Clean Slate health service

There are currently only really three methods of running a national health service in practice at the moment, a taxation based socialized health service, an insurance based service, and a fee based service. They each have their problems, the taxation based service works from a fixed budget which means more expensive treatments become difficult to pay for while the insurance and fee based service tend to lead to health exclusion for the worse off. There is however a deeper and more insidious difference, a expanding trend in health care for this century will be preventative health care, where the health service is taxation based spending a little money ahead of time to fix behavior or faulty genes to prevent an expensive disease makes monetary sense, where it is insurance or fee based, the expensive disease will obviously be what they'd prefer to treat, because it is much, much more expensive for the patient and thus makes more commercial sense to the service provider.
Currently this has only a slight impact on health provision but with the possibility of things like genetic vaccination for bad heart genes or better aging, or any number of other genetic related ailments, for a taxation based system these things would save billions while a fee based one would lose billions.
I would suggest therefore, for wont of any better ideas, that a CS health service would be a combination of the two, a taxation based system for residents of the city but built with enough extra capacity that it also functions as a fee based system for the regional neighbourhood. If, as has been suggested elsewhere, the CSCS is located in the third world as a regional center of excellence offering first world standards of care this could be highly profitable, also it should be noted that any health service built to cope with emergency and disaster occurance must operate day to day at less than maximum capacity and for purely efficiency reasons around 70% is preferred.

You have to be very careful were you allow profit in a health care system, because your in a situation were you already have people over the barrel. In any system, its very easy for the cost to creep up for reasons legitimate or not and people, because they enjoy living, will pay.

What I think you need is a taxpayer funded health care infrastructure, where the facilities and production of needed supplies are built and produced at size and rate that allows a surge compacity and surplus for contingencies. Staffing is included in this at a bargain rate, so that yearly costs are fixed.

Now in order to provide a deterrent to overuse, we need both a regular preventive medicine and a cost of every visit. Doctors should be able to supplement their salary (that I mentioned should be set to the low side) with a time based charge. This rewards quality doctors, because customers won't line up at an office twice if they don't get the results they want, and gives the customers choice in where they put their dollars. It would also be a good idea to charge a for-cost fee for expendable supplies used. These things don't come out of thin air, but are also not individually cost prohibitive.

The third vital segment of medicine is the development of new treatments, drugs and devices. This has to be encouraged, but not to the point were drug companies turn us all into hypochondriacs to sell more happy pills. We need to set key categories of need, stick a pile of money in each one, and allow researchers to compete for it with the results they get. During trials they can sell it for whatever they want, and once a treatment proven safe and effective, the companies get a lump sum so the government can manufacture it.

There are far too many aspects to health care for me to address but, to form a foundation to build on I would suggest a taxation based system, but with a deductible to prevent abuse.

I think the worry with having a fee system for doctors is that it will disuade the less well off to put off a visit until it's urgent at which point what could have been easily treatable has become far worse, or alternatively, a lot more expensive. Secondly if the best doctors can hike up their fees the poor will be forced to visit only the less good ones.

Needless to say the US is not the place to look for a good example of a socialized health system, but socialized medicine or at least partially socialized is necessary. Insurance based is a joke when all the company cares about is making a profit, and fee based is not fair because there are catastrophic expenses that come up through no fault of the individual. How to minimize abuses of the system is a tough question.

Whaat exactly is an abuse of a health system? Getting sick twice in one year?

How about gang bangers getting into a turf war and going to the local hospital to get patched up and then going out and doing it again the next week.

That's just one of a number of examples.

Creating a national insurance bureau would allow virtually everyone to access health care. Doctors would get paid what they deserve and the profession would still attract the best of the best.

If you socialize health care, doctors get paid less, therefore there would be less incentive to do your best, especially when your job is guaranteed by the government.

Surely that's a failure of their local health service. When the individual came in he should have been given a psychological evaluation, when he was then found to be a threat to both himself and others he should have been sectioned.
Doctors also get much lower insurance peremiums, so it's swings and roundabouts. They also don't get paid badly by any definition of the word.

I never said they get paid "badly", but less. Less money, less incentive is how it works most of the time, whether we like it or not.

A government national health insurance bureau could be considered a partially socialized system. I don't think that totally sociallized medicine is best. Partially socialized medicine sounds like the best of both worlds. i think the best thing to do in regards to this is examine the health care systems of a number of different countries and find out what aspects are successful and what aren't and incorporating them into one system.

Partially socialized..... semantics

As a city-state it could be more than just semantics, for the residents it is socialised, for everyone else, its a cheque book.

I was merely kidding

Kidding or not there is a need to differentiate. I'm just not sure how to compensate excellence in this system. This is where I would have to examine the health care systems of other countries. There are a lot of health care workers who are not just in it for the money. For example Doctors Without Borders. What motivates them to strive for excellence?

There are a lot that are in it for money, and they will cause problems in the system.

Edit - A little redundant I realize.

This is where finding out what motivates the altruism in anybody, not just doctors and encourage that. Hopefully this will release this quality in SOME of the others.

I think you might be moving on to talk about an exclusively American thing because everywhere else money is by no means the prime motivation to becoming a doctor. In the rest of the world there are far easier, less traumatic ways of making money.

Very true. The US, thanks to conservative propaganda, has been fixated on money at all cost. Screw society, what's in it for me, and they hide behind the facade of self-sufficiency. What I hear is screw my country, screw my fellow Americans, I got mine and
I don't care about anybody else. In fact along these lines the American Medical Association has lobbied to stop any legislation along the lines of socialized medicine. This is where a clean slate would be nice. Get rid of the selfish greed and try and make a good place for all.

Pointing the finger at conservatives for creating our fixation on money is a mistake. Liberals and conservatives alike are motivated by money and power. And by liberals I mean the majority in the Democratic party and by conservatives I mean the majority in the Republican party. Let's not beat around the bush, we'll call them what they are.

Since when has MTV or VH1 been influenced by conservative pressure? I would say that the media and the consumerist attitude it so obviously perpetuates as the ideal, is the real cause of Americans' pigheaded and give-it-to-me-now attitude.

Is it possible that american doctors have become more money driven in response to an increasingly litigious society which awards huge pay outs and thus demands doctors pay hefty insurance premiums?

My father works for a medical insurance company that insures doctors. A majority of cases are frivilous (sp?) and some are completely unfounded. I'd have to say that's a factor as well, lkm.

Granted, my points were generalized, but with respect to medicine, there is a difference in the motivations of US doctors and the doctors of other countries.
I can't say I agree with the fixation on money on both sides. This is true to a certain extent, but it's the conservatives who have embraced the Social Darwinism philosophy, but ironically rejected biological Darwinism.
Litigation in medicine is a factor, but why would the AMA reject socialized medicine completely rather than consider it with protection against frivolous litigation?
Medicine is a science, but has a lot of aspects to art in it. A doctor has to be very intuitive in order to absorb a lot of, albeit incomplete, information and to come up with a diagnosis based on this. They very often make a GOOD decision, but it happens to be the WRONG decision. That's when the Monday morning quarterback lawyers come in and focus on the wrong as opposed to the good.

I think in a system without effective welfare where any illness or accident could be ruinous litigation could be viewed as the only possibility for providing for the future for anyone with even the hint of a case, and as a result of that degree of litigation people who have a genuine greviance and more than anything just want a sincere and honest apology and an explanation of exactly what went wrong also are force to sue just to get those answers because doctors have been made so afraid of litigation that they cannot admit to any mistake, and as a result of that the ability of the proffession to collect and tackle bad practice and failure modes is potentially restricted thereby increasing the risk of error.

The problem with socialized medicine is that it throws tax payer dollars at the expenses of a private built, maintained, staffed, and supplied health care infrastructure without addressing the expenses. So there's a thousand and one places where costs can inflate, and the only control the government has is to say, no, we are not going to pay for that. Or pass the cost along, so its your pay check that dies from a thousand cuts.

If your going to apply public funding to it, you have to go literally from the ground up, so there is no surprises. Build hospitals stronger to avoid high maintainance costs, design offices to be more efficient, make mass purchases of equipment so that economy of scale reduces the overall cost.

Unless of course your of the opinion that giving as much of your hard earned dollars as possible is patriotic and that the government can not only keep you alive, but make your life worth living as well.

I was merely trying to analyze the reasons for litigation, do you disagree with my reasoning?

lkm wrote:

I was merely trying to analyze the reasons for litigation, do you disagree with my reasoning?

No, though I would add that entire legal industries have built up around the idea that if something doesn't go as planned in a medical procedure, you are entitled to giant piles of cash, but only if the lawyer gets one too.

Make sure you give credit to the lawyers.

I have lived in England for two years in my youth and both my parents are English by birth but naturalized US citizens. I have experienced socialized medicine first hand as have my parents. I don't pretend to know all the reasons why, but England's national health system works pretty well (except of course when it comes to dentistry!)