Humanities desk
< November 5	<< Oct \| November \| Dec >>	November 7 >

Welcome to the Wikipedia Humanities Reference Desk Archives
The page you are currently viewing is an archive page. While you can leave answers for any questions shown below, please ask new questions on one of the current reference desk pages.

November 6

Single-payer healthcare

I was reading Single-payer healthcare and noticed that Monopsony is linked at the bottom. Is this actually a case of monopsony though? According to the article both Canada and Australia have a coexisting private health system; if a private party can buy healthcare then it's not a monopsony. Is there any single-payer healthcare country where it's an actual monopsony? Pizza Margherita (talk) 05:19, 6 November 2016 (UTC)[reply]

I'm not any kind of expert on economics, but reading that article it seems to be monopsony from the workers' point of view. With one buyer of healthcare services that is very large (the NHS directly employs more people than any business in the world except Walmart), wages in healthcare are to a large extent set by the government in the UK. (Incidentally, this is not without problems, especially in the expensive London area where many skilled workers are not keen to work for the "official" government pay rate. The result is you have an interesting black-market type situation where "temporary" workers from an "agency" are brought in on higher-than-official wages to fill vacancies because it's hard to recruit for permanent positions.) Blythwood (talk) 05:31, 6 November 2016 (UTC)[reply]

NHS employs the vast majority of the health workers, sure, but there are still private hospitals in UK, right? I'm not personally familiar with the UK case, just taking a guess from reading Healthcare_in_England#Private-sector_medical_care. Pizza Margherita (talk) 06:39, 6 November 2016 (UTC)[reply]

Yes, of course, and many healthcare workers may dual-practice, especially consultants, across their careers. But to give some idea, only about 11% of British people have any kind of private health insurance, and they are disproportionately distributed in the wealthy south-east of England anyway. (Obviously, some of those will not use it because NHS provision is more convenient, and some without private insurance will pay for specific procedures. But it's a reasonable benchmark - this is a more complete explanation.) To put it another way, the NHS has never been intended as a safety net or a backup option for the poor. It's intended to function as the UK's entire health system, with the ethos that one shouldn't "need" to use private healthcare for any "reasonable" set of requirements. Blythwood (talk) 09:10, 6 November 2016 (UTC)[reply]

Since Canada and Australia have coexisting private health systems, they're arguably not "true" examples of single-payer healthcare, in the sense that "the state, rather than private insurers, pays for all healthcare costs", now are they? Gabbe (talk) 07:08, 6 November 2016 (UTC)[reply]

That's a very good point. Single-payer healthcare, as defined in the article, implies monopsony by definition. Then I guess my question becomes "Is there any actual 'true' single-payer healthcare country out there in the world?" Pizza Margherita (talk) 07:23, 6 November 2016 (UTC)[reply]

The only examples I can think of where the politicians also have a legal monopoly on healthcare (as opposed to merely being the dominant provider) are countries like Cuba and North Korea. Gabbe (talk) 07:38, 6 November 2016 (UTC)[reply]

I'm not sure if there are any other countries with a legal monopoly on healthcare, where working as a private doctor is illegal, but I would suspect there are heavily socialist democratic countries such as the Scandinavian ones, where seeking private medical care for anything essential, whilst legal, would very much be the exception, no? In other words, to use Gabbe's term, the government is very much the "dominant provider", significantly more so than countries like Australia, where I live (if you want a hip or knee replacement - any "elective surgery" - or dental care in the public system, you may be in for a long wait - the public system here "rations by quene" in many areas, so if you have the money or private health insurance, you go private. And if you want public psychiatric care, you need to be truly seriously mentally ill, practically floridly psychotic, to qualify. Though if you see a private specialist, the government still covers part of the bill). Obviously, even in these countries (the heavily socialist wealthy democratic ones, where Government care is good quality, delivered in a timely fashion (i.e. no "rationing by queue" as in the UK and Australia), pays for pretty much anything genuinely related to one's health needs, and very much the rule), I doubt the public health system would pay for purely cosmetic procedures such as breast implants, so I assume a (relatively small) private medical market to cater for such needs would still exist? Are there in fact any such countries? How does health care work in the most socialist of the democracies, such as those of Scandanavia? As an interesting aside, whilst the German public healthcare system does not pay for breast enlargements, the German tax department has ruled that prostitutes are entitled to claim the cost of breast enhancement surgery as a business-related tax deduction.Eliyohub (talk) 08:58, 6 November 2016 (UTC)[reply]

Discouraging private healthcare has been a more-or-less explicit goal of some health workers' unions in the UK. The logic is that it benefits the majority of health workers, those in the NHS, if all but the very richest in the UK feel that they have a stake in the NHS being well-funded. There are some restrictions, you don't lose anything specific by going private - healthcare in the UK is a universal right, remember - but you can't get a procedure part-NHS, part-private. I'll quote the official guidance page on this topic: "If you're receiving private and NHS care for the same condition, your NHS and private treatment can be supervised by one healthcare team [but] you cannot choose to mix different parts of the same treatment between NHS and private care. For example, you cannot have a cataract operation on the NHS and pay privately for special lens implants that are normally only available as part of private care. Instead, you either have to have both the operation on the NHS and standard NHS lens implants, or pay for both the operation and implants privately." Blythwood (talk) 09:10, 6 November 2016 (UTC)[reply]

Procedures for choosing a new nominee for presidential candidate post-convention

Let's assume, after the party has held its convention and chosen their candidate for president, the candidate withdraws or cannot continue in the race - whether due to scandal, ill health, family crisis, discovery of ineligibility, unexpected death (natural, accidental, violent, whatever), etc. What are the two major parties official procedures for choosing a replacement candidate, particularly at short notice?

In general, this may happen too close to election day for a proper full new emergency convention to be held, where the already-elected nominees (who were pledged to one of the previous candidates) can all be assembled and get to vote on whom they want to take the spot. So what would the party do? What does the rule book say? Does the rule book vary between the Democratic party and the Republican party?

As a separate question, has this ever happened - that a candidate has been nominated as presidential candidate by the convention of their party, but did not reach election day as a "live" (still officially in the race) candidate? (There were times candidates were assassinated, such as Ted Kennedy, but this was pre-convention, I believe, so didn't cause this issue). And if yes, how did the party choose a replacement? (I'm sure it's happened at State level at least once in a gubernatorial election. Are the rules the same? What happened? I'm exclusively referring to times where the candidate was in fact replaced by the party, not where the dead or withdrawn candidate remained on the ballot). Eliyohub (talk) 12:15, 6 November 2016 (UTC)[reply]

First, I think you meant Robert F. Kennedy not Teddy.

I think the answer is an unsatifying "we don't know what would happen if a presidential nominee were to die or drop out after the convention, but before the election. It has never happened at the Presidential level, so there is no precedent to draw upon. Blueboar (talk) 13:12, 6 November 2016 (UTC)[reply]

It's an easy mistake to make, since Ted Kennedy committed political "suicide" at the time, though he mounted an attempt to win the Democratic Party nomination in 1980, as noted at Democratic Party presidential primaries, 1980, the incident was still enough of a drag on his career nationally to shift the balance to Carter. --Jayron 32 12:50, 7 November 2016 (UTC)[reply]

This has been brought up several times during this past summer. You could search the archives for roughly that time period and get some useful links. And there was a case where a nominee died (Horace Greeley in 1872), and the electors voted for various others, although the other guy (U.S. Grant) had already effectively secured the election anyway. (This, of course was after the popular election.) ←Baseball Bugs ^{What's up, Doc?} carrots→ 13:16, 6 November 2016 (UTC)[reply]

1. Baseball Bugs, excuse my cluelessness and uselessness at searching for such things, but I wouldn't know what words to search for. If you (or anyone else reading this) could provide me with the relevant links to the questions you're referring to, I would be most grateful.

2. Is there a precedent in State gubernatorial races of a candidate dying or dropping out post-nomination but pre-election, and being replaced by the party with another candidate on the ballot (NOT the dead or dropped out person remaining on the ballot)? What process did they follow?

3. Despite there being no actual precedent, what do each party's rule books say about this situation? Surely they must say something about how to deal with such a contingency?

No need to answer questions 2 and 3 if the answers are already contained in the links Baseball Bugs or anyone else can provide, either to previous questions on this desk, or other sources. Though if you additional info to offer which those sources don't please do offer it. Thanks, much appreciated. Eliyohub (talk) 14:52, 6 November 2016 (UTC)[reply]

I find the "search" function to be clumsy and pretty much useless as it returns items in random order. Better to go into the weekly archives, one by one, and look in the TOC for anything promising. ←Baseball Bugs ^{What's up, Doc?} carrots→ 15:10, 6 November 2016 (UTC)[reply]

Given the difficulty of finding this, could you tell me, what was the gist of the answers given? Also, I find the search function most useful when searching for phrases (put them in talking marks), so if you remember even a few words strung together from either the question or an answer to it, you can still provide me with a link. Did anyone have any quotes from the rule books to offer? Eliyohub (talk) 15:19, 6 November 2016 (UTC)[reply]

Typing the phrase "how does a political party replace a candidate after the convention" into google turned up some interesting results, the first two were not that reliable, but this was result #3 and this was result #4 and both look to solidly answer your question; this was also a first page result, and looks good as well. --Jayron 32 12:47, 7 November 2016 (UTC)[reply]

The only case that comes close is the 1972 Democratic vice presidential candidate. Thomas Eagleton was the original nominee. About two weeks after his nomination, Eagleton was pressured to step down after concerns of mental illness and depression. According to our article United States presidential election, 1972, a new nominee (Sargent Shriver) was "nominated by a special session of the Democratic National Committee". (The article does not specify the mechanics of the new nomination.) → Michael J Ⓣ Ⓒ Ⓜ 14:11, 7 November 2016 (UTC)[reply]

Thatcher's cause of death

Hello. Judging from the death certificate of the late prime minister, can it be concluded that she specifically died of an ischemic stroke? Thanks.--Nevé –selbert 22:55, 6 November 2016 (UTC)[reply]

It would be my conclusion that the person who filled out her death certificate believed that to be the case. Unfortunately, he was not as careful, explicit, or specific in his terminology as one might have wished. Nor is it recorded thereupon whether the cause of death was determined by medical history or autopsy. - Nunh-huh 02:56, 7 November 2016 (UTC)[reply]

I would think it most unusual to perform an autopsy in a case where there is no reason to doubt that the deceased died a natural and timely death. Thatcher was not young or in good health. The doctor would probably do a relatively simple examination and give a "best guess" as to what exactly killed the elderly and sickly person. Autopsies are generally reserved for cases where there's a coronial investigation, meaning something is deemed "not right" about the death. So I'd be very surprised if an autopsy was performed on Thatcher. Eliyohub (talk) 06:38, 7 November 2016 (UTC)[reply]

Yes, the cause of death on most death certificates are usually simply the best guesses of the physician in attendance upon the person at the time of death. Sometimes those guesses are right; sometimes those guesses are wrong. Autopsies are certainly more reliable, and their use varies. Sometimes a guess is enough. But autopsies are certainly not reserved for the edification of coroners.- Nunh-huh 09:34, 7 November 2016 (UTC)[reply]

Re "he was not as careful, explicit, or specific in his terminology as one might have wished", are British death certificates usually that much more careful/explicit/specific than that? My very fleeting experience of the system that generates them is that if the cause of death is in-your-face-obvious, it's just a brief bureaucratic irritation for the next of kin and clinician. --Dweller (talk) Become old fashioned! 08:26, 7 November 2016 (UTC)[reply]

He could easily have written cerebrovascular accident, for example, instead of cardiovascular accident, which would have been more exact. And indicated, for example, that the "transient L/Ischaemic attacks" were strokes on the left side of the brain (resulting in right side of the body deficits and language apraxia) rather than stroke affecting the left side of the body. - Nunh-huh 09:34, 7 November 2016 (UTC)[reply]

Stroke may not be in-your-face-obvious in a dead person without an autopsy or brain scan showing the brain bleed (I'm no doctor, so tell me if I'm wrong), but when an elderly person dies in non-suspicious circumstances which give the Coroner no reason to get involved, the exact cause of death is of limited relevance, I would think. So a "best guess" based on observations of the body and medical history would probably be deemed "good enough" for all intents and purposes, wouldn't it? There would be no practical reason for the clinician to rigorously investigate. But if you really want to know more (your curiosity is eating you), my advice is, contact the clinician named on the death certificate and ask him or her. They'd be under no obligation to talk to you, but they might just agree to do so. I don't think medical confidentiality extends to this circumstance. The death certificate publicly names the cause of death, and the clinician would probably be in their rights to elaborate, if they're the talkative and forthcoming kind. Eliyohub (talk) 09:13, 7 November 2016 (UTC)[reply]

Nunh-huh, I don't know the law in the UK. But I know for certain that here in Australia, the coroner is the only authority that can order an autopsy against the wishes of the deceased (in the instructions they've left behind) or their family. Which means it must be a "reportable death" - a suspicion that something is amiss - generally an unnatural or untimely death, or suspicion thereof. Is the law different in the UK? (If the family consented, it would be a different story). Eliyohub (talk) 11:26, 7 November 2016 (UTC)[reply]

Why are you assuming an autopsy would be against the wishes of the next of kin of the deceased? - Nunh-huh 12:30, 7 November 2016 (UTC)[reply]

Apparently not - see What to do after someone dies from the British Government website. Alansplodge (talk) 11:22, 7 November 2016 (UTC)[reply]

So absent family consent or a coroner's order, an autopsy could not be performed in the UK either, correct? Eliyohub (talk) 11:27, 7 November 2016 (UTC)[reply]

When someone dies a detailed certificate is prepared, of which the certificate filed with the Registrar of Births, Marriages and Deaths is a summary. The filed certificate summarises the main cause of death and contributory factors. Cause of death is not always cut and dried - for example someone might contract an infection and die from it, but they might not have fallen ill if their immune system had not been weakened for some reason. 80.44.161.39 (talk) 12:21, 7 November 2016 (UTC)[reply]

Nunh-huh, sorry, I didn't mean to apply that I'm assuming that an autopsy in Thatcher's case would have been against the wishes of her next of kin. I was simply pointing out, in response to your comment that autopsies "are not reserved for the edification of coroners", that if the next of kin do not explicitly consent, only the coroner would have the power to overrule them. And note that in many jurisdictions, in such a situation, the family can challenge the coroner's decision in court. The issue has arisen in cases where the coroner is investigating the death of an orthodox Jew, for example, whose beliefs generally preclude autopsies. The courts (here, at least) have usually deferred to the family, absent good reason why an autopsy is essential (e.g. suspected foul play). Curiosity about what exactly caused an elderly person to die a non-suspicious death certainly wouldn't cut it, judging by precedent. But I admit I'm going a bit off-topic here. Point is, barring consent from the next of kin, only the coroner can order an autopsy. That's the law. Eliyohub (talk) 13:08, 7 November 2016 (UTC)[reply]

Well, yes, that's your point. My point was that an autopsy gives actual evidence for a given cause of death, while a death certificate is only a reasonable guess—the accuracy depending a great deal on the diligence, or lack thereof, of the physician filling it out. - Nunh-huh 14:52, 7 November 2016 (UTC)[reply]

In the UK, if someone is under the care of a physician at the time of death there is no need for a post-mortem, and a doctor can sign the release form which releases the body into the custody of the family. This form is taken to the Registrar in the local authority concerned, and the death certificate is issued. What goes on the death certificate is what is written on the release form. So as far as I can see, there would have been no need to perform an autopsy or post-mortem examination on Thatcher's corpse, and no way for anyone to do so - outside of a prurient wish to know. --TammyMoet (talk) 15:43, 7 November 2016 (UTC)[reply]

The "wish to know" has pretty much motivated all human progress. And we do many things that don't "need" to be done to satisfy that wish to know. - Nunh-huh 19:57, 7 November 2016 (UTC)[reply]

I would like to see a reference for that, please; in particular your first point. At the very least it seems to preclude the possibility of malpractice investigation. Matt Deres (talk) 17:46, 7 November 2016 (UTC)[reply]

"Medical certificate of cause of death (MCCD): The MCCD (more commonly known as the death certificate)... A death certificate may be issued by a doctor who has provided care during the last illness and who has seen the deceased within 14 days of death (28 days in Northern Ireland) or after death. They should be confident about the cause of death. In some circumstances, a doctor is unable to provide a death certificate and the death must be reported to the coroner (or procurator fiscal in Scotland) rather than issuing a death certificate". [1] Alansplodge (talk) 18:26, 7 November 2016 (UTC)[reply]

Thank you very much. Am I way out to lunch in thinking that leaves a rather large opening regarding surgical or medical misadventures? If the attending doctor messes up somehow (wrong dosage, cut the wrong thing, you name it), wouldn't allowing them - seemingly encouraging them - to sign off on the MCCD themselves open up a huge conflict of interest? Matt Deres (talk) 21:27, 7 November 2016 (UTC)[reply]

Harold Shipman wouldn't think so :) - Nunh-huh 21:45, 7 November 2016 (UTC)[reply]

More than half-a-million people die in the UK every year. [2] That's an awful lot of autopsies. Alansplodge (talk) 22:16, 7 November 2016 (UTC)[reply]

Quite an intriguing discussion above, I must say. I don't think there is any harm done to assume that, given the statistics shown at Stroke, she most likely died of an ischaemic one. "Ischaemic" is mentioned on the certificate of death, anyway.--Nevé –selbert 17:56, 7 November 2016 (UTC)[reply]