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emilianate's avatar

Would/Does a national education/health-care system lower the quality of life?

Asked by emilianate (594 points ) September 28th, 2012

There are organizations dedicated to researching the best hospitals and universities in the world. Most of the best are privately owned.

Top hospitals in the world: link

Top Universities in the world: link

I’m not sure why, but it also seems a lot of american private ones out-best other private ones in other parts of the world.

Why do people push nationalization of education and healthcare if they perform poorly in comparison to private? Are they just unaware of the research?

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23 Answers

marinelife's avatar

The best hospital in the world can only trat a limited number of people, but giving everyone access to education and health care raises the standards for everyone.

wundayatta's avatar

In fact, most of those Universities are public and not for-profit. I don’t know exactly the proportion of health care in the US that is provided through privately owned facilities, but I’m pretty sure its a minority, and that those facilities do not rank as highly as the non-profit institutions.

So the basic premise of your question is wrong. You have several other incorrect premises as well. By most standards, countries with public health care systems do better than the US. I think we rank near many third world countries in overall health outcomes such as low birth weight babies and the like.

The one thing we do well is pioneer new technologies and techniques.

Another basic premise you have wrong is this idea that anyone is talking about nationalizing the health care delivery system in the US. The only thing that most people want is universal health insurance funded by a single payer. We’re talking about health insurance, not health care delivery. Doctors and hospitals would remain private or non-profit, the same as they are now. The only difference is that they would no longer see patients who couldn’t afford to pay.

emilianate's avatar

@marinelife,

But if you nationalize then you get rid of the private private ones, no? And if you do that, you just lowered the quality of life for those who made use of the private ones, no? Wouldn’t it make more sense to help private expand its facilities if they’re performing better? Give them an incentive, like lowering taxes or something.

@wundayatta,

It is not a fact because I just gave you the proof in the links. Most of the best are private. The rest of your argument is based on the same false premise. I think you’re confusing private for public vs public comparison, not private.

Also, the reason private offers a much higher qualify of service is because of money. That is the fueling incentive for them. You want a good service, how much are you willing to pay for it? If you make them see patients who can’t pay then you just killed the fueling incentive that makes them so great.

marinelife's avatar

I don’t care whether it’s a nationalized private system or a national system. I just want to make basic care available to everyone.

BTW, in Britain there is private health care even with a national health system.

Lightlyseared's avatar

Your hypothesis is faulty. The last time the WHO looked at health care systems around the world the US (with all it’s fancy private hospitals) came 79th (it looked at stuff like life span, morbidity etc). There are 3rd world countries whose citizens enjoy better access to healthcare and are healthier than US citizens. For the few who can afford it I’m sure its fantastic but modern healthcare is amazingly expensive and the majority of US citizens simply don’t have access to services that people with nationalised health care take for granted.

Pandora's avatar

This is what I think. The best schools (private) can pay the best salaries and so they get the best teachers.
Same for hospitals, who have to pay higher wages to the best doctors because they have an enormous bill to pay from those best schools.
But you are right that it kills incentive. I mean if I am a teacher or a doctor with a doctors degree in a difficult field that required years of learning, and I get the same pay as a regular person with a lower and easier to come by degree, than why would I apply myself.
But there are nations that have national health care and still turn out some top notch doctors in specialty fields. That is when you know you have a teacher or doctor that either really like what they do, vs. one that does it for money.
Plus not every hospital will be able to specialize in everything. It would be too costly. The ones that do can do so because they have patients that can either pay and because of public donations and drives.

emilianate's avatar

@Lightlyseared,

I gave you the latest 2012 studies from two neutral organizations. I don’t see anything faulty here.

The WHO has gone under very heavy criticism for its analysis of health-care rankings among its many other studies. They’re a very controversial organization.

@Pandora,

Good points.

LostInParadise's avatar

What is at fault is not the statistics but how you are applying them. To compare public health systems and private health systems, you have to look at overall quality of care, not the top rated hospitals. The health statistics in the U.S. compares unfavorably to countries with national health care. As far as I know, not a single nation that switched to public health care ever switch backed to private care.

Are you sure that University of Michigan and University of Texas hospitals are private? Both of the schools are public institutions.

I don’t know how the universities were rated. A person can get a top notch education at a number of state universities.

emilianate's avatar

Well I didn’t say all were private, I said most were private.

Here is the explanation on overall quality of care Methodology and Objectives

wundayatta's avatar

@emilianate Which ones do you think are private, because I didn’t see many. Most belonged to state university systems. State. As in public.

CWOTUS's avatar

Interesting question. You’re being hit with some false criticisms, too. Just because “the USA overall” doesn’t have good health rankings worldwide does not mean that the best hospitals and other treatment centers aren’t located here. The data are not in conflict; they simply measure different things.

The USA also has some of the best universities in the world, too… and generally poor elementary and secondary education results. Again, the data are not mutually exclusive. You can have both of those conditions.

flutherother's avatar

A national education/health-care system would not lower the quality of life. It raises it for the majority of people.

Lightlyseared's avatar

@emilianate Your two independent studies only list the best hospitals and universities, nothing else. You provide NO evidence regarding quality of life. You assume that the US has the highest quality of life. What evidence have you that that is the case? That is the fault in the hypothesis.

emilianate's avatar

@wundayatta,

I don’t have time right now to go through the list, but I count 10 private just of the bat. I’ll give you a better response later.

Let me ask you this though. What exactly do you think public is? You think you can just walk in and get a medical procedure for free from these medical centers in America? You think tuition is free? Just because a state owns it doesn’t mean it doesn’t behave like a business. It fact that is exactly what it does. It still behaves like a business.

@Lightlyseared

The hospitals are ranked the best because of the quality of medical service it brings. It’s best in overall care for those who have access to such a service. Are you asking me to prove that receiving better care leads to longevity?

@CWOTUS,

Good point. Apples and oranges.

Lightlyseared's avatar

@emilianate your question states Would/Does a national education/health-care system lower the quality of life? Having a world class hospital on your door step will not improve the quality of your life if you can’t afford to pay the quarter of million dollars it costs to have a liver transplant or whatever. Taking the US as a whole it may have some of the best hospitals bit nearly 50% of the population do not have access to it. How the world class healthcare improving the quality of their life? I don’t see what is so hard to understand about this concept.
Incidently doesn’t webometrics.info rate hospitals on the visibility and quality of their webpages not the care they provide but… that’s really beside the point here.

josie's avatar

Of course it does. It tends to reduce everybody’s quality of life to the lowest common denominator.

But, “education” and “medical care” make for great political/social issues. Politicians need such issues because otherwise nobody will give them money to buy influence. Soon, people believe it is actually something that simply must be fixed in Washington. Thus the subjects become part of a national political tug of war, and thus one more reason to give politicians money. Which in turn attracts more and more politicians who are corruptible. Etc. etc.

It is not unlike drug dealers introducing heroin into a neighborhood, and then cashing in on the market created by addiction.

rojo's avatar

@emilianate I take issue with your statement “You want a good service, how much are you willing to pay for it?”
Sometimes is it not a matter of whether you are willing to pay for it but if you are able to do so. I think you were talking about health care here but the same thing goes for education. I was able to get a good education at a publicly financed university (it is only ranked 38th but still….) and it was one I could not have afforded at a private school. Is the world a better place because I did? I think so, and I want as many people as possible to be able to do the same because I think that we, as a society are better off with an educated populace. Case in point; Libya and Egypt. Ignorance breeds more than just contempt, it breeds intolerance, fanaticiscm and violence. Same goes with health care. We are better off if most of the population is healthy. Do you want to return to the middle ages and the ravages of the black plague. Remember, the plague doesn’t care how much money you make. And, to make an argument that is probably more in line with the capitalist train of thought, a healthy workforce produces more for less money putting more into the pockets of the 1%. So, actually, they should be the ones pushing for health reform to keep us wage slaves on the job.

rooeytoo's avatar

II don’t think it lowers it but it is a simple fact of life and I don’t think can or should be changed is that the person with money in their pocket can afford the best. We have socialized medicine in Australia but there are still “private” hospitals and also most citizens choose to pay for their own private health insurance in addition to what is provided by the government. This gives an individual more freedom of choice and you don’t have the wait for surgery and you can go to a private hospital if you feel the service is better there.

woodcutter's avatar

The quality of care and performance (of everything) is directly related to the amount of incentive available (money). Prime example- NFL referees.
Thats why you hear conservatives bitch…hard, that they can’t find decent help. No…they can’t find decent help for what they want to pay. But it’s out there. The best people are well paid, but they want to bust up unions to get the cheap labor thinking they will trade straight across and get the same performance. Low paid docs are no different.

whitenoise's avatar

The list of hospitals you provided is about their web presence, which is not really likely to be directly linked to quality of life of the American people.

With respect to the Universities, it would be good to realize that the doctors at your bed are likely trained in other places than the top private universities. 22.5% of the physicians in the US did not receive their training in the US or in Canada. they may have had it in India, for instance.

Health care in my view is not well suited for a fully free market approach. In free markets, an equilibrium will be found in which a certain share of the potential buyers don’t buy, because the services are too expensive.

In truly free markets, there would also be little to no true effort in setting up certain prevention measures and no inclination to create overcapacity.

Overcapacity is expensive. We need it though, to make sure that we are being helped when we need care. Most consumers though are willing nor able to pay for it until the need arises. So in a free market only the rich will have direct access, because they can afford to pay for scarcely available care.

The positive externalities are very present but nobody is willing to pay for them. Care for the poor,care for the young, care for the elderly, care in rural areas, care in prevention. Etc.

In general I would say that the overall quality of life for people living in a country where the state gets involved in the allocation of health care resources will likely be a lot higher than in those where the free market rains. Unless you’re rich of course.

harple's avatar

You may find this page on NHS pay in the UK interesting. According to this website medical practitioners in the UK, based on an average salary that fits with the former nhs-based information, are the 4th best paid occupation in the country.

Here is a website showing the most respected professions in the UK, as voted for by listeners to the national radio station, BBC Radio 4. This is, of course, just a poll (and one from 10 years ago) so less factual than the previous two websites. I include it though to highlight that people here do not distinguish between private and national health professionals when it comes to respect. And that respect doesn’t come from nowhere.

We really take our National Health Service for granted here in the UK. I’m pregnant, and all of the care I have already received and will receive, even if there are complications, are not going to cost me a penny. I can’t even begin to imagine having to be able to pay thousands of dollars to be able to have a child. And the level of care I shall receive is excellent, I have absolutely no complaints. I visit the midwife at the local medical centre in my town, and she does home visits to me here. My first scan was at the local hospital, and was a joyous experience.

My ageing Dad has had a great deal of experience with his local nhs in the last two years in particular, and he is going from strength to strength thanks to their support.

On the national education side of your question, I can proudly say that I am a product of national education and it in no way held me back. I got into the university of my choice, to do the course of my choice, and am now in the career of my choice. There has at no point been a case of making do or missing out through not having had a private education.

And, as has been pointed out by others above, I would like to add that the fact that the UK works on a NHS basis and on a nationalised education system does not mean that private alternatives don’t exist. They do, and for those who wish to and are able to pay, they are available. The publicly available education, however, is not automatically second class by comparison. My own experience of being a peripatetic teaching in different schools confirms this for me. I have taught at both private and non-private schools, and the non-private ones actually outweigh the good experience for the students.

GracieT's avatar

@harpie, way to rub it in! :0)
I’m jealous, and would love to live in the UK. They just wouldn’t let me immigrate.

wundayatta's avatar

@emilianate I think you need to define your terms because the way you ‘ve got it now, I think you are getting useless answers.

You point out that it doesn’t matter whether the private sector or the pubic sector own an organization, it still has to behave like a business. Even a non-profit entity has to take in more money than it spends, but that extra is not called profit. It’s just taxed differently. The US does this in order to encourage certain types of “businesses” because they benefit the community.

Businesses that only benefit the owners are taxed at much higher rates. Businesses that benefit the community, are not taxed at all. So churches and universities and university affiliated hospitals that receive state funds are considered public universities or non-profit organizations, and they are taxed differently.

The majority of universities on your list are public universities. Now what public really means is hard to say. The university I work for is state affiliated, as opposed to being public. But we are a non-profit organization and are considered to be a state university, even though we get a smaller portion of our budget than ever from the state. However, in return for not having that amount cut this year, we froze tuition. That’s what the state bought with its contribution to our bottom line.

We run a medical school and several hospitals that are tertiary care units where most of the poor people in the region go. As a result, we get extra money from the federal budget to help us deal with the uncompensated care burden. We’re a non-profit hospital. We don’t pay taxes. We are not a private hospital. It’s not a for-profit business. Most of the hospitals on your list are in the same financial structure.

These are some of the best hospitals and universities. The question is what do you mean when you say nationalize them? Do you mean that the government would buy them up? Doesn’t make sense, because the government already plays an integral role in their operation. Are you talking about some kind of management change?

If so, where does this idea come from? Because to my knowledge, no one is talking about buying up the hospitals and/or universities. Even the universities where the chancellor is appointed by the governor, so it is already managed by the state, no one really thinks of that as state run universities and hospitals. Yet they are state run. And, as you have pointed out, they do very well.

So what are you thinking? Where are you going with this question? It just doesn’t make much sense to me.

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