The British Health Care Scandals in Context
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  • Andrew Allison
    • Corlyss

      Perhaps everything you say is true, Andrew, but it’s still a keystone program in a passel of unsustainable fiscal calamities that has only one choice: continuing to shovel money at them until there is no money left for the really important national functions.

      • Andrew Allison

        Well yes, that certainly appears to be the US approach. The UK and other single-payer systems however both limit the cost (to half that in the US) and deliver better outcomes. We could debate the reasons for this, but the real issue is: is healthcare a right or a privilege (it’s clearly the latter in the US)? If the former, single-payer (with all its faults) is the only affordable approach.

        • cubanbob

          You have a right to seek it. And you have a right to pay for it. You don’t have a right to compel someone else to pay for it.

          • Andrew Allison

            Sorry, but if our duly elected government decides that it’s in society’s best interest to educate children, go to war, or provide universal health, taxpayers are compelled to pay for it.

          • cubanbob

            Really? The duly elected house of representatives who has the sole constitutional authority to initiate spending bills and taxes begs to differ. Incidentally this far from settled law so the courts will have a second bite of the apple and you may not be happy with the result.

          • Andrew Allison

            Utterly irrelevant to the point I made, which was that we are, in fact, compelled to pay for things of which we may not approve.

          • cubanbob

            What’s relevant is whether the house chooses to fund it or not. The rest is commentary. Other than bonds and contractual obligations the government isn’t obligated to fund anything. Laws are neither self-funding or self-executing. And no past or present congress can bind a future congress. Boehner’s House isn’t obligated to fund Pelosi’s House legislation. And this law like any other law is subject to repeal by any future Congress.

          • Andrew Allison

            “What’s relevant is whether the house chooses to fund it or not.” Of course it is, and if that happens, we taxpayers will be compelled to provide the money. In other words, as I wrote, Congress has the power to compel us to pay for anything it so chooses.

          • cubanbob

            The house refuses to fund. You may have missed the current affairs. As for going forward the court ruled it was a tax but didn’t define what kind of a tax it is simply since the issue isn’t ripe until someone pays it. But when its paid and challenged we won’t know if the court will uphold it as a permissible tax.

          • Andrew Allison

            More irrelevancies. WTF does ACA have to do “We could debate the reasons for this, but the real issue is: is
            healthcare a right or a privilege (it’s clearly the latter in the US)?
            If the former, single-payer (with all its faults) is the only affordable
            approach.” This sub-thread is about the ridiculousness of “You don’t have a right to compel someone else to pay for it.”

        • Corlyss

          “The UK and other single-payer systems however both limit the cost (to half that in the US) and deliver better outcomes.”

          I disposed of that rejoinder sometime back: once the same governments were caught lying boldly and barefacedly about their crime statistics, the statistics they offer up in defense of far more comprehensive and electorally significant programs are compromised. These are the same governments who enthusiastically endorse bogus AGW which we all know now is based on lies, cooked books, phony data, and computer models designed to sustain the lies. You should have more health skepticism about government when they control the info about their programs.

          • Andrew Allison

            Denying it didn’t dispose of it. The facts are clear (see below)

          • Kavanna

            The UK system does not deliver better outcomes than the US. The death rates from the major killer diseases (cardiopulmonary, cancer) show that plainly. VM keeps reminding people in the US of this reality, because so much of the discussion here is shot through with denial about costs, rationing, and poor lifestyle choices.

            The Canadian system does better (single payer versus single employer), but their hospital system is more like the UK’s than ours and has similar broad, systemic failures, just not as bad.

            The interesting thing is that most countries with socialized medical systems have gone through, or had near-death experiences with, bankruptcy. Canada went through it in the early 90s, as did Scandinavia and some other places (like Germany, Holland, and Israel). Subsequently, all of them adopted mixed medical systems of public-payer plus private supplemental insurance. It’s worth considering here. It would end the obnoxious mandate that Romney and Obama made the center of their systems, as it relies on government’s clear power to tax, borrow, and spend. It leaves the choice of private insurance up to you.

            What’s happening in the UK is good, because it means the Brits are awakening from decades of “consensus” on this issue and taking note of what other countries are doing. Canada went through the same in the last 20 years. OTOH, we seem to be heading in the wrong direction.

          • Andrew Allison

            I fear that I must disagree. First, the outcome issues are not debatable — they’ve been reported in numerous objective studies. Second, public/private insurance has been a feature of all single-payer systems for a very long time (I should mention that I’m from the UK, have family there, and know whereof I speak).

    • cubanbob

      The Washington Examiner has better credibility than the New York Times. As for outcomes, that’s debatable since their metrics are different than ours.

    • BrianFrankie

      ” much better overall outcomes ”

      This is simply far off the mark. While recognising that comparison of health systems is inherently difficult because of the confounding factors, the vast majority of reputable studies have shown NHS outcomes for a vast range of specific treatments are far, far worse than in the US, or, for that matter, the rest of Europe. The NHS is responsible for thousands of annual discretionary deaths, many of which are euthanasia, if not outright murder, in all but name.

      http://metro.co.uk/2013/08/29/death-of-gillian-astbury-mid-staffordshire-nhs-foundation-trust-faces-prosecution-3942080/

      http://www.telegraph.co.uk/health/healthnews/10324570/Whistleblower-warns-elderly-left-to-suffer-because-regulator-refuses-to-act.html

      Having suffered under the NHS for four years, I can also anecdotally verify the NHS is terrible. Absolutely atrocious beyond words. It is worse than most third world systems I have visited. There is no way – none – that any rational person with eyes that are capable of seeing could conclude anything else after visiting NHS facilities.

      • Andrew Allison

        Rubbish. “Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to
        improve care coordination for the chronically ill.” From: http://www.commonwealthfund.org/Publications/Fund-Reports/2007/May/Mirror–Mirror-on-the-Wall–An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx

        • f1b0nacc1

          So let me see if I have this right: a study taht lists 5 dimensions of health care systems (quality, access, efficiency, equity, and healthy lives) suggests that the US system is inferior because it ranks poorly on those metrics. Fair enough, except that several of those metrics are in fact irrelevant to health care, notably access and equity (arguably effciency and healthy lives as well…and “quality” is rather ill-defined). One might suggest that equity and access (for instance) are desirable features for all sorts of reasons, but they are NOT indictators of the quality of a health-care system. Equity in Cuba, for instance, is excellent (as is access, for that matter), but I do believe you would have to be insane to prefer their system (even for the very poor) to ours. European systems (and lets be honest, that is what we are talking about here) offer heavily subsidised access and questionable equity (take a look at the way private hospitals vs the NHS are used in the UK for example), but because they offer it, they get a checkmark where the US does not. That doesn’t suggest greater quality, that suggests gaming the system, in this case gaming the ratings.
          As for quality, the difference in the way metrics are calculated in most European countries, and the different populations of those countries tends to grossly skew the results. France, for instance, does not provide (i.e. fund) the sort of medical interventions for difficult births and complex prenatal conditions that the US does, instead relying upon early detection and abortion to eliminate the problem. While this may be an entirely suitable approach (I do not believe it to be, but reasonable people may differ), it does mean that its infant mortality numbers are going to be very, very different compared to the US, and not because a significant difference in quality of service. In a like manner the demographic makeup of the US is very different than that of most European countries, and as a result we have a more complex set of health issues (and a generally lower overall life expectancy) than many of teh EUnicks. Of course when you disaggregate those numbers and compare apples to apples (Irish Americans to Irish, Japanese Americans to Japanese), the differences almost entirely disappear. More to the point, when you correct for income levels (i.e. middle income Americans to middle income Europeans), the US actually does better.
          My point here is that the ‘single payer gives better results’ argument is not nearly as clear-cut as we might assume, and that there is a much more searching discussion that needs to be had regarding different approaches and overall priorities. I have enjoyed your commentary in the past, and know that you are (unlike some that we have both had to suffer through on this site!) a reasonable person…perahps we can find some way to bridge this gap

          • Andrew Allison

            Pardon the (relatively) short-form response to your lengthy reply but quality, access, efficiency, equity, and healthy lives exactly describe how well a country’s health care serves its citizens. To address just one of your arguments, everybody has access to a single payer system (equity). That fact that some of those who can afford to buy something better is completely irrelevant (think Chevy vs MBZ).

            What I suggested above is not that we should have a single-payer system but that IF US society as a whole wishes to match the overall healthcare provided by (developed world) single-payer systems, it will need a single payer system.
            As a participant in the single-payer system which serves 16% of the US population (Medicare, other than to try and separate rhetoric from reality I don’t have a dog in this fight.

  • Corlyss

    Fear not! Obamabots will not be deterred by experience or overt hostility to their dream program.

    • Suzyqpie

      Once their fisher-price IT department emerges from their coma it will be great.

      • Corlyss

        Brilliant! First laff I’ve had all day!

        • Suzyqpie

          Here’s another laff, commenter on another site analogized the launch of DemocratCare to the docking of the Hindenburg.

  • paridell

    Hey, criticise the NHS all you want, but it’s a bit lazy to illustrate the story with a stock photo of an abandoned ruin. There’s nothing to say this supposed hospital is even in the UK, let alone part of the NHS.

    If a British blog were reporting on US healthcare, do you think it would be fair or credible to illustrate it with a ruin-porn picture from Detroit?

    Hint: Alastair Cooke used to complain that reporters would come to America, find a man drinking beer out a bottle still in the liquor store’s paper bag, ask him a few questions and then report what he had to say as the views of the “typical American”. This guy’s opinions were unlikely to be representative, and the vandalised wreck in your photo is for sure not representative of the NHS, however bad it can be.

    • f1b0nacc1

      You should read more British newspapers. The Guardian uses precisely this technique all the time.
      Regarding the disaster porn shot, I concur that it is overdone, but nobody seriously believes that this is representative. Having spent some time in NHS facilities, I would suggest that the real thing would be mroe than shocking enough to American audiences.

      • paridell

        How do you know I don’t read British newspapers? As a matter of fact, I do. I subscribe to one of them. And I wouldn’t be at all surprised to see a report in the Guardian (or the Independent) supported with a dodgy photo. If they were reporting on U.S. health care, most likely both the story and the photo would be dodgy. But that hardly justifies Via Meadia using the photo above to illustrate “The British Health Care Scandals in Context”, at least in my opinion.

  • paridell

    To answer my own question, a browse of Shutterstock shows that the image is from a set of pictures of the decaying Beelitz Hospital in the former East Germany. It has been abandoned since 1992.

    Surely you can do better than this!

    • Corlyss

      Oh, I beg to differ! What’s more apposite than one image of a failed socialist system than another standing proxy for another on the edge of collapse???

      • Andrew Allison

        Huh? The, outrageous, intent was clearly to imply that the image represented conditions in British hospitals. How ’bout I dig up some photos of atrocities in other countries to headline an article about the US military?

      • paridell

        I suggest a picture of Stafford Hospital would be more apposite in a story based on, you know, Stafford Hospital. There are plenty of stock photos available – a lot more than there are for Beelitz Hospital, in fact. Via Meadia must have gone out its way not to use one of them.

        In any case, I trust we have seen the last of such tricky imaging.

  • Boritz

    ***Because the system prides itself on creating equity by putting the needs of society as whole ahead of any given patient***
    Society doesn’t sustain broken bones, gallbladder attacks, and cancer. The practice of medicine can’t treat society. Once you start doing that you are playing politics, not practicing medicine. I seriously doubt anybody reading this blog wants their medical caretakers to be thinking “What is best for society?” when they are wheeled into the emergency room in pain and bleeding. And incidentally, anybody can get emergency room care insured or not.

  • Jacksonian_Libertarian

    Monopolies cannot be fixed, and Government health care monopolies are no exception. They all lack the one thing which would bring improvements in Quality, Service, and Price, the feedback of competition.

  • free_agent

    And yet, despite it all, the life expectancy in the UK is 1.6 years longer than in the US, and the infant mortality rate is about 10% less.

    I am starting to believe (and I say this as a US citizen with “good” health insurance) that there seems to be a fundamental tension between (1) affordability of the health care system as a whole, (2) treating patients well, and (3) generally high levels of health in the population. In the US, we sacrifice (1) and to some degree (3); in most European countries, they sacrifice (2) and do rather well on (1) and (3).

    I may be wrong, and Staffordshire Hospital may be closer to the norm in the UK. But essentially none of the complaints I’ve heard in the US relative to non-US systems are “a patient was denied treatment that would be statistically expected to significantly improve the length of their non-disabled life”. I’ve heard lots of complaints about denial of treatment, but none have been paired with evidence that the treatment in question was expected to work well.

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