I think that Medicine, aswell as other basic infrastructure like roads and water, should be in the hands of the gouvernment.

Cuba has one of the highest doctors:patient ratios in the world, and this means that even without a huge investment of money and technology, patient care is some of the best in the world.

I've never been to cuba, but it is investment in education which makes the difference here. More time with a doctor or more choice of which doctor you go to can only benefit patients. The fact that Cuba has socialised health care also means doctors could be given incentives to reduce costs - reduce illness - rather than being paid per ill person.

I don't know if this is actually the ideal, but theoretically it should be much better than what i've seen at home.

Despite the trade embargo, which must hurt drug imports and what is available to cubans in terms of their health care.

In some ways the trade embargo strengthens the Cuban government as any threat from outside makes the people more likepy to support their own government; any 'bad stuff' which happens in Cuba can be blamed on the US government rather than the Cuban authorities... (similar to North Korea in many ways... But Cuba has a very different culture)

@redhouse - a question regarding market vs government;

If the government offers to pay incentives, then a market still exists - it is just skewed by the demand (from the government) for good outcomes, for reduced incidences of the worst diseases, whether heart disease, or smoking related illness, or whatever other area a modern western government might want to prevent.

With doctors still having the power over what services they sell to achieve these goals and patients still having the choice of which service to use.

So do you accept a model which can have the benefits of both with tue downsides of neither? (though my model may only be an example and is not a perfect system by any means, i hope it serves to discredit the false dicothemy of choosing between one OR the other.)

I think a nation that claims itself to not only be among the first-world but "the hope of the world"--as BOTH candidates repeatedly described the United States as this past beauty pageant, er, election season--has a duty to its citizens to make sure their basic essentials are met.

But I DO mean the basic essentials--

No one should go hungry in America...
No one should be homeless...
No one should be unable to receive health services when their lives or livelihood depends on it...

But that doesn't mean such state-run options should be exorbitant or excessive.

No one should starve--but unfortunately, state-supplied food is likely to be poor and cheap in quality.
No one should be homeless--but shelters are hardly enviable living conditions.
No one should be refused medical services--but that doesn't mean they'll always be top notch.



There should and must remain a balance between the private and public sectors--

It is the duty of the public sector of government to give the basest safety-net of care...

It is the role of the private sector to offer improved quality versions of that care at their own prices, albeit with regulations (ie, not allowing someone onto a health plan because of pre-existing conditions simply isn't fair if they're willing to pay for it the same as anyone else.)

Such is my moderate take, and like most moderate takes...

I suppose everyone will take issue with a part of it and none will agree.

But then, if I were agreeable, I wouldn't be Obi, now, wouldn't I? ;)

@orathaic, I'm just not sure yet about this issue, so I think I'll await further discussion on your question re: government emulation of market.
@obi, I disagree re: hungry, homeless. I believe the market for food and housing are pretty good AFAIK, but medicine I don't know. Also, you use too many enters: please condense.
@Partysane, I tentatively agree with you on that.

@redhouse, i would not characterise it as emulation, i think that like a well regulated market the government can, no even must, act within the market.

So regulation biases the market in some way by placing costs on breaking the regulations (prohibition making it a large cost) and government purchase of health care can - if done correctly - still allow freedom of choice which is neccesary for a market system. That places the government as a customer, a part of the market who is making purchases in the interest of the public.

As such i actually object to Obiwan's description of the role of government - i think a minimal role results in a class division which hurts society and further biases the health care in such a way (if all the best doctors want to work in high paid positions) that the poor need more health care and costs for them are above average - this is a bad outcome for society.

I'm talking about community based incentives - so if an entire area benefits from less illness then all the doctors get a bonus. Thus the doctors interested in making the most should spend their time targetting the poor and least healthy.

Similar arguments could be made for housing - that living in a shelter actually makes it harder to find a job and escape from poverty. Thus government plicies like this have a negative impact on social mobility.

The poor need better quality or service and opportunity not worse.

The same argument could be made for education, food, or any other basic provision. Though the simple fact is i argue for a flat bacis income for all - thenn anything you earn on top of that is taxed, but you get to keep the majority of your hard labour. A simple system to ensure all people can afford the services they need and prevent them becoming a drain on society (whether that is their kids being difficult in schools, the crime rate associated with some people having more than others, or the health care costs associated with homeless people who are more likely to develop expensive chronic illnesses)

This is also a mixture of communist and capitalist. Free market controp of what is produced and who demands what, but a basic income for everyone to survive.

"i think a minimal role results in a class division which hurts society and further biases the health care in such a way (if all the best doctors want to work in high paid positions) that the poor need more health care and costs for them are above average"

I agree with you fully there, they should have better healthcare.

But I do temper my idealism with realism...

And, at least for the time being, when ANY government healthcare and aid is such a challenge to legislate and get going here in America, we must settle for this modest start and get at least some care through to them before we improve the service.

An expanded role, or expanded care, someday, may be plausible, and in my view (to at least some extent) is certainly desirable.

But for the present, we have to take what we can get, as it were.

Well Obiwan, we're not talking about realistic things here. We're talking about the more general case.

What you want for tomorrow and what could be an ideal system may be very different things.

If there's a system out there that can cure my cold I'll vote for it.

then vote for research into immunology.

@ redhouse

"I once saw this movie by Michael Moore which I found manipulative"

Haha that made me laugh. God forbid Michael Moore would make a manipulative, propagandist movie. But I am glad you recognize it for what it is, redhouse.

@ obiwanobiwan

"No one should go hungry in America...
No one should be homeless...
No one should be unable to receive health services when their lives or livelihood depends on it..."

Where do you get the money for all of that, obiwan?

Fidel Castro banned Mores movie from Cuba because it painted such a rosey picture of Cuba's healthcare. The doctor in the movie was Castros personal doctor, and hence why it looked so nice.

Que?

I don't find the quality of Cuban healthcare suprising. The main factor is the human capital. While medicine is one of the most prestigious careers in any country, it is especially attractive in an embargoed socialist country. If you are in opposition to the ruling ideology, you can automatically discount most social sciences from your list of potential education since those are always affected the most by ruling ideology. This draws students to areas like engineering or medicine, as those are taught the same way everywhere. Furthermore, with non-existent private sector, the brightest youngsters won't be setting up start-ups (because they can't) or immediately climbing the corporate ladder (since promotion is mostly based on seniority) but are forced to study, an another source of excellent students. Also, in a country where travelling abroad is not exactly easy yet the doctors are one of the most valued exports, being a doctor opens the doors to the outside world, where you can make a direct impact by helping people and saving their lives. So despite coping with worse funding and equipment, Cuban doctors are on average recruited from more elite section of population and are also more motivated. Since the quality of work is always affected mainly by the people doing the work, better doctors beat better equipment on any day and that's why Cuban healthcare system punches way above its proverbial weight.

Interesting ulytau, very interesting contributions from all of you. How about Canada?

I don't know anything about Canadian healthcare. No one knows anything about Canada. Nothing ever happens there so no one cares.

Okay. I think there are two key issues in 21st century medicine.
1. Prevention and age
2. Administrative costs
I read a little something about the Canadian health care system and it seems it tackles both. Given the terrible plans of the new Dutch government regarding health care, we should implement it pronto.

The point is that you can't combine the private sector and the public sector like we've foolishly done in America, because all you get is one massive clusterfuck of bureaucracy and expensive healthcare.