How Government Killed the Medical Profession

[Marco]

There is no problem about improving the funding, management and delivery of the NHS. It is simple:

1. Spend about half ($4.6K) what they do in the US per capita ($9.2K) instead of the $3.7K it is now. Just think of it, a 25% increase in NHS spending (quite apart from savings below) would be all we need and that would still be only half what they spend in the USA. Since 75% of NHS spending is tied to the most basic infrastructure a 25% increase ($60billion) would have a huge impact. People might actually have a good service. All very easy.

3. Sack 90% of administrators whose time is spend entirely on moving money around within the system and trying to reduce the amount of money spent (on them trying to reduce the amount of money spent (on them trying to reduce ....

But the real problem seems to have been identified by Plato - who said that democracy would never work because the politicians would just take bribes to reduce the amount of taxes collected and the whole thing would collapse - or something like that. And the Cato institute seems a very good example.

Number 3 - Great - let's do it.

Raising the budget? Who's going to pay for it? General taxation? I doubt the great British public would be keen on that especially after Black Friday, cyber Monday and the weekend shopping in between. Plus general taxation doesn't adress the fundamental problem of the perverse incentives of a 'free good' where personal responsibility isn't a factor. Time to revisit free at the point of service? It seems acceptable enough in socialist France.

 

[Jonathan Edwards]

In the UK we don't really have insurance companies dictating everything. However there has been a big push for patients formerly treated in the hospital to now be treated in the community and this has led to an increasing use of tickbox protocols and simplistic guidelines.

In the past, I used to see a hospital consultant for T1 diabetes, then I saw a specialist nurse in a hospital. Latterly, the hospital employed an (incompetent) GP to run the hospital clinic for diabetics. These days I only see a GP practice nurse who admits that nurses aren't trained to deal with T1 diabetes and just ticks boxes to score income-related points. From a patient point of view, it seems like a progressive dumbing down.

I imagine next that all diabetics will be transferred to the GP receptionists for their annual reviews as apparently with EBM protocols, diabetes management is so easy and you don't really need any training to tick the boxes.

I would support a continental style system and believe that we should pay more tax to improve the system. However, British people are always aping the US, so we'll probably end up with a US-style health system in a few years.

Exactly my thoughts and it is interesting but saddening to hear your personal account of just how this retrograde policy is working at present. I think the good news is that in certain parts of the country the squeeze of resources has got so tight that they have realised the only solution is to put the GPs in the hospitals where they can get trained to do something properly. My prediction is that within 4 years the GP health centre system will collapse. The system is under such sever strain that it will fracture very quickly now.

 

[Jonathan Edwards]

The Netherlands is running into a big problem with private insurers (who have to offer certain services) raising premiums, reducing what they cover, and reducing choices of patients regarding which doctors and hospitals they can visit. The current health minister (Edith Schippers) seems to be very pro-business and anti-patient on many topics, and does not seem inclined to do anything about this trend. So insurance companies have been earning and stockpiling much more money than they are spending on patient care, while premiums still rise.

Basic birth control (the pill) was removed from being required by plans a couple years ago, and deductibles are increasing, which discourages preventative and pre-emergency visits. So basically costs are being permitted to shift from the insurance companies to government agencies who will be picking up the fallout from these policies.

But I guess at least you have safe health care in the Netherlands, which now in the UK we do not - it has changed out of all recognition in the last ten years. And if we spent what the Netherlands spends using a government based system with nobody creaming off profits we would have an even better system. It sounds to me a good thing if insurers are passing the buck back to government. Government based care has to be cheaper because nobody is making a profit. The US spends more than twice as much as we do and the outcomes are less good for the general population I understand.

 

[Jonathan Edwards]

Raising the budget? Who's going to pay for it? General taxation? I doubt the great British public would be keen on that especially after Black Friday, cyber Monday and the weekend shopping in between. Plus general taxation doesn't adress the fundamental problem of the perverse incentives of a 'free good' where personal responsibility isn't a factor. Time to revisit free at the point of service? It seems acceptable enough in socialist France.

The people can pay for it and create jobs and stimulate the economy. Increasing the health care budget by $60bn would sen the economy through the roof - remember the economy is how much money is being spent. Except that the government wants people to believe that the economy is just money being paid to private business. For some reason public spending doesn't count for them - oh yes the reason is that it would mean they wouldn't get elected next time - which was where Plato came in. The evidence is that the British public are very keen to spend more on healthcare in fact. Maybe we need the German system of a krankenfund or whatever its called - just be honest that we have a single central insurance system that need have nothing to do with the concept of tax.

My perception is that the issue of perverse incentives and irresponsible use is trivial. The real issue is that people like me with cancer, my wife with psychosis and everyone with ME are just not getting treated unless we scream. A friend of mine has just been admitted with osteomyelitis that has been missed by nurses and GP in primary care for weeks.People are dying outside casualty waiting in ambulances. The problem of 'worried well' (which incidentally might include PWME in many cases) is a trivial irrelevance. And there is absolutely no problem with affording a proper service. As I say, it will lift us out of economic doldrums. The economic incompetence of the present government beggars belief.

 

[Sasha]

Raising the budget? Who's going to pay for it? General taxation? I doubt the great British public would be keen on that especially after Black Friday, cyber Monday and the weekend shopping in between.

I'd be willing to pay more tax for this and I expect a lot of people would. I don't know that we can make assumptions about what people would and would not be willing to pay tax for. People hold the NHS in great regard. In the last few years there has been growing awareness of how poor the care is in "care homes" and people realise that if we want our frail elderly (including our later, frail elderly selves) to be well cared for then we need to spend more money. I think we realise that about the NHS too.

 

[Valentijn]

But I guess at least you have safe health care in the Netherlands, which now in the UK we do not - it has changed out of all recognition in the last ten years. And if we spent what the Netherlands spends using a government based system with nobody creaming off profits we would have an even better system. It sounds to me a good thing if insurers are passing the buck back to government. Government based care has to be cheaper because nobody is making a profit. The US spends more than twice as much as we do and the outcomes are less good for the general population I understand.

Yes, I think it's both a matter of funding and of policies. There should not be business and profit involved in any aspect of health care.

Even with the money spent on the Dutch system, we face the same problems as patients in the UK, at least with regards to chronic and complex illnesss. And there is an extreme reluctance for Dutch GPs to prescribe anything to anyone - the long-running joke is that most doctor visits result in a prescription of paracetamol at most, even when the problem obviously warrants more serious action. My year-long sinus infection only warranted a couple nose-spray attempts which had no impact, so I just do home remedies now (neti pot, vaporizer with anti-microbial oils), and use a ton of tissues all the time.

Hospital treatment has generally been quite good, on the other hand, especially when my fiance was discovered to have sky-high glucose and was kept for several days to stabilize him and give him the tools and information he now needs for managing adult-onset Type I Diabetes. But private clinics are allowed to set up residence in hospitals, which creates some misconceptions about the quality and oversight of them - something I discovered with the "fatigue" clinic I went to a few years ago - and which later became a fatigue & weight loss clinic, then a fatigue & pain clinic. And the biggest assholes I've ever run into were neurologists working in hospitals, so there might be a big problem with oversight of doctors, quality of treatment by doctors, and how patients are interacted with by individual doctors.

So basically good spending doesn't seem to help much when bad policies are entrenched.

ETA: The Dutch system also doesn't believe in yearly screening or preventative visits. Detection and treatment of cancer is quite abysmal, and the pressure for home births has resulted in one of the highest newborn death rates in Europe.

 

[Marco]

@Jonathan Edwards

I've no doubt that increased spending on health would have considerable economic benefits but unless we are planning to export our expertise or provide a charged service for non-UK residents then it contributes nothing to the balance of payments which is after all what determines a 'nation's wealth'.

 

[Marco]

I'd be willing to pay more tax for this and I expect a lot of people would. I don't know that we can make assumptions about what people would and would not be willing to pay tax for. People hold the NHS in great regard. In the last few years there has been growing awareness of how poor the care is in "care homes" and people realise that if we want our frail elderly (including our later, frail elderly selves) to be well cared for then we need to spend more money. I think we realise that about the NHS too.

Unfortunately electoral history suggests the opposite. While many may 'hold the NHS dear' when comes to voting they tend to vote for their own immediate economic self-interest.

 

[Sasha]

Unfortunately electoral history suggests the opposite. While many may 'hold the NHS dear' when comes to voting they tend to vote for their own immediate economic self-interest.

Can you separate out party political voting from a single policy in a party's manifesto like that?

 

[user9876]

My perception is that the issue of perverse incentives and irresponsible use is trivial. The real issue is that people like me with cancer, my wife with psychosis and everyone with ME are just not getting treated unless we scream. A friend of mine has just been admitted with osteomyelitis that has been missed by nurses and GP in primary care for weeks.People are dying outside casualty waiting in ambulances. The problem of 'worried well' (which incidentally might include PWME in many cases) is a trivial irrelevance. And there is absolutely no problem with affording a proper service. As I say, it will lift us out of economic doldrums. The economic incompetence of the present government beggars belief.

I worry that there is a problem with GPs obsessing about the 'worried well' and in doing so missing many things particularly early. I don't think this is a new thing though. I wonder how much this attitude costs with diagnoses being made late leading to more expensive treatments? Hence I'm not convinced the problem of the 'worried well' is trivial just badly stated. If the problem of the worried well is constantly pushed and talked about this will be framed in doctors minds when they first see patients and affect their decisions. One of the reasons things like checklists work well even for experts is that we naturally make decisions based on recent experience, knowledge
and what is in the forefront of our mind. A good checklist will ensure other aspects are thought about.

 

[user9876]

Unfortunately electoral history suggests the opposite. While many may 'hold the NHS dear' when comes to voting they tend to vote for their own immediate economic self-interest.

Although if you think about the policies people in the UK vote for they are not voting for their immediate economic self-interest. Look at how we keep voting for policies that redistribute wealth to the very rich.

 

[Marco]

Although if you think about the policies people in the UK vote for they are not voting for their immediate economic self-interest. Look at how we keep voting for policies that redistribute wealth to the very rich.

If you're talking about the current government then their policies (and economic instruments such as quantitative easing) have those who have lost out have been the very poor and the very rich. The 'squeezed middle' have enjoyed a small benefit from tax changes and a much more substantial one from the 5 year mortgage holiday due to artificially suppressed interest rates. The 'squeezed middle' tend to be those who vote.

Not as catchy a slogan though.

 

[user9876]

If you're talking about the current government then their policies (and economic instruments such as quantitative easing) have those who have lost out have been the very poor and the very rich. The 'squeezed middle' have enjoyed a small benefit from tax changes and a much more substantial one from the 5 year mortgage holiday due to artificially suppressed interest rates. The 'squeezed middle' tend to be those who vote.

Not as catchy a slogan though.

I was thinking of a more general economic trend where inequality is getting much greater particularly in the UK and the US.
I think without the low interest rates the recession would have been much worse. But I seem to remember figures suggesting housing costs haven't changed much and we've had relatively low interest rates for a while but the slack is taken up by an increase in house prices. I assume that's a bit of a UK problem since we keep housing supply suppressed.

 

[Marco]

I think without the low interest rates the recession would have been much worse. But I seem to remember figures suggesting housing costs haven't changed much and we've had relatively low interest rates for a while but the slack is taken up by an increase in house prices. I assume that's a bit of a UK problem since we keep housing supply suppressed.

If interest rates hadn't been suppressed then we would have all had to face up to the consequences of the massive overhang of public and personal debt. Yes it would have been painful but instead we just push the problem further down the line and meanwhile cheap money fuels spiralling house prices which encourages even more borrowing. When mortgate rates get back to the 6-7% rate typical since the mid 1990s it'll feel more than a 'cost of living crisis' and the last thing folks will vote for is higher taxes.

 

[Valentijn]

I wonder how much this attitude costs with diagnoses being made late leading to more expensive treatments?

If they wait long enough to properly diagnose and treat, the outcome can be death due to the disease or due to suicide. In that case, money is saved.

 

[JAM]

In the UK we don't really have insurance companies dictating everything. However there has been a big push for patients formerly treated in the hospital to now be treated in the community and this has led to an increasing use of tickbox protocols and simplistic guidelines.

In the past, I used to see a hospital consultant for T1 diabetes, then I saw a specialist nurse in a hospital. Latterly, the hospital employed an (incompetent) GP to run the hospital clinic for diabetics. These days I only see a GP practice nurse who admits that nurses aren't trained to deal with T1 diabetes and just ticks boxes to score income-related points. From a patient point of view, it seems like a progressive dumbing down.

I imagine next that all diabetics will be transferred to the GP receptionists for their annual reviews as apparently with EBM protocols, diabetes management is so easy and you don't really need any training to tick the boxes.

I would support a continental style system and believe that we should pay more tax to improve the system. However, British people are always aping the US, so we'll probably end up with a US-style health system in a few years.

I hope you are wrong. I still dream of a system like Denmark for healthcare, education, and law enforcement. One can dream, or move to Denmark...

 

[Cheshire]

I hope you are wrong. I still dream of a system like Denmark for healthcare, education, and law enforcement. One can dream, or move to Denmark...

where Karina Hansen lives...

There's no ideal place for us yet... nor ideal health system, altough some are obviously bad.

 

[JAM]

where Karina Hansen lives...

There's no ideal place for us yet... nor ideal health system, altough some are obviously bad.

True, but some are much better than others. I think ME care is lagging everywhere, no matter the system, which is frustrating.