American Elephants

Pay Attention to The Bitter Truths About NHS — And Our Future? by The Elephant's Child

I refer frequently to Britain’s National Health Service, which is the oldest of the “single payer” health care plans, initiated right after World War II, when Labour returned to power. When Obama’s health care advisers began talking about health care, they all expressed their admiration for NHS. In devising a health care plan, they talked a lot about how the big costs all came from old people in their final years. And they talked about things like life years and useful life, and did a lot of comparing a vigorous young person with many life years ahead — contrasting it with useless old people.

Well, I had this strange idea that that’s what the practice of medicine was all about, caring for people and their health problems throughout their lives, from every kid’s broken arm to the failing health of someone who has lived a long and valuable life. The Inuit supposedly left their old people to die out on the ice when they were no longer useful, and there have been tribes who eat their enemies as well. Are we still struggling to find an ethical way to deal with life?

Britain still has private health care for those who can afford it. The NHS provides care that is free at the point of service, and just what every liberal wants as their most cherished goal. But it doesn’t work. The incentive for the people immediately becomes to use as much as they want because it has no (visible) cost. This inevitably drives costs up sharply. The incentive for the government immediately becomes to control costs. The government who hires, fires and pays for the medical establishment, cannot do much about the people whom they urged to use all the medical care they want, but they can put a lot of pressure on the medical establishment to cut costs.

Escalating problems and the inevitable results should be obvious to the dimmest intelligence, but  politics and ideology get in the way. Not everyone believes in incentives, in spite of  overwhelming evidence that they are what moves events.

Can’t have people piling up waiting to get into the emergency room, ordered to fix that, hospitals took to holding people in ambulances so admissions would be spread out more equally. Cut costs more, and pretty soon hospitals were saving money by keeping the same sheets on the bed. When all the incentives become to cut costs, the old folks don’t get clean sheets or fresh water, and start dying of dehydration and starvation in the hospital.

ObamaCare incentives are just the same. We are just taking our first stumbling steps down the same long road to perdition. Nobody has even experienced actual ObamaCare yet. So far it’s all just the incredible fiasco of the rollout. The exposure of Obama’s lies about the law is just the surface. Everybody’s insurance is getting cancelled, if not this year — just wait until next year. Premiums are drastically higher, deductibles reach levels that almost make insurance useless. People don’t know if they are actually enrolled. They don’t know if their doctor will still be available to them, or who will be in their physician network. They don’t know if the drugs they need will be in the formulary. All is uncertainty. Much of the details of enrollment and payment have not yet been written.

A panicky HHS is just making up new ObamaCare ‘laws’ on the spot. They’re extending deadlines for making payment for coverage, requiring insurers to accept premium payments, changing due dates, ‘strongly encouraging”  insurance companies, HHS won’t release real numbers, and those numbers include those who haven’t paid anyway. Glenn Reynolds asks: “Where, exactly, do they get the authority for all these exemptions, waivers, and extensions?” Good question.

Please read this article from yesterday’s Telegraph, and do read the whole thing. This is the state to which the NHS has fallen, and it is our future if we don’t fight to stop it. See the related articles listed in the column. They are not just talking about dirty sheets, they are talking about lives lost unnecessarily.  Unnecessarily!

A Warning Voice from Across the Water: by The Elephant's Child

As the Supreme Court hears arguments about the fate of ObamaCare, it is useful to once again take a look at the country with the longest experience with socialized medicine. Britain adopted their National Health Service just after World War II.

When we read the accounts of NHS care in the British papers, we are told that they are only “scare stories.” They would never happen here, we are told. Yet, we were told, Obama’s health care advisers — Dr. Ezekiel Emanuel, Peter Orzag, Tom Daschle, and Dr, Donald Berwick — were all extravagant admirers of the National Health Service.  They talked a lot, we were told,  about the fact that the highest costs of medicine came in a person’s final years.

That’s where the ideas for the Independent Pay Advisory Board (IPAB) that Congress is trying to repeal right now, came from.  That’s where “comparative effectiveness research” came from. Obama even referred to it when confronted with a woman in one of his campaign events, who wanted to know what value ObamaCare would place on ‘zest for life’ when deciding on a procedure for an older person (in this case, her mother who needed a pacemaker at age 100 — got it— and has enjoyed 5 more years and is still going strong). Obama mumbled a little and said something about there was a time when radical expense maybe wasn’t worth it, and pain pills were more in order.

Monday, March 25, 2012, The Telegraph reports: Elderly Dying due to Despicable Age Discrimination in NHS.

A lack of treatment or insufficient treatment is contributing to 14,000 deaths a year in people over the age of 75, Macmillan Cancer Support has found, in what it called an ‘unacceptable act of discrimination’.

Deaths from cancer are reducing in most age groups but at a slower rate in those aged 74 to 84 and are increasing in people aged 85 and over, the report said.

Professor Riccardo Audisio, Consultant Surgical Oncologist at St Helens Hospital, said: “It is despicable to neglect, not to offer, not to even go near to the best treatment option only on the simple basis of the patient’s age. “This has been a horrible mistake that, particularly in the UK, we have suffered from.”

According to research published in the journal Cancer Epidemiology, there would be 14,000 fewer deaths from cancer in those aged over 75 per year if mortality rates from cancer matched those in America.

Keep in mind that this is just, we are told, a “scare story” from England, and has nothing to do with ObamaCare.

Free market medicine is based on competition, which helps to keep the costs down, and rewards excellence. Socialized medicine, which offers all things pretending to be “free,” encourages overuse, because nobody really knows what anything costs. It’s just that the taxes keep going up. And both the providers and the administrators focus becomes reducing the cost. Providers try to receive adequate recompense for their efforts; administrators make more rules to slash expenses. The incentives have changed, and excellence goes by the wayside. It’s just the way of the world.

About those “Death Panels”, Britain’s NHS Shows the Way. by The Elephant's Child

When we look to the future of ObamaCare, we necessarily look to Britain’s National Health Service (NHS). It has been in place since the end of World War II, and is the world’s oldest government-run system.  It is free at the point of service, paid for in taxes, and some say the closest thing in Britain to a religion.  Scotland, Wales and Ireland each have their own system, administered by their governments.  There is a private health system alongside NHS, and people can buy insurance for that.

Well, what more could you want?  Free at the point of service, paid for in taxes, and apparently popular. One suspects that this is as far as Democrats’ investigations went.  If you have an emergency — a heart attack, say — you get immediate attention.  If you need to see a specialist, get some tests, the wait may be as long as 18 weeks. The NHS has approximately 1.5 million employees, most of them administrators.  I should add here that I have never been to England, so I depend on what I read.

Scandals have been a constant. Hospitals that were parking patients in ambulances outside so they didn’t appear for treatment at once, so the hospital could meet guidelines for prompt service.  Illnesses caused by the hospitals, like MERSA and other strep infections have been common at one time or another. Complaints about dirty hospitals, poor or absent care, pop up with regularity. It sounds as if you are healthy and your needs are not life-threatening, free treatment is a great drawing point. If you really need help — good luck.

The latest scandal is one of elderly patients condemned to early death because hospital personnel issued Do Not resuscitate (DNR) orders without consultation with the patient or with their relatives.

The medical guidelines require DNR orders to be issued only after senior staff have discussed the matter with the patient’s family.  A form, signed by two doctors, is then placed in the patient’s notes to record the official decision.

The findings emerged in spot checks of 100 hospitals undertaken by the Care   Quality Commission (CQC), an official watchdog, earlier this year.

A charity for the elderly said the disclosures were evidence of “euthanasia   by the backdoor,” with potentially-lethal notices being placed on the files of patients simply because they were old and frail.

Although at least five hospitals were found by the CQC to be in breach of medical guidance regarding consultation with families, the watchdog declared four of the five to be “compliant” with its standards on dignity for patients, which cover broader aspects of care.

There you go, compliant with “dignity,” but don’t bother to tell the patient or his family that you’re going to bump him off.  Call it euthanasia by default.

Here’s the story of one elderly patient, father of two physicians, and their efforts to navigate the NHS.

The problem with socialized medicine is that the goal quickly becomes holding down costs, rather than patient care.  Ezekiel Emanuel, adviser on health care to Obama, was famously an admirer of NHS. The best care, he thought should go to the young who have many life years ahead of them: and not to old folks who used up too much expensive care before kicking the bucket.

That has been a frequent attitude among Democrats — They resist any effort to reform Medicare (they prefer to be portrayed as the saviors of Medicare in contrast to nasty Republicans who want to save the system) while they cut the reimbursement rates to physicians and suppliers from Medicare — currently –$500 billion.  This only means that fewer physicians will see and treat Medicare patients, as they have done with Medicaid.  They congratulate themselves on seeing that way more people are now insured, but ignore the fact that the newly insured cannot find doctors to treat them. It is so dishonest!

ObamaCare is a mess, a system guaranteed to fall apart if not repealed. The much vaunted Long-Term Care plan (CLASS) that was going to offer all Medicare patients insured long-term care has just been dumped before it ever goes into effect, as the administration has finally realized that there is simply no way they can make it work.

The population of England is around 51 million, and NHS is slowly falling apart. ObamaCare proposes to cover 33o million Americans without any understanding of what is not working in England and why.  ObamaCare was largely based on Massachusetts plan, and the population of Massachusetts is only 6.5 million, and it is not working.  Taxpayers in the rest of the country are supporting Medicaid in Massachusetts, and they have still had to put on price controls.  Lots of their doctors have departed for Texas.

The incentives are all wrong. The goal for providers becomes how to get the most out of the insurance, not how to do the best for the patient.

If you want to see how socialized medicine plays out, watch the British system. How it works if you break an arm or hav e tonsilitis is not what’s important.  It’s how the system treats the frail, the elderly and the needy. Seems to me that’s who you have a health care system for, not the young and healthy who can probably get along fine without it.

In Britain, the NHS is Starving its Patients. Are We Next? by The Elephant's Child

We frequently include stories here about Britain’s National Health Service.  Britain has had socialized medicine since just after World War II. Some call them “scare stories” and so they are. Many Britons like their National Health Service, and feel that they get good treatment.  The scare stories are compelling.  Why do we include them?  Britons hate it when we use their NHS as a bad example; and they, in turn, use their idea of American medicine as a bad example.

Much of health care is routine and minor. You can’t judge health care by the occasional broken arm or deep cut.  Most anyone can fix it. You have to judge health care by the very sick,  the elderly in failing health, the difficult diseases, and the chronic disease. The well don’t need health care. So the real customers for health care are probably in poor health.  And the question of quality becomes how do we care for those in poor health?

The goal of socialized medicine is to give good health care to the poor — those who cannot pay the usual cost of good health care.  The theory is that they will save enough money elsewhere to afford to give good care to the poor.  But are we talking about routine care for healthy poor people, or the care for poor people in poor health?

There is an assumption that “preventative care” will prevent people from getting any condition that is expensive.  This is nonsense. Diagnostic medicine is expensive.  A single blood draw may result in a whole battery of tests.  Machines like MRIs and C–T scanners cost a fortune.  A diagnosis usually begins with a symptom and the attempt to discover the cause of the symptom. Running tests on people who have no symptoms is not usually cost-effective.

What about the modern epidemic of obesity?  A few years ago, they changed the standards for what was called obesity to include more of those people who had never been called obese before.  Voilá, and “epidemic” of obesity.  The same thing happened with diabetes.  They lowered the standards sharply to include more people, and there was suddenly an “epidemic” of diabetes.  The intent was to get more people treated early, but the idea that everybody had better stop eating Big Macs or anything that tasted good was probably misguided.

The Wall Street Journal today has a postcard from the NHS. In 2007, 230 patients died of malnutrition in British hospitals, the latest year for which figures are available.  Age UK, a monitoring charity, says “the true figure may be much higher” due to under-reporting.  In 2007-2008, 148,946 Britons entered hospitals suffering from malnutrition and 157,175 left in that state, meaning that hospitals released 8,220 people worse-off nutritionally than when they entered.  In 2008-2009, that worse-off figure was up to 10,443.

The problem is not insufficient food.  It is individualized mealtime assistance.  The constant scarcities created by socialized medicine, and the constant drive to cut costs leaves nurses with more responsibilities and less time.  It is not, the Journal points out, a Labour problem or a Tory problem.  It is a single-payer health-care problem.

It is a problem of bureaucracy. Anyone who has worked in an organization of any size recognizes that the bigger the bureaucracy, the greater the problems.  Group think doesn’t work. And the more remote the bureaucrats from the actual sick person, the worse the system will be.   Examine this chart (click where noted to enlarge) and note the stubby yellowish star in the lower right-hand corner.  That represents you the sick person.  All the rest of the bubbles and squares and rectangles represent not individual people, but bureaus, who are making decisions about what treatment you get and whether their decisions will allow you to live or die. Not you.  Not your doctor.  Hundreds and hundreds of faceless bureaucrats.

Democrats are facing a nationwide backlash.  Democratic congressional candidates have a new message for voters.  We know you don’t like ObamaCare, so we will fix it.  Do not believe them. Endless tinkering does not fix anything.  It is a single-payer health-care problem.  It does not work. The inevitable result is the NHS — which is what the ObamaCare people want.  They have said so.

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