If Uncle Sam Were Your Doctor
See how well socialized medicine works in the U.K.! I got permission to post this incredible true story of an American going through the horror that is the British National Health Service. He's Don Miller, a 31-year-old American studying for a Ph.D. in ancient history at the University of Newcastle in the northeast of England. He'd sent the e-mail about his experience to friends. One of them forwarded it to me. Here it is:
"I had the dirtbike accident at 5:30 pm on a Saturday evening. Verity called the NHS (National Health Service - you knew that though) to ask for an ambulance. I knew I had broken something but at the time I thought that I had broken my ankle and foot were all wonky. The NHS said that they only sent out ambulances if it was life threatening. I was in the middle of a field so it took 45 minutes for Verity to figure out how to get a car to me. We drove to the nearest hospital (the shittiest one in the Newcastle area of course). I sat in the car while Verity went into the Emergency room to get a wheelchair. I waited 10 minutes before she got back. The hospital staff wouldn't help her find a wheelchair when she asked for one and told her that she'd have to look around for one. They also told her that wheelchairs were in short supply so she might have a hard time finding one. The wheelchair she brought out was a donated one and had rust stains on it. It didn't have leg or foot rests so I had to hold my foot up. The seat cushion had fluff and stuffing coming out of it. Verity wheeled me into the reception and the lady behind the desk took my info. Then she told me that I would have to wait to see a triage nurse. I waited for 45 minutes with no pain medicine or ice. While I was waiting there was this guy and his girlfriend waiting in the waiting room too. The guy had obviously had the shit beat out of him and his face was covered in blood. The nurse had given him some Kleenex to clean up the blood and a tray to put the Kleenex in. After about 20 minutes the guy got tired of waiting for the doctor and got up and left, leaving his bloody Kleenex behind on a chair in the waiting room. Those nasty bloody Kleenex were still sitting on that chair 5 hours later when I came back to the waiting room. Can you believe that? If he had HIV or something else anyone with an open cut could have caught it. Someone during this time also spilled a coke on the floor and the coke spill was still there 5 hours later too. No one had cleaned it or put up a sign to warn people about it.When I saw the triage nurse (who was about 19 and completely clueless) she looked at my foot, gave me some paracetemol (same thing as Tylenol), and told me that I would have to wait to see a doctor and that the wait was about 3 hours. She didn't give me any ice to put on my foot which was really swollen or any painkillers. I was so pissed off that I asked Verity where the nearest private hospital was. I had her push me outside so that I could call my mom for advice on what to do. While I was talking to my mom outside a car pulled up next to me and Verity. A 40ish year old woman and an early 20's guy got out. The guy was drunk or high. He came over to the hospital wall about 5 feet from us and started urinating on the wall. That's right. He peed on the wall directly in front of the hospital right next to me!
I decided to wait for the doctor because of the time it would take to drive to the nearest private hospital (an hour). I had to sit in the lobby and tried to keep my foot off the dirty nasty floor. I waited 3 hours to see the doctor. While I was waiting a police van pulled up outside and two cops brought in a drunk man who looked like he had been beaten up. While he was sitting in a chair nearby waiting to see a doctor he peed his pants and pee went all over the chair and on the floor. When he got up to go see the doctor another woman came over and sat in his chair not knowing that he had peed in it, so she sat in his pee. No sign was put up. No one came out to clean it up.
It was about 10:30 pm when I got to see the doctor. I have to give her credit. She was really nice. She apologized to me for having to wait and looked like she was really pissed off with the hospital (as if she knew it was gross and disgusting but she didn't have the power to change it). She said that the triage nurse should have immediately given me ice and painkillers and should have sent me to see a doctor right away instead of making me wait. She sent me off for x-rays and then I had to go wait in a room for an orthopaedic surgeon. I waited there until midnight. He said that I would have to spend the night because my foot was really swollen and they needed to get the swelling down before they could put it in a cast. I didn't get into a hospital bed until 1:30 am. The guy who came to take me to the hospital bed brought a wheelchair with him, a nice one. He looked at the rusted one in disgust and asked me if I had brought it from home myself.
I told him that I had gotten it from the hospital and he said "That's a right piece of shit, that is." I didn't get a private room or a double room. They put me in a ward with 5 other people. I had to ask the nurse to bring me ice because she "forgot" that she was supposed to put ice on my foot.
I stayed in the hospital until 5:30 pm the next day. They wanted me to spend another night there, but I told them I was going home. The crutches they gave me were wooden and looked like they were made out of matches. They were so crappily built that I had to go to a medical supply store the next day and buy some metal elbow crutches.
That was my hospital ordeal. I didn't make any of it up. I didn't exaggerate one bit. With socialized medicine they can only afford to give you the absolute minimum. Since the government has a monopoly on healthcare they can treat you however they want because you can't really go anywhere else. Private hospitals are rare and there aren't many. I told Monte about what I saw and what happened (because he's a nurse anesthetist) and asked him what would have happened if I had broken my foot and gone to a hospital in the US. He said that they would have put me on a morphine IV as soon as I came in and that I would have seen a doctor almost immediately. He said that if his hospital had been that dirty and treated me that way, they would be shut down.
No socialized medicine! It's bad. Socialized medicine sounds good in theory because people think they will still get the same excellent service and healthcare they do now (talking about the US here), but no socialized healthcare system can support itself giving that kind of treatment. Standards will go down and instead of quality, you'll get quantity, as in how many people can we treat for the least amount of money.
At first the whole hospital ordeal pissed me off, but after everything just kept getting worse I just had to laugh because it was funny that things were so bad. At least I kept my sense of humor!"
Don the Survivor
Y'know there is a reason we pay for health care, because it is in high demand and the good stuff is in short supply. People who think socialized health care is a good idea need to take another economics class.
I wish I didn't feel like my options in terms of the next presidential candidate were basically a choice between endless war and continued religious craziness (plus no more abortion) or no more decent health care for anyone and higher taxes. I'm being melodramatic but the thought of having to wait that long with a broken foot made me whiney.
Shinobi at June 15, 2007 6:24 AM
I believe Cathy Seipp lived as long as she did for two reasons: 1. She was Cathy Seipp. 2. She had Blue Cross and excellent care from her doctors and Cedars Sinai.
Amy Alkon at June 15, 2007 6:29 AM
His experience sounds like any public hospital in the US. My brother waited on a gurney in a hallway at King in LA for 36 hours, after he fell off a roof; at least they doped him up. And yes, private medicine, good, socialized bad... and why didn't he want to drive the hour to the other hospital?
Sorry, but I hated his babyish tone. Wow, some drunk peed on a wall - incredible! And "Don the Survivor..." pfft.
nancy at June 15, 2007 6:51 AM
Love that line:
"people think they will still get the same excellent service and healthcare they do now (talking about the US here)"
Hello? Like the woman who died on the floor of the ER lobby in L.A. the other day... Excellent service indeed.
Having experienced years of socialized health care in France and years of Kaiser and Blue Cross here, I find that the French system is well worth the price. The messy U.S. system (including the unbelievable mountain of paperwork that goes with it, the phone calls, the frustration, doctors offices that feel like factories) is a cause for bad health in itself, inducing stress, high-blood pressure, sleepless nights... and this is when you're lucky enough to have health insurance. Experience both system for a long period of time and see for yourself.
Emmanuelle at June 15, 2007 7:45 AM
I agree with Nancy. The guy was riding at his own risk, and "suffered" the consequences.
Don't forget that the NHS has been administered by since Thatcher by people who want to starve it to death and make it go away.
John O at June 15, 2007 7:51 AM
Something similar has happened in the U.S., and happens all the time. Haven't we been through this already? Let's skip this round of Dueling Anecdotes, okay?
Lena at June 15, 2007 7:57 AM
I have Kaiser, and while it's an HMO, it's not the same as health care by the government.
Amy Alkon at June 15, 2007 8:08 AM
Here it very much depends on the hospital. Emergency rooms can be awful. I have a good friend who had her miscarriage in the filthy bathroom of Potomac Hospital in Virginia after being in the ER for 4 hours with no treatment whatsoever. I've sat and waited with profusely bleeding or dangerously sick friends in various hospitals while hours go by. And what about the hospital in California, where a woman died on the floor, as other patients called 911 *from the ER* because no one would see her. The story is appalling.
There are severe flaws in our health care as well. I'm not touting socialized health care at all, far from it, but there are so many instances where ours is a far cry from even acceptable. Especially when it comes to emergency rooms.
Allison at June 15, 2007 8:22 AM
I've gotta say that Mr. Miller's experience doesn't sound any different from the experience he would have had (and I have had) at any hospital in any big city in the United States. Especially if he didn't have insurance. I'm not at all sure what this story is supposed to prove.
Larry at June 15, 2007 8:51 AM
People keep saying that the same thing happens in large hospitals here in the US, and I think it's true that awful things happen especially the lady who died in the ER. However, the standard of care that we receive here in the US is much higher. What he is writing about is the standard of care under a socialized system. I have had to wait in the ER before which is annoying, but never have I ever seen anything like this. And this town(Newcastle) isn't a huge city. There are problems with huge city hospitals here. But on a whole, there are way more positive stories than there are stories like this. This is the exception, not the rule in the US. Whereas in the UK this is the rule. I for one don't want to lower the standard of care for everyone and that's why I'm against socialized health care.
As for saying he deserves this kind of crappy care because he was taking risks by riding a dirt bike, I think that is totally absurd. What about the overweight person with diabetes... do they deserve crappy care for over-eating? Does the former smoker with lung cancer deserve crappy care? We all take risks. Walking down the street is a risk. It doesn't mean that you don't deserve good medical care when something happens.
Starfox5253 at June 15, 2007 9:42 AM
Indeed. The notion that he deserves crappy care because he was dirtbiking is ludicrous. And as for the claims that medical care can be crappy here, I don't think people in the U.S. are told to get their own ass to the hospital unless they're having a heart attack.
Amy Alkon at June 15, 2007 9:50 AM
I need to comment on a few pieces of information above.
Yes, there are shitty hospitals in the U.S. But guess what - there are lots of great ones, too. Those shittier hospitals are shitty because there isn't much money going into them. The nicer hospitals are in the areas where people can actually pay for the services. I've heard of a few places shutting down in "border states" because so many people were getting care and not paying (you can't refuse care to someone in the ER...and the people getting free care no son de los EEUU). So, if you want a good hospital go to a city or nicer town. This is inconvenient and I'm sure a socio-economic argument about rich people getting better care will arise. Solutions?
With government monopolized health care the majority of the hospitals suck except for the few private ones. If the private ones suck they get no "customers" so they have to be decent if they want to make a profit. NHS type places don't give a shit about the bottom line. It's a tough thing to talk about bottom lines and revenues when it comes to sick people but if it keeps things moving a bit more efficiently I'll take the cold world of consumer driven markets over a fucking government-run circus.
As far as the guy who got injured because of his choice to ride a dirt bike - of course it was his choice and he's suffering the consequences of a painful broken bone. But assumption of the risk and dealing with the outcome is completely irrelevant. Who gives a shit how or why he is hurt, the bottom line is that he is and that the hospital was horrendous. People get hurt all the time and anyone should be able to have good care - just because his appendix didn't rupture (not his fault) doesn't make his case less compelling. Piss on a seat...bloody tissues... no pain meds... it doesn't matter WHY he's there, those are unacceptable standards of care. Period.
Gretchen at June 15, 2007 9:52 AM
Starfox - you read my mind while I was typing away! ...right on, dude.
Gretchen at June 15, 2007 9:54 AM
Gretchen, he did that on purpose! :)
Re: the dirtbiking, Ozzy did the same thing, pretty close to the same place that "Don the Survivor" did, and I'm betting Ozzy had all the creature comforts he could wish for and more. Money talks. But it would be interesting to get his take on this.
Flynne at June 15, 2007 10:19 AM
People from countries (or people that admire countries) with socialized healthcare are always saying it's great because it's "free."
Well, as this story from Don shows, nothing's free! The indifference of the hospital employees is appaling. I mean, not even getting the guy some ice? ICE!!!
Starfox5253 at June 15, 2007 10:45 AM
Well, you've found us out. May as well just wind the whole thing up now, since Don has exposed the ugly truth.</sarcasm>
Someone's been reading too many tabloids. If the plural of anecdote is not data, what is the singular? I've used the NHS all my life - 57 years - and seen it in several other lifetimes (wife, children, parents), so my anecdote's bigger than yours. There are problems with the NHS, but "the horror that is the British National Health Service" is nonsense. The NHS is not a horror. We get health tourists, for goodness sake!
Norman at June 15, 2007 10:47 AM
> And this town (Newcastle) isn't a huge city.
It SO is.
Stu "El Inglés" Harris at June 15, 2007 11:33 AM
Anecdotes are a really poor way to argue. No matter how good a system is (and one may assume theirs is better than ours based on satisfaction levels), one can ALWAYS find a horror story- witness the poor woman who recently died in an American hospital, vomiting blood while staff ignored her, janitors mopped around her, and dismayed bystanders called 911 from the emergency room, trying to find someone who cared.
Jason at June 15, 2007 11:48 AM
> I find that the French system
> is well worth the price.
The price you've paid doesn't reflect its full costs, and will never to be available to Americans anyway.
Postwar Europe had budgetary wiggle room in developing health care schemes because they knew all their likely military adversaries were going to be held off inexpensively, i.e., by the American taxpayer. These were precisely the years that whole new technologie$ for treatment were bring offered.
Secondly, France now has a huge number of immigrants who are going to be pressuring that system immediately, but who haven't been contributing value to the economy (either through productivity or taxpaying). This is not going to get better.
Thirdly, even if it weren't too expensive, it's simply too late for America to take a move towards the socialism, the ship's sailed in another direction.
The whole of humanity's going to have to come to terms with what it means to be sick and need treatment, and it won't be more fun in the United States than anywhere else. But it's just inane (and a little galling) when the nations who've been living under the American military umbrella say "Well golly, why don't you do what we did?" That option is not available. The United States is its own United States. It's like hearing a neighborhood of parents say "We should get newspaper routes and play video games like our kids."
Crid at June 15, 2007 11:50 AM
In Ontario (Canada) you are either asked for your health card, or a credit card. They are trying to cut down on the free rides from those who shouldn't be using the system.
Chrissy at June 15, 2007 11:58 AM
> my anecdote's bigger
> than yours.
That a great line. You're a snot for using it like that, but I'm gonna steal it someday.
> We get health tourists,
> for goodness sake!
Every place with hospital gets tourists, that's the problem.
Not meant to be critical of Amy or any commenter or any other blogger, but health care posts are starting to seem like the equivalent of a standup comic's material about TV commercials or airline food. Everyone can relate, so the tales kill no matter how mundane they are. Being anecdotal is the whole point. "Well let me tell you, my rheumatiz was acting up the other day, and so I went..."
Crid at June 15, 2007 11:58 AM
His friend Monte was mistaken. No way does a patient get an immediate morphine drip in California. No way should you expect to see a doctor in under 3 hrs, though you could be more lucky or less.
The only obvious difference I see is that afterward he'd have had tens of thousands of $$ in debt here in the States.
So, this article has nothing to do with private vs state-run medicine. Instead, it's about bad medicine. And unfortunately that happens all to often here in the States too.
cjumper at June 15, 2007 12:06 PM
Great comments Crid (and Lena).
I was tempted to post my own "I am highly insured but here is my US healthcare anecdote of horror" - and you are right.
The international comparisons are seldom like with like anyway.
Jody Tresidder at June 15, 2007 12:21 PM
Jody, if you want to kvetch, you've come to the right group... Let 'er rip.
(I got the best hospital story of any of you: I've been healthy across five slothful decades.)
Crid at June 15, 2007 12:46 PM
Now that I've vented my spleen, whatever that is, how about a discussion of health care provision? The NHS has problems, but it is sacrosanct. No government dares to be accused of killing it off. The problems are not ones like the OP describes, because that is exceptional. The problems are the unlimited costs of health care, the lack of dentists, the recent cock-up in GP recruitment, the fact that no-one dares mention "rationing" even though it must take place when there is a limited resource and unlimited demand.
Is there a comparison of cost and benefit between different systems?
Personally, I don't see what would be wrong with the NHS providing, say, 90% of health care, and the remaining 10% being outsourced by the NHS to private health care providers, or even to overseas providers - just so long as it's still free at the point of delivery.
Norman at June 15, 2007 1:08 PM
The problems are the unlimited costs of health care, the lack of dentists, the recent cock-up in GP recruitment, the fact that no-one dares mention "rationing" even though it must take place when there is a limited resource and unlimited demand.
But Norman,
Those ARE the problems discussed over and over in the UK press. Journalists DO certainly gibber endless about "rationing" - the whole cancer-treatment-according-to-postcode slew of stories.
I agree that dismantling the structure is considered beyond the pale, though.
Because I'm now based in the US, but both my hulking teenage sons were NHS births and my own parents live permanently in France, I tend keep an eye on different systems.
The most valid comparisons seem to be carefully specific ones: i.e. in which country would you "prefer" to suffer from life-threatening cancer.
The most detailed, serious analysis I read (no cites, sorry..) indicated, ideally, you would be seen by your French doctor, diagnosed under the care of NHS specialists in the UK - and come to US for heavily insured treatment.
Jody Tresidder at June 15, 2007 1:34 PM
Ugh...
Working for the California State Legislature, I get to see protests, demonstrations, etc. everyday. This week, we were all subjected to the socialist rants and raves of those supporting SB 840 (healthcareforall.org). The oh so wonderful Michal Moore was pushing for this onerous bill (and his new movie). If SB 840 gets anywhere (chances are low), than all health insurance company operations would essentially be abolished and moved to the state government.
Additionally, there are some legislators who are pushing for a less intrusive option (by less intrusive, they mean a 7.5% payroll tax increase for almost all employers to pay for universal health care). Details on the site I created for the Assembly Republican Caucus--> republican.assembly.ca.gov/topics/hc1
I swear some day I am going to want to move to a quiet little hidden valley somewhere in colorado...
André-Tascha at June 15, 2007 1:56 PM
a little gulch somewhere?
newjonny at June 15, 2007 2:12 PM
exactement, mon ami newjonny!
André-Tascha at June 15, 2007 2:20 PM
Emmanuelle, maybe you can tell people about the unique mix of public and private healthcare that France has. It really is not pure socialised healthcare and should not be judged as such.
FWIW, my (half-English, half-French) fiancé and I are fleeing the UK in part because of the horrific healthcare (which, guess what, we pay for whether we use it or not, at exorbitant personal cost to us). He was nearly killed by them, twice, and my ex's father was killed by inept NHS care (being on the "urgent consideration" waiting list for bypass surgery for 18 months - they kinda just hope you'll die if they leave you on there long enough - he never regained consciousness after the operation, died three days later).
For all of you who think American healthcare sucks, I have no idea what leads you to believe that FORCING people to pay for state healthcare is going to improve things. If businesses are funded by force of law, what incentive do you they to be good? Very little, I can tell you, from very sad, painful experience.
Lastly, if you're telling me you think politicians like GWB should be put in charge of public health...Well, I'd love to hear the rationale behind that argument.
Jackie Danicki at June 15, 2007 7:49 PM
The idea that the dirt-biker "deserved" to suffer for losing at his risky behavior is one of the two things you should scream about AGAINST in discussions of socialized health care.
Set aside for the moment that what the socialist asks for is the Post Office, public housing and the IRS to run medicine: think about the list of things YOU do that would no longer be permitted because someone else thought it was "too risky" and "a burden on the system".
These arguments are already well advanced against motorcycling of any kind, gun possession, skydiving, private aviation, skateboarding, being gay etc., because Mrs. Grundy doesn't see a "need" to do those things as she sits at home with her cat.
Health care MUST BE RATIONED. It is right now by supply and demand, and that's not going to get better when a government agency full of can't-fire-me civil "servants" gets to stand in line for your money.
Look. Everybody understands the idea of a credit card. I suggest that a credit card standard be adopted, with laws that state that paying it off on schedule comes first, with monetary fines levied against estates and other credit balances. That will force the consumer to do something other than say, "Yes, please" when offered a medical service and return more control to the individual by introducing the novel risk of poverty as a penalty for careless behavior.
(I say, "careless" because the skilled should never be held back by the behavior of the unskilled. For instance, there are innocent people who should never hold a firearm, while there are millions who are as reliable as humanly possible.)
Radwaste at June 15, 2007 8:26 PM
This is the ultimate red herring, because nobody in the mainstream is suggesting a completely socialized system. How about comparing our system with Switzerland, Australia, France, Germany? Every one of them spends far less per capita than we do, and delivers better care. Does anyone think that an accident victim in Switzerland would encounter a system like what is described above? By the way, the Swiss pay about a third less than Americans per capita. Try the same question for Australia or Germany or France, and you will find a similar answer.
If the US could deliver care at the level of UCLA or Cedars-Sinai to everyone and do it for what we already pay as a nation, that might be considered a useful way to spend all that money. As it is, we don't, and the system is getting worse.
Of course most other developed countries have more doctors and nurses per capita and pay them less than they make here, and they don't waste twenty-five or thirty percent of their healthcare dollars on insurance company overhead and profits. But the last time I pointed this out, Amy typed that I am boring. Could be, but being boring doesn't make the facts less than facts.
PS: One of my scientific colleagues just saw an offer to go off to Bishop, CA and work as a doctor with a guaranteed income of at least $350,000 per year. This was considered low compared to the Carolinas, which routinely promise $400,000 per year and up. I wonder how all the free market folks feel about the fact that we have an artificially low number of medical students and nursing students due to the limits on the number of entering students, resulting in an artificially low number of practicing physicians. Even if you don't like socialism, you might at least consider the effects of monopoly pricing.
Bob G at June 15, 2007 9:05 PM
"How about comparing our system with Switzerland..."
Oh dear, please don't. I live in Switzerland, and care is good. At the moment. But we are suffering all the same arguments, and the system is moving in the same "socialized" direction.
bradley13 at June 15, 2007 10:34 PM
Some writers seem to think that people in the US only pay for the health care they use, while in countries like the UK people pay whether they use it or not. Is this correct? I thought that in the US people took out health insurance to pay their bills. In other words the cost is borne by people who pay insurance premiums but don't claim. Does anyone pay huge bills without insurance?
The difference with nationalised schemes is that the insurance company is the state, you don't have a choice about paying and the premium depends on your income. Private insurance companies have to pay not only for health care, but also profits to shareholders; national insurance has no monetary incentive to be efficient. But many civil servants are motivated by the idea of public service itself, and honestly strive to do the best they can for the pubic good. That attitude can't survive in a market competition between private insurance companies: they are forced to keep an eye on their dividends.
Norman at June 15, 2007 11:57 PM
I'm Verity, the girl mentioned in the story and let me say that i've grown up in Newcastle and am dying to get out. This latest experience at the hospital was just another example of why i want to leave.Firstly, i don't believe that cleaners are qualified to treat patients , so there is absolutely no excuse for the blood, piss and spilled coke being left in the waiting area for more than 5 hours! Secondly, could a nurse really be that stupid in not automatically givng ice to a patient in obvious need? It's only water, surely they have plenty, this isn't third world. It doesn't mention in the article but there were 2 guys climbing on the roof of the A and E {accident and emergency} dept and not one single security guard in sight. They were crazy and could have done anything to anyone with nobody to prevent it. Peole are scared and in pain when thay arrive at these places and not exactly at their best in protecting themselves. Yes, i know that across the globe there are problems with healthcare but the encounters here were disgusting and completely unjustifiable.
Verity Pinkney at June 16, 2007 6:32 AM
But many civil servants are motivated by the idea of public service itself, and honestly strive to do the best they can for the pubic good.
I invite you to read - skim - the US Government Manual, and to note that various estimates of benefits reaching the intended recipient from US government agencies all hovering around the 25% mark.
I work at Savannah River Site for a contractor whose workforce includes an appalling number of people who merely appear at work "to get a paycheck". Yet, since our job involves technical tasks where progress is actually measurable - as opposed to social work with recurring or "unsolvable" problems - we have a lot of our budget actually getting to the work site. That makes us atypical - but I can still show you how to save $400K/year by not paying people to sit and talk on the phone.
Radwaste at June 16, 2007 6:41 AM
"But many civil servants are motivated by the idea of public service itself, and honestly strive to do the best they can for the pubic good."
So what happens if everyone isn't on their best behavior? What if they are only motivated by a paycheck and a pension?
Socialism doesn't work because I don't care who you are, no one has pure motives 100% of the time, and that is what it would take for socialism to work. Everyone will always look out for themselves and their own families first. I know I do.
Verity, thanks for weighing in! It's interesting to hear about the other things going on too. I can't believe there were two crazy people and no security. You guys gotta get out of there!
Starfox5253 at June 16, 2007 7:03 AM
Verity, thanks for commenting. And yes, these are anecdotes, but when the medical care available in a country makes people want to leave that country (see Jackie's comment above) that says a lot about the quality of care available.
Amy Alkon at June 16, 2007 7:47 AM
And Starfox is absolutely right about socialism.
Amy Alkon at June 16, 2007 7:48 AM
Medical care may make Verity want to leave. It makes other people want to stay. YMMV.
Surely this argument against socialism is too wide. Why does it not apply to the police, armed forces, fire brigade, roads department, sewerage, water supply, and so on? These services are provided socially. Do you think they should not be?
Unless you would have no taxation system at all, you are in favour of socialism in some circumstances. What makes health care different? I'm not arguing one way or the other here, just trying to analyse the situation. We've had a socialist government in the UK - or at least one that had socialist tendencies - and it has been an eye-opener.
In Scotland, we have at the moment one private prison. The rest are all state run. The newly elected government intends to nationalise the prisons. Good idea or not? Surely, if the government sets the standards, and carries out inspections, and has the power to grant licenses and shut unsatisfactory places down, there is no reason not to have private prisons?
Norman at June 16, 2007 10:05 AM
"if the government sets the standards, and carries out inspections, and has the power to grant licenses and shut unsatisfactory places down, there is no reason not to have private prisons?"
The government-led quality assurance program you just described sounds perfect. Of course, the ability to successfully implement such a plan in the real world is an entirely different story. Can you elaborate a bit on how you'd enforce fidelity to this program?
Even if you were able to pull it off, here's one drawback of an entirely privatized system: Administrative costs. For all its problems, Medicare in the U.S. is an example of government efficiency. With approximmately 3% administrative costs, a lot more of the money is going toward the actual provision of medical care.
I'll defer here to a study from Harvard:
N. Engl. J. Med. 2003 Aug 21;349(8):768-75.
Costs of health care administration in the United States and Canada.
Woolhandler S, Campbell T, Himmelstein DU.
Department of Medicine, Cambridge Hospital and Harvard Medical School, Cambridge, Mass, USA.
BACKGROUND: A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike
approaches to health care have decreased administrative costs.
METHODS: For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars.
RESULTS: In 1999, health administration costs totaled at least 294.3 billion dollars in the United States, or 1,059 dollars per capita, as compared with 307 dollars per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.)
CONCLUSIONS: The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a
Canadian-style health care system.
Lena at June 16, 2007 11:17 AM
> if administrative costs could be
> trimmed by implementing a Canadian-
> style health care system.
And what if they can't? I can imagine making all sorts of changes to the administration of our health care (well, actually I can't imagine that, but work with me here) yet not getting the same results. Here's one reason why, as I was suggesting above:
http://www.colbycosh.com/old/november02.html#csag
After a casual dash through the net on a day when we should all be dancing on the beach, I can't find a link that quickly summarizes this point: Canada's system has preferential delivery for people with political power. They get to cut in line. That wouldn't wash down here; when a guy from poverty's clawed his way to the top of the automated lawn sprinkler control business and has a few ducats in his pocket, he's not going to wait in line for his angioplasty just because some congressman has the sniffles.
I hope this paragraph isn't too obvious, but, like, something's got to give. We're taking too much value from people's lives in order to give them a very high standard of care, and we think that standard should be universal. But, like, maybe it shouldn't. I'm not on the side of pain, but the fact that people are suffering doesn't mean that their responsibilities as consumers have ended, -- or even that they should end.
Repeating a comment from years ago: The genius of America is in finding hidden value. (France and Canada and all the rest are wonderful people, but they're not nearly as good at this, and they know it, so their more socialist inclination is to let someone in Paris or Ottawa tell them when they've had the health care they deserve.) As long as American policy prevents sick people from using their genius, this is not going to get better.
You can bet that Hillary Clinton's solution will coddle and hamstring us just as badly as the current arrangement. Thanks for you attention to this matter.
Crid at June 16, 2007 2:04 PM
"Behind the door of Army Spec. Jeremy Duncan's room, part of the wall is torn and hangs in the air, weighted down with black mold. When the wounded combat engineer stands in his shower and looks up, he can see the bathtub on the floor above through a rotted hole. The entire building, constructed between the world wars, often smells like greasy carry-out. Signs of neglect are everywhere: mouse droppings, belly-up cockroaches, stained carpets, cheap mattresses. The wounded manage other wounded. Soldiers dealing with psychological disorders of their own have been put in charge of others at risk of suicide...etc"
A nasty British NHS hospital? No. It's the famous
Walter Reed Army Medical Center and the patients hadn't just fallen off their dirt bikes either had they?
Mike Power at June 16, 2007 3:32 PM
You guys battling with anecdotes need to remember that two wrongs do not make a right.
Radwaste at June 16, 2007 4:24 PM
I would be curious how the scenario would be different in a rural U.S. hospital. I've heard similar horror stories from American hospitals. Several years ago when my brother was hit by a car in Edinburgh, Scotland the medical treatment was sterling.
Darry at June 16, 2007 6:28 PM
What, you want an anecdote?
Cosh has your anecdote... On the end of a rectal thermometer!
http://urltea.com/sbz
Quintessence of the nut graph: "I have followed the emergence of these parallel stories with increasing disbelief, and by now I suspect a lot of readers must be asking whether Canadian doctors and nurses are ever officially taught the germ theory of disease."
But get this... The last sentence is even worse!
Crid at June 16, 2007 11:10 PM
The end of rectal thermometer? What might this have to do with the American genius for finding hidden value?
Lena at June 16, 2007 11:23 PM
> But many civil servants are motivated by the idea of public service itself, and honestly strive to do the best they can for the pubic good.
I hope they strive to do the best they can for the public good as well.
Doobie at June 16, 2007 11:26 PM
> might this have to do with
> the American genius
That was funny... You fucker...
> I hope they strive
Reread.
PS- Any word on how our hostess made out?
Crid at June 16, 2007 11:35 PM
Kimberly says she won. Did she thank the little people?
Crid at June 17, 2007 2:02 AM
Crid,
I ended up on Maia's blog (by accident, actually), and her top post is from the awards. She mentions that Amy won two, but not which two.
Kimberly at June 17, 2007 2:10 AM
I worked as a house officer in the UK for the NHS a couple of years ago. While I do understand that this kind of stuff does happen, my typical experience as a doctor in the system was that patients received excellent care overall. The entire spectrum of care from general practice to emergency surgery was very very beneficial for the population as a whole. People were more likely to use the NHS to prevent medical disasters than to only see a doctor after a small preventable problem had grown into an emergency. For many millions of people in the US, it is as if they have no medical care at all. These same problems of waiting and not getting care is one of the cracks in any system: none of them are perfect. The overall system in the US scores miserably when looked at from different points of view.
I'll stop now.
Eamonn Keane at June 17, 2007 1:25 PM
These kind of anecdotes neglect the obvious truth: He got treated. In the US, if you are unable to obtain insurance and do not qualify for a publicly funded program, you are out of luck.
I can't speak for the UK, but in the US, ERs are crowded because they are the only access to care for the uninsured and broke. In the US, you literally *cannot* make an appointment for a doctor if you are without insurance or the means to pay for the appointment out of pocket. It's one thing to sit in a filthy ER for a couple hours, but if the docs had determined that his fall had been caused by a brain tumor, he would have been treated in the UK. In the US, if he were uninsured and unable to pay for treatment out of pocket, he'd be sent packing.
And now, to fall back on anecdote: Based on my sister's experience in Ireland, I think it probably makes sense to augment a public health system with private insurance. Prices for private insurance are considerably less in countries with socialized medicine, and provide (anecdotally) fairly good care. And we know that Americans are more than willing to pay for preferential treatment. Yes, it would create a two tier system, but at least the bottom tier would involve something better than "go home and die."
Harriet at June 17, 2007 4:33 PM
Harriet, I wasn't going to post this because it is a dead thread now, but your post is absurd. Anyone can get care in the US. They don't "send people packing" if they can't pay. The people that don't have insurance or some government program have to pay out of pocket. It's terribly expensive, and yes, you have to pay it off, but they don't turn you away. My husband became sick when we were without insurance, and they didn't turn us away. He was treated, and we had to pay the bill.
Hospitals in the Southwest part of the US are going bankrupt because so many people come in that have no insurance and no way to pay. They still have to treat them. They end up eating the cost, which basically means prices go up for everyone else.
I just couldn't let your irresponsible comment sit out there for all to see without responding.
Starfox5253 at June 18, 2007 7:35 AM
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