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Samizdata quote of the day The only serious black mark against the NHS was its poor record on keeping people alive
– Denis Campbell and Nicholas Watt.
This was written in all seriousness in a Guardian article praising the NHS. Seriously. Not joking. You could not make this up.
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Yup, there it is in the sixth paragraph–“The only serious black mark against the NHS was its poor record on keeping people alive.” Shoot, anybody can nitpick.
I must confess that I have no choice but to admire the sort of nitpicking that picks only the big bull nits, the ones that charge when they’re wounded. That’s manly, that is.
I was going to say that this is the best, most succinct example of ‘cognitive dissonance’ I have ever read but that isn’t quite accurate. That term refers to the mental stress caused by believing two contradictory beliefs equally.
I doubt the writer has any stress about that statement which makes it merely stupid !!
I think Jerry nails it. The purpose of the NHS is political, not medical. In the UK, in our Coronation of the State as our Bountiful Lord, it is the Crown, the dole is the Orb and State Education is the sceptic sceptre.
Those who question the State threaten to leave you without medical treatment, leading to a horrible death, or starve or be illiterate. Yet a Slaughterhouse like the Mid-Staffs can kill on a scale that an early 1940s German bureaucrat might admire, and nothing happens until hospital the pile of corpses becomes too obvious for excuses not to be shuffled out.
Yes – it was a front page story in the “Guardian” about how “experts” (i.e. collectivist scumbags – like Plato’s “Guardians”) thought the British the best “healthcare system” in the world (although if these “experts” were seriously ill themselves I suspect they would run away from this “envy of the world”).
When people start to talk of a “healthcare system” it shows they have no knowledge of basic economics (in healthcare or anything else).
For example there should be no “American healthcare system”.
Local government should not get to decide whether there is a “need” for another hospital – anyone should be allowed to set up as many hospitals (of any type) as they want to.
Nor should State governments “license” doctors and nurses (Milton Friedman exposed that as a guild scam 60 years ago – it is nothing to do with “protecting the patients”).
Nor should the Federal government get to license medical drugs – that has cost tens of thousands of human lives with years of delays and increased costs (all in the name of “protecting” people – as if the media and consumer groups would not be only too happy to expose dangerous or fraudulent medical drugs).
Nor should the local, State and Federal governments regulate (i.e. massively increase the costs) insurance and mutual aid (commercial or non commercial).
As for subsidising health care (via Medicare and Medicaid and SCHIP – and now Obamacare) and then being astonished when healthcare costs EXPLODE (as they have done since this was started in 1965).
David Ricardo showed how subsidies explode costs – and the principle applies just as much to healthcare as it does to government backed student “loans” and their effect on exploding the cost of university tuition.
“But Paul you have not discussed Britain”.
The majority of British people seem think that entrusting their health to the government (the same organisation that can not even issue passports on time) is a good idea.
So there is no point in talking about Britain.
This is also true of many other aspects of life in Britain.
P.E. Moore (the friend of Irving Babbitt and mentor of T.S. Eliot) visited Britain in the 1930s.
At first he was charmed – Britain was so much more peaceful than the intense ideological conflict (at that time between New Dealers and Liberty League types)in the United States.
But then P.E. Moore worked out WHY Britain was so much more peaceful (why there was so much less real ideological hatred – with politicians of different political parties going for drinks together and so on….).
It was because the pro freedom side was more-or-less DEAD in Britain – with leading “Liberals” and “Conservatives” having much the same “the state should take care of the people” attitude as the Labour Party.
Beware “consensus”, beware “working together for the good of the people” – beware all the things that RINO (Republican In Name Only) types teach are good.
They are not good – they are terrible.
When all political factions agree that the state is there to “help the people” (“look after them” and so on) then freedom is a dead duck.
The same study also castigated healthcare provision in the US as the worst globally.
Most expensive globally? Quite possibly. Unnecessarily bureaucratic, and filled with medieval guilds and rentseekers? Yes, but hardly alone on that score. But objectively the *worst globally*? Some people need to get out more.
The obvious point is that this survey and article was purely political, and barely actually about healthcare.
From para. 2:-
“The same study also castigated healthcare provision in the US as the worst globally.”
Er… what? Seriously? Worse than Cuba’s, is it?
Dig a bit deeper and you find that the report only compares 11 highly developed and wealthy countries, all in Western Europe, Scandinavia, North America and Oceania. You can find the summary here, or the full thing here.
I haven’t had the time to go through it all, but there seem to be a lot of holes to pick. For instance, the US has a high rate of patients not receiving the recommended follow up test or treatment on grounds of cost, while the UK has a low one. Nowhere does it address whether the recommended tests or treatments are the same in both cases though, so the measure doesn’t tell us a lot. Once you recognise doctors in the NHS can’t offer certain drugs and procedures due to NICE not approving them due to their cost, it becomes totally meaningless, yet it’s presented as a high scoring measure for the NHS and a black mark against the US system.
Similarly, in the UK it is apparently very easy for a doctor to print out a list of patients by diagnosis, while in the US it’s harder. This is supposed to reflect badly on the US system, but frankly I don’t think I *want* to show up in a list derived from a simple SELECT query in that way. Especially when the diagnosis is one relating to the patient’s mental health, that’s the sort of list that can be used to stigmatise whole groups. It fails the Jews In The Attic test.
The Commonwealth Fund’s purpose in publishing this report was plainly to attack the pre-ACA American health system and to tout the supposed benefits of Obamacare. You can tell that from their home page, which links to an infographic detailing the rising costs of health insurance premiums prior to the ACA. However, what they don’t show is how premiums have risen after the ACA came into force. If the anecdotal evidence I’ve read is to be believed, those rises dwarf anything that occurred beforehand.
To be fair, it wasn’t dead last, possibly not the best phrase to use, the U.S. came 11th so the apparatchiks of the NHS can still hold their heads up. On the other hand that nice Mr. Hunt, Health Secretary, does have this to say, “NHS staff work incredibly hard to care for patients and these encouraging results pay testament to that.” Unless of course you’re dying of dehydration in Mid-Staffs or have an illness that requires “timely and effective healthcare” to ensure you don’t pop your clogs.
As others have pointed out, the suspicion of a political motive is strong when the UK healthcare system is ranked at the top and the US system at the bottom.
There is more for the conspiratorially minded (which includes me in this context): why is Canada second from the bottom? could it be because that is the healthcare system that Americans are most familiar with (apart from their own), and therefore it won’t do to proclaim that it is awesome?
And why is the Swiss system second from the top? could it be because most Americans won’t know that, within Europe, it is possibly the most market-oriented? (Please correct me if i am wrong about this.)
Jerry: that statement does not generate mental stress/cognitive dissonance for the writer, because it is meant to resolve cognitive dissonance: the dissonance between the (wishful) belief that government-funded health care is good, and the (fact based) belief that the NHS has a “poor record on keeping people alive.” The writer resolves the dissonance by saying that keeping people alive is a minor detail.
It is correct to say, however, that, in normal people, cognitive dissonance would not be resolved by such a preposterous claim.
The “worst globally” out if a list off eleven countries? Bless them, the Guardian now has it’s own “World Series” everyone else can sneer at.
As they say, ‘We are the world’.
RogerC, what a lot of people forget is that while the US spends per-capita more on healthcare than most other countries in the world, they are happy to parasitically feed off the innovation that is driven and funded by that high spending. Canadians are more that happy to sneer at the latest boondoggle south of the border (usually some poor bloke handed a $15,000 bill for some xrays and a cast) and say “that wouldn’t happen here” but we’re very eager to have access to the drugs and procedures developed by corporate and university research labs in the USA. Over 80% of pharmaceutical innovation is US-based and the number is similar number for procedure and technical innovation as well.
However, hat tip to the University of East Anglia for some promising work on antibiotic resistant gram-negative bacteria
As is usual for ratings of this kind, even if the org doing the rating is not lying outright, the claims must be carefully examined. It is easy for systemic errors to creep in.
For instance, in any system with long wait times just to see a physician or a specialist, some of the sickest patients will die before being diagnosed so any stat that measures outcomes of treatment for a given diagnosis will be skewed to the benefit of that service, the “death by queue” effect I like to call it. Also, if a national service is being deliberately sneaky, it may report outcomes just for those patients who receive treatment without mentioning that a rationing board denies treatment for those deemed not worth trying to treat, disproportionately those who are the sickest and oldest. The U.S. then looks particularly bad by comparison because part of the “inefficiency” of healthcare delivery in the U.S. is the cost of treatment provided to patients who have a lower chance of responding well to treatment. One gets what one pays for.
Then, of course, there are demographic considerations. How many “deaths among infants and patients who would have survived had they received timely and effective healthcare” in the U.S. are the result of not receiving timely care because the patient’s condition became critical while they were residing in their home country in Latin America before sneaking into the U.S. in a desperate last-minute attempt to stay alive?
“The patient died, but otherwise the operation was a success”.
There is a lot wrong with the NHS, (and even more wrong with ‘The Guardian’) but on the whole I do prefer a system where the first question a doctor askes is, “What’s wrong with you?” And not, “What’s your insurance like?”
Fruitbat44, I’d prefer to be asked those question tomorrow rather than after a two week wait to see my GP, who will then put me in a queue to see a specialist eventually.
I’m strongly tempted to get some T-shirts printed up.
There is a lot wrong with the NHS, (and even more wrong with ‘The Guardian’) but on the whole I do prefer a system where the first question a doctor askes is, “What’s wrong with you?” And not, “What’s your insurance like?”
I, as a UK resident, suffered sharp chest pains within hours of arriving in the USA while on holiday five years ago. I was taken to the local hospital in the Philadelphia suburbs to be checked out. I was very interested that no questions were asked about money or insurance before they started doing tests.
My experience may be limited, but in that limited experience, the first question the doctor asked was “What’s wrong with you?”
On the use of the word “system”, I would strongly agree with what Paul Marks said at 7:41 a.m.
A system where the doctor implicitly starts with a “don’t worry about the costs, the police and law courts will ensure other meet it” isn’t a system to rejoice in.
John, maybe they could tell from your accent that you are British, and they could bill the NHS?
And I very much doubt that Cuba has a wonderful health system. I think that they are not living to a ripe old age- the place is so boring (everything outlawed) that 1 year seems like 10! They probably think they’re reaching 100, at 50.
But in reality, the NHS doctor may be thinking ‘Is this a Do Not Resuscitate case yet?’ or ‘Have I met my target yet?’ before handing you over to a dirty hospital where you might die of thirst.
Then there’s a doctor asking “How much can I make off this patient before his insurance company starts yelling?” versus “How much can I spend on this patient before he starts costing the NHS too much money?” Which would you prefer?
Incidently, if an NHS professional, a doctor or nurse or administrator, ever ticks you off for ‘costing the marvelous NHS too much money” for having an expensive illness or using expensive medicine, feel free to point out that you are ‘a taxpayer’ paying into the system and they are the cost to the NHS with their salary, pension holidays and the rest.