Sunday, August 23, 2009

obligatory NHS post

Something worth remembering, from comments at Making Light:
Back before she became a vice-presidential candidate, Sarah Palin proclaimed a "Healthcare Decisions Day" in Alaska, when Alaskans would be encouraged to discuss end-of-life care with their physicians. Just last month Newt Gingrich wrote an editorial for the Washington Post praising "community-wide advance care planning".
They're faking it, of course. It's just another alternative truth; the post-modern politics package is what they do.

But I wondered: what is the special impact of maintaining a system that wastes about a trillion a year, compared to the cost of the same performance elsewhere? Even if there's $80bn of profit in there, surely any system or elite that was even minimally sane couldn't accept something the size of the war-swollen budget deficit going down the toilet every year.

As far as I can see, there are a couple of ideological/aesthetic effects of the healthcare system that may explain (or expalin - freudian!) it. The first one is something which I've noticed thanks to the blogosphere: Americans talk about health insurance the way drug people talk about drugs. Indeed, it's the drugs that vary. It's all about waiting for this, trying to get that, coming up with schemes to get hold of that despite not having such-and-such - a combination of dependency and fascination, on the one hand, and bitter, whining resentment on the other. The system is so complex, and its motivations so mean, that the good ol' fundamental attribution error makes it impossible to avoid imputing will and whim to it; I'm waiting for my man, indeed.

British conservatives tend not to get this bit, the degree of insecurity it provides; they imagine that you pay a bill every month and it just works. This is of course because of the NHS; if your employer stuck to the premiums, you're still covered anyway, and the private healthcare biz is limited in how far it can go in "medical loss management" because of the system's existence.

And insecurity is deeply political - whilst you're desperately trying to score the next month, what aren't you thinking about?

The second: The desperate insufficiency of negative liberty. Another thing which always comes up - sticking to some crappy job to get health insurance. This raises an interesting point. What kind of a huge X-inefficiency must that be? Further, if you believe in liberty, what kind of an infringement of it is this? One of the great achievements of the NHS is that you never need to think about it, or rather, that you can think about it in rational, public terms rather than under constant personal and private insecurity.

This is a crucial point about libertarian ideas of liberty - if, as they usually maintain, we need freedom in order to be creative, innovative, and enterprising, why does this usually get delivered in the form of making it as dangerous as possible to be any of those things? It's almost as if...there was a complete disjuncture between the top layer of ideology and the operational code that makes it all happen!

And thirdly, the flip side of being obsessed with health insurance is being obsessed with health (self, quackery, etc).

No wonder they're so keen.

Which reminds me; while the transatlantic bit of the whole palaver played out, my grandfather was waiting for the results of an NHS case conference as to whether they could carry out a procedure to place a rather special stent at the very top of his throat, in order to re-open it, without the tumour interfering with his breathing. He's over eighty, he's been ill for some time, he's already had several rounds of radiotherapy. And, of course, he's not Stephen Hawking, but an old sailor and former GEC Marconi electronics engineer, an orphan who was a communist from the Depression until he got to know Yugoslavia in 1945. The procedure is complicated; they need the respiratory specialist to be present at the same time.

They provisionally scheduled it for Friday after next.

The NHS is perhaps the definitive creation of democratic socialism in Britain...


Nick said...
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Nick said...
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Alex said...

Plus, you don't have to pay for pensiuons for the next 60 years for treatment received this year.

I've saved this from idiot troll's ill-spelled drivel, because there's a point here.

However health care is organised, if the workers in it have pensions, SOMEONE'S GOT TO PAY THEM. You can pay them in tax, or you can pay them in the price of healthcare...but guess what? you've got to pay them.

Even if they are entirely privatised, those workers have to have enough disposable income to pay for them - you've got to pay them - and eventually, they have to liquidate investments when they retire, which means someone has to buy their shares. The money has to come out of current national income at some point.

You've got to pay them; there is no pony. There will never be any pony. The payment can go through the public budget, through upfront prices, or through the sale of investments; but payment there must be. You've got to pay them. There is no pony.

Nick said...

However health care is organised, if the workers in it have pensions, SOMEONE'S GOT TO PAY THEM. You can pay them in tax, or you can pay them in the price of healthcare...but guess what? you've got to pay them.

So why leave the bill for future generations?

The pensions should be funded, and that means people have to pay the bill for the service in the year it is received.

What's being done is Enron accounting. The bill for state pensions doesn't appear on the books, and the only reason for that is that the plan is not pay it.

Even if privatised, you aren't telling the whole story either.

The money doesn't have to come out of national (British) income, it has to come out of the shares or their earnings.

So why should today's children be born, 3rd world style, into debt.


20-80K deaths a year where mistakes by the NHS contribute to those deaths. NHS's own figures.

I'm not surprised you want to hide those details. It goes to the heart of the problem. People are paying a lot of money, and a large part of the bill is still to come, for a not very good service.

That's why the Labour tactic is to attack, but not talk about the costs or the quality of the service.

Here is Burnham's speech.

Notice how he never talks about the cost, and even more pointedly never talks about the patients.

PS, If you disagree with the death figures, just sit down and think about it. Take the lower estimate, 20K. We have had one hospital that killed 200 from one cause alone, MRSA. We've had the PM say its a huge problem. Scale that across the NHS and you will see that its going to be a significant number, from just one cause alone. Now consider all the other causes and the same standards apply. It's not an outrageous

Alex said...

The only way money can come out of "the shares" is if someone buys them off you, or if someone buys whatever the company makes.

A pension is a transfer payment. In the year of payment, part of current income has to go to the codgers. There is no pony and no way around this. (Think, if you will, how many French pensioners have Vodafone and GSK shares in their funds; is it more than British ones have Alcatel or Elf?)

What is your figure for MRSA infections in the US? It's a germ that's evolved to live in an antibiotic environment. That should scare the shit out of you; nature doesn't recognise the difference between state or private. A working public health surveillance system does make a big difference; ask the Mexicans.

Nick said...

Does it matter what the rate is in the US? What matters is the avoidable, with the emphasis on avoidable, death rate in the UK. NHS quotes 20-80K per year.

On the pension front, lets say you go out and buy a car. 12K new. Might well be a reasonable deal.

However, next year, the car company gives you a ring, and say, you know that car we sold you last year. Well we didn't include our pension costs in the bill. You know owe us another 500 pounds. Is that it? Not, really, we've got to pay pensions next year too. That will be another 500 pounds plus interest, and the year after ...

Same with government. It's not 12K you pay, you've got to pay the money in the future.

Funded schemes avoid that, since your liability ends the year of the service. Funded schemes, unlike tax based schemes don't depend on one particular state.

So why the continued emphasis on national income? It's true for tax, but funded, I could buy Chineese, American, even French assets and get their nationals to work for my retirement


Alex said...

And the Chinese, Americans, and French could do that! *Are* doing that - the Chinese are accumulating foreign assets in vast quantity as we speak.

THERE IS NO PONY, and you are boring.

Nick said...
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Nick said...

Anyway, back to your original post. You've no doubt read the transcript of Hannan's comments in the US.

Just which bit of his interview are wrong?

And perhaps with Burnham and the link I've posted.

He never mentions the patients, just the instituition. Is this because he realises no institution or allowing people to go private a la Swiss (universal coverage) means the pension scheme collapses?

After all going private and taking your NHS funding with you in the current scheme would mean people going private would get their care cheaper.


Nick said...
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Anonymous said...

Tam Pain says;
Great post with 2 utterly brilliant observations in it - "Americans talk about health insurance the way drug people talk about drugs."
Exactly, totally spot on. You could expand that to say that neoconservatives talk about capitalism in the same way that addicts talk about their drugs. After all, consumer capitalism is most certainly a mind-altering drug!

The other was at the end - "The NHS is perhaps the definitive creation of democratic socialism in Britain." In fact, it is one of the fundamental institutions of democracy and egalitarianism in the UK - why else do the Tories and the City mavens hate it so?

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