Healthcare, health policy, cognitive science. , and the path to Universal Healthcare..
Frontline: Sick Around the World
Lots to digest, and I’ve only begun to explore the web extras, so I post now for convenience’ sake. Overall, though, TR Reid did a terrific job all around.
From the physicians’ perspective, I, of course would have liked more but they only chose to do an hour. Frankly, this would have been another good use of an extended format Frontline, as they did with “Bush’s War.”
Britain’s health care amounts to malpractice – BostonHerald.com
I don’t know of a person who advocates for universal health care in the US who advocates for a nationalized system such as Britain’s that the author holds up as his bogeyman. The discussion is about which type of single payer system or universal insurance coverage scheme we should adapt to the US. As Michael Moore has stated, we aren’t talking about blindly adopting another contry’s system wholesale, we are talking about having a policy discussion and creating a uniquely American system, emphasizing our strengths and remedying our weaknesses.
But what really prompted me to write this were a couple of absurd statements by the author.
First, “No one can complain that the NHS is underfinanced. This year’s budget is $210 billion – about $1.05 trillion if adjusted to match America’s population.” Really, no one? The Internets have this thing called “Google” and if you search for “NHS underfunded” you might find out that at least a few people (Tony Blair, for one) who believe it is underfunded. But more importantly, is there anyone who doesn’t get that we spend roughly twice as much per person on healthcare and get terribly shaky outcomes for it? Specifically, is there anyone writing a piece for a major newspaper who doesn’t know this?
And this: “A September 2007 Lancet Oncology article found 66.3 percent of American men alive five years after cancer diagnosis. Only 44.8 percent of Englishmen survived after five years. Across the European Union, 20.1 females per 100,000 under 65 died prematurely of circulatory disease. Among British women, that number was 23.6.”
Here’s an interesting table from that study, showing the UK NHS as the worst, except for Slovenia, Iceland, Poland and the Czech Republic. And I’ll say it again, nobody wants to replicate the British system here. And for more comparisons on US versus other countries healthcare outcomes, go here.
And, finally, my favorite, “Within this maze, patient needs often yield to the wants of pols and medicrats.” Go see Sicko, man! Are you kidding? You think we don’t have pols in the hands of Pharma and the health insurance and health care industries and “medicrats” at our insurers? Who do you think draws those multi-million dollar salaries at the Blues and Aetna and the rest?
Aren’t these people getting tired of flogging this dead dog? Probably not, because apparently that dog still hunts in the imaginations of some.
Cheers,
Thanks to Maggie Mahar for doing the work on this. I was willing to accept Dr. Gottlieb’s facts at face value and make my case, but Mahar went the extra mile to show that, not only is the argument bogus, so are the facts! Here’s the prime of the post:
But what Gottlieb omits is the crucial fact that, when the researchers went back and looked at “patients who survived the first post-transplant year,” they discovered that “patients who had suffered from chronic liver disease in the U.K. and Ireland had a lower overall risk-adjusted mortality” than patients in the U.S. In other words, survival rates for patients who had a chronic disease before the transplant were better in the U.K. and Ireland. As for patients suffering from acute liver disease, longer-term survival rates past one year were just as good in the U.K. and Ireland as in the U.S. Moreover, if you checked patients in the interval between 90 days and one year, outcomes were similar in the two health care systems.
So “equilibrated” wasn’t just a dodgy piece of jargon; it was inaccurate. When researchers checked on patients more than a year after they had the transplant, outcomes in the U.K/Ireland and the U.S. weren’t in perfect balance (or in equilibrium) with results in the U.S. Outcomes in the U.K./Ireland were just as good for one group and decidedly better for the second —assuming that if you go through the trauma of a liver transplant, the outcome you are hoping for is to live more than a year, rather than just 90 days.
Why is chronic care better in the U.K. in the years following surgery? Because the “primary care infrastructure” is stronger in the U.K. and Ireland, the article explains. Add in the fact that patients have “equal access” to health care and that the cost of care is “lower,” and this helps explain superior long-term results. As the researchers point out, “the 2002 Commonwealth Fund International Health Policy Survey found that sicker adults in the US are far more likely than those in the UK to forgo medical care and fail to comply with recommended follow-up and treatment because of costs. In the U.S., it seems, outcomes tend to turn on whether the patient has money.
Finally, what about outcomes after five years? What Gottlieb forgot to mention is that survival rates for patients who had originally suffered from chronic liver disease were similar in the two countries, while mortality rates for patients suffering from acute liver disease were higher in the U.K. and Ireland.
Thanks, Maggie!
Politics What Sicko doesn’t tell you …
Local people from Portsmouth to Scarborough have been protesting against ISTCs draining scarce NHS funds, which has led to service closures and staff redundancies to balance the books. There is not an area of the country where services are not being cut and closed. Protests against the closures of accident and emergency departments and hospital services are happening in Surrey, East and West Sussex, Kent, Worcester, Manchester, Leeds, Durham and Huddersfield; and against the 150 community hospitals in places such as Norfolk, Cambridge, Leicester, Devon, Marlborough and Bromley. The NHS, the government says, has had unprecedented levels of funding – so where has all the money gone if it isn’t into services? Is it really all down to bad managers and greedy doctors and nurses?
All markets need systems for pricing, billing and invoicing. Labour has introduced those: the electronic patient record, part of the £1bn IT disaster. The NHS too is being transformed from within. Foundation trusts such as University College London Hospitals Trust have been given new powers to enter joint ventures with commercial companies such as the Hospital Corporation of America and to spend millions of pounds on advertising campaigns, PR agents, mega-departments of finance and accounting, press officers, management consultants and profits. As in the US, billions of pounds, probably approaching 20% of annual NHS funds – estimated to be £20bn in England in a year – are being squandered on what are called the transaction costs of the market.
Earlier this year the US chief executive officer of UnitedHealth, Bill McGuire, was sacked along with other board members for repricing share options. His annual $126m package was not enough for him. Meanwhile more than 50 million Americans, including 10 million children, go without care – in the richest country in the world. Is this what we want?
· Allyson Pollock is author of NHS plc: The Privatisation of Our Healthcare and professor and head of the centre for international public health policy at the University of Edinburgh.
Interesting piece about how greed and capitalism are not turning out to be the cure for the NHS. And, on the other hand, how the NHS needs some serious work, making the case for Medicare for all all the stronger.
First world results on a third world budget Special reports Guardian Unlimited:
A nice, evenhanded piece on the Cuban system, with some comparison with the UK’s NHS at the end. Clearly not the be-all-and-end-all of healthcare, but, really, can’t we do better than Cuba?
“But how good, exactly? And how does Cuba do it given such limited
means? Neither question is easy to answer. The communist government is not
transparent, some statistics are questionable and citizens have reason to muffle
complaints lest they be jailed as political dissidents. According to the World
Health Organisation a Cuban man can expect to live to 75 and a woman to 79. The
probability of a child dying aged under five is five per 1,000 live births. That
is better than the US and on a par with the UK.Yet these world-class results are delivered by a shoestring annual per capita health expenditure of $260 (£130) – less than a 10th of Britain’s $3,065 and a fraction of America’s $6,543. There is no mystery about Cuba’s core strategy: prevention. From promoting exercise, hygiene and regular check-ups, the system is geared towards averting illnesses and treating them before they become advanced and
costly.”