Talk:Universal health care

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List of Countries with "Universal Health Care" is Deceptive

This reads like it was written by advocates or activists for universal health care in the United States, with the intention of making the rest of the world look like nirvana, for the purpose of promoting a particular kind of universal health care in the United States, a kind perhaps not available in the countries listed as having universal health care in the article.

I live in Japan, which is listed, without qualification, as having universal health care. Here's what Japan actually has: Either your employer administers a health care plan, or you buy it from the city. Only larger employers have their own plans. They cost maybe $350 per month. Cities charge maybe $500 per month. These costs will vary with location. You get a health insurance card when you join. With that card 70 percent of your costs are covered. If you don't work for a large employer who deducts the payments and you don't pay the city's fee, you don't get health care. If you don't have the 30 percent co-payment, you don't get health care and you don't get medicine.

Is this what most Americans understand to be universal health care? In the U.S. if you don't buy health insurance, you don't get health care. In Japan if you don't buy the city's health insurance, you don't get health care. (There is some free health care: most cities offer a free annual exam (blood and urine, chest X-ray, electrocardiogram, weight and height), and there is some 100 percent care for the disabled in some cities.)

I wonder how many of the other countries "with universal health care" in the list don't really have universal health care when examined in detail.

Japan's system basically works because the population is mostly homogeneous, there is a large middle class and fewer poor than in the U.S., and people just pay for health insurance. They put priority on paying for the insurance, over buying a car or eating out or having another kid or whatever. Those who don't pay are in the same boat as the U.S.

Don't get me wrong: I love the Japanese system. I get to choose my doctors, mostly showing up without an appointment. I can just go to another doctor for the same problem if one doctor's treatment doesn't satisfy me. There are no records or cross-checking to prevent that.

You seem to imply that health insurance in Japan is optional and that there are uninsured persons. But from what I have read, it is not. It is compulsory. In other words it's just like a tax except the money goes into an insurance Fund and virtually the whole population is covered. So in that sense it is quite unlike the US system and IS universal.

• ...every government jurisdiction, whether city, town or village, was required to provide health insurance to every uncovered resident by 1961. Since 1961, virtually all Japanese have been covered by either employers or the government. (From an academic web site http://www.nyu.edu/projects/rodwin/lessons.html#II.)
• In 1961, health insurance was established for all, enabling anyone to afford necessary medical care. To make this possible, everyone was (and still is) required to join some kind of a health insurance plan (From a Japanese government web site http://www.sg.emb-japan.go.jp/JapanAccess/health.htm). Can I ask you to double check your information? --Tom 17:28, 4 September 2007 (UTC)

Me again. Those sources are not correct.

Practically speaking, most employers will deduct your health insurance payment, and you don't have a lot of choice about it, I suppose. But I know expats working for Japanese employers who have talked them into not deducting the payment when they told them they had purchased their own insurance from overseas providers.

If you are self employed, unemployed, or work for a small company (I have experienced all three of those states), you simply do not have to pay for health insurance, and nobody tracks you down and asks you about it. The only way to get insurance is to hop on the subway to the ward office and apply for it and pay for it, about 50,000 yen a month (it varies by city, this was Nerima Ward in Tokyo circa 2004). If you don't pay for insurance, you don't get a card. If you don't have a card, one of two things happens (I have personal experience with both): (1) The doctor refuses to treat you, or (2) they ask for 100 percent payment in cash, rather than the normal 30 percent copayment. If you have a card an forget it, same thing. They either ask you to go get the card, or they take a deposit of 100 percent of the cost pending your return with the card, at which point they refund 70 percent. And, by the way, if you have a card and don't have the 30 percent copayment? No treatment.

Now mind you, practically speaking, a very large percentage of the Japanese population has insurance compared to the United States. Your statement "virtually the whole population is covered" is probably true. It's true because virtually the whole population pays insurance premiums, monthly, with "cash-money," not because it's just magically there from the government.

And those who don't and who get sick, usually get their bills paid by relatives (who may be pissed off at them, but this is kept within the family and dealt with outside the public system).

As for the statement on the Japanese Web site to the effect that "everybody is required to join," I suspect that is similar to the "requirement" that you pay for public television. Since there is no sanction, many people don't pay their NHK bill. Even if you may be in some sense "required" to buy insurance, there is no followup, audit, investigation, census, central record keeping or whatever by the city to check on this. And if you don't have it, you don't get care.

So in summation, there is a single nationwide system to which doctors bill for medical care (actually, two parallel systems, as I explained in my first post), but it's not a universal entitlement, but rather a monthly premium billed, cost controlled insurance plan that is the same for everybody, without the requirement of medical checks and the like to qualify. But still, you need to pay your 30,000 to 45,000 yen monthly premium.

My problem is that Japan is being used here as implicit support for the idea that there should be a zero-premium entitlement style universal health plan in the United States ("because _everyone else has it_"). That is not what Japan has, and I suspect if a country-by-country, ground-level check by informed expats living in other countries in the list here were made, there may be similar discrepancies.

The acid test: does a homeless person living in a cardboard box on the west exit of Shinjuku station get health care? No. He gets nothing. In a Canadian style system would that person get health care? My understanding is yes. So you can call these two systems universal health care, but they are different. If you apply Canada to the U.S., everybody gets care, but if you applied Japan, you'd get a huge number of people not paying their three or four hundred dollars, and things might not be so different than now. The cost differences between a Canadian and a Japanese style health care system would be pretty massively different in the U.S., I'd reckon. —Preceding unsigned comment added by 203.216.99.100 (talk) 11:20, 17 September 2007 (UTC)

"particularly since you are not disputing the fact that you are simply trying to bully your opinion onto this and other articles" "However, if you insist on foisting your particular opinion on readers, then you are engaging in a violation of the rules." "They do not justify your efforts to transform this article into a US bashing session."

You might want to see Wikipedia:Assume good faith

"I have so far refused to play the little game of finding citations, because I've thought it contemptible to have to do such a thing" "Very simply, there is no reason why your opinion should get to trump mine." "I am not going to argue about which of the different possible tests for determining whether a country is "wealthy" and "industrialized" is best, because 1) I don't have the time to do so and 2) I don't need to."

You might want to see Wikipedia:Verifiability specifically where it says "The threshold for inclusion in Wikipedia is verifiability, not truth." on the top of the page. You should also see WP:Undue.

--JEF (talk) 17:51, 9 February 2008 (UTC)

Bizarre reliance on docs from the Cato Institute

Is there a reason that every single anti-UHC point in the For/Against section is derived from documents from the Cato Institute? I know they have different contributors, but it seems a bit limiting... What's the WP view? Is one Institute's POV on a subject enough to cite it? I don't believe so.

--Conor 22:56, 30 July 2007 (UTC)

WP:NPOV requires that we represent all significant points of view. The Cato Institute is a significant point of view. Politicians and lobbyists bring out their reports to justify their positions.

Their positions are ridiculous. They believe that if people can't afford to buy health care in the free market should do without it. Ridiculous positions are a significant part of the debate, and they belong in an encyclopedic article. If you disagree with them, you can find a reliable source with good response to their ridiculous positions, and let readers see how ridiculous they are. That should be easy enough. A debate is often a good way to explain these ideas. Nbauman 02:00, 31 July 2007 (UTC)

The problem isn't that their views are silly - that's a matter of opinion - rather the difficulty is that an entire section of the page is supported only by reports from this one institute. The heading says "Common arguments forwarded by opponents of universal health care systems" but lists only those found in Cato documents. One would expect "common arguments" to be sourced from multiple credible reports. What we have here is essentially a list of reasons why Cato think UHC is a bad idea. Surely that's not conducive to a good Wikipedia page? --Conor 00:19, 6 August 2007 (UTC)

Conor is correct. The issue is whether citing only one source is valid under wiki guidelines or not for referencening data. A position is silly or ridiculous or not is merely opinion based. The content (in my opinion) of this entire article would better serve the public if it controlled the opinionated material. This is suppose to be a ENCYCLOPEDIA article, not a debate forum. There are other cites and links, even within wikipedia, for that, such as here. Not in the main article. —Preceding unsigned comment added by 64.107.246.50 (talk) 18:45, 14 February 2008 (UTC)

Refusal to treat and duty of care

A key point of UHC in most (all?) countries is that patients cannot be refused emergency care (or indeed almost any care, once they have the resources), even if it is extremely expensive; a good example being a liver transplant. Duty of care in the US requires docs to treat in all viable cases, but financial restrictions don't allow it. My experience with transplant surgery in the US meant I saw patients regularly turned away due to lack of insurance - these patients sometimes died as a result. Transplants can cost hundreds of thousands of dollars, and so patients could not reasonably be expected to pay for them if their insurance fails. This could not occur in Ireland, UK, France etc. While it would have been original research to add this to the article, yesterday CNN reported on an interesting story (http://edition.cnn.com/2007/HEALTH/conditions/12/21/teen.liver.transplant.ap/index.html?imw=Y&iref=mpstoryemail) which documented such a refusal by a US insurance company.

My question is: can this now be added as a proposition point in the Yea vs. Nay debate on UHC?

Perhaps it could be used as a source for the second-last point on the prop side:

The profit motive adversely affects the motives of healthcare. Because of medical underwriting, which is designed to mitigate risk for insurance providers, applicants with pre-existing conditions, some of them minor, are denied coverage or prevented from obtaining health insurance at a reasonable cost. Health insurance companies have greater profits if fewer medical procedures are actually performed, so agents are pressured to deny necessary and sometimes life-saving procedures to help the bottom line.[citation needed]

Also, it would be great to get more sources for the opposition side too - still a lot of citations needed.

Cheers! Conor (talk) 12:50, 22 December 2007 (UTC)

Characterizing the U.S. System

We've had some back and forth edits on the language describing the U.S. system, based on the IOM report. The website says that it's the "only wealthy, industrialized nation" to lack universal health care, but the body of the report qualifies it a bit differently. It says that the U.S. is "one of the few industrialized nations" to lack universal health care [1]. It isn't clear to me what the criteria is for "wealthy" in this context. It strikes me that the second characterization is better sourced, and makes the critical point adequately. —Preceding unsigned comment added by 146.145.79.247 (talk) 17:47, 2 January 2008 (UTC)

I disagree. The website characterization -- the U.S. as the only wealthy industrialized nation lacking universal health care -- is equally valid as a source statement and is supported by other comparisons which do account for comparability in wealth, such as the Commonwealth Fund's comparisons, the OECD's comparisons, and the World Health Organization's comparisons. I feel that stating the uniqueness of the U.S. in this regard is important and notable. "One of the few" does not capture this uniqueness. --Sfmammamia (talk) 17:58, 2 January 2008 (UTC)

I'm not so sure - the formal written report signed by the committee strikes me as a stronger source than the blurb at the top of the website. There's another subtle difference between the website and the body of the report - the report talks in terms of guaranteeing access, rather than universal coverage, which is real technical issue involved. Overall, the report itself appears to me to be more careful and nuanced than the website summary. Having said all that, I'm not going to arm wrestle you over it, though  ;-) —Preceding unsigned comment added by 146.145.79.247 (talk) 14:40, 3 January 2008 (UTC)

Glaring omissions

Why are there virtually no mentions of the healthcare systems in Europe?

England is about the worst funded and lowest quality health care n Europe. Some countries like Germany have a system on mandatory private insurance. Some countries like France has a completely private care part of the system but with fixed payouts by a single payer stabilizing the system. Why is non of this explained?

Do we even have articles on these systems? If no, just ask someone to translate them from the French and German wikipedia's, then summarize them here.

What have you people been doing?!? JeffBurdges (talk) 12:52, 20 January 2008 (UTC)

This comment is completely stupid, and ill informed. The UK's (not England's, get your countries right) health care is neither the worst funded (it's now one of the best) or the lowest quality (try going to Greece) in Europe. It's a fantastic system, it's universally accepted as the right thing by all political parties, and we look to America with horror about how inhumane a country can treat its poorest citizens. We also have very low opinions about Americans who can't spell, have no knowledge of geography and make idiotic assertions. Wikidea 23:39, 22 January 2008 (UTC)

the article talk page is not for general discussion of the issues, it is for discussing article improvement. your commentary is interesting, but belongs elsewhere. see WP:FORUM. your comments are also quite uncivil. Anastrophe (talk) 01:10, 23 January 2008 (UTC)

Anastrophe: I think you are taking this remark too literally. Look at the substance, not the form; Wikidea is voicing (in personal and non-encylopedia-like language), a viewpoint that is rightly included in the discussion, on which we need not all agree. However, as an adherent to his viewpoint, the author of the comment probably thinks the article is well-served by having his comment on the record. Civility issues aside, is there anything wrong with wanting to add some emphasis on the user page to an issue in (or about) an article's subject, that you consider important? Non Curat Lex (talk) 23:29, 1 April 2008 (UTC)

• Thanks for your suggestion. When you believe an article needs improvement, please feel free to change it. You can edit almost any article on Wikipedia by just following the Edit link at the top of the page. We encourage you to be bold in updating pages, because wikis like ours develop faster when everybody edits. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. You can always preview your edits before you publish them or test them out in the sandbox. If you need additional help, check out our getting started page or ask the friendly folks at the Teahouse. --Ryan Delaney ^talk 15:47, 20 January 2008 (UTC)

Jeff: You say that England has about the lowest quality care in Europe. An interesting claim. I'd be interested to know where you get that information from because if its true it represents a big change since the last major assessment was done by the WHO. Perhaps you can tell us here or at National Health Service or Healthcare in the United Kingdom. Its even more remarkable because the UK has increased spending from about 6.7 per cent of GDP on health in 1997 (the date of the stats below) to about 8.1 per cent today, so other countries must have been doing phenomenally well too.

The WHO in 1997 ranked the UK in 18th place out of 191 in a World league table of performance attainment ahead of 21 other European countries. These include Ireland(19th), Switzerland(20th), Belgium(21st), Sweden(23rd), Cyrpus(24th), Germany(25th), Finland(31st), Denmark(34th), Solvenia(38th), Croatia (43rd), Poland(50th), Slovakia(62nd), Hungary(66th), Lithuania(73rd), Ukraine,(79th),FYR Macedonia(89th), Romania(99th), Bulgaria(102nd), Latvia(105th), Yugoslavia(106th), and finally Russia at (130th). All of which are European countries. And as far as I recall, the UK health service has improved greatly since these stats were taken with huge capital and people investment and grealty decreased wait times.

In overall attainment the UK was, in 1997 ranked 9th out of 191 countries, with an index score of 91.6 and only 6 European countries bettered that. France managed 91.9. The worst country scored 35.7. The USA scored a very respectable 91.1 and was placed 15th, just behind Germany. --Tom (talk) 18:50, 20 January 2008 (UTC)

Tom, where's the link for those WHO data?

That would be a good table -- WHO ranking in one column, and the type of system (universal, private, otherwise) in another column. (I don't think the WHO rankings are quite as accurate as some of the peer-reviewed journals, but for a lot of countries that's all we've got.) Nbauman (talk) 19:07, 20 January 2008 (UTC)

Its from the The World Health Report 2000 Health Systems: Improving performance. I have the PDF on my PC but I downloaded it from the internet so you must be able to Google it and find it. --Tom (talk) 19:53, 20 January 2008 (UTC)

_Actually, the UK really did much better than 9th because ahead of it were Monaco, San Marino, Andorra, Malta and Luxembourg most of which are European microstates) with tiny populations relative to Europe as a whole (together less than one fifth of one percent of the total European population). Many of these are also tax havens for the rich so its not surprising they come out at the top of the table. I also accidentally omitted several other European states below the UK including Slovenia(38th) which came out just ahead of the US (at 37th). We can raise the US by 5 places too (maybe more) if we exclude those very small countries :) --Tom (talk) 20:18, 20 January 2008 (UTC)

"Debate in the United States" - with italian sources??

i'm afraid i'm unclear on how this is legitimate. the section 'debate in the united states' has three arguments in favor of UHC that are referenced to italian language sources. this makes no sense at all. the debate in the united states isn't put forth by italian language sites. this strikes me as little more than POV pushing under the guise of being additions to the pro/con section on the US debate. Anastrophe (talk) 16:47, 22 January 2008 (UTC)

The 'debate in the united states' is also done using comparison with countries with different systems: you can check this for most of the points raised. Unfortunately, the references to prove what happens in other countries may be more easily available in other countries' languages.

Of course we all are encouraged to find and add better references for each topic cited in the article.

The debate about Universal health care is not limited to US, so we should also consider to change the section title.

An other problem with references: the arguments used in the debate are listed as "common arguments forwarded by the ...", however, for no argument is given a reference that it is common forwarded indeed, and not used by a few people only. The references are about the argument itself, and not about being common.

Laurusnobilis (talk) 17:21, 22 January 2008 (UTC)

the article makes the pointed contention that there is no notable debate about UHC in the rest of the world; that the US is the only developed nation where there is a debate. changing the title of the section would be inappropriate. the european union encompasses english language nations; since this is the english language wikipedia, english language references should be used exclusively, although i acknowledge i was wrong that english language references are required. regarding the last point, it could be used as a rationale for removing the entire section, since there is no reliable source provided that codifies that these are common arguments at all. final point, please do not edit another user's comments. it is inappropriate. Anastrophe (talk) 17:26, 22 January 2008 (UTC)

I agree that this section, about a debate in the United States, should rely on English sources. Surely these points have been made in English in a reliable source somewhere. --Sfmammamia (talk) 18:40, 22 January 2008 (UTC)

There is a debate about UHC in the rest of the world (some quick found references: [2][3]); let's omit the discussion about whether it is "notable" or not, however it is less prominent than in US.

Most of the argument used are not specific to US, for instance, whether health is a right, and "Unequal access and health disparities still exist in universal health care systems".

My proposal is to change the section name from "Debate in the United States" to something without reference to US, and "common arguments ..." into "arguments ...". Of course, only relevant (in the sense of the wikipedia policy) argument should be listed.

Each country in European union has a different health care system, hence is possible that you don't find English references for most of the Europen union health care systems.

Laurusnobilis (talk) 19:04, 22 January 2008 (UTC)

I'm not really clear why there is a section in this article about the specific debate in the United States at all. If discussion about that debate belongs anywhere in WP it belongs in the article Health care in the United States with a simple cross reference to that additional material in the United States section of the current article. This article is about Universal health care and the US does not have Universal health care. End of story. Its not the only country without UHC and it would be very dull to represent every country's issues here.--Tom (talk) 21:20, 22 January 2008 (UTC)

US does not have Universal health care, yes, but in US there is a debate about adopting it.

The debate about advantages or disadvantages of UHC is general and not specific to US, so it makes sense to have this section, and to have it here Laurusnobilis (talk) 23:04, 22 January 2008 (UTC)

i generally agree, however, by all appearances this section has become somewhat of a 'dumping ground' for random arguments on the pro and con, rather than a reliable list of the most critical issues. it really should be trimmed extensively. Anastrophe (talk) 23:21, 22 January 2008 (UTC)

Quite honestly, the main article Health care in the United States is already long enough, and some of the points of debate are more gracefully interwoven into subtopics within that article, so tacking this debate section on there seems inadvisable to me. That points to the need either for a separate article on the US health care debate (and what an editing nightmare that would be, especially with regard to concerns of neutrality of structure and undue weight!) or just deleting the US debate section altogether. There is a more abbreviated form of this debate at Publicly funded health care, perhaps material from both debate sections could be merged into a separate article? I have no good answers here. Others' thoughts? --Sfmammamia (talk) 02:01, 23 January 2008 (UTC)

canada UHC

the following quote from the NEJM was added recently: "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed". while an accurate quote, it tends to misrepresent the reality. the legislative process is long, slow, and laborious. the fact that this sentence attempts to soften is this reality: There are laws prohibiting or curtailing private healthcare in some canadian provinces. it would be better to cite the reality, not NEJM's speculations. Anastrophe (talk) 18:11, 27 January 2008 (UTC)

Nbauman: I corrected the error in the heading that I accidently introduced earlier today having misread the requirement in the Canada Health Act requiring provincial health insurance to be publicly managed, not for profit, and accountable to parliament. I took that to mean that private health insurers cannot operate, but of course that is not so. I thank you for the clarification in the section that you added. --Tom (talk) 18:23, 27 January 2008 (UTC)

Anastrophe: Regarding provincial curtailments, so you mean privately funded heath care? Or privately insured health care? Or do you mean that private providers cannot do both state funded work AND privately funded work? Or is any health care not funded by the state banned? I am quite unclear about the restrictions that the provinces and territories may have laid down.--Tom (talk) 18:23, 27 January 2008 (UTC)

i have no idea. i'm going strictly by the NEJM quote, which 'softens' the reality - whatever that reality is - by speculating about how laws can be changed. Anastrophe (talk) 18:38, 27 January 2008 (UTC)

Anastrophe, the NEJM does not engage in "speculations." They have doctors from Canada on their editorial board, they have many articles by doctors from Canada, they have experts who review their articles before they're printed, and they publish letters with dissenting views. And they travel to Canada for medical conferences all the time, just as they meet Canadian doctors who travel here. They are very familiar with the reality. I'd like to know what you know about reality that they don't know, that is not speculation. If you can find a WP:RS who knows as much about the "reality" as they do, you are free to add it to the article. Nbauman (talk) 01:45, 28 January 2008 (UTC)

read the plain text of the sentence. of course laws can be changed, but it's a meaningless suffix to the sentence. it's as meaningful as saying "there are laws which prohibit people from committing murder, but they can be changed". the accurate and true statement is "There are laws prohibiting or curtailing private health care in some provinces". all laws can be changed. it's meaningless to the reality today. Anastrophe (talk) 03:23, 28 January 2008 (UTC)

It is wrong to claim most care is subsidised by taxpayers'

I think the claim that "most care is subsidized by taxpayers" is inherently wrong.

Most health care in universal systems is in fact paid for the users of the system. In a big pot kind of way the government ensures that the very healthy subsidize the needs of the very sick, the very wealthy subidize the health care costs of the very poor, and the economically active subsidize the economically inactive (e.g. children, retired people and the unemployed). But the vast majority of users are not permanently in those extremes and will pay in over time broadly what they get out (either through tax or compulsory insurance). Indeed, most people pass through all of these phases at some point in their lifetime so subsidy is probably not the right word. For most of us, its a way to even out the burden of these factors over a lifetime.

Health care in The Netherlands is only 5% funded by government and is a universal system. So it is mosly not subsidized by taxpayers. I think most Britons do not think their health care is subidized either, even though they get it for free when they need it. The NHS is not government charity. In the long run we pay for it through taxes. At the extremes, if we are lucky, we pay our taxes and never fall ill. But we don't begrudge that because because we know we could just as easily have been very seriously ill. Britons (and I presume the Dutch) vitually never have to worry about health care costs whatever their health or financial status. --Tom (talk) 10:20, 8 February 2008 (UTC)

Question, Tom: if it is only 5% funded by government, who funds the other 95%? Non Curat Lex (talk) 23:31, 1 April 2008 (UTC)

5%? No way. It's been more like 60%, with an increasing shift to more private insurance under recent reforms. England has 85% public funding, Germany about 75%, Canada is 70%,the US has about 45%....Netherlands is far less a market-oriented system than the US, until recent reforms the extent to which the private/public funding split will need to wash-out after the changes are fully in effect. Numerous OECD sources and Holland's government documents clear this up, but I don't have the figures right at hand.JackWikiSTP (talk) 17:17, 12 May 2008 (UTC)

Again with the normative claims

Here we go again. Let me repeat what I said on the talk page on socialized medicine:

There is no such thing as an objective definition for the terms "industrialized" or "wealthy." The questions that one would ask to determine whether a country is either of those two things is open to individual interpretation. For instance, you might say that measuring GDP per capita is a more effective approach to determine whether a country is wealthy, while I might argue that looking at the aggregate GDP is better. Who's right? Well, that's a question of opinion. Another example, what's the appropriate level of "industrialization" for a country to be considered "industrialized?" Indeed, what does it mean for a country to be "industrialized"? Is it possible for a country to be "un-industrialzied"? Again, those are all matters of opinion. At what point is a country objectively "wealthy"? Finally, explain why some "industrialized" countries with high GDPs (i.e. wealthy by some people's standards) that don't have universal health care, like China or India, shouldn't be counted alongside the US. It is a matter of opinion, and it should be reflected as such. Freedomwarrior (talk) 05:16, 9 February 2008 (UTC)

China and India are not industrialized countries. Un-industrialized countries exhibit high GDP growth (which China and India do), have a majority of there population in rural areas (which China and India do), have a lack of the rule of law (which China and India do), and have significantly lower GDP per capita then industrialized nations (which China and India do). Aggregate GDP is really affects wealth at the national level. It really only affects foreign relations and the amount of power and influence the very top have. You are not more wealthy if your country has twice the aggregate GDP of another country, but you have to distribute it between 6 times as many people. By your reasoning, we could argue that Zimbabwe is more wealthy than Monaco. Also, current GDP does not reflect GDP accumulated from previous generations. China and India are just now emerging economically after government mismanagement pretty much erased their nations' wealth, while the United States has been able to accumulate wealth from previous generations. Numbers and number taking methods are not perfect gauges which is why there is no absolute standard for the word industrialized. For example, GDP is not a perfect number as it does not reflect the informal economy which makes up a large part of less developed nations' economies and is expressed using an absolute currency standard (dollars for example), which often does not reflect the cost and quality of living in a country. For more on the problems with GDP alone see Gross domestic product#Criticisms and limitations. The reason why we don't include China and India is because America was developed based on European tradition and not Eastern tradition. We share a long established Democratic tradition unlike the East, so it is a better comparision to compare ourselves against Europe.--JEF (talk) 06:12, 9 February 2008 (UTC)

I am not going to argue about which of the different possible tests for determining whether a country is "wealthy" and "industrialized" is best, because 1) I don't have the time to do so and 2) I don't need to. By conceding that "there is no absolute standard for the word industrialized," you made my point for me. My changes simply reflect that there are some who believe that the United States it not the only country without some form of universal health care and others who do. All that you're saying is that you (and other editors) have a right to pass on your opinions as facts to this article's readers, which constitutes a violation of Wikipedia rules. Therefore, I once again insist that we edit the text to reflect an impartial statement of the facts in the form of the compromise put forth by Gregalton on the Socialized Medicine talk page. Freedomwarrior (talk) 07:13, 9 February 2008 (UTC)

Nonsense. There are quite standardized definitions, and references provided on that talk page. If you were even attempting to be serious on this issue, you would recognize that every definition of "wealthy" countries corrects for per capita GDP. You don't wish to argue about which definition is best, but refuse to recognize even the most widely accepted part of the definition. If you refuse to recognize any outside sources, other editors can rightly refuse to countenance your edits.

And there is no requirement that any listing of wealthy, industrialized nations be absolute: even the most biased editor would note that wealth and levels of industrialization will and have changed over time. And even using lists with slightly different compositions does not disprove the (cited) reference.--Gregalton (talk) 07:38, 9 February 2008 (UTC)

These "standardized" definitions are normative in nature. I have so far refused to play the little game of finding citations, because I've thought it contemptible to have to do such a thing (particularly since you are not disputing the fact that you are simply trying to bully your opinion onto this and other articles). But if you need a source for the very obvious claim that there is not an objective definition of wealth, you can turn to Van den Bossche's treatise on WTO law or a random journal on economics.

There is no requirement that you provide an objective definition of what constitutes an "industrialized" or "wealthy" country, if you recognize that those claims are not factual, but rather normative. That does not violate Wikipedia rules. (And that is why I did not press the issue on the socialized medicine page further) However, if you insist on foisting your particular opinion on readers, then you are engaging in a violation of the rules. Very simply, there is no reason why your opinion should get to trump mine. As I've said before, an opinion is an opinion is an opinion. Your sources are worthless (other than to demonstrate that there are some who are of the opinion that the US is the only wealthy country without some form or universal health care). They do not justify your efforts to transform this article into a US bashing session.

Ohh, by the way....not "every" definition of "wealthy" countries relies on per capita levels of GDP as you seem to proclaim from on high. Broadly speaking, those in the security studies field are prone to looking at a country's aggregate wealth alongside per capita GDP, etc.Freedomwarrior (talk) 08:07, 9 February 2008 (UTC)

The point is not whether there is a consistent or absolute definition of "wealth" but of the phrase "wealthy, industrialized nations". Which there is. You may be right that in some other contexts, "wealthy" may be used differently, but this is not in the context of security studies. In the relevant field, wealth is not used in the way you're referring to.

The rest of your point above appears to consist of accusing me of foisting a point of view or bashing a particular country. As a general point, that's not worth responding to, although I will note that you seem to insist on pushing points of view like definitions of socialism, etc., that appear to correspond only to your own conception thereof.

If you think I am breaking "the rules", by all means complain or start a formal process rather than just maligning me.--Gregalton (talk) 09:39, 9 February 2008 (UTC)

As I understand WP's core policies, the cited statement meets them. I can find no distinction made in the core policies between how WP edtors should handle "normative" claims and factual ones. Is there one? To dilute the statement as Freedomwarrior wishes to do, he is welcome to add a cited statement from a reliable source that counters it. But adding weasel words to dilute the cited statement based on an editor's individual and unique evaluation of the validity of the statement seems to me to violate WP:OR --Sfmammamia (talk) 17:47, 9 February 2008 (UTC)

• "particularly since you are not disputing the fact that you are simply trying to bully your opinion onto this and other articles"
• "However, if you insist on foisting your particular opinion on readers, then you are engaging in a violation of the rules."
• "They do not justify your efforts to transform this article into a US bashing session."

You might want to see Wikipedia:Assume good faith

• "I have so far refused to play the little game of finding citations, because I've thought it contemptible to have to do such a thing"
• "Very simply, there is no reason why your opinion should get to trump mine."
• "I am not going to argue about which of the different possible tests for determining whether a country is "wealthy" and "industrialized" is best, because 1) I don't have the time to do so and 2) I don't need to."

You might want to see Wikipedia:Verifiability specifically where it says "The threshold for inclusion in Wikipedia is verifiability, not truth." on the top of the page. You should also see WP:Undue.

--JEF (talk) 17:52, 9 February 2008 (UTC)

Let's try this Sfmammamia: WP:ASF. According to wikipedia rules, "Assert facts, including facts about opinions—but do not assert the opinions themselves." Therefore, [[User:Sfmammamia|Sfmammamia], Wikpiedia does have a rule against including normative statements (i.e. opinions) as factual statements, because such comments tend to amount to nothing more than blatant POV pushing (as is the case with the comment in dispute). Sfmammamia, there's a reason that editors are not allowed to list their own particular opinions as facts, as Gregalton insists. For instance, (this may sound familiar since it's what Gregalton is doing) I could go to any number of websites that share my own particular bias and just find links with whatever biased claim I want to insert, and foist it on editors. Ultimately, the article would become nothing more than a blog on behalf of a certain position (which is what some editors seem to insist on). If you are allowed to pass of your normative claims as fact, you have no justification for excluding me from including something as fact provided I have a source that makes the same claim (no matter how inane it happens to be). I could even include things like, "the proletarian revolution is inevitable" in the article on communism (since Marx makes that claim). See the problem? A source that reflects a normative opinion cannot transform that opinion into facts (or else, you're going to have a massive edit war on your hands when other editors decide to turn their opinions into facts).

Sfmammamia, I provided a source at the top of the thread, which undermines Gregalton's claim to having some form of an absolute standard for. I do not have an on-line version (since it's a treatist on WTO law), however, I can provide page number, etc. if you insist on it. If there is an absolute standard Gregalton, you've demurred on demonstrating it; therefore, I would invite you to either "enlighten" me or refrain from wasting my time with your silly claims about non-existent "objective" standards. The claim must be modified to demonstrate that it is not a factual (positive claim) but rather a normative claim (an opinion). Failure to do so means that this article is violating wikipedia rules.

By the way, Gregalton, unless you have a Masters or a PhD in the relevant field you should be a bit more modest and stop making enormous categorical claims about what is and isn't said in a field...Freedomwarrior (talk) 18:18, 9 February 2008 (UTC) a The term industrialized is recognized as a mostly objective term with subjectivity only really near the cutoff mark due to the lack of numerical guidelines, but there are recognized taxonomical guidelines (some of which I outlined above) that all indicate China and India do not fall into this category. A limited amount of subjectivity does not make a term subjective. You may want to look at the article Developed country. You will notice that there is a high level of consistency among the lists. You will see that by any standard China and India are not industrialized countries.--JEF (talk) 18:47, 9 February 2008 (UTC)

Freedomwarrior, I do not see the source you say you provided at the top of the thread, perhaps it has been buried in the lengthy discussion? If you'd like to quote it here and provide cite information, perhaps that would be a valuable contribution to the discussion. With regard to WP:ASF, perhaps a compromise would be to attribute the statement to the source, such as: According to the Institute of Medicine of the National Academies of Science, the U.S. is the only wealthy, industrialized nation that does not provide universal health care. I'd have no objection to that change. Would that satisfy your concern? Also, with regard to the top part of your post, you seem to misunderstand the definition of reliable sources. Let's see, the policy says "reliable, third-party published sources with a reputation for fact-checking and accuracy." I would say that the Institute of Medicine meets that standard. As you put it, going to "any number of websites that share my own particular bias and just find links with whatever biased claim I want to insert" does not appear to meet the same standard.--Sfmammamia (talk) 18:50, 9 February 2008 (UTC)

JEF, I have to laugh at your claim that "A limited amount of subjectivity does not make a term subjective." What does it make it then? Objective? That most editors are consistent in their opinions here and elsewhere reflects their willingness to accept opinions on the basis of authority, it does not reflect a set of objective facts. If a statement is subjective, as the one that you are defending, I don't understand why there is such strong opposition to reflecting the fact that it is the opinion of a group of like-minded individuals. Can someone please explain this to me? Are you scared that readers will suddenly realize that it's just a cheap shot at the US?

In describing the WTO process for determining whether a country is "developed" or "not developed," Peter Van de Bossche says that countries are left to determine in what categories their level of development puts them in (this is in the 2005 version of his case book on The Law and Policy of the World Trade Organization, the exact text is found at page 101). The determination is based on a subjective self-assessment on the part of the state. Very simply, the organization has recognized what I've been arguing: there is no objective means for categorizing a country into any of these groups. These are all subjective valuations, which vary from group-to-group and academic-to-academic.

Having said that, I have not objection to the change that you are proposing Sfmammamia, since it would reflect that it is a claim being made by the Institute of Medicine of the National Academies of Science and not an objective pronouncement.Freedomwarrior (talk) 19:13, 9 February 2008 (UTC)

Done. --Sfmammamia (talk) 19:18, 9 February 2008 (UTC)

And this is what the Dutch health minstry video says about the role of the "market referee" in the Dutch system

Martin van Rijn: lf you want people to have more responsibility and more choice to get better care, and not have a top-down decision-making process you need two very important rules. One is: guarantee good quality care. The Health lnspection ensures that quality is guaranteed in the Netherlands. And you need a market referee who ensures that negotiations between insurers and care providers are honest. To avoid creating monopolies and power blocks.

And this from http://www.europeanvoice.com/downloads/NL_New_Health_Insurance_System.pdf about the insurance regulator and the Netherlands Care Authority...

Registration with the Supervisory Board for Health Care Insurance (CTZ) Health care insurance companies must additionally be registered with the CTZ to allow supervision of the services they provide under the Health Insurance Act and to qualify for payments from the equalisation fund.

The choice for private insurance that assigns greater responsibilities to insurers who are allowed to make a profit makes it inappropriate for the government to supervise the effectiveness of the way health insurance is operated. Therefore, the main objective in overseeing lawful performance of the new-style health insurance is for the government to ascertain whether the care insurer is fulfilling its obligation to provided insured persons with the services to which they are entitled under the Health Insurance Act. The regulator that exercises this supervision, the Supervisory Board for Health Care Insurance, CTZ, has various duties and powers under which it:

• reports to the minister on whether the Health Insurance Act is being carried out in accordance

with the law;

• reports on the practicability, effectiveness and efficiency of proposed policy concerning

performance of its regulatory role;

• investigates care insurers at the request of the Health Care Insurance Board;
• has a possibility to impose rules for audits by care insurers and for the content and structure of auditors’ reports.

Tasks of the Netherlands Care Authority The Netherlands Care Authority exists to: · regulate the markets for providing, insuring and procuring care. This task extends to making and monitoring markets as well as regulating them. The authority regulates tariffs and services. It also promotes the transparency of markets and the availability of information about choices available to consumers; · oversee lawful implementation by care insurers of the provisions of the Health Insurance Act, including the care and acceptance obligations and the prohibition of premium differentiations; · oversee lawful and effective performance of the provisions of the Exceptional Medical Expenses Act by care insurers, care offices and the central office that administers the Exceptional Medical Expenses Act.

Principal new powers of the authority

The most important new power held by the Netherlands Care Authority is to impose specific obligations on parties with significant market power. It has been given the power to do this in order to cultivate the care procurement market in fields where free pricing exists. The authority further has powers to lay down general rules for care providers and care insurers to increase the transparency of the market for consumers. The authority will also be given the power to publish transparency information if care providers and care insurers fail to do so.

Essentially it is all about transparency.--Tom (talk) 19:49, 9 February 2008 (UTC)

"That most editors are consistent in their opinions here and elsewhere reflects their willingness to accept opinions on the basis of authority, it does not reflect a set of objective facts."

It is not most editors being consistent with their opinions. It is all government agencies being consistent with their opinions if you actually took a look at the article on developed countries which I am assuming you haven't due to your response.

"I don't understand why there is such strong opposition to reflecting the fact that it is the opinion of a group of like-minded individuals. Can someone please explain this to me? Are you scared that readers will suddenly realize that it's just a cheap shot at the US?"

No, it is not a cheap shot at the United States. It is realistic assesment that the United States is the only country without universal health care among similar countries. The opposition is because your edit the article reflects a level of uncertainty about what constitutes an industrialized country where virtually non exists which fails WP:Undue.

"Very simply, the organization has recognized what I've been arguing: there is no objective means for categorizing a country into any of these groups. These are all subjective valuations, which vary from group-to-group and academic-to-academic."

It would be very easy to say this, but this could represent an unwillingness on the behalf the WTO to put into place a set of objective rules. The process also likely reflects the danger involved in making a conclusion on this due to its complexity; if they created a standard it would likely be incomplete and they would rather avoid that entirely, but that does not mean that there is a lack of an objective definition. It could easily be due to individual governments access to information, which the WTO does not have access to. Your source therefore does not necessarily indicate your position. There are always difficult to classify objects in taxonomical systems, but taxonomy is generally objective. The classification of organisms into familia, genus, and species is much more subjective than what constitutes a developed country, but the classifications are well established where there is only on classification per organism. If you attempted to name it something else no one would recognize your name for it. Likewise, despite some subjectivity be involved, there are countries that are classified as industrialized and countries classified as un-industrialized.--JEF (talk) 19:50, 9 February 2008 (UTC)

This debate about the meaning of “industrialized" and "wealthy" is pointless and off-the-mark for this topic.

What people mean--and what is said in most quarters--is a reference to the OECD nations, often referred to as the “Western democracies” and also "industrialized democracies." The point is that the reference is to the OECD nations, all (most? to avoid that debate) of which meet the standard of industrial and wealthy. Referring to the OECD nations is an objective standard. Though there are now some OECD nations that aren’t considered under the traditional "Western Democracy" label. I'll --or some else can--try to work out appropriate language, which would include the link to OECD's page, but I think everyone is referring to the same thing--including most readers who generally understand the given labels--OECD exempted. I see “wealthy" and 'industrialized" as more subjective and less normative, but this topic isn't the place to get into those debates. JackWikiSTP (talk) 17:34, 12 May 2008 (UTC)

population insuring itself...

Freedomwarrior: I have reinstated this. I see this as the intent of the schemes that are implemented. Tax and subsidy are POV. I don't think anyone in the UK thinks their health care is subsidized, except to the extend that some people get out more than they pay in and vice versa... but that happens in insurance. You don't talk about motor insurance being subsidized. Its insurance. It just happens that the government is the insurer. You will not find a UK official web site referring to health taxes or health subsidies... its your POV.--Tom (talk) 20:03, 9 February 2008 (UTC)

DoopDoop: I see you have a strikingly common view of things with Freedomwarrior. Would you by any chance be related? You have again deleted the phrase population insures itself. I know that you may think that this is just semantics, but most UHC is based on a form of National Health Insurance passed by legislation in which the population collective insures itself against paying medical costs at the point of need. The 1948 British system was set up under a scheme known as "National Insurance", and the 2006 Dutch law Zorgverzekeringwet translates as "Health Insurance Law". The Canada Health Act begins with a preamble "An Act relating to cash contributions by Canada and relating to criteria and conditions in respect of insured health services' and extended health care services". They are not called health tax and health subsidy laws. As I say above in another section, no Briton thinks that health care is subsidized because they know it is collectively paid for by contributions paid for by contributions over a lifetime and neither do Finns where I live now. And I suspect Canadians think they are insured too. What gives you the right to declare that this isn't a form of collective insurance? --Tom (talk) 02:30, 10 February 2008 (UTC)

It is obvious that universal health care systems have a strong insurance component (not because of the names of the laws, but because benefits of the schemes depend on the unpredictable ilnesses). However it is just a matter of emphasis. Here in the lead section leftwingers generally would be comfortable with the "collectively insuring itself" part, but some rightwingers will think that these words are POV for various reasons, so I think that consensus about these words is not likely in the lead, and I think that insurance theme could be developed more in a separate section (including moral hazard, asymmetric information and cost control topics). --Doopdoop (talk) 21:32, 10 February 2008 (UTC)

Its not a matter of emphasis. It is the intent! You seem to accept that compulsory health insurance is a form of collective insurance for the protection of the community, but in effect state that we must not call it that because it might upset some on the right (in the USA I presume) who might think otherwise. What would they call it? Robbery? An infringement on civil liberties? Do they think the same about compulsory auto insurance? Or paying tax to have a national defence system? People on the right in other countries do not think like this. This is such a minority view. Even it was as high as 20% in the U.S. (which I greatly doubt) it would amount to just 60 million people in a world of 6 billion? I don't think that 1 per cent should have a veto on what the other 99% can hear.--Tom (talk) 22:58, 12 February 2008 (UTC)

Publicly-funded health care is the main article for this page

It seems that Publicly-funded health care covers nothing except universal health care. --Doopdoop (talk) 22:22, 11 February 2008 (UTC)

I disagree. As is true in the U.S. you can have publicly funded health care for specific segments of a population, hence not universal, so while there's an ample overlap in the topics, they are distinct concepts. --Sfmammamia (talk) 01:18, 12 February 2008 (UTC)

current state of publicly-funded health care does not reflect this distinction (except in very few places). --Doopdoop (talk) 22:11, 12 February 2008 (UTC)

Publicly-funded health care does not necessitate universal health care. This is like claiming that Health care is the main article for Publicly-funded health care, this can go on ad infinitum. For example, U.S. Medicare, Medicaid, the Veterans Administration, the U.S. military, in fact ALL U.S. versions of publicly funded health care are not universal. --Historian 1000 (talk) 22:43, 12 February 2008 (UTC)

Doopdoop, if the current state of the article on publicly funded health care does not reflect the distinction both Historian 1000 and I have pointed out here, how about taking your concerns to that article and/or making bold edits there? --Sfmammamia (talk) 22:50, 12 February 2008 (UTC)

Even after bold edits there would be 95% overlap. --Doopdoop (talk) 23:02, 12 February 2008 (UTC)

This article, on universal health care, is twice the length of the article on publicly funded health care. So, unless my understanding of math is very messed up, 95% overlap between the two articles is impossible. So far, you have not gained consensus on your assertion in the topic header, so continuing to revert the hatnote seems less-than-constructive to me. --Sfmammamia (talk) 23:39, 12 February 2008 (UTC)

Regardless of what is or isn't currently in the Publicly-funded health care article (and this can obviously change at any moment with editing), the fact remains is that the two are distinct issues. This is really just POV pushing by Doopdoop and nothing more. --Historian 1000 (talk) 23:43, 12 February 2008 (UTC)

So far the only difference presented is in the details of USA health care system. But those details are covered in both articles. Also please explain why there is no Universal vehicle insurance page (only vehicle insurance page). --Doopdoop (talk) 23:56, 12 February 2008 (UTC)

Doopdoop, as this article states quite clearly, there are several funding models for universal health care, including ones that rely primarily on compulsory insurance. Have you read the description of Singapore's system within this article??? How about the multilayered funding of Germany's system???? That is why this hatnote has no consensus. Slow-motion efforts to re-insert it are not a method of achieving consensus. --Sfmammamia (talk) 00:29, 15 February 2008 (UTC)

Compulsory insurance is just a tax with a different name. --Doopdoop (talk) 07:03, 15 February 2008 (UTC)

Great sound bite. Got a reliable source for that? Because otherwise, it's just your POV. --Sfmammamia (talk) 17:22, 15 February 2008 (UTC)

Many sources, including Taxation_in_Germany, include healthcare insurance in the overall tax burden. --Doopdoop (talk) 22:04, 19 February 2008 (UTC)

It's my understanding that internal references are not useful as reliable sources, and I see that that section in the Taxation in Germany article is entirely unsourced. --Sfmammamia (talk) 23:06, 19 February 2008 (UTC)

Another great example that's described in this article is The Netherlands. With a universal system that is 55% government funded and 45% privately funded. In other words, only somewhat more "publicly funded" than the US system, which is 45% publicly funded and leaves 1 in 7 uninsured. --Sfmammamia (talk) 17:46, 20 February 2008 (UTC)

This article () discusses German insurance contributions as a taxation issue. --Doopdoop (talk) 21:45, 20 February 2008 (UTC)

Thanks for the reference. I think it would be good to check and update the Germany section of this article against the reference, even though it is 2 years old. The referenced article states: "A central health-care fund will be introduced to pool contributions made by workers and employees as well as the tax money. The fund will pass on money to insurance companies, who -- should they require additional funding -- can also raise cash directly from their members through a levy." I would argue that this paragaph is an indicator that Germany's system still is a mixed-funding system.

Please note that the source covers future plans so do not use it for updating the article unless you verify that there were no last minute changes. --Doopdoop (talk) 21:22, 21 February 2008 (UTC)

WHO statistics back me up and may be helpful to this discussion. According to the WHOSIS database, Germany's system is 77% publicly funded; 23% privately funded. The Netherlands: 62% public, 38% private. Singapore: 34% public, 66% private. And yet, all of these systems are universal. That is why I think it is a gross oversimplification, POV, and inaccurate, to say that Publicly funded health care should be the main article for this topic. --Sfmammamia (talk) 22:30, 20 February 2008 (UTC)

Publicly funded healthcare article also covers Germany, so there is no POV. --Doopdoop (talk) 21:22, 21 February 2008 (UTC)

(undenting) I've made an attempt to meld the two different versions of the lead into something of a compromise version. I think the WHO statistics bear out the point that public funding is not the only mechanism used to achieve universal health care, and that mixed public-private funding is fairly typical. I will add references to the WHO statistics in each of the country areas cited in this article as a way of illustrating the blend of funding (and varied degrees of "public") that go into universal health care systems around the world. --Sfmammamia (talk) 22:19, 21 February 2008 (UTC)

Auto-archiver proposal (and be bold)

I'm going to be bold and put an auto-archiver to work here. Any objections welcome...--Gregalton (talk) 12:03, 22 February 2008 (UTC)

Quality of Cites in the "Debate in the United States" section

I just thought I ought to point out that quality of cites given on the "left" side supporting universal health appear to be of much higher quality than those on the right, which ironically enough depends more on nonscientific, right wing/libertarian sources like the CATO Institute. (This somehow seems to be a familiar pattern....)

Also I came across this detailed, pro-universal health care "position paper" paper by the American College of Physicians titled Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries (PDF shortcut). This appears to be a good ref to add for multiple cites in the article. FYI. -BC aka Callmebc (talk) 14:48, 1 March 2008 (UTC)

Callmebc, that ACP article is a good cite. Here's another one: [http://tcf.org/list.asp?type=PB&pubid=636 The Basics: National Health Insurance: Lessons From Abroad

The Century Foundation, Century Foundation Press, 2/7/2008]

I agree with you that there is an absence in this entry of cites to high-quality studies opposing universal health care. What can be done about that? Nbauman (talk) 01:34, 2 March 2008 (UTC)

Well, it's probably not easily fixable because you're getting into politics not too different from the topic of Global Warming -- you are apparently finding most of the experts and researchers lined up on one side, while on the other you are getting mostly politically driven conservatives and free marketeers. If you try to give equal room for both, you then short change the experts and violate WP:WEIGHT. If you try to structure the article by giving weight based on merit, you'll then likely end up having to constantly contend with frustrated conservatives alleging that the article is biased. But merit is merit: I think the best refs and arguments should be found for both sides and presented sectionally rather than side by side. If this means the pro-universal health care section becomes larger, so be it. -BC aka Callmebc (talk) 07:37, 2 March 2008 (UTC)

I think it is better to integrate pro and contra arguments by grouping them by topic they discuss (quality of care, cost, social justice etc.) --Doopdoop (talk) 13:28, 2 March 2008 (UTC)

I would caution us all to be very careful about evaluating the "quality" of citations and studies offered to support positions we disagree with. It's very difficult to objectively evaluate evidence for the "other side" - whatever that evidence or position may be. Cato has a point of view - but so does any other think tank you may want to mention, whether it be Public Citizen, the Urban Institute, the Economic Policy Institute, Kaiser Family Foundation, Brookings, Aspen, Heritage, etc. Frankly, I've seen some pretty shoddy work from some of these institutions that are generally considered liberal or moderate. (Of course, in some cases my biases may have kept me from seeing that it really was solid, persuasive research; in other cases, it probably really was schlock work - the problem is that it's hard for me to tell.) None of these organizations, Cato included, are fly-by-night operations. They're well known, and their philosophic affiliations are generally well recognized.

If we are concerned that someone may be misled because they think Cato is something other than it is, I'd suggest that we wikilink to the the article on Cato. If we have concerns about a particular Cato work product that's being referenced, we should clearly describe what it is or how the work was done (e.g., "based on an internet opinion survey with 23 participants," "in an opinion piece published in their monthly newsletter," "in an op-ed . . .," "in a position paper . . ." etc.) I'd suggest the same rules for organizations all across the political spectrum. For every Cato Institute that one person thinks of as controlled by politically-driven free-marketers, there's a Center for American Progress that someone else thinks of as controlled by politically-driven anti-market tax-and-spend liberals.EastTN (talk) 16:49, 5 March 2008 (UTC)

As an aside, I just noticed that the sentence starting this discussion has a link for the Cato Institute that takes you to the website for People For the American Way, rather than to either the website or the wikipedia article for the Cato Institute. Indicting an group because it shows up on a list of "Right Wing Groups" compiled by self-described progressive advocacy organization probably isn't the best way to create the appearance of maintaining a NPOV.EastTN (talk) 18:49, 5 March 2008 (UTC)

That was deliberate -- CATO is a politically based advocacy group and not a scientific organization by any means, and is quite typical of the groups against universal health care, the "right side". Whereas the pro universal heath care advocates are far, far more likely to include organizations in good scientific and/or medical standing like the American College of Physicians. -BC aka Callmebc (talk) 02:29, 8 March 2008 (UTC)

I thought it might be. Again, I'd simply urge caution in evaluating and characterizing groups that we disagree with - especially blanket evaluations of entire organizations. It's also important to be careful about the sources we use to support our own positions. People for the American Way is also "a politically based advocacy group." Whether they agree with us or not, it doesn't strengthen the claim that Cato isn't credible because they're an advocacy group when we appeal to another advocacy group to make our case. (And for those of us with long memories, it might be useful to remember that American Medical Association fought vigorously against the enactment of the Medicare program - just because a group has solid medical or scientific credentials does not necessarily mean that it will be on the "progressive" side of any particular public policy debate.)

If the Cato materials really are that weak, there's no need to arm-wrestle with other editors. Just go to the source, add factual information to correctly characterize that source, and let readers judge. "Quality" is subjective and in the eyes of the beholder. Survey methodology and sample size are factual and objective. If one group's source is a peer reviewed study, that should be clear. If another group's source is an opinion survey of 150 physicians, that should also be clear. If a third group's source is a policy paper written by committee, say so. We can fight forever over "Public Citizen is good, Cato is bad . . . no, Cato is good, Public Citizen is bad . . . , no no, you just don't get it, Public Citizen . . ." There's nothing to fight over when you add "in an undated press release Cato claimed . . . ," or "the study considered A, B, and C, but did not address X, Y, or Z, which Brookings suggests . . .," or "based on a survey of 12 leading conservative thinkers . . ." If we play it straight and get all the facts on the table, we don't have to worry about the consequences. We just have to remember that people who disagree with us will be (or, at least, should be) adding exactly the same kind of qualifications to our sources - and we need to be not just o.k. with it, but helping them to get our sources correctly characterized. EastTN (talk) 14:01, 10 March 2008 (UTC)

I agree with most of what EastTN is saying -- attribution and detail about sources and their methodologies are generally a good thing. However, I think a "tit for tat" approach to neutrality can easily get us into WP:UNDUE. This is especially true with sloppy sourcing. One editor posts a peer-reviewed, soundly researched article; then to counter its conclusions, another editor goes out and finds an opinion piece from a highly biased source that doesn't even meet WP:SOURCES: "reliable, third-party published sources with a reputation for fact-checking and accuracy", as if this was a way to reach neutrality. It isn't, and every editor should take responsibility both for posting only reliable sources, and removing material that comes from questionable sources. Some of what Cato publishes is labeled as opinion, some of what it publishes is based on research, and I think there's a qualitative difference between those two in terms of reliability. --Sfmammamia (talk) 14:38, 10 March 2008 (UTC)

That's absolutely right. My only point is that we need to be careful in how we handle the citations of people we disagree with. We can easily misjudge them, and even when we don't, reacting too quickly can lead to an unproductive fight. If a source really is bad, it will quickly become evident if we characterize it correctly. Working through the details first encourages us to debate the merits of the evidence, rather than fighting over who's wearing a white hat and who's hiding under the black stetson. If the facts on a source are bad enough, multiple editors are going to start asking "now, just how large was that survey, and how did they select the participants?" - then we can delete it based on how it was done rather than our opinion of the author or publisher. I also agree that Cato publishes a mix of opinion pieces and research. But, the particular section we're discussing is focused on "Common arguments forwarded by supporters/opponents of universal health care systems" - for that, even if they're completely wrong and misguided, even a pure opinion piece by Cato is a valid example of arguments advanced by opponents of universal health care.EastTN (talk) 17:58, 10 March 2008 (UTC)

Just for kicks - here's a totally research free think-tank piece (no peer-reviewed studies were harmed it its writing) that made me smile. Why link to something with no numbers? It reminded me to keep my sense of humor.EastTN (talk) 21:41, 10 March 2008 (UTC)

I just wanted to point out that perhaps the reason it sounds unbalanced is because it IS. I have added numerous references (from respected sources, not just CATO) on the con side, and they have been removed. There was no discussion about why they were removed, only that someone felt they didn't do a good job. Seeing as how they have been items that include the economics of health care issues in private vs universal models, they are strong arguments against universal healthcare that contributed in a NPOV manner. But not everyone wants NPOV now, do they? —Preceding unsigned comment added by 141.214.17.17 (talk) 23:59, 28 April 2008 (UTC)

Unfair benefits...

The article currently states that "Universal healthcare is unfair to healthy tax payers because it gives people who smoke, drink, do drugs, and eat unhealthily unfair benefits"

This is not entirely true. Across most of Europe, tobacco and alchohol are taxed heavily to both discourage behavior that leads to ill-health and to ensure that users (who do indeed add to the burden of health care costs) meet a fairer share of the cost. In the UK, a general agreement between the NHS and the motor insurance industry ensures that the NHS receives a sum of money each year from all motor insurers to meet the health care costs caused by motor accidents. This agreement avoids the need for every claim to be contested, keeps the lawyers out and costs down. It does however mean that motorists are making extra contributions towards heath care through their insurance premiums. There has even been talk of taxing "junk food" but politicians are wary to do so because there are rather too many value judgements that would never reach consensus.--Tom (talk) 23:38, 1 March 2008 (UTC)

Remove this paragraph if you think it NPOV problems. --Doopdoop (talk) 23:41, 1 March 2008 (UTC)

Criticism of Canadian healthcare

I deleted the following paragraph recently added, because almost all of it is outdated, poorly or unsourced, or contradicts reliable sources:

Universal health care in Canada has caused some problems for the country's funding. On December 24, 1999 the Toronto Star reported "The Ontario government is bailing out deficit ridden hospitals to the tune of $196 million." In the same report the paper also stated a shortage in the number of doctors. Canada's health care has also been seen as inferior to private health care, such as in the United States. The British Columbia Medical Association released a paper criticizing this and calling for "the establishment of maximum wait times or 'care guarantees' for various medical procedures" and saying "patients not helped within the guaranteed time frame should be able to seek care out of province - at no cost to themselves." This is because it's criminal for citizens to pay out of pocket for private health care. The only other two countries with these laws are North Korea and Cuba.

Here are the problems I see with the paragraph:

• The 1999 quote from the Toronto Star is uncited and almost 10 years old.
• The statement about doctor shortage is fairly accurate, but also poorly sourced; there's a much better statistic cited in the Health care in Canada article.
• The statement about inferiority to U.S. is unsourced and contradicts the well-sourced and more neutral comparison in Canadian and American health care systems compared.
• The BC Medical Association quote is undated and unsourced.
• The statement that includes the phrase "it's criminal" is totally inaccurate -- about 30% of Canadian healthcare is privately funded. Again, a much more accurate portrayal of this is in Health care in Canada.
• The comparison statement about North Korea and Cuba is pure rhetoric and highly inaccurate.
• The only source cited for the entire paragraph is Human Events Online, which bills itself as the Conservative Voice, so fails on neutrality and is of dubious reliability.

A more balanced and better sourced critique of Canadian healthcare might fit in this article. But those are contained in the other articles I noted. --Sfmammamia (talk) 15:16, 6 March 2008 (UTC)

JaaJoe.com Just Another Average Joe spam

I've removed the external link to JaaJoe.com Just Another Average Joe twice. According to Whois, the domain was just registered 3 months ago. It's not a notable source. The main page has a Google page rank of 0. The article is not professionally written and the author does not even use a full name, just "Cisco." It's also been spammed by the same IP 24.243.31.156 (talk) on the Cardiopulmonary resuscitation page. --Lifeguard Emeritus (talk) 09:50, 20 April 2008 (UTC)

The IP 24.243.31.156 (talk) has reinserted the link twice more (4 times total) despite being reverted by another editor. The IP has been issued a spam warning. --Lifeguard Emeritus (talk) 05:31, 21 April 2008 (UTC)

How to expand the "Debate" section

I have added examples to the debate section numerous times. They have been sourced. The sources are reputable sources (not just CATO-like think tanks.) They complied with NPOV. They were relevant to the topic at hand. They did not erase any other entries on the article. They have been removed shortly after (ie less than 5 minutes.) Why are they being removed? I know I am supposed to assume good faith, but the fact that they are consistently removed from the "con" side of the argument makes me wonder if not everyone is willing to have this article contain all relevant information. —Preceding unsigned comment added by 141.214.17.17 (talk) 00:41, 29 April 2008 (UTC)

Your most recent additions did not cite any sources. You are welcome to add them back when you have sources to cite for them. Please read WP:V and WP:CITE if you are unfamiliar with how to cite your sources.--Sfmammamia (talk) 01:41, 29 April 2008 (UTC)

My last edits, yes. In fact, I put those in as a test just to see how long they would survive (about 2 minutes.) However, my additions earlier that WERE sourced have also been deleted, each time I put them in, as I said in my original point. I want to know how to get them added in without them being deleted 2 minutes later. —Preceding unsigned comment added by 141.214.17.17 (talk) 06:36, 11 May 2008 (UTC)

Please cite the specific diffs where you added reliably sourced material that was removed, and perhaps we can address and discuss your question. ----Sfmammamia (talk) 18:51, 11 May 2008 (UTC)

Proposed merge

I am proposing that the article Socialized medicine be merged into Universal health care. I see these two articles as being broadly about the exact same issue, where socialized medicine only focuses on the more negative political connotations in the American political landscape. However, Wikipedia is not US-centric. Rather, it should represent a worldwide view of the subject. The purpose of providing the reader with the most accurate, verifiable, and neutral exposition of health care programs is not best achieved by the division of this subject into two separate articles. --Ryan Delaney ^talk 02:55, 6 May 2008 (UTC)

Oppose: the term itself is US-specific, and should remain documented as a political term. Likewise, universal health care is a political term in the US, and mostly non-controversial elsewhere. The subject of this article should remain universal health care; the subject of socialized medicine should be the use of the term and its political connotations (esp pejorative); most of the "analysis" content in the socialized medicine article could be moved/integrated with this, publicly-funded health care, or health care economics, etc.

So I agree there should be some rejigging, but there is no way the socialized medicine article can be removed - it will get searched for. It should be cut down tremendously, however, with links to other appropriate articles.--Gregalton (talk) 05:04, 6 May 2008 (UTC)

Oppose. One can have universal health care without full-blown public funding or public provision of health services (which is what socialized medicine refers to). UHC is a broad concept with many ways of achieving it or aiming to achieve it. Socialized medicine is a politicized term used only in the U.S. whereas UHC is mostly an internationally used term with no particular political bias (at least not outside the U.S.) I agree with Gregalton that people will search for socialized medicine and it would be wholly inappropriate for people to believe that that this equates in any way to UHC. --Tom (talk) 09:05, 6 May 2008 (UTC)

Oppose. User: Ryan Delaney argues that a WP article shouldn't deal with an American issue, but should be merged with an international article. That doesn't make any sense. Lots of WP articles are national articles -- U.S. health care, U.K. health care, etc. By that logic, we should merge all our national health care articles into one big health care article.

Health care is too complicated. The articles tend to be, if anything, awkwardly long. It has to be broken into separate topics. Socialized medicine is a distinct, separate topic, and it's complicated enough to require its own treatment.

Furthermore, as editors above point out, socialized medicine is not the same as universal health care. Many national systems, such as Switzerland, Japan, and Canada are universal but not socialist.

User: Ryan Delaney hasn't been working on this article. Among those of us who have been, there is consensus not to change.

But thanks for bringing up a provocative idea. Nbauman (talk) 15:31, 6 May 2008 (UTC)

Oppose. Issues of length and focus as raised by other editors above. --Sfmammamia (talk) 17:55, 6 May 2008 (UTC)

Weak support. There are too many articles about the same topic (POV forking). Not 100% sure universal health care is the best name for this topic. --Doopdoop (talk) 21:31, 10 May 2008 (UTC)

Oppose. For purposes of this debate and future debates about the various labels to define central concepts, I want to add some commentary; also to address the comment directly above by Doopdoop.

The traditional meaning of Socialism as practice and ideology--based on Marx's definition--is when the means of production (land, labor, capital) are in public hands. (There are other definitions of socialism dating back to the 19th century, but the means of production issue is always key). A component of that is public funding. However, I want to point out to an above comment, mere public funding does not constitute being "socialist" (to refer to a specific sector rather than an overall system or philosophy) when it is not accompanied by public ownership of the means of production. Were the “socialist" label to be applied as a definition to any publicly-funded activity, then the entirety of government spending would be defined as socialist. While some (e.g. some libertarians) might hold that position, it is only an infinitesimal number in the US--or elsewhere in the West. The public provision of health care services--with publicly owned facilities--is the mark of “socialist,” e.g. Britain, though they do have some private services and spending. No Western nation has either 100% private or public funding.

More generally, "universal" refers to access, not to an economic model, e.g. socialist, capitalist. The access and economic model concepts are distinct, as previously noted. Hence, discussing "universal" as a separate topic is appropriate. I think the major details of other nations is too much baggage and takes up too much real estate to the detriment of clarity on the "universal" concept; the level of emphasis on practices diminishes the value of explicating the concept.