The Future of Obamacare will be Poor Patient Care and Gag Orders for anyone Speaking Out against that Poor Care

Posted by PITHOCRATES - February 17th, 2013

Week in Review

Time travel has always fascinated people.  To go back in time before the loss of a loved one.  To go forward into time to see your children’s weddings before your premature death.  Or traveling to the future to find a cure for the disease that will take you prematurely.  As well as traveling back for definitive answers for the great mysteries that have puzzled us.  Did Lee Harvey Oswald act alone?  Why did the people build Stonehenge?  How did they build the pyramids?  Or imagine the ability of going back in time to stop Adolf Hitler.  And what would have happened if there was no World War II because there was no Adolf Hitler?

The concept of time travel is fascinating.  But as of now it is still science fiction.  But there are ways we can travel into the future.  Sort of.  As they implement more parts of Obamacare people wonder what it will be like in 10 or 20 years from now.  Will it be a great success?  Or a great failure?  We can actually travel in time to get the answer to these questions.   Because that alternate reality already exists in our own time dimension.  In Britain.  So we can get glimpses of the future of Obamacare by looking at the past and present of the National Health Service (NHS).  So get ready for a little time travel.  As you read the following substitute ‘Obamacare’ for ‘NHS’.  As this will take you into the future world of Obamacare (see Jeremy Hunt warns NHS health trusts over gagging orders posted 2/16/2013 on BBC News Health).

Health Secretary Jeremy Hunt has warned NHS bosses against allowing a culture that is “legalistic and defensive” in dealing with staff who raise concerns over patient care.

In a letter to all English NHS trusts, Mr Hunt highlighted fears that “gagging” clauses were being used to “frustrate” such whistleblowing…

It comes after one former NHS trust boss broke a gag to talk to the BBC.

Gary Walker, former chief executive of United Lincolnshire Hospitals Trust (ULHT), said he had been forced out of his job and gagged from speaking out about his concerns over patient safety…

The health secretary insisted that “fostering a culture of openness and transparency” was essential in creating a climate “where it is easy for staff, present and former, to come forward with any concerns they have relating to patient safety”…

Mr Walker, who was sacked in 2010 for gross professional misconduct for allegedly swearing in a meeting, told the BBC he had no choice but to sign an agreement linked to a confidentiality clause in April 2011…

Our correspondent said the letter was certainly a warning shot across the bows of the trusts. It appeared the use of these gagging clauses was widespread in the NHS, he added…

ULHT is one of 14 trusts in England currently being investigated for high death rates, in the wake of the Stafford hospital scandal, where hundreds are believed to have died after receiving poor care.

It emerged on Friday that police and prosecutors are now studying a damning report into failures at Stafford to see whether any criminal charges should be brought against staff.

Scary.  Gagging orders?  High death rates?  Poor care?  Getting fired over voicing concerns over poor patient safety?  Confidentiality clauses?  So this is what national health care is like.  You don’t hear things like this at American hospitals.  But this is where Obamacare will take us.  Not a very pleasant future.

Pity we can’t take our time machine back in time.  Expose the corruption the Democrats used to pass Obamacare into law.  The Louisiana Purchase.  The Cornhusker Kickback.  And all the other corrupt backroom deals made to give Harry Reid his 60 votes to pass Obamacare into law.  To bring these to the light of day before the vote.  So the American people could see these outrages while they had time to do something about it.  But, alas, time travel isn’t possible.  So we’re stuck with the gagging orders, high death rates, poor care, poor patient safety and confidentiality clauses that will be Obamacare.  Just as they are the NHS.

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In the Coming Years the NHS will Suffer Budget Cuts, Rationing and Poor Patient Care

Posted by PITHOCRATES - October 7th, 2012

Week in Review

The problem with national health care is that it is very, very expensive.  It’s one of the most expensive things a government can do.  And there comes a time a government can’t just keep raising taxes, or can’t keep borrowing money, any more.  And when a government reaches that point in time this is what happens (see NHS budget may be cut after election, says Hunt by Rowena Mason posted 10/4/2012 on The Telegraph).

The NHS budget may have to be cut after the next election if the economic crisis worsens, the new Health Secretary has suggested…

The NHS is already having to make savings because it is accustomed to its budget rising by more than inflation to deal with an ageing and growing population. It may also have to find up to £5billion a year to pay for the Dilnot reforms, which propose a cap on how much people must pay towards their elderly care..

Hospital bosses are already warning that the NHS savings needed before 2015 will harm patient care.

Finance directors working in the NHS said last week that the service has coped so far but things will get worse next year. In a survey for the King’s Fund, 40 per cent said that patient care would get worse in the coming years and the NHS would miss its overall target of making £20billion efficiency savings by 2015.

Free health care turns out to be very expensive health care.  Especially with an aging population.  Which is why the future of national health care is budget cuts, rationing and poor patient care.  As it will be under Obamacare.  After it puts the private health insurance companies out of business.  So they can transform Obamacare into the national health care system they always wanted.  And when it does there will be budget cuts, rationing and poor patient care.  Because America has an aging population, too.

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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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Solving Public Spending and Debt Crises with Privatization

Posted by PITHOCRATES - May 23rd, 2011

To Privatize or not to Privatize the NHS

Some want to start privatizing parts of the National Health Service (NHS).  Some don’t.  Some want to improve quality and cut costs.  Some don’t.  But as people live longer into retirement, there is no place for costs to go but up.  Especially when there is no competition (see Where lucre is still filthy posted 5/19/2011 on The Economist).

THE profit motive is alive and well at the Circle hospital outside Bath, in south-west England. The hospital was designed by the architect Norman Foster, and is run by Circle Healthcare, a firm part-owned by its employees and set up by Ali Parsa, a former banker at Goldman Sachs, in 2004. It treats a mixture of National Health Service and private patients. Corridors are wide and gleaming, operating theatres newly equipped. Doctors and nurses have more say in management decisions than in many English hospitals.

So a private, for-profit hospital is well run, clean and has new equipment.  Which implies that the run of the mill NHS hospital is bureaucratic, cramped, dirty and outdated.  Hmmm.  Based on this it would appear that the private, for-profit hospital is a better hospital than your run of the mill NHS hospital.  At least, from a patient’s viewpoint.  And who could argue?

Trade unionists and lobby groups are queuing up to denounce any expansion of the private sector’s role in health care.

So trade unionists and lobby groups are against cleanliness and modernity.  They prefer bureaucratic, cramped, dirty and outdated.  One can only presume so because of the money.  For it usually is.  Of course, they will deny this.  And say they are just looking out for what’s best for Britons.

To some foreign observers, this reticence about private involvement looks odd. There is ample international evidence that competition among private providers yields better results. For example, a report last year by America’s National Bureau of Economic Research found that increased competition in health care was correlated with improved financial and clinical outcomes; adding a rival hospital and instigating patient choice substantially increases the quality of management. As Nick Seddon, of the British think-tank Reform, points out, “It’s a fallacy to think you can choke off the profit motive without losing momentum and innovation.”

And the current debate somehow overlooks the fact that for-profit companies are already delivering many support services in health, education, prisons and other public services. Family doctors have been private operators since the foundation of the NHS in 1948. The profit motive has been making further steady advances in the state sector since Margaret Thatcher’s outsourcing campaign in the 1980s. Tony Blair let privately owned treatment centres provide specialist services within the NHS. His wider reforms were restricted by internal battles in the Labour Party; all the same, a recent report from the London School of Economics found that introducing competition among NHS hospitals in 2006 helped to reduce patient deaths.

The history appears to side with privatization.  Both in the UK.  And the USA.  That is if you’re measuring by the quality of patient care.  And by the number of people you prevent from dying.  Which is a rather important statistic in any hospital I would think.

Let’s take a closer look at this ‘not dying’ thing.  Suppose there is only one hospital serving an area.  And suppose that 5 out of every 10 patients that enter dies.  Now suppose a second hospital opens up.  Where only 1 out of every 10 patients that enter dies.  Which hospital would you want to go to?  I’m guessing the 1 out of 10 one.  Because that ‘not dying’ thing is pretty relevant when choosing a hospital.  And when more people do in this example, the ‘5 in 10’ hospital will have no choice but to improve.  To become a better hospital.  This is what competition does.  It makes everything better.  And it’s just not the UK and the USA seeing this.

Britain is unusual among rich democracies not in how much private involvement there is in its public services, but how little. Only 4% of acute-care beds are provided by private companies. In Germany, the proportion of hospitals run for profit (32%) overtook the number of publicly run ones (31%) two years ago (charitable and voluntary organisations account for the rest). The Spanish region of Valencia allows for-profit firms to run over 20% of its health-care services, with the sort of long-term deal British providers hanker for. New European democracies are experimenting with similar public-private mixes. Two-fifths of Slovak hospital provision is delivered by private operators.

It’s rather ironic.  The people who did so much to improve the life of the individual coming out of the Middle Ages is now among the least free nations when it comes to health care.  They’re talking about privatizing more health care to improve quality.  And cut costs.  Because the NHS, as all state monopolies do, is trending in the wrong way in areas of quality and costs.  The fact that there is a debate proves this.  Now, don’t get me wrong, the NHS is full of good people.  It’s not the people in the system.  It’s the system.  And the people managing the system.

But old bureaucracies are hard to reform.  People trust them.  Because they’re used to them.  Like a comfortable pair of filthy, worn slippers.  But people are living longer.  Consuming more health care in their retirement years.  Vastly increasing health care costs.  Which the NHS has to pay.  Either by more taxation (which can reduce economic activity, which will reduce tax receipts across the board).  Rationing services to make what they have cover more people.  Or by more deficit spending.  Borrow and spend for today.  Leaving a debt bomb for future generations to worry about.

Italy and Spain Circling the Drain?

And speaking of debt bombs, a couple more are about to go off in the European Union (see U.S. stocks plunge on European debt worries by the Associated Press posted 5/23/2011 on the Los Angeles Times).

Stocks plunged Monday after warnings about the finances of several European countries stoked fears that the region’s debt crisis is worsening. The euro dipped briefly to its lowest level against the dollar in two months…

Italy is the latest European country to be affected by the region’s widespread debt problems. Standard & Poor’s said Saturday that country was in danger of having its debt rating lowered if it could not reduce its public borrowing and improve economic growth.

Too much public sector spending has caught up to the Italians.  High taxation to support that spending is hindering economic growth.  And they’ve borrowed so much that people are starting to think that they won’t get their money back.  Making people that much more reluctant to loan (i.e., buy Italian bonds) them money again.

Spain’s public finances are also worrying investors. Spain’s ruling Socialist party was roundly defeated in local elections, raising concerns that political instability would keep that country from enforcing spending cuts. The Ibex 35 index on the Madrid stock market fell nearly 2 percent in midday trading.

The 10-year U.S. Treasury yield fell to 3.10 percent, its lowest level this year. Bond yields fall when prices go up, so the drop is a sign that investors are clamoring for the safety of long-term U.S. debt.

And the Spanish are in the same boat.  Even with their partial privatization of health care, there’s still just too much public spending.  And a political atmosphere that won’t take kindly to spending cuts.  Unemployment among the young and educated is high.  Close to 50%.  Making their prospects for future borrowing not that favorable either.  So they, like the Italians, will not be able to pay their bills one day.  Which will eventually bring about those spending cuts.  The hard way.

Greece too far gone to Save?

The big public sectors in the social democracies of the European Union (EU) are taking their toll.  Their costs are crippling some of their economies.  And it all started in Greece.  Who is still trying to dig themselves out of their debt hole (see Greece mulls deeper spending cuts as borrowing rates hit record by Derek Gatopoulos, Associated Press, posted 5/23/2011 on thestar.com).

Greece’s borrowing costs surged to another record Monday, as the crisis-hit country’s prime minister chaired emergency talks to deepen austerity measures beyond his own government’s term in office.

A Cabinet meeting began as yields rose above 17 per cent for Greek 10-year-bonds, hitting a record margin — or spread — over the benchmark German rate.

Greece suffered another bond downgrade late Friday from the Fitch ratings agency, lowering its investment ranking by three notches deeper into junk status. Prime Minister George Papandreou conceded over the weekend that plans to return to bond markets next year may not be achievable.

Junk status.  Wow.  That’s bad.  That means few people think they’ll get their money back if they loan any to Greece.  And according to Papandreou, no one will next year.

Greece’s economy is being kept afloat by €110 billion ($156.6 billion), in a 2010-2013 package of rescue loans from European countries and the International Monetary Fund.

But that rescue package does not cover all of Greece’s financing needs for 2012, and EU countries are demanding tougher cost-cutting action from Greece before considering offering another financial lifeline.

In return for the bailout, the government imposed a series of austerity measures, including pay cuts in the public sector, tax hikes and social security reforms, and is under strict supervision from the EU and IMF to ensure the country is meeting the conditions for the rescue loans.

And here we see why they have such a debt crisis in Greece.  High salary and benefits for a bloated public sector.  And state benefits that are too generous.  Things that are hard to cut.  As is evident by the requirement of another bailout.  And the demand by those doing the bailing for tougher cost-cutting.  Because what they’ve done so far isn’t enough.

In Vienna, top financial official Olli Rehn said Greece needed to take more steps “in the coming days and weeks” to convince other EU nations and lending institutions that it is serious about overcoming its huge monetary deficit.

He urged the crisis-hit national to urgently step up its ambitious privatization program. General elections are due in Greece in 2013.

And here again we come to that wonderful panacea.  Privatization.  For the EU countries with the greatest debt crisis are the ones with the least privatization.  Whereas the strongest economy in the EU, Germany, has quite a bit.  Even in the one area people fear most.  Health care.  Germany has more private hospitals than public ones.  So profit (i.e., lucre) isn’t a dirty word in Germany.  They have a strong economy.  And fiscal restraint.  Which is why Germany is doing a lot of the bailing in the EU.  Of course, they have experience rehabilitating financially weak nations.  They no doubt learned a lot when they reincorporated the former East Germany into a reunified Germany after the Cold War.

Ticking Debt Bombs

Public spending has grown in countries big and small.  And it is crippling countries big and small.  Privatization is a way to cut public spending.  But it doesn’t help win elections.  So it’s not easy to do.  People get set in their ways.  And once people grow up on generous state benefits, it’s hard to convince them that things will be better if they start paying for what they once got free.  So few try.  It’s easier to just keep promising more of the same.  And close your eyes to that ticking debt bomb.  Hoping that it will blow up later rather than sooner.  And that the people continue to enjoy their comfortable pair of filthy, worn slippers.  No matter how filthy and worn they get.

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