Very interesting, Ken.  Its also one of three or four ways the US
government provides
huge tax benefits to the middle and upper classes -- through making
private health insurance
and mortgage interest payments tax advantaged, and also to allow private
savings accounts to pay out-of-pocket health costs (as well as child
care) from pre-tax (untaxed) earnings.  Tax dollars allocated this way
-- private property, you say -- provide much larger benefits for home
owners and privately insured Americans than public health & housing
programs for the uninsured and renters. 

Barbara Krimgold
Senior Project Director
Center for the Advancement of Health
2000 Florida Avenue, NW Suite 210
Washington DC 20009-1231



-----Original Message-----
From: Thompson, Kenneth [mailto:[log in to unmask]] 
Sent: Monday, November 29, 2004 10:02 PM
To: [log in to unmask]
Subject: Re: Not Such A Quick Question


hi all,

has anyone ever really considered private health insurance as an example
of private property?  seems to me that such a pespective might begin to
help explain how private curative health care might be associated with
health inequities..  its not only what private health care does, but
whats associated with it..property!

ken


-----Original Message-----
From:   The Health Equity Network (HEN) on behalf of Sonj Hall
Sent:   Mon 11/29/2004 7:35 PM
To:     [log in to unmask]
Cc:	
Subject:        FW: Not Such A Quick Question

in light of the turn of these discussions I thought some readers may
find this publication interesting. You can browse it on line which is
useful. Some of the premises made in it, such as the private insurance
sector increases choice and responsiveness within the health sector, are
interesting, but for me begged the question of whose choice? who are the
beneficiaries? Certainly not those who have the worst health status.

***The OECD Health Project - Private Health Insurance in OECD Countries
This report provides the first-ever comparative analysis of the role and
performance of private health insurance in OECD countries. It analyses
private health insurance markets and identifies policy issues arising
from their interdependence with publicly financed health coverage
schemes. The report assesses the impact of private health insurance
against health policy objectives, paying special attention to the
challenges and benefits associated with different insurance mixes.

http://oecdpublications.gfi-nb.com/cgi-bin/OECDBookShop.storefront/EN/pr
oduc
t/812004101P1



-----Original Message-----
From: Mike Hughes [mailto:[log in to unmask]]
Sent: Tuesday, 30 November 2004 4:55 AM
To: Sonj Hall; [log in to unmask]
Subject: Re: Not Such A Quick Question


I think the discussion is going in quite an interesting direction. Do,
and how do, curative services exaccerbate inequity?

Private medicine - especially pay-to-access primary care and emergency
treatment is one obvious way. Mixed health economies are another. In the
UK we don't make provision for those going private to opt out of the
state scheme but there are plenty of examples of how the NHS makes
private medicine cheaper, better and safer for the better off, for
example through subsidised ICU, staff training, and use of  NHS
facilities including primary care.

But also as I suggested earlier, free-at-the-point-of-delivery is
definitely not a sufficent condition for health equity in curative
services.

The NHS is  a fine example of the way that creation of a universal
free-at-the-point-of-delivery health service had a disproportionate
benefit to the middle classes and may have directly contributed to
widening the health gap. Firstly it encouraged the take up by the middle
classes of primary care - that hitherto the rich didn't think twice
about paying for, and the poor generally accessed through charitable
institutions. Secondly the expansion of the professional health services
created pheneomenal career and earning opportunities for the middle
classess and their families.

Mike

----- Original Message -----
From: "Sonj Hall" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, November 29, 2004 1:07 AM
Subject: Re: Not Such A Quick Question


> Hi
>
> an interesting debate especially here in Australia, where we are not 
> just talking about the right of wealthier people to purchase private 
> health insurance but that the government subsidises the rich to take 
> out private health insurance from the general tax pool; thus the poor 
> are subsidising the rich to access 'better' health care and health 
> care not available in the public system. Interestingly though, our 
> work is showing that for some major
> diseases, such as colorectal cancer, these additional services are not
> increasing survival. The state is therefore supporting the
over-servicing
> of
> the wealthy and the private health system without improving health
status.
> There is little if any substantive evidence that the support of the
> private
> sector has eased the burden on the public sector.
>
> This to me seems a very strange form of distributive justice - Robin 
> Hood in reverse!
>
> Sonj Hall
> Aus
>
>
> -----Original Message-----
> From: The Health Equity Network (HEN) 
> [mailto:[log in to unmask]]On Behalf Of Thompson, 
> Kenneth
> Sent: Saturday, 27 November 2004 1:25 AM
> To: [log in to unmask]
> Subject: Re: Not Such A Quick Question
>
>
> i am not sure that, when we are dealing with private medical 
> insurance, that we are dealing with any ethic other then the right of 
> an owner to use his or
> her property- which is not much of an ethic but a very strongly
position
> of
> power, supported by the state.
>
> in societies which admit a public function, the state has the power to

> seek payment from private resources for its services (ie. taxation) 
> and, from the
> public pool thus created, redistribute these resources as it sees fit.
> why
> shouldnt it favor those sectors of the society without recourse to
private
> resources?  especially since in the first instance, it is the state's
> actions which have permitted the accumulation of private resources in
the
> first place..??  seems only fair to be able to take some of what has
been
> given..
>
> ken thompson
> pittsburgh
>
> -----Original Message-----
> From: The Health Equity Network (HEN) 
> [mailto:[log in to unmask]]On Behalf Of Mcdaid,D
> Sent: Thursday, November 25, 2004 12:40 PM
> To: [log in to unmask]
> Subject: FW: Not Such A Quick Question
>
>
> From: Kelleher, Kevin [mailto:[log in to unmask]]
> Sent: 25 November 2004 17:34
> To: Oliver,AJ; [log in to unmask]
> Subject: RE: Not Such A Quick Question
>
>
>
> I have f0llowed the debate with much interest and intrigue 
> particularly as seen from here in Ireland with a public/private mix. I

> intuitively go for the model where individuals are given the level of 
> intervention needed to produce the same outcome. So clearly this may 
> mean some require more and maybe different interventions to achieve 
> the same ends. Our system actually does this as some people are 
> discriminated in favour of by getting preferential treatment over 
> others with equal need or even less need. This is as a result of 
> economic considerations ie Private Insurance, and is not deemed 
> generally unacceptable so why is economic discrimination alright and
> not social justice (or whatever it might be called). Indeed we have a
> situation in one specialty where there is an evidence based objective
> criteria for deciding who should access the treatment and who should
wait
> but PMI allows you to bypass this and have your operation when you
wish.
> As
> a consequence of being exposed to this I have no problem in seeing why
it
> is
> right to positively discriminate in favour of those who are in most
need
> even if this negatively discriminates against those who are in less
need.
>
> Slainte
>
> Kevin
>
> Dr Kevin Kelleher
>
> Stiurthoir Slainte Poibli(DPH)
>
> Mid-Western Health Board
>
> 31 Catherine Street
>
> Limerick
>
> IRELAND
>
> Tel: +353-61-483338
>
> Mobile: +353-87-244-7632
>
> Fax: +353-61-483211
>
> E-Mail: Mailto: [log in to unmask]
>
> Web: http://www.mwhb.ie
>
> Web: http://www.icsp.ie
>
>
> -----Original Message-----
> From: The Health Equity Network (HEN) 
> [mailto:[log in to unmask]] On Behalf Of Oliver,AJ
> Sent: Thursday, November 25, 2004 12:05 PM
> To: [log in to unmask]
> Subject: Re: Not Such A Quick Question
>
> Just a final comment (I hope), as I keep getting misinterpreted. My 
> point is that I think we can reasonably argue that there are health 
> inequities across
> income groups. Alan takes lifetime health experience - there are
arguments
> for and against this measure, but let's accept it here for
convenience.
> Alan
> goes on to suggest that unless you are prepared to discriminate, you
will
> never reduce the inequality. This is (probably) true (although if you
> treated people entirely equally over a long enough period of time, the
> inequality would presumably fall), but the additional point that Alan
> overlooks is that there are many areas over which we could
discriminate,
> and
> whilst it may be acceptable to discriminate over some, it may not be
> acceptable to discriminate over others.
>
> A quick hypothetical example:
>
> 2 infants, one relatively well off, one relatively poor. The 
> relatively well off (RWO) infant has a higher probablity of a higher 
> lifetime health experience. We might try to address this by allocating

> resources to the family of the RP infant, to try improve their housing

> conditions, family income, educational prospects, diet etc etc. All 
> well and good. Suddenly, at
> age (say, 6 years), both infants begin to suffer from an identical
illness
> for which a curative health care intervention can significantly
improve
> their lifetime health prospects. Do you treat both infants identically
in
> terms of their receiving the health care, or do you deliberately
> prioritise
> the poor infant? If you agree with the latter, you agree with Alan (I
> think), but you'd better think through all of the implications of this
> before you make your decision.
>
>
>        -----Original Message-----
>        From: AH Williams [mailto:[log in to unmask]]
>        Sent: Thu 25/11/2004 11:39
>        To: Oliver,AJ; [log in to unmask]
>        Cc:
>        Subject: RE: Not Such A Quick Question
>
>
>
>        For those of you who think that the fundamental health 
> inequality we
>        should address is people's whole-lifetime experience of health,
the
>        "fair innings" argument should have strong resonance.   It
tells
> you
>        that unless you are prepared to discriminate against those with

> the best
>        prospects of achieving a fair ainnings (eg the rich old, like 
> me) in
>        favour of those with poor prospects of doing so (the young poor
>        unemployed) you will never reduce that inequality.    So there
is a
> nice
>        clash of "equity" principles .....   Principle A is that we
should
> treat
>        people unequally because of any personal characteristics (in 
> which I
>        include their past history) and Principle B is that we should 
> strive to
>        reduce inequalities in people's lifetime experience of health.
> Adam
>        seems to have abandoned the latter in favour of equal treatment
for
>        equal need, where to him "need" means capacity to benefit from
> health
>        care, which is entirely prospective.       So if an extra five
> years
> of
>        healthy life could be given to a 90 year old or a 30 year old
(both
> of
>        whom will otherwise die), he would be unable to choose between
> them.
>        I would have no problem whatever .....
>
>        For further reading try Alan Williams "Intergenerational
Equity: An
>        Exploration of the Fair Innings argument" HEALTH ECONOMICS 1997

> Vol 6 pp
>        117-132.
>
>        Alan Williams
>
>
>
>
>
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