The scary left

“As citizens we should all use the same health care system. Poor and rich should have access to the same health care services from teh same providers … the well-off and the poor should not have separate providers … All should share the one, high quality system.”

This is a very scary mentality. The authors of the above (McAuley and Menadue, quoted by Buckmaster) want to enforce total equality when it comes to health services. Note that their prioerity is not to improve health, but simply to make sure that it is always equal.

Enforced equality is so important to them, they repeat it four times in the same paragraph.

The above position is not simply an argument for government intervention in the health industry. And it is not an argument for improving the health care for poor people. Both of these are common and reasonable suggestions.

It goes far beyond that, and calls for the government to actually ban the purchase of extra health cover. The authoritarian policy suggestion of McAuley and Menadue would limit the amount of health cover that a person could buy to the government-approved level, with obvious negative consequences to health outcomes.

This policy cannot be defended on the basis of concern for poor people. The only defence for this policy is that the proponents simply want to hurt richer people and prevent them from buying extra health services. And the likely long run consequence would be worse health care for everybody.

Mostly when I disagree with people on the left I can sympathise with their goal, but disagree about their approach. In this instance though I think the thought process is offensive and dangerous.

34 thoughts on “The scary left

  1. It’s worth looking at the performance of the modern (and heavily taxpayer-subsidized) health insurance industry versus the older model of friendly societies (the latter typically paying out more than they took in subscriptions by wise investment of the capital).

    If you go through the annual reports of the health insurers (and they are tricky to track down on the web, I cannot find any more recent than FY06/07), you find that the modern insurers pay out much less than they collect – indeed, the difference is fairly close to the subsidy provided by government (saying quite a bit about the funds management skills of the insurers). Overall, group self-insurance looks to be the sensible way to go through a nationalized system to smooth things out statistically.

    Now if richer people want to pay more for more health services, that’s fine – unless they are swapping resource allocation away from more essential health services. An example might be the availability of orthopaedic services that can be directed either to getting people walking again, or fast-tracking repairs that allow the wealthier people to play competitive sport again).

    Just imagine the outcry if there was government subsidies for 30% of house insurance! I wouldn’t mind it the insurance was to ensure people got a roof over their heads quickly, but would object if the government funds were used to repair swimming pools. It’s not that silly an analogy if you see some of offerings by the insurers – non-functional things like fashion spectacles. Hmmm. Government subsidized high-fashion. I wonder how small-government idealists feel about that?

    So, lets assume that the government is continuing to subsidize the health insurers (not that true libertarians are in favor of corporate welfare): how do we ensure that the government funds are not being redistributed to luxury goods rather than for merely functional services?

    Has anyone done a study that compares regimes achieving a reasonable figure for mortality and morbidity (e.g. life expectancy about 75 seems fair), and comparing these to the dollars allocated to the health system? If the idea is to maximize the efficiency of delivery of health services to a population, then I say find the most cost-efficient nation (again, providing an acceptable minimum service level) and copy it as world’s best practice.

  2. Forgot to mention: I need quite expensive investigations and specialist services (private specialists, not through public hospitals) every few years for chronic illness. I’m glad I’ve self-insured – though I’m not wealthy at all – because even the subsidized premium for basic cover would have been much greater (about 25%) than my out-of-pocket expenses.

    And I’m a moderately scary lefty.

  3. They can’t stop it though, try as they might in their quest to endure everyone has a chance of dying equally.

    Medical tourism numbers are rising by a material factor around the world, so the idea of putting people in lines is not going to stop them from finding treatment when they want it. Of course they can try to stop traveling but I find they’ll find that hard to do.

  4. I’ve just returned to Australia from 2 years in Alberta, Canada, where everybody is covered by the same health system, rich or poor, and it is illegal to buy extra cover. In Calgary, there are many medical conditions which if your dog suffers from, he can be see the same day (in a private veterinary practice), but if a human suffers from the same condition, he must join a waiting list many months long. A friend suffered a serious accident while I was over there, the waiting list for the MRI he needed was over 12 months (the injuries were non-life threatening but enough to seriously reduce quality of life). He flew back to Australia, saw a surgeon the day after he landed, and had surgery within a week. The surgeon expressed some concern about scar tissue making his recovery more complex, this was about 3 weeks after the accident – how much worse would it have been if he’d waited 12 months for an MRI, then some further period waiting for the operation?
    My friend was lucky to be an Australian with private insurance over here, however there are plenty of people over there who face the stark choice between waiting for the Canadian health system to get round to looking after them, or crossing the border & getting operations done in the US, which they have to pay full price for, as their law forbids them from buying private insurance. Import this system here? No thanks.

  5. Having moved here from Britain this sounds like someone intends to copy the UK’s National Health Service, and having been on the receiving end of what the NHS laughingly described as treatment I’d like to say a few words to the people of my adopted country:

    Don’t. Fucking. Do. It.

    Seriously, and with apologies for the f-bomb, just don’t. Health provision here may not be perfect, but where is? This is certainly not going to help and if you ask me is likely to prove a massive step backwards. Sorry for the length of this comment but let me describe my NHS experience to give you an idea of what an “it’s there for everyone, free at the point of delivery, one size fits no-one” system of socialized medicine is like.

    I needed a minor op to drain an abscess, and since it was getting infected I was admitted in the afternoon as an acute case. The op was done that evening and I was told I’d be in for a few days. So far, so good. They took their time wheeling me back to the ward because my blod pressure was a bit low and they wanted to get some extra fluid dripped into me before then. Fair enough, though they said I’d be peeing for Britain all night long. Early the next day someone came to change the bedding and put the sheets on my feet. I was still half off my face from a combination of poor sleep and morphine and accidentally kicked it onto the floor. The staff member picked it up and put it on one side. I stumbled off to the lavvy, which had someone’s blood on the seat, to deal with the last of the previous night’s extra fluid and wake myself up with some water on the face, and when I got back apologized for making them go and get another set of bedding because of my clumsiness. Yeah, you guessed it, they didn’t bother and just used the bedding the stoned patient had kicked on to the floor. A floor, incidentally, on which I’d left a blood stained piece of dressing on my trip to or from the bog. And there it stayed for the next hour and a half before I called a nurse and asked if it might be an idea if someone got rid of it. Nobody cleaned the area of floor where it had been because the cleaners had already been around, so it wasn’t to be done again till the next day. I had regular BP checks by some patronizing woman who kept saying that it was fine even though the damn machine was next to me and I could see that the reading was still on the low side (I’d had a medical a few months earlier for work and remembered what normal was supposed to be), though being treated like I was either 15 years younger, 50 years older or simply retarded may have just been an unorthodox treatment to get my blood pressure back up again. I had a very boring afternoon because I hadn’t been able to shell out the cost (hugely overpriced having been, like the car parks, subbed out to a private contractor) of the card for my bedside phone and internet via the TV due to my quick admission the previous day, and couldn’t have used the internet anyway as the TV was bust. Nor did I feel like going to the hospital bookshop and since they had a huge theft problem I’d given my wallet and mobile phone to my wife on the advice of the doctor who’d admitted me the previous day. It was a very hungry afternoon as well because the incompetent clowns forgot to feed me, and I assumed they were just being cautious because I’d been under general anaesthetic for the op. No, it was just the good old British cock up at work, so I got an apology and a plate of stone cold beef and potatoes in what might have been congealed gravy. Given what else it might have been in a hospital and how tasteless and rubbery it was anyway I decided being hungry was actually the better option. The good news was that my blood pressure must have been fine now, though in hindsight I think they probably overdid it. So did the guy in the next bed who kindly lent me his phone card so I could call my wife. I told her what had been going on and to please come and get me the hell out of there, at the point of a twelve bore if necessary, before I either cracked or croaked. The suggestion that I was going to leave didn’t go down well with the BP monitor woman, who said it was supposed to be a 2.5-3 day stay so I shouldn’t go until sometime the next day, and that in any case I wouldn’t be allowed home – yes, that was the phrase used – allowed home until I’d moved my bowels. Not wishing to argue post operative care I checked the toilet again, only to find there was even more blood on the seat than earlier. I went back and told her that if she thought I was going to drop my arse in a khazi that was slick with someone else’s blood while I still had an open wound from my operation then she was a mad as a box of frogs and should get herself to the pharmacy PDQ for some lithium or something. Shortly afterwards my wife turned up with a banana she’d managed to get by shouting at someone. I wasn’t sure whether to eat it or use it to poke the BP monitor woman in the eye with, but since she’d wandered away I settled for eating it, getting dressed and doing a runner hobbler, telling only the main reception that I’d left the ward and was going home to crap in a clean bathroom.

    Bad luck, you might think. Maybe, but maybe good luck. My dad got food poisoning in hospital (soooo glad I left that dodgy looking gravy) and thousands, perhaps as many as ten thousand, die in British hospitals every year from secondary infections they pick up while they’re there. Compared to going down with C. Difficile or MRSA (as happened to a client’s son who’d gone into the same hospital for the same op) being treated like a moron and not being fed wasn’t so bad. We must also remember that among other things Britain’s NHS – the envy of the world according to politicians, especially Labour politicians – has long waits for many treatments, regularly rations treatment according to where patients live and has one of the poorest cancer survival rates in Europe. And that’s despite employing over 1.3 million people – approaching the population of South Australia, though famously the NHS employs more admin and clerical staff than it has beds for patients – and enjoying the lion’s share of Britain’s enormous (something like 45% of GDP) public sector spending. Think Britain’s nuclear deterrent sounds expensive? Or the fleet of nuclear powered submarines, both missile launchers and hunters, that goes with it? Nope, it’s cheap by comparison with the NHS. The replacement for the Trident nuclear weapon system was provisionally estimated at Β£20 billion, and even allowing for a cost blow out of 25% that’s still less than the increase – the increase – in annual NHS spending proposed a year ago by the opposition Conservatives after they got suckered into a spending competition with Labour. Compared to that lot a fleet of nuclear submarines looks like a bargain, on top of which it kills far fewer people. So in Britain most people who can afford it prefer to go private, and many will go so far as to get on a plane and have elective surgery done abroad. An elderly relative tells me that India is a popular destination for Britons wanting their cataracts fixed, and she was seriously thinking about it herself until an appointment to see an eye specialist in the UK came up. I don’t want you to think that has racist undertones because it’s nothing to do with colour or India being usually considered a developing nation. It’s simply an observation that more than a few British people prefer nine hours on a plane, quite possibly with Slumdog Millionaire as the in flight movie, to get their eyes operated on in an Indian hospital to having it done on the health service for which they’ve already paid for through their taxes and which, they’re constantly told by their government, is supposedly the envy of the world. With what I experienced I’d agree with them 100%. You might be wondering why they don’t simply pay the difference between the cost of treatments to the NHS and at a private hospital and have them done privately? Or even to pay up front and get reimbursed later similar to the way I now pay $50 to see my doctor and then get about $33 back from Medicare? Well, it’s because that’s not allowed in Britain. It’s not equal you see. Can’t have “two tier” health provision, say the politicians, though if wealthier Britons with health insurance or simply leaving the country and paying for treatment abroad doesn’t qualify as “two tier” I don’t know what does. But for those who can’t afford that, and whose local NHS trust can’t or won’t give them the best treatment, the pig headed, bloody minded, stubborn refusal to allow patients to buy “top up” treatment can be as good as a death sentence.

    So don’t do it, Australia. Please, just don’t.

  6. Incidentally, I forgot to mention something about that op I had, the one that was supposed to be a three day stay before I was able to get my wife along and discharged myself. My best mate here in Melbourne has been in for the same thing – he was in first thing in the morning and out again early in the afternoon, and while he’d have been happy to wait and have it done on Medicare it was a busy year for him for various reasons, and being able to pay to have it done right away made life much easier for him. When he told me that I saw that Australia has a lot more going for it than better weather and wished I’d made the move years ago.

  7. “When they start talking about the gap, you know that they would rather the poor were poorer as long as the rich were less rich.”
    -Slightly paraphrased Margaret Thatcher

  8. I agree with John. The thought process in the quote from McAuley and Menadue is sick (no pun intended).

    I also agree with Dave Bath (shock horror). Private health insurance should not be subsidised. Private health insurance is mostly a scam. I would ditch it in a heartbeat if not for the governments coercisions and incentives. Far from pooling risks (like happens when you insure your house against fire) it is mostly about glorified saving schemes with lots of the saving skimmed off for the insurance company. Banks are a heck of a lot better for saving.

    What we ought to move towards (and then perhaps beyond) is a reform of Medicare so that each year we get a statement from the Medicare people outlining the services we have used for the year and the government outlay involved. This amount should then increase our HECS liability by a comparable amount (even if we currently have no HECS liablity). This would then allow the government to shave up to 8 percentage points of the regular income tax rates and increase the repayment rate on HECS debts without leaving anybody significantly out of pocket.

    I would then self insure for 99% of ailments and take out an extremely cheap policy to cover the unlikely medical events that will cost you more than a years income. In other words I would not flash my medicare card at the doctor but would put it on the VISA card or pay cash in most instances.

    Some would use private insurance to pay.

    Others would stick with medicare as their prefered payment option. And they would repay through the tax system as and when their income was high enough.

    All of us would get a significant tax cut.

    Doctors and health providers would now be operating in a much healthier market (no pun intended).

    The public hospitals should then be privatised with possible special consideration for emergency departments.

  9. I take Dave Bath’s point to be that rich people should not have their private health insurance subsidised. I also agree.

    My perspective is that richer people both pay tax to the government and then receive this subsidy back, which constitutes pointless tax-welfare churn.

    Friendly societies were valuable institutions which were covering an increasing percentage of society and offering most of what the modern welfare state attempts to offer. It is a great shame that they have been crowded-out and replaced by a 2nd-rate public version.

  10. And some of the views leave you wondering about the fate of all people in the healing professions. Taken to it’s logical conclusion, all healing would become a public service, a branch of Medicare. Doctors and nurses would be slaves providing a service, unable to leave. Nice for some, maybe, but the majority would emigrate or seek asylum overseas, and fewer and fewer people would enrol in the ‘service’.
    I wonder how long such a system would last?
    Still, there might be a few votes in it. Enough pensioners kept alive to keep Labor in the Lodge.

  11. The case for medicare HECS is actually stronger in my view than the case for higher education HECS. My gut feeling is that education produces more positive externalities than medical services (with the containment of infectious diseases being an obvious counter example). As such education is more worthy of public subsidies and medical services more worth of user pays initiatives. Although obviously the user is the primary beneficiary in both instances and I’d prefer both industries to be based on user pays principles.

  12. No progress John. Too busy slaving to feed my kids in these tough times. Soon but, real soon. πŸ˜‰

  13. So what happens to people who start ‘illegally’ trading higher quality ‘unequal’ black market health care or do not wish to cooperate with ‘equal’ health care?

    There is no quitting with these sick bastards and I wish somehow they could just for a moment muster up the intellectual capacity to think through the real world political, economic and social implications of what crazy alternate realities they conjure up out of their addled subjective little minds.

  14. Damien:

    They can’t stop people who want decent health care when they want it and not when the state decides.

    You can buy decent health in various countries now for a fraction of the price.

    need extensive dental work? You can buy it for a fraction of the price in places like Thailand and have money left over for a holiday on the side.

    They can’t stop it.

  15. TerjeP@9: “I also agree with Dave Bath (shock horror)”
    Yeah, well, I self-classify as a libertarian for the freedoms you’d have in a state of nature (i.e. without pockets or bank balances), so we can probably see the merit in each other’s arguments at least half the time. (And I hope I’m polite enough to try an be friendly in your forum) πŸ˜‰

    John@10: (On friendly societies) “It is a great shame that they have been crowded-out and replaced by a 2nd-rate public version”
    I’d add, “and more recently a third-rate privatized system”

    NicholasGrey@11: “Taken to it’s logical conclusion, all healing would become a public service, a branch of Medicare. Doctors and nurses would be slaves providing a service”
    Scary lefty me sees health and education of all members of the population as a public good, an infrastructure to allow more efficient (and happier) human capital to society (sorry if those last couple of words are “scary”). Slaves providing a service? Those who don’t have the calling are best kept out of the game, and those who /do/ have the calling don’t give a toss, as long as they are given the opportunity to get the job done well (speaking as a former medical student, and someone who has worked in non-profits AND big pharma, I reckon that’s about 50:50 of the medicos).

    Terje@12: “(with the containment of infectious diseases being an obvious counter example)”
    I’d add the subsidized drugs I get – costs the taxpayer about $5 a day, without which I wouldn’t be able to work (and pay taxes). But subsidizing cosmetic surgery (apart from those with major problems, whether congenital or acquired – and see this on self-perception and vanity surgery) should obviously NOT be supported by the taxpayer in any way. This is where it would be good to have a better way of separating out what I call “functional” from “vanity” health interventions – and I’m all ears if anybody can get a scheme to separate the two that has a hope of being accepted by politicians. (Actually, the PBS non-subsidy of viagra is an example of something that works. They get their decisions approximately right whenever the politicians don’t intervene. See the appropriate episode of “The Hollowmen”)

  16. Whilst I can see that it’d be nice to have oodles of health services, nothing really comes free. Who would be compelled to pay for these ‘services’? the taxpayer? Would healers be allowed to go into the private sector if they wanted to?

  17. Dave – I don’t mean to be crass however I have trouble seeing the provision of $1825 per annum in subsidies for your drugs as creating a positive externality. Are you saying that without subsides you would cease being able to pay taxes? From what you’ve said I understand that you could not work without these drugs, however that sort of logic could be used to justify almost anything. Without food I couldn’t do my job. Should we subsidise food?

  18. I couldn’t work without transport to work, food, a house, clothing, and a constant supply of alcohol for when I get home. I look forward to Terje paying for all of it. πŸ™‚

  19. Terje@19:
    I accept you are not meaning to be crass, and your question arises naturally from any discussion of government spending, including, perhaps, the spending required to define laws and a currency that allows spending. πŸ˜‰ But thanks for the “I don’t mean to be crass” – it helped clarify what you mean.

    That $5/day permits me to work (most of the time), generate product (used by others to generate revenue), pay taxes, and buy stuff. Without those drugs, I’d be on a pension, as my epilepsy would be too unmanageable for any employer. (Although I’d have more time to try and contribute in other ways). As I’m able to work, I don’t take from the limited pool of funds available for disabled taxi vouchers, and while usually not bulk-billed, I usually don’t keep the paperwork to get money from Medicare (I’m not necessarily virtuous, my memory for paperwork is shonky).

    It’s worth remembering that I’m epileptic, that I design data models and software, and that creativity probably is at least in part a result of my epilepsy (being forced to use long associative links in your brain because declarative memory is screwed has that effect). How many of you ever had a FlyBuys card? Guess who designed the backend analytical side of that and wrote most of the server side? Other projects have generated export earnings too. Talent ain’t fungible.

    Ain’t paid much, because my epilepsy is unpredictable, and there are all sorts of added unsubsidized costs I have to deal with. So, without the drug subsidies, I wouldn’t be able to impart my knowledge by giving a talk to a lot of higher paid enterprise data managers next month, which hopefully will lead to greater efficiencies in the organizations they all work for.

    Note that I am NOT arguing that only those like me who can work with drugs, but not without, should be subsidized. But I do think smart selection of what drugs are subsidized (or which vaccines) can lead to good outcomes – better than no subsidies, and better than opening the welfare floodgates to benefit Big Pharma.

    Besides, you could argue that your food IS being subsidized by various agricultural assistance schemes, by subsidized roads, and with other social services. And I have no objection to my taxes being used to support you and your family in hard times, even if they are permanently disabled. But I /do/ object to subsidies for gold-plated walking sticks or caviar. (Hmmm, freedom to waste social security benefits at the pokies… don’t like that, but stopping it is too totalitarian unless you ban the pokies altogether for everyone).

    This is another of those areas where it’s hard to draw a sharp line. The tensions of views in a pluralistic society, erring on the side of compassion, will hopefully cause policy to evolve in a directive that leads to better humane outcomes.

    However, I think the fact that we, of markedly different views about matters of economics and size of governments, can both see the problems with subsidizing health insurers, should give us both greater confidence on that particular issue.

    I suppose we agree about the idea that governments shouldn’t subsidize luxuries. Where we don’t agree is on what is a public good. I think your education benefits me, for example, so ensuring a reasonable standard of education for you, and helping you make constructive use of that education, is something I’m happy for my taxes to be spent on. I happen to see health in a similar light. I also happen to see that I benefit from the contentment others in society (admittedly in a Confucian manner of expanding circles).

    As mentioned earlier, I would be sorely tempted to ban the purchase of health cover for luxuries/vanities in a country with very limited health resources, and the skewing of the market to provide luxuries precluded the provision of basics. But I’d want darn good figures to support such a ban (and would go to someone like Andrew Norton to help me go through them).

    … your friendly libertarian lefty, Dave.

  20. Dave – are you saying that without the $5 per day subsidy you would give up the drugs? Based on your description of your lot in life I can’t see why this would be the case. I suspect that you would shell out the extra $1825 per annum due to the obvious utility of the drugs. So the subsidy creates a benefit to you of $1825 but no positive externality that I can see.

  21. Terje@23
    Yes, I am saying that. It’s one of those things that the drugs stop working after between 8 and 12 years, you go downhill big time or take increasingly toxic doses, and this forces a change of drugs. You have good years and bad years, even with subsidized drugs. Head’s above water now, just, but the cycle necessarily involves near-drowning.

    Yes, amusing about banning pokies for all being less totalitarian – one of those odd special cases I think. The partial ban would require invading the privacy of many, and let’s not forget the admin costs. The total ban is an inconvenience to a few investors, who can easily find other things to capitalize – perhaps something of greater social utility or export potential. The total ban doesn’t stop Packer owning a yacht, but would help many keep their shirts. The only people who would be worse off would be former state treasurers now working as lobbyists for the members of the gambling industry!

  22. The Packers own casinos. Outlawing poker machines would probably suit them just fine as it would elliminate competition.

    I’m perplexed as to why an increase in price of $5 per day would lead you to abandon a course of treatment that you articulate as having such great practical benefit. And assuming that demand would drop like a lead balloon without such a subsidy I wonder at what the suppliers price response would be in that instance. And if you got a tax cut of $5 per day and lost the subsidy would you still abandon treatment?

  23. TerjeP, lead balloons can fly. This was shown on an episode of mythbusters.
    Dave, my brand of libertarianism wants to eliminate taxes and compulsory activities. Health services would be offered, but would not be an automatic ‘right’. Even citizenship should be voluntary!
    When you call yourself ‘libertarian’, what do you mean by it? I usually take it to mean less government.

  24. Terje@26: Abandon? Hardly. Sometimes it\’s not a matter of choice. Have sometimes gone without food for a couple of days to avoid even the post-subsidy bit.

    Nicholas@27: \”libertarian\”…
    Libertarian left: a.k.a. \”social liberals\”, the opposite of the \”social conservative\”. See my placement post which has a dialogue between Mick Sutcliffe and myself.

    From the \”Worlds Smallest Political Quiz\”: \”LEFT (LIBERAL):
    Liberals usually embrace freedom of choice in personal matters, but tend to support significant government control of the economy.\”

    You can see quantitative scores on Facebook, as well as for the political compass.

    This is getting out of scope of the post. I\’d rather build bridges between the economic left and right of the social liberals on the worst excesses out there. And as seen here, there IS common ground on a couple of things (yay!!). We can fight elsewhere about things relating to Thatchers \”There is no such thing as society\”.

  25. What Terje is asking is “would you buy the epilepsy meds using your own money?”

    Bear in mind you would have a bit of extra money in your pocket due to tax cuts.

    It seems absurd that the only two choices in your mind are “subsidised drugs” and “no drugs”.

  26. DanielFamilo@29/30:
    Tax cuts presuppose an income subject to tax. With unpredictable diseases, especially where your body gradually resists a drug, you’ve got to get into pretty bad shape before going on to the newer drug.

    As I said, I’ve had to choose between eating and getting even the subsidized script.

    And the subsidies have pretty tight controls. Cost/benefit analysis to go on the PBS, a specialist required to write the initial script (and every time the dose changes) and the GP phoning Canberra every time another script is written.

    The burden of keeping off the dole or disability pension can mean that for month at a time, I can be working 80 to 90% of waking hours. Add the additional costs (high rent to have public transport to get to work, constraints on place of employment because you need good public transport there too, and 99% of employers won’t deal with unpredictable hours), and government gets off lightly, and so do employers (I do more sophisticated work than I did ten years ago, but my hourly rate is much lower adjusted for inflation).

    Because ability to work varies from day to day, week to week, administration of varying subsidies through Centrelink would cost society a fortune – and when you are down, you can’t get to Centrelink anyway.

    I don’t think you folk get it. It’s not much different from Terje’s admission that subsidized vaccinations are a good idea. I honestly hope none of you are forced to understand the issues properly. A less generous person would wish you to have all the necessary information thrust upon you.

    Besides, the main thing to consider if you want to lower the cost of medical services is to note that more dollars are typically spent in the last two years of life than before then. Palliative care, and “heroic” interventions in an 80 year old are expensive and give little benefit… but voluntary euthanasia is illegal. Solve /that/ problem, and there’d be no need to quibble about these relatively minor costs. Is there an interest group that sees voluntary euthanasia as a threat to a cash cow? If so, your biggest enemy on health expenses is pretty obvious.

    (Declaration of personal stance: when I judge my ability to contribute is less than the cost of resources demanded from government or family, I’ll certainly be going through my old toxicology texts and taking appropriate action – illegal or not)

    As my last point on this thread, I’ll pose a question for you to discuss among yourselves: Would you support government funding of genetic counselling services, including amniocentesis for at-risk couples. What about in Taswegia, given the incidence of Huntington’s which doesn’t raise its ugly head until you are 30 or 40 and have already had kids?

  27. As far as health and drugs go, I’m probably in favour of more regulation than most here.

    If your income isn’t subject to tax, then I understand. I’m not sure you made that point earlier. If you did, I’m sorry I missed it.

    I don’t think any of us would argue that the poor or severely disadvantaged should be left without essential medical care. I was operating under the assumption that you could cough up the extra fiver each day and take advantage of the tax cuts. I’m sure you can see how our argument works with someone of a higher and more stable income. This just becomes a matter of means testing now, potentially.

  28. Dave – I admit to not entirely getting it. It’s not through indifference however. The reason I ask questions is because I want to get it.

    I have a relative that for many years needed medication that costed around $1000 a week and almost the entire cost was worn by the state. I have a child with a condition that requires us to on occasion see a specialist that charges about $800 per hour. I know that medical costs can be financially harsh.

    Recurrent epilepsy is a particularily troubling condition and you have my full sympathy. Please don’t confuse determined analysis as personal indifference. In any case your $5 per day subsidy is certainly no where near the top of the list on things I’d like to see reformed.

    The point with vaccinations is not that they are a superior activity that needs to be government funded. Simply that vaccination has significant positive externalities for those that are not receiving the vaccination.

    The medicare HECS proposal that I alluded too does not really deal with medication, although it could. It would retain full public funding of medical services for those on low incomes. It would just expect them to repay the cost as and when their income became more substantial. Even if only 50% of the population were paying their own way as and when the services were used I think the market dynamics involved would help to improve quality and would ultimately wittle down costs for everybody. Although a lot of medical cost is tied up in regulation which isn’t fixed by a mere alteration to funding arrangements.

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