In the states the reason for this is not a cost issue per se. It is a lack of primary care physicians who will accept new patients. primary care is dying in this country because of stifling over regulation arising mostly from medicare, which makes it extremely difficult for a PCP to make a profit and still provide good care. PCP's are in generally unhappy with their jobs, and medical students know it...as a result there are less and less people going into primary care. Posted this before I think, but very relevant here...
http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1200.htm
And the profit model is an important one, because even if the companies don't need to make a profit, the doctors sure do. What incentive is there to become a doctor if you can't make money?...Volunteer EMS is one thing, but volunteer medicine is pushing it a bit.
I don't disagree with this either. Of course PCP's need to make profits for themselves and their practices. Abuse of government systems do occur however and this is certainly true in Australia with some felonious GP's (PCP's) thinking that the taxpayer dollar under the medicare system is a ticket to free money - a number have been busted for making fraudulent claims sometimes amounting to thousands of dollars. Most PCP's (GP's) do the right thing of course.
Further, relative to the idea of the profit/market model I would suggest that abuse is more rampant in the corporate sector (as we've all seen in the current financial crisis) and as I reflected upon with majority corporate ownership of clinic services here in Australia. This is all about market share or course.
An example that occurred here was private health groups setting up ED departments at private hospitals ostensibly to help cater for demand. Some honourable Dr's working at these Ed's revealed that the hospitals were deliberately turning away geriatric pts whose multiple and more complex morbidites meant longer times at the hospitals and greater costs with a lower ability to pay. So they "encouraged" their treating physicians to accept younger short stay pts at the expense of the elderly. Hardly a glowing endorsement of their ethics or motives.
See above. In a true free-market cost/profit driven system, those tests would represent a PROFIT for the company, as they would charge slightly above cost in order to perform them. I betcha the reason they discourage the tests is because gov't regulation prohibits them charging their actual cost.
Not so. It was the AMA -the Australian Medical Association, a conservative body representing the doctors themselves who dobbed in the corporates. It was nothing to do with government regulation and everything to do with minimalist health care for maximum profit at the expense of any ethical/medico-legal obligation to meet pt need.
The free market system operates in the health sector as it does in the financial and housing markets. The current financial crisis has made clear a number of deficiencies with this approach.
Same thing happens here. The super gov't program, medicare, pays something like 70 or 80 cents on the dollar for EMS. That means that every medicare pt. transported is a loss for an EMS service...
Side note - universal health care, or anything like it, is UNCONSTITUTIONAL here! No one cares anymore...but I'm going to keep saying it
Universal health care was never meant as a replacement for all other service provision but meant to provide a minimum bottom line that was accessible to ALL citizens not just those with the ability to pay. As you said yourself your own system doesn't cater very well with 47million of your public with no ability to pay for health care (ie no health insurance).
I'm a little mystified why health care provision by the democratically elected government should be unconstitutional. I thought governments were supposed to provide for their citizens?
Sounds like your system has a VERY clear delineation between haves and have nots. Haves = have "full" private health insurance. Have nots = only afford the not full or top version from the government.
Only true up to a point. People with top health insurance cover can use the private health system (via their premiums) to do things like "choosing" their own doctor/specialist, a private hospital for their operation, a room with one bed not a ward etc and subsidised costs via their insurance ( Many seem to think they will get it free under the private system).
Despite the promises of the private health insurance industry none of these things are guaranteed in fact many a private patient has complained bitterly when they discovered there were no single rooms left at their hospital of choice, their doctor of choice was away on holidays or decided to let a trainee do the procedure under supervision and the "GAP" fee - what the doctor charges above the rebated cost from government + insurance pay out was way higher than they expected and they are out of pocket big time.
Many surgeons and specialists here have come under scrutiny for abusing this system and charging exorbitant fees. Our Traffic accident compensation system is a classic example. Every driver pays a small "third party" insurance levy in his drivers license fee. This makes all traffic accident related injuries and care free. But his system has been abused also.
A major trauma surgeon here is currently under investigation for allegedly abusing the system with multiple overcharging and fraudulent claims for services.
Even an ED director told me personally that all an anaesthetist has to do to claim a consultation from TAC is to open the curtain, look at the pt and close it again - and a number of them have done exactly that - and been payed. Public systems are easily abused unless well regulated and accountable. I guess the argument is what and how much regulation there should be.
So is the fault with the system, its regulation,or with those looking to make a killing off the public purse?
The point I was making about a government backed/funded national health scheme was at least in principle, in terms of emergency procedures, there would be no "John Q" situations under such a system - if you're kid needs a heart transplant he will get it free from the government if you can't pay. He wont be sent home with palliative care only.
The system is far from perfect and waiting lists here are a big problem particularly in non-elective procedures - there has been much media scrutiny of this fact here.
You are responsible for yourself. Self-reliance used to be a primary value in this country. I can't imagine relying on the government to look after me...why should it? The government is made up of unflinching regulation, lying self-interested politicians who pander to whoever will keep them in power, and power-hungry regulators. Pretty much everything the government touches it messes up...
Absolutely people should be self reliant. Our EMS system is abused here frequently sometimes mischievously,through ignorance, to avoid cost and other times through desperation or fear. Telling people they must pay every time may well reduce the load but would guarantee disenfranchising large segments of the community - in fact complications of their medical problems because they didn't access acute care (including EMS service) when it could have made a difference may well entail greater costs for all stakeholders down the track or at worst death and disability because you lived in the Bronx instead of the Hamptons.
The reality is, there are always going to be those who cannot provide, despite their own willingness to try, for themselves. A recognition of this reality led to the concept of "Parens Patrae" - "the father of the people" - a concept drawn from the Magna Carta of King John that underpins most modern western government philosophy including the US.
It is too easy to lump all welfare recipients, the needy, the poor, the ignorant, the poorly educated, the mentally challenged, the abused etc into one basket that reads - "BURDEN on society". Somebody has to
care about these people.
Not everybody is cut out to be an "entrepreneur". Some guy getting a regular job at the local auto shop or supermarket filling shelves may well have reached the peak of his development. He's being the best that he can be. But his wage is crap. Why should he be discriminated against in the system when somebody, (governments are a common choice) can cover his bases for him.
In our country at least, the government in theory is acutely circumscribed in the actions it can take. The constitution is not long. Thus the list of things the government is allowed to do is not long. I mean its a silly pretense to assume the the constitution is still in effect in this country, but in theory...
"trust the government" is the sort of thing that leads a country to slip into totalitarianism. It justifies the continual expansion of government control over virtually any aspect of life. Germany circa late 1930's is a decent example - economy collapses, people turn towards the government to help, charismatic leader promises that the government will make everything better.....
On this matter I would say only that the government is the people, not the politicians. We should all get much more involved beyond just the ballot box in keeping our politicians accountable. When we do good things can and do occur to force positive change.
The great thing about elections, especially Presidential ones is that it gets us all thinking and talking - that can't be a bad thing.
Thanks very much for the considered reply.
MM
