"1. Such an operation would mean the delivery of a vital service to 300 million people in a very large country by one supplier holding a monopoly. By the laws of economics, this would lead to poor service and high costs due to very high inefficiency."

1- By make sure that there is also a private sector
2- It does in fact reduces the cost (USA is one of the most countrys spending money per capita in health care, although it does not have an universal health care)
3- If you have the right laws and competiton between hospitals doctors etc there is no poor service

"2. Government is not morally superior to business."

4- People are

I'll reply from the point of view of the current status in Belgium:

First objection: High costs yes. Poor service no, since Belgium has one of the best public health care systems in the world. It is funded by taxes, coming down to about 1.400 euro per capita per year. It is strictly regulated, not reimbursing 'luxury' health care like eye laser surgery and other aestethic procedures, and keeps an incredible balance between a very high level of nearly free (just call it extremely easy affordable)  medical care and drugs and rigid quality control of provided care. Ineffeciency is imaginable, but is, as our system proves, easily avoided.

Second objection: It's not moral neither to equalise a basic right such as affordable quality health care for your citizens with plain old demand-supply business. Our government makes sure it's affordable, as is their duty. It's not a question of moral, it's a question of duty, and we made sure they're aware of it. But maybe that's my eurotrash leftist socialist downright hazardous point of view.

"3- When i mean competition between doctors and hospitals is a system much equal to my coutry Portugal (we have nation ensurance)"

I'm surprised people don't look into this more often.  The feasability of private health care BUT public health insurance.  This ensures that everyone has health care paid for, but there is still competition between health care providers.

and to be honest thats what most public health countries have, atleast partially allready

Um DPS, why would they care about those mails? They have all the right on their side and they'd take you to a court (which you couldn't afford) to make sure they are right.

It's extremely !@#$%^ up however. And they belive that that's the only way it can be done (from their media) so they can't really get angry. "Brainwashed" I think the word could be.

@ZoZferatu:
You have to mention some important problems tough:
*Because of the increasingly older population, expenses will get very high.(maybe to high to pay)
*They recently adjusted the current system by, in general, supporting generic medicins over the brand product.
*A lot of people go to the doctor needlessly, tough arguably thats the same elsewhere (we need figures here)

> Little Paul wrote:

> @ZoZferatu:
You have to mention some important problems tough:
*Because of the increasingly older population, expenses will get very high.(maybe to high to pay)
*They recently adjusted the current system by, in general, supporting generic medicins over the brand product.
*A lot of people go to the doctor needlessly, tough arguably thats the same elsewhere (we need figures here)

The attention span here is equivalent to that of a goldfish, so i kept it short. I'll elaborate on your points

-aging population:
I don't hold the solution to all, but sure thing is that retirement age will rise, making for longer taxpaying, and the age piramid will stabilise after 15-25 years (when most of the babyboomers are dead). It's still doable.

-generic medicines.
The generic products are only let into the market after the original brand patent expires (making for about 8 years of horribly expensive reimbursment monopoly for the brand). By the time it expires, they focus on new patented products for the same illness and leave the 'old' ones for the generics. However, everyone wants the new, improved, better one, even if it costs more.

And I think that's healthy (no pun intended). Pharma companies need the money to do the expensive r&d work on new medecines for new and old diseases. It costs us, but I think that's worth it. The generic industry is right behind them waiting to take over the 'expired' market share, kind of similar to a whip to keep it up.

- Needless doctor visits
Tricky one, that. Two aspects:
1. There's a whole bunch of OTC medicines (over the counter, no prescription needed) available, and any pharmacist will be able to tell you how to use them. However, everyone knows how to treat a stomach flue or lung infection with OTC products, but still you go see a doctor. Will you penalise that reassurance? Will you penalise the chronically ill? Will you penalise the hypochondriacs?

2. The cheapest doctor is the general practicioner (huisdokter) and serves as a first line help, who can direct you to specialists and who can prescribe reimbursed medicines. I can assure you and can prove with RIZIV figures if needed that they are *very* carefully monitored to prescription and treatment behaviour. So they act very rationally, and don't prescribe or forward uselessly or needlessly. The unneeded visits paid by non-ill patients, though they exists, are  not at all that high.

> [TI] ZoZferatu [Pw9] wrote:

> I'll reply from the point of view of the current status in Belgium:

First objection: High costs yes. Poor service no, since Belgium has one of the best public health care systems in the world. It is funded by taxes, coming down to about 1.400 euro per capita per year. It is strictly regulated, not reimbursing 'luxury' health care like eye laser surgery and other aestethic procedures, and keeps an incredible balance between a very high level of nearly free (just call it extremely easy affordable)  medical care and drugs and rigid quality control of provided care. Ineffeciency is imaginable, but is, as our system proves, easily avoided.

Second objection: It's not moral neither to equalise a basic right such as affordable quality health care for your citizens with plain old demand-supply business. Our government makes sure it's affordable, as is their duty. It's not a question of moral, it's a question of duty, and we made sure they're aware of it. But maybe that's my eurotrash leftist socialist downright hazardous point of view.>

Yes but the circumstances in Belgium are very different from the ones in the US. Belgium is a very tiny country, has a high population density, and a population small enough for centralization to be okay. The US controls a large land mass, is one of the most populous countries in the world, and population density is low. Universal health care would also lead to poor service, because of the very difficult task of micromanaging it compared to Belgium. It's easier to be efficient with centralization in a smaller country than a bigger one. The bigger the country, the more inefficient centralization becomes.

Well in America we have mixed views on rights. I, for example, don't believe there are any rights or duties other than the ones we make up. Everything, even government, is governed by the laws of supply/demand.

DPS,

Probably because the laws aren't guaranteeing they meet their terms of contract, the laws aren't enforced, or the insurance companies are too small to be competitive.

Freelancer,

<<1. Such an operation would mean the delivery of a vital service to 300 million people in a very large country by one supplier holding a monopoly. By the laws of economics, this would lead to poor service and high costs due to very high inefficiency."

1- By make sure that there is also a private sector
2- It does in fact reduces the cost (USA is one of the most countrys spending money per capita in health care, although it does not have an universal health care)
3- If you have the right laws and competiton between hospitals doctors etc there is no poor service>>

1. Yes, a private sector that has control over 10% of the market and can't compete?
2. The US health care system isn't a free-market solution, so that isn't a fair assessment. The US solution is very inefficient because of this oligopoly and government interference. Moreover, our large population and low population density adds to the problem.
3. Monopolies and Oligopolies always give poorer service, especially when they are big.

> [TI] ZoZferatu [Pw9] wrote:

> Justinian:

I'd say population density is far from being a decisive factor in an industrialized country's health care. I'd say it's the level of education and training, and the quantity of trained health care providers. I'm sure you can imagine some government services succeeding well in their mission (IRS or FDA, to name two), even in your massive continent-wide country. What you need is the political will and sacrifice to establish that system. "The bigger the country, the more inefficient centralization becomes." I disagree. The organisation becomes more challenging, difficult to make efficient. It doesn't become more inefficient just by expanding the scale.

There's a big difference between the training needed for a tax auditor and the training needed for a brain surgeon.  A decentralized IRS can increase recruitment of personnel after the fact relatively quickly by obtaining employees from similar fields, such as other accounting fields.  Medicine?  Yeah, right.

"It's easier to be efficient with centralization in a smaller country than a bigger one. The bigger the country, the more inefficient centralization becomes."

Is it not possible to divide this service amongst the States? 'Centralised' on a State level?

"Ofc it is possible and even not hard, but they refuse to belive that it could work... cause... cause... the media tells them that? Weird"

Humour aside you are right implementing State level health care wouldn't be difficult but it would be complicated.  From what I've observed complexity is the American krptonite they appear, in general, to want things to be kept simple and orderly.  Please note this is not meant to be an insult I enjoy simplicity and order as well.  It would also require a lot more beaurocracy since each State would need to have a government agency looking over health care as well as a Federal agency to act as a watch dog.

Also it would eventually give rise to another form of State envy where people from Texas are upset because people in New York get better health care or vice versa.

"-aging population:
I don't hold the solution to all, but sure thing is that retirement age will rise, making for longer taxpaying, and the age piramid will stabilise after 15-25 years (when most of the babyboomers are dead). It's still doable."
There's another factor yet. You don't know how long people will live in the future. And 15-25 years is a long long time.

"-generic medicines.
The generic products are only let into the market after the original brand patent expires (making for about 8 years of horribly expensive reimbursment monopoly for the brand). By the time it expires, they focus on new patented products for the same illness and leave the 'old' ones for the generics. However, everyone wants the new, improved, better one, even if it costs more."
idd

"And I think that's healthy (no pun intended). Pharma companies need the money to do the expensive r&d work on new medecines for new and old diseases. It costs us, but I think that's worth it. The generic industry is right behind them waiting to take over the 'expired' market share, kind of similar to a whip to keep it up."
agreed

"- Needless doctor visits
Tricky one, that."
I'm specialised in those .

Two aspects:
"1. There's a whole bunch of OTC medicines (over the counter, no prescription needed) available, and any pharmacist will be able to tell you how to use them. However, everyone knows how to treat a stomach flue or lung infection with OTC products, but still you go see a doctor. Will you penalise that reassurance? Will you penalise the chronically ill? Will you penalise the hypochondriacs?"
I wasn't talking about that specific groop. I agree this particular case is justified.

"2. The cheapest doctor is the general practicioner (huisdokter) and serves as a first line help, who can direct you to specialists and who can prescribe reimbursed medicines. I can assure you and can prove with RIZIV figures if needed that they are *very* carefully monitored to prescription and treatment behaviour. So they act very rationally, and don't prescribe or forward uselessly or needlessly. The unneeded visits paid by non-ill patients, though they exists, are  not at all that high."
Maybe. Tough arguably this figure will always be up to speculation. There are a lot of common disseases wich can't be easely detected. Its impossible to control really if they go see a doctor for a good reason or not. The same way its not always possible to control the doctors behaviour on every front. Doctors are still humans and those are known to be materialistic. Saying what the patient wants to hear, as long as there are little risks, results in more clients. More clients means a better income.

Next to that, it is known pharma businesses are behaving more and more aggresive in bribing doctors. I also know this from doctors themselfs. One example I heared: They offer a vacation trip to the champaign area if they prescribe a certain product instead of another. Now it can be a coincidence ofcourse, and a few out of the whole isn't much of proof but I still wonder. It would make perfect sence.