Friday, August 14, 2009

£1.2bn bill for the bureaucrat army within Britain's NHS

The NHS has become a 'bureaucratic black hole' under Labour. Spending on NHS bureaucracy has almost doubled in four years, research shows. Nearly £1.2billion went on administrators and clerical staff in Primary Care Trusts in 2007/8, a rise of 81 per cent since 2003/4. The total is nearly twice as much as the £700million the Health Service spent on anti-cancer drugs last year, with some patients being denied life-prolonging medication. A further £139million was spent on management consultants - almost three times as much as the £ 53million spent five years ago.

The increase comes despite the number of PCTs halving from 303 to 152 - which was supposed to release £250million to front line services. PCTs are spending £115million a year on agency administrative and clerical staff, more than twice as much as in 2003-04. At the same time acute hospital trusts - which provide the healthcare patients receive in hospital - have cut their spending on bureaucrats by 8 per cent.

Andrew Lansley, health spokesman for the Conservatives, who obtained the figures under the Freedom of Information Act, said: 'Every penny spent on unnecessary management and paperwork is a penny less to provide better care for patients. 'These figures show just how far Labour have broken the promise they made in 1997 to spend NHS funds on patients not bureaucracy. 'The Conservatives are the only party that has set out a clear plan to root out this waste and bureaucracy and get money to the front line.'

Michael Summers, of the Patients Association, said 'Surely if these management consultants were doing the job they're paid for the bill would be going down because there's less need for them.' But health minister Ann Keen said administrative and clerical staff formed only 8 per cent of the NHS workforce of more than 1.3million. [What about all the time that doctors and nurses spend on paperwork? EVERY NHS employee is a bureaucrat, with the possible exception of the cleaners -- but there are not many of them]


I deeply resent the Americans sneering at our British health service - but perhaps that's because the truth hurts

President Barack Obama's political enemies are rounding on his controversial proposals to extend government involvement in health care. One way in which they are doing so is to hold up our own cherished NHS for ridicule. His Right-wing critics accuse the NHS of putting an 'Orwellian' financial cap on the value of life by allowing elderly people to die without treatment.

The case of a dental patient in Liverpool who supposedly had to superglue a loose crown has been mentioned as an example of the appallingly low standard of dentistry in Britain. At the wilder reaches of seemingly lunatic allegations is the suggestion that anyone over the age of 59 in Britain is ineligible for treatment for heart disease. One leading Republican has also declared that the 77-year-old Senator Edward Kennedy, who is suffering from a brain tumour, would have been allowed to die in this country on account of his relatively advanced age.

In fact, President Obama's plans fall well short of the sort of state-run health service we have in this country. He wants to ensure that the 40 or 50 million Americans - many of them black or Latino - who do not have health insurance are able to receive the same standard of care as the majority who do. Nevertheless, his proposals are characterised as 'socialist medicine', and the NHS is invoked as the living example of this abomination.

We may be sure, I think, that most of those who are cheerily dredging up British scare- stories do not really believe them. We are merely providing the ballast in a domestic American argument that is getting dirty. Let's not take offence at this wildly overstated depiction of Britain as a sort of feral, failed state with Third World standards of health care.

The question that interests me is whether there is a grain of truth hiding amid these insults. I'd say there was. I'd say that under the present system which President Obama is hoping to improve, most middle-class Americans are liable to receive better health treatment than their British counterparts. If I were a middle-income American living in Seattle or Chicago, I could almost certainly rely on superior care than if I lived in Birmingham or Newcastle.

This would probably not apply if I were poor, though there is a safety net for the sick and uninsured in the United States that is more effective than British critics commonly suppose. I accept, too, that American healthcare can be wasteful and unnecessarily extravagant. It suits vested interests to perpetuate this lavish system, which partly explains the attacks on President Obama.

Once, in America and suffering from bad earache, I visited a local doctor. In this country I would probably have been greeted with a weary smile, and, if lucky, offered an aspirin. In the United States I was cosseted by a pretty nurse, and subjected to several exhaustive tests by an accommodating doctor, one of which involved me sitting in a sound-proof booth to have my hearing tested. At the end of it all I was presented with a bill for several hundred dollars - and the verdict that I had nothing to worry about.

But whatever the failings and excesses of the American system, the statistics suggest that it delivers better outcomes than the NHS when dealing with serious illnesses. I say 'suggest' because we should always be wary of comparing figures compiled in different ways in different countries. In treating almost every cancer, America apparently does better than Britain, sometimes appreciably so. According to a study in Lancet Oncology last year, 91.9 per cent of American men with prostate cancer were still alive after five years, compared with only 51.1per cent in Britain. The same publication suggests that 90.1 per cent of women in the U.S. diagnosed with breast cancer between 2000 and 2002 survived for at least five years, as against 77.8 per cent in Britain.

So it goes on. Overall the outcome for cancer patients is better in America than in this country. So, too, it is for victims of heart attacks, though the difference is less marked.

If you are suspicious of comparative statistics, consult any American who has encountered the NHS. Often they cannot believe what has happened to them - the squalor, and looming threat of MRSA; the long waiting lists, and especially the official target that patients in 'accident and emergency' should be expected to wait for no more than four - four! - hours; the sense exuded by some medical staff that they are doing you a favour by taking down your personal details.

Most Americans, let's face it, are used to much higher standards of healthcare than we enjoy, even after the doubling of the NHS budget under New Labour. Of course, the U.S. is a somewhat richer country, but I doubt its superior health service can be mainly attributed to this advantage. Americans should beware of any proposals that might threaten their standards, though President Obama is right to want to extend them to the poor.

As for us, it is time we accepted that the NHS is not the envy of the world, if it ever was. Even though it may not deserve many of the brickbats being thrown at it by Right-wing American critics, the practice of rationing expensive cancer drugs and treatments is undoubtedly more widespread in Britain than it is in America.

The principle of equal healthcare for everyone regardless of income is a precious one. The fact is, though, that there are other, better ways to achieve this than through an increasingly inefficient, centrally planned leviathan set up over 60 years ago. In our hearts many, perhaps most, of us know this. We all have horror stories to tell about the NHS, though we are likely to have good things to say about it, and its sometimes selfless medical staff, as well.

An increasing number of us take out private health insurance, and many others would like to do so if they could only afford to, which hardly indicates unbounded confidence in the NHS.

And yet, despite its shortcomings, we are reluctant to think about changing it, and any politician who suggested doing so might as well slit his own throat. For all his admiration of the NHS as a result of the treatment it offered his severely disabled son, David Cameron is quite clever enough to recognise its deficiencies, but he will only dare talk about putting ever more money into it as it is. I doubt he will be any braver, or more imaginative, in government.

In view of the failure of President Bill Clinton's healthcare proposals more than 15 years ago, and the opposition he is now facing, the omens may not be good for Mr Obama. If he really could preserve all that is good about the present U.S. system, while making it available to everyone regardless of income, I would wish him all the luck in the world.

The President is discovering that people are apt to want to defend and preserve what they have. The same is true of we British and our lumbering health service. The difference, though, is that what the Americans have is, for the most part, better than the NHS.


Britain's NHS ‘is putting the patient last’

In Britain the health secretary matters far more than the patient, argues a new report

While British health ministers have been quick to applaud the advantages of a “national” health system to fight the swine flu outbreak, the very centralised nature of the service cuts two ways, according to a new report. Civitas, the think tank, blames the monolithic nature of the National Health Service for “putting the patient last”. It argues that the “customer” of the NHS business model introduced by Tony Blair and continued by Gordon Brown is the health secretary rather than the patient.

The report sees much in favour of attempting to introduce private provision within the state system and competition between NHS trusts to attract patients. But it says that all this has been stymied by incessant interference from the Department of Health. Health service managers say that a staggering total of 69 public bodies – excluding the Department of Health and 10 regional strategic authorities – currently regulate, inspect or demand information from NHS organisations. Questions posed by bodies such as the Care Quality Commission and the Environment Agency are frequently duplicated or irrelevant, imposing a huge unnecessary burden.

James Gubb, director of the health unit at Civitas, which has no political affiliation, said the nature of Britain’s centrally funded system inevitably meant that ministers were constantly intervening and setting targets because they saw themselves as the taxpayers’ guardian. This undermined the market mechanism. He contrasted Britain's “unique” approach with that in continental Europe, which is based on competition between insurers and between hospitals and clinics. “The continental system seems to deliver better results than the NHS and has done so for a number of years,” he said.

Recent government reforms in the Netherlands to introduce more competition between insurers showed the way ahead. “Some 20 per cent of patients switched insurers in the first year. Some insurers are burgeoning because they are so popular while others seem to have gone bust.”

The Civitas report, Putting Patients Last, concludes that the NHS has put into practice the 10 Commandments of Business Failure as drawn up by Donald Keough, past president and former CEO of Coca-Cola. Among these commandments are “assume infallibility” – the report says politicians talk of the NHS as “the envy of the world”. However its outcomes are worse than other universal health care systems and the NHS ranks low in international surveys.

Another commandment is “isolate yourself” – healthcare is conducted in separate "silos", particularly regarding communication between GPs and hospitals.

A further commandment, “be inflexible”, is met by hamstringing units with state control: staff pay is set centrally, capital expenditure is constrained, IT is a top-down programme and availability of drugs, such as expensive cancer treatments, is centrally determined.


Below is a report of a GOOD experience by the standards of what many British mothers experience

She was lucky nature did most of the work. If there had been complications ....

"Rationing" is a word justifiably wreathed with alarm in the United States. With the looming prospect of Obamacare, horror stories are pouring in from Britain and Canada about nationalized medicine: The callous administrators, the long waiting lists for routine treatments, the scandalously high death rates for ailments that are, within our borders, swiftly cured.

But rationing isn't always as extreme as it sounds, as I discovered 12 years ago when I lived in London. I had just climbed out of a black cab and entered the hospital where I was about to have our second child. I was experiencing the fierce urgency of now, and if you've ever had a baby you will know exactly how urgent and fierce "now" can be.

Very quickly, I was ushered into a grim little room with a gurney. The great thing about hospitals under nationalized systems like Britain's National Health Service is that you don't go through an absurd amount of paperwork before gaining entrance.

The lousy thing is that no one working at the hospital even remotely shares your sense of urgency, or feels the need to pretend he does. This is an unappreciated aspect of the rationing that invariably results from single-payer systems: Those who are fragrantly termed "caregivers" needn't lavish sympathy on patients who can't go anywhere else. In my grim little room, I seemed to have been forgotten by the authorities. When a nurse finally arrived, her attitude was decidedly brisk. "You look ready to go," she observed. "Right, do you have your paper supplies?"

"My what?"

The nurse was annoyed. She explained that I was supposed to have brought a supply of towels and cotton wadding. Did I not know this? I did not, I apologized, eager to appease a powerful individual who might bring me to a bed. I explained that I was used to American hospitals, which, so far as I could recall, provided paper products to their customers. I hoped it would not be too much trouble that I had failed to provide the materials needed by the National Health Service.

Privately I was shocked, though I did not say so. Having traveled in the impoverished Third World, I was used to bringing syringes and other medical supplies with me in case they weren't available. But here, in Britain?

The nurse, only faintly exasperated, led me to another, much nicer small room. I told her I didn't want an epidural, which she said was just as well since there was very little chance of getting one. Paper products were clearly not the only comforts in short supply. What followed was medically uneventful. The infant arrived, and was weighed and measured. Now, obviously, it was time for us to be wheeled to a maternity ward to recuperate for a couple of days.

But hospital personnel kept popping in to say that they were having trouble "getting a bed" for us. The room we occupied was needed by the next customer, yet there was no spot in the maternity ward for us to take. So it was that six hours after arriving at the hospital, I was in a taxi again heading home. This time I held a newborn in my arms.

I had just tasted the health care rationing that Britons live with as a matter of course. It wasn't a ghastly experience, but it also wasn't something that Americans, accustomed as we are to comfort and plenty, would regard as acceptable.


Fury over Obama healthcare plans

Barack Obama faces the biggest crisis of his presidency as seething opposition, stoked by alarmist rumours and fear of rationed healthcare, threatens to sweep away the cornerstone of his political agenda. America’s biggest group representing older people accused him yesterday of falsely claiming their support, and Democratic congressmen who were trying to sell the health Bill to constituents were drowned out by protesters.

Veteran observers said that they had not seen gatherings as big as those flocking to the town hall-style meetings in August, usually the quietest month of the year, for a generation. At a meeting on Tuesday night Claire McCaskill, a Democratic Senator, asked her constituents in Missouri: “You don’t trust me?” “No,” came back the reply in unison.

So many are packing the halls that the numbers of voters called to speak have had to be limited. The cameras have captured middle-aged mothers and the elderly scuffling with security guards. “If they don’t let us vent our frustrations out, they will have a revolution,” a woman warned at Ms McCaskill’s meeting in Hillsboro.

At a meeting in Lebanon, Pennsylvania, hosted by Arlen Specter, the Democratic senator who defected from the Republicans in April this year, more than 1,000 people turned up at a hall that could hold only 250. Mr Specter was greeted outside with posters denouncing “Obamacare” and comparing Mr Obama to President Ahmadinejad of Iran. Inside the protest was more mild-mannered, with a 59-year-old man explaining the frustrations of his generation. These are the people who have paid into the government-funded Medicare sytem all their lives and fear facing NHS-style waiting lists.

Standing face-to-face with Mr Specter, Craig Anthony Miller shouted: “You are trampling on our Constitution.” As security guards rushed towards Mr Miller, the Senator intervened. “Wait a minute,” he said. “The man has a right to leave.” Mr Miller stood his ground, however, shaking with fury. “One day, God is going to stand before you, and he’s going to judge you,” he said as he left to thunderous applause.

Worse has happened in the past two weeks as Democratic legislators have tried to sell Mr Obama’s $1 trillion (£607 billion) health Bill to their constituencies. They have seen their effigies hanged, they have been made to flee from the meeting hall and one legislator received death threats.

They have been branded variously as Communists and Nazis. Their offices have been daubed with swastikas — an act that the White House denounced as a “sign that things have gotten out of hand” — and Mr Obama acquired a Hitler moustache on one of his portraits. When legislators take the voters’ message to Congress it is unlikely to grant the Bill the swift endorsement that Mr Obama hoped for.

Judging by the polls and opinions at town-hall gatherings, most Americans do not approve of the reforms. Pensioners with Medicare, the biggest demographic group among voters in mid-term elections — believe they have nothing to benefit from the promised improvements, but everything to lose when, as Mr Obama suggests — Medicare is “rationalised”. In other words, its kitty will lose $159 million.

Members fear that they will be at the mercy of their doctors and that it will be like the NHS, as depicted by advertisements put up by political lobbies and insurers.

Some have more alarming concerns. Sarah Palin, the Republican candidate for vice-president in the election, claimed that the new regime would have power over life and death, and be able to discard disabled people. “The America I know and love is not one in which my parents or my baby with Down’s syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society’, whether they are worthy of healthcare. Such a system is downright evil,” she wrote last week.

A right-wing newspaper said that the physicist Stephen Hawking would not receive treatment in Britain because of his disability. Conservative groups have alleged that taxpayers would have to pay for abortions. Such claims are spread by chain e-mails, blogs and right-wing talk show hosts. The White House is trying to fight them with a website that links to social networking sites, but the opposition will not cede.

Mr Obama has taken it upon himself to spread the word personally. Referring to “death panels that will basically pull the plug on grandma because we’ve decided it’s too expensive to let her live any more”, Mr Obama told a crowd in New Hampshire on Tuesday that “I am not in favour of that”. He denied that patients would have to queue for care and not be allowed to choose their doctor.

The assurances have failed to cool tempers so far, with allies warning that the malaise runs deeper than the health reform. Mr Specter said: “It’s more than healthcare. I think there is a mood in America of anger with so many people unemployed, with so much bickering in Washington . . . with the fear of losing their health care. It all boils over.


The Truth About Health Insurance

Only nine states have the costly rules that Obama wants to impose nationwide

The White House is priming the defibrillator paddles to revive ObamaCare, and its new strategy is to talk about "health-insurance reform," rather than "health-care reform." The point is to make its proposals seem less radical than they are, while portraying private insurers as villains for supposedly denying coverage to the sick.

Sounds like a good time to explain a few facts about the modern insurance market. Start with the reality that nine out of 10 people under 65 are covered by their employers, most of which cover all employees and charge everyone the same rate. President Obama's horror stories are about the individual insurance market, where some 15 million people buy coverage outside of the workplace.

Mr. Obama does have a point about insurance security. If you develop an expensive condition such as cancer or heart disease, and then get fired or divorced or your employer goes out of business—then individual insurance is going to be very expensive if it's available. But what the President and Democrats won't tell you is that these problems are the result mainly of government intervention.

Because the tax code subsidizes private insurance only when it is sponsored by an employer, the individual market is relatively small and its turnover rate is very high. Most policyholders are enrolled for fewer than 24 months as they move between jobs, making it difficult for insurers to maintain large risk pools to spread costs.

Mr. Obama wants to wave away this reality with new regulations that prohibit "discrimination against the sick"—specifically, by forcing insurers to cover anyone at any time and at nearly uniform rates. But if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care. This raises the cost of insurance for everyone else, in particular those who are responsible enough to buy insurance before they need it; they end up paying even higher premiums. And the more expensive the insurance, the less likely people will buy it before they need it.

That's one reason that only five states—Maine, Massachusetts, New Jersey, New York and Vermont—have Mr. Obama's proposal for "guaranteed issue" on the books today. New Hampshire and Kentucky repealed such laws after finding that they soon had an even smaller individual insurance market as companies fled the state.

Another proposed reform known as "community rating" imposes uniform premiums regardless of health condition. This also blows up the individual insurance market, by making it far more expensive for young, healthy or low-risk consumers to join pools—if they join at all. And if the healthy don't join risk pools, then premiums go up for everyone and insurers have little choice but to reduce their risk by refusing to cover those who have a high chance of getting sick, such as people with a history of cancer. This is why 35 states today impose no limits whatsoever on how much insurers can vary premiums and six states allow wide variation among consumers.

New York, New Jersey and Massachusetts have both community rating and guaranteed issue. And, no surprise, they have the three most expensive individual insurance markets among all 50 states, with premiums roughly two to three times higher than the rest of the country. In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively. ObamaCare would impose New York-type rates nationwide.

There are better ways to go. Tax credits to individuals to buy insurance would make it more affordable and thus strengthen the individual market. Other tax rule changes could also make it easier for people to join and form their own risk pools beyond their employers, such as through business federations, labor unions or, say, the Kiwanis Club. They would no longer be hostage to one job for insurance.

University of Chicago economist John Cochrane also argues that in a more rational individual insurance market, people could insure not merely against medical expenses but also against changes in health status. This kind of insurance would cover the risk of premiums rising as you get older and your health condition changes.

In turn, that would free insurers to compete for the business of all patients, including those with pre-existing conditions, because then they could charge enough to cover the costs—instead of passing them to others. As for those with rare conditions ("orphan diseases") that require a lifetime of special care and are thus uninsurable, this is where government subsidies could be both appropriate and affordable.

ObamaCare would impose on all 50 states rules that have already proven to be failures in numerous states. Because these mandates would raise the cost of insurance, ObamaCare would then turn around and subsidize individuals to buy the insurance that the politicians made more expensive. Only in government could such irrationality be sold as "reform."


AARP wields its power in health care debate

If there is anyone or anything President Obama cannot afford to offend in his battle to overhaul the nation's health care system, it is the powerful seniors lobby, AARP.

Perhaps that is why the White House was so quick to backpedal Wednesday after Mr. Obama mistakenly claimed that the organization, with its tens of millions of politically active members, had already signed on to his plan. Mr. Obama drew a forceful rejoinder from the group, the nation's largest organization for retirees, when he said during a town-hall meeting Tuesday in New Hampshire that it was endorsing his health care reform proposal. White House press secretary Robert Gibbs acknowledged the error Wednesday but said Mr. Obama was not trying to mislead anyone.

That the AARP so forcefully knocked down the claim of support shows the group is wary of being used as a political football. Leaders on both sides of the debate are well aware that seniors have the power to help push through a health care bill or block it entirely. "We knew [the health care debate] would get to this position, that it would be very difficult, with partisan politics and ... misinformation," AARP spokesman Jim Dau said.

AARP has supported the concept of overhauling the system and has endorsed an $80 billion White House deal with pharmaceutical drug manufacturers that will save seniors money under Medicare Part D, but it has not expressed support for any of the specific pieces of legislation making their way through Congress.

"AARP's decision to put daylight between them and the president, coupled with the activity of seniors at these town-hall meetings, indicates that the supporters of health care reform haven't sold it well enough yet," said David Di Martino, a Democratic media consultant at Blue Line Strategic Communications. "Because of their depth of knowledge and participation rate in political debates, [seniors] usually have the loudest voice, figuratively, and in this case it seems literally as well."

Senior citizens, the largest consumers of health care and recipients of the Medicare government health care program, are increasingly questioning the health care reform plans on Capitol Hill. Polling shows that in general, seniors, who are also more likely to be Republican, aren't likely to support the reform plan. A CNN/Opinion Research Corp. poll released last week found that the majority of voters older than 50 oppose a health care overhaul, while voters younger than 50 support it.

More here

Some older postings

I am having trouble keeping up with the huge amount being written on the subject at the moment -- JR

Why not try ownership? : "America does not face a health-care crisis. America faces a manageable challenge: how to help a relatively small share of the population purchase health insurance. Obamacare is too big a solution chasing too small a problem - like hunting quail with a howitzer. Rather than endorse such big-government overkill, pro-freedom members of Congress should promote a simple concept: Let every American own and control an individual health-insurance policy that can be transported among jobs, self-employment, graduate school, and life's other twists and turns."

Designing the health care economy: "It's crazy for a group of mere mortals to try to design 15 percent of the U.S. economy. It's even crazier to do it by August. Yet that is what some members of Congress presume to do. They intend, as the New York Times puts it, `to reinvent the nation's health care system.' Let that sink in. A handful of people who probably never even ran a small business actually think they can reinvent the health care system."

Healthcare blinders: "For decades, outdated ideologies have hamstrung national politics. Now it's happening again: Healthcare reform threatens to derail over the burning question of whether we need another public program. This is a massive diversion. If structured correctly, a new public program could help transform the healthcare marketplace. But if it's Medicare-for-all, with fee-for-service reimbursement, it could intensify the rate of healthcare inflation and make universal coverage unsustainable. The crucial issue is not public or private. It is the incentives and performance standards built into the system. If we don't change those, we're sunk. Put simply, we must change the way we pay for care. The financial incentives in our system are backwards."

Channeling Woody Allen on health care: "For nearly two decades - and probably longer - Republicans lagged Democrats when it came to voter trust on health care. But for a variety of reasons, that deficit is easing. `People seem ready to hear our message,' Congressman Dave Camp, the senior Republican on the House Ways and Means Committee, told me this week. `They are paying closer attention because of the president's emphasis on the issue, but we've stepped up our efforts as well.' He's right. Voters normally ignore the GOP on health care because Democrats talk about the issue and Republicans don't. Yet as Mr. Camp notes, that's changing: in part because the GOP is now engaging on this issue. And it's starting to have an impact."

How much is a year of your life worth?: "All advocates of socialized medicine, including the President and his congressional accomplices, believe that government-imposed rationing is necessary to control health care costs. Having little faith in the judgment of individual patients and even less in the workings of the market, they are convinced that only the state is capable of efficiently allocating our medical resources. Very few of these people, however, have the courage of their convictions. With a few notable exceptions, they vehemently deny that they are for rationing. Indeed, as a matter of general strategy, they have done their best to exclude the `R' word from the reform debate. President Obama has gone so far as to explicitly to admonish his political allies `to avoid terms like `rationing" while promoting the Democrat health care agenda. But, make no mistake about it, rationing will be an integral component of Obamacare."

Losing control of health decisions: "Who should have the ability to make medical decisions when it comes to your care - your family doctor or a bureaucrat responsible for nothing more than looking out for the government's financial bottom line? Three states recently weighed in on that question, filing a federal suit to have final medical decision-making authority transferred from doctors to state bureaucrats. In March, Georgia, Florida and Alabama joined in an appeal of a 2008 U.S. District Court ruling that a patient's physician was better positioned - and better qualified - to make decisions about that patient's medical treatment than state bureaucrats."

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