Is health insurance immoral?

Ticking and Bashing

I think if people want to spend their money on health insurance then so be it.

What's immoral about health insurance is the high degree of confusion surrounding health insurance. (1) vast number of products with confusing titles, (2) difficulty to make direct comparisons with competitor products, (3) difficulties in understanding products including policy, cover, excesses, and waiting periods. I believe there's a significant number of people who don't fully understand the level of cover they have at the point of sale / renewal and subsequently when it comes to making a claim.

Sean.3516

Dorakman wrote: »

I hear a lot of people harp on about the 2 tier health system. How is private practice coexisting with public healthcare such a bad thing?

It isn't a bad thing at all. Private healthcare is a tremendous thing. When it comes to healthcare the three things we want to maximise are: (1.) accessibility, (2.) affordability and (3.) quality. Neither the public system or the private system alone can give you all three but a mixed system might be the best we can do.

If the system were fully public, we would have (1.) but not (2.) or (3.). Affordability is an issue because in a fully public system, you pay through your nose on taxes. Middle class tax rates in Denmark are upwards of 60%. Quality is an issue because in public systems healthcare rationing is inevitable hence waiting lists. You also don't have access to the most cutting edge medicines and procedures due to lack of innovation in the sector when the profit motive has been eliminated.

If the system was fully private, you would have (3.) but not (1.). With (2.) affordability, it's hard to say for sure. If the only way to get healthcare is through private companies, then those companies will inevitably lower their prices in order to compete for customers. But there may always be a minority of people who are left without healthcare or with substandard healthcare because they can't afford the plan they need.

If we're looking at this purely in terms of efficacy, both systems have their flaws and advantageous but a system combining the two may be the best.

There's also the basic libertarian argument in favour of private healthcare. ie. I have a right to my own labor therefore if I wish to invest my labor in building a healthcare service and if others wish to invest their labor in using my service on a voluntary basis then we should be able to do that.

Sean.3516

mikhail wrote: »

I have no problem with private healthcare and private health insurance so long as the public system provides a good baseline cover. The ****e US system can't be allowed creep in.

The US has brilliant healthcare but a bad healthcare (system). The reason healthcare is linked to your employer is thanks to a holdover from World War Two, believe it or not, when wage controls meant that employers started paying for people's healthcare because they couldn't give them a pay rise.

In terms of the quality of the care itself the US is one of the world's leading countries. If you have cancer, you don't want to be anywhere else.

There's a case to be made that we could improve our overall quality if rather than having the government being the one administering care in the public system through the HSE, we instead just had the government subsidise the private companies for the care of people who can't afford healthcare as is done with MediCare/MedicAid. The premise being that private companies are just better at doing healthcare. AFFORDABILITY is the main issue.

cython

piplip87 wrote: »

We have a highly subsidised public health system. The maximum anybody can pay publicly for approved treatment in a hospital is 800(may have changed since I worked on HSE accounts).

Where as if a private patient presents at the public hospital this subsidy is no longer exists. So by having private healthcare you are saving the state money on your healthcare.

That's a slight but significant oversimplification. If a patient with private insurance is receiving the same treatment/facilities (i.e. public ward, etc.) in public treatment as a public patient, then hospitals have to ask patients with insurance to waive their treatment being publicly funded. There is no obligation on patients to do this, and in the event that they don't, then the insurer only has to cover the outpatient levy (which is the capped fee you outlined), while the HSE foot the rest of the bill as they would for a public patient.

Health insurers have, for the last few years, been actively canvassing their customers to not sign this waiver, citing it leading to increased premiums. Personally I'm of two minds on the matter; on the one hand someone with insurance could unburden the system financially, but on the other hand they're likely paying their share of taxes and just as entitled to the treatment. The insurers, either way, will nail both sides with impunity when they can!

The real benefit of insurance is in non-emergency cases anyway. If you attend A&E in a public hospital, you'll be treated under the same system regardless. If, however, you need a referral for something less urgent, going private funded by insurance is a godsend.

blackbox

Spend your money how you choose.

Health insurance
Children's education
Cigarettes
Betting
Holidays

It's your money, your choice.

SEPT 23 1989

Heart attack stroke and certain children's A & E

They have the treatment of these running perfectly

If they could only extend this success out to the rest of the system

boombang

As long as the freedom to buy healthcare with your own resources (directly or through insurance) remains, then at least some element of two tier will remain. I don't see that freedom going anywhere, so, in my view, anybody that said we're going to a single tier is naive or lying. Despite that, I think as close to a single tier is desirable.

Regarding the comment "I thought everyone was for Slaintecare", I think the plan is vague enough to allow everyone to agree. If they really got down to making a realistic, detailed plan then there'd be no consensus. Expect the consensus to vanish once any hard questions emerge.

Regarding the notion that healthcare has been effectively nationalised: that's as about as meaningful as saying I own villa in the South of France because I rented one for a holiday.

jimmycrackcorm

Fred Cryton wrote: »

It's not a bad thing. it's just petty jealousy and envy from the SF & welfare dependents who want middle class people to have to wait in line with them. They can't see that public sector inefficiencies are what is causing the problem in health in the first place.



They want to bring the rest of us down to their level. The word spiteful comes to mind.

It's the same ideology that suggests that private school fees should be banned as it gives some people prepared to pay an advantage. It does give richer people an advantage, but equally, it gives people of ordinary lesser means a chance to prioritize their children's education over paying for brand new cars.

A ban on private healthcare would create a negative effect like banning private schools fees. In the latter case, it means bringing everyone down to the same level but does not bring anyone up. So no improvement for anyone, and particularly in the education sector, it means the state has to pay more in pupil capita payments, so costs us all more.

Spiteful is accurate because it pulls down everyone.

boombang

School fees aren't a good analogy in the Irish case as the state pays for education in private schools and private payments top up. I've no problem with private payments, once you're fully outside a public system.

Sean.3516

boombang wrote: »

School fees aren't a good analogy in the Irish case as the state pays for education in private schools and private payments top up. I've no problem with private payments, once you're fully outside a public system.

To what extent does the state fund private schools? I never knew this was the case.

the_syco

mickdw wrote: »

It should however be priced at a level where people with average wage / pension should be able to afford it.

It can be. But I've found health insurance to have several tiers itself.

Health insurance can cost €30 or it can cost you €100. The €30 was through the company I worked with at the time, but reading through it didn't really get you that much. The VHI plan that I was paying €100 a month for had a load of benefits.

I view it like retirement funds. Everyone gets a state pension, but those who put money aside for it can get to retire better.

boombang

Sean.3516 wrote: »

To what extent does the state fund private schools? I never knew this was the case.

As far as I know the state pays teachers' wages (the majority of the cost of running most schools). I think this is grossly unfair and can only persist because Irish middle classes somehow never seem to raise in policy discussions. I think that tells us a lot and about the likely prospects of a significant single tier health system.

boombang

Plenty of tiers within private health insurance. There currently are 307 different adult health insurance packages on sale in Ireland, each with a different cost and level of benefits.

Sean.3516

boombang wrote: »

As far as I know the state pays teachers' wages (the majority of the cost of running most schools).

But I thought that the reason private schools do better is because of superior teachers (who are payed more). Does the private fee pay them on top of their state wages?

ILoveYourVibes

Its unfair some people don't have access to the best healthcare. We are all human.

But i dont think if you go get health insurance you are a bad person. I have it and I am grateful. I would like if it just wasn't even questioned that everyone had it though.

the_syco

Sean.3516 wrote: »

Does the private fee pay them on top of their state wages?

Mostly no. Some are even paid less; https://www.irishtimes.com/news/education/private-school-teachers-are-treated-like-second-class-citizens-1.2594344

L1011

the_syco wrote: »

It can be. But I've found health insurance to have several tiers itself.

Health insurance can cost €30 or it can cost you €100. The €30 was through the company I worked with at the time, but reading through it didn't really get you that much. The VHI plan that I was paying €100 a month for had a load of benefits.

I view it like retirement funds. Everyone gets a state pension, but those who put money aside for it can get to retire better.

€100 plans these days are surprisingly sparse in what they cover.

The state charging insurers for their patients hospital costs was something they never really expected and really ramped up premiums.

jimmycrackcorm

boombang wrote: »

School fees aren't a good analogy in the Irish case as the state pays for education in private schools and private payments top-up. I've no problem with private payments, once you're fully outside a public system.

Sean.3516 wrote: »

To what extent does the state fund private schools? I never knew this was the case.

boombang wrote: »

As far as I know the state pays teachers' wages (the majority of the cost of running most schools). I think this is grossly unfair and can only persist because Irish middle classes somehow never seem to raise in policy discussions. I think that tells us a lot and about the likely prospects of a significant single-tier health system.

Sean.3516 wrote: »

But I thought that the reason private schools do better is because of superior teachers (who are paid more). Does the private fee pay them on top of their state wages?

I don't want to sidetrack this into a discussion about private schooling. Only to make an analogy as we have a similar comparison given the base public system in both. But it seems a lot of people don't understand how private schools work. The government pays teachers salaries in both systems. This is correct because there is a duty on the government to provide schooling for all children regardless of status. But private schools don't get per capital payments to fund buildings/gymnasiums etc. so private money from parents funds that. Parents are also basically funding extra teaching hours and other curricular activities. That's their choice.

If we banned private schooling then the government would be on the hook for this extra expenditure and there would be none of those extras. So no one would get any benefit.

Likewise in public health, banning private healthcare does not improve anything one iota. Private hospitals add extra capacity where private patients can take advantage of them instead of clogging up the public system. If, for example, we had banned private hospitals form the start to only have a single-tier system, then we'd have much less bed capacity than we have now. We'd have longer queues, because there is a false narrative in believing that private patients are somehow less sick than public patients.

Theres also an imaginative belief that the money paid to the private system will somehow go toward the public system to compensate. But this is a ridiculous idea. It will simply go to pay for ski holidays, or maybe, for private schooling, if we don't ban that also.

jimmycrackcorm

L1011 wrote: »

€100 plans these days are surprisingly sparse in what they cover.

The state charging insurers for their patients hospital costs was something they never really expected and really ramped up premiums.

I refused to sign the wiaver form that the hospital gave me to allow them to charge my insurer 800 per night instead of the public fee of 80. It's a rip-off and as a taxpayer, let alone a citizen, I should be equally entitled to state services without being overcharged.

Geuze

Sean.3516 wrote: »

To what extent does the state fund private schools? I never knew this was the case.

Just be careful with language here.

All primary schools are private, typically owned by churches.

(There are a few State-owned VEC/ETB primary schools)

Most secondary schools are private, excl VEC/ETB.

The State pays the wages of all teachers in all schools.

the_syco

L1011 wrote: »

€100 plans these days are surprisingly sparse in what they cover.

Yeah. A few years back I got a private room for a few days when I broke the elbow, so it wasn't that bad. I know it's not great, but it's (VHI Company plan) awesome compared to the €30 thing that the company at the time was giving to my colleagues at the time, who thought it was awesome.

hatrickpatrick

Yes, it is indeed immoral. One's wealth should have absolutely no bearing on the quality of healthcare one can access.

Yellow_Fern

hatrickpatrick wrote: »

Yes, it is indeed immoral. One's wealth should have absolutely no bearing on the quality of healthcare one can access.

I dont agree. If you are a billionaire yes its ethical to have your own private doctor. I just struggle to understand why this is wrong? How come your principle doesn't apply to food and water, or does it? The rich can obtain the finest organic food monitored for trace toxins, perfectly matched to your body composition but the poor can't.

Strumms

When I got ill, I had let my health insurance lapse, biggest mistake ever...
Without it, the access to the intensive treatment which I needed just wasn’t available. I was linked up to a private rehabilitation / fitness organization through pure fortune, a mutual contact shall we say. Public is a fûcking joke in this country, i cannot stress it enough, brilliant ‘frontline’ staff, doctors, physios, nurses, carers, but ‘access’ to post treatment care of a rehabilitative nature is only generally accessible with piles of cash otherwise...

hatrickpatrick

Yellow_Fern wrote: »

I dont agree. If you are a billionaire yes its ethical to have your own private doctor. I just struggle to understand why this is wrong? How come your principle doesn't apply to food and water, or does it? The rich can obtain the finest organic food monitored for trace toxins, perfectly matched to your body composition but the poor can't.

I don't approve of that either. As far as I'm concerned, the only things to which access should be based on wealth are life's luxuries; Necessities for living should be universally accessible and backed by public funding.

Antares35

hatrickpatrick wrote: »

I don't approve of that either. As far as I'm concerned, the only things to which access should be based on wealth are life's luxuries; Necessities for living should be universally accessible and backed by public funding.

The public health service is backed by public funding - mostly from the tax of those who opt for private healthcare.

Dorakman

hatrickpatrick wrote: »

I don't approve of that either. As far as I'm concerned, the only things to which access should be based on wealth are life's luxuries; Necessities for living should be universally accessible and backed by public funding.

My taxes help prop up the HSE. I’ve health insurance, which I pay extra for, in order to get private care. Is that not fair?

salonfire

hatrickpatrick wrote: »

I don't approve of that either. As far as I'm concerned, the only things to which access should be based on wealth are life's luxuries; Necessities for living should be universally accessible and backed by public funding.

Nurses didn't think much of the necessities for living walking out on cancer patients during an immoral strike.

Urethral Buttercup

Is private health insurance immoral? Yes, absolutely. In principle, everyone should receive the same level of care regardless of wealth. Everyone should contribute to the health care system through taxes and that should be the end of it.

Geuze

Urethral Buttercup wrote: »

Is private health insurance immoral? Yes, absolutely. In principle, everyone should receive the same level of care regardless of wealth. Everyone should contribute to the health care system through taxes and that should be the end of it.

It seems you are implying that the provision and sale of healthcare be made illegal, outside of the HSE?