Hi, I am from Barcelona, and I was there. Stallman is a great man. I dont know what happened at the end, but when we were in the talk the organizers told us that the talk is suspended because Stallman was not well. The medical service arrive 20 minutes after Stallman ask for attention. This delay was used by him to say: "Son los recortes, Rajoy nos quiere matar a todos", meaning: The delay is because of the cuts in the spanish health systems, Rajoy (the president) want to kill us". :-).
I came here expecting a troll :) in Europe you don't have to rely on Government for health care: you have an array of options in the private sector, which are usually much better (in my experience) than the US private hospitals since they have to compete with a free and good-enough option.
Most of the population prefer to use the free, government subsidized health system though.
The health system is not free nor is it government subsidised. It is paid for from taxes, which people pay according to their income. There is no additional charge to then use the system other than paying taxes. (IMHO this is a good thing and it is fair.)
In the US it is a complete mess. Half of all healthcare spending is done by the government anyway (Medicare, Medicaid, government employees, army/veterans etc) and hence paid for by tax payers according to their income but not available to most taxpayers. The other half is paid for by charities, individuals, companies and by taxpayers (the government chooses not to collect tax on premiums paid by companies). Add in "insurance" companies which act as middle men between the payments and the healthcare delivery, plus a lot of regulation, and a large number of people whose jobs are to try and increase or decrease payments from the other groups and the whole thing is an unholy mess.
What is the difference between "subsidized by the government" and "paid for from taxes"? Maybe you could draw a distinction if a specific segment of taxes went to healthcare and nothing else, but that seems a thin semantic distinction at best.
The OP wording implied that the healthcare was free and the costs were mostly borne by "them" (the government). Although it is technically correct that the government is the people/tax payers, voter turnout has (mostly) been steadily decreasing. For non-voters the government is "them", not "us".
Everyone is a tax payer. Based on income the amount you may end up paying on your tax return is zero. Of course no one actually ends up paying zero. There are usually sales or value added taxes. Even if those direct taxes do not exist, you'll still pay indirect taxes. When you buy a product or consume a service the amount that goes back to the producer includes money that they then use to pay taxes.
It's not the same in all European countries. I think in the UK it is like you describe. I was quite shocked, however, when I heard about the typical wait times for things like broken teeth or bones (weeks - that was 18 years ago, though, don't know the current state). In Germany there are specific health insurances you have to pick. However it has become mandatory to have health insurance a couple of years ago, and the public insurers may not reject you.
No the UK does not make you wait weeks for broken bones. That would never make sense, because the bone would have healed in that time in the incorrect position, and then require expensive surgery to re-set it. It's so obviously nonsense.
In the UK for serious broken bones is about half an hour to an hour, in my experience. Broken wrist, ribs, elbow, skull, pelvis and ankle, so far. I'd be broke or dead in many other countries by now. The inpatient care can be a bit hit and miss, but A&E is generally awesome.
I can be amazingly stupid when sober, this is true, especially for the first 30 minutes after waking up. But to really screw things up there is normally booze involved.
As for consciously deciding to get drunk when sober, I normally decide to get tipsy. It is when I am tipsy that I decide to get absolutely hammered.
But then again according to statistics, drinkers live longer, have more sex and have higher IQs than teetotallers, plus for most of human history it was one of the few sources of clean water, so is not an entirely stupid activity.
Are the health insurance plans means tested? ie does a millionaire pay the same as someone who is unemployed? Does the government also contribute some money behind the scenes?
In the UK dentistry is not covered by the National Health Service. (More accurately it can be but the vast majority of dentists opt out.)
As for waiting lists the UK did significantly increase spending in order to reduce them. (The UK also had one of the lowest per capita spending rates in the EU.)
However every health system anywhere has to do some form of rationing. There aren't an infinite number of beds, doctors, machines, or money for that matter. When there is some waiting then whatever is being waited on can achieve 100% utilization although queues can easily get out of hand. How to do the rationing is very tricky. Ultimately some value has to be put on human life. Spending $5000 on a course of treatment instead of $100,000 where the latter has 5% better outcomes needs to be decided.
> In the UK dentistry is not covered by the National Health Service. (More accurately it can be but the vast majority of dentists opt out.)
I don't know about the whole country, but in the cities I've lived in recently it's been no problem to get NHS dental care, at least for the basics. I guess I can't fault your words technically, but I think "In the UK dentistry is covered by the National Health Service" would be at least as accurate as your version.
In the cities I lived in in the UK (west London, Cambridge) it was impossible to get NHS dentists and there were very few of them. They even had waiting lists to join. Admittedly this was over a decade ago. Perhaps the intervening years of increased spending has had an effect. Or maybe it is correlated with the cost of living - more expensive areas mean dentists want the higher private income?
The public insurance companies basically all offer the same coverage (defined by laws) for the same price. They used to differ slightly in price but the government made that illegal. Now they try to differentiate on little things, like paying for Yoga classes.
Dentistry can get expensive, as only amalgam fillings are covered by insurance. If you want other fillings (without quicksilver) you have to pay extra.
Europe doesn't have one health care system. There is a large variety in approaches. Most debates regarding reforms seem to quickly deteriorate into FUD about "americanization" rather than meaningful comparisons with other European countries.
I'm nervous about moving to the states because of just that. Here in New Zealand it's easy because we're all guaranteed access to a great public health system, no matter what. You can buy private insurance and expedite certain things if you want, but the public system is always there and available to everyone. Moving to the US and having to deal with health insurance makes me nervous.
That's hardly fair. You might feel anger, or you might feel despair. If you're a misanthrope, you'll feel pleasure in watching who can't afford their medical bills fall into complete financial ruin.
I live in Boston, Massachusetts, where we have universal health care and some of the best doctors and hospitals in the world. They don't have to be mutually exclusive.
I live in Boston too, and I have to say the system does seem pretty good for American citizens and foreigners who are permanent residents; but it's not so hot for foreign families on student visas who are poor by US standards. Schools give health insurance to the student and offer the option of buying very expensive health insurance for the rest of the family, other private health insurance companies won't take the rest of the family without the student signing up as well but the student's school doesn't usually let him or her opt-out of the school's insurance, the goverment run health insurance programs don't take the family because being here for 5 years on a student visa makes them "visitors" and thus ineligible. One affordable but risky option for a healthy family seems to be to not have health insurance and pay for all medical care directly, plus pay the fine for not having the mandatory health insurance --it is a small fraction of the cost of the health insurance.
Massachusetts, not Boston. The way the US is setup each state is different - if you want that kind of health care, you move to Massachusetts. If you want fierce independence there are states that do that, there are states that heavily promote gun ownership, and those that discourage it. Some places have high income taxes, some property taxes, some no taxes, etc.
You can pick where you want to live based on what you like. A state in the US is almost as big as many countries, so you can think of the US as a conglomerate of many countries.
However Massachusetts is having some adverse selection going on as people who otherwise could not afford health care are going there and putting a drain on the system. They are also having a shortage of family doctors.
What is making the states very upset at the current federal plan is that they loose the opportunity to decide for themself how they want the state to run.
Thanks for the clarification. From the outside (I'm from the Netherlands) it is easy to forget the US is made up of many states which still have at least some sort of independence.
Same goes for Europe and its member states I guess.
Or better yet, where if you don't have a job with a group plan you just might find it impossible to get insurance at any cost, and if you pay the medical system directly you'll pay 3 times what the insurance companies pay, and 10 times what you would pay in the second most expensive country in the world.
I wasn't going to respond to this to avoid prolonging this burgeoning off-topic health care flamewar, but I figured that in the name of cross-cultural understanding, I'd correct you:
Hospitals in the US are obligated to treat any emergency patient regardless of whether they can pay.
The problem with that is that emergency care is absurdly expensive. I was in an accident last year that put me in hospital for one night for observation, and I was billed almost $20k. Where illness rather than accident is the problem, people postpone going to a doctor or hospital until they are really ill, even though it would be much cheaper to address a minor illness before it becomes a medical emergency - a stitch in time saves nine, and all that. But people without insurance find access to non-emergency care difficult because of cost, and so the emergency spend half their resources dealing with completely avoidable medical problems.
And even if you do have insurance or the ability to pay, or (AFAIK) if a hospital waives payment for someone indigent, there's still a metric ton of paperwork to be filled out, which makes doing my taxes seem simple and fun by comparison. Don't even get me started on the catastrophically bad state of medical record-keeping.
This isn't entirely true and varies from state to state and hospital to hospital. We had a trip to the hospital last year (non-ambulance, but was an actual emergency). Prior to checking out, we refused to sign anything from the hospital itself until checkout time. (quick sidebar, I've never seen anything as sleazy as an administrator trying to get someone who's heavily sedated and mediated but hasn't been fully diagnosed yet (triage and stabilization only) to sign paperwork related to billing and insurance, and then to authorize a room change to long term and the to an overnight room...all before they even knew what was going on). At checkout time, they had no insurance info...if we had no insurance, they would consolidate the fees from all groups (contracted doctors, anasthesiologists, equipment use, medications, etc.) and waive 2/3 of it and set up a payment plan (non-loan style, so no interest, or fees). This total was lower than if we used insurance and paid what was remaining on the deductible for the year and happened late enough that we wouldn't have benefited from using the insurance. I have no idea if it was attitude, handling it like business, persistence or just how they do business, but it greatly impressed me.
It's coming. The law is a mess, and phasing in slowly. But it passed, and it's real. It will no doubt have to be fixed over the coming decades, but universal health care in the USA is a reality.
But the "lot of money" thing is just reality: health care costs a lot of money, period. And it must be paid. Coming up with a regime to do so without leaving people out or inappropriately burdening them is a hard problem, and frankly no entity, government or private, can claim to have solved it "well".
As I mentioned here (https://news.ycombinator.com/item?id=3955537), living in Boston, Massachusetts, we have the best of both worlds when it comes to access to health care at some of the best healthcare organizations in the world.
I should also add that even if you don't have money, you still have access. I was seen at a clinic at Mass General (http://www.massgeneral.org) recently by making an optional $2 donation.
It can't be, because if it's a fundamental right (read: entitlement) then someone else is obligated to provide that care. So, in a hypothetical world where no one chooses to go into the medical profession, we'd have to put guns to people's heads and force them to become doctors, because, after all, medical care is a "fundamental right." There's an obvious paradox in that.
Medical care is a "right" in the sense that it's something you shouldn't have to ask for permission to seek, but we aren't entitled to it. It's a service that can be provided and bought on the free market like all other services.
That argument is perfect in a theoretical world where no one choose to go into the medical profession. Back in real life, that doesn't happen. At most, you have to hire foreign doctors. So yes, it's a right, which like any other right, it's subject to the constraints of reality.
Real world / hypothetical world / thought-experiment aside, the point stands: treating a service as an entitlement entails imposing an obligation on somebody else to provide that service, OR to pay for that service, etc.
If granting one person a "right" means violating someone else's rights (that is, their right to choose how to direct their energy and the fruits of their labor) then it's unjust.
I don't think it's unjust to make people contribute to society through taxes if they want to live in it. They're free to opt-out from that implicit contract by going to live elsewhere. There's plenty of inhabited places on Earth still.
In any case, rights can and are sometimes eclipsed by others. The idea of natural, absolute rights is just ridiculous.
Yeah, I think me_myselft meant rights in terms of social justice, and not "fundamental rights" in the sense of abstract political philosophy. So many arguments get caught up over semantics and not what people are trying to say.
> It's a service that can be provided and bought on the free market like all other services.
Maybe in a hypothetical world where you can find this hypothetical free market. In the real world, health care can be treated as a fundamental right because there are enough doctors available.
We pay for lots of services that only other people end up using. It's part of being in a society.
When something is reasonably considered optional, ideally and hopefully you aren't forced to pay for other people's partaking of that optional service.
Healthcare is not one of those things. It's optional in the sense that everyone has the option of refusing medical care, even if sometimes that means dying, but it's not optional in that almost every sane person with more than a minor cut or sniffles or food poisoning opts for medical care if it is available rather than the alternative.
Other mandatory goods and services, like food, clothing, housing, city utilities (water/electricity), even internet access, work better in a mostly private model for a couple major reasons. First, the price variance for the necessary part of those goods and services is very low compared to variance for the medical costs someone might incur. Second, a lot of people can afford and want more than the bare necessities. Not so with medical care, where few people can afford major surgery or routine treatments for some major chronic conditions.
Another aspect of medical care is that we benefit even if we're never treated. Do you know anyone who has ever needed significant medical care at a hospital? I doubt your relationship with those people means nothing to you.
Thinking that way, btw, is bound to make you feel bitter. Why should you pay for other people?
Why not think of it as insurance instead (social security)? Less desperate people means less muggers on the street. Less sick people means less risk to get infected yourself. Plus, should you ever happen to fall on hard times yourself (god forbid), you would be provided for.
I believe in selfishness as the best basis for a society, and I still think it is in favor of social security and public health care.
Discussing fundamental rights is bound to be bullshit. The only right that exists is the right of the stronger party (established by guns, majority votes etc). If the stronger party believes x is a right, it is a right. So if a majority of voters in a democracy is convinced x is a right (perhaps because the better smooth talker convinced them), it can become a right. That is all there is to it. Philosophy is irrelevant.
As much as I appreciate all that Stallman's done over the years (though I don't always agree with him), that just strikes me as a remarkably dickish comment to make.
To my mind, 20 minutes is hardly an unreasonable delay when you're not an emergency. To make a snide remark about it when you're a guest in the country and getting the advantages of their free health services is just poor taste and bad manners.
It was obviously a joke and I seriously doubt anyone would be offended by that. I know I'm not and I'm relatively understanding about the austerity measures.
You'd have to point me at something that would suggest it was said in jest then, since I don't see anything that would support that assertion.
Frankly, there's a reason why I used the word 'appreciate' rather than 'respect' and that's because while RMS has done much good for the world, he's also an extremist and a fundamentalist who's publicly held convictions in some areas indirectly damage the cause he's fighting for.
Spanish speaker here. That's a joke, like, 100% a joke, I can imagine the situation, everyone worried and complaining about the ambulance delay. He wanted to calm everyone down.
