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I'm not clear how any healthcare system is supposed to be "self-sustaining" in the sense it is always going to be a cost factor - whether those costs are paid for privately or publicly through taxes.  "Self-sustaining", and patient funded are not the same thing. Also, as medical science progresses and populations age, there seems to be a remorseless trend towards higher total costs - but would you prefer to have have bigger cars or better healthcare?

Of course there can also be service inefficiencies and cost inflation, but what evidence I have seen appears to indicate that public service ethic led healthcare systems tend to deliver better healthcare for more people for less cost than private profit centred systems do - which invariably seem to cherry pick what services they deliver to what patients based on their profitability, whilst leaving the public sector to pick up the tab for the rest.  

Certainly I would want my doctor or hospital to be motivated by concern for my health rather than concern for their profit margins, and merely relying on their "professional ethics" to guarantee optimised healthcare doesn't cut it for me.  Why have a perverse incentive to maximise profitable treatments when my best treatment might be highly unprofitable and yet still expect doctors to choose the latter course?

notes from no w here

by Frank Schnittger (mail Frankschnittger at hot dotty communists) on Mon Dec 14th, 2009 at 11:41:41 AM EST
[ Parent ]
And I certainly agree with you on the ethic part, my interrogation was rather about the fact that it tends to be too expensive for the society. It strikes me in a weird way in its similarity with the TGV: superb trains, but more and more costly, tickets more and more expensive (if we set aside the reductions) and I suspect, soon unaffordable for the John Doe, who might end up asking for his old Corail back. Unfortunately the same cannot be said about the healthcare - you can't want to be treated like in the 19th century. But since many speak these days about overproduction, overconsumption and so on, it rather looks to me like most of our modern western life attributes are in reality quite unaffordable. (and as an aside, those who ask for support from the west, don't really realize how fragile the west in reality is, alas..)

Free at last! Free at last! Thank God Almighty, we are free at last! (Martin Luther King)
by ValentinD (walentijn arobase free spot frança) on Mon Dec 14th, 2009 at 06:12:18 PM EST
[ Parent ]
In which fictional alternative universe are electric trains unaffordably expensive?

- Jake

If you only spend 20 minutes of the rest of your life on economics, go spend them here.

by JakeS (JangoSierra 'at' gmail 'dot' com) on Mon Dec 14th, 2009 at 08:48:37 PM EST
[ Parent ]
In the Ryanair world of exploiting workers, gaining market share and delaying price hikes until you have gained a near monopoly of key routes.

notes from no w here
by Frank Schnittger (mail Frankschnittger at hot dotty communists) on Tue Dec 15th, 2009 at 06:57:46 AM EST
[ Parent ]
I should add, exploiting children. The last time I flew Ryanair, I thought the personnel was made up of school children.

Free at last! Free at last! Thank God Almighty, we are free at last! (Martin Luther King)
by ValentinD (walentijn arobase free spot frança) on Tue Dec 15th, 2009 at 03:18:12 PM EST
[ Parent ]


notes from no w here
by Frank Schnittger (mail Frankschnittger at hot dotty communists) on Thu Dec 17th, 2009 at 03:13:29 PM EST
[ Parent ]
In the fictional alternative universe in which airports don't receive public subsidies. (Incidentally, the Spanish Government just declared that only the airports at Madrid and Barcelona are profitable)

En un viejo país ineficiente, algo así como España entre dos guerras civiles, poseer una casa y poca hacienda y memoria ninguna. -- Gil de Biedma
by Migeru (migeru at eurotrib dot com) on Tue Dec 15th, 2009 at 07:19:33 AM EST
[ Parent ]
I did say TGV, did I not.

By the way, I like clean seats, but I hardly ever need all that sophisticated lighting, the air conditioning, or the bar wagon. That looks more and more like a train for those Serious People swissshhhing from Paris to Brussels to London - or off to the Côte d'Azur.

Free at last! Free at last! Thank God Almighty, we are free at last! (Martin Luther King)

by ValentinD (walentijn arobase free spot frança) on Tue Dec 15th, 2009 at 03:24:28 PM EST
[ Parent ]

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