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You’ve got things precisely in reverse. The best thing about socialized healthcare is that people know exactly who to blame: themselves. For example, in the UK, Canada and elsewhere there is widespread acceptance that, where the healthcare system fails, it fails because there isn’t enough money, and that’s that.
No Brit is assassinating an NHS official because of a lack of care, because they know that the money for great service doesn’t exist. A “denial” or a “delay” is the fault of anyone who doesn’t want vastly higher taxes, ie. almost everyone. People occasionally complain about bureaucratic managers, but the real reason is obvious. There are no villains, just hard financial reality.
In America, the private system means people can blame “greedy” capitalists for this kind of thing, instead of looking inward. Nobody has to confront that fact that paying $1m/year so some old person can live another year in extreme pain is actually a terrible deal (not to mention cruel), any denials or issues are just the fault of muh corporate greed.
The US system therefore allows for an endless pity party that, when it meets listless and likely mentally ill young men, results in actual violence.
Who cares about some assasination once in the blue moon as a measure of the healthcare system? It doesn't register in the grand scheme of death and misery involved.
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Debatable for Germany. Leftists will always claim this of course, to justify more redistribution and centralization. But the rest of society seems to have a set of beliefs that blame anything from buerocratic overregulation to protectionist doctors to immigrants overtaxing the system to people being pussies who go to the ER for every bullshit reason.
I think the you-can-only-blame-yourselves-voters aspect of the NHS is specific to systems where the payers look like democratically accountable government organisations. The social insurance systems of Continental Europe (tl;dr for Americans - more like Obamacare done right than Medicare for All) work better than socialised systems if you are collectively willing to pay first-world prices for first-world healthcare (something the British voters are deeply conflicted about right now), but they do involve organisations that look like non-profit (but somewhat commercially managed) insurers and non-profit (but very much commercially managed) hospitals which are scapegoatable for the same reason that Brian Thomson is.
The reason why nobody is murdering Krankenkrasse executives is that the German system works well in general, and very well on the dimensions that are most emotionally salient to patients (waiting times, patient experience, prevention of the kind of horror stories that go viral on social media).
There must be a rap group operating under that name somewhere.
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Germany could have a rate of healthcare executives being murdered 4x as large as the US and given it's happened a single time in the US, a country >4x larger than Germany, we still wouldn't know it because it's only happened a single time over a very long time horizon.
Or even a magnitude more than that Americans murder at a rate 6x higher than Germans. Or really a long list of reasons having nothing at all to do with satisfaction with the healthcare system.
Claiming the reason Germany hasn't seen a healthcare executive being murdered is because of healthcare system satisfaction is a pretty bad argument.
Good point. I do think that there is a difference in public sympathy. Brian Thomson's killer gets more sympathy than the killers of politicians, for example - implying that health system executives in the US are less popular than politicians. If you are at a medical law conference where all the lawyers are in one hotel and all the hospital and insurance company executives are in the hotel next door, and you only have one bomb... In the US this is a difficult question. In most other countries, "don't set the bomb off" is the right answer.
I don't think this forum is a good place to make large long-term conditional bets, but I would bet at 4:1 odds conditional on a German healthcare executive being murdered by a stranger in the next 10 years, the killer does not get public sympathy from anyone as prominent as a backbench Bundestag member. 10:1 for an NHS senior manager in the UK.
I know a whole lot of Americans in real life and not on the internet and no this isn't a difficult question. If the hypo has 3 options, with 1 being "don't set the bomb off," the overwhelming vast majority of Americans wouldn't set the bomb off. America is not the curated social media posts Europeans see on the internet.
Again, this has happened a single time. Up until a couple weeks ago, this never happened. Healthcare execs and CEOs walked the streets of rough cities without security all the time.
If you're defining "public sympathy" as saying "murder is wrong, but I understand why people are upset" and perhaps some quibbling about "prominence," I would be happy to take either of these bets, depending on the custodial conditions.
I've seen Bundestag members express public sympathy by lamenting the "rough childhoods" and "different cultures" of child rapists, so I would hope one would stoop so low as to express "public sympathy" by recognizing justified frustration. If this wouldn't qualify as "public sympathy," then I likely wouldn't take the bet as I don't have much experience with German or most European discourses.
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While I agree that we haven't yet reached the stage where NHS managers are getting shot (probably due at least somewhat to lack of access to firearms), I don't agree with the rest of your point. People absolutely put the blame elsewhere than their unwillingness to pay higher taxes: capitalism, the tories, the rich (who don't pay their "fair share" of taxes), etc.
I think that was more true when I came to the UK in 2016. It feels like today there’s increasing acceptance that the mythic “tax the rich” well is not as deep or as well-supplied as it seemed during Occupy or even upon Corbyn’s Labour leadership election victory.
Seen on Reddit literally an hour ago:
New calls to increase personal tax allowance from £12,570 to £45,000
The comments are, as you might expect, supportive of the general thrust of this idea (consensus seems to be that £45,000 is too much, we should "merely" increase it to the minimum wage) and proposals to make up for the tax loss are the usual "tax Amazon", "fight tax fraud" etc. etc. without realizing just how big of a black hole they need to fill.
I have zero faith left that the common man will ever see sense. The good ending for humanity is probably to keep feeding him antinatal propaganda until his TFR drops to below 0.5 and his numbers slowly dwindle away over the next few hundred years while we create sensible human beings through genetic engineering of zygotes incubated in artificial wombs to replace the lost people.
If the system isn't working for the people of Uk they might as well Starve the Beast.
They all blame austerity, ironically, for causing their current economic malaise
More evidence for the "Brits only sound smart because of their accents" thesis.
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People on that Reddit are especially stupid. On the UKpolitics subreddit there was some good discussion about UK’s fiscal situation and some actually highly upvoted replies saying that the 20% band should be raised to 30% and the personal allowance should probably fall to the ~£8k range.
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American healthcare is also insidious in that A) emergency care is mandated to to administered, regardless of circumstances and B) if the patient can't pay for their emergency care, then the provider eats the costs.
For SOME reason, Americans can't do the math and realize that this means that paying customers are charged more, and that's why their ER rooms are over-capacity from being used as a universal health service.
To fix healthcare costs, either emergency care is paid for by the state - or emergency care is not administered to those who can't pay.
Sounds like we need a 2 tier emergency room system. An "actual for real" ER for people with medical emergencies and a "you seem to be using this as free healthcare, sit here and we'll get to you in 20 hours" ER. I know they do triage. Some triage strategy would make non-real-emergency people effectively wait forever for an available doctor.
The complicating factor is that many presentations of illness look very similar - does your young person with chest pain have heartburn, an honest to god heart attack b/c of something like genetic disease, anxiety, costochondritis, or something else?
The triage process tries to prioritize people and then once questions are answered (okay the EKG is reassuring, anxious Karen can wait for six hours) readjust how to prioritize people. If you send someone back out to the waiting room and they die because you missed something or had an atypical presentation.....massive lawsuit.
How you get prioritized and triaged usually happens in the background without you knowing about it (for the obvious reasons).
One approach that a lot of places uses kinda zigs a bit from your idea. EDs will have a "fast track" area (will likely have a euphemistic name to make it harder for patients to know) for simpler chief complaints. Work that is expected to be more brainless and less acute (what constitutes this is not necessarily obvious, someone with a diverticulitis flare up or a broken arm is in crippling pain and need some specific intervention but it doesn't require a lot of cognitive resources to figure out the plan) and it's staffed with generally less experienced or competent staff. They can then churn through the simpler cases while people spend an extended period of time in the main idea waiting on labs, images, consults, a hospital bed, someone to figure what the fuck is going on).
You might note the name is kind of the opposite of what you are saying - fast track, so it doesn't disincentivize the over utilization behavior, but ultimately getting people out of beds or the waiting room takes priority, and a lot of regulatory/bonus/compliance structure involves reducing wait times anyway.
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My local hospital does have this. I've gone there a few times, all for trauma, and when you go to the triage desk in the emergency waiting room (in the instant case, full of "frequent flyer" senior citizens who are indeed quite ill) with a trauma they immediately send you to a different area (Critical Care).
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EMTALA's not getting repealed, so that leaves finding some way to frame publicly paid emergency care as pro-middle class and anti-bum without having too many epicycles.
There's a good discussion on EMTALA today on Meddit:
https://old.reddit.com/r/medicine/comments/1hdpuq6/seeking_advice_on_emtala_violation_allegation/
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