It was a Bad Year for the NHS which Portends a Bad Future for Obamacare

Posted by PITHOCRATES - December 29th, 2013

Week in Review

Britain has had its problems with their National Health Service (NHS).  Where national health care is proving to be unaffordable.  Especially now that their population is aging.  People are living longer into retirement and consuming more health care resources.  While a falling birthrate is producing fewer new taxpayers to replace those retirees leaving the tax-paying workforce.  Forcing them to raise taxes on those still paying taxes.  Or cutting spending on those who aren’t paying taxes.  Those consuming the lion’s share of their limited health care resources.  Those retirees.

Those are the choices.  And they are the only choices.  Because when it comes to national health care it’s a zero-sum game.  Either you take more from some to pay for others.  Or you spend less on everyone to make those limited resources cover more people.  Which is the great flaw in national health care.  Because your health care depends on what others are willing or able to give you.  Something that’s been happening ever since health insurance became an employee benefit.  For before that you paid for your health care.  And no one denied you anything.  Because you were in control by paying your own bills.  But then came the third parties.  First the health insurance companies.  And then the government.  As always is the case when you introduce ‘middle men’ costs rise and efficiencies fall.

As health care became a benefit it required generational theft.  Taking money from the young and healthy to pay for the old and sick.  When health care became a right the generational theft grew greater.  And when government took over the generational theft grew even greater.  As government is notoriously less efficient than private health insurers.  Requiring ever more money to provide the same level of health care found in the private sector.  Which is why 2013 was not a good year for the NHS (see Was 2013 the NHS’s annus horriblis? by Nick Triggle posted 12/27/2013 on BBC News Health).

It has been a bruising year for the NHS in England…

It kicked off with the publication in February of the Francis Inquiry into events at the Stafford Hospital, which accused the service of betraying patients.

By the start of the summer, another 14 hospitals with the highest death rates were being hauled over the coals for their failings in their care…

As autumn came, another review – this time on complaints – was scathing about the attitude of the NHS to complaints.

The report, led by Labour MP Ann Clywd who had broken down on radio over the care given to her late husband, said there was a culture of “delay and denial”.

Of course, controversy has surrounded the health service before…

But that was about how the service was structured.

This year has been about the very basics – the quality of care – and so in that sense it has felt different…

According to Chris Hopson, chief executive of the Foundation Trust Network, the giant hurdle in the way of further progress is money.

“This is perhaps the trickiest position the NHS has ever been in,” he says.

“We are looking at a period of 10 years where money will be incredibly tight and what we are seeing now is a mismatch between what is being asked for and what is achievable.

The United States has an aging population just like Britain.  And has the same problem paying for their health care as they do.  Requiring ever greater amounts of generational theft.  As Obamacare all but picks up our young by the feet to shake whatever money they can out of their pockets.  Which begs the question if the NHS is such a case study in what not to do why did President Obama and the Democrats do the Affordable Care Act?

The answer is simple.  Because Obamacare is not about health care.  It’s about government power over one-sixth of the U.S. economy.  For if it was about health care they wouldn’t have done the Affordable Care Act.  Because of the lessons offered by the NHS.  Lessons President Obama and the Democrats ignored when passing Obamacare into law.  As they weren’t being honest with the American people.  Because they want what the British have.  Even if it reduces the quality of our health care.  Which is obvious by their passing the Affordable Care Act despite all of their woes in the NHS.  Which will soon be our woes.

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Elderly Patients suffer Poor Care and Neglect in the NHS as Hospital Staff finds them too Burdensome

Posted by PITHOCRATES - July 27th, 2013

Week in Review

One of the big problems with national health care is old people.  They cost a lot.  And consume a lot of the limited resources available.  Especially with their repeat hospital stays.  Becoming too great a burden for some hospital personnel.  Leading to poor care.  And neglect.  As this family in Wales experienced (see NHS neglect: Calls for inquiry after woman’s death by India Pollock posted 7/25/2013 on BBC News Wales).

“It was absolutely appalling,” a relative said. “Quite often I’d go in to visit her and I would find that she had been left nil by mouth for several days until she was weak and wasn’t able to lift a glass of water to her mouth, she was dehydrated.”

Another family member said: “We sat by her bedside until her tongue swelled up and cracked and her lips split open for want of hydration.

“She became delirious at first, then barely conscious, almost coma-like…”

The health board said it would conduct a Protection of Vulnerable Adults (Pova) investigation.

However, the board did not contact the family for six months. It apologised and said that lessons had been learnt but no Pova proceedings took place.

When the woman was readmitted in 2012, relatives said they discovered the same problems.

They reported their concerns to social services which is when they learnt that a Pova investigation had not actually taken place.

Pova proceedings were then used and a number of allegations were proved.

The health board admitted giving unnecessary sedation and failing to administer prescribed medication.

The board also failed to care for the woman’s amputated leg.

A family member added: “We explained how her prosthesis could be taken off and showed them the bag of clean amputation socks that we’d taken in for her.

“We also gave them oils to treat her leg to ensure it didn’t become inflamed. We explained it all to the staff.

“When I complained that she was having unnecessary sedation, they said it was because she was screaming at night. When I asked her why she was screaming at night, she told me that they hadn’t taken her leg off in the two weeks that she’d been there.

“A member of staff pulled back the bedclothes and sat by the side of her bed and took her leg off with me, and took off the urine sodden socks that had been left on her amputation for two weeks and he turned away in disgust, holding the urine sodden socks at arms’ length.”

Recommendations were put in place, but the family said there were similar issues when the woman was admitted to Neath Port Talbot hospital in August 2012.

Then she was transferred to the Princess of Wales Hospital, where she died in November.

The family said they were told by staff that they were stopping her medication as she was dying of pneumonia.

However, a post mortem examination was carried out and the coroner’s report said her lungs were free of chronic disease, and that she died of a heart attack…

Peter Tyndall, the Public Service Ombudsman for Wales, said: “It’s absolutely tragic for the individual and for the family, and I think although there are lots of people who have very good experiences of the NHS in Wales, there are still too many cases of this kind occurring.”

He said there had been a 30% increase in complaints about the NHS in Wales in a year.

This is our future.  What we can expect under Obamacare.  As the government moves us closer and closer to national health care.  Poor care.  Neglect.  And an unfeeling bureaucracy.  Who will look at our loved ones with contempt.  Annoyed by their excessive health care needs.  Looking for any opportunity to withhold their medications so they just hurry up and die.  So they can go and treat less burdensome patients.

You won’t find the phrase ‘death panel’ in Obamacare.  Just as you won’t find them in the NHS.  But they have one.  It’s called the Liverpool Care Pathway for the Dying Patient.  A death panel by another name.  Which lets patients supposedly die with dignity.  After consulting with the patient’s family.  But that didn’t happen with this patient in Wales.  And, sadly, it’s not an isolated incident.

For those of you who wanted Obamacare, for those of you who want national health care, this is what you have to look forward too.  It’s not utopia.  It’s trying to do more with less.  Which is just a recipe for poor care and neglect.  For the only way to cut costs so you can provide health care to more people is by giving everybody a less costly and a lower quality level of care.  It’s simply math.  The more people you treat the less each person gets.  And things like this become a little too common in the NHS.  As they will under Obamacare.

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The NHS is Rationing Health Care to give Everyone the Same Quality of Health Care

Posted by PITHOCRATES - May 18th, 2013

Week in Review

We have Obamacare because there was a crisis in American health care.  Or so said the proponents of national health care.  Not everyone had equal access to the same high-quality care some people had.  The opponents of Obamacare said a quasi-national health care system wouldn’t change that.  All it would do is stretch limited resources over more people.  Ultimately reducing the quality of care for everyone.  Like in the NHS.  Where they are closing emergency departments in south Wales because they don’t have the resources to staff them all at the same level (see Wales NHS: Abandon south Wales A&E shake-up, say Conservatives posted 5/14/2013 on BBC News Wales).

The NHS is due to announce a cut in number of specialist A&E departments in south Wales from seven to four or five.

Officials say the current range of services can no longer be provided safely at all hospitals.

They say the planned changes, due to be unveiled this month, will result in the most seriously ill patients seeing consultants more quickly, although they may have to travel further.

Hospitals across Wales have said they have faced “unprecedented” levels of admissions this spring, with A&E consultants warning their departments are at “meltdown” due to overcrowding and a bed shortage…

Speaking on behalf of the health boards involved in the South Wales Programme, Dr Grant Robinson, medical director of Aneurin Bevan Health Board, said: “We cannot continue to provide all these services in every location across south Wales.

“We need to concentrate these services to ensure all patients receive safe and sustainable care.

The NHS is national health care.  Where they provide free health care to all of their people.  But to do that some people will have to travel farther than others.  Because they just don’t have the resources to have the same specialties at all hospitals.  Not when their aging population is consuming so much of the NHS budget.  Just as an aging population will consume the majority of the Obamacare budget.

National health care works better when you have a population growing younger.  When there are more people entering the workforce than leaving it.  So there are always more people to pay the high costs of retiree benefits.  But thanks to birth control and abortion populations are aging everywhere.  Making the national health care model simply unsustainable.

These nations set up their entitlement states before birth control and abortion shrank future generations.  Not really a problem in a nation with a limited government.  But a big one in a social democracy.  For that falling birthrate not only undermines the sustainability of national health care.  It also undermines state pensions.  And public sector union benefits.  Which include generous health care and pension benefits.  None of this will survive as the consumers of these benefits grow at a greater rate than those paying for these benefits.  Which will lead to higher tax rates on a shrinking workforce.  Or anarchy.  As people take to the streets as the government simply can no longer give them their benefits.

This was really not a good time to nationalize health care.  A blind person could have seen this.  But the proponents of national health care pushed for it anyway.  Even while the NHS is struggling under the weight of an aging population.  Proving that Obamacare is more about power politics than health care.  Or that those who gave it to us are just not that bright.  Whichever it is there is one thing for certain.  We would want neither to be in charge of our health care.

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The Canadians are Cutting Doctors’ Medicare Reimbursements due to the Costs of an Aging Population

Posted by PITHOCRATES - May 5th, 2013

Week in Review

The United Kingdom has national health care.  Which is struggling to meet the demands of an aging population.  And is currently working on cutting their health care spending by £20 billion ($31.8 billion) to help stretch their limited resources meet the demands of their aging population.

Canada has private health care providers but a single-payer system.  So it’s not quite national health care.  But it is somewhat universal.  And something the proponents of Obamacare would settle for if they can’t get national health care.  But like the UK the Canadians are struggling to meet the demands of an aging population (see ‘Future of health care’ hangs on medicare talks posted 5/3/2013 on CBC News).

More than 200 doctors have voted in favour of supporting a lawsuit against the provincial government over medicare cuts, says the head of the New Brunswick Medical Society.

The doctors, who gathered for an emergency meeting in Fredericton on Friday to discuss the matter, were unanimous, other than one abstention, said president Dr. Robert Desjardins…

Desjardins said doctors are still willing to help Health Minister Ted Flemming find ways to cut $20 million from the health budget, but first things first.

“First and foremost importance is respect of the actual signed agreement,” said Desjardins.

“There’s not much of an incentive to discus the future of medicare when there’s no plan on the table and the signed agreement isn’t respected. So from there, what are we talking about?”

In March, the government announced plans to cut funding for doctors who bill medicare for each service by $18.8 million to $425 million and to cap that amount for two years.

The medical society, which represents about 1,700 doctors, contends that violates a fee agreement that expires next March.

Cutting doctors’ Medicare reimbursements?  That’s how Obamacare plans on bringing down health care costs in the United States.  Guess cutting doctors’ Medicare reimbursements isn’t the panacea they thought it would be.  As Canadian doctors actually want pay commensurate with their education, skill and experience.  Imagine that.

Becoming a doctor isn’t easy.  That’s why few people in the population become doctors.  And why countries that don’t pay their doctors well have doctor shortages.  Like they often do in countries with national health care.  Or in countries with a single-payer system.  Who look to break contracts to pay their doctors less.  To help stretch their limited resources meet the demands of their aging population.

Just something to look forward to under Obamacare.  People will at first praise the government for punishing those who choose to make a profit off of other people’s suffering.  But when doctors start leaving the profession and these people have to wait months for an appointment because of the doctor shortage they will long for a return to the old days.  When we had the finest health care system in the world.  And doctors got rich for being the best in the world.  How it once was.  Before Obamacare.

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Cost Cutting and Rationing in the NHS has Patients being Treated in Corridors where they Wait for a Bed

Posted by PITHOCRATES - May 12th, 2012

Week in Review

Yet another example of the cost pressures on a national health care system.  And the ill affect those cost pressures have on their patients (see Patients ‘treated in corridors’, claims Royal College of Nursing by Nick Triggle posted 5/12/2012 on BBC News Health).

Patients are being left stranded on trolleys for hours and forced to have treatment in corridors due in part to the loss of hospital beds, nurses say…

The RCN said that was putting patients at risk by potentially leaving them without access to essential equipment such as oxygen supplies and heart monitoring equipment as well as compromising their privacy and dignity.

Other problems highlighted included ambulances being forced to queue outside A&E units and patients being put in unsuitable wards.

The RCN said the crisis was being caused by a combination of staff shortages, the long-standing drive to reduce the number of beds in hospitals and the rise in A&E admissions…

Mike Farrar, chief executive of the NHS Confederation, which represents hospitals, said the problems identified should not be happening.

But he added hospitals were facing a struggle because of “growing financial pressure and significant structural upheaval”.

In other words the cost of Britain’s national health care is growing so great that they are cutting costs and rationing care.  To treat as many people as possible with their limited resources.  Which can be expected in a country with an aging population that is living longer. 

It took the National Health Service (NHS) awhile to get here.  Obamacare is starting with these dire statistics.  So there will even be more cost cutting and rationing under Obamacare.  Which will try to treat far more people with their limited resources.  Which begs the question whose bright idea was Obamacare?  And couldn’t they see the problems the NHS has been having these past few decades?

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Waiting Times in the UK’s National Health Service Grow Longer, some even Waiting a Year or More for Treatment

Posted by PITHOCRATES - April 22nd, 2012

Week in Review

The advocates of national health care said that it will give all people quality health care.  While cutting costs, too.  Which was the claims made during the Obamacare debates.  Opponents said it was impossible to increase the number of people getting quality health while cutting costs at the same time.  For any national health care system would require massive new taxes and the rationing of services.  To make those limited resources spread over the greater number of people in the system.  Increasing wait times for medical treatment to unacceptable levels.  Like they are struggling with now in the UK.  As wait times have increased for the second year in a row in the National Health Service (NHS) (see David Cameron faces pressure as NHS waiting times grow by Denis Campbell posted 4/18/2012 on The Guardian).

Patients are enduring increasingly long delays before having some of the most common forms of surgery, according to official data that casts serious doubt on David Cameron’s pledge to keep NHS waiting times low.

New research by the Patients Association also shows that fewer patients are undergoing planned operations such as joint replacements, cataract removal and hernia repairs, as the NHS tries to make £20bn of efficiency savings at a time when demand for healthcare is growing.

A report from the association, based on information supplied by 93 of England’s 170 acute hospital trusts, found that waiting times for a range of elective operations rose between 2010 and 2011

The average wait before having a new knee fitted rose from 88.9 days to 99.2 days, while patients needing hernia surgery typically waited 78.3 days in 2011 compared with 70.4 the year before. The delay before the removal of gallstones increased over the same period, by 7.4 days, as did the delay before having a new hip (6.3 days longer), hysterectomy (three days) and cataract removed (2.2 days).

Smaller numbers of patients also had surgery for all these procedures over the same period, according to responses from hospitals to freedom of information requests submitted by the association. Trusts that supplied figures jointly performed a total of 18,268 fewer operations for these conditions in 2011 than in 2010, with those blighted by worsening vision, especially older people, most affected.

There is only one reason for these increases.  Their limited resources can’t treat the same amount of people as last year so they increased waiting times.  That is, they rationed these services more.  Now funding could have remained the same and the number of patients rose.  Or they cut funding while the number of patients remained the same.  Or more likely it was both.  More patients and less funding.  Because of an aging population.  And rising budget deficits (the NHS accounts for a very large part of Britain’s budget deficit).  Which is exactly what will happen under Obamacare.  Only on a greater scale.

But the health department said data from every hospital trust showed waiting times were low and stable and more patients were being treated, including for conditions in the report. The document was based on “partial” data and did not reflect the situation across England, it added.

Health secretary Andrew Lansley said: “There are fewer patients than ever waiting a long time for treatment in the NHS. The number of people waiting over a year for treatment has reduced by two-thirds since we came into office and the average time patients have to wait for treatment is at the same level as two years ago.”

Okay, so the data may be a bit skewed.  For the people waiting longer than a year for treatment has fallen by two-thirds.  Which means that one third of that group is still waiting over a year for treatment.  So that’s something to look forward to with Obamacare.  A new metric to enter our lives to remind us how good Obamacare is.  People waiting a year or more for treatment is down.  Yeah.  But the US is far more populated than the UK.  So Obamacare will treat far more patients than the NHS.  So it’s not likely that we’ll be hearing that metric reported as going down.  So we’ll probably hear something more along the lines like “though the number of people waiting over a year for treatment has increased the rate of that increase is smaller than the previous year.  Just another fact to tell you that Obamacare is taking care of you.”

Let’s face it, based on the sheer size of the US and the amount of time the British have been practicing national health care Obamacare will never be as good as the NHS.  For the size of Obamacare will make the NHS look like a walk-in clinic.  Because all the numbers are working against it.  An aging population that is living longer.  And declining birth rate that creates fewer people entering the workforce than leaving it.  You put these together and it can only mean one thing.  Massive new taxes and the rationing of services.  And all on a far greater scale than in the NHS. 

The only thing Obamacare will do is make the NHS look better.  Even with wait times of over a year.

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Obamacare: Stupid or Devious?

Posted by PITHOCRATES - October 1st, 2010

The passage of Obamacare is cutting quite the swath of destruction in its path.  Businesses had to book million dollar charges to comply with the new legislation.  The requirement to insure children with preexisting conditions has caused insurance companies to drop plans for children.  (Not because they are ogres.  But because no one will buy insurance for their kid until they’re sick or injured.  So the cost of these plans will have to equal the actual medical costs.  So what’s the point?  If you’re paying actual costs just pay them directly to the health care provider.  And cut out the middleman.)  And now McDonald’s may drop their mini-med plans.  Because these low-premium policies have the same overhead as comprehensive plans.  Which means they spend more of the premium on overhead costs (as a percentage) than the big comprehensive plans.  So they can’t meet the required medical-loss ratio (the percent of premiums they must spend on actual health care benefits).

The idea was to prevent the ‘evil’ health insurance companies from paying huge bonuses to their people to keep costs down.  But bonuses are the least of their cost worries.  The Obamacare mandate to cover an additional 32 million people is a much bigger cost worry.  Especially when there is no cap on benefits and they’re required to cover all preexisting conditions.  And you know what?  It can’t be done. 

Oh, there will be a doctor shortage, too.  Especially when we add another 36 million or so to the Medicare program.  (If you’re doing the math, that’s an additional 68 million new patients that will need doctors.  Can you say rationing and ‘death panels’?  Someone will have to decide how to use these limited resources.  Replace the hip of an 89 year old grandmother?  Or do the appendectomy on the 21 year old man?)

Obamacare is a train wreck.  You have to ask yourself how did they make such a mess of it.  Well, there are two possible answers.  Either they’re just stupid and these are all unintended consequences.  Or this was the plan all along to kill the private health insurance industry.  So the devious bastards could get their public option/national health care they’ve wanted all along.

You can read McDonald’s May Drop Health Plan by Janet Adamy on the Wall Street Journal on line for more detail.  McDonald’s has denied this, however.  You can read the AP’s Health care law may hamper limited insurance plans by Tom Murphy on Yahoo! Finance for their denial.  Whether or not McDonald’s is considering dropping their mini-med plans (unless they get their exemption) doesn’t change the fate of these mini-med plans under Obamacare.  Those mandated medical-loss ratios could push these very popular plans into extinction.

Lying or stupid.  Either way it’s bad for us.

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FUNDAMENTAL TRUTH #22: “The only problem with health care these days is that it’s approached from a cost basis more than a medical basis.” -Old Pithy

Posted by PITHOCRATES - July 13th, 2010

THE PROBLEM WITH cost cutters is their vision.  They see costs.  Not the big picture.  Rockefeller was a notorious cost cutter.  Even determined he could save money by using a few less welds on his oil barrels.  But he saw the big picture, too.  He grew sales.  Something that cost cutters have trouble doing.  He didn’t.  In fact, he was so good that it took the government to stop his sales growth.

Roger Smith was a numbers man.  He managed costs.  Starting in the accounting department of GM, he reorganized GM to make better sense.  On paper.  To make nice, neat, bookkeeping-like ordered sense.  Things tend to work better on paper, though, than in reality.  Suffice it to say that few laud Smith as the greatest CEO of GM.

Robert McNamara was also a numbers man.  And he ran the Vietnam War by the numbers.  He carefully determined what U.S. forces could NOT attack.  (Any place outside South Vietnam was basically a sanctuary for the enemy.)  And he introduced the body count.  There was no strategy to win.  Just a policy to verify you were killing more of theirs than they were killing of yours.  Wars of attrition, though, take years.  And lives.  On both sides.  Americans don’t like sitting back and waiting for enough of their sons to die to declare victory.  McNamara failed to see the big picture.  Strategy.  He just tried to make the combat efficient.  Which did little to inhibit the enemy from making war. 

Managing costs is important.  It can improve profits.  But it can’t grow sales.  And if you can grow sales, you’ll be able to pay your costs.  Even if they are high and inefficient.  Few companies fail because they have a cost problem.  They file because they have a revenue problem.  They lack sales.  Cost cutting cannot fix this problem.  It can temporarily help reduce operating losses.  But if you don’t increase sales, you’ll probably fail in the long run.

There are detail people.  And people with vision.  Rarely are people both.  Rockefeller was.  Smith and McNamara were detail men.  They could not see the forest for the trees.  And this is the problem in health care.  We’re not looking at the big picture of medical care.  We’re looking at the details of cost. 

YOU WOULD THINK that doctors would oppose the government taking over health care.  Because when governments do, they tend to put salary caps on doctors.  Kinda diminishes the return on all that costly medical training.  I talked to two recently who favor a national solution.  Why?  Because of costs.  They like Medicare.  Because it’s simple.  Most of their patients are seniors.  So the bulk of their billings are uniform.  Medicare reimbursements.  They like anything that simplifies their overhead costs.  Private insurance companies don’t do this.  They’re not all the same.  Different people to call.  Different procedures.  Different approved tests.  Different paperwork.  And more of it.  And a bigger staff to handle it.

Doctors hate paperwork.  No doctor ever went through medical school because they wanted to shuffle paper.  Or because they wanted to fend off malpractice lawsuits.  Doctors are under a bureaucratic assault.  They spend more time with paperwork than with patients.  And paperwork does have a cost.  As do frivolous lawsuits.  A government takeover would standardize the one.  And, hopefully, eliminate the other.

I understand these doctors’ concern.  But they can’t see the forest for the trees.  Government is not going to approach health care from a medical basis.  They’ll approach it from a cost basis.  They’ll use statistical analysis.  They will manage care to maximize cost efficiency.  They will approach health care like Smith did in GM and McNamara did in Vietnam.  They’ll crunch the numbers.  Then determine what health care is cost effective.

THEY PROBABLY NEED no introduction.  Most people are family with the British comedy troupe called Monty Python.  Funny, a bit naughty and rather bookish, they’ve appealed to the masses across generations.  They spent a lot of time researching before making some of their movies.  Reading books.  The realism it adds made some of the funniest scenes.  A Roman centurion gives a Jewish terrorist a Latin lesson at the point of a sword (Life of Brian).  Dennis the constitutional peasant arguing with King Arthur (Monty Python and the Holy Grail).  And this scene from The Meaning of Life during a live birth lampooning the British National Health Service:

Nurse:  The administrator’s here, doctor.

First Doctor:  Switch everything on!

[They scramble to do so.  Machines turn on with flashes and sounds.  The administrator enters.]

Administrator:  Morning, gentlemen.

First and Second Doctors:  Morning Mr. Pycroft.

Administrator:  Very impressive. Very impressive.  And what are you doing this morning?

First Doctor:  It’s a birth.

Administrator:  Ah, what sort of thing is that?

Second Doctor:  Well, that’s when we take a new baby out of a lady’s tummy.

Administrator:  Wonderful what we can do nowadays.  [A machine makes a ‘ping’ sound.]  Ah!  I see you have the machine that goes ‘ping’.  This is my favorite.  You see we leased this back from the company we sold it to.  That way it comes under the monthly current budget and not the capital account.  [They all applaud.]  Thank you, thank you.  We try to do our best.  Well, do carry on.

This is funny.  Because it’s true.  When we approach health care on a cost basis.  You must show you need and use every piece of expensive equipment you have so it stays in the budget.  And the administrators administrating health care don’t understand health care.  They understand and make their decisions based on numbers in columns.  And speaking of numbers in columns.

 ONE THING STANDS out more than everything else when looking at numbers in columns.  In one cost column in particular.  Of all the costs in columns, one dwarfs all others.  The costs in treating very sick and very old people.  You can cut and trim the budget everywhere else but you won’t make a dent in overall costs.  Unless you cut and trim this one column.  Manage these costs.  Do some statistical analysis on these costs.  For if you cut THESE costs, it will make a difference.  It could even stave off bankruptcy without having to further raise taxes.  Yes, we can make the system more financially sound if we just stop treating so many sick and old people.

But it’s a body count mentality.  You have to willingly accept a defined number of additional deaths.  The Soviets were willing to trade 10 lives for one against the Nazis.   A steep price to pay.  But it did wear the Nazis down and lead to victory.  There was a similar ratio in Vietnam with America on the better side of that ratio.  But it was still too high a price for Americans.  It goes against our nature to think in terms of ‘acceptable’ losses.

But there will have to be a line that health care will approach but does not cross.  Where there are ‘acceptable’ losses.  Statistical analysis will take into account probable remaining years of life in a potential patient.  If few, the system will assign an appropriate value of care to match the health care expenditure with the expected return on the medical treatment.  People with more probable years of life left will receive more health care treatment.  People with fewer years left will receive less.  We’ll help manage their pain until they no longer feel that pain.  For it would be inefficient to spend a lot of money on someone who is going to die ‘soon’.

Perhaps I can best summarize this in song.

When you were young and your heart was an open book
You used to say live and let live
(you know you did, you know you did you know you did)
But in this ever changing world in which we live in
Makes you give in and cry
Say live and let die
Live and let die
Live and let die
Live and let die

(Live and Let Die, Paul McCarthy)

And that’s what bureaucrats will use all that statistical analysis for.  To determine who to let die.  You can sugarcoat it anyway you’d like, but it comes down to this.  A bureaucrat, not a doctor, will have the power of life and death as they decide what health care is appropriate and prudent.  As it must be under a system where bureaucrats distribute limited resources on a cost basis.  They will have no choice but to deny care that is not in the budget.

ONE PUZZLING THING about health care is that it is perfectly acceptable to approach it from a cost basis but not on a revenue basis.  For it is immoral to profit on health care.  Pity, because introducing market forces is one sure way to bring down costs.  People are willing to pay for medical services.  They pay for abortions.  And abortion clinics are readily available.  The free market laws of supply and demand work for abortions.  And so they would for other outpatient medical services. 

Instead of running a battery of tests because an insurance company requires this incremental approach of the cheap stuff first, you could go to an MRI (or some other expensive procedure) clinic and pay out of pocket.  Because they do nothing but MRIs, they achieve economies of scale.  The clinic makes money by offering low cost, high quality MRI scans that result in a high sales volume.  You benefit because you miss less work.  The doctor benefits because he gets your MRI scan results without additional paperwork to process.  I’m sure a market is there just waiting for an entrepreneur to come along.  I mean, if you can make money by performing abortions, you should be able to make money with some non-invasive, high-tech machines.

HEALTH CARE SERVICES will not become more affordable and more readily available by cutting costs.  If the bean counters try, they’ll damage the quality of health care.  Because the bean counters rarely look at the big picture.  You need someone with vision.  Because no cost cutter ever saved a business.  Or made the world better.

www.PITHOCRATES.com

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