To charge or not to charge – Fandango’s Provocative Question #48

Wednesday. I am just on my way to do some charity stuff (fittingly at my local hospital) but hopefully I can blast out a meaningful paragrath and come back later. It is time for Fandango’s Provocative Question.

In his question this week, he notes that the USA does not really “do” public healthcare, and asks us whether this is a good or a bad thing.

First of all, we need to be clear on the exact difference between the two systems – where they are alike and where they differ.

The USA does private healthcare to a very high standard, probably the highest. So, it’s not a difference in quality. Rather, the difference is a case of how we pay for it – whether we pay through taxes or through premiums. So, all we’re really talking about here is just the funding model.

I say just – because we’re not really talking about healthcare at all, we could apply our argument to many different areas – healthcare just becomes an example. Public healthcare is funded every bit as much by people, because a state’s only assets is its citizenry, except in the form of taxes, not in premiums.

Also, each system has a beginning and an end. Some things are covered, others not. We can argue about whether certain treatments should be available – a common example is IVF, but that same debate might be had under both systems. Even in the UK, smaller than many countries, there are variations about what is funded and what is not, so different people have different ideas about what makes the best health service. That’s true also when you compare the public and private systems. There’s no guarantee that one allows you to offer more than the other.

One aspect of difference, however, is how much we pay. Certainly, in the UK model, what you pay is pretty flat throughout your working life. And because it is out of taxes, it is a certain proportion of what we earn, just like income tax. With a private system, one would expect premiums to be much more bespoke – there will be times when you’re a lesser risk, others when you’re a greater risk. So there will be fluctuation in your premiums.

I prefer the flatter model, simply because none of us plan to get ill. In my own case, I had my stroke at forty-eight, unusually early. I was at the hospital yesterday and heard of a woman, thirty something, five children already, pregnant with her sixth (six!), who also had a stroke. More unusual still. None of us plan to be ill, and a flatter model takes us less by surprise when it does happen.

Private health insurance can also cover unplanned illnesses, I hear you say. Of course it can, provided you have bought sufficient cover. And that’s the heart of the debate. In a private system, you pay for the cover you can afford, or, if you’re lucky, the cover you wish to pay for. Whereas in a public health system, your “premium”, obligatory, is a percentage, is based more on your ability to pay. And when you’re covered, you’re covered, period.

So, it boils down to your overall politics in the end. You might wonder about a system where one person pays thousands, and the next person pays nothing, for the same cover. Or you might recognise that the reason somebody pays thousands is precisely because their income allows them to do so. I say again, this is just like income tax. People who question the use of tax dollars to pay for healthcare, they probably also question the use of tax dollars to pay for education, roads, defense etc. If they claim that healthcare is different, we should ask why they think it’s different.

I can only really finish this piece with a personal anecdote. Once upon a time, I was in the top few percent of UK earners. It was never silly money – it was a good salary, but not really any more than hundreds of thousands of other people. I saved my money, I built a stash. I decided to take a break and set myself up as a bicycle mechanic. You know, Lance Armstrong and all that. Boy, that was hard, trying to pick up something new in my forties, especially when (as I realised later) my eyesight was going. So the stash got smaller. Then, the stroke. Almost four years, and I haven’t had a “proper” job since. The state has made it quite clear that it desn’t really expect me to work again. Maybe I will, maybe I won’t. And that stash is now almost gone because I still have to pay the bills. And I’m only in my fifties. Now, I don’t want this to be a sob-story, but my point is that circumstances do change. Whilst people might be healthy and paying what they consider to be way over the odds for their healthcare package, they should be aware that this is a lifetime committment, and that there might well come a time when the tables are turned.

Tick Tock Tuesday #5 (12 November 2019)

I thought I’d create a new challenge. It is a challenge primarily for me, because I’m new to this platform, and because you don’t really know me yet, nor I you. As my name suggests, I am recovering from a stroke, and I like to push myself in all kinds of little ways… including getting to know the Wonderful World of WordPress. Although this is something I will be doing, I invite you, if this idea takes your fancy, to play along with me and share with me some of your own selections.

My plan is: each Tuesday, until I run dry, I shall post some piece of art with which I have some connection – which has helped to mould me, which makes me tick. Okay, a piece of art is a bit vague – it might be a piece of music, a movie, a book, a painting, or ???? – so my phrasiology is deliberate. It might be anything – I will play this post by ear, so I’m not sure what I’ll think of each week. And, I’ll keep posting on the theme weekly until I run out of ideas.

My rules? Well, I’m not big on rules! My choice will be something with which I feel a connection. That’ll be the important thing, just having some kind of fleeting affection for something probably won’t be enough, unless I’m using my choice as an example of something bigger.

It will be one choice per week – I’m aware that long posts can be quite onerous to read, and I’m in no hurry to complete this so if I have two ideas, I’ll probably hold the second until the next week.

In that same vein, I’ve created this block as a Reusable Block, which I intend repeating for every post on this theme. The block ends with a full-width separator, so if you want to skip ahead each week it doesn’t really matter.

I probably won’t post any lyrics, or any kind of analysis – if you like my choice, the information will be out there for you. But I will try to briefly explain why I feel a connection to my choice, just to try and enhance readers’ understanding of what makes me tick.

I will tag my posts #TTT and I will go looking for other posts with that tag. If you’d like to join in, please do the same, or comment, or pingback to this post, and feel free to reproduce my graphic. Lastly, I look forward to reading about what makes you tick.


Okay, so in the last few weeks I introduced my first love, reggae. This week, I’d ike to introduce another genre of music, Irish. In fact, a fellow blogger posted that they were in Dublin just recently – so I hope you had a great craic, Bronwyn! Did you manage to see the sun while you were there?

You can most likely spot a link between Irish and reggae- both Ireland and Jamaica are former British colonies, so I was interested in the history of what had gone on in both places in any case. And very murky it is, too!

But certainly London, being the melting pot of the empire, ended up with significant communities of both Black and Irish people. Some of you will have seen my SLS post a few weeks ago featuring Shane MacGowan, once the lead singer with The Pogues, a London-Irish band which achieved UK chart success, and which sparked my discovery of Irish music.

Another Irish band who achieved later success both in the UK chart and internationally was The Corrs, and I choose them today. Not particularly because I have any great connection with either the band (although they are a good band and their music is well-produced) or this track, but more because it is a traditional track which exemplifies why I love Irish music – the tempo, the instruments played with great skill and dexterity…

Toss The Feathers.

Excuses

I worked on a post over the weekend that I published early this morning, on the subject of Remembrance Day – or rather, as I am helpfully reminded by the media, on the subject of the anniversary of the armistice.

Don’t get me wrong – for someone to put themselves in the firing line, I’m grateful for that. I don’t think that saying thank you glorifies war at all.

But, you see, it goes further than that. I can’t separate that thanks from how we treat the people who come home. I’m more interested in actions than words. When the state condemns somebody to using food banks, even to homelessness, when the Poppy Appeal is a clear money-making exercise to help veterans financially, because they can’t get by on their own, does it really offer any solace when people then say, thank you for your service, one day of the year? Okay, let’s be charitable to the state here. Maybe these people ended up on the streets through their own stupid fault? Does that excuse how troops were ill-equipped when the state sent them into battle? As happened to British troops as recently as Iraq?

Come to that, many people contribute to the greater good, even when they don’t pick up a weapon. Doctors, nurses, teachers – even somebody who just pays their taxes in order to allow the state to function from day to day – they all do their bit to keep the cogs running smoothly. So there is more than one way of serving.

And I must be thankful for how the media has developed over the years. While a hundred years ago, we might not have had an adequate view of world events, or of the politicians behind them, now there is no such excuse! If Trump called the USA to arms, say, how many would follow him? There is a reason that armed forces are now professional, rather than conscripted – because people would refuse to take part! And he can only lock up so many people… On that subject, would a serviceman be making the sacrifice for me, or for Donald J. Trump? US Iraq veterans, were they fighting for the good old star-spangled banner, or for Halliburton?

So I think that people have sufficient information now to decide for themselves whether their involvement improves the situation or not. We have to do a lot of separation of wheat and chaff, but we’re in a better position than we were years ago.

I must admit I sit here in a kind-of twilight zone, on the one hand being grateful for the sacrifice, yet on the other that sacrifice has got to mean something – there has to be a lesson there somewhere. Like what can happen when diplomacy is allowed to fail. I wonder how many politicians feel likewise? I wonder what they would say Remembrance Day is all about?