Talk:Socialized medicine

Cost of care section

I've added a paragraph at the front of the cost of care section because the argument as I hear it is mainly about the high cost, low returns, and low population coverage in the U.S. compared to other similar industrialized countries. The rest of the section is a dull discusssion which more or less examines the reasons for this. But not much of it seems to address the topic of the article (i.e. socialized medicine).

Finland

I made 2 changes to the section on Finland. First, neither Finns nor the cited references refer to Finland as having socialized medicine. Second and more importantly, the wording of the 2nd paragraph sounded like 60.8% of Finnish taxes went for health care (when it is actually 6.8% and falling) and then offered a PoV conclusion that Finland was more socialized than other nations.

I went back to the actual wording from the source documents that "the percentage of total health expenditure financed by taxation" is 60.8% (and falling) and removed the PoV conclusion.

Best regards, --UnicornTapestry (talk) 03:29, 10 September 2009 (UTC)

Well no, it would not refer to the term "socialized medicine" because, as the article explains, the term "socialized medicine" is one that is not used in official circles but is generally restricted to those using the term for political purposes in the United States. You have also misunderstood the difference in terminology. The 6.8% figure is the percentage of GDP devoted to health care. It covers all expenditure (private and public) expressed as a percentage of GDP. This figure tells you nothing about the level of government spending and therefore the degree to which health care is paid directly by government. The 60.8% figure is the total of public expenditure from taxation that goes to health care. This definitely puts Finland in the same cluster group as the UK, Spain and Italy, three European countries that share the same model of health care as the strict definition of socialized medicine; i.e. where government is largely responsible for the funding and the delivery of health care services. In Finland it it is the local communities that obtain income from taxation that run all the local community hospitals and community health centers and national government that runs the major teaching hosptials. There are no private hospitals though some private clinics run as part of the occupational health care system financed by employers can do minor surgeries. The volume of these is however, insignificant.

Also you were wrong to say "...that depend more upon taxation as a source of revenue than insurance or out of pocket expenses" because the graph in the source refers not to "insurance or out of pocket expenses" but "percentage of total health expenditure from social health insurance". Social insurance is compulsory insurance (usually related to income) that goes to non-profit sickness funds established by or regulated by government) to direct legally sequestered funding from employers and employees (and in France by those living on private wealth) into health care. The money from these funds does not pass thru government hands and therefore the cluster A represents the least socialized from the point of view of government actually receiving health care funds and delivering care. That is the meaning of the clusters A B and C.

So for this reason I will undo the last of your two edits. If you are still unclear why, please discuss this here.--Hauskalainen (talk) 10:34, 10 September 2009 (UTC)

P.S. That the percentage of GDP fell (over the years in the table) was due to the recovery from the terrible slump in GDP during the early 1990s that Finland suffered because of the collapse in trade with its neighbor and trading partner Russia following the collapse of the Soviet Union. As GDP rose faster than the rise in health care spending, the percent of GDP spent on health care naturally fell. --Hauskalainen (talk) 10:34, 10 September 2009 (UTC)

Actually, I completely understand the difference in terminology– it was the wiki article that wasn't clear. I carefully read (and reread) both PDF documents to understand how the article combined the references. As written, the article sounds like 60.8% of taxes goes to health care, which it does not, which is why I lifted half a sentence intact to clarify. Having been an economics instructor, these 'little things' are crucial to understanding. While I wouldn't object to removing the out-of-pocket verbiage (which I used from the other PDF), without the other changes I made, a false impression is created.

The majority of health care facilities are community owned, like a large proportion of hospitals in the US. Much of Finland is remote and rural, making a free market hospital impractical (and unprofitable) in many regions. Finns, who are very sensitive about proximity to the former USSR and history with Russia, take great offense in attempts to ally the Finn medical model with Russia rather than with, say, the US, which makes parts of this section sound like it's written by an American who's never set foot in Finland. Part of my problem is the pejorative terms used, such as loaded POV words 'compulsory' and 'socialized'. FICA in the US is compulsory, but Americans call our models 'compulsory' and 'socialized' but not their own.

Be that as it may, the first sentence of the 2nd paragraph (if I remember correctly) is the most troublesome. Without extended debate, I suggest we use the phrase from the actual article. I further suggest we consider ideas how to make other parts less POV. It worth noting that Finn satisfaction with health service approaches 90%. I'm not sure what the number is in the US, but it is certainly greater than most other EC nations and especially Russia.

Best regards, --UnicornTapestry (talk) 21:01, 10 September 2009 (UTC)

I haven't seen a response about removing the politically loaded words and using the precise wording in the source documents instead of the present muddled wording. Thank you.

--UnicornTapestry (talk) 17:53, 11 September 2009 (UTC)

I have used the precise wording from the PDFs to remove the mistaken implication that 61% of taxes goes toward health care. In a spirit of compromise, I have left 'compulsory insurance' in place, although it could be argued it is used in a pejorative sense sine American FICA is not described as 'compulsory'.

--UnicornTapestry (talk) 06:48, 13 September 2009 (UTC)

Actually there is something deeply wrong with this paragraph because accordng to more recent OECD data Finland sits between Germany and France in the propotion of public funding. See http://www.oecd.org/dataoecd/52/33/38976604.pdf. It may be because tthe original source quoted is now 10 years out of date or it may be that the WHO regards both direct taxation and compulsory earnings related social insurance contributions as a form of taxation in the reference I just gave. If I get time I will try to figure this out. In the meantime, given the apparent conflict, I may adjust the text slightly.

Pretty good job! --UnicornTapestry (talk) 19:10, 13 September 2009 (UTC)

Why is it rationing if the NHS restricts coverage but not when a private insurer does it?

(section originally titled "Deletion of silly citation requests ") to reflect the more important issue on the "name calling" of coverage restrictions which emerged

Someone had added a request for citation about sevices which are available on the NHS which are not available from private insurers. I have given a reference from the ABI regarding private insurers positions in the UK about not covering treatments like cosmetic surgery, organ transplants, dialysis, pregnancy etc. If you seriously believe that these services are not available from the NHS then I am not sure what all those organ transplant specialists, midwives and delivery suites are doing in NHS hospitals. If you like, you can go to the nhs web site at www.nhs.uk and follow the Health A-Z link. I seriously do not think that it necessary to show that most of these services which private insurers exclude are provided by the NHS. The ABI statement makes it clear that the NHS provides these services. And as the article already shows, health care in the UK is free at the point of use (except in a few circumstances like some dental treatments for some people, and small drug co-pays for some people).--Hauskalainen (talk) 15:20, 10 September 2009 (UTC)

You know better than this Hauskalainen. What you are adding here is quite clearly original synthesis. It wouldn't make the slightest difference if you were to provide addition cites to what the NHS provides. If you are going to insert an argument about what the NHS provides in comparison with what insurers provide then you need a reliable source that has already done this. You cannot make a comparison out of combining separate cites. Nor can you provide your own analysis of why this situation occurs. You need a reliable source that has already done this.

More specifically;

• You have an uncited and emotive statement about "enraged" persons, but provide no proof of any. Cites shouldn't be hard to get here.
• You describe allegations as "galling", hardly a neutral description, without any cite to describe them thus.
• You boldly state "it is private health insurers that are much more likely to ration care (in the sense of not covering services) than the NHS" - but have no cite to demonstrate this other than your following synthesis,
• You say "Insurers do not cover these because they feel that they do not need to since the NHS already provides coverage and to provide the choice of a private provider would make the insurance prohibitively expensive." You need a reliable cite that states Insurers' supposed reasoning here. All you cite is a list of what they don't provide, the explanations as to why simply do not appear in the cited pdf. So how do you know this is the case?
• Then you round it off with the conclusion Thus in the UK there is cost shifting from the private sector to the public sector, which again is the opposite to the allegation of cost shifting in the U.S. from public providers such as Medicare and Medicaid onto the private sector. - whose conclusion is this? Why is it not cited from a reliable source?

I'm afraid that it all looks like your own personal conclusions based on the few cites you do supply. That's as good a definition of original synthesis as you're ever likely to get. --Escape Orbit ^(Talk) 17:21, 10 September 2009 (UTC)

There is no problem of misinterpretation. Clearly the ABI says these service are excluded are from private insurers list of covered items and the same reference also says why.

"PMI isn’t designed to cover the long-term treatment of chronic conditions for a number of reasons.

• The private-hospital sector’s main purpose is to treat conditions that can be cured, or mostly cured, quickly.
• A large part of the NHS’s funding is to care for patients with long-term conditions. So, for example, patients with diabetes can go to clinics, be regularly monitored and have their insulin needs met. This will often happen locally, in a primary-care setting such as their GP surgery. As well as the practical reasons mentioned before, insurers also have to balance how much cover they provide with what you are willing to pay for that cover. So, insurers don’t cover the treatment of long-term (chronic) conditions. This is because their premiums would become too expensive for most people." (Page 10 of the ABI guide)

Insurers in the UK do not want to and providers are not set up to care for long term chronic issues and they leave people to get care in the NHS. The reason why the private sector existed was to enable people to have a choice and to jump the queues that used to exist for elective surgery. That is presumably why childbirth is not there. The NHS does not queue women in labor! Surely, the insurers are cost shifting the cost of childbirth (and dialysis for that matter and other things besides) onto the NHS because they deny this coverage to their customers. Its cost shifting of the highest order!

Now, no British journalistic or academic source would ever have to inform the public or his readership that you get a wider range of services from the NHS because everyone knows this. Your argument is saying that if I can show that there are no emergency room services in UK private hospitals and that private insurance will not even pay the cost incurred of treatment in an NHS hospital (which they will not) and that the NHS treats annually around 18 million people (which it does), this would still not satisfy you because some other person has not made the same observation. Your argument that this would be WP:SYNTH and therefore inadmissable is totally laugable! Take your argument to the WP:SYN noticeboard! I can get references for the NHS providing most of the services excluded by the private insurers but the effect is just that it is going to clog up the references list unneccessarily.

I will get you a reference for enraged (or whatever similar adjective many have been used by the British media). As you say, I am sure it will be easy to find.--Hauskalainen (talk) 20:48, 10 September 2009 (UTC)

Whether my argument is laughable or not, you are still indulging in original synthesis. Makes no difference if "everyone knows this" or not. If the situation is as you claim, and is significant enough for the article, it will, inevitably, have been discussed elsewhere. If it hasn't, then either your analysis is flawed, or not notable. Either way, it shouldn't be there.

It is also a flawed argument to equate health insurance with the private sector. One is only part of the other. No-one offers insurance against pregnancy because, logically, it is not an unforeseen medical condition that you insure against. But that doesn't mean that births don't happen in private hospitals. Your definition of health insurance excluding certain conditions as being "rationing" is also dubious. If you had a cite describing it such there'd be no problem, but as the paragraph is largely uncited, it has to be questioned.

Your concluding sentence remains uncited. You have no source where this conclusion is made. --Escape Orbit ^(Talk) 20:10, 10 September 2009 (UTC)

Why is denial of coverage "rationing" if it happens in the public sector, but not if it happens in the private sector? I fail to understand that logic entirely! Do you have a WP;RS dor that ;) ? As for childbirth there are very very few private hospitals catering for this. See http://www.privatehealth.co.uk/private-healthcare-services/private-maternity-services/private-maternity-hospitals/ The difference in cost (I am guessing but it must be in the region of 8-15k pounds -about 15-25k US dollars- compared to a free delivery in an NHS hospital) would mean you would have to be fabulously rich for the cost not to be a concern. Take your argument about about WP:SYN to the relevant noticeboard if you are concerned about it.--Hauskalainen (talk) 20:48, 10 September 2009 (UTC)

If McDonalds decline to sell you alcohol, are they "rationing" alcohol, or simply not interested in entering that market? Healthcare insurers, for their own reasons, are not interested in certain areas of healthcare provision. They are not preventing anyone else having access to it, and they are not preventing anyone else providing it. They are not 'rationing' it in anything like the way discussed in the rest of the article, and calling it so is misleading. --Escape Orbit ^(Talk) 21:07, 10 September 2009 (UTC)

Another silly comment because nobody expects to get alcohol from McDonalds. They do expect to get health care costs covered by their health care insurer! A coverage restriction is a way to cut expenditures. Given that issues like diabetes and high blood pressure and COPD and arthritis are all major chronic ilnesses and there are normal expected lifetime health care needs during pregnancy / family planning/ terminal care, one might expect one's insurer to cover these items. Well the NHS does and the fact is the private insurers do not. That means that their non-entry is worse than a form of rationing, its a denial of choice. Thank God for the NHS!

"Not entering the market" is merely a euphamism for passing the costs of expensive care onto the taxpayer. It really is rationing (because it is saying "we are not paying for that - go find someone else who will or pay it yourself) and a form of coat ahifting. When the NHS refused to pay for a drug against Alzheimers it pointed out that other treatments (social interaction and mental exercises) were very much cheaper and more effective. (The NHS and local social services offices run day centers for older people where they can get stimulation to stave off mental decline). It does not abandon people but uses best available knowledge to treat people. Passing the medical care buck is what the British insurers do, as did the American insurance industry in the 1960s with the passing of Medicaid, and more recently in the Part D extension, pushing costs onto the government. Given that most people have the highest health care expenditures in the last years of life, its amazing how well Medicare does against the private insurers because it is not consuming 80% of health care costs as one might expect.

"What I'd like to know is that Britain and America have roughly the same number of doctors and nurses and hospital beds per head of population and the Brits cover all their Citizens (irrespective of their age and health status) whereas the Americans cover only 85%. And yet U.S. health care costs per head are four times higher than they are in Britain. Four times!! Nobody getting service from the NHS receives any medical bills. Salaries are the biggest single cost in the UK health service and yet nurses and doctors salaries are not receiving 4 times higher salaries in the U.S. than their counterparts in the UK. I think that someone seriously needs to follow the money and most of it, I suspect, is found to be wasted in the insurance industry. This creates a whole layer of bureacracy (marketing, selling, underwriting, funding, tracking, reconciliation, claims scrutiny) most of which is entirely absent in many other countries' systems. And that's before you get to those obscene executive salaries. Someone surely has done the research, but I have yet to find it. Does anyone know of any?--Hauskalainen (talk) 21:02, 11 September 2009 (UTC)

You cannot 'ration' a commodity unless you control a monopoly on it. Simple as that. A UK health care insurer cannot "ration" healthcare because they are not anywhere near a monopoly position. People are free and able to obtain their heathcare elsewhere. Insurers simply do not provide certain care because there's no profit to be made in it. That is not rationing.

I'm not going to respond to the rest of what you say, as this is not a discussion forum. The fact you are still thrashing around looking for cites is indication enough that what you have added is your own synthesis that you have been unable to source anywhere. --Escape Orbit ^(Talk) 22:08, 11 September 2009 (UTC)

But the NHS is not a monopoly supplier. Price level rationing assumes a free market so rationing per se does not need a monopoly. I agree that people can get their health care elsewhere in the UK. There are no practice restrictions and there are plenty of private clinics, hospitals and doctors. If you want to get coverage for NICE excluded drugs for example you can indeed buy it. But if the NHS sets a coverage limit it gets labeled as rationing. If an insurer does it is not. That remains a fact. A weird one to be sure, but a fact nevertheless. The only difference as I see it is that you cite the profit motive as the driver in the actions of private insurers denying coverage. Profit is not a word that exists in the NHS lexicon. Equity is. --Hauskalainen (talk) 00:17, 12 September 2009 (UTC)

Get a room already you two. Since the precedent has already been set that this is a health care debate forum, I will add my two cents.

If health care rationing occurs at all, it occurs not only by single-payer or publicly funded health care systems but also by private health insurance companies. Information about anything is added on this encyclopedia because people have done research on something that they already have a feeling that it is happening or has happened. You know, I know, my dog knows that rationing--or whatever liberal v. conservative term you want to use--happens. It happens in the United Kingdom and it certainly happens in the United States. There was a comment above that stated something to the effect of "it's not rationing when private insurance companies do it, they're just trying to make a profit." Newsflash, that's called rationing....it occurs because the cost of an operation or a doctor's visit is so high that it is a liability to the company and so it must be prevented. In America, where I live, I've known countless people who were either or both outright denied health care coverage or were denied certain procedures. Some have died. I would hate to attack the ego of a conservative by calling it rationing, but it is nothing else. It's capitalist health care.

Because health care rationing is a reality in both public and private health care systems, whether one or two of you believe so or not, it would behoove one or both of you to do the necessary research and fact-finding to uncover documentation, whether it be studies or news articles. The gentlelady or gentlemen who brought the topic up might, in my opinion, have been far more successful in this debate had he or she come prepared with citations.

On a side note, I will give it 72 hours before someone tells me here on this page that rationing in private health care systems doesn't exist. GnarlyLikeWhoa (talk) 04:22, 4 February 2010 (UTC)

Haiti

For those interested in furthering the article, I read a news article not long ago (which I can no longer locate) that discussed Haiti's medical system. Apparently Haiti had a devilishly awful HIV infection rate, a factor greater than Western nations who predicted disaster for the island nation. If I recall the article correctly, government medical programs took the matter in hand, provided the HIV cocktails at cost, and now has a mortality rate a fraction (1/15 I think was the number) that of the US. My specifics may be faulty, but not the substance of the article.

Good luck, --UnicornTapestry (talk) 11:56, 21 September 2009 (UTC)

Spelling homoginization

It seems appropriate that the spelling should be standardized in this article, rather than switching from American to British back to American spellings (e.g. socialised, socialized).

It may seem appropriate to standardize the spelling, but keep in mind that not every user knows that a word might be spelled differently by other users of English. Steggall 17:05, 21 Nov 2009 (UTC)

The majority of "ises" in British English can be spelled "izes". If fact the OED preferes the latter. Using the "s" variant in British English is a phenomenon of the last half century and its ubiquitous use has led many to wrongly identify "izes" as American English. To answer your point there should be consistency in any article. Dainamo (talk) 18:39, 3 January 2010 (UTC)

Re: Citations needed, section 4.8 (United States)

I don't feel competent to add the necessary tags to refer to the poll that was conducted, but a PDF of the poll report is available at www.hsph.harvard.edu/news/press-releases/files/Topline__Socialized_Med_Havard_Harris.pdf

It's not well formatted and contains only brief summary stats but hopefully it will address the "citation needed" requirements.

There's a link to the PDF on the page containing the press release (which is already a reference attached to the article). This may have been added at a later date. HTH, AncientBrit (talk) 16:04, 25 March 2010 (UTC)

Debate: Political controversies in the United States

too many opinion pieces are cited.

I have added the {{Debate}} tag to this section. As I read it, it sounded like a point-counterpoint debate to push the POV of one side of the controversy. Both sides are represented fairly in the quantitative sense, but there is a very obvious bias in the resolution of the discussion. Comments are invited. Sabin4232 (talk) 03:39, 5 May 2010 (UTC)

It seems that someone decided to delete properly-linked relevant information that I have added. The text was:

The strongest objection lies within the US Constitution, which only gives certain enumerated powers to the Federal Government, none of which include dealing with health care. Opponents of socialized medicine who object on these grounds suggest that such a system may be viable (and legal) on the State or Local levels of government, but not at the federal level.

Did I write something wrong here? I will hold off reverting (or re-adding) until I get some consensus (or lack of an answer at all). Thanks! Sabin4232 (talk) 08:24, 26 May 2010 (UTC)

As the ediitor who reverted, let me help you here. In addition to the text you mention above, you also wrote "The debate has been undermined by the Progressive subparty, currently embedded within both of the major parties to carry out its agenda, which includes a fully-socialized system such as the United Kingdom's NHS."

1. You gave no references for the claim that there is a "progressive sub-party" nor
2. That it wants to create a fully socialized system as the United Kingdom's NHS". That is opinion but unless you tell us whose it is then we shall have to assume it is yours (which, unless you can claim to be a WP:RS we have to ignore.
3. As to the other text, the "strongest objection" is also opinion. And
4. as for the legislation passed this year the best you can say is that the Adminstration believes it is constitutional and some state officials believe it is not. Until it has been tested in the courts this remains to be opinion.

The fact that you have added wikilinks is irrelevant. Your text expresses opinion, is one sided, and totally lacking any references.--Hauskalainen (talk) 02:00, 27 May 2010 (UTC)