More Budget Cuts increase Wait Times to see Doctor in the National Health Service

Posted by PITHOCRATES - February 23rd, 2014

Week in Review

The problem with national health care is that it is zero-sum when it comes to budgeting.  There is one big pie of funding that they divide throughout the system to pay for all of its parts.  But anyone who has ever paid attention to a budget debate in Washington has seen that there is never enough in the pie.  And no one is ever satisfied with their slice of the pie.  Worse, every department will spend every last cent in their appropriation lest they reduce next year’s appropriation by the amount of any unspent funds in this year’s appropriation.  No matter how wasteful that spending is.  Such as for conferences in Las Vegas.  Or extravagant office parties at home.

Britain’s National Health Service (NHS) is straining under the cost of an aging population.  More people are leaving the workforce than are entering it.  Which means fewer people are paying taxes.  Just as the number of people using the resources of the NHS is growing.  Forcing the NHS to do more with less.  Which has everyone complaining about their chunk of the NHS budget (see ‘Unprecedented’ cuts see GPs warn half of Britain will be unable to get appointments by Charlie Cooper posted 2/23/2014 on The Independent).

More than 34 million people will fail to secure an appointment with their doctor at some point this year, the GP’s professional body has claimed, blaming “unprecedented” cuts to funding for family practices.

The Royal College of General Practitioners said that the profession was “on its knees” and called for GPs to get a larger share of the NHS budget.

However, the Department of Health dismissed their findings – which would imply that more than half the UK population will miss out an appointment this year – as “complete nonsense” and accused the college of “sensationalising” the issue.

General practice has seen its share of the NHS budget – which totalled more than £109bn in England last year – significantly eroded in recent years, from 11 per cent in 2005/06 to 8.5 per cent in 2011/12…

“GPs and practice nurses want to provide high quality care for every single patient who seeks a consultation, and over the last decade we have increased the number of patients we see each year in England by 40m,” she said. “However [we] can’t keep doing more for less…”

“The GP survey showed the vast majority of patients are satisfied with their GP and rated their experience of making an appointment as good,” the spokesperson said, adding that GPs had been given an extra £50m to modernise services and stay open longer.

Whenever you want to see your doctor you need to make an appointment.  In the NHS that could take a few weeks.  Which is driving a lot of people to the A/E (accident and emergency departments).  Because they are sick now.  And don’t want to wait 2 weeks to see a doctor to get an antibiotic for their strep throat.

If you read the comments following the linked article you can get a feeling of what the British people think about the NHS.  And an idea of what Obamacare may lead to.  They love their NHS.  But are exasperated by it.  Some think the doctors are too greedy.  But there isn’t a mad rush to become a doctor to relieve the doctor shortage.  So whatever the pay is it isn’t enough to get people to join the profession.  Which ultimately increases the wait times to see a doctor.

The problem is that aging population.  People who remember a kinder and gentler NHS remember one before the baby boomers retired and overloaded the system.  Who are living longer into retirement.  Consuming more of the NHS’ limited resources than people did before the baby boomers retired.  Had Britain (and every other advanced economy) not reduced its birthrate around the Sixties they would not have this problem now.  But they did.  So they are.  As we will, too.  And every other advanced economy with an aging population will.  Making it a very bad time for national health care.  Yet President Obama and the Democrats have given us Obamacare at precisely this time.  Which is guaranteed to make health care in the United States worse.  If you don’t believe that just read the comments following the linked article.


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Ontario will try to Fix their Doctor and Nurse Shortage by luring Doctors and Nurses from Quebec

Posted by PITHOCRATES - September 15th, 2013

Week in Review

The political left has long wanted national health care in the United States.  And often point to Canada and their health care system.  For the left does not believe that anyone should be denied their right to medical care.  Or that anyone should profit off of the medical misfortunes of others.  So everybody gets free medical care.  While no one is allowed to profit from the giving of that care.  A noble idea.  But a flawed idea.  For being a doctor or a nurse is not easy.  It requires years of education.  Further years of on the job training.  Enormous school loan debt.  And long and stressful working days.  Not everyone can do it.  Which is why we pay those who do well.  Unless you have national health care.  Which leads to doctor and nurse shortages because they don’t pay their doctors and nurses as well as they do in a private health care system (see Ad aims to lure Quebec doctors to Ontario, targeting values posted 9/12/2013 on CBC News).

An Ontario hospital is trying to lure Quebec-trained health-care workers by tapping into the controversy surrounding Quebec’s values charter.

Lakeridge Health is planning to run the ad, which features a woman wearing a headscarf, in a McGill University student newspaper.

The ad says: “We don’t care what’s on your head. We care what’s in it…”

Empey said the hospital is in need of qualified medical staff and they chose to target the ad at McGill students because they have a strong medical program…

Quebec’s proposed secular values charter, announced earlier this week by the Parti Québécois government, includes a provision that would prohibit public employees from wearing obvious religious symbols while performing their official duties.

That includes the wearing of kippas, turbans, burkas, hijabs and “large” crosses by civil servants while they are on the job.

There isn’t a whole lot of love between French Canada and English Canada.  Personally I love both Canadas.  I spent a lot of time in both and the people couldn’t have been nicer to me.  It’s just each other they have a problem with.  I won’t go into details about that as it is not necessary to make a point.  That point being that English Canada is trying to lure French Canada to come and be doctors and nurses in their hospitals because there is a doctor and nurse shortage.  This despite the fact they don’t love each other.  Which shows how bad that shortage is.

It is admirable that English Canada is offering these French Canadians a place to work without having to suspend their religious principles.  But note one thing English Canada is NOT doing.  Offering these doctors and nurses more money.  Because they just can’t afford to.  So they hope to exploit Quebec’s new secular values charter to cure a problem common to national health care.  Doctor and nurse shortages.  But if Ontario reduces their shortage it will only increase the shortage in Quebec.  For national health care is a zero-sum game.  For someone to win someone must lose.  As there are a finite number of doctors and nurses in Canada.

This is what Obamacare will do for the American health care system.  Create doctor and nurse shortages.  Because Obamacare is going to fix the high cost of health care by paying doctors and nurses less.  Because no one should profit from the medical misfortunes of others.  But it is okay for patients to wait longer to see a doctor.  Apparently.


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Woman waits over 12 Months for Colonoscopy in Australia

Posted by PITHOCRATES - September 2nd, 2012

Week in Review

Health care in Australia is a hybrid of public and private service providers.  It is mostly a public universal health care system with a private system layered on top for those who wish to pay for it.  The federal government subsidizes private insurance to encourage some to use it and leave the federal system.  For Australia, like most developed nations, has an aging population.  Thus a growing rate of people leaving the workforce and becoming high consumers of health care services while there are fewer people entering the workforce to pay for this large rise in health care consumption results in a doctor and nurse shortage.  Which leads to, of course, longer waiting times (see Still on hospital waiting list by Richard Bruinsma posted 9/3/2012 on the Sunshine Coast Daily).

A MAROOCHYDORE woman who requires a simple exploratory colonoscopy every five years has “celebrated” 12 months on the Nambour General Hospital waiting list.

The woman, who did not want to be named, has a family history of bowel cancer and requires the regular check-ups as a precaution…

“Five years ago, I got in within three months, so I couldn’t believe a whole year has passed since I’ve been referred by my doctor…”

“If I’m waiting for 12 months for a simple colonoscopy, then what’s the rest of the health system like?”

A Nambour hospital spokesman was restricted from speaking specifically about the woman’s case but said the opening of new procedural suites at the hospital in April meant patient through-put had increased…

“All referrals to the service are reviewed and categorised according to clinical urgency and need by a medical officer. Those deemed more urgent are given priority.

“The Sunshine Coast Hospital and Health Service is working hard to assess and treat all patients on the waiting list.”

Most Australians are satisfied with their health care.  It’s one of the better universal health care systems.  Thanks to the hybrid structure of it.  And a relatively small population.  Though as baby boomers are retiring and leaving the workforce it is making an impact on their health care services.  As time goes on the Australians may love their health care system.  But they may complain about it more.  Such as in the UK.  And Canada.  Even in the United States.  Which before Obamacare they didn’t complain about the same kind of things.  The rationing of services.  And longer waiting times.  But that will come.  Because it’s happened in the UK, Canada and Australia.  And they’ve been practicing universal care for a long time.

Australia’s population is less than 10% of the United States’ population.  And it’s about a third of the UK’s.  So they don’t need a very large health care system by comparison.  But as Obamacare takes off the bureaucracy running it will be enormous.  As will the costs.  The bill itself had over 2,000 pages of new rules, regulations, fees and fines.  A lot of which were fill-in-the-blanks.  Things left noted ‘as to be determined’ by some government bureaucrat.  Meaning they will be making a lot of it up as they go.

So while the UK, Canada and Australia have universal systems with some problems with rationing and waiting times the Americans will see under Obamacare an explosion in rationing and waiting times simply because they will have so many more patients in their system than the British, the Canadians or the Australians.  Resulting in their own doctor and nurse shortage.  And if they are having problems after doing universal health care for such a long time you know some newcomer to the game will have even more problems.  Especially considering the US will have about five times the number of patients the British have.  And about thirteen and a half times the number of patients the Australians have.


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A Glimpse of Obamacare through the Death of a Child in the NHS

Posted by PITHOCRATES - April 8th, 2012

Week in Review

The problem with health care everywhere is twofold.  Our aging populations.  And our longer life spans that allow people to have more illnesses.  So improvements in medicine are compounding the problem.  By allowing people to live longer so they can consume more medical services.  And unlike manufacturing we can’t use new technology to increase efficiencies.  At least not yet.  So the only way to control costs is to spend less.  Treating only those who are sick.  And sending those who are not quickly on their way.  A health care triage system.  Where they quickly weed out the non-sick to make room for the sick.  To make sure they don’t waste their limited funds and services on those who don’t need it. 

It works well on paper.  But it has one serious drawback in practice.  The ‘assembly line’ triage can only catch the glaringly obvious.  Like a missing leg.  Or blood squirting out of a cut artery.  But if everything looks okay on the outside and the standard tests come back negative, doctors can discharge a patient.  Missing something a little more rare and unusual.  Like dehydration and kidney failure in an otherwise healthy child (see Doctors failed to spot toddler’s fatal illness on THREE occasions before he died by Jill Reilly posted 4/6/2012 on the Daily Mail).

A devastated mother is demanding to find out why her young son died after medics sent him home three times in less than two weeks. 

Harry Connolly died of dehydration and acute kidney failure after medics repeatedly failed to diagnose his illness…

Mrs Connolly said: ‘The fact remains that Harry died as a result of dehydration and acute renal failure despite being admitted to hospital twice and attended by an out-of-hours doctor in the space of just five days.

‘He would have survived if he’d remained in hospital from 26 April and fully rehydrated, he would have survived had he been readmitted on 28 April, and would have survived had the out-of-hours doctor referred him to be readmitted on 29 April.

Suppose the doctors admitted a similar child who proved not to be sick.  Taking a bed in pediatrics.  Taking a doctor away from other patients.  Taking nurses away from those more ill.  Taking up time on diagnostic equipment that they could have used on others actually ill.  Perhaps pushing back someone else in line.  Who may die because of the delay.  Then the doctor responsible for admitting a healthy child has to stand before an administrator.  To explain the waste of resources.  The death of a patient they couldn’t save thanks to the waste of said resources.  And the unnecessary expense of all those tests on a healthy child.  Exceeding the department’s budget.

Sadly, these are real concerns for those in the health care industry today.  Especially in national health care systems.  Like Britain’s National Health Service (NHS).  That are bursting at the seams because of the explosion in costs because of that aging population.  And their longer lives.  Taxing available resources so much that doctors have to carefully ration health care services.  To make sure that they are available for the patients who need them most.

This is the world of national health care.  Where you try to take care of everyone.  With resources that can’t save everyone.  Where the rationing of services leaves some to die.  And causes others to die that they could have saved had they only spent a few more moments on their diagnosis.  So if you want a glimpse into the world of Obamacare, here it is.  It will be like the NHS.  Only bigger.  And because it’s bigger it won’t be as good as the NHS.  Which is the problem with health care for everyone.  We don’t have resources to cover everyone in a national system.  Because the bureaucracy to run it will consume so much of the budget.  Requiring some sort of triage system.  Or death panels.  To ration those limited services.  To choose who to save.  And who to send home.  To let nature take its course.


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Obamacare: A Bridge Too Far

Posted by PITHOCRATES - December 22nd, 2010

This part of the road…it’s the wide part

In the movie A Bridge Too Far, there is a humorous line following a bloody World War II battle.  This movie was about Operation Market Garden.  The plan was to use airborne troops to seize vital bridges over rivers that would take the Allies into Germany.  Once they secured the bridges, British 30 Corps was to advance up a narrow road to link up with the airborne troops.  Then, Bob’s your uncle, war is over.  And the good guys win.

But it wasn’t a very good plan.  And it was an extremely bold plan.  That required speed.  Two things not in Bernard Montgomery’s (British general who came up with the plan) repertoire.  His troops loved him.  Because he was very cautious.  Took his time.  And he liked to fall back and regroup.  Again, all the wrong attributes for such a bold plan.

The big problem with this plan was 30 Corps.  The airborne troops reached their objectives.  But 30 Corps just couldn’t link up fast enough.  In the movie, shortly after Michael Caine jumps off with 30 Corps, they run into a hail of German fire.  Being on a narrow road, there was little room for the British to maneuver their armor.  And armor that can’t maneuver has another name.  Targets.  They won this battle.  After taking some losses.  A subordinate vented to Lieutenant Colonel J.O.E. Vandeleur (Michael Caine), saying their superiors were asking the impossible of them, advancing up such a narrow road.  And Michael Caine replies, “This part of the road…it’s the wide part.”

Going Home from the Hospital

My father spent about a month in the hospital after suffering a bad heart attack.  He’s 86 and the damage done is irreversible.  Heart is only pumping at 15-20%.  His lungs suffered some damage.  Kidneys, too.  He’s pretty weak.  Has no stamina.  Can’t sit up for more than 10 minutes without hitting the wall and collapsing.  But he was in rehab the last two weeks.  Bitched and moaned more than he did rehab.  But he did enough.  Because they said he was good to go home.

We met with a social worker to discuss life after the hospital.  Well, that was the plan.  It was more of a dog and pony show to see what my father could do.  He came a long way, too.  He was cursing and bitching like his old self.  Calling his rehab torture.  Which it was to him.

The social worker made some small talk.  About different things we could do with dear old Dad.  Nursing home.  Go home with some in-home care.  Go home without the in-home care.  I guess I must have been napping during this part when we were standing in the corridor, because that wasn’t small talk.  That was our intensive discharge family interview.  And, according to the discharge nurse some 5 days later, we signed forms saying that we refused all in-home care.  I don’t remember discussing it.  But, like I said, I could have been napping while I was standing there.

With that ‘interview’ having been a week before his discharge, I had no idea what we would have to do for him at home.  Did he need a wheelchair?  Walker?  Bed commode?  Bed pan?  Home oxygen?  Respiratory equipment?  The day before the discharge we talked to a social worker who got a little snippety with me (it was documented that you had your interview).  A nurse and a therapist came in to talk to me eventually.  In about 45 minutes, they answered pretty much all of my questions.  These two gave a damn.

I asked again about home oxygen.  They tested his blood oxygen levels lying down, sitting up, standing and walking.  They said he didn’t need home oxygen.  Even though he was gasping for dear life during this testing.  So we talked with the nurse one last time.  Agreed to meet with him at 3 PM the following day.

The following day we got there about 2:45 PM.  Went through the medications.  Talked with his therapist again (a great lady).  About an hour or so later, we were ready.  We just needed to wait until his cardiologist could see him one last time.  Dad had to use the bathroom while waiting.  The doctor showed up about 10 minutes after he used the bathroom.  And heard him gasping for dear life.

So he checked him out a little and talked to the lung doctor.  They did a series of blood oxygen level tests.  All the while my father was cursing them for the torture they were putting him through.  This doctor spent the next 2 hours or so reversing the previous decision not to put him on home oxygen.  Then we waited another 2 hours for the hospital oxygen service to deliver a portable tank and to follow us home so he could set up a unit in the house.  The whole discharge process lasted about 6 hours (included the home oxygen set up). 

The Punch Line

I guess I was being a bit belligerent.  The frustration and exasperation got to me.  When we finally got Dad home, we got him into bed.  With the ordeal of the last 6 hours, I didn’t want to force him to walk to the bathroom to urinate before going to bed.  The hospital gave us a couple small urinal bottles he could use while in bed.  It was the least I could do for him.

Well, now here’s the funny part, as he handed me the filled bottle, I took a step or two towards the bathroom to pour the contents into the toilet.  And as I did I noticed a spray of urine falling behind me.  The urinal leaked.  Like a sieve.  Worse than a drivel glass.  Over the bed.  On the floor.  Everywhere.

Lesson?  Don’t be belligerent in the hospital when picking up family.

The Good Old Days of Health Care

This was not a pleasant experience.  Going to the hospital rarely is.  All I could think about was that this was the ‘wide part of the road’.  Before Obamacare takes over.  When they replace the touchy-feely kindness of health care workers with cold, disinterested bureaucrats.  As bad as things are today, under Obamacare, we’ll remember these as the good old days of health care.


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