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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.

Jul 252009
 

They have decided that reforming the British parliament is the only way of distracting us from the expenses scandal. Pretty good scheme as parliamentary reform is well overdue, but what makes them think that we would trust politicians (said in the same tone of disgust as you would say child molesters or investment bankers) to do an honest job? We are supposed to passively sit back whilst they thrash out the ideas and eventually vote yes or no on a reform referendum. It is our parliament and we should be telling them how it will be.

Fewer MPs?

The Conservatives have come up with the idea of reducing the number of MPs in parliament, and the idea of fewer politicians involved in government sounds pretty good. At least at first.

After all, fewer MPs means that parliament costs less. But are we really bothered by the costs ? Assuming that each MP costs £200,000, and as we currently have 646 MPs, then the total cost is £130 million. That sounds quite a lot, but in terms of the total cost of government it is not so much. The suggestion is to reduce the number of MPs to around 400, which would cost £80 million.

But why do we have MPs? It is to represent us the public. And reducing the number of MPs is effectively telling us that our voices are less important. Each MP represents a parliamentary constituency containing a number of us; given the total population of 61 million and averaging out the number of people per MP, each MP represents 94,000 people. So they do not get much time to talk to us!

In 1801, we had a population of 10.5 million with 658 MPs meaning each MP represented just under 16,000 people. It would (in theory) have been a great deal easier to bend the ear of your local MP! If we were to have the same ratio of MPs to people, we would have nearly 3900 MPs! Perhaps that is too many especially as the cost would work out at £763 million! But I believe more MPs would be better …

Why do the politicians want fewer MPs ? What fringe benefits are in it for them? Given our current crop of politicians, we should always look beneath the surface to see what advantages their proposals have for them rather than us. Sure fewer MPs will cost less, but is that the real reason behind the proposal?

Perhaps it is instead that fewer MPs makes a parliament more easily controllable by the party whips. Fewer rebelious backbench MPs to upset what the government wants to do. Do we really want that ?

I want my MP to feel rebelious and to ignore the party whips on occasion because they represent me and not their political party.

End Of First Past The Post?

There has even been a hint that some politicians without a yellow hue have expressed an interest in ending the first past the post electoral system. The current system where the person with the most votes in a constituency wins is undoubtedly the simplest possible voting mechanism.

The big problem with our archaic voting system are the millions of people whose voice is effectively ignored. If you are a fan of a smaller party, or live in a constituency whose MP is someone you did not vote for, then your views are effectively unrepresented. If you look at the last election in 2005, Labour held onto power retaining 55% of the MPs, with only 35% of the popular vote – a majority of those who voted did not vote for a Labour government.

And the raw statistics do not necessarily tell the full story. Many people (myself included) will not vote for an MP they really want because they know that their preferred MP has no chance of being elected. Instead we vote for an MP who has a chance of getting in whose views we dislike the least. This tends to favour the large parties.

I could ramble on for ages about the weaknesses of the current system and highlight possible alternatives. But without the time to model the behaviour of alternate voting systems I don’t have the right to go into too much detail. Remember that – anyone who advocates a particular voting system needs to have spent time modelling their voting system so they can have some form of evidence for the expected behaviour.

I can tell you what features a new voting system should have :-

  • It should end the travesty of “safe seats” where a particular party can almost expect their candidate to win. And let’s see an end to situations where political parties choose not to put up candidates to allow one particular candidate (like the speaker) a “free run”.
  • It should break the close association with the geographic area to allow minority views to be “grouped” in a larger area.
  • Constituents should have the right to recall their MP and fire him or her. This would have to be constrained in some way – perhaps a 3 month cooling off period after a motion to fire has been started.

Why London?

I am sure those Londoners reading this (all two of you!) will be horrified at the thought of the mother of parliaments moving elsewhere, but why is it necessary for the parliament to be located in London?  Whilst it has good transport links, it is really only convenient to get to if you live in the South. Moving it to Birmingham would make it more equally inconvenient to get to, and Birmingham has pretty good transport links itself.

But why do we need a physical parliament at all? This is after all the 21st century, and there is nothing stopping MPs from taking part in debates and voting from their constituency offices. This would solve the problem of travelling and second homes, and give us greater access to our MPs.

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