Britain’s Aging Population shrinks the Tax Base and forces Nurses to Care for up to 15 Patients

Posted by PITHOCRATES - August 5th, 2012

Week in Review

The National Health Service (NHS) of Britain is one of the best national health care system in the world.  But even it can’t withstand the effects of an aging population (see Nurses look after 15 patients at a time by Laura Donnelly posted 8/5/2012 on The Telegraph).

The findings show a sharp rise in their workload to levels which patients’ groups said compromised safety and left little time for compassion.

It follows growing public concern that hospital patients, especially the elderly, are being denied basic dignity and left thirsty and hungry.

A public inquiry into the Stafford Hospital scandal – where hundreds died amid “appalling” failings in care – is preparing to recommend changes to improve the quality of nursing…

The NHS has never set rules on nurse number, but in parts of the US and Australia, mandatory levels have been imposed – typically at around six patients per nurse…

Among the findings of the research were:

* On average, nurses were allocated 11 patients at night and eight by day;

* At some trusts, nurses were asked to care for 15 patients at night..;

The statistics disclose a sharp increase in nurses’ workloads. Five years ago, they were allocated an average of seven patients on day shifts and nine at night, previous research shows…

Although the health service has been given increases in its budget, just above inflation, it has been told to make £20 billion of efficiency savings by 2015 so services can meet the needs of an ageing population.

The Coalition had pledged to protect frontline jobs from any cuts. Last month, after official figures showed the number of nurses has fallen by 4,500 in two years, Andrew Lansley, the Health Secretary, conceded that the number of posts has fallen. He said decisions were taken by trust boards, not the Government…

The research, led by the National Nursing Research Unit at Kings College London, found that older patients received the least care and attention. More than three-quarters [76 %] of nurses polled by researchers said there were not enough staff to get the work done.

Anne Milton, health minister, said the NHS had 10,000 more nurses than it did five years ago, and that the review of nursing had been asked to find ways to free up staff so they could spend as much time as possible with patients.

This is what you get with an aging population.  And a falling tax base that aging population gives you. More patients.  Fewer nurses.  Rationing of services.  And poorer quality.  Or, in other words, welcome to Obamacare.

The NHS is one of the finest national health care systems in the world.  It’s not the fault of the people in the NHS.  It’s the fault of those who set up the NHS.  Who assumed a growing population growth rate would continue to grow.  But that was before the Sixties.  When the world changed.  Women were no longer getting married, staying home and raising a large family.  Birth control and abortion changed that.  And a more libertine sexual attitude.   The women of the Sixties and the Seventies slammed the brakes on baby making.  Decimating the ranks of future taxpayers.  Turning a young population into an aging population.  Where more people left the workforce than entered it.  Who went on to overwhelm the health care system just as funding for it began to fall.  Which brings us to today.  Where they ask nurses to care for up to 15 patients.

The UK is no different than the US.  Except having only one fifth the population.  An aging population will do to Obamacare what it’s doing to the NHS.  Even making it worse.  As American nurses currently can care for no more than 6 patients.  Pretty much what it was in the NHS only 5 years ago.  So in 5 years there will be reports like this about Obamacare.  Which will quickly suffer the problems it took the NHS decades to suffer.  As the Americans will be starting with an aging population that will only age more in the next 2-3 decades.

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Foreigners using Britain’s Free Health Care are making that Free Health Care ever more Expensive

Posted by PITHOCRATES - May 6th, 2012

Week in Review

National health care systems are straining budgets everywhere.  As countries constantly cut costs and improve efficiencies.  To keep their floundering systems afloat.  And every time they think they’re getting their costs under control something like this comes to light (see GPs ‘threatened with legal action’ for taking failed asylum seekers off surgery lists posted 5/3/2012 on The Telegraph).

It emerged in an investigation which revealed that more than £40 million is owed to NHS hospitals by foreign patients who were not eligible for free care, research indicates…

Freedom of Information requests by Pulse revealed the average unpaid debt for the provision of care to foreign nationals was £230,000 in the 35 trusts which responded.

If this figure was the same across all 168 English acute trusts, the total debt would be almost £40 million, the magazine claimed…

In response to the figures Dr Richard Vautrey, deputy chairman of the British Medical Association’s GP committee, said trusts must put in place arrangements ”that ensure people cannot exploit the system”.

A spokesperson for St George’s told Pulse: ”A high percentage of our patients require life-saving trauma, neuroscience, cardiovascular or paediatric care…

”It is too simplistic to call it health tourism. The reality is a lot more complex.”

The investigation comes days after campaigners warned GPs had too much freedom to register sick foreigners who may not be entitled to expensive British healthcare…

The group’s chairman Sir Andrew Green said: ”To allow such easy and potentially hugely-expensive access without any entitlement must be stopped at once, otherwise the NHS risks becoming the World Health Service.”

The National Health Service (NHS) is the biggest chunk of Britain’s deficit.  So not only do they tax their people heavily they borrow heavily as they are already facing an uphill battle.  An aging population that is living longer is consuming ever more health care services.  And they don’t need to add more to a straining system.  Especially when they are not paying any taxes to fund the NHS.  Or paying any taxes to service the debt that funds the NHS.

Even when the health care is ‘free’ someone has to pay for it.  Because nothing is truly free.  All of this free health care is pushing Britain to the breaking point.  As Obamacare will push the U.S. to the breaking point.  Based on current exchange rates and population differences between the UK and the US, Obamacare could expect a foreign patient loss of approximately $325 million annually.  Or more.  Probably a lot more.  Especially if it’s treat first; bill later.  For people already travel to the US for the best in health care treatment.  Just imagine the health tourism when that care is free to American nationals.  And treat first, bill later for everyone else.  When it becomes difficult to say no.  Because saying no will bring in the lawyers with discrimination lawsuits.  So it will be treat first; bill later.  And based on the UK experience, a large percentage of those bills will go unpaid.

With a large budget deficit already exceeding one trillion dollars all of this health care spending will fall directly to the deficit.  Making it ever larger.  With no hopes of ever reducing it.  Especially when Obamacare evolves into the World Health Service.  Which we can’t afford any more than we could afford being the world’s policeman.  So when will it end?  This ever increasing government spending?  Soon.  And it won’t be pretty.  Because there just won’t be enough people to tax to service the accumulated debt.  And pay for Obamacare.  As well as everything else in the bloated federal budget.  Then the debt defaults will start.  Followed by the collapse of the banking system.  And then the depression.  Sort of like the Great Depression.  Only with a massive welfare state collapsing on top of it. 

But on they spend.  These old people.  Taking comfort in the fact they will be dead before the collapse.  So only their children will suffer through the experience of the oncoming economic carnage.  So not only are they bad stewards of the people’s trust.  They’re bad parents, too.  And if they sacrifice their own children what hope do we have?

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LESSONS LEARNED #65: “The only thing the market is inefficient at is funneling money to anti-business politicians.” -Old Pithy

Posted by PITHOCRATES - May 12th, 2011

Microsoft Learns the hard way about the Costs of Lobbying

Once upon a time Microsoft had no lobbyists.  Microsoft grew to dominate the PC operating system with no help from the government.  Bill Gates became the richest man in the world with no help from the government.  And how did that go over with the government?  Not well.

Because of complaints by Microsoft’s competitors, the U.S. Justice Department began antitrust proceedings against Microsoft.  The complaint?  Microsoft was giving away something for free that others wanted to sell.  A web browser program.  Internet Explorer (IE), to be specific.  The competitors said that Microsoft had an unfair advantage when they bundled IE with their operating system.  Because why would people pay for something that they can get for free?  Consumers never complained about getting something free.  Just other corporations trying to make consumers pay for something that they could get free from Microsoft.  So the Justice Department went after Microsoft so consumers could no longer get something for free.  In other words, the antitrust case against Microsoft was to raise prices.  Which is kind of the opposite reason for an antitrust case.

Government may not know how to create or expand business activity.  But they sure know how to hurt a business.  Microsoft still bundles IE with their operating system.  But they learned a very important lesson.  And, today, Microsoft spends millions of dollars on lobbyists.  To lobby politicians for nothing in particular.  But to pay tribute.

There was no Health Care Cost Crisis before World War II

Once upon a time people paid their doctor’s bill.  Really.  They’d see their doctors.  The doctor would bill them.  And they would pay.  Of course, that was a long time ago in a mystical place.  The United States.  Before World War II.  Yeah, I know.  Crazy talk.  Paying your doctor’s bill.  But some crazy sons of bitches really did. 

Of course, back then, medicine wasn’t socialized yet.  Market forces controlled medical costs.  How, you may ask?  Simple.  The people ‘buying’ the medical services paid the bill.  Medical services were just another service provided by licensed professionals.  Like a plumber.   And though plumbers are expensive, they are affordable.  Because if they weren’t affordable, there wouldn’t be a market for their plumbing services.  As it was for doctors.  Before World War II.  Doctor services were affordable.  Because if they weren’t, there wouldn’t be a market for their medical services.  And it worked like this until World War II.  When health care became a benefit.  And benefit administrators came between buyers and sellers of medical services.

Let’s do a little experiment.  Let’s say you work for a company that is putting together a company picnic.  The company is paying the tab for all 20 employees attending.  And you get a company credit card to buy the food with no restrictions given.  What are you going to buy?  Hotdogs and hamburgers?  Or filet mignon?  Now, later in the summer, you’re having a family BBQ.  There’ll be 20 people in all.  But this time you’re paying the entire bill.  What are you going to buy?  Hotdogs and hamburgers?  Or filet mignon?  Chances are that you’ll be eating different food at these events.

The Price Mechanism doesn’t work if someone else Pays our Bills

Do you see how having someone else pay for your benefits affects your purchasing decisions?  You’ll be enjoying filet mignon on the company’s dime.  But you’ll be satisfied with hotdogs and hamburgers on your dime.  This is the problem in post World War II health care.  There are no market forces anymore in health care.  Someone else is paying for your benefits.  So you don’t care what the costs are.  So you’ll never object to getting the filet mignon of health care benefits.  Even if you’re a single guy.  And your employer is paying for insurance that includes breast and cervix exams.  If you were paying the full cost of your health insurance bill, though, you probably would not pay for breast and cervix exams.  Sure, they’re nice.  But as a guy you would probably never use these benefits.  So you probably wouldn’t pay for them.

This is a big reason why health care costs are so out of control today.  There are no market forces in play to control costs.  Other people pay for our benefits.  So we never ask, “Can I afford this?”  Which everyone does before hiring a plumber.  Dr. Gratzer, a physician and senior fellow at the Manhattan Institute, wrote that Americans pay only twelve cents for every dollar of health care services they receive.  Which means 88% of the American health care is already socialized medicine.  In other words, other people pay for 88% of an American’s health care.  And when other people are paying, how often do you ask, “How much does this cost?”

This is why health care costs are out of control.  Elsewhere in the economy prices serve as a mechanism to adjust supply and demand.  Not in health care.  No one knows the prices in health care.  Because no one asks.  And the further we go in this direction the worse it’s going to get.  Yet that is exactly the direction some in government want to take health care.  Why?

Politicians Matter more than the Cost of Health Care

Because the market is efficient.  It works very well when left alone.  Just ask Bill Gates.  Or anyone who saw a doctor before World War II.  The market works.  But it has one drawback.  It doesn’t need government.  And for those who are looking for a career in politics, that’s a problem.

Microsoft wasn’t harming any consumers.  They were hurting other businesses that couldn’t make consumers spend more money.  So the politicians stepped in.  To show they mattered.  And cared.  Also, Microsoft was obscenely wealthy.  A little lobbying on their part could fill a few campaign war chests.  And provide a nice vacation or two.  They just needed to see the light.  How things worked in Washington.

But becoming a senator or a representative needs more than a fat war chest.  You need people to vote for you.  And a good way to do that is to get as many people dependent on government as possible.  Either as patients in a new national health care system.  Or as employees in a vast new bureaucracy for the new national health care system.  Which is why they’re not turning to the free market to fix the cost problems in their health care system.  Like they are in the UK and Canada.  They don’t want to fix the cost problems.  They want the dependency created by a new national health care system.  They can worry about costs later.  After they’ve taken over one-sixth of the U.S. economy.

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LESSONS LEARNED #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 15th, 2010

ONCE UPON A TIME, in a distant land, there once lived a merry people.  And life was good.  They lived together in sweet harmony.  They worked long and hard to sustain their happy life.   And when people fell ill, they went to the doctor.  And after treatment, THEY PAID THEIR OWN DAMN BILL!

But those days are gone.  We don’t pay our own doctor bills anymore.  Health care is no longer between a doctor and a patient.  There’s somebody else involved now.  Someone who says what a patient can or cannot have.  Someone that tells doctors what they can or cannot do.  And our doctors have a bull’s-eye on their backs.

Medical care has taken a back seat to medical costs.  It’s not about what’s best for the patient.  It’s about what costs the least.  Think of a graph.  Increasing along the bottom are medical services rendered.  Increasing up the y-axis are costs.  On this graph picture two curves.  One that plots costs of medical malpractice lawsuits (very high when the doctor provides no medical services and decrease as the amount of medical services increase).  The other that plots costs of doctor reimbursements for services rendered (very low when the doctor provides no medical services and increases as the amount of medical services increase).

This is what a doctor considers when seeing a patient.  They don’t want to.  But the system forces them to.  Because of the conversion of health insurance (to protect your personal financial wealth) into a benefit/entitlement (to get free stuff with other people’s money).  And the rise of that other benefit/entitlement, the malpractice lawsuit as a vehicle to early retirement.

What better way to illustrate how cost takes center stage in our health care today but by some personal anecdotes?  So here is a smattering of our collective pasts.

I WAS IN some junior officer training program.  It was the last full day.  The last training we did was a run on the obstacle course.  It was hot.  Humid.  I kept pushing myself.  Now, I’ve suffered dehydration and heat exhaustion before, but whatever hit me wasn’t that.  I looked okay.  I had one of those ‘spike driven through your skull behind the eye’ migraines.  Nausea.  Some other discomforts.  All we had left was retreat.  Where we formed, though, we faced into the setting sun.  I asked my CO if he would excuse me from retreat.  I just wanted to hit my bunk.  To die.  Or sleep it off.  Whatever it was.  Training was over.  After retreat, they were going to open the pool for us. 

Well, he denied my request.  And made me feel like a little girl for even asking.  (I regret that moment of weakness to this day).  After I was dismissed, he called me back and said, “And if you do vomit in rank, vomit with bearing.”  “Yes, sir,” I replied and saluted.  Made it through without vomiting.  Crawled into my bunk.  When my CO saw that I was not partaking in the ‘mandatory’ fun he came to see me.  Was about to send my ass to the infirmary.  But whatever I had passed.  I felt fine.  The following day it was as if nothing had happened.

When you got through something like that, you’d be surprised how it impacts you.  You ignore things.  And live with things. 

I HAD A WART once under my thumbnail.  I made an appointment with my doctor to have it removed.  The day before my appointment, though, was a very busy day at work.  Didn’t sleep well the night before, either.  So I was tired.  And drinking coffee.  Apparently, I was the only one.  In the afternoon, half a pot was still remaining.  From the morning.  Nice and black.  Thick, too.  Like tar.  Strong.  I finished that pot.  Later that night, I had heart palpitations.  I rationalized it was from drinking too much coffee.

While getting that wart removed, I mentioned in passing the heart palpitations from the night before.  Laughing about it.  Last time I drink a pot of coffee, I said.  The doctor looked up from the wart and said, “Heart palpitations?  That’s serious.  This,” he pointed to the wart, “is piddling.  Heart palpitations?  That’s serious.”  The next thing I knew was getting an EKG and sent home with a heart monitor strapped to my chest.

I now thought about those things I was ignoring and living with.  Perhaps I was being irresponsible.  I mean, I was feeling things in my chest.  When I went in to get the results of all those tests, I told him about those things I’ve been ignoring and living with.  My test results were fine.  I asked him about those other things.  He asked, “How old are you?  You’re fine. You just have some anxiety.  Here’s some Xanax.”

When I mentioned heart palpitations, he couldn’t laugh it off with me.  For one, he was a doctor.  It’s what doctors do.  Save lives.  But he also buys malpractice insurance.  He was leaving himself open to a lawsuit if he didn’t do everything expected when a patient says he has had heart palpitations.  Once those tests came back confirming it was most probably the excess amount of coffee I drank that day that gave me the palpitations, I was just a young, healthy man.  Who did not justify any further testing.  At least, my insurance company wasn’t going to reimburse any further testing.

My test results looked good.  Feeling things in the chest, though, could mean something.  A stress test might be prudent.  But unless something turned up in that test, the insurance company wouldn’t reimburse that cost.  Which meant I would ultimately end up paying for it.  And stress tests are expensive.  Of course, if I paid cash outside the bureaucracy of the health insurance maze, it could be less.  So I said let’s do the stress test.  I’m buying.  I took the test.  Did okay.  Didn’t die.  Nothing strange happened.  The cost?  About half of what they would have charged had it gone through the myriad levels of overhead that process an insurance claim (at the health insurance company, at the hospital where the test was done and at my doctor’s office).

And I continued to ignore and live with those things I was feeling in my chest.  Even stopped taking the Xanax.  If I was feeling any anxiety, it was from my little episode in the health care machinery.

BUT THINGS SEEMED to only get worse after a year or so.  I started wondering that maybe I was only making things worse by ignoring them.  So I went to the doctor.  I explained what I was feeling.  He did the perfunctory tests that shrunk the lawsuit window.  Again, things looked good.  “How old are you?” he asked.  “You’re fine.  Look, we can keep doing tests but it’s going to get expensive.  Your insurance isn’t going to pay for them if nothing turns up.  And, I gotta tell you, I don’t think anything’s going to turn up.”

Again, he was looking at the cost-service tradeoff.  He felt he had minimized his costs.  He did enough testing to protect himself from a frivolous lawsuit.  And he didn’t do more testing than the insurance companies would reimburse.  Further testing would be on my dime.  Not that I didn’t think my life was worth the investment, but more tests would mean more missed work.  And with me feeling he wasn’t going to do anything but throw darts in the dark, I didn’t pursue additional testing.  It didn’t appear that anything big was wrong so I continued to live with those feelings.

THIRD TIME’S A charm.  After another year or so, I went to another doctor.  Again, I thought I might be doing more harm by ignoring these things.  Being further away from my original heart tests, I didn’t really discuss them this time.  Which was good.  It was a red herring.  You start talking ‘heart’, you look at all things ‘heart’.  High risk.  High costs.  But if you don’t start from ‘heart’, you can explore things that are lower risk and lower costs.  I had some serious acid reflux.  Acid regurgitating up your esophagus can mimic heart attack symptoms.  Who’d a thunk it?

HAVING AN INTERMITTENT problem is hard to diagnose.  All but impossible if you’re young.  I was a young college student.  With intermittent stomach pain.  I went to a doctor.  He felt me up to see if it was appendicitis.  I didn’t feel anything when he pressed over my appendix.  So he ruled that out.  “How old are you?” he asked.  “You’re fine.  You just need to get drunk and get laid.” 

A couple of years later, I was still feeling that intermittent stomach pain.  So I went to another doctor.  (It was a clinic.  The doctor I saw last since retired.)  He felt me up.  Ruled out appendicitis.  Sent me for an upper GI (where you drink a cup of barium and they x-ray your esophagus and stomach).  Test came back.  Everything looked fine.  “How old are you?” he asked.  “You’re fine.  Just drink some Maalox.”

So I drank some Maalox for awhile.  Didn’t seem to help.  Another year and another trip to the doctor.  And another upper GI.  The instructions this time called for a wait time before one last x-ray.  This x-ray showed an ulcer.  Just past the stomach at the beginning of the small intestine.

MY MOTHERINLAW WENT into the hospital with chest pains.  She was in her mid-sixties.  She spent the night in the ICU.  The next morning they transferred her to the cardiac care wing.  They did just about every test they could.  She was elderly.  Elderly people have health problems.  So doctors do ALL the tests to slam shut the lawsuit window knowing that the health insurance company or Medicare will reimburse for most of those tests.  They found nothing.  She went home.  Without them doing anything or being able to explain what had happened.  They had practiced due diligence to protect themselves legally.  And the health insurance company would rule that any further testing would be frivolous and unnecessary, only to produce additional revenues for the hospital and doctors. 

This repeated a few times until they found pancreatitis and stones in her bile duct. 

IT’S NOT THE doctors.  It’s not the hospitals.  Or the insurance companies.  It’s the system.  When other people pay your way there has to be rules.  For a free ride is not free.  We just make other people pay.  The problem with all things free?  We over consume.

How many plates of food do you eat in a restaurant when you pay per plate?  One?  How many plates of food do you eat when you eat at an all-you-can-eat buffet?  The answer?  More.  It’s happening in health care.  Those with insurance don’t care a whit about cost.  Don’t give me generics, I have insurance.

But someone is paying all those bills.  And they see this over-consumption.  They raise their premiums to cover it.  But when they do, they find some people stop buying their health insurance.  Which means they have to raise their premiums again.  More people stop buying.  So they need to raise their premiums again.  But they can’t keep doing this.  So they have to put in some kind of spending rules.  Say what they will reimburse and what they will not.  And they force the poor doctor to police this mess who is trying to help you get well at the same time.  All the while trying to keep the lawyers off his back.

It’s worse on the Medicare side.  For private health insurance has some young, healthy people paying for insurance who aren’t consuming medical care.  Everyone in Medicare is sick and/or old.  Big consumers of medical care.  The trend has been to micromanage the rules more as the consumption of medical care has outpaced the taxes collected to pay for that care.  And with an aging population, those costs are running well ahead of tax receipts.  It’s not a question of if the program will go bankrupt.  But when.  And a national health care system will only be worse.  The added costs will require massive taxation and cost management worse than any hated HMO.

AND LOST IN the shuffle is the patient.  Who, once upon a time, went to his doctor.  And the doctor did what was best for the patient.  And the patient paid the doctor for his services.  And everyone lived happily ever after.

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