[robbiep]

Access to life saving treatment when required, as required, access to free hospital and cheap/free out of hospital medication.

The issues are no more entangled than that 'healthcare providers' are a subset of 'healthcare' and within healthcare providers are going to be doctors administrating care that is not up to the best evidence. Universal healthcare is no defence against that, but either is any other form of healthcare. If you select your own doctor you have every chance of choosing one that may give you treatment against the best evidence.

It seems you are saying that universal healthcare means that you will get poor healthcare. I vehemently disagree with this proposition, not just based on your single anecdote but because I live in a country with a universal healthcare system and I have worked within it and in a few months I will be dispensing care from within it as a doctor. Every system has failures but this criticism isn't an indictment of the entire system

[dnautics]

no, I am saying in universal healthcare, you will get poor or no healthcare if you are poor and you will get good healthcare if you are rich. You will simply shift around who gets marginalized. For example: If you have a country that aggressively hounds, say, educational debtholders - because, maybe the nation decided to socialize educational debt. How long will it be till the bureaucratic machine calculates the bottom line and decides to use the system to redflag people and those people are effectively forced to avoid the government healthcare system. It could be anything else, say, "child support deadbeats". Or "illegal immigrants".

If you think that there will be an effective firewall between the two systems, I've got a bridge I want to sell you.

>Access to life saving treatment when required, as required, access to free hospital and cheap/free out of hospital medication

What happens when that medication is fundamentally uncheap, like herceptin, in New Zealand? Sure, herceptin is contrived, because that's a patenting issue. what if it's discodermolide, which doesn't exist in more than ~10 g quantity in the universe and is rediculously expensive to manufacture? Who gets/who doesnt?

Ultimately, no treatment is life-saving. We all die. Which ones are worth it? Who makes a valuation on life? How long until we find a hyperexpensive drug that prolongs the life of a politically-connected child with an orphan disease, and people begin to question, "why is this person's life subsidized", but not mine?

[robbiep]

> no, I am saying in universal healthcare, you will get poor or no healthcare if you are poor and you will get good healthcare if you are rich.

Well, there you go, you've said it yourself. What you are talking about is not universal healthcare. Debate over, closed; we aren't even talking about the same thing. You are in no way, shape or form talking about universal healthcare, don't even delude yourself that you are - in trying to define it you are explicitly defining against it.

> What happens when that medication is fundamentally uncheap, like herceptin, in New Zealand? Sure, herceptin is contrived, because that's a patenting issue. what if it's discodermolide, which doesn't exist in more than ~10 g quantity in the universe and is rediculously expensive to manufacture? Who gets/who doesnt?

Well, let's first look at the other side of the coin. What happens in the US if you want access to this Drug? What happens in Africa? These new monoclonal antibodies are presenting big challenges to health economics everywhere. As far as I can ascertain NZ currently will pay for 52 weeks of Herceptin, as best evidence suggests is most effective, in line with most other countries with universal healthcare. So in these countries, regardless of who you are, how much money you have, how old you are - if you have a HER2+ breast cancer you will receive a year's worth of Herceptin, along with all your other medical treatment. So that's Initial screening mammography , Ultrasound, FNAB, Surgcial resection +- sentinel node biopsy, radiotherapy (if local excision performed) and THEN chemotherapy.

Your cost? In australia, that would be 4.20 per filled prescription of you are a health-care card holder (low income) or $23 if you don't. All that for around $40,000 worth of surgery/Investigations and another $50,000 of chemotherapy.

In the US? I guess it would depend on your insurance but if you don't, I guess you go without.

>>Who gets/who doesnt?

Whatever way you try to spin this, more people have access in countries with universal healthcare. In the US you can either afford to pay or you can't. In other countries with universal healthcare, it is either provided free to all (thereby increasing uptake and availability of care); or, in the case of newer biologic treatments in the tens of thousands of dollars, it may not be approved, and you will then go without or for the top order who can afford to pay for it themselves, get access. So if you want to be really anal you can point and stare at that glaring inequity which occurs in very expensive drugs that have not yet been approved, or you can say that 'the system works! people are getting access to lifesaving medicines!' - which is what is actually happening

>>"why is this person's life subsidized", but not mine?

Again, the scenario you are making doesn't happen in the brutalistic 'death panel' terms you are attempting to cast it in. Yes, some medicines aren't available on government subsidy as mentioned before. But a hyperexpensive drug that prolongs the life is an example of Herceptin; it increases the survival of patients with HER2+ cancers, previously a poor prognisticator, to that of the hormone-receptor positive tumours. The actual decrease of recurrance was approx 13% over 5 years. So here we have a perfect example of a hyperexpensive drug, that improves survival, in a small subset of the population, that was relatively rapidly approved by the government for treatment. "why is this person's life subsidized", but not mine? - This doesn't happen. No-one is making those types of decisions. Anywhere. I don't know why everyone in the US who wants to argue so strongly against universal healthcare believes this is going to be the case. It simply doesn't happen and if your proposed system is looking like these things WILL happen then you should be trying to make your systems more like ours.

Bottom line: Universal Healthcare works. It delivers good outcomes to everyone without imposing a financial burden that will cripple for the remainder of life. It does this without 'death panels' that decide who gets care and who doesn't. If you want to argue differently, then you are not understanding how Universal healthcare actually works in the countries that have had it implemented for over 70 years. Is it perfect? No; but it does seem inherently more just.

[dnautics]

>Well, there you go, you've said it yourself. What you are talking about is not universal healthcare. Debate over, closed; we aren't even talking about the same thing. You are in no way, shape or form talking about universal healthcare, don't even delude yourself that you are - in trying to define it you are explicitly defining against it.

Well, then any case I give you you will define away as no true scotsman, so yes, our debate is over. I think you have an idealistic and privileged view of what universal healthcare is that is completely closed-minded to the reality of it and the inherent flaws of it, and for that reason you will never understand my argument.

> but it does seem inherently more just.

Yeah of course, the US system is terrible, but if you're comparing the universal healthcare to the US system, I'm going to let you know, the bar is pretty damn low.

[dnautics]

>It does this without 'death panels' that decide who gets care and who doesn't

Making the decision objective does not make it just. Let's say I invented a drug that would keep people with blue eyes alive. Forever, no matter what. Doesn't work on brown eyed folk. Should such a drug be covered by universal healthcare?

[robbiep]

Obviously this has been weighing on you to come back 8 hours later and add that. It is not the objectivity of it that makes it just, it is the availability of it.

Additionally, your thought experiment is utterly useless at illuminating any debate over the merits (or otherwise) of universal healthcare. Beyond the obvious absurdity of a drug of such potency being known about and deemed effective on such a small group of people lies the fact that were such a drug possible then the correlate for the rest of the population would doubtless follow. But I'll play. If it was possible, then the question of whether to make it available to everyone would be a matter for the government of the day. But having been tangentially involved with healthcare consulting the debate would go as such -'we have a drug that costs $x, but will make a person with blue eyes live forever (and, presumably, never need medical treatment again and be a productive tax-paying member of society). If we give everyone with condition a this, our healthcare costs to down by y, despite the one off cost'

So I'm not sure the point you're trying to make. Is it that the government shouldn't be involved in healthcare? Is it that people should be forced to suffer unless they can pay? Is it that you just want to strongly argue on the internet with a perfect stranger with lots of time to waste? You keep on shifting the goalposts on where you want this argument to head, it is clear to me that you have no concept of how a universal healthcare system works because the points you are raising seem really absurd to me; conversely I have no idea what sort of system you are trying to advocate for/against because most of your arguments seem directed against a fox-news image of universal healthcare that Has no basis in reality and that just don't understand.