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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).
This is not really getting anywhere. Can I suggest that the parties waring over this stop and start to open a rational argument for and against inclusion here with reference to WP:policies and why they apply (or do not apply, if that be the case). Then we can get other editors to give an opinion based on sound logic and decide its fate in the proper way.--Hauskalainen (talk) 16:31, 31 August 2009 (UTC)[reply]
Only Americans do not want a National Health System?
This is certainly dubious since, after all, there really is no such thing as a 'pure' government healthcare system, there's some degree of private healthcare in the system in some fashion. It's more of a %X verses %Y issue. But the point is: There is some debate in other countries about having more of the system become private. See this story for a good example in Canada. See this story for an example in the Island.
You can argue that the majority of the people in those countries support more government, but that's the point. The point is that there is a debate. After all, the majority of Britons wanted to keep the Libya's mad bomber in jail- but that didn't stop the policy debate from deciding against the majority. The Squicks (talk) 05:59, 2 September 2009 (UTC)[reply]
The article does not say that "only Americans do not want a National Health System"! What it says is that there is little pressure in countries which HAVE socialized medicine to go in the OTHER direction.
Now you claim that the references you provide are evidence of precisely that. The Canadian reference is pure invention by the journalist quoted. I strongly urge you to view the whole interview with Robert Ouellet at c-span.org because the reform he is talking about there is that the public system can be improved WITHOUT the need to abandon the principles inherent in the Canadian system and further he says that on the fact finding trip he went to showed that European countries were doing just that. Doig has gone on to say the public-private issue is a distraction (see http://www.cbc.ca/health/story/2009/08/17/cma-doig.html). But you are right that there is some debate and that is that ideology could be forgone if doing so works in the interest of patients. The fact finding mission to Europe did find that Europeans were less ideological about who delivers but they passionate about social solidarity as the model for funding health care. You can see a pdf of the slide presentation findings at http://www.cma.ca/multimedia/cma/content_Images/Inside_cma/Speeches/SRPC-Presentation-April2009_e.pdf. It makes interesting reading.
As for the Telegraph story, this is not a grass roots movement but a government threat to the managers of poor performing hospitals in the public sector (and of course when comparing performance, as the Brits do, some will be doing worse than others). One can argue that this is the government aborogating its responsibilty to others but on the other hand I am sure misinisters would argue that it might just be the kind of threat needed to jolt these people into action. The UK government has an ideology on public services but it is willing to break this (as it has done so sometimes in Education policy with a few failing state schools) to bring in fresh ideas to turn things around. This is however, only action at the margins and is not a substantive idea for reform. Public hospitals in the UK are remarkably good at what they do and deliver an amazing services at a price considerably lower than any in the private sector. In fact, private hospital demand from the public has been waning. Somw private hospital groups have had to sell their hospitals (e.g. BUPA, which was once the most famous private hospital group now owns NO hospitals, and the remaining provders are desperately trying to get the government to outsource work to them to cover their fixed costs. This is the main reason why there has been a slight trend towards more NHS work being done in private facilities. The NHS is getting the work done at a very marginal cost which is quite a good deal for them, but it has only happened because the NHS is much more effective than it once was.--Hauskalainen (talk) 10:49, 2 September 2009 (UTC)[reply]
The article does not say that "only Americans do not want a National Health System"! What it says is that there is little pressure in countries which HAVE socialized medicine to go in the OTHER direction. This statement is false.
The section claims that there are only "Political controversies about socialized medicine" in the United States. As you have just admitted, this is a false claim. There is pressure in other countries to make them more privatized. Just because they are not the majority does not mean that they do not exist, and you have admitted. The Squicks (talk) 07:20, 3 September 2009 (UTC)[reply]
Given health is always high up the political agenda if you were right and I were wrong then we would expect a major political party to be backing a change in UK 8or Canada for that matter) - and there simply is not one. The myth perpertrated in the U.S. is that there is no private medicine in the UK or in Canada and people are unhappy because they suffer long wait times and just want to be unshckled from their health care system. Nothing could be farther from the truth. A little more private delivery in Canada or the UK does not mean that there is a significant shift in direction. The interview with Doig makes it very clear that nether she nor her predecessor is calling for a free market in health care in Canada. Again, I stand by the assertion that no other civilized industrial country runs its health care system in the way that the U.S. does and no country believes the U.S. system is superior to their own. --Hauskalainen (talk) 02:14, 5 September 2009 (UTC)[reply]
Rationing / Pricing / Queuing
The Squicks has asserted that socialized systems ration care by applying waiting times. I know that this argument has been used by opponents of socialized systems but I actually see no evidence for the claim that queuing is a deliberate policy.
Here is my understanding.
1. All economic systems have to have allocation mechanisms to allocate scarce resources.
1.1 Free markets use pricing to allocate. Those that cannot afford the market price have their demand unsatiated.
1.2 Rationing uses a fair-shares system to ensure that everyone can get their fair share of the scarce resource at the time they need it. The government issuance of food ration books to families in the UK during WW2 is a good example of this. The ration book limited the total of a given food that could be bought in the week indicated on the coupons in the book.
1.3 Queuing allocates resources according to a a prioritization rule. For example, at a bus stop the rule is that access to the bus is on a first come first served basis. In health care, whether you get in the line depends on your medical need and its severity. In the UK if your medical condition is so severe that your life is in imminent danger, then you do not even hit the line but go straight to theater. If its a severe condition without imminent risk you may wait a week or two. If its a minor condition such as heart beat murmer that can be regulated with a pacemaker it may take a month or two.
The allocation of scarce resources on a fair shares in health care basis means that rationing requires the definition of need. I would argue that there is RATIONING in the UK for example when the NHS says that an NHS plastic surgeon may be used to reconstruct a breast deformed by breast surgery but may not be used just because a person feels that her breasts are too small. This person is not denied access to a plastic surgeon but has to pay for that surgery separately from a private surgeon. NICE does make some rationing decisions based on cost per QALY, but this affects relatively few people.
But queing is NOT rationing. The heart patients described above are not subjected to RATIONING because the system is designed to ensure that all their needs are met. The only issue is when. I doubt that anyone would argue that Walt Disney World is rationing out its rides when its paying customers may have to queue for 20 minutes to get a ride. They know that if WWW built as many rides as it would take to ensure that nobody every queued, the cost of the entry tickets would be prohibitively expensive. But if customers found they they queued all day and never got on the ride WWW would never get anyone to buy a ticket and WWW would natuarally have to build more capacity. That is exactly what happens in socialized medicine in the UK which has added more resource and designed the processes differently to cut the wait times. Canada is now looking at how public systems in Europe manage to control costs and keep their queues to a minimum.
The price mechanism and lack of formal queing in U.S. health care means that there is overcapacity but also that there is hidden queuing inherent because there are some people who have a medical need that cannot be met until they can find a way to pay for it. The UK system is always working at a higher capacity but because there is no overcapacity the average cost of health care is much lower than in the U.S. but everyone with a true medical need in the UK gets care.
Wow, there's a lot of unsourced commentary. Let's look at some facts.
The British Medical Journal says that the use of waiting lists are rationing. [2]
The Journal of Public Economics says that the use of waiting lists are rationing. [3]
Inserted comment. I actually do have a background which encompasses economics though it was not my major. You make the classic mistake of treating health care as a commodity in which consuming more of it confers more utility. Actually it is more like water. You only need so much and there is little personal utility in having more of it of you don't need it. Needing it but but not getting it however can be deadly! In a sense I amarguing about a semantic difference between rationing (which implies demand is higher than supply and must be shared out with some going unsatiated to some degree) and queuing by medical need (which recognizes that current demand outstrips supply and first turn allocation goes to those in the greatest need). This is very different to price rationing where need is not really the allocation mechanism, but price is. I am willing to concede that even some medical economists refer to this as rationing. But the basic point I make is true. --Hauskalainen (talk) 08:29, 3 September 2009 (UTC)[reply]
If it's between your opinion, and these two ironclad reliable sources, I would prefer the sources.
Here is my understanding. Clearly, you have no background in economics whatsoever. As anyone with any education on economics will tell you, given that (a)People have unlimited needs and (b)People have finite resources, every system in the world rations healthcare. Repeat: Every system rations. Now, Britain uses the "black box" of NHS staffmember dictates whereas the U.S. uses prices. Whether or not one is better than the other is an opinion. But it is objective fact, fact, to say that they both ration care. The Squicks (talk) 07:07, 3 September 2009 (UTC)[reply]
Inserted comment.The "black box" is NOT how the article says WAS happening in the UK, but what MIGHT happen if the politicians focus solely on waiting times and not on the medical priority. The UK still queues people according to medical priority but it has also focussed on the causes of wait times since that paper was written. As a result, wait times have been considerably reduced without the risk which that report alluded to.--Hauskalainen (talk) 08:30, 3 September 2009 (UTC)[reply]
I don't mind working out edit conflicts with you, but if your only argument against ironclad reliable sources (which imply that queing = time incentives as a price = rationing) is "I don't like it"... Then, well, there's really nothing to say. The Squicks (talk) 07:10, 3 September 2009 (UTC)[reply]
Inserted comment. If you read the section I wrote, I acknowledged that even some health economists wll use the term in this contect and I gave the very same reference as an example--Hauskalainen (talk) 08:02, 3 September 2009 (UTC)![reply]
In your statement, you say that "socialized systems ration care by applying waiting times" is false. The BMJ has said the opposite- saying that wait times "ration" and that they "ration" better than the Americans.
I'm sure that they're some people who have the opinion that waiting lists are not rationing. I'm fine with including reliably sourced attitudes. The article currently says Countries with socialized medicine use waiting lists as a form of rationing compared to countries that ration by price, such as the United States, according to several commentators and healthcare experts. It does not say that 'all experts think this way.
What is not okay is you putting your unsourced opinion into an article. Other commentators continue to insist that waiting times as a method of rationing without recognizing that the alternative is denying necessary care to those unable to meet the financial cost is a horrible, crying out example of this. The writer of the article said no such thing. He did not write that he denied or 'refused to recognize' anything. This is original research by you in its purest form. Find a source criticizing the Doctor or include no criticism. It's that simple. The Squicks (talk) 08:14, 3 September 2009 (UTC)[reply]
The point is, as you well know, people like Gratzer use words like rationing to make it sound unacceptable, but do not acknowledge that the other form of rationing is rationing according to the depth of your financial resources goes on all the time and can be even less unacceptable. Of course Gratzer did not say that. That was what the edit was saying!
Would you care to address the point I made that there are actually two types of rationing that goes on the UK and in other European countries. There is the type of rationing that says
"you will get your heart surgery but you may have to wait for it" (rationing by queueing)
and the other type of rationing which says
"New Drug B in this clinical condition has only marginal benefits over the more traditional and much cheaper Drug A. The marginal cost of switching versus the marginal benefit is too high for society collectively so Drug A cannot be funded from the public purse in this clinical condition - but you may buy it yourself or use private insurance to buy it if you have such a policy" (rationing by assessed clinincal cost effectiveness or "cost per QALY")
Rationing by queueing is common in Europe and is acceptable to most people because people get the care they need according to the severity of their condition and the impact it has on their lives. People who find it unacceptable have the choice to skip the queue by going private (an option not always available in Canada unless they go abroad).
Rationing by coverage is much rarer and mostly applies to cosmetic surgery for vanity reasons (though for some reason varicose veins are often operated on in the UK) or else for very expensive treatments that could break the bank.
Kidney dialysis is a good point. In the 1960s when dialysis became more common the machines were very large and expensive to buy and manage. It was impossible to treat everyone that needed dialysis. There was a s shortage of machines and they were simply very expensive to buy and run for everyone to have access. Therefore the young were indeed given priority because they potentially more years of life to lose. Now we have much better control over the development of kidney disease and fewer people get to the stage where they need dialysis. For many many years everyone HAS got access to free dialysis because dialysis technology has developed to the point where it is economically feasible to treat everyone.
Insurance companies in the USA had the same dilemma. Treating these people would have pushed premiums up and pushed profits down, so they conveniently persuaded congress to shift the cost onto the government! Dialysis is one of the few cases where everyone in the USA has a right to health care because the insurers did not like seeing pictures of people dying on the news every night because they were not funding their health care. This, and the passage of Medicare parts A, B C, and more recently part D was the start of a big shift in health care funding away from private insurance and onto the government for those health care coststhat threatened insurance company profits.
Of course Gratzer did not say that. That was what the edit was saying!
Facepalm. Okay, seriously. Seriously. Can't you even begin to understand that it's not acceptable to take text that is your own person opinion and then cite it to a source that says the opposite? You can't put your words into someone else's mouth. Read WP:RS and WP:V. The Squicks (talk) 05:03, 4 September 2009 (UTC)[reply]
If I were talking to you face to face, than I would be more than happy to debate politics with you. But this is not the place for that. This is Wikipedia. This is not a blog. This is not a forum. This is not a personal website. This is not a news article. Wikipedia is an encyclopedia.
If only that was some way that I make you see that I don't care what your personal beliefs are about healthcare. I'm not going to address your point because your personal opinion about healthcare does not matter. Once again, I have noted that there are two ironclad reliable sources that say that socialized medicine rations by time.
If you had any reliable sources as such that said that it is not rationing, than please mention it here. You can keep going on about your own personal opinions about healthcare. But can't you see that it doesn't matter? You can't write large blocks of text into an article that has no source except for yourself. The Squicks (talk) 05:10, 4 September 2009 (UTC)[reply]
As a side note, please stop manipulating what I write by inserting your comments in between my text. I know that you are deliberately doing this to annoy me, and it is working very well. Please stop it. It's juvenile. The Squicks (talk) 05:16, 4 September 2009 (UTC)[reply]
Points of confusion
Having lived in and received healthcare in 3 of the 8 countries named in the article and 2 others not mentioned and having taught economics, I can offer a little insight. I try hard to always be neutral in my work comments, but the very title of this article strikes me as NPoV.
American talk radio (unfortunately available in Canada on XM radio), tends to blur terms such as 'social programs' with the word 'socialism'. Similarly, talk radio confuses 'capitalism' with 'free market', 'left' with 'liberal', and 'right' with conservative, none with are synonymous.
Actual socialized medicine
An avowed entrepreneur and free market proponent, I worked in several countries in the Americas and Europe. Out of the nations listed in the article, I consider only Cuba to presently have socialized medicine, i.e, nationalized hospitals and little or no private healthcare. (It's not clear to me why 50-year-old policies of the Soviet Union are germane to this article, unless it's intent is to describe how not to implement healthcare.)
Rationing
Americans presently have built-in rationing thanks to AMA and efforts to limit the number of physicians and nurse practitioners who graduate and are licensed each year, a problem on-going for decades. America's rationing has the effect of draining doctors from Canada, Britain, Europe, and especially India and the Far East. When getting healthcare in the US, the odds are high that service will come from medical personnel imported to the US.
Public funding
Much, if not the vast majority of US medical research is 'publicly funded', meaning that every taxpayer helps pay for the research in hospitals, universities, and private companies which receive grants and tax incentives. This hasn't received much attention and it's ironic then that some taxpayers are deemed 'less worthy' of the very research and services they helped pay for.
As a final point, many of those who campaign against public healthcare also seem to be the same people who oppose workplace healthcare benefits, which, it would seem to me, would further reduce the number of Americans with the ability to seek medical services. I don't understand the scare tactics– at one time public education, libraries, public water and fluorination, and even opposition to child labour was considered socialist or communist. Would you be willing to give up any of those now?
There's a right way and undoubtedly a wrong way to implement healthcare. It is shameful for America to remain the one 'civilized' nation where people can still die from lack of proper medical care.
Unfortunately, what you have done is shed a gigantic amount of heat with no light. You may be right. You may be 100% right about what the country needs to do. You certainly seem like a intelligent, informed commentator.
But you are not a reliable source. See WP:V and WP:RS. It's simply not acceptable for editors such as yourself and others such as Hauskalainen to put large sections of your own personal opinion into an article. The Squicks (talk) 05:14, 4 September 2009 (UTC)[reply]
Please note I have not added (or deleted) anything in the article. I agree articles should be about facts and, as far as we can strive, not about opinion.
Answer: The American Broadcasting Company source is included because the ABC source quotes the book verbatim, and because I don't happen to have a copy of that book on my bookshelf to cite for WP readers a page number for-- might we say -- those WP editors that might be inclined to put a "page-number-required" template w.r.t. citations with which those editors might not agree without being able to see it online. If the American Broadcasting Company is willing to quote it verbatim, obviously we don't need a page number for the quotation in order to satisfy either the policy WP:V#Reliable_sources or the related guideline WP:RS. ... Kenosis (talk) 06:45, 5 September 2009 (UTC)[reply]
More non-sourced additions and POV
Some merely oppose what they see as socialized medicine because they say it will lead to health care rationing by denial of coverage, denial of access, and use of waiting lists, often without remarking that coverage denial, lack of access and waiting lists exist in the U.S. health care system also.<ref>"95,000+ U.S. patients are currently waiting for an organ transplant; nearly 4,000 new patients are added to the waiting list each month. Every day, 17 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow. Because of the lack of available donors in this country, 3,916 kidney patients, 1,570 liver patients, 356 heart patients and 245 lung patients died in 2006 while waiting for life-saving organ transplants:National Kidney Foundation http://www.kidney.org/news/newsroom/fs_new/25factsorgdon&trans.cfm </ref> Or that waiting lists in the U.S. are sometimes longer than the waiting lists in countries with socialized medicine.<ref>"Right now more than 8,000 people in the UK need an organ transplant that could save or improve their life. But each year around 400 people die while waiting for a transplant". National Kidney
(a)The claim "often without remarking that" is Hauskalainen's own POV. For him to claim that the website says this is a lie. It's a black and white lie. The website does not talk about rationing at all. All it does is talk about kidney statistics.
(b)"Or that waiting lists in the U.S. are sometimes longer than the waiting lists in countries with socialized medicine." This is another lie. The website gives statistics. That's it. The website does not criticize American health experts. In fact, I see no personal criticism in there. For Hauskalainen to claim that the website has attacks on American health experts there is a lie. The Squicks (talk) 02:23, 7 September 2009 (UTC)[reply]
Both of the websites give statistics. That's it. They don't have criticisms of anti-socialized medicine advocates there. For Hauskalainen to claim that these websites criticized anti-socialized medicine advocates is a lie. The Squicks (talk) 02:25, 7 September 2009 (UTC)[reply]
Methinks the man does protet too much. You too have added opinion that are not supported by facts. You do this by for instance claiming that you are adding a definition of rationing but actually adding an article in the point scoring debate about truth and lies in the health care debate. E.g. http://en.wikipedia.org/w/index.php?title=Socialized_medicine&diff=312273091&oldid=312272257. I have not claimed these articles say that waiting lists for kidney transplants are longer in the U.S. than they are in the U.K., but I have pointed out that they ARE longer in the US and than the UK. Nor did I point out that the UK does about two and half times MORE kidney transplants per head of population than the US does, but that happens to be true also. The issue I made (and it was also made in the journalist pieces you are keen to demote) that people in the U.S. talk about rationing in the UK like it does not happen in the U.S., which is a total misconception. Our job as editors here is to inform and not to misinform, mislead, or use Wikipedia as a political platform. That is why my edits here are honest and promote balance. I have edited this article for longer than any current editor here (assuming no one is editing under multple names). I know my ground. The Kidney waiting list exists in the U.S. and it is proportionately longer than the that in the UK. Fact. It is NOT WP:OR and the fact that it is not cited in an article about the debate in the United States is neither here nor there. --Hauskalainen (talk) 02:42, 7 September 2009 (UTC)[reply]
I have not claimed these articles say that waiting lists for kidney transplants are longer in the U.S. than they are in the U.K. YES YOU DID. You claimed that the two websites say that anti-socialized medicine advocates are obvuscating facts. And the sources say no such thing.
You cannot cite two statistics that do not compare kidney treatment and then put in your own personal analysis of the issue- e.g. that the U.S. is worse than the U.K. The sources do not say that the U.S. is worse than the U.K. You are lying. One source gives some information- it does even mention the other country! The Squicks (talk) 02:52, 7 September 2009 (UTC)[reply]
No! The points I made and referenced were that waiting lists can exist in the U.S. and indeed the waiting lists can be longer. Which in some cases they clearly are. This does not becme WP:OR. I am not lying! Please withdraw that allegation.
According to the National Kidney Foundation, over ninety-five thousand U.S. patients are currently waiting for an organ transplant, nearly 4,000 new patients are added to the waiting list each month, and 17 people die while waiting for a transplant of a vital organ every day. It has also stated that, because of the lack of available donors in the country, 3,916 kidney patients, 1,570 liver patients, 356 heart patients and 245 lung patients died in 2006 while waiting.[160] The group's UK branch has stated that more than 8,000 people in that country need an organ transplant that could save or improve their life but around 400 people die while waiting for one each year.[161]
This is what is currently in the article. And this is true, factual material. Your interpretation of this material violated WP:SYN and WP:OR and should not currently be in the article. The Squicks (talk) 03:04, 7 September 2009 (UTC)[reply]
No! Simple mathematical calculation shows the claim (about waiting lists being longer in the US relative to population) to be true. This is neither WP:SYN or WP:OR because simple interpretations like this are permissible by WP:Policy
First off, I have seen nothing- nothing from you to support your claim that the references criticized anti-socialized medicine adovcates. Your claim that these references criticize those people for ignoring "coverage denial, lack of access and waiting lists" is a lie. Those references give statistics. That's it. That's it.
The words "People in the United States are ignoring that waitings lists can be better here" are not in either citation. For you to say that people in the U.S. are ignoring facts are your opinion. You can't have this in an article=
"Obama says that Americans have less access to Y things, and he is ignoring what group X says.<ref>Statistics from group X about Y in another country that never mentions Obama or even America ever.</ref>"
Second of all, Wikipedia policy does not let editors put in their own information. Even if it is simple. Read WP:SYN. The example that they give as what not to do is exactly what you are doing. The Squicks (talk) 03:30, 7 September 2009 (UTC)[reply]
The debate in the U.S. seems particulary odd to observers living within a country with socialized medicine. Oh... my... God. How can you put this into the article? It's just your own opinion. Also, it's pretty presumptuous of you to claim that all Americans are "odd" in your eyes... The Squicks (talk) 03:41, 7 September 2009 (UTC)[reply]
You are making a straw man. The cites I gave support the statements I made in the edit. There are waiting lists in the U.S. and they can be longer. They are verifiable statements and not WP:OR or WP:SYN. Read the editing rules more carefully! As for the piece about the NHS doing much less rationing of care than the private sector, it is as clear to me as as an Englishman as the fact that Tuesday follows Monday. That it needs to be pointed out to an American audience tells you more about the misleading information about the NHS in the United States and makes it something that dervervedly needs to be in Wikipedia. It is not some kind of fantasy. I did give a reference from the ABI. People in the UK simply don't need to be told this. They know it very well. Its why you won't find anyone writing about it - its common knowlege. I can also get you a reference from a company in the UK that promotes private health care that basically says the same as I do. People only basically use the private sector to jump the queues. Even the ABI admits that the NHS does long term chronic care and the private sector only focuses on simple curative procedures. The same insurance promtion company I spoke of alsi admits that its better to have an operation in the NHS if there is ANY risk of complications arising from the Op because private providers have woefully inadequate medical staffing when it comes to dealing with emergencies. There is not a single private hospital in the UK that offers an Accident and Emergency service for example. Not even in London. I doubt that many in the U.S. know this and yet you won't find it written about in the UK because its so blindingly obvious.--Hauskalainen (talk) 04:12, 7 September 2009 (UTC)[reply]
This is a crying example of everything that I've pointed out. When I ask you to only add material that can you can cite sources for and I tell you that you must present those views neutrally, you go off on a tangent about how stupid Americans are and how wonderfully smart Britons are. What does any of this have to do with anything? The Squicks (talk) 04:20, 7 September 2009 (UTC)[reply]
it is as clear to me as as an Englishman Well, your user page says These days I live and work in Finland. So you are either lying in what you wrote here or you are lying in what you wrote there.
Regardless, I find it odd that you assume that I and every other American must simply take your word for it that the NHS is better than the American system. Maybe it is. Maybe you're right. But I don't know you, and I have no reason to take your word for anything. Would you trust me if I told you, say, that it's clear to Americans that Dallas has hotter weather than Los Angeles? No. You would ask for a source. And you would be right. There's no reason for either of us as people to be any more trustworthy and anyone else. It's the sources that are trustworthy! If the British Medical Journal says something, I take it seriously. If you say your own opinion, then that is different. The Squicks (talk) 04:26, 7 September 2009 (UTC)[reply]
Oh, and I did not say all Americans are odd or stupid. Another straw man there! I said the debate seems odd (because it actually runs contra to the fact here that insurance companies clearly do engage in all sorts of rationing whereas the NHS largely does not. Another thing that needs to be corrected is that when socialized systems ration, somehow choice has been taken away. As far as I know that never happens because socialized systems do not disallow the right for people to pay for services if they are outside the government scheme. For example, there is a private insurer in the UK that will insure you against the possibilty that you might hit the drug policy ceiling where some drugs are too expensive for the NHS to justify. If you want the extra coverage you can simply pay for it. As far as I know, supplemental insurance for out-of-scheme items and private funding is allowable in all countries. That people like Michael Cannon of Cato don't like to publicise this is not hard to understand.--Hauskalainen (talk) 04:29, 7 September 2009 (UTC)[reply]
Once again, and for the last time, your own personal POV is completely irrelevant here. I know that you have a religious fundamentalist-like devotion to the idea that the British health care system is superior to the U.S.'s system, and that you think both me and you would receive better care in the U.K. But I don't care what you think. And you shouldn't care what I think either. My views aren't fact. And your views aren't fact. Truth be told, I hate our healthcare system. I wish that there was more government aid to help the downtrodden in the U.S. But my views don't matter.
Neither of us can add our opinions to an article. As per WP:V and WP:RS as well as WP:NPOV, we can only add the views of reliable sources. There are over twenty [citation needed] tags in this article- and this is because of a conscious decision by you to add material without reliable sources to this article. That has to stop. The Squicks (talk) 04:41, 7 September 2009 (UTC)[reply]
I have no such religious fundamentalist-like devotion. All that I add to the article are facts. It is a fact there are waiting lists in the US health care system (though admittedly, that is true for organ transplants - most hospitals who reject treating people who cannot pay do not keep lists of those who are rationed out on price gounds do not keep tabs on those waiting as do the health care systems in most civilized countries). And the waiting list for kidney transplants is larger in absolute and relative terms. That is not WP:SYN or WP:POV. I am not interested in whether you hate your health care system. All I am interested in is facts. Yes of course I have been a tad flexible with the rules in saying that the US debate is odd to British eyes, but the simple fact is that most British people know that if you need emergency treatment or care for a chronic problem or have an age related problem, or get pregnant, you will not get much help from your private insurance policy in getting private care for these issues. Brits know this. I would suspect that most Americans would have no idea that this was the case. Given the negative press the NHS gets in America (and at times in Britain), this is perhaps not surprising. Using WP to pass on factual data (such as the ABI list of coverage exclusions) and inform is the whole purpose of WP. It is not a platform for selling a political message which some editors can be inclined to do. I do not live in the U.S. and am completely unaffected by your policies there. I am therefore a more neutral observer than you seem to take me for. --Hauskalainen (talk) 05:10, 7 September 2009 (UTC)[reply]
All that I add to the article are facts. As I have pointed out repeatedly, this is not the case. Whether it's you putting your own personal opinion into the mouth of Gratzer, or of the ABI, or of the Kidney group- this is a frequent pattern of all your edits. You call this being flexible with the rules. I call it lying. You claimed that the ABI said that Britons consider the US healthcare debate odd. This is a lie. And this is a pattern.
the waiting list for kidney transplants is larger in absolute and relative terms. That is not WP:SYN or WP:POV. You claimed that those websites with waiting list information criticized anti-socialized-medicine advocates. That was a lie. They criticized noone; all they did was give information. But you stubbornly insist despite everything that your personal opinion must be in the article. You are violating WP:SYN clear as crystal. A source that does not mention a person cannot criticize a person. You cannot put in an article C just because you have a source A and a source B and- in your personal opinion- A + B = C. That is wrong. The Squicks (talk) 05:28, 7 September 2009 (UTC)[reply]
I am therefore a more neutral observer than you seem to take me for. There is no such thing as superiority or seniority in non-administrative Wikipedians. You and I are at the same level. Neither of us is "better" intellectually than the other in any sense of the word than the other. It is not a platform for selling a political message How wonderfully cute of you. Yes, I know that you consider yourself to be superior to me since you think that you have no political bias and I am completely biased in your eyes. I don't care. Okay? You can bloat the talk page with as much self-promotion as you want. It is irrelevant to anything.
I am also tired of seeing you accuse me of removing facts from Wikipedia. You wrote a section about coverage exclusions in the UK that cited no accurate facts. Then, I complained. Only- repeat- only after I complained about it did you provide a reference. And since the reference is correct, I have supported keeping the section about coverage exclusions. I have been removing your orginal research. When you cite a fact supported by a reference, I keep it. The Squicks (talk) 05:35, 7 September 2009 (UTC)[reply]
From an economics perspective, all goods that face a insatiable demand greater than the finite supply of resources has to be rationed, meaning that some needs cannot be met.[141][142][143] As President Barack Obama has said, the U.S. "could not construct a system in which you could see any doctor anywhere in the world any time, regardless of expense." A healthy, yet also polarizing debate has sprung up in the United States about rationing in health care.[141][144] Health care rationing happens already in the U.S., mostly in terms of the price of care,[145][144] and the central issue of the debate is which combination of methods would be the most sensible.[146][143][147] Some in the U.S. oppose what they see as socialized medicine because they say it will lead to health care rationing by denial of coverage, denial of access, and use of waiting lists. Proponents of it state that all those forms of rationing currently occur in the U.S. anyway and that another system would distribute care more ethically.[142][143][144]
You put into the article The debate in the U.S. seems particulary odd to observers living within a country with socialized medicine. And then you put that the source for this material, as a citation, as the ABI. You were wrong (e.g. you lied).
You put into the article Some merely oppose what they see as socialized medicine because they say it will lead to health care rationing by denial of coverage, denial of access, and use of waiting lists, often without remarking that coverage denial, lack of access and waiting lists exist in the U.S. health care system also. You cited this statement to a website about Kidney treatment that never mentions people who oppose socialize medicine. You lied.
In contrast to you, I wrote "Some in the U.S. oppose what they see as socialized medicine because they say it will lead to health care rationing by denial of coverage, denial of access, and use of waiting lists.". And I cited it to people who say that. I then wrote "Proponents of it state that all those forms of rationing currently occur in the U.S. anyway and that another system would distribute care more ethically." And I cited it to people who do say that.
This is the difference between me and you. You put your words into other people's mouths. I put down information that is sourced and that fairly represent the opinions of the source. The Squicks (talk) 05:58, 7 September 2009 (UTC)[reply]
Bias in the editing in this article
I have met a certain kind of editing before which introduces subtle bias within Wikipedia by using the rules as far as possible but attempting to structure the article to represent a particular point of view.
Methods used by this kind of editing (and here I am not referring to particlar edits by any particular editor) include the following:-
Representing something that may not be true by quoting others as saying these things.
Promoting in the sequence of edits the story that the editor would like to convey whilst demoting further down any text which the editor disfavours. Preferably buryinh it in other sections or as far away from the promoted text as possible.
Highlighting with wikilinks, words that are intended to trigger negative or positive emotions to fit the mood which the editor wishes to engender in the reader.
Using references to highlight a point that does not need to be made, or indeed which may be controversial and doubful, the main purpose of which is not to verify the text, but to lead the reader to an article off of Wikipedia which may influence the reader.
I could go on, but I think you get the drift. If I can think of more examples later I will add them. Such editors are a menace to the general purpose for which Wikipedia exists.
Clearly myself the The Squicks are going to edit war all night long over this one unless something gives.
I am going to suggest that we discuss ALL changes that are made to this section here FIRST.
To be fair I am going to suggest that we take the section back to the way it was before he or I started these recent series of edits. Maybe even to the way it was on January 1 this year.
We should try to get other editors to help to iron out our differences if they arise during this process. We need to agree
1. The skeletal sequence of argument
2. What the arguments are on both sides
3. Which references best illustrate the arguments
We need to avoid pushing one argument over another and giving references without highlighting which part of the text we are referring to. In other words, a claim may made, a reference should contain a link to the source if appropriate and a brief quote from the source which illustrates the point.
The problem is that you wrote this article and you made all the edits before I came along. So, taking the article back in time constitutes nothing more than a demand by you for me to leave and to then never come back. That's hardly "fair".
But, at the same time, I welcome your proposal to work everything out here. How about this=
1)The article stays as it is temporarily.
2) You post, paragraph by paragraph, the sequence of the article (writing in generalities) that you believe would make the most sense.
3)You then post, word by word in detail, what you believe should be in the introduction.
4)I reply and then we hammer something out for that paragaraph.
5)We repeat the process until every paragraph is completed.
6)Both of us promise not to edit the article again until some set period of time passes (like, say, 2 months).
You know what? Actually, I give up. I have just spent some time looking at your contributions and the archives forthispage. It is clear that you have a POV that never be compromised with and can never be talked with rationally. You have edited this page (and others) with the strategy that if you revert enough, make enough personal attacks, and spout on with irrelevant points enough- then other editors will give up.
And it works! You're the only one left. Everyone else who has tried to work with you has quit! I'm not going to fall into your trap in which I'll spend page after page of argument and then you will ignore me. I give up. Feel free to put as much of your personal opinion into this article and remove as many reliable sources as you want. I'm not going to waste my time. The Squicks (talk) 06:35, 7 September 2009 (UTC)[reply]
Oh And I've just answered all your points! I am actually quite reasonable when you test me if you use logic and reason nicely. But your edits are a bridge too far and I cannot countenance the insertion of politically charged edits which do not fairly reflect the balance of opinions out there and worse still use sublte techniques to try to sway opinions. Oh and Obama is not planning any form of socialised medicine as far as I can tell. I just wanted to point that out.--Hauskalainen (talk) 06:53, 7 September 2009 (UTC)[reply]
It's okay. Don't worry. I give up. You'll never see me on this article again; I promise. I'll let you have the last word on this page as well. Post away. The Squicks (talk) 07:11, 7 September 2009 (UTC)[reply]
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.
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.
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)[reply]
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.
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.
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'.
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.
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)[reply]
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?
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)[reply]
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.
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)[reply]
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)[reply]
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)[reply]
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)[reply]
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)[reply]
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.
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)
