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2/25/2010
IS THIS THE FUTURE OF HEALTH CARE RUN BY THE GOVERNMENT?

A growing scandal in Great Britain may give us a glimpse of America’s future under a health care system run by the government.

Note, I said “may.” The fact is, government run health care systems in other countries have varying mixes of public and private care available to consumers, which gives many citizens options regarding their care. Canada is a good example. Most Canadians are satisfied with their health care system despite its long waiting periods for routine procedures for many. That’s because private insurance is still available for those who wish coverage for prescriptions, dental and vision, as well as little extras like private hospital rooms. Up to 2/3 of Canadians have some form of private, supplemental insurance, mostly paid by their employers.

And unlike Great Britain, almost all services are provided by private companies. Doctors are paid a fee for services rendered rather than receiving a salary. The industries are heavily regulated and competition is stifled to a large degree. But there is no rationing per se and no lifetime limit on using the system.

But the National Health Service in Great Britain is a different story. Here, only about 10% of citizens purchase supplemental private insurance, although the government will pay for some procedures performed by private concerns if the waiting period in the public sector is too long. We’ve heard of the NICE Commission - the National Institute for Health and Clinical Excellence - which functions as a de facto rationing body by approving or denying treatments. They say they base most of their decisions on quality of care and only deny treatments that “don’t work” or have limited value in improving the condition of patients. The Medicare Cost Control board that the health care reform bill would set up here would perform similar duties.

Since private insurance companies routinely make those kinds of decisions here already, the difference will be in treating the patient as a number or a customer. While the motivation underlying both private insurer and government may be similar, it is not the same and most critics of Obamacare make the point that the pressure on government to deny services will be greater than on a private insurance company due to efforts by government to not only put downwards pressure on the cost curve of medical care generally, but also meet budgetary targets. It’s a political argument and I’m not sure about it’s real life implications. But looking at the workings of NICE, one has to wonder about some of their decisions.

But the big difference between Great Britain and Canada is that almost all health care facilities are run by the NHS. The result?

Up to 1,200 people lost their lives needlessly because Mid-Staffordshire NHS Trust put government targets and cost-cutting ahead of patient care.

But none of the doctors, nurses and managers who failed them has suffered any formal sanction.

Indeed, some have either retired on lucrative pensions or have swiftly found new jobs.

[...]

The devastating-report into the Stafford Hospital-shambles’ laid waste to Labour’s decade-long obsession with box-ticking and league tables.

The independent inquiry headed by Robert Francis QC found the safety of sick and dying patients was ‘routinely neglected’. Others were subjected to ‘ inhumane treatment’, ‘bullying’, ‘abuse’ and ‘rudeness’.

The shocking estimated death toll, three times the previous figure of 400, has prompted calls for a full public inquiry.

Bosses at the Trust - officially an ‘elite’ NHS institution - were condemned for their fixation with cutting waiting times to hit Labour targets and leaving neglected patients to die.

But after a probe that was controversially held in secret, not a single individual has been publicly blamed.

The inquiry found that:

• Patients were left unwashed in their own filth for up to a month as nurses ignored their requests to use the toilet or change their sheets;

• Four members of one family. including a new-born baby girl. died within 18 months after of blunders at the hospital;

• Medics discharged patients hastily out of fear they risked being sacked for delaying;

• Wards were left filthy with blood, discarded needles and used dressings while bullying managers made whistleblowers too frightened to come forward.

If the hospital were run by a private concern, would those kinds of problems exist? There are many private nursing homes and hospices that are a disgrace in this country but a big municipal hospital like the one described above would be under intense examination by state boards and other bodies. And you would think insurance companies would also be concerned if they were paying out for treatment in such a death trap. There’s no way to prove it, but common sense would dictate that conditions like the kind described above would not exist for very long in many privately run American hospitals.

Some Draconian proposals coming out of the NHS in recent years - denying care to the very sick, patients being diagnosed as “close to death who aren’t - only happens when government run health care pays too much attention to budgets and rules and not enough to individual patients and their needs.

To hear health care reform advocates on the left in this country, it is apparent that they wish to do away with private insurance entirely in favor of a single payer system. In fact, the very idea of for-profit health care seems to annoy them. I would guess that if given a choice, liberal health care reform advocates would prefer the British model as opposed to the Canadian model.

In that sense, if they eventually get their way - and they have made absolutely no secret about their view that Obamacare is a gateway to that kind of system - such horror stories could indeed alight here. But we can only hope that a more rational approach, mixing public sector funding and the efficiency of private companies to deliver services, will eventually emerge from the current process.

It won’t happen today at the health care summit. And I’m not sure that President Obama and the congressional Democrats are open to that kind of real compromise anyway. They have used the insurance industry, the drug companies, for-profit hospitals, and doctors as political whipping boys so often in this debate that they are almost forced to forgo any hint of market reforms in their package.

I don’t like much of anything that the Democrats have proposed so far. But if we’re going to have some kind of national health insurance program, we should think about what works in the real world rather than what we would prefer to see as a result of an ideological bent on the part of the legislature.

By: Rick Moran at 8:59 am
4 Responses to “IS THIS THE FUTURE OF HEALTH CARE RUN BY THE GOVERNMENT?”
  1. 1
    brokenpolsys Said:
    9:37 am 

    And the people dieing now, for utter lack of healthcare in America? How do they not figure into this article at all? Talk about the pot calling the kettle black…

    I guess you didn’t understand. Not surprising since I have no idea where that analogy fits. I would say first that there are no provable figures for people “dying” for lack of health care in America. It is impossible to make that claim and those that do are politically motivated. (Harvard) There are people who have health insurance who also don’t go to the doctor for treatment. You would have to be a mind reader to figure out how many people don’t go to the doctor out of fear and how many don’t go because of the cost. Since I don’t think you’re a gypsy, we can dispense with the idea that anyone has any idea about numbers of people who die because they don’t have health insurance.

    Secondly, this post was about the conditions of hospitals in a government run health care system. If you want to write about the uninsured, get your own damn blog.

    ed.

  2. 2
    Drongo Said:
    10:07 am 

    Interestingly, Staff Hospital is one of the trusts that has been made a “foundation” trust in the current push towards an internal-market driven NHS. The idea is that, while normal acute trusts were closely monitored by the health authority, foundation trusts are given a lot more leeway in managing their affairs. The long term goal was to semi-privatise these trusts as they proved more financially independant and proved their flagship status. They already run by charging by service provided rather than by simple budget allocation. The problem has been that the move to a more loosely controlled model has allowed people tobasically fudge their figures in a way that hits the targets rather than improving healthcare as a whole.

    Oh, and the Daily Mail is one of the more extreme papers in the UK. I’d get my information from a more unbiased source, like the Times (centre-right), Guardian (left), Independant (centre-left) or Telegraph (right).

  3. 3
    bobnoxious Said:
    10:44 am 

    Rick, you wrote regarding the rationing of health care:

    “Since private insurance companies routinely make those kinds of decisions here already, the difference will be in treating the patient as a number or a customer”.

    Please inform me, if my health coverage is denied, will I be a number or a customer in the US? Can you flesh that out a bit?

    Oh, here’s something I read yesterday:

    “A new study has shown that nearly 50000 US medical patients die every year of blood poisoning or pneumonia picked up in hospitals”.

    Faced with that should I prefer to be a number or a customer?

  4. 4
    Eric Blair Said:
    11:06 am 

    bobnoxious: your troll-fu is weak.

    You already are a number to an insurance company, that is how you are identified, it is generally called a member number. Now, if your coverage is denied, you get told why, and typically there is an appeals process. It is messy. That’s just the way it is. Now, what Rick leaves out is that if it is an insurance company, you do have the option to sue them if you want. Good luck with that if it’s the government.

    As to the 50,000 dead of secondary infections, that has nothing to do with insurance companies, and everything to do with hospital hygenic procedures, I read the article.

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