[Icare dixit]

Basically, a country's health and care system can be one of sixteen types:

- one public healthcare provider or many private providers; and
- one public, national insurance or many different insurers; and
- completely free at the point of use or only partially paid for by an insurer, possibly distinguishing between primary and secondary care; and
- mandatory insurance or optional insurance.

Which type of system would you prefer and why?

I do think one, public provider is best, but the type of organisation is key: it should be lean, basically many public, small providers which work the same way, but without any self-reporting/-assessment, just regular inspections done by talking to patients. No private subcontractors providing care.

More importantly still, I think there should be one, public insurance. It is the best way to use most of the money while avoiding too much risk. It also ensures there is solidarity between as many people as possible.

Also to ensure solidarity, there should be no extra costs at point of use.

I think insurance should be mandatory to ensure solidarity and to avoid risk.

[Icare dixit]

One more thing: do you think anyone should ever be excluded from receiving care?

Maybe when you smoke cigarettes, are obese or the treatment would be too expensive, given high costs and small chances of improvement.

I live in a place of 'public' healthcare - but not all things are covered. Not all service providers are equal. Example chiropractors, dental, eye care are not covered. These can be privately insured. Also, seeing a specialist (example psychiatrists and psychologists) is not always covered. Generally if you have a doctor's referral then it will be covered.

Public healthcare does NOT mean your pharmacare is covered. In my ow case the only reason they are affordable is because I am on government assistance.

Public healthcare here also does NOT mean that user pay service does not exist. For example, to get a knee replaced is about a 2 year wait via the public system, yet I can go to a private clinic, pay for it, and have it done immediately.

In essence then we have a 'two tier' healthcare system. A seperate one for those who can afford it.

[Icare dixit]

But do you think waiting lists are a consequence of a public healthcare system, or just underfunding?

Of course, in most countries, such a two-tier system as you mention, can and does exist, if there is public healthcare. But as long as people still pay for the general/public/national insurance through taxation, is it necessarily a bad thing? It doesn't really create a divide, it just makes it more apparent. It does make the waiting lists shorter.

This question is above my pay grade. All I care about is that is works. I think the provider/physician you end up with, and how much they care about you is the most important. That has a lot of luck involved.

[Icare dixit]

People matter most, indeed. But organisations, external forces and structures, influence people. But there are sure pros and cons to any healthcare system. Sufficient funding might be what matters more (I believe it does).

[Icare dixit]

Does anyone (in the UK) think the NHS is deliberately being sabotaged, by lack of sufficient funding and quasi-privatisations, by the current government to dismantle it?

I mean, it's like a (PR/propaganda and financial) war. It's no coincidence that the NHS was so promoted during the Olympic opening ceremony.

[zepchic]

Hmmm...I think everyone should have healthcare and no one should be excluded. Though I can't speak to the best way to accomplish this. I really appreciate the fact that I can actually go to the gp, therapy, pdoc. We live below poverty line and prior to obamacare I only had coverage when pregnant...though didn't actually use it to have my babies, we paid out of pocket for a (unlicensed) midwife because the hospitals are so f'd up.

[Icare dixit]

What do you think of the strike?

[Anxiousvalkyrie]

Living in Sweden I have a very strong opinion on public healthcare. Even well funded healthcare systems struggle from obscene wait times and other problems. Unfortunately right now I don't have the constitution to get into the debate. Perhaps I will feel up to it another time.

[Icare dixit]

Waiting lists would mean underfunding. I do think it's healthy to have some: it puts prevention higher on the agenda.

However, bureaucracy should be fought continuously: it can use up all the funds. There should be a cap on overhead costs.

Some artificial market dynamics might be useful. But no competition for money, but for ideas on how to improve. More lean.

[Anxiousvalkyrie]

The problem in Sweden isn't underfunding, it's lack of healthcare professionals. They don't want to come here because it's not as lucrative a career as they could have elsewhere. Swedish doctors will even admit to this.

We have had a bit of a strain on all social systems lately as a result off the influx of refugees who aren't working or paying taxes. But wait times were a problem even before that.

It's not uncommon for unionized government employees to become lackadaisical at their jobs. Doctors here are underpaid and generally do the bare minimum to treat you when possible, or refer you back and forth to other doctors so you are not their problem. For example, I have really severe endometriosis. I had surgery 9 time in the United States resulting in a total hysterectomy. Now after being given too high a dose of estrogen in Swden I am having a bad recurrence. To the point that it has messed up my intestines so they barely function. I need surgery to fix it. I've seen six different surgeons. All of them have denied me the procedure I need. Why? According to my primary care doctor (who is not Swedish) surgeons in Sweden will look for any excuse to not do a complicated or lengthy procedure. If your condition is not life threatening they send you back to your primary care physician. Their suggestion on how to deal with my condition? Pain control and 'hoping it goes away'. I have to take morphine twice a day to function. If I were in the states I would have been able to ah the procedure already and wouldn't be doomed to take narcotics for the foreseeable future. Sure the System in the US is also horribly flawed but I would trade it for government healthcare just to ease the length of my suffering.

[Icare dixit]

I believe that a public healthcare system can be something to be very proud of.

As long as it's publicly championed by the public and politicians, efficient, there isn't much bureaucracy, people doing the actual work are respected and they don't have to work insane numbers of hours, the pride and comfort is enough to keep them working in the public sector.

Underpaid doctors would mean underfunding.

Mass migration will destroy all public services. And that's exactly what those in power want: destruction of the welfare state.

I do understand how you could care less in your situation, but needless procedures/treatment can also be very damaging, always risky and sometimes lethal. Take us: do we need all these drugs all the time?

[Anxiousvalkyrie]

I think in theory government healthcare is an excellent idea, but practical applications just do not work like one would hope they would in the real world. Politics, greed and other side effects of human nature make a totally successful public healthcare system nothing but a dream.

I totally agree that needless procedures / treatment can be damaging but there are a large number of people out there not getting needed treatment for absurd reasons. That's where I have a problem.

I always get into arguments with people I know back in the states about public healthcare. Many of them think it is the avenue towards the best healthcare for everyone, which just simply isn't the case. Many of them have utopian dreams of how it should work, but none of them have actually experienced it for themselves.

[Icare dixit]

It's very good value for money.

It's money that's the problem.

Edit:
And I have experience with it.