Purpose of a Healthcare System

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Purpose of a Healthcare System

Postby jewish_scientist » Tue Apr 30, 2019 7:47 am UTC

I have this idea for how healthcare should be provided in an industrialized, Western society, but there is a really big flaw. There is one underlying assumption, without which the whole argument in favor of this system becomes magnitudes weaker.

"The purpose of a healthcare system is to provide healthcare i.e. treat diseases."

I feel very confident that no one would object to this, but that is not good enough. I need this to be bulletproof, which is why I am asking you guys to play Devil's Advocate with me. Even if you believe this is true, I want you to criticize it as if you did not.

One objection I already know about comes from libertarianism.
Spoiler:
They would claim that the purpose of a healthcare system (or any social system involving goods) is to generate profit. My counter would be to dig one level deeper into libertarian thought. People who arrive at libertarianism through consequentialist logic say that if every individual pursued their own rational self-interest, then the result would be the best distribution of resources. This means that although the profit-motive is what motivates the individuals making up a healthcare system, the purpose of the system as a whole would still be the best distribution of healthcare.
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Re: Purpose of a Healthcare System

Postby Angua » Tue Apr 30, 2019 9:04 am UTC

WHO defines 'health' as a "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity." Now, there is a bit of controversy over the definition, especially surrounding the word 'complete' given there are many people living with long term conditions that for all intents and purposes would consider themselves 'healthy'.

They define a 'healthcare system' as follows "A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities."

I don't think your definitions of health or healthcare system are broad enough. I would advise looking up more about the social determinants of health, and the field of medical sociology. There is interesting work on things like 'what is the definition of 'old age' - it is defined by societal values, but what determines it (eg do we allow people to retire because we need to make room for the young)'. I've already mentioned controversy on the definition of health. What has been more important in terms of overall health improvement for the world - traditional medical interventions (incl vaccines, drugs, etc) or improved sanitation and environmental management? Have a look at WHO's website - there are guidelines on things like housing for a reason.

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Re: Purpose of a Healthcare System

Postby elasto » Tue Apr 30, 2019 12:03 pm UTC

Even though it comes from WHO, Angua's definition strikes me as overly broad. I'd describe that more as a system of 'social services' than 'healthcare' - though I would agree that 'health' goes beyond merely the physical and into mental health, which, agreed, is a very nebulous arena...

jewish_scientist wrote:"The purpose of a healthcare system is to provide healthcare i.e. treat diseases."

I feel very confident that no one would object to this, but that is not good enough. I need this to be bulletproof, which is why I am asking you guys to play Devil's Advocate with me. Even if you believe this is true, I want you to criticize it as if you did not.


I think my objection to your definition would be simpler: The purpose of a healthcare system should not merely be to treat disease after the fact but also to help people help themselves prevent it.

A modern healthcare system should be 'pro-wellness' rather than merely 'anti-illness' - so simple examples might be free contraceptives, help to quit smoking, needle-exchanges and so on.

(The grounds for doing so would not merely be the simple humanity of it but cold, hard economics: A stitch in time saves nine and all that...)

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Re: Purpose of a Healthcare System

Postby Angua » Tue Apr 30, 2019 12:26 pm UTC

As I said, the definition of health is a controversial one (the WHO definition is from 1948, not surprising that there would be some issues with it now). However, most definitions as used by medical and public health bodies include other domains than just physical and mental.

https://www.bmj.com/content/343/bmj.d4163
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Re: Purpose of a Healthcare System

Postby PAstrychef » Tue Apr 30, 2019 1:42 pm UTC

If you think that market driven, profit based healthcare will bring about the best results you have just ignored the realities of health in America over the last fifty years.
The New Yorker published a long piece comparing the outcomes of the healthcare systems in a city in Texas that has the highest Medicare/Medicaid billings in the country and the Mayo Clinic, where all of the staff get a set salary. Guess who does better at healing people.
And ignoring external effects on health is stupid. The people of Flint, MI, have many health issues that relate directly to the water. Poor housing exacerbates problems like asthma. Stress is a major factor in overall health, living in poverty creates a massive amount of stress.
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Re: Purpose of a Healthcare System

Postby Thesh » Tue Apr 30, 2019 2:34 pm UTC

Your definition of health will depend on what ethical system you are thinking about. From a hedonist perspective, health is your ability to experience pleasure and avoid pain. From an egoist perspective, your health is your ability to act in your self interest. From these perspectives, healthcare should be applied to environments and relationships, and not just individuals. You may even conclude that healthcare is the only purpose of the economy.
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Re: Purpose of a Healthcare System

Postby elasto » Tue Apr 30, 2019 2:55 pm UTC

Angua wrote:As I said, the definition of health is a controversial one (the WHO definition is from 1948, not surprising that there would be some issues with it now). However, most definitions as used by medical and public health bodies include other domains than just physical and mental.

Yeah. I have no problem with defining health in the broadest possible terms; But the wider we define it, the less I regard the healthcare system specifically as responsible for it.

I mean, a functional sewage system is vital to good health, but I wouldn't say it's the job of the healthcare system to provide it; I'd say it comes under the jurisdiction of some other public department.

I'd prefer to label the collection of such responsibilities as 'social services' rather than 'healthcare', but, I mean, maybe that's just semantics.

(Then again, exploring semantics seems to be the goal of this thread, so, meh.)

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Re: Purpose of a Healthcare System

Postby jewish_scientist » Tue Apr 30, 2019 3:27 pm UTC

Angua, maybe we can get around the whole problem of defining health. If we define healthcare as 'any good or service designed to improve health' and define a health care system as, 'any social system designed to provide healthcare', then we do not actually need to need an exact definition of health. Do not get me wrong, I am not saying that a discussion about what healthy means is not fruitful. I am saying that we do not need to have that discussion before having one on the purpose of a healthcare system.

elasto, I would say that vaccines, proper diet, etc. are preemptive treatments of a disease, so my principle still holds.

Thesh, I think you may be interesting in looking into the philosophical concept of a good life.
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Re: Purpose of a Healthcare System

Postby Angua » Tue Apr 30, 2019 3:37 pm UTC

How are you expecting to make a system to care for something you can't even be bothered to define?

elasto wrote:
Angua wrote:As I said, the definition of health is a controversial one (the WHO definition is from 1948, not surprising that there would be some issues with it now). However, most definitions as used by medical and public health bodies include other domains than just physical and mental.

Yeah. I have no problem with defining health in the broadest possible terms; But the wider we define it, the less I regard the healthcare system specifically as responsible for it.

I mean, a functional sewage system is vital to good health, but I wouldn't say it's the job of the healthcare system to provide it; I'd say it comes under the jurisdiction of some other public department.

I'd prefer to label the collection of such responsibilities as 'social services' rather than 'healthcare', but, I mean, maybe that's just semantics.

(Then again, exploring semantics seems to be the goal of this thread, so, meh.)

You can think of it as the overall healthcare system advising/outsourcing to other departments what needs to be done? Like, you might not be aware of the need for better sanitation in x area unless you have a notifiable disease system that suddenly starts reporting a lot of water borne diseases there. There's not much point in having a system to detect outbreaks if you don't also have a system to control them. You can quibble on which type of service is in charge of providing the sanitation, but you still need to be able to provide it for a functioning healthcare system, and have a way for that healthcare system to talk to the sanitation stakeholders and get them to do what is necessary.
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Re: Purpose of a Healthcare System

Postby ucim » Tue Apr 30, 2019 4:07 pm UTC

jewish_scientist wrote:I have this idea for how healthcare should be provided in an industrialized, Western society, but there is a really big flaw. There is one underlying assumption, without which the whole argument in favor of this system becomes magnitudes weaker.

"The purpose of a healthcare system is to provide healthcare i.e. treat diseases."
I have a problem right away with "should", and with the oxymoronic definition provided. As to the definition, substitute:

"The purpose of a schender system is to provide schender."

...and see where that gets you. Since you don't know what schender is, or why you ought to have it, or why anybody (else) ought to have it, or how it could be provided, you end up exactly nowhere. But substitute "healthcare" for "schender" and now everybody thinks they have an answer. However, you haven't added anything to the mix; you are just reflecting everyone's preconcieved notions on them, and it won't work because your preconcieved notions are not the same as mine or anybody else's.

If this is to be a useful exercise, we need to start from the same assumptions. Which means we have to agree on the fundamental "what" and "why". To wit:

What is healthcare? What is health? Why is it good? Why is your health good for me? How much {effort | money | sacrifice | etc. } is it worth, and to whom?

These sound like exceedingly dumb questions, but people don't agree on the answers. Without that, (either agreement or stipulation), the answers to the questions you are asking won't be useful, let alone bulletproof.

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Re: Purpose of a Healthcare System

Postby Thesh » Tue Apr 30, 2019 4:15 pm UTC

What are you trying to accomplish by defining a healthcare system? Without an objective, it doesn't really make sense to use anything broad definitions.
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Re: Purpose of a Healthcare System

Postby elasto » Tue Apr 30, 2019 4:24 pm UTC

JS wrote:I would say that vaccines, proper diet, etc. are preemptive treatments of a disease, so my principle still holds.


I think you could state it more clearly than you did in that case. Rather than:

"The purpose of a healthcare system is to provide healthcare i.e. treat diseases"

perhaps something more like:

"The purpose of a healthcare system is the maintenance and restoration of good health"

And then, as others have said, you do have to make a sensible stab at how to define 'health' in this context.

('Maintenance of good health' can become Orwellian in a way that 'restoration' doesn't, though. Should healthy food be given away free? Should unhealthy food be taxed? Should unhealthy food be banned? It can get tricky.)

Angua wrote:You can think of it as the overall healthcare system advising/outsourcing to other departments what needs to be done? Like, you might not be aware of the need for better sanitation in x area unless you have a notifiable disease system that suddenly starts reporting a lot of water borne diseases there.

Well, I mean clearly departments should be communicating and cooperating, but I'd say it's the responsibility of government as a whole to maintain global health and well-being of its citizens, whereas I see the responsibility of The Healthcare System as much narrower.

For example, it's not the responsibility of the healthcare system to prevent drunk-driving even though individual instances have a huge effect on health; I'd argue it's the responsibility of the police, of the education system, of each of us via social shaming and so on.

It is the responsibility of the healthcare system to prevent outbreaks of measles though, even if, for sake of argument, drunk-driving causes far more deaths...

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Re: Purpose of a Healthcare System

Postby Angua » Tue Apr 30, 2019 4:40 pm UTC

elasto wrote:For example, it's not the responsibility of the healthcare system to prevent drunk-driving even though individual instances have a huge effect on health; I'd argue it's the responsibility of the police, of the education system, of each of us via social shaming and so on.

And you don't think services to help people stop drinking or drink less are provided by public health? You would be hard pressed to argue that alcohol in general is not a health concern. What is the best way to run a campaign to limit people's drinking? Who determines that? If there are lots of drunk driving accidents in a certain area, then you are going to get pressure on the local A&E and medical services to treat them.

Again, even if you have separate departments for things like sanitation, housing, etc you will still need to have your healthcare system informing and liaising with these other departments, and need to have in built mechanisms for this. Hepatitis C clinics will help homeless people obtain and stay in housing and offer psychological support. This is not just to treat them by helping them have a more stable lifestyle, therefore more likely to complete a successful course of eradication therapy, but to help prevent spread of disease. Things like asthma rates inform decisions on whether there should be laws to prevent idling outside of schools. Community gardens/allotments have an impact on mental and physical health, but who is in charge of allocating space for them? While the healthcare system itself may not be in charge of maintaining things like sanitation/housing/public spaces in the long run, it certainly must inform their use, otherwise the healthcare system, especially when it comes to preventative medicine, will be much less effective.
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Re: Purpose of a Healthcare System

Postby jewish_scientist » Tue Apr 30, 2019 5:08 pm UTC

Angua wrote:How are you expecting to make a system to care for something you can't even be bothered to define?

Lets say a natural disaster happens and the government comes to a group of philosophers and asks, "Who should we send supplies to first?" The philosophers can have a very intense and productive conversation about triage without ever defining what 'supplies' means. Does supplies mean only food, water, cloths, and medicine, or do other services like therapy and home reconstruction initiatives also count? However someone answers the second question does not change the answers provided about the first.

I am trying to do a similar thing. The arguments for free market, single payer system, etc. do not depend on what the actual definition of health is. Defining health is a very important issue that needs to be resolved, but it does not have to be resolved before this other issue can be tackled.

ucim wrote: As to the definition, substitute:

"The purpose of a schender system is to provide schender."

...and see where that gets you.

It seems to me that when comparing schender systems, the focus should be on the quality and quantity of schender provided. Someone arguing that a certain schender system is bad because it requires more rednehcs is making a non-sequitur.
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Re: Purpose of a Healthcare System

Postby elasto » Tue Apr 30, 2019 5:10 pm UTC

Angua wrote:And you don't think services to help people stop drinking or drink less are provided by public health?

Some services are, but some (such as police breathalysing motorists) are not.

Look, I don't think we are disagreeing in any substantive way here. I'm arguing that there is a body overseeing the healthcare system (as well as the police and so on) - a body that is therefore not synonymous with the healthcare system - which we term 'government'. And I don't think it's useful to conflate the two.

Take a public health issue like hard drugs. The government may take a view that it's basically akin to an illness - that drug addicts should be treated in hospitals - or it may take a view that it's basically a crime issue - that drug addicts should be locked up (or killed).

The fact of the matter is that not all health issues are addressed by the healthcare system; Some are and some are not (but sometimes should be).

Maybe my hangup here is that I consider the NHS to be the UK's healthcare system, and I don't think it should be responsible for all aspects of societal health. It plays a vital role, and it can certainly coordinate and suggest new policies, but it is not the only player in the health & well-being arena.

All those things WHO says a functional healthcare system should provide, I say a functional government should provide, so, as I say, I don't think we have any substantive disagreement here.

@JS: Definitions still matter though; All you're really saying is that one doesn't need a perfect definition to move forwards. That doesn't mean a completely vacuous definition has any use though - especially in a thread whose sole purpose is based on said definition...
Last edited by elasto on Tue Apr 30, 2019 5:15 pm UTC, edited 1 time in total.

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Re: Purpose of a Healthcare System

Postby Quercus » Tue Apr 30, 2019 5:15 pm UTC

jewish_scientist wrote:"The purpose of a healthcare system is to provide healthcare i.e. treat diseases."


Leaving aside the "treat diseases" part for a moment, it's worth addressing a syntactic issue here. It would be very hard to argue that the purpose of a "healthcare system" is not to "provide healthcare" as you request, after all it's in the name - the premise assumes the consequent.

This might seem overly pedantic, but I think it sheds light on a further need, beyond what Angua has mentioned, to clearly define our terms. What defines "healthcare system" if not the provision of healthcare? If the provision of healthcare does define it, then you have just answered your question, albeit in a trivial manner. If the provision of healthcare does not define the system, then what does define the system in question, which presumably may not always provide healthcare, or not provide only healthcare. That which draws from the health budget? What takes place in what zoning laws define as healthcare buildings? Those things undertaken by registered healthcare professionals?

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Re: Purpose of a Healthcare System

Postby ucim » Tue Apr 30, 2019 5:17 pm UTC

Angua wrote:And you don't think services to help people stop drinking or drink less are provided by public health?
Alcohol, per se, is a health issue. Drunk driving is not, at least not in that sense. Similarly, reading while driving is exceedingly dangerous, but there are no programs to help people stop reading, or to read less. Reading is not a health issue per se, and reading while driving, though dangerous, is not a health issue any more than skydiving or bad building construction procedures.

jewish_scientist wrote:It seems to me that when comparing schender systems, the focus should be on the quality and quantity of schender provided.
Without regard to the cost of schender? If it's three times more expensive to provide somewhat better schender, is it worth it? (The less money people have, the less they can spend on their own schender). It really does matter what schender is, and why (or whether) it should be provided in the first place.

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Re: Purpose of a Healthcare System

Postby SecondTalon » Tue Apr 30, 2019 5:17 pm UTC

jewish_scientist wrote:...the government comes to a group of philosophers and asks, "Who should we send supplies to first?" The philosophers can have a very intense and productive conversation about triage without ever defining what 'supplies' means. Does supplies mean only food, water, cloths, and medicine, or do other services like therapy and home reconstruction initiatives also count? However someone answers the second question does not change the answers provided about the first.

I am trying to do a similar thing. The arguments for free market, single payer system, etc. do not depend on what the actual definition of health is. Defining health is a very important issue that needs to be resolved, but it does not have to be resolved before this other issue can be tackled.

I, uh, disagree completely. Using the scenario you describe, defining "supplies" first absolutely determines who you send stuff to first and foremost. If, for example, your definition absolutely requires reconstruction efforts then the places with the near total building destruction are going to be higher on the list than places with limited or no building damage but limited food stores, or places with many injuries but abundant food and little to no damage. On the other hand, if you define supplies as "Food, water, medicine, and a pop up tent" then the places with limited food or more than average injuries are now ahead of the place where everyone's mostly fine, just homeless.

You have to define what the fuck supplies are before you can rank order of importance.

Same thing with healthcare. If you define it as just physical condition than some place where 10,000 people were ravaged by Carl "Armtaker" Jones is going to rank higher than the 500,000 people fucked up by Jim "Mindfucker" Smith, because 10,000 people missing one or more arms are on the list of physical condition problems while the 500,000 who can't really sleep well anymore and scream when they see the color yellow are basically fine.

On the other hand, if you include mental health, then those 500,000 are a hell of a lot more important.
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Re: Purpose of a Healthcare System

Postby doogly » Tue Apr 30, 2019 5:40 pm UTC

Or, rather, you *could* have a discussion of whom to send supplies to without knowing what "supplies" means, but you'd be having a *dumb* discussion. We do not want to have a dumb discussion.
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Re: Purpose of a Healthcare System

Postby Angua » Tue Apr 30, 2019 6:14 pm UTC

SecondTalon wrote:
jewish_scientist wrote:...the government comes to a group of philosophers and asks, "Who should we send supplies to first?" The philosophers can have a very intense and productive conversation about triage without ever defining what 'supplies' means. Does supplies mean only food, water, cloths, and medicine, or do other services like therapy and home reconstruction initiatives also count? However someone answers the second question does not change the answers provided about the first.

I am trying to do a similar thing. The arguments for free market, single payer system, etc. do not depend on what the actual definition of health is. Defining health is a very important issue that needs to be resolved, but it does not have to be resolved before this other issue can be tackled.

I, uh, disagree completely. Using the scenario you describe, defining "supplies" first absolutely determines who you send stuff to first and foremost. If, for example, your definition absolutely requires reconstruction efforts then the places with the near total building destruction are going to be higher on the list than places with limited or no building damage but limited food stores, or places with many injuries but abundant food and little to no damage. On the other hand, if you define supplies as "Food, water, medicine, and a pop up tent" then the places with limited food or more than average injuries are now ahead of the place where everyone's mostly fine, just homeless.

You have to define what the fuck supplies are before you can rank order of importance.

Same thing with healthcare. If you define it as just physical condition than some place where 10,000 people were ravaged by Carl "Armtaker" Jones is going to rank higher than the 500,000 people fucked up by Jim "Mindfucker" Smith, because 10,000 people missing one or more arms are on the list of physical condition problems while the 500,000 who can't really sleep well anymore and scream when they see the color yellow are basically fine.

On the other hand, if you include mental health, then those 500,000 are a hell of a lot more important.

Pretty much this.

The arguments for free market/single payer system very much do depend on the definition of health. Who is benefiting from better 'health'. Is it the individuals, is it the economy? If the 10 000 people without arms are now unable to look after themselves and cost 1billion altogether to the economy do we then treat them and ignore the 500 000 with mental health issues because they are semi-able to cope and only cost 100 million? But what if the treatment for the 10 000 is substantially higher altogether than then 500 000? Do you treat both sets to a slightly lower than perfect standard so that they are able to manage? What if you can treat people to make them happier and improve their quality of life, but they are unable to return to work?

Healthcare is frought with mulitiple ethical scenarios and more and more complex versions of the trolley problem. Your solutions are going to depend on the angle you are taking for the definition of 'maximum benefit'.

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Re: Purpose of a Healthcare System

Postby cphite » Tue Apr 30, 2019 8:59 pm UTC

jewish_scientist wrote:I have this idea for how healthcare should be provided in an industrialized, Western society, but there is a really big flaw. There is one underlying assumption, without which the whole argument in favor of this system becomes magnitudes weaker.

"The purpose of a healthcare system is to provide healthcare i.e. treat diseases."


Why not try to prevent diseases? Why not promote healthy lifestyles? Also, are we just treating diseases and not injuries? The problem is that if you cannot define "healthcare" in some tangible way, you're going to have a helluva time convincing people that they need to support it.

I feel very confident that no one would object to this, but that is not good enough. I need this to be bulletproof, which is why I am asking you guys to play Devil's Advocate with me. Even if you believe this is true, I want you to criticize it as if you did not.


I consider healthcare to be anything directly related to individual health; it ought to cover people who are sick or injured, and help them avoid becoming sick or injured. It ought to help with things like childbirth, and things like getting old and even dying. It ought to cover people who are troubled either physically or mentally. It ought to be available - fairly - to anyone who needs it.

It needs to be cost effective. I personally don't care if it's public or private; though it seems like public is probably the right direction to move towards. Thing is... cost effective has to mean cost effective where it's being implemented. A system that works in a tiny country with 6 million people isn't necessarily going to work as-is in a massive country with 400 million people - but it can certainly serve as a starting point.

One objection I already know about comes from libertarianism.


Lots of folks want to automatically reject for-profit when it comes to healthcare, but the reality is that profits can be an amazing force for innovation. A lot of really effective drugs, procedures, and equipment have been borne from the desire to make money. The problem is when the desire to make money overrides everything including the desire to help people.

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Re: Purpose of a Healthcare System

Postby gmalivuk » Wed May 01, 2019 10:27 pm UTC

jewish_scientist wrote:
ucim wrote: As to the definition, substitute:

"The purpose of a schender system is to provide schender."

...and see where that gets you.

It seems to me that when comparing schender systems, the focus should be on the quality and quantity of schender provided.

Yeah, good luck focusing on the quality and quantity of something you haven't actually defined.
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Ranbot
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Re: Purpose of a Healthcare System

Postby Ranbot » Thu May 02, 2019 7:20 pm UTC

jewish_scientist wrote:Angua, maybe we can get around the whole problem of defining health. If we define healthcare as 'any good or service designed to improve health' and define a health care system as, 'any social system designed to provide healthcare'...

Environmental consulting companies test and clean up soil, water and air to comply with local/state/federal regulations, which were designed to improve public health. Under your definition are environmental consultants healthcare workers now? Are environmental regulations/policies part of the healthcare system?

I feel like a troll asking that, but you seem to want people to poke holes in your statements in this thought exercise...

cphite wrote:Lots of folks want to automatically reject for-profit when it comes to healthcare, but the reality is that profits can be an amazing force for innovation. A lot of really effective drugs, procedures, and equipment have been borne from the desire to make money. The problem is when the desire to make money overrides everything including the desire to help people.

Agreed. An effective health care system gently guides and directs the market with minimal burden on it. Rational people can disagree on what the balance is.

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Re: Purpose of a Healthcare System

Postby Pfhorrest » Thu May 02, 2019 8:20 pm UTC

This discussion of how other things not usually reckoned part of health care still have an impact on health reminds me of a discussion I had back in 2010 or so with someone who, on the incoming Obama!Care bandwagon about how everyone must have insurance so that costs are spread around as widely as possible, criticized me for not having health insurance, and tried to appeal to my own self-interest to motivate me to buy it. When I pointed out that not only would the cost of the cheapest available health insurance drastically exceed anything I was likely to pay in health care (which, at the time, I basically just didn't get, at all, because I couldn't afford it), that cost of health insurance would subsequently leave me unable to afford either food or housing (pick one), either of which would end up being pretty bad for my health.
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Re: Purpose of a Healthcare System

Postby CorruptUser » Fri May 03, 2019 4:46 am UTC

As the federal age curve was (and still is) insufficiently steep as one ages, younger people are still charged too much for insurance while old people too little. In other words, one of the effects of the ACA was a massive wealth transfer from Millenials to Boomers. Given that young people generally have less wealth than older people in the first place, the Great Recession hitting those first entering the job markets the very hardest, and arguably it was the Boomers (and GRATIST EVARS!) who screwed everything up in the first place, it seemed kind of unfair. There was talk of updating the age curve to something more reasonably in line with reality, but that hasn't happened yet.

The effects of doing away with separate curves for men and women have... odd effects. Young men now massively subsidize young women*, and old women subsidize old men, which is mostly a wash if the people are married. If single, which is more likely for young men than young women and for older women than older men, then not so much, so to a lesser extent the ACA also transfers wealth from single people to married couples.

*Though in fairness, having only the mother pay for the child is itself kind of an injustice

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Re: Purpose of a Healthcare System

Postby elasto » Fri May 03, 2019 12:36 pm UTC

Pfhorrest wrote:When I pointed out that not only would the cost of the cheapest available health insurance drastically exceed anything I was likely to pay in health care (which, at the time, I basically just didn't get, at all, because I couldn't afford it), that cost of health insurance would subsequently leave me unable to afford either food or housing (pick one), either of which would end up being pretty bad for my health.

CorruptUser wrote:As the federal age curve was (and still is) insufficiently steep as one ages, younger people are still charged too much for insurance while old people too little.

The effects of doing away with separate curves for men and women have... odd effects. Young men now massively subsidize young women*, and old women subsidize old men

Sad that America as a whole rejects what seems the most equitable solution: The rich subsidise the poor...

The NHS has its flaws but 'each paying according to their ability; each calling upon it according to their need' just seems by far the least worst option...

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Re: Purpose of a Healthcare System

Postby CorruptUser » Fri May 03, 2019 11:15 pm UTC

Oh, the rich do indeed subsidize everyone else, but "rich" in this case means anyone above 400% of Federal Poverty Level. Family of 4 with 2 incomes, making $100,000k per year, fuck you that's what.

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Re: Purpose of a Healthcare System

Postby elasto » Fri May 03, 2019 11:25 pm UTC

Well, imo, it's fair enough for a family on $100k to pay disproportionately more than a family on $25k, so long as a family on $400k pay in disproportionately more again. That's the part where the equation breaks down I suspect.

(Still, I could be wrong, but I bet a family on $100k in the US pay way less in tax than a family on an equivalent wage in most other Western nations...)

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Re: Purpose of a Healthcare System

Postby CorruptUser » Fri May 03, 2019 11:41 pm UTC

Nope, anyone above 400% of FPL pays exact same for health insurance on the ACA. Well, not exact same, rich people being in healthier areas like Connecticut, but whatever. Plus, federal monies pay for the poor, and the rich do pay more in income tax, so they do sort of pay for the poor. It's a huge problem, since health costs have been growing so much more than inflation that the subsidies dont smooth off at the 400% mark (will explain in a bit). Depending on the region, it's possible for someone earning just a few hundred dollars more would result in tens of thousands more in insurance costs, forcing people to avoid earning more money. SMBC had a special comic regarding this as this is exactly what happened in Weinersmith's area.

The plans are generally bronze silver and gold, which theoretically cover 60% 70% or 80% of medical costs. The subsidies begin at 133% of FPL and end at 400%. Depending where you are, you pay anywhere between around 2% and 10% of your income for the second lowest cost silver plan in your county, and the government pays the rest. It's called the Advanced Premium Tax Credit, APTC. This can be applied to any plan, so if the silver plan would cost you $6000 and you only are required to pay $2000, you get a $4000 reduction on any plan. If the bronze plan was $4000, you could get it for free, something which absolutely everyone involved loved since the working poor would have a hard cap of how much into debt they could get from a health problem and the hospitals were guaranteed the bulk of their bills would be paid. Problem is when someone is at the edge. For a family of 4 where the FPL 400% mark is $100k, at that point they are only paying $10k but the APTC could easily be another $10k on top. Go above $100k, and bam, the bill doubles to $20k. There are ways around it, such as 401ks and HSAs not being counted in the income, but there are had limits at how much can be contributed to avoid the hit.

It's almost as if the system was intentionally designed by both parties to fuck the middle class.

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Re: Purpose of a Healthcare System

Postby Thesh » Sat May 04, 2019 3:19 am UTC

It was designed based on the idea that everyone should pay for their own healthcare, but some people need help. For the most part, the middle class was already insured through their employers; it was primarily the young, old, and poor who were getting healthcare through the marketplace. The goal was to get young, middle-class people to start buying insurance, to lower the costs for everyone else. This was just a compromise between the "free bootstraps" and the "no free bootstraps" parties.
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Re: Purpose of a Healthcare System

Postby elasto » Sat May 04, 2019 9:45 am UTC

CorruptUser wrote:Nope, anyone above 400% of FPL pays exact same for health insurance on the ACA. Well, not exact same, rich people being in healthier areas like Connecticut, but whatever. Plus, federal monies pay for the poor, and the rich do pay more in income tax, so they do sort of pay for the poor.

[...]

Problem is when someone is at the edge. For a family of 4 where the FPL 400% mark is $100k, at that point they are only paying $10k but the APTC could easily be another $10k on top. Go above $100k, and bam, the bill doubles to $20k.

It's almost as if the system was intentionally designed by both parties to fuck the middle class.

As I say, it's sad that America as a whole rejects what seems the most equitable solution: The rich subsidise the poor.

Because that would be terrifyingly evil socialism something something something...

(Also sucks that country after country doesn't get that gently tapering benefits/taxes is critical for psychological reasons even if it's not the most efficient use of public funds...)

Crazy how much more expensive the US system is though, overall:

BBC wrote:If you look at all healthcare spending, including treatment funded privately by individuals, the US spent 17.2% of its GDP on healthcare in 2016, compared with 9.7% in the UK.

In pounds per head, that's £2,892 on healthcare for every person in the UK and £7,617 per person in the US.

In the summer, US think tank the Commonwealth Fund ranked the NHS the number one health system in a comparison of 11 countries for safety, affordability and efficiency. It did less well when it came to cancer survival

The US was ranked last out of the 11 countries.

The American health system came off badly in comparison when it came to infant mortality, life expectancy, and preventable deaths, but did relatively better on cancer, heart attack and stroke survival.

Meanwhile, the UK's cancer survival rates have historically been below the European average, although they are improving for certain cancers.

The UK has fewer doctors, nurses and hospital beds than the OECD average.


link

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Re: Purpose of a Healthcare System

Postby Thesh » Sat May 04, 2019 11:17 am UTC

I think it mainly comes from the idea of personal responsibility combined with the conservative tendency to resolve the is-ought problem by simply declaring "ought is". Literally, the belief is that if you are poor it is because you are irresponsible, and that if you are rich it's because you are responsible, and so redistribution punishes responsibility and rewards irresponsibility. They are authoritarian elitists: they see rewarding good behavior and punishing bad behavior as the best way to build good character, and character as the main determinant of success.
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Re: Purpose of a Healthcare System

Postby PAstrychef » Sat May 04, 2019 12:31 pm UTC

Hidden because sort of off topic-
Spoiler:
It goes beyond that, to the prosperity gospel. If you prosper, it’s because god loves you. Add that to the idea of preordination as pushed by Cotton Mather and his ilk and you end up with “we deserve to be rich because we were set in this place by god, and nothing we do can or will change our status with him, and heaven is the only reward that matters. So suck it, you poor people who are poor because god hates you, and you are never going to be as worthy as we are because this is all preordained.”
So on one hand it’s all personal responsibility and bootstraps, and on the other it’s all god’s plan. That’s why those vile creatures who run mega churches and ask for money for jets and wear thousand dollar sneakers appeal. Obviously god loves them, and maybe that can be shared.
Therefore, if you are poor and sick it’s your own fault and proves that god wants you poor and sick. Like mother Teresa used to deny suffering patients pain medication because the suffering ennobled them in the eyes of Jesus.

Perhaps,instead of referring to whatever plan was in the OP’s mind when opening this topic as a healthcare system, it could be referred to as medical care access.
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Re: Purpose of a Healthcare System

Postby CorruptUser » Sat May 04, 2019 2:35 pm UTC

Elasto, you dont quite understand. The poor ARE being subsidized by the middle class and the rich. The problem is that things have gotten so out of whack that now the middle class needs to be subsidized too, and as things get worse soon even the upper middle class will need subsidies. The system as is is part of the reason the middle class is shrinking, not the largest part but part, because many people are intentionally earning less money to avoid getting whacked upside the head with the costs, which of course means less taxes for public services.

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Re: Purpose of a Healthcare System

Postby PAstrychef » Sat May 04, 2019 3:30 pm UTC

CorruptUser wrote:because many people are intentionally earning less money.

Um, what? This needs some evidence.
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Re: Purpose of a Healthcare System

Postby SecondTalon » Sat May 04, 2019 4:40 pm UTC

The only people I've seen afraid of earning more money are people who are going to lose some government benefit due to hitting a cutoff point (ie - the poorest of the poor), people avoiding some payment garnishment of wages above a certain point (like people years behind on child support), or people who don't understand taxes at all.
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Re: Purpose of a Healthcare System

Postby ijuin » Sat May 04, 2019 6:18 pm UTC

Thesh wrote:I think it mainly comes from the idea of personal responsibility combined with the conservative tendency to resolve the is-ought problem by simply declaring "ought is". Literally, the belief is that if you are poor it is because you are irresponsible, and that if you are rich it's because you are responsible, and so redistribution punishes responsibility and rewards irresponsibility. They are authoritarian elitists: they see rewarding good behavior and punishing bad behavior as the best way to build good character, and character as the main determinant of success.


I have noticed that, as a corollary to this, people who subscribe to this worldview also perceive themselves to be superior judges of character, and thus believe that they can spot all of the charlatans themselves (and therefore anybody who is deceived by one must merely have failed their Sense Motive check).

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Re: Purpose of a Healthcare System

Postby CorruptUser » Sat May 04, 2019 11:59 pm UTC

Here is Zach Weinersmith on it

Yes, people are afraid to earn too much exactly because they lose a federal subsidy. People's insurance cost (for second lowest cost blah blah plan) is capped at 10% of income, but due to age of them and dependents the actual cost may be in far excess of 10%. After all, health costs are something like 18% of US GDP.

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Re: Purpose of a Healthcare System

Postby cphite » Mon May 06, 2019 6:28 pm UTC

elasto wrote:Sad that America as a whole rejects what seems the most equitable solution: The rich subsidise the poor...


Meh. Frankly, a lot of us who reject the idea of government healthcare in the US aren't rejecting it because of who is paying... we're rejecting it because we don't believe the US government is capable of running healthcare, at least not in any way that'd actually be an improvement over the current system.

Most people who look objectively at the problem understand that a single payer system - assuming it was run competently - would be more cost effective, both at the individual level and for society at large. We just don't trust our government to run it competently.

The NHS has its flaws but 'each paying according to their ability; each calling upon it according to their need' just seems by far the least worst option...


It would take our government three years and $22 billion just to come up with that motto.

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Re: Purpose of a Healthcare System

Postby SecondTalon » Mon May 06, 2019 6:43 pm UTC

I reject that reasoning on the grounds of it being a lazy as fuck answer.

"I don't trust this person to do this task - so rather than finding someone who is competent, I'm going to continue to rely on a fundamentally broken system because it's what we're currently using."

Fuck that, shut up, never talk about it again. Come up with ways to control it, make it transparent, make it accountable, sure. Go nuts with that. But reject it outright?

Fuck you.
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