Adventures in British Medicine
Michael C. Moynihan | November 2, 2007, 4:41pm
It's been a while since I've beat up on the NHS, and in light of Rudy's comments criticizing Britain's health care system, cribbed from this City Journal article, it's, I think, time to catch up with the wacky world of socialized British medicine. Some recent stories for your amusement:
From the BBC (10/24): "NHS trusts have a £4bn ($8 billion) backlog of key maintenance repairs which range from fixing heating to meeting fire safety rules, government figures suggest. The figure is eight times this year's much-heralded NHS surplus, which was achieved by making a variety of cuts."
From the BBC (10/25): "Poor leadership within the NHS is to blame for the problems with hospital superbugs, according to the minister in charge of reviewing health care. Lord Darzi told MPs on the Commons Health Committee that hospital deep clean programmes had already started. But he said the deaths of 90 patients in Kent from Clostridium difficile showed the need for cultural change."
From the Daily Mail (11/02): "A 75-year-old man was forced to spend his life savings on a vital hip operation after the NHS cancelled his appointments four times. Edward Crane claims he has nothing left after clearing out his bank account for the £9000 private surgery after waiting more than six months for a consultation at his local hospital."
From the Daily Mail (10/28): "Record numbers of Britons are travelling abroad for medical treatment to escape the NHS - with 70,000 patients expected to fly out this year. And by the end of the decade 200,000 "health tourists" will fly as far as Malaysa and South Africa for major surgery to avoid long waiting lists and the rising threat of superbugs, according to a new report."
From the Daily Mail (11/01): "Banning a heart treatment on the grounds that it is too expensive could end up costing both lives and money, doctors warn. The Health Service's rationing watchdog saysdrugcoated stents used to treat around 30,000 patients a year are not cost-effective and should no longer be provided."
From the BBC (11/01, supply and demand edition): "The number of NHS dentists in London is well above the national average, but only half the city's population use them, a London Assembly report shows."
Incidentally, Michael Moore's Sicko has been released in Europe and, as I predicted in my review of the film, the reaction has been less charitable than in the past. Writing in the London Times, Minette Marrin was puzzled by Moore's depiction of the NHS. A sample:
Unfortunately Sicko is a dishonest film. That is not only my opinion. It is the opinion of Professor Lord Robert Winston, the consultant and advocate of the NHS. When asked on BBC Radio 4 whether he recognised the NHS as portrayed in this film, Winston replied: "No, I didn't. Most of it was filmed at my hospital [the Hammersmith in west London], which is a very good hospital but doesn't represent what the NHS is like." I didn't recognise it either, from years of visiting NHS hospitals. Moore painted a rose-tinted vision of spotless wards, impeccable treatment, happy patients who laugh away any suggestion of waiting in casualty, and a glamorous young GP who combines his devotion to his patients with a salary of £100,000, a house worth £1m and two cars. All this, and for free.
Full review here.
Ken Shultz | November 3, 2007, 11:21am | #
I am sure that a complete free market of the kind you envisage (only those who pay get treated) would provide great care for many, but others would die untreated.
As if people didn't die because of the socialization of medicine. Never mind those who croaked because they put off care until they had to go to the emergency room, and then it was too late.
What if health insurance was more affordable--what if private health insurance customers' premiums didn't have to cover the 70% of the bill (for the overwhelming majority of the national census) that Medicare/Medicaid doesn't pay? How much would health insurance cost?
I used to work in an acute care hospital--it's a full lock-down psych ward now.
We went out of business as acute care because the demographic in that part of Los Angeles didn't have a large enough privately insured population to support a hospital. Now that emergency room is gone--all those people have one less emergency room to go to. I don't need to do a study--somebody died because of that.
Increasing the number of people who are eligible for care, if the cost of that care isn't covered, won't bring that hospital back. No one can keep a hospital afloat if it can't charge enough to cover its costs of operation. ...and that goes for government hospitals too.
King Drew is always in the news. County USC has been in trouble for years. Harbor UCLA, likewise.
Socialization has destroyed what access once was in this country. Complete socialization might turn a lack of access in the inner cities into rationing in the suburbs and relieve some of the financial pressure on having a hospital in an undeserved area, but for what reason?
...please tell me you're not advocating this to increase the accessibility of care! Making care inaccessible to all of us is not a reasonable solution to inaccessibility among the poor in the inner cities.
"If you're prepared to step over the bodies, fine - but to pretend that a free market solution is without any cost at all is insane."
All hail the hyperbole, straw man, ad hominem combo! ...five points!
Ken Shultz | November 3, 2007, 3:10pm | #
"So actually the way to lower prices is to make everyone "pay their fair share" and purchase health insurance. The libertarian in me winces, but it looks like we need government intervention to correct a market failure."
Like I said above, HillaryCare, as bad as it is, does seem to address some of the causes of the problem. ...not that it won't cause all sorts of other problems and make many things worse than they are now.
...and it isn't a "market failure"--it's government intervention that's causing this in the first place. I'm tryin' to keep it brief here, 'cause I have a weekend to start, but, again, if government intervention is the problem, doesn't the suggestion that a government takeover will make things better seem really counter-intuitive?
Other suggestions? Theoretically, they could stop forcing so many people to pay for other people's health care. ...or at least they could lessen the burden, which is why I was suggesting means testing as an interim step.
They could exempt some hospitals and plans from taking people on government programs--even if they come through the ER. I imagine something like a charter school program for hospitals--just not funded by the government.
At the very least, they shouldn't load the system up with more entitled people. If the system is having problems when government programs are only paying for 1/3 of the costs of the program, how much will it cost if they pay full price?
...and before we answer that question, let's not forget that the first social security check mailed to a baby boomer went out about a month ago.
We need to limit the number of people on the program--not make it universal.
And there's more at risk here than our libertarian sensibilities. We're talking about an enormous cost burden on our economy, a deteriorating quality of care, unquestionably we're talking about rationing, and we're talking about inefficiency in the economy. ...and that's just getting started.
VM | November 5, 2007, 1:37pm | #
"that is the society depends on extra-market intervention to maintain itself."
I actually don't understand that, either. Maintain itself? Extra-market?
It's not extra market - there certainly can be a market for charity. The consumer would donate, based on various constraints, and would gain utility. Also, how the tax structure currently is, there is a healthy market for charitable goods or services.
Trying to see where JW may be going for a second - he might be saying that the free market based society he's talking about cannot guarantee outcomes. There are going to be downtrodden. Even in highly social democracies there is a need for charity. There are people who fall through the cracks.
Do I think that FREE MARKET FREE MARKET is the answer to all the ills? No. There are times where there is market failure. There are other times where it does appear as though there are regulatory barriers thrown up to protect one interest group from the competition from up and coming entrepreneurial individuals.
Do I have an answer how to address problems of poverty?
Dunno: there are some pretty tough social ills. Some of them reinforced by the Great Society. Some reinforced by imagined "pull up yourself by the bootstraps".
There are definitely places where I do think regulation is a problem (hair dressing licenses), other times I see the start up costs or the information costs so high in poor areas that there's a barrier that cannot be overcome.
But there is market failure in the competitive market for health insurance, and that's a problem (the FREE MARKET cannot solve the problems).
I'm sorry I can't give a more definitive answer.
