Government considering mandatory health insurance

Mucco

The overwhelmingly negative opinion of the proposals on this thread have got me questioning why the government have not made a better effort of explaining the proposed system.

Up to now, I have been disappointed that the government have not used the crisis as an opportunity to tackle the health care issue. Now that they attempt to, everyone is negative, I'm not sure why.

I think most people would agree that the current health system is far from ideal: the proposed system is intended to introduce incentives to improve quality of health care provision, and also maybe improve cost-effectiveness.

The incentives firstly include patients having a choice of insurer, and ensuring changing insurer is easy. Therefore the insurers have to actively compete for clients. The minimum healthcare package is to guarantee that the insurers don't reduce quality in order to offer cheaper prices.
Secondly, the insurers will be encouraged to selectively contract hospitals. Again, the aim of this is to improve the quality of care - evidence from the Netherlands shows that insurers only drop contracts where they can prove the quality is sub-standard, otherwise they get a reputation for being cheap, and lose customers.

Tony EH

And all that for just 1600 a year per person.

Which is a lot more than the current VHI plan B cost, which will no doubt rocket when the government basic tax is brought in.

Great.

AlexisM

Mucco wrote: »

Up to now, I have been disappointed that the government have not used the crisis as an opportunity to tackle the health care issue. Now that they attempt to, everyone is negative, I'm not sure why.

Those who don't currently have health insurance are concerned that they will be forced to pay for health insurance - even if it means a better service as they will move up to an 'average' (public/private) level of service.

Those who currently have health insurance are concerned they will have to pay more - and for a worse service as they will be dragged down to an 'average' level of service.

So who 'wins'? - Those who will be exempt from paying (who are most likely currently exempt anyway) - they'll get a better service for free.

Not really scenarios that will give most people the warm and fuzzies...

Godge

AlexisM wrote: »

Those who don't currently have health insurance are concerned that they will be forced to pay for health insurance - even if it means a better service as they will move up to an 'average' (public/private) level of service.

Those who currently have health insurance are concerned they will have to pay more - and for a worse service as they will be dragged down to an 'average' level of service.

So who 'wins'? - Those who will be exempt from paying (who are most likely currently exempt anyway) - they'll get a better service for free.

Not really scenarios that will give most people the warm and fuzzies...

Exactly and that is the problem.

This system will cost more and it seems that the middle/upper classes will be asked to pay more tax or health insurance for it.

Mucco

AlexisM wrote: »

Those who don't currently have health insurance are concerned that they will be forced to pay for health insurance - even if it means a better service as they will move up to an 'average' (public/private) level of service.

Those who currently have health insurance are concerned they will have to pay more - and for a worse service as they will be dragged down to an 'average' level of service.

So who 'wins'? - Those who will be exempt from paying (who are most likely currently exempt anyway) - they'll get a better service for free.

Not really scenarios that will give most people the warm and fuzzies...

I think your reply has proven my point: the government don't seem to want to explain this proposal well, hence many people are against it.
Currently, everybody pays for the health service through their taxes, whether they choose to top up with PHI or not. Per capita expenditure on healthcare in Ireland was greater than the UK in 2011 (source: OECD), so we should expect a good system with this money, but that's obviously not what we've got.
The proposed system incentivises quality and efficiency improvements through insurance company and hospital choice, whereas the existing system, financed through taxation and block grants offers no such incentives.
Everybody is jumping on this 'extra' 1600 cost. I doubt the per capita expenditure will increase dramatically, so, in theory, taxes should be reduced by the same amount - though this remains to be seen.

GCU Flexible Demeanour

Mucco wrote: »

<...>- evidence from the Netherlands <...>

What the evidence from the Netherlands mostly shows is the planned reform doesn't work.

http://www.nejm.org/doi/full/10.1056/NEJMp1106090

Advocates of this system argued that competition among private insurers would reduce health care spending, enhance consumer choice, and improve the quality of care and the health system's responsiveness to patients <...> The reality of managed competition in the Netherlands, however, has not matched the rhetoric.

<...> competition has not sharply slowed the rate of growth in health care spending. Health care expenditures continue to outpace general inflation, having increased at an average annual rate of 5% since 2006. At the same time, the total costs of health insurance for Dutch families, including premiums and deductibles, increased by 41%. According to Statistics Netherlands, in 2010 the country spent 14.8% of its gross domestic product on health care and welfare (including long-term care and other social services).

Reforms aimed at increasing and managing competition also produced high administrative costs and complexity. Administering premium subsidies for low-income people has proven expensive. More than 40% of Dutch families now receive such subsidies — and the national tax department hired more than 600 extra staff members to check incomes each month and calculate the value of the vouchers.

Jolly Red Giant

AlexisM wrote: »

Those who don't currently have health insurance are concerned that they will be forced to pay for health insurance - even if it means a better service as they will move up to an 'average' (public/private) level of service.

Those who currently have health insurance are concerned they will have to pay more - and for a worse service as they will be dragged down to an 'average' level of service.

So who 'wins'? - Those who will be exempt from paying (who are most likely currently exempt anyway) - they'll get a better service for free.

Not really scenarios that will give most people the warm and fuzzies...

No they won't - all the evidence indicates that the health system will actually deteriorate if UHI is introduced - and costs will spiral out of control.

noodler

zielarz wrote: »

@GCU Flexible Demeanour
Thanks for explaining what that government levy is. You're right. I don't support it since it's unfair. It rises costs for young people who require less care.

With this proposal they're going after younger workers who were smart enough to cancel their policy. I canceled and I am saving over 100 euro/month on income taxes. They're going to force me to insure now. That's why I believe this proposal is unjust.

I just think whats really unfair is VHI being stuck with all the higher aged, higher risk folk just because they were here first whilst other companies come in later and cream the younger customers.

If the elderly can't afford health insurance, then we would simply pay for it indirectly as the HSE's would have to look after them in the public system.

I, like many others, love the idea of equality in health insurance but I really hope the Government get it right first time. It doesn't even matter greatly what is included in the upcoming white Paper, there are so many consultations and revisions to take place over the next few years that the original proposal will bear little resemblence to what is finally implemented.

Godge

noodler wrote: »

I just think whats really unfair is VHI being stuck with all the higher aged, higher risk folk just because they were here first whilst other companies come in later and cream the younger customers.

If the elderly can't afford health insurance, then we would simply pay for it indirectly as the HSE's would have to look after them in the public system.

I, like many others, love the idea of equality in health insurance but I really hope the Government get it right first time. It doesn't even matter greatly what is included in the upcoming white Paper, there are so many consultations and revisions to take place over the next few years that the original proposal will bear little resemblence to what is finally implemented.

Where the mistake was made was not to allow loyalty or length of service bonuses.

At the moment if you don't pay health insurance until you are in your 50s you pay the same as someone who has paid since their 20s.

A loyalty discount would encourage people to start younger.

noodler

Godge wrote: »

Where the mistake was made was not to allow loyalty or length of service bonuses.

At the moment if you don't pay health insurance until you are in your 50s you pay the same as someone who has paid since their 20s.

A loyalty discount would encourage people to start younger.

Agreed, it looks like a carrot and stick is being seriously considered in the short-term by the Government in this regard though.

allenup

if other countries do it ireland should follow suit! anyone earning over 100000 say should be omitted from it!

GCU Flexible Demeanour

There's a good economic argument against an insurance model, grounded in the fact that demand for health insurance is price inelastic.

But I've a feeling this is what will actually sink this plan is the fact that we actually don't have a shared belief in access to healthcare on the basis of need. We believe in a safety net for the poor, but equally believe people should be able to pay for better and faster access. We have a two tier system, because we believe that to be right.

http://www.independent.ie/lifestyle/health/opposition-grows-to-plan-for-universal-healthcare-30161443.html

<...>More than two million people have health insurance but under Health Minister James Reilly's plan they will not be able to avoid waiting lists.

Almost nine out of 10 people (88pc) who currently pay for cover say they don't want to queue for treatment, according to a new poll by Red C.<...>

Reilly's UHI plan effectively means that current private health insurance premiums will be used to buy care for those deemed to have the most critical health needs, rather than provide care for the people actually paying the premiums.

It's actually quite an extra-ordinary position for Fine Gael to the advocating. I can't see FG voters being slow to express their disagreement, now that they are starting to understand what UHI means.

_Kaiser_

Hmm.. Seems Denis O'Brien is buying a hospital...

THE BUSINESSMAN DENIS O’Brien is to take over the Beacon Private Hospital in Sandyford, Dublin.

Nothing to do with his FG friends pushing mandatory UHI at all I'm sure. Wasn't he getting write-off's only last year?

creedp

Kaiser2000 wrote: »

Hmm.. Seems Denis O'Brien is buying a hospital...



Nothing to do with his FG friends pushing mandatory UHI at all I'm sure. Wasn't he getting write-off's only last year?

Didn't the company he bought, which coincidently got awarded one of the contracts to install water meters just after he buying it, receive substantial write-downs in its debt also prior to him buying it? Lots and lots of innocent coincidence there obviously. Makes you wonder .. is it better to be born lucky or smart!

hmmm

Everyone seems to be nodding and looking pleased that this will "end the system whereby some pay for quicker access to healthcare".

What no-one is saying, because it is politically incorrect, is that those people who pay the taxes, who don't have medical cards, who pay for their doctor visits, who get up in the morning and go to work, perhaps should get priority access to healthcare.

GCU Flexible Demeanour

hmmm wrote: »

Everyone seems to be nodding and looking pleased that this will "end the system whereby some pay for quicker access to healthcare".

What no-one is saying, because it is politically incorrect, is that those people who pay the taxes, who don't have medical cards, who pay for their doctor visits, who get up in the morning and go to work, perhaps should get priority access to healthcare.

What Reilly is depending on is the impossibility of anyone actually putting their name to that statement.

_Kaiser_

Looks like Leo is putting this one on the back burner ...

The Minister for Health is delaying the introduction of the universal health insurance scheme.

It is currently supposed to be in place by 2019, but Leo Varadkar has now decided that date is too ambitious.

Can't say I disagree with the decision, but I wonder what's REALLY going on?

Jim2007

_Kaiser_ wrote: »

Can't say I disagree with the decision, but I wonder what's REALLY going on?

Well as someone who lives in a country that operates a similar system, I'd say it is a missed opportunity. Because the system works - in 20 years I've never heard of nor experienced having to wait for an appointment, admittance to hospital etc... And on the two occasions I had to bring the kids to A&E with we were seen within 15 to 20 minutes.

Princess Consuela Bananahammock

Jim2007 wrote: »

Well as someone who lives in a country that operates a similar system, I'd say it is a missed opportunity. Because the system works - in 20 years I've never heard of nor experienced having to wait for an appointment, admittance to hospital etc... And on the two occasions I had to bring the kids to A&E with we were seen within 15 to 20 minutes.

Is there a direct coorelation though?

harpsman

Princess Consuela Bananahammock wrote: »

Is there a direct coorelation though?

Exactly-how is everybody having insurance going to change work practices in the HSE?

This is basically gouging another grand in tax/levy/charge/compulsary insurance from people-given that the government have committed to reversing the Haddington Road "savings" how much of this money will disappear into salaries,allowances etc

Geuze

harpsman wrote: »

Exactly-how is everybody having insurance going to change work practices in the HSE?

The current 2-tier system means most doctors face incentives to NOT treat patients.

They get paid a fixed annual wage + private practice fees.

So they have an incentive to devote less time to public patients and treat more private patients.

This means longer public waiting lists.

With UHI, every patient means a payment to the doctor/hosp, as central Govt block grants will be reduced/abolished.

So hosps/doctors will be keen to treat all patients, as all patients will have UHI, and "money will follow the patient."

seamus

Geuze wrote: »

With UHI, every patient means a payment to the doctor/hosp, as central Govt block grants will be reduced/abolished.

So hosps/doctors will be keen to treat all patients, as all patients will have UHI, and "money will follow the patient."

Are there any examples of the UHI model working in other countries?

My primary concern here would be the (mis)adage that when everybody has health insurance, then nobody has. Will this actually result in a better service in our hospitals, or just a poorer service overall as more people (i.e. those currently paying health insurance) are brought into the "public" system?

What's to stop the second tier from just raising the bar again so that the likes of the Beacon and Blackrock place themselves in a position where they're not covered by the basic UHI packages, but are covered by more expensive packages from the insurers?

Geuze

Geuze wrote: »

The current 2-tier system means most doctors face incentives to NOT treat patients.

They get paid a fixed annual wage + private practice fees.

So they have an incentive to devote less time to public patients and treat more private patients.

This means longer public waiting lists.

With UHI, every patient means a payment to the doctor/hosp, as central Govt block grants will be reduced/abolished.

So hosps/doctors will be keen to treat all patients, as all patients will have UHI, and "money will follow the patient."

In theory that is true, but not in reality, I have seen the same consultant in both the public system and the private system cant talk about all consultants but the one I saw works very hard and long hours and the private client's are not treated differently by her, they are seen in a different place. There is noting to stop anyone in the new system buying a policy as an extra to the state one which would give you greater choice and accesses to consultant who only work in the private sector.

Geuze

seamus wrote: »

Are there any examples of the UHI model working in other countries?

France, Germany, Belgium, NL all have UHI, well AFAIK.

The UK and Scan countries tend to have tax-financed healthcare.

Geuze

seamus wrote: »

My primary concern here would be the (mis)adage that when everybody has health insurance, then nobody has. Will this actually result in a better service in our hospitals, or just a poorer service overall as more people (i.e. those currently paying health insurance) are brought into the "public" system?

What's to stop the second tier from just raising the bar again so that the likes of the Beacon and Blackrock place themselves in a position where they're not covered by the basic UHI packages, but are covered by more expensive packages from the insurers?

The division between "public" and "private" hosps won't be important under UHI.

All patients will have UHI, so all hosps will accept UHI patients, unless they want to closedown.

Yes, Blackrock Clinic may offer single rooms, en-suite, which won't be covered by UHI. Yes, people will be free to buy top-up ins to cover that.

hmmm

_Kaiser_ wrote: »

Can't say I disagree with the decision, but I wonder what's REALLY going on?

Probably just sensible management in dealing quickly to address an unsustainable timeline. It will take 2 years to commission a few reports which will detail how the plan will work in the Irish system, 2 years to agree an implementation plan and schedule, and 5 to 10 years to implement. We'll be lucky to have this in place by 2024, and more realistically you're looking at 2030 for full implementation.

It will also avoid the political problem of telling the taxpayer, who is paying for everything, that the only difference they will see is higher premiums and they will now be made to join the same waiting list as those paying nothing in tax. Which hasn't been noted by commentators but will become a big issue when the details are announced.

dissed doc

_Kaiser_ wrote: »

Looks like Leo is putting this one on the back burner ...



Can't say I disagree with the decision, but I wonder what's REALLY going on?

Nothing is going on, nothing ever was. Reilly only ever came up with decision he took himself, but completely without costing, discussion,e tc., . LIke the free GP care - never a word to the GPs.

There is no mystery or secretive meetings taking place. Nothing has happened because.....nothing has actually taken place

Reilly made announcements usually to distract media attention from some other government problem.

Jim2007

seamus wrote: »

Are there any examples of the UHI model working in other countries?

Switzerland and The Netherlands are the closed to what is proposed.

seamus wrote: »

My primary concern here would be the (mis)adage that when everybody has health insurance, then nobody has. Will this actually result in a better service in our hospitals, or just a poorer service overall as more people (i.e. those currently paying health insurance) are brought into the "public" system?

To survive a service provider (doctor, hospital etc...) has to do two things very well attract patients and be very cost efficient. This is because the only source of income is the patients you attract and since you can't increase prices you need to control costs.

seamus wrote: »

What's to stop the second tier from just raising the bar again so that the likes of the Beacon and Blackrock place themselves in a position where they're not covered by the basic UHI packages, but are covered by more expensive packages from the insurers?

Nothing and everything! Where is the incentive to pay for a second insurance if the one you have to pay is delivering a good service??? In 25 years here in Switzerland, I've never heard of anyone going to a private hospital - there are in fact few and they mostly attract patients from abroad.

I think for the post part the Swiss experience has been that will it has slowed down the cost increases it has not in fact reduced the costs. But it has resulted in a good standard of healthcare with very few waiting lists.

Jim2007

harpsman wrote: »

This is basically gouging another grand in tax/levy/charge/compulsary insurance from people-given that the government have committed to reversing the Haddington Road "savings" how much of this money will disappear into salaries,allowances etc

No, I don't think so - in the type of system being proposed, the central government element is very small as it is only responsible standard setting,
ombudsman services and perhaps some kind of quality audit function. It would in fact become a small department with limited budgetary powers - perhaps this is why the new minister is being steered away from it???

The hospitals, doctors, insurance partners and so on are responsible for their own administration costs, so now big government department needed. And to be successful these providers need to attract and keep patients by providing good quality services and low costs.

i don't believe the overall cost would fall much but I do believe the level of service would improve dramatically because the money will be pointed at provision of service to the patient, not other areas like admin etc...

Jim2007

hmmm wrote: »

Probably just sensible management in dealing quickly to address an unsustainable timeline. It will take 2 years to commission a few reports which will detail how the plan will work in the Irish system, 2 years to agree an implementation plan and schedule, and 5 to 10 years to implement. We'll be lucky to have this in place by 2024, and more realistically you're looking at 2030 for full implementation.

Hanging concentrates the mind! If a hospital or other health service provider was told it has two years to get it's act together of face closure, they'd figure it out. It is amazing what can be achieved when people have the right incentive.

harpsman

Geuze wrote: »

The current 2-tier system means most doctors face incentives to NOT treat patients.

They get paid a fixed annual wage + private practice fees.

So they have an incentive to devote less time to public patients and treat more private patients.

This means longer public waiting lists.

With UHI, every patient means a payment to the doctor/hosp, as central Govt block grants will be reduced/abolished.

So hosps/doctors will be keen to treat all patients, as all patients will have UHI, and "money will follow the patient."

Yeah but doctors arent the only people who work in the irish health care system. There are lots of other staff whos work practices wont change.

_Kaiser_

I fail to see how forcing everyone to pay for mandatory health insurance would improve anything when those who want/can afford to can still buy "priority" access to the system the same as they can now.

Like Water charges it's merely yet another tax by another name, except the gullible electorate seem to see a distinction between a non-optional "charge" and an income tax hike.

Speaking for myself I don't have health insurance because I don't need it at this point in my life - which is a good thing really as I couldn't afford it anyway!! As it stands I only go to a doctor as a last resort (I don't even have a "regular" GP) and haven't been in a waiting room in about 3 years because I can't afford to waste money like that.

I actually make more (gross) than ever, but net I have less than I did years ago because of the extra taxes, charges, levies and cost of living hikes. I also have a child to support who doesn't live with me but at the other end of the country.

The idea that I could just stump up a few grand or whatever for this shyte is a fantasy and I certainly won't be paying it if it ever comes to pass.

Jim2007

_Kaiser_ wrote: »

I fail to see how forcing everyone to pay for mandatory health insurance would improve anything when those who want/can afford to can still buy "priority" access to the system the same as they can now.

Well first of all you can't buy priority because providers can't operate in both markets. And again why would you want to buy priority if there is practical no waiting list any ways?? Also there would not be much motivation for a provider to opt out, the market would be too small and provision of services would very expensive. This was a very radical proposal and can not be compared to the current situation.

Jim2007

_Kaiser_ wrote: »

The idea that I could just stump up a few grand or whatever for this shyte is a fantasy and I certainly won't be paying it if it ever comes to pass.

But you are already stumping up the money as part of your social security taxes. The health insurance is instead of, not in addition to your current deductions. The big difference is that your preferences in providers will impact where the cash gets allocated rather that the block grants today.

K-9

_Kaiser_ wrote: »

I fail to see how forcing everyone to pay for mandatory health insurance would improve anything when those who want/can afford to can still buy "priority" access to the system the same as they can now.

Like Water charges it's merely yet another tax by another name, except the gullible electorate seem to see a distinction between a non-optional "charge" and an income tax hike.

Speaking for myself I don't have health insurance because I don't need it at this point in my life - which is a good thing really as I couldn't afford it anyway!! As it stands I only go to a doctor as a last resort (I don't even have a "regular" GP) and haven't been in a waiting room in about 3 years because I can't afford to waste money like that.

I actually make more (gross) than ever, but net I have less than I did years ago because of the extra taxes, charges, levies and cost of living hikes. I also have a child to support who doesn't live with me but at the other end of the country.

The idea that I could just stump up a few grand or whatever for this shyte is a fantasy and I certainly won't be paying it if it ever comes to pass.

It's probably best for you and society in general that you shouldn't be worrying about the cost of a GP visit.

Geuze

_Kaiser_ wrote: »

I fail to see how forcing everyone to pay for mandatory health insurance would improve anything when those who want/can afford to can still buy "priority" access to the system the same as they can now.

Incorrect.

It will be illegal for insurers to sell insurance that offers faster access under UHI.

One waiting list for all patients - no priority access.

Geuze

_Kaiser_ wrote: »

Like Water charges it's merely yet another tax by another name, except the gullible electorate seem to see a distinction between a non-optional "charge" and an income tax hike.


The idea that I could just stump up a few grand or whatever for this shyte is a fantasy and I certainly won't be paying it if it ever comes to pass.

Note that UHI will replace tax-financed spending.

The overall costs of healthcare shouldn't change.

So taxes will fall by 5-6bn, to be replaced by UHI.

Your tax bill will fall, as the Govt will no longer be funding hosps.

_Kaiser_

Geuze wrote: »

Note that UHI will replace tax-financed spending.

The overall costs of healthcare shouldn't change.

So taxes will fall by 5-6bn, to be replaced by UHI.

Your tax bill will fall, as the Govt will no longer be funding hosps.

In theory, however history has shown us that what the Govt giveth with one hand, they taketh away with the other.

It's the same way as they bleat on about how Income tax hasn't increased - but VAT, and all these non-optional charges and levies more than make up for it.

I wouldn't trust the bunch of teachers, publicans and lawyers we call a government to manage the finances of a sweet shop, never mind the entire economy!

Godge

Geuze wrote: »

Note that UHI will replace tax-financed spending.

The overall costs of healthcare shouldn't change.

So taxes will fall by 5-6bn, to be replaced by UHI.

Your tax bill will fall, as the Govt will no longer be funding hosps.

When you read it like that, it sounds great. However, you are missing one big point. Those on lower incomes and social welfare will not have to pay for their health insurance - the government will cover it.

Inevitably, as health insurance costs rise, there will be a bigger burden on taxpayers to pay the health insurance for the less well-off.

To sum up, if you are working and paying tax, your bill will increase.
If you are on lower income or social welfare, you will get a better service.

Now, this is not a bad thing. However, as with every government policy, there are the unintended consequences to think about. This will be mainly a further reduction in the incentive to work.

K-9

Godge wrote: »

When you read it like that, it sounds great. However, you are missing one big point. Those on lower incomes and social welfare will not have to pay for their health insurance - the government will cover it.

Inevitably, as health insurance costs rise, there will be a bigger burden on taxpayers to pay the health insurance for the less well-off.

To sum up, if you are working and paying tax, your bill will increase.
If you are on lower income or social welfare, you will get a better service.

Now, this is not a bad thing. However, as with every government policy, there are the unintended consequences to think about. This will be mainly a further reduction in the incentive to work.

I thought the idea is that the less well off do pay a minimum amount?

Seems fair enough to me. I know PRSI is more for SW in this country but it's massively under funded, then we have the USC which was basically an emergency tax which looks like it will be permanent. Really, people under about €350 a week pay no PRSI and even up to about €5/600 the deduction isn't that much.

Godge

K-9 wrote: »

I thought the idea is that the less well off do pay a minimum amount?

.

http://www.imo.ie/policy-international-affair/overview/White-paper-on-Universal-Health-Insurance.pdf

Nope, read from page 78 onwards. The financial support for UHI (i.e. covering the cost for the less well off) will be funded from general taxation - tax rises on the way!

Varadkar is a low tax politician - he will want to look at this again.

K-9

Godge wrote: »

http://www.imo.ie/policy-international-affair/overview/White-paper-on-Universal-Health-Insurance.pdf

Nope, read from page 78 onwards. The financial support for UHI (i.e. covering the cost for the less well off) will be funded from general taxation - tax rises on the way!

Varadkar is a low tax politician - he will want to look at this again.

When I heard Leo got it my first thought was, well that's the end of UHI then. Laudable idea, but they've seen how difficult it was to get even free health care for U-6's so I don't think the fight is there, especially with 2 years to an election.

Godge

K-9 wrote: »

When I heard Leo got it my first thought was, well that's the end of UHI then. Laudable idea, but they've seen how difficult it was to get even free health care for U-6's so I don't think the fight is there, especially with 2 years to an election.

They would have to take on the GPs, raise taxes for the middle-class (significant increases for the young who currently have no health insurance at all or for those whose employer pays for it) and also reform the health care system to be able to deal with multiple health insurance companies as well as attract the requisite number of insurers to Ireland.

Imagine if the cost went up significantly and say Aviva pulled out of the market. massive risk going into a general election for a policy that may be unaffordable.

Jim2007

Godge wrote: »

When you read it like that, it sounds great. However, you are missing one big point. Those on lower incomes and social welfare will not have to pay for their health insurance - the government will cover it.

Inevitably, as health insurance costs rise, there will be a bigger burden on taxpayers to pay the health insurance for the less well-off.

No you are the one this is missing the point! Whatever department would be responsible for health sets the max prices for the services, so taxes would only rise if the government decided to put up the prices - not a popular option for a politician.

Also the cost of administering the system for low income citizens would be much cheaper than the current system, because all it requires is a once off payment each year. There after it is up to the service providers to carry the costs of administration and the only way they can be successful is if they keep that admin cost as low as possible.

And furthermore the total cost would not change very much, it the direction that the money goes that changes and the incentive to manage that money in a cost effective way.

Jim2007

Godge wrote: »

They would have to take on the GPs

You are right, it would require a ratical change in the healthcare policy. But the equation is very simple, provide a good service, attract patients or go out of business. Any GP who provides a crappy service will find his patient list dwindling very quickly because people will simply switch to some other provider.

Godge wrote: »

...raise taxes for the middle-class (significant increases for the young who currently have no health insurance at all or for those whose employer pays for it)

The healthcare element of your social taxes would disappear, so the change would not be as drastic as you suggest.

Godge wrote: »

also reform the health care system to be able to deal with multiple health insurance companies

No, you simply pull the plug on it! The insurers and the services providers are responsible for the admin costs not the state. It is in their interests to keep the costs down because the fees are capped.

Godge wrote: »

as well as attract the requisite number of insurers to Ireland.

Imagine if the cost went up significantly and say Aviva pulled out of the market. massive risk going into a general election for a policy that may be unaffordable.

There are over 100 insurance companies offer healthcare policies under such a system here in Switzerland and in 24 years I've never heard of one of them going bust or pulling out of the market and yet the have to accept all comers, preexisting conditions etc... and the still make money. So there is definitely money to be made|

hmmm

Jim2007 wrote: »

No you are the one this is missing the point! Whatever department would be responsible for health sets the max prices for the services, so taxes would only rise if the government decided to put up the prices - not a popular option for a politician.

Not possible. The price of the service is the price of the service, and no government Minister would get to set this.

E.g. if a heart transplant costs 50k, and the department sets the price at 10k, no hospital would offer the service.

And furthermore the total cost would not change very much, it the direction that the money goes that changes and the incentive to manage that money in a cost effective way.

I agree that it would be great to remove the HSE, and get private hospitals competing with each other. However, I see it causing large tax rises for the middle class, who would lose their ability to leapfrog waiting lists. There has to be some incentive for the people who pay everything in this country to sign up for this scheme, and at the moment I'm not seeing it. It would be great for the "entitlements" crowd who draw the dole, have their free house and get quick and free access to healthcare as well.

quadrifoglio verde

_Kaiser_ wrote: »

In theory, however history has shown us that what the Govt giveth with one hand, they taketh away with the other.

It's the same way as they bleat on about how Income tax hasn't increased - but VAT, and all these non-optional charges and levies more than make up for it.

I wouldn't trust the bunch of teachers, publicans and lawyers we call a government to manage the finances of a sweet shop, never mind the entire economy!

Income tax hasn't increased, but they snuck in a hefty income tax of up to 7 % in the form of usc.
The amount of people who don't realise that USC is an extra income tax is astounding. It replaced both the health and income levy, which were just income tax in another way, but easier to get out of people

Tony EH

hmmm wrote: »

It would be great for the "entitlements" crowd who draw the dole, have their free house and get quick and free access to healthcare as well.

FFS :rolleyes:

Who are these people, because I'd like to join that group. TBH, those words make you just sound like a bitter shite.

UHI is a bad idea, because this is precisely what will happen.

It'll start off at 1600 a year (as was the figure put forward) and like all bills in this country, will be subject to upward only changes. A very large number of people already have given up VHI, because they cannot afford the cost of private health insurance, so they won't be paying the bigger cost of the proposed UHI.

That means that there will be offers of other packages that will be lower in cost, but won't have the cover of the 1600 package. This means that inevitably there will be people in some very serious situations, as they'll either end up in crippling debt for their ops, or just won't be able to get them, leading to horrific scenarios.

At present, if you are a citizen of the state, you are entitled to free health care and that SHOULD stay as it is.

We absolutely DO NOT WANT an American style health care system in this country where those that can pay do and those that cannot are fucked.

comongethappy

Tony EH wrote: »

At present, if you are a citizen of the state, you are entitled to free health care and that SHOULD stay as it is.

Welcome to Ireland.... I hope you enjoy your stay..... Obviously if you were more than a visitor you would know that health services are not free.

(Or can you tell me why they keep asking for money when I visit them?)

We absolutely DO NOT WANT an American style health care system in this country where those that can pay do and those that cannot are fucked.

Like it or not, the systems are very similar
- large body of privately insured patients.
- large group of elderly & unemployed paid for by the state.
- some in the middle who pay cash.

Its just the costs are higher in the US.

robp

comongethappy wrote: »

Its just the costs are higher in the US.

Interesting point. The fact that the US system has been consumer driven has created an absolutely superb standard of care but it also has created terribly excessive and frivolous additional costs which are not in their interest.