Debate:Should a just government provide healthcare to its citizens?
From RationalWiki
This is a Debate Page. Feel free to add your own spin on the story
But keep it civil or we will like totally do... something involving something that could be considered in some way hurtful. This Debate was created by Electrified mocha chinchilla
I'd like to note that this is largely a question of ethics. The question isn't flawed just because a "just government" doesn't necessarily exist. Answers should prove why a just government (your subjective definition thereof) should or should not provide healthcare (non-private) to its citizens (individuals legally residing in said country). Good luck! --e|m|c [TALK] 14:21, 20 February 2008 (EST)
- Back up one step. Should hospitals be required to make a best effort to save the life of anyone who walks in immediate need of medical treatment? For example, you are walking down the street in your home town and start vomiting and fall unconscious. I would assume you would like them to take you to a hospital and make a best effort to make you better - even if you don't have an idea or aren't from the area (check your pockets, oops, this guy is from Canada, ship him north guys). The extension of this is what do you do for a homeless person who starts vomiting and falls unconscious on the street. Well, the hospital is going to try to help that person too, and the tax payers are going to pay for it. It has been found time and time again that preventative healthcare is much more cost (effective?) than emergency health care, both in terms of time and quality of life. One could (I don't, but one could) care less about the quality of life of other people, but most people prefer to pay less taxes.
- On a related note, free housing can also drastically reduce the cost to tax payers in some cases too.[1]
- --Shagie 13:16, 20 February 2008 (EST)
- Sorry to invade your space, but this is a kind of side note: first of all, isn't every doctor obliged to give care to people in immediate need of help? I thought it was in their oath. Second, I have read at least a couple of times, in the Mediterranean country where I am now living, of people who collapsed and died in front of a hospital. In this country, doctors/nurses are required to stay in the hospital, they can't go out - even if just 5 meters/yards! The correct procedure is to call an ambulance, which will come from who knows where and take you to the hospital when it's too late. Editor at RWSchumi on Ducati? 13:44, 20 February 2008 (EST)
- You sure about starting this debate, EMC? We're all gonna' get whumped by PalMD. :-) --Essayist RA Talk _Fruitcake! 15:00, 20 February 2008 (EST)
[edit] Radioactive afikomen
Arguably, it is the responsibility of a state to concern itself for all its citizens/residents. An important part of such a responsibility is to protect the innocent and the helpless. The "helpless" includes those who do not possess the means to take care of themselves, which clearly includes those who are too poor or whose treatment is too expensive for them to afford on their own.
Guaranteed universal healthcare would greatly raise quality of living. Additionally, while some (read: libertarians and other anti-statists) may argue that government healthcare would make the people more complacent and dependent on the state, it would actually "help the people help themselves". Particularly when it comes to long-term, often lethal diseases, such as cancer or AIDS, paying for treatment is always very costly. Households often bankrupt themselves, or sacrifice any existing financial security, in order to pay for such long-term, often highly specialized treatment. By letting the government pay for it, people will no longer be driven into desperation or poverty by healthcare costs.
As for the free market, it is arguably ill-suited for providing healthcare. Despite libertarian opining to the contrary, the free market is actually business oriented—when consumers benefit it is only a pleasant side effect. On its own, the free market focuses on selling as much as possible in order for businesses to maintain as high a profit as possible. However, the entire principle behind healthcare is to sell as little as possible, and emphasize prevention over treatment. The ethical goal of healthcare is reach the point where it is only barely needed, and maybe even not needed at all.
There do, of course, need to be a few things purposely not covered by national healthcare. Frivolous procedures like cosmetic surgery shouldn't be covered, except for the injured (burn victims who need skin grafts, for example). Medical woo treatments should also not be covered. --Essayist RA Talk _Fruitcake! 13:36, 20 February 2008 (EST)
- I need to
pentype a longer response at some point, but a few things. First, while preventative medicine is undoubtedly a public good, and good for public health, it is not clear how cost-effective it is. Whether or not it is cost effective should drop a bit in relevance anyway, as prevention is important to public health. - A few things are involved in centralized health care. First are the ethics, second is how it is put into practice, as the implementation effects the ethics. For instance, centralized health care with Draconian rationing would be perhaps utilitarian, but less ethical than other systems (current US system is rationed, not in a Draconian fashion, but in a somewhat haphazard, economic fashion).
- Health care is not as amenable to a pure "marketplace of ideas" as other services. It requires highly specialized professionals who have a fiduciary relationship with their patients. The current (US) financial incentives can disrupt this relationship.
- Under our current system, all hospitals (at least, all that participate in any government programs--US) are required to treat emergencies to the best of their abilities. People in private practice like myself have no such obligation (i'd go broke anyway).
- More later, but it's just some things to chew on.--
PalMD --You don't know harsh! 14:04, 20 February 2008 (EST)
- Do you have any quibbles with the financial argument (second paragraph)? --Essayist RA Talk _Fruitcake! 14:10, 20 February 2008 (EST)
- Any system that provides real health care (as opposed to voodoo, etc) will spend a lot of money on a few people. Given it's a gamble to figure out who will be the few expensive people, the only way to finance such a system is by pooling risk and money.-- PalMD --You don't know harsh! 14:40, 20 February 2008 (EST)
- Any system that provides real health care (as opposed to voodoo, etc) will spend a lot of money on a few people. Given it's a gamble to figure out who will be the few expensive people, the only way to finance such a system is by pooling risk and money.--
- Do you have any quibbles with the financial argument (second paragraph)? --Essayist RA Talk _Fruitcake! 14:10, 20 February 2008 (EST)
- This subject is a veritable mine-field as the provision of universal healthcare can be a tremendous drain on the public purse if not controlled. I don't know if this debate was inspired by my posting about my wife's cancer therapy but we received a lot of value back from our health taxes. There's a lot wrong with the British NHS but there's a lot of good there too. In the UK the Government is the primary employer of health-care workers so has the controlling say in how most of them are paid, people don't want to pay a lot of tax so they try and keep wages low, this tends to lower the quality of native healthcare workers but our wages are still higher than say the Philippines or Poland so we get an influx of foreign workers who are often higher qualified than those they replace. However, they have no long term comittment to stay in the country and might return home if conditions improve there which means that a lot of qualified staff could disappear at short notice. Pharmaceutical companies spend a lot of money developing drugs and have to recoup their costs and make a profit. Now in some countries (like the USA) they can charge a high price as a lot of people either are prepared to pay for the treatment or can afford health insurance. However, at some point that price puts a cap on sales as there are a lot of poor people in the developing world who can't afford the drugs. Socialists (for example) then make a point of bashing big pharma for not giving the drugs to these poor countries or maybe charging a much lower price. Well as the actual costs of manufacturing the drugs are often not a significant part of the price the companies could charge a lot less and still make a profit on these extra sales, profit that they wouldn't have had if they charged the same premium price as in the USA. Now if you are an African entrepeneur of some kind you can see that there are a bunch of cheap drugs being brought into your country, so spotting a business opportunity decide to sell them back in the USA either to people who can't afford them in the first place, or to someone who can afford them but would rather spend their money on something else if they could. This then removes the drugs from those who need them in Africa and undermines the pricing structure in the USA. There is also the dilemma of how much treatment you give one person, there have been cases where a health authority has refused to supply a particular drug because of the cost. Patients in other areas where the needs are different may have been given the drug, the patient then goes to court to get the drug prescribed. This may cost as much £5000 per month for the rest of their life (although the cost would probably come down over time). The health authority now has to fund that drug which may mean reducing treatment for 10 people who need something that costs £500 per month. How we balance the value of the one person who needs the drug against treatment for all the others is really a no-win situation. Do we place a higher value on someone who has great potential or treat someone who is old but has paid their share of taxes and is entitled to something back? Cosmetic surgery may actually be a valid procedure. In my twenties I had a mole on my face removed (it was done privately) because I was very self-concious about it. Some people can be greatly affected by parts of their body which they find disfiguring, like birthmarks, harelips or even moles and may be driven to self harm or suicide. I am currently afflicted by a rapidly expanding bald patch and it's driving me to despair. In France, quite bizarre treatments which are more in the realm of health-farm treatments are available. Unfortunately the demand for these has led to an enormous national debt that must be settled at some point. It may sound callous but as everything has to be paid for, ultimately we may have to put a price on everything including people's lives and make those who can afford treatment pay as much as they can to subsidise the less well off. After all, a lot of rich people's wealth is obtained as the result of other people's low wages. People who cannot afford to pay for their own medical care. Some of us vote with our heart while others vote with their wallet, I'm just glad that I don't have to make a judgement of Solomon over this.
Genghis Marauding 15:37, 20 February 2008 (EST)
- This subject is a veritable mine-field as the provision of universal healthcare can be a tremendous drain on the public purse if not controlled. I don't know if this debate was inspired by my posting about my wife's cancer therapy but we received a lot of value back from our health taxes. There's a lot wrong with the British NHS but there's a lot of good there too. In the UK the Government is the primary employer of health-care workers so has the controlling say in how most of them are paid, people don't want to pay a lot of tax so they try and keep wages low, this tends to lower the quality of native healthcare workers but our wages are still higher than say the Philippines or Poland so we get an influx of foreign workers who are often higher qualified than those they replace. However, they have no long term comittment to stay in the country and might return home if conditions improve there which means that a lot of qualified staff could disappear at short notice. Pharmaceutical companies spend a lot of money developing drugs and have to recoup their costs and make a profit. Now in some countries (like the USA) they can charge a high price as a lot of people either are prepared to pay for the treatment or can afford health insurance. However, at some point that price puts a cap on sales as there are a lot of poor people in the developing world who can't afford the drugs. Socialists (for example) then make a point of bashing big pharma for not giving the drugs to these poor countries or maybe charging a much lower price. Well as the actual costs of manufacturing the drugs are often not a significant part of the price the companies could charge a lot less and still make a profit on these extra sales, profit that they wouldn't have had if they charged the same premium price as in the USA. Now if you are an African entrepeneur of some kind you can see that there are a bunch of cheap drugs being brought into your country, so spotting a business opportunity decide to sell them back in the USA either to people who can't afford them in the first place, or to someone who can afford them but would rather spend their money on something else if they could. This then removes the drugs from those who need them in Africa and undermines the pricing structure in the USA. There is also the dilemma of how much treatment you give one person, there have been cases where a health authority has refused to supply a particular drug because of the cost. Patients in other areas where the needs are different may have been given the drug, the patient then goes to court to get the drug prescribed. This may cost as much £5000 per month for the rest of their life (although the cost would probably come down over time). The health authority now has to fund that drug which may mean reducing treatment for 10 people who need something that costs £500 per month. How we balance the value of the one person who needs the drug against treatment for all the others is really a no-win situation. Do we place a higher value on someone who has great potential or treat someone who is old but has paid their share of taxes and is entitled to something back? Cosmetic surgery may actually be a valid procedure. In my twenties I had a mole on my face removed (it was done privately) because I was very self-concious about it. Some people can be greatly affected by parts of their body which they find disfiguring, like birthmarks, harelips or even moles and may be driven to self harm or suicide. I am currently afflicted by a rapidly expanding bald patch and it's driving me to despair. In France, quite bizarre treatments which are more in the realm of health-farm treatments are available. Unfortunately the demand for these has led to an enormous national debt that must be settled at some point. It may sound callous but as everything has to be paid for, ultimately we may have to put a price on everything including people's lives and make those who can afford treatment pay as much as they can to subsidise the less well off. After all, a lot of rich people's wealth is obtained as the result of other people's low wages. People who cannot afford to pay for their own medical care. Some of us vote with our heart while others vote with their wallet, I'm just glad that I don't have to make a judgement of Solomon over this.
[edit] Socio-Economic analysis
My general feeling on the topic is "Yes, almost certainly." I probably ought to make some effort to justify that. I'm going to perform some slight of hand magic here, and argue not that a just government should provide healthcare but that a prudent government, just or otherwise, should provide healthcare. I tend to believe these two are equivalent. A prudent government is almost by definition just, providing your serfs with justice tends to be a prudent survival mechanism. Your mileage may vary.
So, where was I? Oh, right. Economics. Health care it seems to me is not an industry that can draw any great benefits from a free market, at least not what we would call a free market. Like any pure service industry, it doesn't really have any great economies of scale. Health care providers and suppliers form natural monopolies and cartels. One can hardly choose where emergency medical care is provided, and since the recipient is in general terms almost never the payer, we aren't in the habit of getting quotes and comparing prices as we would with many other artisans who provide services to us. The supply of drugs and equipment to medical practitioners are largely monopolies too, thanks to the patent system. In really free market, this would not be so, patents wouldn't exist and industrial espionage would be the order of the day. Do we want to go down that road simply to get cheaper medical care? Probably not. On the other hand, I think the WIPO treaty with India a couple of years back is the greatest injustice ever perpetrated by man, no less so for being almost totally unreported in the west. India until recently was the world's largest manufacturer of knock off generic drugs, including AIDS medications at prices the third world could afford. If I ran the world, everyone affiliated with WIPO would be tried for crimes against humanity for forcibly putting an end to that, a crime far worse in scale than Hitler's holocaust. Whatever can be said of Hitler's motives, at least he didn't kill people for corporate gain. But I digress...
To restate, health care does not and can not benefit from the free market. Given this, where does that leave us? It leaves us trying to decide what is more prudent, with no economic distinction to be made. Can we simply leave it to private industry to care for the sick in our society? I do not believe so. With pure private industry involvement, the middle and upper classes can afford reasonable standards of health care without too much impact on their lifestyle. If they choose not to pay, well, that's their lookout isn't it? The poor however, are a different story. Poor people will get an inferior standard of health care, and in some cases no health care at all. What impact does this have on society? There are a number of societally damaging consequences, which include having a whole class of people in society who are simply a breeding ground for drug resistant illnesses and a reservoir for the preservation of illnesses that one might hope to eradicate through vaccination programmes. This is to say nothing of the moral implications of failure to provide health care to any individual. The prudent society must provide adequate health care to all in society regardless of wealth and social status if they wish to have any hope of implementing social health programmes. How this is done seems to me up to the country in question to decide, there are a number of fine schemes for universal health care operated by many different countries. It does not strike me that there is an awful lot to choose between them. As a British person, I naturally prefer our NHS. Since money is never, ever mentioned at any stage of proceedings it appeals to me a great deal.
As a final, personal opinion I'd like to add that access to a decent minimum standard of health care ought to be classed as a human right. Not something that we as a nation seek to supply to our own citizens as an ideal, but that we seek to supply to the whole world as a given. I freely admit this tends to colour my thinking on the matter, so take what I've said in this mini-rant with a pinch of salt. --Jeεv☭sYour signature uses all my CPU time... 19:05, 20 February 2008 (EST)
I find it a bit worrisome that in the US right now, your right to exist is directly tied to how much money you have. --Gulik 13:23, 30 March 2008 (EDT)
"Right now, your right to exist is directly tied to how much money you have", Gulik? I think the times in history when this has been otherwise is in the minority. --TheNerd 17:27 1 May 2008 (EDT)
- I believe there's an economic element to health care that hasn't been brought up here: collective bargaining. When I was growing up, both of my parents were electrical engineers at a major tech company, and they got health insurance for the family through their work. The company providing the insurance covered a very large number of people, including all the employees in the health insurance program at my parents' company. As a result, our insurance company had significant leverage in negotiating prices with healthcare providers, and it seemed to do so very effectively. My mom once told me that, on average, the total price our insurance paid for our medical care was about 1/5 (one-fifth) of what the provider initially quoted us for a given doctor's visit/checkup/procedure. We then had to pay 10% of what our insurance paid as a deductible. Her impression was that healthcare costs are ridiculously inflated, and that the doctors and hospitals we did business with could still cover their costs even if they were only paid the 1/5 price our insurance negotiated with them. That means that, when they charge some hourly-wage laborer 5 times as much as they charge us, they make a profit of 80% or more. The only reason healthcare providers don't appear to be absolutely reeling it in is that most of these working-class people can't really pay the inflated prices, so they end up going bankrupt or making some other kind of agreement with the provider. I'm still in college, so I (thankfully) haven't had to deal with insurance or healthcare much on my own yet. That means I can't verify how accurate my mom's description and speculation on all this was. PalMD? OneForLogic 11:37, 17 July 2008 (EDT)
- Since I'm here, I might as well chime in on the rest. I agree that focusing on preventative medicine is definitely better for society than focusing on treatment. This may very well mean that the strict economic analysis favors the action (make and sell expensive treatments) that is less favorable for society; I haven't really thought about this enough to strongly assert that I consider this true, but at a glance it seems plausible. I'm also hesitant to agree with the conspiracy theorists who believe that Big Pharma is deliberately keeping us all sick to suck up our money selling treatments, if only because they're conspiracy theorists.
- I think the macroeconomic analysis might get a little more interesting if you consider the entire aggregated economy, as it also seems plausible at a glance that better pubic health means more productivity and profit for, well, basically any company that makes and sells things, as healthier people will be both better able to work productively and produce things and better able to buy them. I find this effect very interesting, as it implies that it is in the best interests of all for-profit companies to help improve public health, education, and welfare in general (meaning the general kind of "welfare", not the government kind). This kind of analysis, obviously, requires considerations of really big time-scales (think centuries, not years), generally bigger time-scales than individual companies exist in (check on any large currently-operational US corporation; how many mergers has it had in the last ten years? Or, how many companies go out of business within ten years of operation? The answer to both is generally "lots".). Anyway, I digress a little. And I have to get back to work (irony, anyone?). OneForLogic 11:56, 17 July 2008 (EDT)
