fair share meets galt's gulch

paul wheaton wrote:

Tyler Ludens wrote:I'm doubtful about how effective this strategy will be.  To me it looks like "get poor and die."  

Perhaps you can paint a picture of what you think would be a lovely community model?

Probably something like national or regional/state health care.  I'm not sure a small community can muster the resources to deal with major health crises.  

I don't have a real good personal answer for this problem.  It is one thing I worry about much of the time.  My plan is to just die, I guess, because I'm not going to let my family get poor, once we lose our insurance.

There is a meme going round on facebook comparing the medical systems in europe and the USA bacically what it reports is the number of people going bankrupt in the USA because of medical bills and those in UK France etc . Its lots in the USA and zero in these other countries .
I define working in care systems as covering the whole population and providing a high standard of care, it can be done and is being done in a large number of countries .
How do other people define it ?
When you have a system based on competition you always have winners and losers .

David

Regional solutions are not unpermacultural.  See Chapter 14 in the Big Black Book.  In my region there are power and telephone cooperatives.  If people felt like it, there could probably be health cooperatives.

David Livingston wrote:There is a meme going round on facebook comparing the medical systems in europe and the USA basically what it reports is the number of people going bankrupt in the USA because of medical bills and those in UK France etc . Its lots in the USA and zero in these other countries .

In the UK they call what happens an "Individual Voluntary Arrangement" or IVA(as opposed to a "Company Voluntary Arrangement" or CVA). This is explicitly classified as NOT a bankruptcy(which is a court procedure). However it functions in the same way as the Chapter 13 bankruptcy, only done under a non-court insolvency practitioner. In France and Spain, defaulting on your mortgage(personal or business) is not considered a bankruptcy. So for countries where official bankruptcy is much more ruinous, mortgage defaults(or other secured debt) are more common. In the US it is easier to file for bankruptcy, so there is less need for non-bankruptcy alternatives like other countries have. The US also has explicit protections for home mortgages, even in the case of bankruptcy.

In most places around the world, a primary cause of personal bankruptcy is losing their job. Lets say you have been out of work for 6 months and then you file; this reason is categorized as "Job Loss". You get sick, rack up medical bills, then lose your job because the company can't keep you on sick leave definitely; this is categorized as "Medical Bankruptcy" due to the large medical portion of the debt.  If you default on your Spanish mortgage, this is not counted in the same way. Just be aware that just because they don't have medical debt, doesn't mean the same problems don't exist. It is not uncommon for people in the UK to pay out of pocket for treatments not covered by the NHS. American complaints about the inefficient medical system are usually filed under the "Greedy Insurance Companies" category, whereas British complaints are filed under the "The Government Sucks" category.

The core problem still exists, which is this...
The medical care available to extend the life of a sick person has an unlimited demand. In order for the provider of the medical care to remain solvent, limits must be placed on care.

This is true for individuals, families, and governments. This falls squarely under the Third Ethic regarding limits to growth and distributing surplus.  The only questions that need answering are these:

Who decides what the limits to my care are?

Who's surplus will I be consuming when I am sick?

What is my responsibility to the previous groups?

Hi Bill
Very interesting but to me not relevant the point remains folks are made bankrupt because they cannot pay their medical bills in the USA but not in europe.
As for the fear that some ones care may be open ended in practical terms this never happens people die I think to suggest otherwise implies some people are immortal . People die for medical reasons not because they are poor , thats the whole point ; You never know it could be you.


David

Getting back to Pauls analogy I was cutting the hedge yesterday and I saw a flock of Redwings and Feildfares . These are members of the thrush family that migrate from the Arctic, Scandinavia to central and Southern Europe . I realized that my boundary is artificial. What I do here affects places far away weather its the arctic or southern africa, where my summer swallows are enjoying the heat while we freeze.
For nature there are no boundaries what happens here is reflected else where if there are problems elsewhere they can have effects here ,I may put up boundaries but in the grand scheme of things they are irrelevant.  We are part of a wonderful dynamic web of life that covers the planet and should recognise this .I could not fence it in or out .
The same applies to economics I have decided not to get another smart phone because they use a mineral from the congo and this trade is behind the misery of the population there .I doubt any human is totally self sufficient any more and if any ever were , there is always trade, exchange and changes going on even if its "just " ideas  . It is possible to see this we  can even see this in the neolithic where it has been realised that red ochre and flint were found hundreds of miles from where they were dug up they did not get elsewhere by accident  . A couple of weeks ago there was a report on the BBC about a new tribe being discovered in the Amazon however they already had Chinese made axes and other tools they had traded for .
I doubt anyone  lives in isolation and that no one ever did.. I think what we consume and our other actions as individuals and nations has consequences and results and we need to be aware of this not ignore it as the results could rebound on ourselves. Particularly on the international stage for instance what the CIA refers to as blow back .
I do not believe selfishness is a virtue as some would say it is in my view self defeating and shortsighted.  A world based on altruism respect for my fellow beings and nature where my connectedness is implicit and celebrated, recognised and enjoyed. A world based not on distrust and self but on love and hope.

David Livingston wrote:The point remains folks are made bankrupt because they cannot pay their medical bills in the USA but not in europe.

Rebutting this statement was covered in the first part of the post. I am not making a statement that Europe and America have the same problem, just in different forms. I am making a statement that coarse comparisons of European and American systems often miss the mark because they are not comparing the same things. People of modest means in the UK and the US will both become insolvent if they try to access an expensive cancer treatments. This manifests differently in each country, but accessing the fundamental resource is still constrained by the ability to pay. The only difference is who pays, when do they pay, and how much do they pay.

In the US:

You get the treatment at the hospital.

You get a bill for the portion the (already expensive)insurance won't cover.

You struggle to pay until your finances are completely shot.

You file for the court insolvency process known as Chapter 11 bankruptcy.

In the UK:

You go to the NHS GP to get the doctor to recommend the treatment.

You find out the treatment you want is not available on the NHS.

You appeal to the NICE committee, which decides which treatments are "worth" offering on the NHS. Your treatment request is eventually denied.

You must purchase the treatment yourself overseas. Overseas because if the NHS won't pay for it, often the treatment isn't even offered privately in the UK.

Your financial situation deteriorates until you file for an IVA. IVAs are a private insolvency process that is not classified as a bankruptcy.

Socialized health systems are subject to exactly the same resource constraints as private ones. They manifest in private systems as uneven, missing, or expensive coverage. In socialized systems they manifest as treatment approval committees(like NICE in the UK), long waiting times, rationing, and periodic bouts of benefit/welfare reform to keep the health systems solvent.

David Livingston wrote:As for the fear that some ones care may be open ended in practical terms this never happens people die I think to suggest otherwise implies some people are immortal .

In 1860, the only treatments for cancer on offer were ether, scalpel, and a bonesaw. You could offer these services to everyone quite cheaply. Today there are hundreds of different cancer treatments that can be tried, each costing a few thousand to a few million. So long as SOMEONE is willing to pay, a person now has the capacity to consume millions in cancer treatments. The only limits are the number of treatments on offer, and the willingness of someone to keep pumping resources into providing them. That is what I mean by unlimited.

A community or family voluntarily giving their surplus to support a sick member of the community is NOT ethically equivalent to demanding(or forcing) that a community give their surplus to support a sick person who is not a member of that community.  My willingness to give to members of my community is the measure of how much I value I place on the interactions with them. The community or individual has no right to claim more.  I don't have to justify giving or denying someone my surplus. "Because I NEED your resources..." is not a good enough argument. That seems to be the core of the Third Ethic argument that Paul was making.

In the UK:
You go to the NHS GP to get the doctor to recommend the treatment.
You find out the treatment you want is not available on the NHS.
You appeal to the NICE committee, which decides which treatments are "worth" offering on the NHS. Your treatment request is eventually denied.
You must purchase the treatment yourself overseas. Overseas because if the NHS won't pay for it, often the treatment isn't even offered privately in the UK.
Your financial situation deteriorates until you file for an IVA. IVAs are a private insolvency process that is not classified as a bankruptcy.

I am sorry Bill but I am from the UK and what you describe is so bizarre I dont know where to start ; As we speak my sister is being treated for cancer . The care and services she is receiving are wonderful  .
She and our whole family and friends trust the doctors to do the best they can . She has had many scans, six weeks of chemo and is due for an operation on the 17th Jan She has even had meetings with a personal trainer and dietitian  to keep her fitness levels up. Since you are not British I really would like to know where you are getting your misinformation from .
Let us start from the top
You go to the NHS GP to get the doctor to recommend the treatment- not true alas .
You find out the treatment you want is not available on the NHS- Note "you want" not what the doctor says
I find it a bit strange that your doctor would recommend treatment you cannot get on the NHS why would he or she do this, in actual fact the procedure is that your GP refers you to a consultant and it is the consultant who decides your treatment not you it is they who are the experts .
You misunderstand the role of NICE here is some guidance from Cancer research UK http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/what-is-nice-and-how-does-it-work
about what NICE does.  This is from an independent cancer charity .

NICE’s main responsibilities are to

   Assess new drugs and treatments as they become available
   Provide evidence based guidelines on how particular conditions should be treated
   Provide guidelines on how public health and social care services can best support people
   Provide information services for those managing and providing health and social care

NICE considers whether a treatment

   Benefits patients
   Will help the NHS meet its targets, for example by improving cancer survival rates
   Is value for money or cost effective

Once NICE issues its guidance, NHS trusts must find the money to make those drugs or treatments available. NICE doesn’t give any extra money, or advise on how to find the money.

When making decisions, NICE asks for expert advice from

   Medical and other health professionals
   Patients, carers and people using social care services
   Patient and carer support organisations
   Drug companies

You may wonder why have NICE well and I suspect this will shock you but the NHS has discovered that we cannot trust  big Pharma , they over hype and over charge for  there products, shocking I know and they use  ill people to emotionally blackmail the NHS to pay for over hyped stuff  . Also stuff like this https://www.theguardian.com/business/2016/dec/07/pfizer-fined-nhs-anti-epilepsy-drug-cma
Plus they pay for propaganda against the NHS I suspect .

As for the cost and insurance well the UK does not trust the insurance companies nor do we fancy paying for the premium lifestyles of their COEs
thats why the NHS cost about about half per person of the population than the american system and unlike the american system it covers 100% of the population . Yup its obligatory frankly tough if you hate it that much then go and live somewhere else. WHO figures put the costs at Americans spend $8,362  per capita on healthcare annually, the Brits spend $3,480.  (2015 figures likely to be a bigger difference due to currency fluctuation now  )
Please I know the NHS is not perfect but in my and my family's and friends experience you seem to be describing some dystopian version not reality Have a look at this from someone who has tried both systems http://www.businessinsider.fr/uk/comparison-uk-nhs-v-us-private-heathcare-2015-1/
.

David

Locking this thread.

Y'all might wanna copy and paste your points about health care and elder care to a thread in the cider press.

I think I wanna take parts of this thread and start a new thread on this topic.