The Elderly suffer Insanitary Conditions and Inadequate Nutrition in Britain’s NHS

Posted by PITHOCRATES - May 27th, 2012

Week in Review

National health care is having problems in the UK.  Their biggest customers are suffering from poor treatment.  The elderly.  In part because the NHS does such a good job at keeping the elderly alive (see ‘Friends and family’ test for hospitals by James Kirkup posted 5/25/2012 on The Telegraph).

Ministers are trying to improve standards after warnings from watchdogs that too many patients, especially the elderly, experience poor standards of basic care, including insanitary conditions and inadequate nutrition.

NHS staff are already asked to take the “friends and family” test, but the Prime Minister will say that extending it to patients will bring benefits to the service…

The Care Quality Commission last year found that one in five hospitals failed to meet basic standards of care for elderly patients.

This is a problem.  For many patients in a hospital are elderly.  Almost half of the patients in the NHS are age 60 or over.  So they’re dropping the ball on about half of the 16 million or so patients in the hospitals of the NHS.  If this were baseball batting almost 500 would be pretty good.  But this isn’t baseball.  And it’s just a bit unsettling that of all the moms and dads getting admitted to an NHS hospital about half of them will suffer poor treatment.  Including insanitary conditions.  And inadequate nutrition.

Will this happen in the US under Obamacare?  Well, the US has about five times the population as the UK.  And the UK has been practicing national health care for a long time.  So we probably won’t be as good as the British are at national health care.  So less skilled with about five times the patients?  I think it’s fair to say that the elderly will suffer even more poor treatment in the Obamacare system than they do in the NHS.  Especially with our aging population.

And it’s this aging population that’s the big problem.  People are living longer.  And because they’re living longer they’re having more hospital stays.  Requiring greater health care expenditures.  But because the population is aging the young have to carry ever larger shares of these health care expenditures.  As in higher taxes.  For the group consuming these health care services is growing faster than the group paying for them.  So they raise tax rates where they can.  And ration services.  To make their limited resources cover more and more patients.  Including having nurses treat more patients.  Sort of in a production line mode.  Spend as little time with each patient as possible.  To increase the number of patients processed.  It’s at this point when patients begin to fall between the cracks.  And suffer poor treatment.

This is the direction Obamacare will take us.  For when it comes to national health care the NHS is one of the best.  But it still ranks below most private health care.  Even Medicare.  For Medicare still operates in the realm of the private sector.  The government reimburses health care providers after the fact.  After the patient received treatment in the private health care system.  But once Obamacare morphs into the full-blown national health care system those on the Left want Medicare will struggle to meet the quality level of the NHS.  It will struggle to only mistreat about half of their elderly patients.  Because Obamacare will have five times the elderly patients than the NHS has.  It’s just simple math.

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Public Goods

Posted by PITHOCRATES - April 9th, 2012

Economics 101

You can’t put a Price Tag on Units of National Defense or Sanitary Sewers and Wastewater Treatment Plants

The free market works because people only trade when buyers and sellers agree on price.  Those agreed upon prices are fair to both.  For the sellers place a higher value on the money they receive than the things they’re selling.  And the buyers place a higher value on the things they’re buying than the money they’re spending.  And because of property rights this can happen.  After these transactions the buyers have exclusive use of what they just bought.  And the sellers have exclusive use of the money they just received.  And this holds true whenever we’re buying and selling private goods.  Things people own and use exclusively.  And have the right to buy and sell.  Thanks to property rights.

There are things, though, in our everyday lives that we don’t use exclusively.  Or own exclusively.  Things that we can’t exclude others from using even if they don’t pay to use these things.  Such as the military.  You can’t put a price tag on units of national defense that people can buy.  Some people don’t like the military and would never buy units of national defense.  If the country was under attack, though, our military couldn’t exclude these people from the common defense they provide.  Because there is no way to exclude them. 

You have another problem with sanitary sewers.  Those pipes under our roads that pipe our toilets to a wastewater treatment plant.  We have to pay for our toilets and the pipes running from our houses to the common sanitary line in the street.  But developers built that common line in the street long before someone built our house.  As they built the wastewater treatment plant long before they built our house.  These go in before they build neighborhoods.  But we still have to pay for these long after we build them.  And once our streets are paved you can’t expect new homeowners to install new sewer lines from their newly built homes to the wastewater treatment plant.  And you can’t build new wastewater treatment plants for each new house built.  They tend to take up a lot of real estate.   And need a place to discharge the treated water.  Usually into a river, lake or ocean.  So it just doesn’t make any economic sense to build more than one sewer system and treatment plant in a given geographic region.

Government Typically provides Public Goods because there are no Viable Private Sector Alternatives 

The military is a public good.  Sanitary sewers and wastewater treatment plants are public goods.  Public goods share two characteristics that make them public goods.  They are non-excludable.  Like the military.  Where it’s impossible to exclude people from the common defense while providing the common defense.  Because it’s common.  Everyone benefits from our warships that protect our shores from invasion.  Whether they pay for them or not.  And public goods are non-rival.  Like sanitary sewers and wastewater treatment plants.  When my neighbor flushers his or her toilet it doesn’t prevent me from flushing my toilet.  That is, their use of the good doesn’t reduce my use of the good.

Because public goods are non-excludable and non-rival it is impossible to put a price tag on them for individual units of use.  This is why we pay for public goods with taxes.  Because we need these public goods and everyone benefits from these public goods we force people to pay for them with taxes.  Something only the government has the power to do.  So government typically provides public goods.  Because there are no viable private sector alternatives. 

There is an option to a public sanitary sewer system, though.  And we use them all the time.  For houses in the country.  Where they pipe their toilets to a septic tank that collects much of the solid waste.  The septic tank then drains the residual wastewater into a septic field.  Where it leaches back into the water table.  But if we don’t connect a house to a public wastewater system we typically don’t connect it to a public water system.  Meaning these people draw their water from a well.  That draws water from the water table.  So septic fields and wells can’t be too close together.  So you don’t end up drinking your wastewater.  Which limits how close you can build homes together.  Not a problem in the country.  But a problem in the city.  Which we can’t build without city water and sanitary sewer systems.  Public goods.  That we pay for with a water meter on every house.  That charges for each unit of water we use.  And each unit we use includes a cost for our sanitary waste.  Because all wastewater starts off being clean city water.

Health Care is NOT a Public Good because there are Viable Private Sector Alternatives

Charities can provide some goods that can appear to be public goods.  Like feeding the hungry.  Housing the homeless.  Or leaving an endowment to a university or a hospital.  But charity doesn’t pay for warships or wastewater treatment plants.  So we generally think of public goods as government-provided goods.  But not all government-provided goods are public goods.  Because they aren’t both non-excludable and non-rival.  Such as feeding the hungry.  And housing the homeless.  Charities were doing these long before government stepped in to provide them.  And continue to do so today.  Soup kitchens and homeless shelters clearly show that these aren’t true public goods.  Because there are viable private sector alternatives.

Government welfare, then, is not a public good.  But the government has taken over welfare from those who have historically provided for them.  Charities.  Churches.  And rich people wanting to give back to the country that was so generous to them.  Andrew Carnegie had a passion for knowledge and built public libraries.  John D. Rockefeller had a passion for education and public health and poured his wealth into these.  John Hopkins built hospitals.  They did these things, and others, out of the goodness of their hearts.  Becoming philanthropists after making their wealth.  To help other people.  Rich people are still doing so today.  After creating great wealth Bill Gates is planning to give pretty much all of it away through the Bill & Melinda Gates Foundation.  Like other great philanthropists before him.

And speaking of health care, health care is not a public good.  Because it is NOT non-excludable.  Your health care is exclusively yours.  There is a direct relationship between patient and health care services.  You consume hospital stays, medicines, rehabilitation, etc.  If you’re not a patient that treatment doesn’t happen.  Unlike a warship protecting our coast.  And health care is NOT non-rival.  When people consume health care services other people can’t consume those same services.  An MRI can only scan one person at a time.  A radiologist can only look at one x-ray at a time.  Hospitals can only transfer someone out of the emergency room when a bed is available elsewhere.  So when people consume these services it reduces the amount available for others to consume.  Which makes health care NOT a public good.  And one the government shouldn’t be providing.  Because there are viable private sector alternatives.

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