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Sep 122016
 

The title of this post came from a tongue-in-cheek post on a forum I sometimes post on, and this post is not about the NHS nor it is even about socialism.

What it is really about is the over the top reaction you get when anything even tangentially related to socialism crops up anywhere someone from the US can see it. I’ve mentioned elsewhere that this is a variant on Godwin’s law whereby if someone accuses something of being socialist, they instantly win and condemn the “thing”.

To which I want to respond: grow up and think for yourself.

First of all, socialism is not the same as communism and in turn, communism is not the same as the kind of communism as practised by the Soviets. It is possible that communism inevitably leads to the kind of totalitarianism that the Soviets were so keen on, although there are those who disagree. But this is not about what sort of government you have.

It’s about how to run certain things. How do we pay for, and run certain services we have decided are essential such as :-

  • Health care (of individuals)
  • Public health (of society as a whole – vaccinations, sewage, water supply, etc.)
  • Police and justice system.
  • Defence

There are plenty of things that we have historically decided that should be paid for by the community as a whole, and be run by our government (in a very loose sense the community itself), including many of the items listed above. Even the most rabid anti-socialist is unlikely to start bleating about how the government is interfering with the private sector when talking about defence.

Yet suggest something new should be paid for by the community as a whole – such as the health care system – and Americans will start shouting “Socialism” and condemn the notion without looking at the merits.

By all means condemn a new community-funded notion if there are obvious problems with it, but to condemn it because it might be something suggested by a socialist government is ideologically-driven stupidity of the first order.

stack-of-coins-p1

Feb 062015
 

I happened to discover today that there is a chaplain within the House of Commons in the UK; fair enough. I don't really have a problem with someone being there to offer some sort of support to the HoC staff. Not even letting them incant some mumbo-jumbo at the start of the day.

But who pays his or her salary? Is it the Church of Englang? Or is it the government … and indirectly, the taxpayer? Which includes me.

I also don't have a problem with a single salary for a member of the clergy – one salary doesn't add up to much compared with the entirity of the public sector. But how many others are employed by the taxpayer?

  • The NHS employs chaplains.
  • The prison service employs chaplains.
  • Universities employ chaplains.
  • The military employ chaplains.

And probably other murkier corners of the public sector. Now when I say "employs", there are some areas of doubt – some are volunteers, and some may be paid for by the Church of England. But there are obviously many who are paid by the taxpayer.

Now I don't want hospital patients, prisoners, University students and staff, nor anyone in the military being derived of chaplains. If some people think they provide a useful service, then I have no objections to them using such services.

But why is my money being used to pay for their services? I would much rather my money was used to pay for properly trained counsellors which would provide appropriate services to all members of the public without being ever so slightly creepy (by talking about the mythical sky-daddy … or indeed the "wrong" mythical sky-daddy). If someone wants to speak to a religious consultant, then a counsellor can find a volunteer to meet that request.

Feb 242010
 

Today the report into the failings at Stafford Hospital was published. I admit I have not read the report, but the gist of the findings have been widely publicised in the media today. Even without reading the report, there are some immediately obvious outcomes.

It is clear that the management of Stafford Hospital failed abysmally to fulfil their basic duty of care to the patients. Some have criticised the government targets for distracting the management from their core responsibilities. That is rubbish – it does not take a genius to realise that no matter how many targets you are meeting, if patients are dying because of inadequate care, then you are failing in your duty as a responsible manager, and as a human being.

Personally I believe there is a clear case for the former Chief Executive, Martin Yeates to be charged with corporate manslaughter. If he had not been in charge and someone else with basic common sense had been running the hospital, then several hundred patients would not have died.

Those campaigners complaining about the report being a total whitewash (even before they had the chance to read it in many cases!) might want to consider bringing a private prosecution against Martin Yeates – even if there is little chance of him being found guilty (corporate manslaughter is weighted in favour of the corporations), dragging him through the courts is the beginning of some sort of punishment.

The other obvious things is that although the NHS did finally spot what was going on at Stafford Hospital, is that the NHS needs to dramatically improve the monitoring of hospitals. To some extent this has already been done, and the government has announced another inquiry into monitoring of hospitals.

Aug 142009
 

I am taking the unusual step of explicitly reserving the right to update this post – in case someone comments and I update the post to reflect their comments

According to the news, the health care debate in the US brought about by Obama’s attempt to reform the health care system is hot and furious. In particular the UK’s NHS is being targeted as an example of how horrendous socialist health care can be – including one ridiculous comment that Stephen Hawking would be dead if he had been British (he is British, and most of his health care is provided by the NHS).

The big concern about the NHS is the length of time it takes to wait for treatment because of health care “rationing”. It is implied that UK health care is rationed whereas US health care is not – nothing could be further from the truth! At a simplistic level, UK health care is rationed by need, and US health care is rationed by ability to pay.

Looking a little deeper, US rationing is mostly controlled by the insurance companies. Now sometimes (perhaps even the majority of times) this is done with the patient’s best interest in mind. But sometimes less scrupulous insurance companies will restrict access to more expensive treatments; particularly those who have pre-existing chronic conditions such as diabetes, or MS.

Looking around I can see there is particular concern with something called “co-pay” where the insurance company pays 80% of the cost of treatment, and the patient pays 20% (undoubtedly this varies between different providers). Sounds like a not unreasonable way from preventing people signing up for unnecessary treatments? Well perhaps, but 20% of many medical procedures is a lot of money and many people will find it difficult or impossible to fund a sudden large bill that might occur because of a medical emergency.

Apparently there are ways to get assistance with paying the 20%, but that involves scrabbling around looking for people to help. This is probably not the sort of thing that is helpful in a medical emergency!

The NHS provides treatment free at the point of delivery with the exception of Dentistry. Prescriptions are also subject to a flat £7 fee in England, although they are free in Scotland and Wales. In other words, you will not suddenly find yourself paying a huge bill.

The real truth is that most people who need it can get treated whether they are in the US or the UK. Although if you are poor and in the US, your access is likely to be not quite so easy. Are there millions of people in the US who have no access to medical care ? Probably not, but there are enough indications out there that a significant number of the US poor find access to medical care difficult. If you read this article it would seem that the uninsured get medical treatment in circumstances that look suspiciously like a field hospital in a third world country!

As for waiting times, it is easy to pick particularly bad examples of NHS waiting times and wave them around as examples of how bad socialist medicine is. Now the NHS did used to have a problem with waiting times and some people did die as a result of not getting the treatment that they needed. This was indeed a scandal, and was a direct result of a long period of chronic underfunding by the Conservative governments (1979-1997).  The situation now is much improved and people do not have to wait so long for treatments.

In fact the NHS this year reached their target of having no patients wait more than 18 weeks (or more explicitly 18 weeks from referral to when treatments start). This is a bit on the high side, but the average wait for ‘inpatients’ is 8.6 weeks and 4.6 weeks for ‘outpatients’. Still too long, but this is far cry from claims of 18 month waits. And these statistics conceal something – for urgent treatment a certain amount of queue jumping goes on including going to non-local hospitals for treatment. The full details can be found here. Reducing waiting times would be a simple matter of increasing the amount of money invested in the NHS – and we pay a lot less than people in the US do – more on that later.

As a little personal example, my grandmother recently had to wait several weeks to be moved from a hospital to a rehabilitation clinic (for physiotherapy), but my Aunt (with cancer) was seen the same week by a specialist after her initial diagnosis.

Another story going around is that the treatment in the UK is very much worse than that in the US. One of the areas that people target is the cancer survival rates. Indeed the UK’s record of treating cancer is not ideal, but this is just one area. And sometimes simple comparisons can be deceptive. A little story from the US media about prostate cancer – the US has a much better rate of long term survival rate than the UK, but prostate specialists point out that the US does more testing for prostate cancer than anyone else.

That would be good except that once prostate cancer is found in the US, it gets treated despite the fact that many prostate cancers are slow and unlikely to cause death in many patients. The US system inflicts painful and uncomfortable treatment on patients who do not need it, and as a result they boost their long-term survival rates (see here). This illustrates the dangers of doing a naive comparison of health care statistics … which is what I’m just about to do!

In fact if you look at a more widespread selection of conditions, the UK does not look quite as bad. Unfortunately the WHO statistics available are a little dated, but can be used to do a naive comparison.

Lets have a look at the mortality rates for all cancers – in 2002, the US had 134 deaths per 100,000 and the UK had 143. It is quite possible that the US rate has improved since then, but if so the UK is likely to have improved more – the NHS was asked to concentrate in this area because of the UK’s poor record here. Still even with the 2002 figures, the UK isn’t that much worse!

Now lets have a look at mortality rates for cardiovascular diseases – in 2002, the US had 188 deaths per 100,000, and the UK had 182. What’s this ? A country with a socialist health care system does better than the US? Obviously I am excluding lifestyle differences, but even so this does not look like the UK has a chronically bad health care system.

And now let’s have a look at mortality rates from injuries – in 2002, the US had 47 deaths per 100,000, and the UK had 26. That’s quite a big difference! The rates for deaths from non-communicable diseases were 460 (for the US) and 434 (for the UK). Again we have the UK apparently doing better.

If we look at more recent figures (2006) for rates of infant mortality, we see the US had 7 per 100,000 and the UK 5. Again the UK looks better!

I would rather like to include some more finely tuned statistics here such as more recent figures for how many people with a set of conditions are successfully treated, and will indeed update this post if I find some.

Because of the lack of recent figures I am not going to say the UK health care system is better at keeping people alive than the US system … or visa-versa. But it should be clear that the UK system is not dramatically worse (or better) than the US system at actually treating people.

What does become obvious when looking at health care statistics, is just how much more the US spends on health care than the UK. The UK spends about 8.4% of GDP on health care and the US spends 16%. That is dramatically more. For that much more, you wonder why the US health care system is not dramatically better than the UK health care system, because it should be! Let’s have a look at some more statistics (sorry, but facts are needed when comparing two systems) … a table from the UK newpaper The Guardian (specifically their “Datablog”) :-

Country

United States

$ per person

6719

Doctors

(per 10,000)

26

Nurses

and Midwives

94

Hospital

Beds

31

Life

Expectancy

78

United Kingdom 2815 23 128 39 80

With only one exception (the number of doctors), the US does worse than the UK in terms of number of health care personnel. Of course this by itself does not show anything about the quality of what is provided (although we covered that earlier). The question seems to be what does the US get for all that money they spend on health care ? Looking at the full table in the relevant Guardian article, we see that the US spend far and away the highest per capita cost on health care than any other country in the table.

For the amount that the US spends, it should have a health care system by far and away better than any other developed nation. It doesn’t. It certainly does better in some areas (cancer) than the UK, but it does not do better in all areas. Is the UK health care system as good as that in the US ? Well I don’t have accurate enough figures to say so, but I think I do have the figures to say that it is not immensely worse to the level that US right-wing politicians with an axe to grind are portraying. I have no wish to try and tell Americans what kind of health care they should have, but they should be aware of the facts when considering health care reform.

One thing to be wary of are anecdotal stories of how bad the UK health system is. Undoubtedly many (if not most) are true, but are frequently very dated. And don’t you think that we could come up with very many similar stories about the problems with the US health care system ? I’m sure there’s a number of stories from people who “fall between the cracks” in the US, and essentially get little or no health care.

On the subject of anecdotal stories, apparently there are short videos circulating in the US (adverts?) detailing NHS horror stories. Interestingly enough those same people have been interviewed recently in the British media to indicate that they are disgusted that their stories are being used in this way, and that they fully support the NHS – they just want more money for the NHS!

I very much doubt that Obama is planning on setting up anything that would come anywhere near the socialism of the NHS. The right-whingers (spelling mistake intentional) over there are spreading disinformation – not only in how bad the NHS is, but in what Obama is planning. Please just find out the facts for yourself and don’t count on so-called “facts” provided by people who have a vested interest in the status quo.

The lies about health care by the NHS are grossly offensive to people in the UK. However if I were a US citizen I would also be grossly offended by the spread of disinformation being spread in this campaign. For more information about the lies and how false they are, there are a number of links to further information :-

And as for the UK people, well we moan about the NHS amongst ourselves but as has been shown in the last week we certainly defend the NHS when it comes to outside attack. One way of judging the success of the NHS is that no sane political party would attempt to dismantle it – if they managed it, they would probably never be elected again. If you watch US media, you will probably be familiar with a certain Conservative politician (Daniel Hannan) who does attack the NHS. He belongs (at present – his future is quite possibly in doubt) to the lunatic fringe of the Conservative party and the party leaders have dismissed his views.

Whilst most people in the UK would greatly like to see the NHS improved by the investment of more money, there is no way that they would trade the system they have for the system in the US.

Jan 182007
 

Everyone hates paying taxes. To be honest nothing is going to change that at all, but there are a few things that could be done to improve the situation. At present people want to pay as little tax as possible, whilst having well funded public services. Which is kind of foolish and impossible to achieve; of course there are ways in which to make public services more efficient but that is a whole other rant.

I should point out at this point, that I’m somewhat partial here as my own salary comes indirectly from taxation (and pretty stingy the tax-payers are too), but that is also a whole other rant.

The funny thing is that when you start working, you get a nasty shock when you get your first payslip about how much disappears in the direction of the government and nobody is there to explain what you get for your money. Why not include classes in school about what taxation gets us ?

All that taxation does provide us with useful services which include :-

  • A public health service that anyone can use at no cost or vastly reduced cost.
  • A police service intended to protect us from criminals.
  • Armed forced to defend us from external threats.
  • A social security system to provide us with a safety net in case we cannot earn an income.
  • An education system that educates everyone.

And I dare say I’ve left loads out … I nearly forgot education where I work! But we don’t get told about what we get for our money, we are expected to “just know”. Of course it some ways it is obvious, but why not make it clearer ?

In fact why not make the yearly pay slip (the P60) larger and include rough figures for how much we paid for each service ? If you get something that says you paid £10,000 in tax, of which £1,500 went to pay for Health, etc., we are more likely to be less critical of taxation.

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