Auditor #9 wrote:

So many questions, so little server space. If you are generally agreed that this thread is looping then it'll be closed and a new one opened on the existing system and what it is, how it works, how much it costs, where we expect it to go, how we will adjust it to meet our needs ...

And I'd be so happy if ye'd all play the ball not the man. Or as Declan Ganley says, "Policy not Politics, David".

Oh no, don't get me wrong Auditor #9. I absolutely don't think this thread should be closed and I've never said it should be closed. My point was that I think it is important to focus on the core original purpose of each thread. This one is the efficiency or not of private for-profit healthcare.

As an aside: I think it should be kinda hard to just close down a thread just on a whim, but perhaps that's for another thread...

Pax wrote:

No I haven't. I've proposed a universal single-tier system that is not illegal under EU law. It is most certainly not politically impossible as it has been achieved in practically all developed nations. Many developing nations are moving towards similar.

Do you accept that this single-tier will have a public-private mix, as in France and Germany, given that it would be illegal to have a public only model? If so, how do you stimulate development of the private part, given that we don't have sufficient private capacity at the moment?

Pax wrote:

seinfeld wrote:

The question again:

If there isn't enough private capacity to accommodate private patients, how do you create it?

I've answered that point repeatedly as has CF. You've repeatedly ignored it. We can all can see that.

The only other poster to comment was Auditor #9, who concurred with me that you hadn't.

Pax wrote:

Well done on linking and quoting civitas seinfeld.

I posted 2 sources, both of which said the same thing. The fact that one of them is from a right wing think tank doesn't mean that the data is inaccurate.

For someone who repeatedly dumps extracts from sources onto threads, its interesting that you don't have a source to back up your claim about the insignificance of for-profit health care in France.

Its also interesting that you haven't answer my question on the new thread: "Alternatives to colocation"

seinfeld wrote:

Pax wrote:

No I haven't. I've proposed a universal single-tier system that is not illegal under EU law. It is most certainly not politically impossible as it has been achieved in practically all developed nations. Many developing nations are moving towards similar.

Do you accept that this single-tier will have a public-private mix, as in France and Germany, given that it would be illegal to have a public only model? If so, how do you stimulate development of the private part, given that we don't have sufficient private capacity at the moment?

I think it's interesting to note how you try and constrict democratic choice over public provision of health care. Most authoritarian. To repeat - I've never proposed not allowing for-profit provision of healthcare.

What I find most interesting is how you think public subsidy can not only go to public not-for-profit provision of healthcare despite democratic choice? Can you further your legal strictures on that democratic choice seinfeld?

seinfeld wrote:

Pax wrote:

seinfeld wrote:

The question again:

If there isn't enough private capacity to accommodate private patients, how do you create it?

I've answered that point repeatedly as has CF. You've repeatedly ignored it. We can all can see that.

The only other poster to comment was Auditor #9, who concurred with me that you hadn't.

CF commented and disagreed with you. I can't fully disentangle Auditor #9's arguments tbh.

seinfeld wrote:

Pax wrote:

Well done on linking and quoting civitas seinfeld.

I posted 2 sources, both of which said the same thing. The fact that one of them is from a right wing think tank doesn't mean that the data is inaccurate.

For someone who repeatedly dumps extracts from sources onto threads, its interesting that you don't have a source to back up your claim about the insignificance of for-profit health care in France.

I mentioned international statistics. You linked to a questionable right wing think tank. You misconstrued the argument.

seinfeld wrote:

Its also interesting that you haven't answer my question on the new thread: "Alternatives to colocation"

It's interesting that you vaingloriously assume I've even read your thread.

Pax, this is a reproduction of our conversation to date. I have asked you repeatedly how do we create private capacity to accommodate private patients other than through co-location. The only answer you have given is that we create a public-only system, which is not possible, as it would be illegal under EU Law. You have not answered the question.


SF:
The issue is that public patients cannot access public beds because private patients are sitting in them.

What needs to be done?

Pax:
Well, certainly not colocation. That's not a solution and only exacerbates the situation (as shown by similar elsewhere).

SF:
What then?

I've never heard an opponent of co-location actually answer this question.

Pax:
You must have missed my posts earlier then where I said we should increase capacity directly within the public system, and how my longer-term ideal would be a single tier universal public system, ideally paid for by the most efficient method which is tax.

Tangent non-solutions like colocation get us nowhere on that road and are justifiably seen as a thin wedge towards the opposite direction.


SF:
Why should we be spending public money to provide capacity for private patients to jump the queue?

The problem is not that we have insufficient public capacity; the problem is that we have insufficient private capacity.

Pax:
That's another one of your non-sequiturs. The private for-profit capacity you propose is at the public expense. It will not free up public beds. It will not increase capacity. It will remove funding from public hospitals.
So why not spend it directly within the public system? Why not include VHI insurance funds to fund *a public only, single-payer single tier system*? If people want ancillary treatements within private facilities then they can pay them without public subsidy via private for-profit insurance if they want. You know, like they do in France.

SF:
What?


Pax:
The money going towards VHI should go directly towards a single tier system. Don't tell me you haven't heard of that before?

SF:
You answer is to the connumdrum is still: increase public capacity, and my question is still: why should the public purse be financing capacity that is being used by private patients.

Pax:
I've answered that already. See above. Also, you're not fooling anyone with this stuff Wink

SF:
You still haven't answered the question.

If we expand the public system without expanding the private system, the public system, financed by the taxpayer, will continue to be used by private patients.

The only way to stop private patients using the public system is to facilitate the creation of enough private capacity to accommodate all private patients.

Please tell us how you propose to stop private patients using the public system, ie, how you would end the situation in which the public patient is subsidising the private patient.


Pax:
Oh I certainly have. All you're now offering is illogical non-sequiturs as 'arguments'. Prior to that you were calling peer-reviewed studies a pile of rubbish. Then you moved towards using yawn smilies.

You are not engaging honestly but I'll try one more time - read my posts again. We shouldn't be funding the for-profit private system, and certainly not via the worst of all worlds which is co-location. You know the co-location you are in favour off.


SF:
I shall persist, Pax.

Lets define the problem:

Private patients using public beds because of absence of private capacity.

Your solution:

Divert all private health premia into public system so that we have a single-tier system where all patients are public.

Fine, except that it isn't possible to implement this solution in Ireland.

We can't ban either the provision of private health care or private health insurance (unless we leave the EU and amend the Constitution so that we can sequester all the private hospitals owned by the religious orders) so we will always have private patients.

These patients have to go somewhere, and currenty they are using the public system, because we don't have sufficient private capacity.

So if we can't legally implement your proposed solution, what *legal* solution do you propose?


Pax:
I never said we should ban it. In fact I pointed out the example of France to you a few posts up.


SF:
So the question comes again:

What do you propose we do with the private patients who are using public beds?

The only fully public system I know is in Canada, but Canada isn't in the EU, so they have that option.


Pax:
That was addressed several times already. Your faux concern for private patients in public hospitals is countered by your fevered ideological support for co-location.


SF:
You haven't answered the question. You have proposed a system (the diversion of private premia into the public system) that would illegal under EU Law (not to mention politically impossible) and hurled lots of personal abuse.

The question again:

If there isn't enough private capacity to accommodate private patients, how do you create it?

You haven't answered the question.


Pax:
I have.


SF:
The question again:

If there isn't enough private capacity to accommodate private patients, how do you create it?


Pax:
I've answered that point repeatedly as has CF. You've repeatedly ignored it. We can all can see that.

Pax wrote:

I mentioned international statistics. You linked to a questionable right wing think tank. You misconstrued the argument.

Fine, but I've given a source for my right wing think tank. You haven't given a source for your international statistics, and you are the Overlord of sources, are you not?

Can you provide a source that disclaims the assertion that 20% of beds in the French Health Service are provided on a for-profit basis?

seinfeld wrote:

Pax, this is a reproduction of our conversation to date. I have asked you repeatedly how do we create private capacity to accommodate private patients other than through co-location. The only answer you have given is that we create a public-only system, which is not possible, as it would be illegal under EU Law. You have not answered the question.

I suggest you address my previous response before you post your preprepared post. It's generally seen as correct netiquette and may be part of this site's charter.


The post in question is
this one

Finally your list of quotes are quite plainly inaccurate and incomplete and I think it is unfortunate that you've had to resort to such tactics.

Pax the man has gone to the trouble of doing that above which is pretty thorough so if he has missed something can you stick it in as it seems plain to me that the thread is in a loop now otherwise.

And can you provide the background to this please as it seems to have nothing to do with the thread at all

Pax wrote:

I think it's interesting to note how you try and constrict democratic choice over public provision of health care. Most authoritarian. To repeat - I've never proposed not allowing for-profit provision of healthcare.

seinfeld wrote:

Pax wrote:

I mentioned international statistics. You linked to a questionable right wing think tank. You misconstrued the argument.

Fine, but I've given a source for my right wing think tank. You haven't given a source for your international statistics, and you are the Overlord of sources, are you not?

Well the first quote you've given on this thread was to a right wing 'think' tank aligned to climate change deniers and tobbacco companies. In contrast I've linked to peer-reviewed studies and meta-analyses going back decades and published in the world's most respected medical journals highlighting the main thrust of the tread - i.e the inefficiency of for-profit healthcare in contrast to the public non-for-profit alternative.

I think we can safely make our conclusions on backing up arguments from that.

Auditor #9 wrote:

Pax the man has gone to the trouble of doing that above which is pretty thorough so if he has missed something can you stick it in as it seems plain to me that the thread is in a loop now otherwise.

In all fairness it's an irrelevancy Auditor #9.

Auditor #9 wrote:

And can you provide the background to this please as it seems to have nothing to do with the thread at all

Pax wrote:

I think it's interesting to note how you try and constrict democratic choice over public provision of health care. Most authoritarian. To repeat - I've never proposed not allowing for-profit provision of healthcare.

Is it not pretty obvious Auditor #9? If we vote for exclusive public funding of the provision of healthcare here in Ireland, then it can not pass according to seinfeld's view of EU law. If he is correct, which he's not.

Pax wrote:

seinfeld wrote:

Pax wrote:

I mentioned international statistics. You linked to a questionable right wing think tank. You misconstrued the argument.

Fine, but I've given a source for my right wing think tank. You haven't given a source for your international statistics, and you are the Overlord of sources, are you not?

Well the first quote you've given on this thread was to a right wing 'think' tank aligned to climate change deniers and tobbacco companies. In contrast I've linked to peer-reviewed studies and meta-analyses going back decades and published in the world's most respected medical journals highlighting the main thrust of the tread - i.e the inefficiency of for-profit healthcare in contrast to the public non-for-profit alternative.

I think we can safely make our conclusions on backing up arguments from that.

Pax, I'll ask the question again:

Do you have a source that disclaims the assertion that 20% of hospital beds in the French Health Service are provided on a for-profit basis?

I have provided you with 2 sources that back up my claim that 20% of the beds are provided on a for-profit basis.

This question is directly relevant to this thread, given that you have claimed that the French have rejected the use of for-profit health care on the basis that it is ineffcient.

seinfeld wrote:

Pax, I'll ask the question again:

Do you have a source that disclaims the assertion that 20% of hospital beds in the French Health Service are provided on a for-profit basis?

My figures in the post above come from the OECD.

Pax wrote:

seinfeld wrote:

Pax, I'll ask the question again:

Do you have a source that disclaims the assertion that 20% of hospital beds in the French Health Service are provided on a for-profit basis?

My figures in the post above come from the OECD.

Please provide a source.

Here's the post again seinfeld. I've gone to the trouble to copy and paste it for you. If I've time I could even find the pdf link.

Pax wrote:

seinfeld wrote:

Pax wrote:

seinfeld wrote:

We can't
ban either the provision of private health care or private health
insurance (unless we leave the EU and amend the Constitution so that we
can sequester all the private hospitals owned by the religious orders)
so we will always have private patients.

I never said we should ban it. In fact I pointed out the example of France to you a few posts up.

So the question comes again:

What do you propose we do with the private patients who are using public beds?

That
was addressed several times already. Your faux concern for private
patients in public hospitals is countered by your fevered ideological
support for co-location.

seinfeld wrote:

Private patients
don't use public beds in France, because France as sufficient private
capacity. In fact, France has an abundance of private health care
facilities and providers (the mix is about 65% public/35% private).
Patients have access to both public and private providers through the
CMU (they get a larger % rebate when they use a public facility) but
the system is composed of both public and private providers.

Interesting that you would use this as an example, given your aversion to private medial care.

The only fully public system I know is in Canada, but Canada isn't in the EU, so they have that option.

You are incorrect about France. In fact, according to the OECD et al, it is a complete misconstruing of the French system.

Which
means those French figures are incorrect and misleading. Almost 80% of
France's total health spending is publicly funded, about 10% is paid
for by mutual non-profit insurers (mutuelles) and private insurers, and
the remainder is paid for directly by patients.

The majority of
the 10% of private sector insurance in France is non-profit - 80%, and
these are known as mutuelles and operate on the principle of
solidarity. France has never embraced market competition as a public
policy strategy for providing health coverage and controlling costs.
Simply because it increases costs as evidenced by the US system and
elsewhere.
Also, the the provision of universal health care based on need was one of the aims of the French resistance during WWII.

Private
health insurance serves as a complementary function in the French
system, private insurance is not purchased to avoid public sector
queues or to access a different type or quality of care than what is
available to patients with only public coverage.


Seriously
seinfeld, as amusing as this is for me, stop digging. As CF pointed out
this thread is about the efficiency or not of private for-profit health
care. As you've --already agreed-- with me on for-profit health
provision's intrinsic inefficiency and increased bureacracy in
comparison to public non-profit healthcare, then I feel we are only
going in round in circles.

In sum. Start yer own thread on this subject that is bothering you, as suggested by CF a few posts up.

More sources:

http://ezinearticles.com/?Health-Care-System-in-France&id=876843

"There are 1,032 hospitals under the public hospital statute. Regional,
university, local and general hospitals are included in this category.
There are 2,139 private for profit and not-for-profit healthcare
facilities actively treating more than 50% of surgeries and more than
60% of cancer cases. In all hospitals, doctors, biologists, and
dentists are all paid as "hospital practitioners." This combination of
public and private medical services produces a health care system that
is open to all and provides the latest in medical technology. Waiting
lists for surgeries found in other socialized healthcare systems do not
exist in France."

http://www.euro.who.int/eprise/main/who/progs/chhfra/system/20050131_1

"Hospitals in France are either public (65% of all inpatient beds),
private not-for-profit (15% of inpatient beds) or private for-profit
(20% of inpatient beds)."

The 2nd link is from the WHO. What conspiracy theory do you have about them?

Yeah all of those links fail to actually contradict what I originally posted seinfeld* as regards for-profit private healthcare.

Public not-for profit is the most efficient, private non-profit is less than efficient than that and then that is followed by the worst of all worlds which is private for-profit.

All of which I've pointed out and which you've helped in highlighting. Thanks.

I'm not sure what point you're making about conspiracy theories though. Also, your current trend of actually backing up your arguments is most promising.

That is - outside of using sources funded by climate change deniers and tobacco companies of course.


*

https://machinenation.forumakers.com/national-politics-f32/the-fallacy-of-private-health-care-efficiency-t541-200.htm#16951

That OECD link (or an OECD link at least, not sure if I can find the original) is provided below the quote where I mentioned the figures for France. The table concurs with my original points below.

Pax wrote:

seinfeld wrote:

Private patients don't use public beds in France, because France as sufficient private capacity. In fact, France has an abundance of private health care facilities and providers (the mix is about 65% public/35% private).
Patients have access to both public and private providers through the CMU (they get a larger % rebate when they use a public facility) but the system is composed of both public and private providers.

Interesting that you would use this as an example, given your aversion to private medical care.

The only fully public system I know is in Canada, but Canada isn't in the EU, so they have that option.

You are incorrect about France. In fact, according to the OECD et al, it is a complete misconstruing of the French system.

Which means those French figures are incorrect and misleading. Almost 80% of France's total health spending is publicly funded, about 10% is paid for by mutual non-profit insurers (mutuelles) and private insurers, and the remainder is paid for directly by patients.

The majority of the 10% of private sector insurance in France is non-profit - 80%, and these are known as mutuelles and operate on the principle of solidarity. France has never embraced market competition as a public policy strategy for providing health coverage and controlling costs.
Simply because it increases costs as evidenced by the US system and elsewhere.
Also, the the provision of universal health care based on need was one of the aims of the French resistance during WWII.

Private health insurance serves as a complementary function in the French system, private insurance is not purchased to avoid public sector queues or to access a different type or quality of care than what is
available to patients with only public coverage.

Mutuelles operate according to the logic of non-profit organisations in France. In France, the private health insurance for-profits entered in the 80s and are a a minority offering complementary and supplementary (or a duplicate) coverage insurances outside of the universal public coverage.

Unlike in other countries, private insurance in France is not used to jump public sector queues or to obtain access to elite providers.
Rather, it provides reimbursement for co-payments required by the public system and coverage for medical goods and services that are poorly covered by the public system, most notably dental and optical care.

Private complementary health insurance is provided by three types of organisations. Mutuelles represent roughly 60% of the total market.
Non-profit provident institutions and private insurance companies(including both for-profit and non-profit carriers) split the remaining 40%. The three types of organisations operate under distinct regulations as well as different philosophies. Mutuelles emphasise the concept of solidarity, which means premiums and contract provisions tend not to vary with subscriber risk. Private insurance companies make greater use of risk-rating, though less so than is typical in the US.

In total private health insurance contributes approx 10% of the total French spending. The vast majority of health financing in OECD countries is derived from public sources, which account on average for 72% of total health expenditure, compared to 6.3% for private health insurance (only 4% excluding the US) and 19% for out-of-pocket payments. Only in the US does the contribution exceed a third of total health expenditure at 35%.*

The US is the only OECD health system where health financing is predominantly reliant upon voluntary health insurance.

*
see page 40 and 41 below

]LINK ONE

]LINK TWO

LINK THREE

Private Health Insurance in OECD Countries[/url]

from "Health expenditure by source of financing" table on page 41

France's public expenditure on health comes in at 75.8%, via private health insurance 12.7%, via out-of-pocket payments 10.4% and "all other private funds" 1%.

Again going by per-person cost and efficiency of systems, paying directly from tax seems to correlate with lower costs and expenditures per-person. For instance with the UK's system spending 2,546 (PPP$) to the US's 6102 in 2004.

Pax wrote:

*
see page 40 and 41 below

]LINK ONE

]LINK TWO

LINK THREE

Private Health Insurance in OECD Countries[/url]

from "Health expenditure by source of financing" table on page 41

France's public expenditure on health comes in at 75.8%, via private health insurance 12.7%, via out-of-pocket payments 10.4% and "all other private funds" 1%.

Nobody asked you about financing.

I asked you to disclaim my assertion that 20% of in-patient bed capacity in France is provided by the for-profit sector.

You haven't been able to do so.

Why?

Because its true.

Now, if you are not going to engage, that fine.

But you can rest assured that if you seek to argue again on this Forum that the efficiency of public-provided health care is beyond doubt and that the debate is over, I will ask you why the best health system in the world relies on the private for-profit sector to provide 20% of its in-patient bed capacity, which is a higher proportion than in Ireland.

And I will provide the 4 sources that I have provided here to back up the claim.

In fact, I might even start a thread on the subject.

seinfeld wrote:

But you can rest assured that if you seek to argue again on this Forum that the efficiency of public-provided health care is beyond doubt and that the debate is over, I will ask you why the best health system in the world relies on the private for-profit sector to provide 20% of its in-patient bed capacity, which is a higher proportion than in Ireland.

And I will provide the 4 sources that I have provided here to back up the claim.

Meh. And around in circles we go. As I said earlier,

Pax wrote:

Yeah all of those links fail to actually contradict what I originally posted seinfeld* as regards for-profit private healthcare.

Public
not-for profit is the most efficient, private non-profit is less than efficient than that and then that is followed by the worst of all worlds which is private for-profit.

All of which I've pointed out and which you've helped in highlighting. Thanks.

I'm not sure what point you're making about conspiracy theories though.
Also, your current trend of actually backing up your arguments is most promising.

That is - outside of using sources funded by climate change deniers and tobacco companies of course.

*

https://machinenation.forumakers.com/national-politics-f32/the-fallacy-of-private-health-care-efficiency-t541-200.htm#16951

So you know, you've repeatedly failed to address the point about the efficiency or not of for-profit private healthcare. We can all see that. All you did was run away from the discussion and call the evidence an "avalanche of rubbish".

Aragon wrote:

Pax wrote:

seinfeld wrote:

Great.

Another thread drown in an avalanche of rubbish from posters who seem more interested in idealogical chest-thumping than mature discussion.

Is it so hard to understand that discussion involves a little bit more than dumping the contents of your bookmarks folder and your spleen onto a thread and annoucing that the debate is over?

"avalanche of rubbish" Is that what you think you the above is? I'm afraid that's not a rebutal, there, seinfeld.

"idealogical chest-thumping than mature discussion."

What is idealogical about my two previous posts?

Oh and I quoted you here. I see you've failed to respond.

Well said Pax. Im tired of Seinfeld resorting to empty, fact-free insult and sarcastic denigration of factual arguments. He has no answers to what you've said. Intelligent readers will not have failed to notice the strategy.

This thread will be locked for now as it's getting a bit unwieldy. It shouldn't stay locked forever as the topic is very pertinent - is private care more efficient than public as the textbook perception would suggest?

If private care isn't believed to be as efficient as public care at this point in time then perhaps it will go that way in future who know?

It's also getting into territory of this government's colocation programme and as that's off topic for this thread then two new threads were opened on it to discuss the alternatives to co-location and the problems in the HSE.

Remember this is Machine Nation and the HSE is full of machines, systems and processes and perhaps could do with a few more machines or the current machines organised differently? We discuss money and energy here too quite regularly and I wonder if anybody can integrate those topics into a discussion on the HSE? A new LED lightbulb which uses 60% less energy is being developed - wouldn't installing a load of them not help the HSE with their budget? What about imported workers and a more democratic and grassroots HSE? What about mobile phone technology and remote consultation over broadband?

Technology and engineering have done wonders for humankind since the wheel and then the other wheel and then the axle were invented - can it do anything to help our issues in the HSE I wonder?

Closed for the time being.

If you are not a teacher here then you are a learner so please let your posts be simple, gentle, communicative and open-minded if you are in teacher mode because I'm sure you will appreciate it one day when you are in student mode.

Please think of your audience when you are posting here generally - if it's a complicated topic or very involved think of a few things: people who are reading this might have a cursory interest and might want to learn more - does your post content or style hinder or help them? Is your post communicative, clear and a distillation of the best references you can locate on the web, that you can scan in from written material, or link to? Have you indeed backed yourself up with an external reference?

Finally, information is a powerful and revolutionary item and I urge you to make your case clearly and compellingly on this forum in terms of information in digestible quantities using graphs, data, tables, links etc. and where possible offering a summary of your case or point and please remember that your readers may be your students so teach them well. Information properly presented can be the most destructive case against your opponent's position ...

A poster has brought up privatisation of the health services in Ireland on another thread. There have been a number of interventions recently by consultants saying that the government's co-location and privatisation proposals make no sense.

One poing being made was that the consultant contracts would make it very difficult to staff the public and co-located hospitals in any viable fashion as an enormouns increase in consultants would be needed. This would also undermine the important health strategy of having centres of excellence/best practice in which each consultant treated a "critical mass" of cases in his speciality each year, to insure a high level of expertise.

There are also concerns about the viability of the private hospitals without additional public subventions over and above tax write-offs.

Is it time that the medical organisations and unions took the government on on this, before it is too late?