The Life of Brian

I'd say it does matter who is doing it. If it's people casually walking across an unguarded border armed with AK-47s and shooting up American villages then it makes sense to build a wall. If it's people who have come through a tunnel or flown with a coyote the wall won't help.

The only question is whether the cost is worth the benefit and whether the people who really need to be kept out will actually be kept out.

Part of the problem with the whole concept of health insurance is that most of it is actually not insurance at all. The point of insurance is the transfer of risk - I don't want to deal with the costs of buying a new car if a tree falls on my car, so I transfer the risk to someone else. In the process they take some money from me and in exchange they cover the costs if the risk event occurs. The risk event, as the name suggests, is an event that isn't expected but is possible.

When health "insurance" starts to cover the cost of routine doctor's visits or routine prescriptions it is inevitable that the cost will rise sharply. This would be akin to expecting my car insurance to pay out when it was time for my annual inspection, when I needed new tires or when I had to fill up with gas. If motor insurance companies suddenly found themselves liable for the cost of routine servicing and consumables you can be sure the cost of insuring a car would spiral out of control. Likewise the whole concept of people with pre-existing conditions is absurd - the whole concept of insurance means that a pre-existing condition cannot be covered because the risk event has already occurred. In this regard it would be like getting home to find your house was a smouldering pile of ash but not worrying about it because you could still take out fire insurance in case your house burned down.

Another major element is the way insurance companies drive costs upwards. I still remember some years ago needing a prescription when I was visiting the US. The cost of it was going to be something like $75 but as soon as I mentioned the magic phrase "I'm paying cash" the pharmacist went back to her terminal, tapped a few keys, and returned with a request for more like $35. It's hard to conclude anything other than that dealing with insurance companies increases the price by more than 100%, which in turn makes everything less affordable for people who struggle to afford insurance.

In England where they have the NHS, it's very much a mixed blessing. It is good to know that if I'm ever scraped up off the road the first question is how to put me back together again rather than who is paying for me to be put back together again, and it's good to know that if I go to the doctor with a recurrent headache that turns out to be brain cancer I'm not going to end up wheeled straight to the cardiac ward when I see the final bill for my treatment. The downside is that the NHS is riddled with inefficiency and ineptitude that you'd struggle to believe unless you saw it first hand and anecdotal evidence abounds of people living in extreme pain because their appointment with the specialist isn't for another three months.

The fundamental problem is that if everything is managed centrally and paid for centrally people abuse the system. If you pay nothing for prescriptions (as is the case for a number of groups of people in England) then if you've got a headache you can always go to the doctor and get a prescription for aspirin, which is cheaper than going to the pharmacy and buying it. It wastes the doctor's time, it takes up an appointment that could have been used for someone who really needed it but hey, you got your free aspirin. On the other hand if things are funded individually it's too bad if you're the one who gets the brain tumor that costs six figures a year to treat. It's like the saying that under capitalism man exploits man and communism is the same but the other way around.

In an ideal world I'd like to see a system whereby people paid their own way (with options for companies to offer health maintenance plans) for their day-to-day medical needs, with some form of centrally provided insurance for the things that are life-threatening and ruinously expensive to treat. It would mean people wouldn't die simply because they couldn't afford to see the doctor but would encourage them to think twice before they took something to the doctor. Using the example above, if you go to the doctor with a headache and the conclusion is that you need to take an aspirin and lie down the doctor will give you a bill; if the headache turns out to be brain cancer you aren't financially destroyed by the bill.

 

De rien!

 

Yeah, it's been brought up already that something like the Canadian medical system is fairly lean when it comes to actual cost per capita (I recall something like close to half of the US), but it comes with the price of increased wait times for diagnostics in particular. When overall health outcomes are compared, there is very little difference between Canada and the US. I like the safety net that my family will not be bankrupted in a catastrophic health crisis, but it would be nice to have quicker access to certain care.

Now that we are living in a smaller northern BC town, a lot of folks are routinely flown down to Vancouver because we lack the specialists and surgeons. A CT/MRI scanner is 4 hours drive away. But some of that is logistics and the fact that there is not the population to justify scanning clinics.

 

How about fish? D'ya like fish?

 

Voulez-vous de beurre?

 

Of course. It's often hard to directly compare taxation. For example, yes we probably pay more income tax for a particular income level, but how much do you pay in insurance premiums? Is it the same/less/more than the amount that comes out of portion of taxes? I honestly don't know that answer.
Most Canadians are generally satisfied with their health coverage. Many employers offer extended benefits (from for-profit insurance companies) for things like dental (not covered nationally), physiotherapy, and other non-covered therapies. Workers are also covered through an additional government insurance (we call it WorkSafeBC here) that will assist workers who are injured on the job.
The biggest issues lie in wait for diagnostic services (MRI in particular) and ER wait times which can be very bad.

 

It's also worth considering the general state of the countries and the political stance they take.

Italy is one of the so-called PIIGS nations that threatened to drive the EU to collapse because of the issues with their economies. It's easy to hand stuff out like candy if you're doing it by borrowing money, until the day of reckoning comes and you have to pay the money back. Then comes the austerity, the riots, the changing of government to one that promises freebies to all and sundry until the nation is bankrupted and the austerity returns with a vengeance.

I don't know a lot about the French system but from what I understand the French are very hot on using the French language in just about every sphere of public life. Whereas many countries will spend endless public funds on translators and interpreters, my understanding is that in France they say that French is their language and if you don't speak French you need to hire someone who does. Whether the political will exists in the US to not translate every single thing into Spanish and any other language someone says they need, at public expense, is debatable. It does seem rather bizarre that someone who does not speak our language can come to the country and demand everything be translated into their language at no cost to them.

 

In England the government decided to introduce performance metrics to figure out which hospitals were doing better. Sadly as just about any management person knows, the things that improve are the things that are measured and all sorts of related metrics that don't get measured fall by the wayside.

So, for example, when the government decided nobody should wait more than four hours to be seen in the ER the hospitals that struggled to meet the target had a simple solution - when an ambulance arrived the patients would be left in the ambulance until they could be seen within the next four hours. They hadn't officially arrived in the ER until the ambulance unloaded them, so the performance metrics were met. The ambulance was tied up until the patient could be unloaded, which was too bad if you needed an ambulance while the hospital sorted itself out, but the targets were met. Targets set to discourage "bed-blocking" were rumored to result in patients being sent home before they were ready, thereby meeting the government targets. If they were subsequently readmitted due to complications (which were avoidable, given they could have stayed in hospital a little longer) that counted as a new admission and didn't affect the targets.

The hospital closest to where I lived was one of the worst in the country for hospital acquired infections, MRSA in particular. A relative of mine suffered severe complications due to contracting MRSA while in hospital, and a friend's father died of an infection he acquired in hospital. Given what passes for a cleaning regime in some hospitals it's not surprising.

 

Very nicely placed!

Ou est Philippe?
A la picine.
Avec qui?
Avec Anne.

 

Scandalous

 

I have no idea what they're talking about, either. But something's going on between Philippe and Anne, and it involves some butter, and a pool, so we can only guess :hmm:

 

What show? I'm so lost here I didn't even realize a show was in this thread.