Healthcare Systems.

[Xentil]

1. Mostly private sector system with health insurance and care given to non insured patients mostly on an ER basis.

2. Private and State funded hybrid with national taxes going to subsidise care for the poor, and government regulation.

3. A National system like the UK's NHS with universal coverage for all, free at the point of use, funded by taxes.

4. None of the above (if you pick this option please provide a suggestion for how health care should be managed in your post)

[Gilles de Rais]

I picked 2. I think it's the closest to the French/Nordic systems and, imo, despite their imperfections, they are delivering the best bang for our buck and, this, for the great many and in most circumstances...

[Neko]

Me too, for the same reasons.

[spindok]

I suppose the second choice for me, but I would be careful about 'regulation'.

Standards ought to exist but they should be collaborative efforts between the industry and government.

There are good examples out there where non-profits have developed standards and work together with government so that those standards are recognized. Medicare and other gov. agencies will accept those as sufficient for reimbursement in many cases, so they hold the purse-strings without becoming overly involved in the actual process. Many of these agencies have proven their worth over time.

It is a big deal in the hospital when you get your visit from the Joint Commision (for example) and a lot of effort goes into meeting their standards all year so that the audit will show that you met the standards.

http://www.jointcommission.org/About...sion_facts.htm

Like the AMA or Specialty Boards it is no cakewalk. Very tough to meet the standards but driven by people outside government who are active in the field.

Right now I am working on obtaining certain continuing education credits so when the JCAH shows up next month all will be in order. When they show up they make random checks and ask individual workers questions "what are you supposed to do if the fire alert goes off in your area? What are the precautions in someone with suspected TB?" stuff like that.

So where the NGO can prove to experts in government, with auditing, they should be left in place. If it doesnt wash then government should step in if need be.

Spindok

[Neko]

Originally Posted by spindok

I suppose the second choice for me, but I would be careful about 'regulation'.

Standards ought to exist but they should be collaborative efforts between the industry and government.

There are good examples out there where non-profits have developed standards and work together with government so that those standards are recognized. Medicare and other gov. agencies will accept those as sufficient for reimbursement in many cases, so they hold the purse-strings without becoming overly involved in the actual process. Many of these agencies have proven their worth over time.

It is a big deal in the hospital when you get your visit from the Joint Commision (for example) and a lot of effort goes into meeting their standards all year so that the audit will show that you met the standards.

http://www.jointcommission.org/About...sion_facts.htm

Like the AMA or Specialty Boards it is no cakewalk. Very tough to meet the standards but driven by people outside government who are active in the field.

Right now I am working on obtaining certain continuing education credits so when the JCAH shows up next month all will be in order. When they show up they make random checks and ask individual workers questions "what are you supposed to do if the fire alert goes off in your area? What are the precautions in someone with suspected TB?" stuff like that.

So where the NGO can prove to experts in government, with auditing, they should be left in place. If it doesnt wash then government should step in if need be.

Spindok

I'm not sure I'd want my taxes to go towards paying an industry providing a public service to come up with its own rules (Rule #1 no boss to be paid under £3m p/a...). There's been a great deal too much of that in Britain lately and it's mostly led to the government getting ripped off.

[spindok]

Originally Posted by Neko

I'm not sure I'd want my taxes to go towards paying an industry providing a public service to come up with its own rules (Rule #1 no boss to be paid under £3m p/a...). There's been a great deal too much of that in Britain lately and it's mostly led to the government getting ripped off.

I am not talking about reimbursement rates or salaries Neko.

Spindok

[Neko]

That was (mainly) a joke. They really have been screwing the government to the wall, though. The best bit is that we really get to pay for it in about 30 years time due to the type of contracts they've used.

[Gilles de Rais]

I am close to Neko's positions on that one. I understand Spindok's pov and the necessity for health professionals to help shape the rules of their particular profession but a self regulated industry is a dangerous thing.

Case in point: Finance in the City of London. Self regulated. The author of 'The money Launderers' makes a powerful point of money being washed in London coz reporting 'suspicions' is entirely volontary...

Case in point: Auditing/Consulting in the US. Arthur Andersen and Enron. Need i say more? (even if A Andersen was later cleared)...

[spindok]

Originally Posted by Gilles de Rais

I am close to Neko's positions on that one. I understand Spindok's pov and the necessity for health professionals to help shape the rules of their particular profession but a self regulated industry is a dangerous thing.

Case in point: Finance in the City of London. Self regulated. The author of 'The money Launderers' makes a powerful point of money being washed in London coz reporting 'suspicions' is entirely volontary...

Case in point: Auditing/Consulting in the US. Arthur Andersen and Enron. Need i say more? (even if A Andersen was later cleared)...

I have thought that Enron wasnt due to lack of regulation, we have the SEC and there are lots of rules, maybe a lack of oversight. Once you go public you are not self regulated.

Spindok

[Gilles de Rais]

Originally Posted by spindok

I have thought that Enron wasnt due to lack of regulation, we have the SEC and there are lots of rules, maybe a lack of oversight. Once you go public you are not self regulated.

True. But the SEC, i think, rely on accountants and auditors doing its job. That's why Arthur Andersen, the auditing firm, was pulled under by the Enron scandal. My case in point was regarding the auditing industry, which is self regulated.

Eventually, but far too late to save the auditing company, AA were recognised 'innocent' in the sense that they did follow every rules and petty regulation of accounting. They were just 'creative' with them... The UK accounting profession is fond of pretending that this cannot happen in the UK because rule # 1, here, is that the accounts got to 'reflect the true nature and situation of the comapny's business', which, everybody agrees, was not the case with Enron.

By making the 'spirit of the law' their guiding light rather than the 'letter of the law', like in the US accounting practise, they say they would always be able to condemn something like AA signing off Enron's books...

So AA was 'innocent' in the US system but 'guilty' in the UK system, if you will...

In any case, self regulated industry is a bit risky... Too many potential conflict of interest... Nonetheless, i agree with you in that, for those kind of professions, input from practitionners is required. But I think the UK is on to something with trying to use 'the spirit of the law' rather than the 'letter' to judge cases. My only recommendation is to, then, add extremely harsh punishments for professionals willingly ignoring that 'spirit'.

[Uplifter]

Originally Posted by Gilles de Rais

I picked 2. I think it's the closest to the French/Nordic systems and, imo, despite their imperfections, they are delivering the best bang for our buck and, this, for the great many and in most circumstances...

The Nordic system is completely free and funded by tax.

The private healthcare companies in Norway have their prices fixed to stop them ripping off the government. This is definately something they should introduce in the U.K.

[clownboy]

I was going to choose #2 but thought I would clarify the meaning of "state-funded". Here, where we are a federation of states, "state-funded" doesn't mean federally or nationally funded.

[Tom Joad]

I voted for the communist one.

[KrisNY]

I picked 3. I know it's nothing like we have now- and I'm sure there are a lot of people that would say it would not work.
Yes there are many cons to this choice. I'll probably talk myself right out of my choice.
Now with our insurance- it's not very hard to get an appointment at the doctor when I need it. If everyone had insurance through the government - how easy would it be for me to get right in? Would my care be as good as it is now? I'm thinking that Government would in turn pay doctors higher wages so that there would be more doctors and the same care.
I would like to see more money in my paycheck each week- no premiums taken out.
I would also like to see EVERYONE pay for health care. This could be accomplished through taxes.