Enrique Diaz-Alvarez wrote:
>
> Mathew Forstater wrote:
> > Public sector activity should not be judged by the same criteria as private sector activity.
> Of course not. Nobody is saying it should. But the fact is that
> resources _are_ limited, even for the public sector. All universal
> health care systems, for example, have to make tough allocation
> decisions, which means that some people who need operations get them
> right away, others have to wait for years, and others will never get
> them. An efficient system, as I see it, does this in a way that
> maximizes the general health and well being of the population for a
> given amount of expenditure.
Resources are not, in fact, limited. Not in the U.S. and not in Canada. Universal health care systems must make allocation decisions - but those decisions are only tough if government funding is not adequate to begin with.
What's at work here - and at stake here - is the right wing propraganda that economies, budgets, money etcetera behave according to some kind of immutable law and therefore things are the way they are just because that's the way things are, when in reality budgets, economies etcetera are tools devised by humans: to govern the flow of trade, goods, or labour, or to ensure equity of qual;ity of life, or minimum living standards, or whatever, but they are products of a process of prioritization. Therefore, they are subject to change by society. change the priorities from ensuring "efficiency" in the cost-benefit or cost-effectiveness sense to ensuring that everyone gets thehealth care they need, when they need it. The economy will conform.
The struggle is to convince people of that. See below.
Enrique Diaz-Alvarez wrote:
> Marta Russell wrote:
> Consider also that the reason universal
> > health care is rationed is because the capitalists still control the means of production for
> > health care.
>
> That's true of the Canadian system, were the profit motive has only been
> removed from health insurance, not health delivery. As a result, the
> Canadian system is fairly inefficient, although not as much as the US
> disaster. I think it consumes 12% of national income, the second highest
> rate in the world.
Canadian health expenditures 1996-97 - 1, 189 million
Canadian Federal revenue - 153, 769 million
That's 7.75%. But who's counting?
> In other socialized medicine systems, such as Spain's and the UK's (I
> think), hospitals and clinics are built and run by the government.
> Doctors are government employees, and budgets are allocated by
> government bureaucrats. The profit motive is completely removed, and
> these systems are vastly more efficienct, consuming about 6% of
> respective national incomes and delivering equal or better access to
> health care.
In the Canadian system hospitals and clinics are built and run by the government, octors are paid by the government, and busgets are allocated by government bureaucrats.
However "efficient" these systems are, the fact is that people are dying because they can't get hospital beds. Increase the percentage to 12%, please! Ten years ago this wouln't be happening - because no-one placed "efficiency" anywhere on the totem pole of performance of the health care system.
Enrique Diaz-Alvarez wrote:
> Jessica wrote:
> > Well, I would argue that cost should take a very low
> > position on the priority list when it comes to evaluating "efficiency" in the public sector.
> > No, on second thought I still think it has no place in that consideration whatsoever - at least
> >in countries like the U.S. and Canada. There isplenty of wealth in these countries.
> I completely disagree, Jessica. This 'regarless of cost' attittude is
> one of the reasons why even socialized health care is grossly
> inefficient in the US (although not nearly as much as private health
> care, of course). Medicare spending, for example, is heavily skewed
> towards the last few weeks of life. This leads to absurdities like the
> US having the worst child inmunization record in the industrialized
> world, while it pays for complicated surgery on 84-year-olds out of
> taxpayer money.
If I take your logic far enough I can make it suggest the way to improve health care - socialised health care - is to cut it further.
Max Sawicky wrote in response to Mat (I think):
<< Public sector activity
> should not be judged by the same criteria as private sector activity.>>
>
> I'm talking about social benefit, not narrow
> private benefits, as per standard welfare
> economics. In this framework, it should be
> clear why private, self-interested organizations,
> particularly business firms, are intrinsically
> ill-suited to providing public services.
I agree.
>
> A basic prejudice harbored by the public with
> respect to government is that it is indifferent
> to cost, that it would help everyone to any
> extent without regard to taxpayer wishes.
> "The heart is bigger than the wallet," the
> conservatives like to say.
Depends on the government.
>
> Rejecting any efficiency criteria with vague
> talk about the wealth of society reinforces
> this prejudice; it says the advocates don't
> care about the after-tax incomes of ordinary
> people. It's silly, since any semi-conscious
> worker knows that it is not, by and large, the
> rich who are going to finance public services.
> It's the worker.
But the talk about the wealth of society doesn'thave to be vague. It shouldn't say "the advocates don't> care about the after-tax incomes of ordinary> people." It should say," look at all these specific examples of corporations on the government dole and not paying any tax. Why are we paying for their profits?"
> O.K. Suppose something costs $1 million, but
> it provides some measure of "social well-being."
> How do we decide whether to buy it, rather than
> some other source of such well-being, or rather
> than higher after-tax incomes, another type of
> social well-being?
Let's use concrete examples. Should we "buy" health care or should we "buy" accessible post-secondary education? Or welfare? The answer is, we "buy" them all. In the short term, they should be paid for through taxes - levied progressively. That doen't mean more taxes for the working class, or even for the middle class.
> I'm interested in your paper too.
Me, too.
> >We should not hang ourselves with the rope of "efficiency."
>
> We're swinging by the privates right now,
> because the public thinks we want to tax
> them into penury to buy them stuff they
> don't want for people they don't like.
>
> Even for liberal trade unionists, I have
> found, expanding the public provision
> for social well-being is not an easy sell.
> All the more reason to demonstrate (and
> live up to) a commitment to social efficiency.
I have found the opposite. It's pretty easy to show the connections between corporate interest, funding cutbacks, privatization, and individual taxes. The arguments just need to be made relevant to those workers.
I can understand a desire to make five pancakes instad of three - but if the batter amount is the same, it all goes to the same place.
Jess