensation. The State can refuse to provide for unecessary or untenable items or levels of service, but only within certain bounds, as the physicians can as a group (and have, at times) refuse to provide services at all unless minimal standards are met. On the other hand, physicians must work within a ceiling of allowable provision and charges -- they have to justify changes in the system at the yearly negotiations. It is an uneasy alliance, but in practice, it seems to work. And, in practice, it seems to work more efficiently than the US system.
Caveat: International health care systems policy and analysis is a subject both dear to my heart and one which I take very seriously. Although everyone is (of course) free to discuss it in any manner which falls within the TOS, I wouldn't care myself to discuss it without grave respect for the complexity and relevance to individual lives that I think it deserves. So, should things move here at a different path than one I'd like to follow, I'll regretfully bow out gracefully as possible. No great shakes to you, likely ( ), just my own issues out there on the table -- so if I disappear, I won't feel that I haven't lived up to a covert bargain.
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Edited to add:
(Difference #3) This may have not been clear, but I take the following for granted: in a State-run system, decisions (I fear) are made on the basis of political expediency and a necessarily limited understanding of medical issues. In a State-run insurance system with private practice physicians that negotiate as a group, a more realistic and accurate understanding of medical issues informs the policy decisions.
quote: My big worry is who decides what lifestyles are dangerous?
Unbiased science would be a great tool
I had thought actuarial tables were somewhat unbiased, but I guess I really don't know.
quote: Oh, and unless you do not have medical insurance, or have insurance through a very small company, you are already paying for other people's genetic misfortunes and lifestyle choices.
Interesting point. The insurance company, of course, declines people all the time for being too expensive.
++++++++++++++++++++++++++++++++++
So, if subsidized health care is instituted, does everyone believe that there should no line drawn in terms of what is payed for or, perhaps, how it is payed?
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quote:Originally posted by Storm Saxon: So, if subsidized health care is instituted, does everyone believe that there should no line drawn in terms of what is payed for or, perhaps, how it is payed?
Subsidized care already exists in the US, comprising about 1/4-1/3 of all care provided.
That being said, my answers to the rest of your question would be "no" and "no."
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Also of note: There already are limits (federally regulated) on who insurance companies can decline and for what reasons, as well as for how long. [Not that anyone has said otherwise, just (I think) worth keeping in mind.]
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Difference #4 (continued from above): Another thing I took for granted but may not be clear to others is that patients get much more flexibility and freedom of choice as to who to work with in regards to their own health care under a state-run insurance program as versus state-run system overall. In the NHS, patients and physicians are assigned to one another -- physicians' offices are designated to cover certain zones without much overlap. A patient can work out a way to see another physician, but this requires some doing and work. That physician would be located inconveniently, as he or she would be out of the curtrent zone for that person.
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Edited to add: Mind you, there are other ways than capitation to structure a state-run system. It is just the most widely studied one.
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Well, when I was writing that, I was thinking along the lines of 100% subsidized by taxes. I understand that it is partially subsidized. Sorry for me not being more clear.
As for the limits, I guess we've all heard the horror stories of people not being able to be covered because of pre-existing issues and whatnot. I know I sure know someone. So, I don't know exactly , qualitatively, how well the laws work.
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quote:Originally posted by Storm Saxon: As for the limits, I guess we've all heard the horror stories of people not being able to be covered because of pre-existing issues and whatnot. I know I sure know someone. So, I don't know exactly , qualitatively, how well the laws work.
They do work as designed, but the design is not intuitive. These are HIPAA regulations. Would a summary be helpful? (not sure if it would be relevant to your larger point or not -- might be a derailment, might be interesting/helpful)
We've discussed it elsewhere here at Hatrack recently, I think.
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Edited to add: further links are in Samarkand's Insurance help, please thread. Excerpts below are from me:
As I recall, there was additional national regulation to prevent someone from being denied coverage forever based on pre-existing conditions. There is a distinction made between work-related-insurance coverage and non-work-related-insurance coverage [as well as state-to-stae variation], but the general gist is that even if you get off the ever-turning Wheel of Insurance Coverage for more than 60 days, eventually (within 18 consistant months of restarted coverage under 1 provider, I think, but don't quote me) everything has to be covered again. You may shell out money for a year and a half without full coverage, but once you do that consistently, full coverage has to be reinstated.
quote:Samarkand, my understanding (and I am a physician, not a lawyer or insurance specialist, so take this with a grain of salt) is that once you are covered by a provider for a certain period of time (I believe this is never longer than 18 months) consistently, then all pre-existing diagnoses must be covered again.
Mind you, if you have never lapsed in healthcare covering insurance, then pre-existing diagnosis clause restrictions will never be able to come into play -- that is, if you were covered during the time when you were diagnosed and have maintained full coverage ever since (or possibly with no more than somewhere between 30-60 days of lapse in coverage per calendar year), then your diagnoses cannot be excluded from coverage.
So, even if you switched providers, if you were always covered, then whomever you are with now (and whomever you might switch to in the future, so long as there is no lapse in coverage during the switches) would have to cover that diagnosis.
That is to say, there are horrible events when someone is not covered because of pre-existing conditions, but as of HIPAA, at least coverage can only be denied for a specified period of time. After that, it must be covered again by an insurance company, unless there are other reasons to deny the policy.
posted
I don't know what 'intuitive' means in the context of your sentence.
All I'm saying is that it's pretty clear people aren't being covered, or can't afford coverage. There's no need for a summary of the regulations that I can see. Of course, if you feel otherwise, that's fine.
Keep in mind, everyone, that I am not arguing against a subsidized system. Far from it. People in my immediate family are probably going to die much sooner than otherwise because they don't have insurance. I'm just looking at issues that might be raised if one were instituted within the context of the article that I linked to.
I sometimes have to play the role of 'conservative' on this board because our resident conservatives can't seem to tie their shoe laces.
(I'm kidding, of course.)
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quote:Originally posted by Storm Saxon: I don't know what 'intuitive' means in the context of your sentence.
I just mean to say that the regulations are somewhat Byzantine. You'd think it could be made simple, but apparently the lawmakers found otherwise for whatever reason.
quote:All I'm saying is that it's pretty clear people aren't being covered, or can't afford coverage. There's no need for a summary of the regulations that I can see. Of course, if you feel otherwise, that's fine.
I think it's worth clarifying when pre-existing conditions are brought up in a public forum because so many people (even kq, whose father is a physician) don't realize that pre-existing conditions don't remain forever (or indefinitely) as a reason to be turned down for being covered.
I was so glad when the "pre-existing clauses" were finally sharply limited.
quote:Keep in mind, everyone, that I am not arguing against a subsidized system. Far from it. People in my immediate family are probably going to die much sooner than otherwise because they don't have insurance. I'm just looking at issues that might be raised if one were instituted within the context of the article that I linked to.
Fair enough. Good, hard questions.
quote:I sometimes have to play the role of 'conservative' on this board because our resident conservatives can't seem to tie their shoe laces.
(I'm kidding, of course.)
Noted and appreciated.
I'm off for a bit. Will catch up later.
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quote:Originally posted by Storm Saxon: I wrote the last before you updated your post.
Well, thanks for the update, CT. Hmmmm.
I would be fervently delighted if this information assists someone you care about. That would be quite awesome.
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I'll let you and anyone else know if that Certain Someone finds out anything, because I know it's an issue that impacts a lot of people.
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quote:Originally posted by Storm Saxon: B) I don't think Porter said that the majority of the country doesn't make healthy decisions. He said (to paraphrase) that the line is difficult to draw.
Further, while I think that there are lots of 'unhealthy' people, it's not clear to me that the majority of people don't make healthy decisions. I grant you, this does go back to what is healthy or not, and how to measure unhealthiness and to draw the line between what is reasonably payed for, and not reasonably payed for. As I said in my initial post, the idea that others shouldn't pay for unhealthy lifestyle choices is a distinction that people have made on this board before...Certainly, insurance companies assign risk to people given their lifestyle, so the line can be drawn. Certainly we already see private companies pressuring their employees to, for instance, quit smoking and get in shape. I don't see that, when it comes to keeping costs down, that the state wouldn't do the same thing.
Porter gave a lot of examples of lifestyle decisions that most of us would fall under, yet most of us consider unhealthy. *Hence*, why the line is difficult to draw.
But there is one issue that you quickly skipped over that is rather key to this discussion.
Insurance companies assign risk (via as you mentioned actuarial tables), they do not necessarily assign responsibility. You're proposing a system that penalizes lifestyle choices, which in some cases is correlated with risk, but far from all.
Take your example of obesity. There is a well studied genetic component to obesity. Yet obviously, there is personal element of free-will.
Or is there? Some laws work on the principle that people are not necessarily responsible for all their choices. A child abuser who was abused as a child may be sent to psychiatrists instead of jail, more related to obesity (in Canada) some advertisements may not be placed too close to a school lest it unduly affect children.
It may be difficult to separate consequences resulting from lifestyle choices and those from predetermined issues.
Depending on what you believe about free will (which is another debate in itself), it may even be difficult to determine what we truly decide for ourselves.
You may even have bizarre cases like, what if two blind people insist on trying multiple times (stopping the in-vitro procedure if they get a healthy child) until they get a blind child like themselves (a true story). Technically the condition is genetic, so the kid is not responsible, but the parents are responsible, so how do you penalize them (or do you)?
I guess this goes back to my first post. On the whole, sounds like a nice idea. But pragmatically, the nitpicks would be pretty difficult/impossible to work through.
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quote: Porter gave a lot of examples of lifestyle decisions that most of us would fall under, yet most of us consider unhealthy. *Hence*, why the line is difficult to draw.
Correct, which isn't saying that most people make unhealthy choices, which your link does speak to.
quote: You're proposing a system that penalizes lifestyle choices, which in some cases is correlated with risk, but far from all.
Take your example of obesity. There is a well studied genetic component to obesity. Yet obviously, there is personal element of free-will.
Or is there? Some laws work on the principle that people are not necessarily responsible for all their choices. A child abuser who was abused as a child may be sent to psychiatrists instead of jail, more related to obesity (in Canada) some advertisements may not be placed too close to a school lest it unduly affect children.
It may be difficult to separate consequences resulting from lifestyle choices and those from predetermined issues.
Depending on what you believe about free will (which is another debate in itself), it may even be difficult to determine what we truly decide for ourselves.
You may even have bizarre cases like, what if two blind people insist on trying multiple times (stopping the in-vitro procedure if they get a healthy child) until they get a blind child like themselves (a true story). Technically the condition is genetic, so the kid is not responsible, but the parents are responsible, so how do you penalize them (or do you)?
I guess this goes back to my first post. On the whole, sounds like a nice idea. But pragmatically, the nitpicks would be pretty difficult/impossible to work through.
I get your point and don't really have an argument against it. I suppose the only question is, will people pay for it?
At some point, I'd like to make a thread about some of the thoughts of Ms. Wolf in Misconceptions. Not because the book is all that, so much as that some of the points she raises seem to me to be things that should be addressed and discussed.
Posts: 13123 | Registered: Feb 2002
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quote:Oh, and unless you do not have medical insurance, or have insurance through a very small company, you are already paying for other people's genetic misfortunes and lifestyle choices.
Interesting point. The insurance company, of course, declines people all the time for being too expensive.
Actually, if you are insured as part of a large enough group (part of a company policy for companies of a sufficient size (I don't recall what said size is, and it may vary by state)), no they can't. They can claim certain costs are not covered (and indeed they may not be, depending what exact coverage your company plan includes), but they cannot opt out of insuring any eligible employees (or their eligible dependants).
Posts: 32919 | Registered: Mar 2003
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posted
There are a couple of CT’s points about the NHS that are not quite correct.
quote: Great Britain, "National Health Service": This is a federally organized and publically funded entire health care coverage that is run at the federal level. Physicians are employees of the State and work in a "capitation" system; i.e., they are assigned a set number of patients and then are compensated at a flat rate, regardless of variations in providing those comprehensive services to all of those various people.
Basically, the State decides which services will be covered and what the compensation will be, along with the workload of each physician. If you are assigned 200 patients as a physician in the NHS, then you care for those 200 patients. You can't decide that you'd rather work fewer hours and cover only 150 patients, or that you'd rather live and work in this other area and with these other (rural, urban, what have you) people. There is a secondary private insurance set-up that runs alongside the NHS, but it is not extensively used. Most citizens seem to use it to fill in gaps in NHS coverage, not to supplant it.
Doctors can decide they want to work fewer hours (my sister has worked part time whilst a junior doctor at a hospital and as a GP). Many GPs work part time. They can definitely choose where they want to live and work. They apply for jobs at practices or hospitals they want to join, just like any one else.
The list of services a GP must provide is not as tightly determined as you imply. There are a basic set that all GPs have to perform with lists of additional services which they can offer and get extra funding for.
quote: Difference #4 (continued from above): Another thing I took for granted but may not be clear to others is that patients get much more flexibility and freedom of choice as to who to work with in regards to their own health care under a state-run insurance program as versus state-run system overall. In the NHS, patients and physicians are assigned to one another -- physicians' offices are designated to cover certain zones without much overlap. A patient can work out a way to see another physician, but this requires some doing and work. That physician would be located inconveniently, as he or she would be out of the curtrent zone for that person.
Patients are not assigned a GP, you choose a GP you want to register with. It is possible that your first choice practice may be full, but that has not happened to me. When you are referred by your GP to a specialist this is more likely to be chosen by your GP, although there is a degree of choice (I’m not sure of the extent of it, as I’ve never been in a position to need to see a specialist). According to what I hear in the news you are supposed to have a choice of 5 hospitals.
The only restriction I know about for matching GPs to patients is if you want home visits you have to live within a certain distance of the practice (the GPs I’ve been registered with have a radius that they will cover for home visits, if you live further away, you are advised to look for a practice closer to home (but not required, for example several people I work with have chosen the practice close to work, rather than close to home).
I’ll go back to lurking now!
Posts: 169 | Registered: Aug 2005
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quote:I'm exploring issues in nationalized/socialized/subsidized healthcare. If I'm paying for your healthcare, then doesn't your health become my business?
In one sense, yes: if you were paying for my health care (which you wouldn't be -- I'd be paying for it through taxes), you'd have the right to direct everything I do that affects health, which is to say, everything. You can order me to marry or not marry (a major factor), what kind of job to take, how many hours to work, what I do with my time off -- everything. All my rights and all my choices are subject to your review.
In another sense, no: human rights are not something you can purchase. Even if you were just giving people money for their rights, their rights remain their rights.
I heard an interview on NPR with a gov't social worker. Her job was to pay regular visits to welfare mothers, to decide whether to take their children away from them. Not mothers who were suspected of abuse and neglect; just mothers. She saw nothing strange about a presumption that giving someone government money entitles the government to regular warrantless searches.
She was wrong. The 4th Amendment doesn't say "except for welfare mothers." Other rights don't end when you use government services, either. But those services do seem to tempt those in power -- or those merely talking about it -- to ignore those rights.
quote: As to your second point, er, o.k.?
Your comment, question, or whatever it was, is a mite ambiguous!
[ December 19, 2006, 08:22 AM: Message edited by: Will B ]
Posts: 1877 | Registered: Apr 2005
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posted
I think you are taking my question a bit literally, Will. (edit: This is, of course, my fault for not being more explicit.) I'm not saying command every aspect of your life so much as have a say in what is done with my taxes in regards to the health care system edit: and, by extension, treatment for you. That is, in a very real sense, everyone gets to vote on how large of a budget a system gets, where the money goes, etc.. The health of everyone in the country is something that becomes tied to what the rest of the country believes is legitimate because the rest of the country is paying for it. This seems self evident.
I didn't want to belabor the point yesterday, but this is just going to be a basic fact of any health care plan. It's not just going to pay for anything. Things are going to have to be budgeted for.
Further, using this money gives the state a larger amount of say in how doctors run their practices. It's already that way with medicaid, medicare, etc., and would be much stronger if the state payed for everything.
quote:Originally posted by Storm Saxon: I get your point and don't really have an argument against it. I suppose the only question is, will people pay for it?
Clarification? What people and what methodology are they following?
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quote:I'm not saying command every aspect of your life so much as have a say in what is done with my taxes in regards to the health care system
That seems fair.
That would put the kibosh on the system paying for any illness. If that's your point, I understand. I thought you were making the point that a government that pays for lifestyle mistakes might reasonably dictate lifestyle choices.
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posted
Kettricken, I am delighted to learn that things are less restricted in the UK than I was told. I will read up more on this. Thank you.
My classes gave the most cursory overview of the NHS -- most of the details I was given were from physicians who had left the UK in search of what they considered a better worklife. I suppose the accounts were more biased than I'd realized.
Again, thank you. I'd love to get the perspective straight.
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quote: I thought you were making the point that a government that pays for lifestyle mistakes might reasonably dictate lifestyle choices.
Well, even so, the state already de facto dictates many lifestyle choices by making them not available or illegal. So, thinking about it, it's not so much of a stretch to say that it might do it with insurance. (Want to smoke? Fine. But you don't get insurance, or states that don't raise their drinking age to 50 don't get funds for insurance.) So, even though I wasn't saying it in this thread, I don't think it's something that the state wouldn't, or couldn't, do.
Posts: 13123 | Registered: Feb 2002
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quote:Originally posted by Storm Saxon: A system that pays for almost any illness.
Not clear what you're asking about the second question.
I don't think you understand what I'm asking.
As in (as a brief summary), you proposed a nationalized system of health care, where coverage is penalized for care stemming from lifestyle choices. You mentioned that actuarial tables might be a way of determining the consequences of lifestyle choices. I pointed out that actuarial tables only measure empirical results, but do not determine responsibility, nor what proportion of a problem (e.g. obesity) stems from personal choice or is pre-determined. You said you got my point, didn't have an answer, and just asked if people would pay for it.
I want you do elaborate on your question of "will people pay for it?"
When you say "people", do you actually mean the healthcare system itself or do you mean you're going to poll people, or what? And by methodology, what system do you propose that the "people" decide what to pay for or not to pay for.
Posts: 7593 | Registered: Sep 2006
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quote:what system do you propose that the "people" decide what to pay for or not to pay for.
Whatever system is proposed, it will almost certainly turn into a system which is ruled by political expediency and beurecracy.
Posts: 16551 | Registered: Feb 2003
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I can think of there being, along the lines of some of the anti-drug commercials the government subsidizes, there being 'get in shape' commercials. I'm pretty sure these already exist in the children's cartoon market. Perhaps signs like 'Nothing tastes as good as thin.' ![[Wink]](wink.gif)
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