American Elephants


Elderly People Are Too Expensive? Try the “Care Pathway.” by The Elephant's Child

Do you remember when Sarah Palin was  thought to be an idiot for claiming that Obama Care was considering ” Death Panels?”

Obama’s advisors on health care, Peter Orzag, Ezekiel Emmanuel, Donald Berwick and Tom Daschle were outspoken admirers of the British National Health Service. The chief concern of Obama’s advisors was the huge expense run up by the elderly in their final years.They talked about denying expensive operations or treatments when the patients had little ‘worthwhile’ time left. Something to be determined by the bureaucracy.

In Britain, the Liverpool Care Pathway, developed at the Royal Liverpool Hospital in the 1990s, withholds fluids and drugs in a patient’s final days— a treatment that is used with 29 percent of hospital patients at the end of their lives. The practice is backed by the Department of Health.

Doctors warned that not all doctors are acquiring the correct consent from patients and are failing to ask about what they wanted while they were still able to decide. Doctors here are now required to ask if you have signed a Living Will or Advanced Care Directive. Doctors also say there has been an increase in patients carrying a card stating that they do not want this “pathway” treatment in the last years of their lives.

A retired geriatrician and former vice-chairman of the Medical Ethics Alliance, told the Daily Mail that “If you are cynical about it, as I am, you can see it as a cost-cutting measure, if you don’t want your beds filled with old people.”

There have been frequent articles in the British papers about NHS care of the elderly, with beds unchanged, drinking water not available, and of relatives having to ring in clean sheets from home.

In the free market, doctors and hospitals are focused on patient care, and on improving their skills and treatments. In a socialized system, where the system must support not only the doctors and clinics, but a vast bureaucracy to administer and control everything, the focus becomes getting paid and reducing costs.

For a certified idiot, Sarah Palin has an uncanny ability to be correct.



The Object is Not Health, Nor is it Care. The Object is Control. by The Elephant's Child

The aim of the Left for many years has been a socialized health care system like that of Great Britain.  That is what the 2,700 page Senate bill proposes. Their ideal is control.  Simple and straightforward.  They assume that what they are doing is good, because they envision it as giving good health care to the poor.

Uninterested in evidence, uninterested in details, and uninterested in thinking through each mandate they have stuck in, they simply have no understanding of what the bill they so passionately demand to pass will do.  Nancy Pelosi exemplifies this when she announces that their health care bill is a jobs bill.  She claims it will create 400,000 jobs. This may come as a complete surprise to members of Congress, but government jobs are a drain on society.  The fewer there are, the better.

The problem with our current health care system is cost.  We have the world’s best health care, but costs are increasing across the board, and particularly in entitlements — Medicare, Medicaid and Social Security.  The first baby boomers reach age 65 this year.  The numbers increase through the peak year of 2024, when they begin to taper off.

If Democrats get their way,America will adopt a system much like the one that is killing patients in Great Britain.  The U.K.’s health care has been held up as a model by the Left for years.  What they have planned for U.S. health care is not a copy of the British system, but a nationalized plan will soon collapse like other socialist programs.  Government-run health care is unsustainable and deadly.

In Britain the Mid-Stratfordshire National Health Service Trust was the focus of a recent independent inquiry.  According to media reports , the review found that at least 400 and as many as 1,200 patients died because of poor care.

The source of these dreadful problems are hospital managers — bureaucrats — who, according to a  Times of London report, “stopped providing safe care because they were preoccupied with government targets and cutting costs.”

The 455-page report is packed with examples that should be the shame of the British health care system. It documents patient deaths due to what appear to be cases of neglect and misdiagnosis. There are records of patients falling, developing infections, left sitting on toilets and not properly fed.

Author Robert Francis says he heard “many accounts of bad care, denials of dignity and unnecessary suffering” from witnesses during his review.

The inquiry also noted “serious departures from the standard of basic care which every patient is entitled to expect” — abuses of elderly patients, a culture of bullying, low staff morale and concerns about the “attitude of staff to patients” as well as to visitors.

Even staff members “lived in an atmosphere of fear,” in part due to “the managerial styles of some senior managers.”

Judging by the report, the hospital resembled a landfill or sewage treatment plant as much as it did a house of healing. Patients went unwashed, as did their bedding, which was “soiled with urine and feces for considerable periods of time.” There were “cases of patients who had soiled themselves who were dependent on their relatives to clean them.”

If you won’t do the things that evidence shows actually do reduce costs, like tort reform, eliminating fraud and waste, putting consumers in charge of managing their own health care; then you are stuck with consistently adding more rules and mandates in the attempt to bring costs down. That’s where the rules come from that killed so many British people.



Is There a “Right” to Health Care? by The Elephant's Child
August 3, 2009, 10:18 pm
Filed under: Capitalism, Health Care, United Kingdom | Tags: , , ,

British author and physician Theodore Dalrymple had a brief and excellent essay in the Wall Street Journal asking “Is There a ‘Right’ to Health Care?” It is an interesting question at this particular time.

There are constant arguments for newly invented  rights coming from the left.  Franklin Delano Roosevelt, in his State of the Union Message to Congress on January 11, 1944, said that the rights guaranteed to us by the Declaration and the Constitution were no longer enough.  He went on to propose a  “Second Bill of Rights” based on “Security and Prosperity.”

The right to a useful and remunerative job in the industries or shops or farms or mines of the Nation; to earn enough to provide adequate food and clothing and recreation; of every farmer to raise and sell his products at a return which will give him and his family a decent living; of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad; of every family to a decent home; to adequate medical care and the opportunity to achieve and enjoy good health; to adequate protection from the economic fears of old age, sickness, accident, and unemployment; to a good education.

Mark Levin, from whose splendid Liberty and Tyranny I extracted this excerpt, says “This is Tyranny’s disguise.  These are not rights.  They are the Statist’s false promises of utopianism, which the Statist uses to justify all trespasses on the individual’s private property.  Liberty and private property go hand in hand.  By dominating one the Statist dominates both, for if the individual cannot keep or dispose of the value he creates by his own intellectual and/or physical labor, he exists to serve the state.  The ‘Second Bill of Rights’ and its legal and policy progeny require the individual to surrender control of his fate to the government.”

Hollywood dreams up its fantasies of world’s end with wrecked and vacant cities and perhaps inures us to the very real things that happen in this world of ours.  If we do not understand history we neither appreciate what we have,  nor grasp the possibilities of what could be.

If you do not look at the stories and pictures coming out of Iran and understand what it is like to live under tyranny, you are missing the point that is so clearly made.  Venezuela, under Caesar Chavez, is eliminating the right to free speech. Cuba, we are told,  has splendid health care, but it is only for cash-paying tourists.  Ordinary Cubans get dirty rooms and abysmal care. Tyranny doesn’t come lumbering in loudly announcing itself,  it creeps in gradually offering goodies if you will just allow those who are wiser and more important to control your life.

In Britain, Mr. Dalrymple says, the recognition of a “right” to health care has led to substandard care.

If there is a right to health care, someone has the duty to provide it.  Inevitably, that “someone” is the government.  Concrete benefits in pursuance of abstract rights, however, can be provided by the government only by constant coercion.

People sometimes argue in favor of a universal human right to health care by saying that health care is different from all other human goods or products.  It is supposedly an important precondition of life itself.  This is wrong:  There are several other, much more important preconditions of human existence, such as food, shelter, and clothing.

Everyone agrees that hunger is a bad thing (as is overeating),. but few suppose there is a right to a healthy, balanced diet, or that if there was, the federal government would be the best at providing and distributing it to each and every American.

Where does the right to health care come from?  Did it exist in, say, 250 B.C., or in A.D. 1750? If it did, how was it that our ancestors, who were no less intelligent than we, failed completely to notice it?

If, on the other hand, the right to health care did not exist in those benighted days, how did it come into existence, and how did we come to recognize it once it did?

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination.  Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?”

When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence.  He cannot think of one.

The rest of the essay is to be found here.  As a physician, Mr Dalrymple has long practiced in Britain, and his reflections on the British Health Care system (NHS) are worth a great deal of thought.



Check Into the Hospital, But Take Your Cleaning Supplies With You. by The Elephant's Child

Britain’s Daily Mail has a story about a hospital patient who was so shocked at the dirty ward around her, that she climbed out of bed, dragging her ‘drip trolley’ behind her, gathered up the antibacterial fluid dispenser and some hand towels from the bathroom and started cleaning.

She said it took her about an hour because she could hardly move her neck from the abscess on her neck that put her in the hospital.

A Colchester Hospital University NHS spokesman said: “In the annual health check ratings for 2007-2008 we scored maximum marks for safety and cleanliness and we have also been praised for our very low levels of infections such as C. difficile and MRSA.

Oddly enough, last night we were watching some reruns of the British comedy series “Yes, Minister,” which if you have never seen it, is based on the worst effects of bureaucracy.  It’s beginning to seem not as funny as it once did.  The idea that “it can’t happen here” no longer seems so remote.

Just another little story in the long, long list of stories about the wonders of socialized medicine.




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