Even with the Bribes Chinese Health Care is Better since Privatization

Posted by PITHOCRATES - April 12th, 2014

Week in Review

China has recently privatized their health care system.  Sort of.  They have private health care providers and a state health insurance that helps pay for it with a small patient ‘co-pay’.  Quality of care did increase.  But health care providers don’t get paid a lot in China.  And turn to other means of compensation that is not without its problems (see ‘Guardian angels’ to protect Chinese doctors from patients by Malcolm Moore posted 4/9/2014 on The Telegraph).

Hospitals in Beijing will recruit 1,500 “guardian angels” to protect their doctors from violent attacks by patients.

In recent years, angry patients have killed a number of Chinese doctors, often citing frustration at how they have been handled by the healthcare system…

Doctors and nurses in hospitals are violently attacked every two weeks on average, the state media said, by patients angry at long waiting times, high medical bills and haughty or uncaring doctors…

The government has promised to root out corruption in the healthcare system, and the Health Ministry said in February it would target patients who bribe doctors for better treatment.

Yes, bribes.  Or hongbao, as it’s called in China.  If you want some decent care in a Chinese hospital you have to slide an envelope with money in it to your health care provider.  Otherwise you’ll only get what the state health insurance will buy you.  Long waiting times, high medical bills (for what the state insurance doesn’t cover—a high deductible, if you will) and haughty or uncaring doctors.  Which tells you how bad the health care system must have been before they privatized it.  For it’s a lot better now than it used to be.

So China made their health care better by privatizing it (although it is still so bad that angry patients who paid good bribes for their loved one’s care are assaulting their doctors and nurses every two weeks on average).  While the United States is going the other way.  Towards more state control.  Pity the Obama administration can’t be more like China when it comes to health care.  And try to improve the quality of health care instead of making it worse.  Which they will likely do as their cost saving measure is simply to pay health care providers less.  Which will likely discourage doctors from entering the system.  Or remaining in the system.  Leading to longer waiting times.  And, perhaps, bribes.  At least from those who want good care for their loved ones.

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Medicaid, Medicare and Frivolous Lawsuits make the Best Health Care System in the World more Expensive

Posted by PITHOCRATES - November 23rd, 2013

Week in Review

The American left loves Canada.  In particular their single-payer health care system.  This is what they wanted in the US.  Not Obamacare.  But they settled for Obamacare.  Until they get what Canada has one day.  Because it’s better.  At least, according to a chart.  That shows how wonderful Canadian health care is and how horrible American health care is (see The U.S. Health Care System Is Terrible, In 1 Enraging Chart by Mark Gongloff posted 11/22/2013 on the Huffington Post).

Yes, among this group of big countries, the U.S. spends far and away more on health care than any other. And yet it has among the lowest life expectancies of any developed country. People live longer in pretty much every country in Europe, including Greece, where the economy has been wracked by austerity for years…

Why is our system so terrible? Largely because it is built for profit. Unlike many other countries, the government has no role in either providing care or setting prices, and so prices skyrocket. It’s also too complex, which is one reason the Affordable Care Act, President Obama’s signature reform law, has gotten off to such a bad start.

The health care law is supposed to help with the cost problem somewhat. But it is built on the existing privatized system, which means it will probably not make a significant difference. A public option, also known as a “single payer” plan, would help. But that still seems like a pipe dream — although maybe Obamacare’s clumsy rollout will bring it closer to reality.

First of all it should be noted that Canada has one of the finest private health care networks in the world.  Outside of their single-payer system.  Which is something they share with all nations that have some form of national health care.  A private health care network for those who want and can pay for it.  And why is Canada’s private health care network the best in the world?  Perhaps you can guess why when you hear the name of it.  The Untied States health care system.  Just south of the border.

That’s right, for those with the means don’t wait in line for less than the best of health care.  They spend their own money to go to the front of the line to get the best health care available.  In the United States.  Often administered by Canadians.  Because the US pays the best doctors and nurses more than they can get in Canada.  So Canadian doctors and nurses, too, travel south across the border.

The US is one of the only countries where their poor suffer from obesity.  Because of generous food assistance programs.  Also, because we are a for-profit nation our food industry has figured out to give us more food for less.  Our beverage sizes have gotten so big giving us so much value for the money that Mayor Bloomberg tried to limit the size of beverages in New York.  And all American restaurants give us free refills.  Because they can.  While some European countries will charge extra for a package of ketchup.  All of this more food for less has led to our obesity problem.  Giving Americans heart disease and diabetes.  Shortening life expectancies.

US doctors are dropping out of Medicaid.  And Medicare.  More so now that the Affordable Care Act (Obamacare) is rolling out.  Why?  Because the government pays for these nonprofit programs.  And they are constantly trying to reduce their reimbursements.  Because the aging population is straining the Medicaid and Medicare programs.  And the government has addressed this problem by ‘discounting’ Medicaid and Medicare billings.  For years doctors and hospitals have tried to recover these shortfalls by charging more.  Especially insurance companies.  Greatly increasing the cost of health care and health insurance.  But the discounting grew so great that many health care providers just dropped these programs.  Because they couldn’t pay their people, their lab costs, their overhead, etc.  Especially since Obamacare has taken money from Medicare.  And ‘forced’ states to expand their Medicaid rolls.  But these discounted reimbursements aren’t the only thing raising health care costs.

While most of Europe has loser-pay laws to curtail frivolous lawsuits the United States doesn’t.  Because of the trial lawyers.  Who get quite wealthy suing doctors, hospitals and pharmaceuticals.  Exploding the cost of malpractice and liability insurance.  Which increase the cost of doctors, hospitals and pharmaceuticals.  Forcing them to raise their prices to recover these costs.  Making American health care more costly.

These are the reasons why the US spends more per capita on health care than all other nations.  Because they have the best health care system in the world.  And the best costs more.  While the government forcing health care providers to work below costs (Medicare and Medicaid) and the cost of frivolous lawsuits raise these costs even more.

The American health-care system is not terrible.  Single-payer systems are.  Because they all have a private health care network.  Which they wouldn’t have if single-payer systems were the best systems.  Just ask the Canadians who use their private network.  The US health care system.  Who will probably be the second greatest losers under the Affordable Care Act.  After the Americans.

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Hinchingbrooke Hospital breaks free from the NHS Bureaucracy and Improves Health Care

Posted by PITHOCRATES - October 13th, 2013

Week in Review

Britain has government-run national health care.  The National Health Service (NHS) provides free health care to all Britons.  And the medical tourists who travel to the country for free health care.  Straining the NHS budget.  At a time when Britain’s aging population is stretching their limited resources thin.  Leading to longer wait times.  Longer travel times as they close local hospitals to consolidate their resources in fewer locations.  And rationing.

Even with their longer wait times, travel times and rationing of services they are still running a deficit in the NHS.  To address these chronic cost overruns they are trying to find £20 billion ($30.54 billion) in efficiency savings over three years.  But there is a beacon of hope for the NHS.  At Hinchingbrooke Hospital (see Set doctors and nurses free to use their common sense – as Hinchingbrooke Hospital does by Charles Moore posted on The Telegraph).

Last month, I visited Hinchingbrooke Hospital, near Huntingdon, the only NHS Trust in the country operated by a private partner…

I spent half a day at Hinchingbrooke, talking to doctors, nurses, administrators and patients, and seeing several wards…

One can visit a large organisation without being aware of big problems. Indeed, one of the great difficulties of the NHS is that internal communications are so bad that people can work well in one area without being aware of utter disaster a few yards away. In the case of Hinchingbrooke, under previous management, maternity was very good while the colorectal unit was shameful. So what follows is not definitive; but I feel I learnt something.

Uniquely in the NHS, Hinchingbrooke’s executive board is dominated by clinical practitioners (doctors and nurses, to you and me). The chief executive is an obstetrician. Only three of the 14 board members have non-clinical backgrounds.

In the only trust that has a private partner doctors and nurses determine how best to treat patients.  Instead of the faceless bureaucracy in the rest of the NHS.  Or what the proponents of Obamacare hope to force onto the American people.

One of the key working methods, borrowed from Toyota, is “Stop the Line”. Anyone in the hospital can stop the line if he or she believes that there might be a “serious untoward incident” or danger to a patient…

A similar, lesser action is a “swarm”. If you are urgently worried about something, you can summon all the relevant people together immediately. Unlike “whistle-blowing”, which is inevitably retrospective and often involves grievance and disloyalty, these ways of acting are instant and preventative. You are encouraged to use them. Someone stops the line in Hinchingbrooke most days.

Nurses work differently from most parts of the NHS. They all wear uniform, even if in managerial roles, and they are encouraged to take part in management without abandoning clinical work…

But what struck me about Hinchingbrooke was not that it was brilliantly original – simply that it was free to act according to common sense. Involve staff in decisions. Make sure that doctors and nurses can run things. Learn from commercial examples of how to improve services. Let the right hand know what the left is doing. Encourage innovation. Don’t “benchmark to the middle”, but to the top. And little things: get A&E nurses to wear identifiable name-badges; get rid of hospital car-park fines. Most of this is simple, but, in the leviathan of the NHS, it is not easy. And at present there are about 2,300 NHS hospitals in the United Kingdom, and only one Hinchingbrooke…

This is far behind the public. As you understand better if you spend a morning in Hinchingbrooke Hospital, the public want health care free at the point of use, but have no ideological prejudice about who delivers it, or how. They rightly judge by results – are they, their spouses, parents, children, well or ill? Are the staff medically competent, efficient and kind? They are not sentimental about the most shocking producer interest ever to have gained power in this country.

The one hospital where things are greatly improving is the one hospital that is moving away from bureaucratic national health care and towards private health care.  Like it once was in the United States.  While President Obama and the Democrats want to move the American health care systems towards the bureaucratic national health care of the NHS.  Where there are longer wait times.  And service rationing.  Well, everywhere in the NHS but Hinchingbrooke Hospital.

Do President Obama and the Democrats care that they will destroy the American health care system?  No.  Because it’s not about health care.  It’s about creating the “most shocking producer interest ever to have gained power in this country.”  Yes, it’s about the power.  Social Security and Medicare made the elderly dependent on government.  Giving the government power over the elderly.  If they can’t raise taxes they just threaten to cut Social Security and Medicare benefits.  National health care, though, makes everyone dependent on government.  Giving the government power over everyone.

Until the day they can no longer maintain that power.  And that day has come in Britain.  Their aging population is breaking the system.  Which is in essence a Ponzi scheme.  The masses in the workforce pay in via taxes.  And the few sick consume health care services at the top of the pyramid.  While a bloated bureaucracy makes sure to take very good care of itself.  But the aging population is shrinking the workforce paying the taxes.  And swelling the number of sick consuming the health care services.  Inverting the pyramid of the Ponzi scheme.  As it will in America thanks to Obamacare.  Because the United States has an aging population, too.

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Canadian Doctors have to Shut Up or the State won’t let them be Doctors Anymore

Posted by PITHOCRATES - December 8th, 2012

Week in Review

Proponents of Obamacare wanted more than what they got in Obamacare.  They wanted a single-payer system like in Canada.  Where they know how to do national health care right.  Where everyone gets whatever they need.  And patients, doctors and nurses live happily ever after.  Just like in a fairy tale.  And they do.  In the minds of those in the United States.  But that’s not quite how it is in Canada (see Doctors urged not to sign ‘muzzle’ contracts posted 12/5/2012 on CBC News).

The New Brunswick Medical Society is urging doctors not to sign any contracts with the province’s regional health authorities because they contain a gag order…

The medical society spoke out on the issue in June, accusing the regional health authorities of trying to muzzle doctors in an effort to avoid public criticism and embarassment…

Existing physicians will begin to reapply for their privileges in the January. If doctors protest the new bylaws by not signing, the medical society says they could start losing hospital privileges and possibly even their billing numbers, as soon as the spring…

Critics have suggested the bylaws are a push-back following some public challenges.

Doctors in Saint John have recently spoken out against the decision to allow Canadian Blood Services to remove some of its services from New Brunswick.

They were also vocal about a lack of access to operating rooms. And, the doctors loudly opposed the government’s initial position to deny Saint John a high-resonance imaging machine called a 3T MRI.

You see, national health care is not the utopia those who want it think it is.  Health care is expensive.  But when it’s free at the time of treatment people like to use as much of it as they can.  Which causes a problem.  Especially when you have an aging population.  Which most advanced economies have.  Including Canada.  The Canadians are having the same problem the British have.  And the same problem the Americans will have under Obamacare.  They have more people consuming health care resources than they have paying for them.  Which calls for budget cuts.  Longer wait times.  And rationing of services.  As well as indifferent attitudes to the falling quality as the doctors and nurses are overworked, underpaid and increasingly left with less of a say in how things should be.

Now the state doesn’t like anyone telling them that they are doing a bad job.  First of all their job isn’t easy.  Doing more with less.  Second, those in power feel a bit elitist.  And their egos don’t take kindly to criticism.  So when they’re in a position to do something about it they do.  Which is the great tragedy of national health care.  When the state pays the bills the state can pretty much do whatever they please.  For where else are those doctors going to work?  Crossing the border into the United States isn’t much of an option anymore.  For Obamacare will even push doctors around more.  If you don’t believe that just ask a US doctor about his Medicare reimbursements.

So this is our future under Obamacare.  Which will be sort of like Medicare.  Only with longer wait times and rationing.  And unhappy doctors.  Who will, too, probably sign gag orders.  Because once the government takes over health care, where else are they going to work?

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FT136: “Unions only represent those who pay union dues.” —Old Pithy

Posted by PITHOCRATES - September 21st, 2012

Fundamental Truth

The Cost of Teachers’ Salaries, Health Care and Pensions are so Costly that there is Little Left to Spend on the Children

The Chicago public school teachers’ strike is over.  And the teachers got enough of what they wanted to go back to the classroom.  Or else they wouldn’t be going back to the classroom.  Which proves the benefit of belonging to a union.  In exchange for those union dues they get a lot of political muscle.  Which they greatly leverage by having children out of the classrooms.  Suffering.  For the kids are losing out on their education.  Worse, parents are stuck with their kids longer.  And must wait longer before they get their break from having their kids home all day long.

And speaking of the children one thing you didn’t hear in the list of demands was more supplies for the classroom.  Despite good teachers everywhere dipping into their own pockets to pay for classroom supplies.  Why?  Because the cost of teachers’ salaries, health care and pensions are so costly that there is little left to spend on the children.  And that pay and those benefits are pretty generous.  Especially considering with all the time off teachers get they’re technically working part-time jobs (30 hours a week or less).  With about two and half months off during the summer and the breaks during the school year teachers work about 9 months out of the year.  Which comes to about 1,548 hours a year.  Compared to the 1,560 hours (30 hours X 52 weeks) a year a part-time worker can work.  With far fewer benefits.

But yet it’s always about the children.  Higher pay and benefits for teachers benefit the children.  At least that’s what they tell us.  The ability to retire with nearly their full salary.  And free health care until Medicare kicks in.  All paid by the taxpayers.  That’s what’s important to maintain.  So the children get a quality education.  By having their teachers live a higher quality life and retirement than these children’s parents.  Who are paying for both their own quality of life and retirement.  As well as their kids’ teachers.

Big Cities set up Generous Public Sector Pay and Benefits based on an ever Expanding Population Growth Rate

Whenever a city is having trouble paying their bills they always threaten to lay off police officers and firefighters.  As if that is the only expense a city has.  They never talk about cutting back on their health care plans or their pension plans for all city workers.  Like everyone working in the private sector has gone through.  How many times have you been told by your employer that they cannot make a contribution to your 401(k) retirement plan this year because business was down?  It happens a lot.  And that’s the retirement plan most people have today.  It’s mostly what you put away for your retirement.  Pensions in the private sector are long gone.  Only those unionized sectors with enough political clout still enjoy generous pension plans.

Recessions reduce tax dollars flowing into city coffers.  But that’s only part of the problem.  The bigger problem they have is a flat population growth rate.  All these big cities set up generous public sector pay and benefits based on an ever expanding population growth rate.  But that growth rate flattened out in the Sixties and Seventies.  Thanks to widespread use of birth control and, to a lesser extent, abortion.  Women stopped having a lot of babies.  Which means there are a larger number of people retiring than there are entering the workforce to replace them.  So you have a higher growth rate of those consuming taxes.  While you have a lower growth rate of those paying taxes.  Which means cities will pay more out than they collect unless they raise tax rates.  Which they often try to do.  While threatening to lay off police officers and firefighters if voters don’t approve a new millage.

Things can be especially hard for some city workers because of that flat population growth rate.  Not to pick on the firefighters but look at a typical firehouse.  Say a firehouse with one engine/ladder truck and one rescue squad.  That’s about 6 firefighters.  If a city has 30 firehouses that’s 180 firefighters.  If they are 24 hours on duty and 24 hours off that brings it up to 360 firefighters.  If a firefighter academy graduates 100 new firefighters a year that’s about a third of all firefighters.  Now unless each firefighter only works 3 years there will always be more firefighters than open positions.  New building technologies and fire alarm/suppression systems have greatly reduced the number of building fires.  All of this on top of a flat population growth rate makes it very difficult for anyone wanting to be a firefighter these days.  Making matters worse a lot of the old cities are actually seeing population decreases.  Which cities respond to by closing firehouses.  Which reduces the number of firefighters.  Making it even harder for aspiring firefighters.

A Union Represents those who pay Union Dues—not Children, Taxpayers or Patients

Cities collect property taxes to pay for the services they provide.  As well as other taxes and fees.  From that pot of money they collect they divide it between the various departments they have.  Such as for education.  From that money educators have to pay all their bills.  From classroom supplies.  To teachers’ salaries, health care and pensions.  They can only spend this money once.  So if they give more to the teachers there is less for the classroom.  So when teachers strike and say it’s for the children it is probably not for the children.  For the children pay no union dues.  As unions don’t represent the children anymore than they represent the taxpayers.  They represent the teachers.  Because they pay the union dues.  And it is their job to get as much of that money spent on education to the teachers as possible.

There are some moves to unionize nurses and other health care workers.  In fact, that will happen under Obamacare as health care workers will all become government workers.  And eligible to join public sector unions.  Which is why all the unions were so adamantly for Obamacare even though many of them have gotten waivers to opt out.  Because it will swell the ranks of the public sector unions.  While greatly increasing the cost of health care.  And hurt the quality of our health care system.  For if we pay nurses like government bureaucrats we will shift more health care money to these new public sector workers while leaving less to spend on patients.

It is remarkable how selfless all public sector workers are.  For they never want more taxpayer money for their own selfish needs.  It’s always for the children.  The safety of our citizens.  And when Obamacare fully kicks in, the quality of health care our patients receive.  It’s just a coincidence that while protecting the children, the taxpayers and our patients that they benefit, too.  Funny how that works.  Which is what happens when you belong to a union and pay dues.  For a union represents those who pay union dues.  Not children, taxpayers or patients.

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Waiting Times may be on the Rise in Britain as the NHS Struggles to Cut Costs

Posted by PITHOCRATES - August 26th, 2012

Week in Review

It would be nice if we could step into a time machine to see how a government policy would turn out in the future.  To see if it did everything they said it would do.  If it made things better.  Or if that policy would be a complete and utter failure.  Well, time machines don’t exist.  But we can do the next best thing to time travel.  We can look at another nation that long ago enacted similar legislation.  And see what it did for them.  Such as looking at Britain.  And their National Health Service (NHS) (see Join the back of the queue: Waiting times set to soar as NHS trusts suffer from tough cuts by Anna Edwards posted 8/23/2012 on the Daily Mail).

Patient waiting times may increase as a growing number of hospitals face financial difficulties, a report warned today.

NHS foundation trusts, a marker of excellence in the NHS, are facing the challenge of improving quality of care while being forced to make cuts.

Trusts have told the regulator Monitor they are coming under ‘increasing pressure’ to meet accident and emergency waiting times and referral to treatment targets.

Under Labour, hospitals were told patients should be have to wait no longer than four hours to be treated in A&E, and should be given hospital treatment within 18 weeks if they are referred there by a doctor.

But struggling hospitals warn these targets may not be met as they face tough financial difficulties…

‘Particular challenges come from the need to improve the quality of care while delivering considerable savings each year.

‘Foundation trusts are planning to do this without planning to treat fewer patients or reduce the level and quality of care they provide…

‘NHS leaders know the real challenge is to tackle a flat budget while managing the increased costs of treating an ageing population, advanced technology and the growing rates of lifestyle diseases such as obesity.

An aging population and a flat budget?  There’s a little more to that than just a flat budget.  And it has to do with that aging population.  The growth rate of retirees (large consumers of health care) is greater than the growth rate of new taxpayers (people entering the workforce to pay taxes that pay for the retirees).  So available funding of the NHS is falling.  It’s not flat.  Funding is falling while demand for health care services is rising.  And it will continue to rise until the baby boomers die out.  And the pyramid re-inverts itself to where there are more people entering the workforce than are leaving the workforce.

This is why waiting times are growing.  More patients with less funding mean fewer doctors and nurses.  And fewer medicines, medical devices, surgeries and treatments.  Which means people wait longer.  Or are simply denied treatment.  Thanks to a system of rationing.

If everyone provided for themselves through a policy of being responsible this would not happen.  If they didn’t tax the people so excessively to support a welfare state they would have more money to spend on themselves.  To pay for routine doctor’s bills.  And to buy an insurance policy for the unexpected and catastrophic medical expense.  It would work.  Everyone paying a little bit on insurance to pay for the few with unexpected and catastrophic medical expenses.  Because that’s exactly how taxpayer funded health care is supposed to work.  The only problem is that the taxpayer funded variety includes everything.  Even those routine doctor bills.  Requiring excessive taxation.  And when the economy slows down, or a population ages, you simply can’t pay for everything any longer.

And so it will be with Obamacare.  Where policies have to cover everything.  And everyone will have to pay a little bit to cover everything.  Even birth control.  Only that little bit will become a lot.  Because it IS paying for everything.  And all of this with an aging population.  And a much larger population than Britain.  About five times the population.  And about five times the patients there will be in Obamacare.  Making the waiting times and rationing look mild in the NHS by comparison.

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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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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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Poor Quality Standards uncovered in the NHS a Glimpse into Obamacare?

Posted by PITHOCRATES - April 1st, 2012

Week in Review

Do you want to know what Obamacare will be like when they fully implement it?  Yes?  Well, then, I give you the UK’s National Health Service (NHS).  Only it won’t be as good as the NHS.  For the United States has far more patients than the UK does.  But even with fewer patients than the US the NHS bureaucracy is still cold, detached and, at times, deadly (see Health regulator ‘gagged own staff against speaking of failures’ by Rebecca Smith posted 3/30/2012 on The Telegraph).

The Care Quality Commission has been criticised for failing to act on concerns of residents being abused by care home staff and reducing the number of inspections to focus on registering organisations instead, a report said.

One of the key ways that poor standards of care in residential homes and hospitals come to light is through staff blowing the whistle yet the CQC shut down a dedicated hotline, the Public Accounts Committee said.

At the same time the CQC gagged its own staff when they tried to raise concerns about the Commission’s work, it said.

One board member told MPs she had tired [sic]to speak publicly about her concerns over the way the CQC was run but had been “ostracised and vilified”.

The report did not name the board member but it is understood to be Kay Sheldon, a psychiatrist, who gave private evidence to the Mid-Staffordshire Inquiry, into dozens of deaths of patients amid appalling standards of care.

Whistleblower hotline?  Gag orders?  Ostracized?  Vilified?  Patient deaths?  Appalling standards?  These are not the things they led us to believe would happen under Obamacare.  But they have them in the NHS.  Which is full of excellent doctors, nurses and caregivers.  So we can expect them in Obamacare.  And far more of them.  Because Obamacare will have far more patients than the NHS.  And it’s not because ‘bad’ people are sneaking into a national health care system.  It’s just the nature of a great bureaucratic beast.  That must spread diminishing limited resources to an expanding and aging patient base.  That turns health care into a game of numbers.  Accounting entries.  Even in the area of quality control.

The CQC has been ‘struggling for some time’, the report said, and the Department of Health is ‘only now’ starting to take action…

The CQC was formed in 2009 under a Labour government led by Gordon Brown, taking over regulation of healthcare, social care and mental health services.

Reports from the Health Select Committee, the Department of Health and the National Audit Office have all been critical of the Commission.

The PAC report said it has been ‘poorly governed and led’ and ‘we have serious concerns about the leadership, governance and culture of the Commission’.

Cynthia Bower, chief executive of the Care Quality Commission, resigned last month from the £195,000 a year post as a review by the Department of Health found widespread failures including a lack of evidence it protected patients, it was too reactive and inspectors missed neglect of care home residents.

Lady Barbara Young who was chairman when the organisation was set up in 2009, left after the Basildon hospital scandal in which dozens of patients were thought to have died despite the hospital receiving a ‘good’ rating from the Commission.

Government does not make things better.  No matter how ‘smarter’ government bureaucrats are than everyone else.  For that’s the belief of politicians and government bureaucrats.  That the world would be a better place if these ‘smart’ people took control.  And that includes health care.  So they can give large salaries (based on the current exchange rate that £195,000 comes to $312,195 US) to their likeminded friends.  Who can put all of their enlightened ideas into practice.  And what happens after they start running things?  Continued patient neglect.  And more patient deaths.  Despite all of their good intentions.

Mrs Hodge said: “The CQC completed less than half its target number of inspections. That is a serious failure that lets down patients and users of care services who rely on the CQC to protect them from poor or unsafe care.”

The Commission now has to register all 10,000 GP practices in England by April next year and the process has been simplified to an online application form in which partners will declare if they meet 16 pre-set standards including cleanliness, medicines management, patient consent, complaints and record keeping.

In pilots a quarter of GPs said they did not meet all the standards.

The report said: “We are concerned, however, that the Commission will simply be a ‘postbox’ for self-certified applications and that the process will not be sufficiently robust to give the public meaningful assurance that registered GP practices are meeting the essential standards.”

Bureaucrats love paperwork.  The more the merrier.  Put it online and they’re in paperwork nirvana.  Because they never have to leave their offices.  They never have to work late.  They never have to travel to these disgusting health care facilities (where they neglect patients and cause many to die).   Out of sight out of mind.  Ergo their system works.  Thanks to the honor system.  And as long as bad care providers identify themselves to the regulators so the regulators can quickly and efficiently complete paperwork addressing the situation.  And then file it electronically.  Confidant that they did everything they could to increase the quality of patient care.  And then they go home.  Trusting that the other bureaucrats in the system will take the appropriate action.  Thus improving the quality of health care.  Efficiently.  And cost effectively.  Leaving more money available for those large salaries they so enjoy.

“But it is also important to keep this in perspective. The main responsibility for ensuring care standards are met lies with front line staff and hospital boards. We must be realistic about what the regulator can do – its role is to act as a backstop when they fail in this task.

“The Commission had a troubled beginning, exacerbated by a lack of clarity about its role and a failure to provide the resources needed for it to meet the enormous and complex task it was given. Politicians must bear some of the responsibility for this – it is no good preaching the virtues of light touch regulation, and then blaming the regulator for not taking a more interventionist approach when problems emerge.

But there is a problem relying on the frontline staff when they follow orders from on high.  Their health-care-providing hands are tied.  They can only do what some bureaucrat in a far distant office allows them to do.  They’re doing the best they can in a broken system.  But when care or treatment is denied based on cost accounting performed in some office that never sees a patient their patients will suffer neglect.  And some will die.  In part from the refusal to give them life-saving treatment.  And in part due to the apathy people will feel when the quality of their care doesn’t matter as much as their meeting cost-reduction targets.  When they see patients suffer and die because they can’t do anything for them.  Because their requested treatment was denied.  It’ll harden the best of people.  Making their patients just numbers.  And not people.

And this will be the world of Obamacare.  For the NHS is full of great people.  Yet even they can’t prevent the ill effects of a bad system.

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Seeing the Bleak Future of Obamacare in the UK and Canada

Posted by PITHOCRATES - May 6th, 2011

The UK and Canada look to the Private Sector to Rein in Health Care Costs

The UK founded the National Health Service (NHS) in 1948.  That’s over 50 years ago.  And you know what they say?  Practice makes perfect.  So the UK must really have this national health care thing down, right?  Delivering everything President Obama promises to deliver with his Obamacare.  Affordable yet quality health care for everyone.  For the problem the Americans have been having is that they don’t have a national board yet to limit health care costs.  To tell providers how much is enough.  To swat them on the nose with a rolled up newspaper and say, “Bad, health care provider.  Bad.  You have to learn to stop being so greedy.”  Like they must be doing in the UK (see Kill or cure by The Economist posted 5/5/2011 on The Economist).

THE government has put its ambitious health-care reforms on hold, while David Cameron tries to calm a bout of anxiety in his coalition. However, many hospitals are already finding that a combination of rising costs, heavy debts and looming budget cuts is forcing them to seek mergers with stronger institutions or even private-sector takeovers. Even less palatable for the coalition—and patients—there are worries that as the government seeks to save £20 billion ($33 billion) in hospital running costs over the next four years, some closures may be inevitable.

Iain Duncan Smith, a predecessor of Mr Cameron as Conservative leader, last month signed a petition outside 10 Downing Street against closures of the emergency and maternity units of a hospital in his London constituency. Trafford hospital near Manchester—the birthplace of the National Health Service (NHS), where its first patient was treated on its founding in 1948—is considering privatisation, among other options, to resolve its debt crisis. In London, three big hospitals, including the historic St Bartholomew’s, are contemplating joining up into one “superhospital”.

Well, that’s odd.  You see, the UK has a national board to control health care costs.  So they shouldn’t have rising costs.  Heavy debts.  Looming budget cuts.  Mergers.  Or private-sector takeovers.  But here the UK is.  Doing exactly these things.  It makes one wonder why the Americans want to go down this road when the UK has demonstrated that it is the wrong road to go down.  Unless it’s not about providing affordable yet quality health care for everyone.  But the government taking over one-sixth of the nation’s economy.  Whatever the consequences to the quality of health care.

Given how Britons cherish the NHS, privatisations of hospitals might prove as controversial as closures. The government wants a “mixed economy” in the health service, citing Hinchingbrooke hospital in Huntingdonshire as an example of its readiness to bring in private-sector innovation. It will shortly become the first NHS general hospital to be franchised to a private company. Indeed, in Canada’s generally well regarded health service, hospital treatment is often provided by charitable or private operators, with the state paying the fees—so there is no reason why more private-sector involvement in Britain’s NHS would put its principle of free treatment for all at risk.

So things may not be that bad.  The NHS may just become more like the Canadian health care system.  In Canada, the Canada Health Act (CHA) determines how the government reimburses private health care providers for their services.  And it is these private health care providers who hire doctors and nurses.  And funds their retirement.  They are not government employees.  Like in the UK.  Canada is more like the USA.  Only with a single insurance company, i.e., a public option.  So the Britons don’t have to worry about change per se in paying for health care.  It will still ultimately come from tax dollars.  And they will have the same problems they currently have in the UK (see Canada’s health care crisis is an economics problem, not a management problem by Brett J. Skinner, President and Director of Health Policy Studies and Mark Rovere, Associate Director of Health Policy Studies Fraser Institute, posted 4/19/2011 on Troy Media).

Government health spending is growing at unsustainable rates, while patients are facing shortages of medical resources and declining access to necessary medical care.

The Canadian health system has been run as a government monopoly since 1970. It doesn’t really matter which level of government tries to manage the system, our experience shows that political planning doesn’t work. Adding federal management would be as effective at averting disaster as rearranging the deck chairs on a sinking ship.

So, yes, the UK is looking to the Canadian system as a lifeboat for the NHS.  Unfortunately, the lifeboat they chose also happens to be sinking.

This cost crisis is happening despite significant government efforts to centrally restrict spending on health, which has resulted in shortages that create long waits for access to necessary medical goods and services.

The Fraser Institute’s annual survey of Canadian physicians shows that, in 2010, patients waited approximately 18.2 weeks from the time they obtained a referral from a general practitioner to the time they received treatment from a specialist. Although health spending consumes a larger share of provincial revenues each year, Canadians are waiting 96 per cent longer for surgery than they did in 1993 when the average wait was only 9.3 weeks long.

The problem is that both the NHS and the CHA have the same problems.  Adopting a system more like the other doesn’t get rid of those underlying problems.  There is something they both can do, though.  Use less government.  And more market forces.

The real solutions are quite simple: user fees and private insurance options would introduce economic incentives for efficiency that would regulate supply and demand, shift costs off the public system and offer a sustainable source of additional resources.

The US has private insurance options.  For now, at least.  But they wrote Obamacare to put them out of business to get the public option in through the back door.  A two-step process to get the US to a national health care system.  So they can have the same problems as their dear friends in Canada and the UK.

National Health Care makes Unhappy Health Care Providers

The problem with a single-payer system is that there is no competition to keep costs down.  That’s what a free market economy does.  Keeps prices down.  That’s why one store can’t sell a TV set for $2,500 when another sells the exact same set for $750.  Because consumers will not pay more for the same thing.  That’s what competition does.  Makes people honest.  Without competition, though, you have to trust someone.  Or some panel.  To set fair prices.  And fair salaries and benefits.  And when costs are too high the only options available are to ration services.  Or pay health care providers less.  Or make them work longer hours for the same pay (see NHS reforms push third of GPs to head for exit by Laura Passi posted 5/5/2011on PulseToday).

The first part of Pulse’s State of the Profession Survey, published this week, paints an alarming picture of GPs’ working lives, suggesting they are being forced to work longer hours, are spending less time with patients and are struggling to meet expectations as a result. Almost half of the 576 GPs who responded to the poll reported they were suffering from stress.

But it is the fallout from the Government’s far-reaching NHS reforms that appears to have pushed the number of GPs looking to quit to the highest level for more than a decade, with 71% claiming morale had fallen as a direct result of the health bill and only 9% saying it had risen. Just 18% said they believe general practice is currently moving in the right direction.

Here’s a news flash.  Being a nurse is hard.  Being a doctor is hard.  Telling them that they have to work longer and harder for less pay just isn’t going to get people to go into medicine.  Or stay in medicine.

BMA chair Dr Hamish Meldrum told Pulse he feared low morale could lead to an exodus of senior GPs.

He said: ‘Morale isn’t that good when it comes to things like pay, the threats to pensions and the various other things that are going on in the NHS.

Yes, we want you to sacrifice and give all you can so we can live healthier lives.  But we don’t want you to get rich in the process or enjoy life.  Your reward should be knowing that we can live a long and healthy life so we can get rich and enjoy life.

Dr Julia Hodges, a GP in Elephant and Castle, south London, was one of many to blame the fall in morale on the NHS reforms: ‘A lot of people feel quite betrayed because the story was that there would be no major top-down reorganisation, and then suddenly the biggest changes since the inception of the NHS are being discussed. I feel the changes are badly thought out and so destructive. Inevitably there has to be more rationing, more cuts, more waiting lists. I think it’s going to be really unpleasant to try and commission services when the budget is shrinking rapidly.’

Yeah, it has to be this way.  Because when there is no competition, the only way to cut costs is for someone or some panel to determine who they are going to pay less.  Or who they are going to make work harder for the same amount of pay and benefits.

It’s about the Power and the Money

When it comes to the health care debate in the United States, people have to understand it’s not about providing affordable and quality health care for everyone.  It’s all about political power.  And the money.  The utopian solutions pointed to in the UK and Canada are not the utopias some think they are.  Their cost problems are worse than the American cost problems.  But does that dissuade the defenders of Obamacare?  No.  Which should tell you everything you need to know about their true intentions.

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