Free Markets, Free People

NHS


When bureaucracies run health care

When they do we see scandals like the VA.  What the left will tell you is that’s an exception.  That the government can run health care vastly better than the private sector because it knows how to control costs.

For example:

NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday.

Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly.

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP.

Need beds?  LCP an oldie.  Problem solved.  Because with the bureaucracy, you’re not an individual or a patient, you are literally a number to be managed in a way that best benefits the bureaucracy.

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.

He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors.

Now it’s not like we don’t have examples that confirm this – this is one, the other is in our own backyard.

Death panels?  Don’t need ‘em.  Doctors – you know, the guys who swear to the Hippocratic oath – are empowered by the bureaucracy to arbitrarily assign you to the death pathway. Or, in the case of the VA, simply ignore you by leaving you on a wait list until you die.  Either way, a smart person would quickly see where the movement here in this country is going.  A bigger version of the NHS.

Just watch.

~McQ


But there will be no death panels

That’s what we’ve been assured would never exist if government is in charge of your health care and paying all costs.

That, of course, in the face of a promise to lower health care costs as well as the fact that the vast majority of health care spending takes place at the end of life.  Forget those conflicting points, death panels will never happen because, well because the left says so. 

Incentive?  Well that’s sort of a foreign word to the left so forgive them if they don’t understand that those two dueling points above provide incentive to end lives whether or not they’re willing to call it the result of death panels or not.

The example?

Well the good old British NHS of course

Shocking news from England today has top NHS officials indicating doctors acting in the UK government-run health program annually kill as many as 130,000 patients prematurely because of overcrowding at hospitals, medical clinics and nursing homes.

In fact they even have a name for doing that – the Liverpool Care Pathway.

Sounds so … benign.

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country. It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

It can include withdrawal of treatment – including the provision of water and nourishment by tube – and on average brings a patient to death in 33 hours. There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP.

Or, in other words, the government and doctors playing God.  And, naturally, it has devolved into something done often just for the medical caregiver’s convenience:

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’. He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors.

Nice.  LCP’d because they put what must be considered excess demands on the staff.  But look at the bright side – costs are cut, an less expensive patient can take the bed and everyone is happy.

Except the dead bloke and his family.   But, it’s not a “death panel”:

In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift.

Professor Pullicino said he had returned to work after a weekend to find the patient unresponsive and his family upset because they had not agreed to place him on the LCP.

‘I removed the patient from the LCP despite significant resistance,’ he said.

‘His seizures came under control and four weeks later he was discharged home to his family,’ he said.

Instead it’s just a “death pathway” protocol.  So nothing to see here, citizen, move along.

~McQ

Twitter: @McQandO


"Death panels"? Don’t make me laugh. Why look at other single payer systems, they don’t have "death panels", do they?

Just check out one of the longest running versions of the liberal/socialist dream:

British citizens who smoke, drink, or tip the scales because they’ve eaten too many fish and chips could soon be denied medical treatment for lifestyle-related illnesses. It’s a system the United States will be forced to implement under ObamaCare.

Great Britain’s government-run health care system, the National Health Service (NHS), has long considered limiting coverage for people with illnesses deemed to be lifestyle-related. In 2005 the National Institute for Health and Clinical Excellence (NICE), the NHS’s guiding body, advised that smokers and obese people be refused health care. Now NHS North Yorkshire and York is preventing certain operations for the obese or smokers because they say unhealthy lifestyles lower their chance of success.

Clare Gerada, chair of the Royal College of General Practitioners, told UK reporters, “These policies are being introduced because of financial constraints,” said Gerada.

And, of course, it is no longer your choice or frankly, your health – it all belongs to the state and the state says, "misbehave and we’ll punish you by making you live with your unauthorized choices and refusing to treat you". And they’ll pin it on those non-compliant miscreants … they just don’t live the proper lifestyle and thus their benevolent government has chosen for them – and it has chosen not to treat them.

But don’t you dare call those decisions the result of “death panels”.

They already have a postal-code lottery. Where you live determines the amount of care you receive. Since there’s nothing available outside the NHS, it means the local trust has the authority to change the benefits or determine the level of care you receive,” Herrick says.

Although everyone is supposed to receive “free” health care from the NHS, Herrick notes, NICE determines the level of benefit from a certain drug or procedure. Based on that NICE research, the local trusts may decide the cost of a certain cancer drug is too high or not effective enough so they won’t buy any or will ration it in some areas of the country.

Because, you know, there are no such things.

~McQ

Twitter: @McQandO


Irony–Former National Hospital Director in UK dies from lack of timely care

It’s a rather old story in more ways than one – it apparently happened at the end of March.  But it is an old story in another way as well – government’s inability to deliver on its promises.  It is also a story still playing out here as we look toward our future:

A former NHS director died after waiting for nine months for an operation – at her own hospital.

Margaret Hutchon, a former mayor, had been waiting since last June for a follow-up stomach operation at Broomfield Hospital in Chelmsford, Essex.

But her appointments to go under the knife were cancelled four times and she barely regained consciousness after finally having surgery.

Obviously her access to government run health care via single payer insurance did her no good (remember, supposedly insuring everyone is “the answer”).  She ended up being lost in the shuffle, critical care was continuously put off and, as a result, she died.

Her devastated husband, Jim, is now demanding answers from Mid Essex Hospital Services NHS Trust – the organisation where his wife had served as a non-executive member of the board of directors.

He said: ‘I don’t really know why she died. I did not get a reason from the hospital. We all want to know for closure. She got weaker and weaker as she waited and operations were put off.’ 

Mr Hutchon, of Great Baddow, Essex, said his wife, 72, had initially undergone major stomach surgery last June but the follow up procedures were repeatedly abandoned.

My guess, and that’s all it is, is she was continuously passed over because of her age.  I obviously don’t know that for sure, but it is one of many stories coming out of the UK that involve “senior citizens”.  Her condition was serious enough that she had been in hospital for months, but apparently not serious enough – or important enough – to receive the priority many would think it would obviously receive (if you’re in a hospital for months, you’ve got a pretty serious problem).

This is where we’re headed if we don’t get some leaders in office to stop this.  And, as indicated by the post below this and the Romney speech last Thursday, neither of those two have the political will to do that.  In fact, both agree, generally, with the direction the Democrats and the Obama administration have taken us.

We’re on our way to becoming a nation of Margaret Hutchons if we don’t push back hard and demand repeal of the odious ObamaCare legislation.  And Romney and Gingrich are not the candidates to do that.

~McQ

Twitter: @McQandO


Government health care’s inevitable fate

Canada’s health care system is in deep trouble financially. So it should come as no surprise that the British NHS is as well. It is simply in the process of proving correct Margaret Thatcher, who said, “the trouble with socialism you eventually run out of other people’s money”.

The Brits ran out of “other people’s money” quite some time ago (as is the US as debt and deficit figues show) and their social structures are existing on debt. And the NHS, the celebrated “single-payer” government run system in place since right after WW II, is failing:

Jeff Taylor of the Economic Voice clarified the problem when he wrote last week that “the U.K. is broke.”

“Our whole society and way of life is now built on the shaky foundation of debt,” he writes in response to the NHS cuts. “Our hospitals, schools, armed forces, police, prisons and social services are founded on debt. In truth we have not yet paid for the operations that have already taken place.”

The NHS is planning on extensive rationing of surgery. The service is looking at eliminating literally millions – with an “m” – of surgical procedures because it simply cannot afford them. Representative of those procedures which will no longer be available are hip replacements for obese patients, some operations for hernias and gallstones, and treatments for varicose veins, ear and nose problems, and cataract surgery.

The intent is to “save” 29 billion by telling patients in need of those procedures “no”.

Rationing, pure and simple – as promised. However, it is government deciding what you can or can’t have, regardless of your preference or need. This is indeed the ultimate outcome of handing things such as health care over to any third party. And it is especially a problem when “cost containment” takes precedence over health care.

That is precisely the mandate government here has assumed with its legislative charter to “cut costs” in the health care business. With that as a priority, and given the structure of the new law, an almost impossible priority to fulfill, the same outcome is almost guaranteed here. With cost containment driving the train, shortages are inevitable. And what those shortages mean, in concrete terms, is precisely what the NHS is planning on doing – denying patients health care.

The inevitable shape of things to come.

~McQ


UK’s NHS In Deep Financial Trouble (update)

The IMF has called out the UK’s NHS as “unsustainable”.

Gordon Brown was warned last night to raise the retirement age above 65 and introduce NHS charges to tackle the soaring state deficit.

In a devastating intervention, the International Monetary Fund called for radical changes to the pension system and spending cuts that go far beyond the plans outlined by the Prime Minister this week.

The global watchdog said root and branch changes to public sector spending would be necessary to ‘help keep a lid on the debt’ and restore financial stability.

And yet despite that example and the fact that our “pension” and government run health care system (Medicaid/Medicare) together have some 57 trillion dollars in unfunded liabilities and are riddled with waste, fraud and abuse, we’re considering allowing government to intervene in more of the market?

Brilliant. Just freakin’ brilliant.

UPDATE: I didn’t mean to step on Michael’s post, I just flat missed the fact that he’d posted on this.  I’m not sure how I missed it but I did.  He and I have done this before. Be sure to read his take as well.  Obviously we both came to the conclusion that this story was important.

~McQ


Those Who Refuse To Learn From History …

As the president gears up for a new push to pass health care insurance reform with a “major speech” to a joint session of Congress this coming Wednesday, it’s always instructive to peek in periodically at a system that is the practical end state he’s claimed he’s always wanted – the single payer system.

Today, as usual, we take a look at the National Health Service in the UK.

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

What’s the criticism of the insurance industry? That a bureaucrat somewhere is making a life or death decision, correct? Of course that’s precisely the same thing that happens in a single-payer system, except it is a government bureaucrat making the decision.

In an insurance system, what are your choices? Appeal. Or tell them to stuff it and pay for the care yourself. But in such a system it is highly unlikely that any insurance company is going to try to issue “guidance” to doctors telling medical staff how to deal with dying patients like what the NHS has done. They wouldn’t presume to do it (and if they did, the option is to find an insurance carrier that doesn’t).

However, when it’s a single payer system and, as in the case of the UK, everyone works for government, such as the UK, then such guidance is completely within reason given the system. After all the basic presumption of such a system is that, in fact, bureaucrats do have a right to call the shots.

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.

Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.

It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004

And there is no appeal as there’s really no one else to whom you can go.

A number of doctors there are concerned about the guidance. Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, is one of them:

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.

It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

He added: “What they are trying to do is stop people being overtreated as they are dying.

“It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”

He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

The key of course, and the reason for the “pathway” is contained in the second sentence I’ve put in bold – “overtreated”. Code for spending money on someone in the last stages of life. Obviously, it is much cheaper to put them in a drug induced coma and let them die than it is to attempt to keep them alive. Hargreaves sees that as a “self-fulfilling” process, where patients who would actually respond to more care and live “significant” amounts of time longer are condemned to death in an uncaring system more concerned about cost than life.

From the beginning one of the primary targets of health care insurance reform has been cost. The claim is that government can help lower those costs. The further claim is it can do it by introducing “competition” into the system. But there’s little in the proposals that anyone can find that actually does that. Instead it appears to most that things like the “public option” are actually designed to move us toward the eventuality of a single-payer system. The NHS provides us almost weekly examples of the cost containment strategies it implements in which extending life takes second place to cutting cost.

If cutting cost is the top priority of a system, any system, those are the types of decisions someone is going to be making. Most likely, if the patient isn’t involved in paying for the service, it isn’t going to be the patient or his family making them. It is going to be some bureaucrat with a budget line busily engaged in the priority of “cutting cost” making the decision.

~McQ


NHS “Neglectful, Demeaning, Painful … Cruel Treatment”

There was a bit of a push-back a week or so ago on Twitter by Brits who wanted us to quit dissing their National Health Service and to say how very happy they were with it. However a report from the Patients Association seems to beg to differ with the happy Twits. They’ve found that the care provided within the NHS is really nothing to brag about:

In the last six years, the Patients Association claims hundreds of thousands have suffered from poor standards of nursing, often with ‘neglectful, demeaning, painful and sometimes downright cruel’ treatment.

The charity has disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff.

The Patients Association said the dossier proves that while the scale of the scandal at Mid-Staffordshire NHS Foundation Trust – where up to 1,200 people died through failings in urgent care – was a one off, there are repeated examples they have uncovered of the same appalling standards throughout the NHS.

Interestingly, much of the complaining has to do with the nurses in the system:

While the criticisms cover all aspects of hospital care, the treatment and attitude of nurses stands out as a repeated theme across almost all of the cases.

[...]

Claire Rayner, President of the Patients Association and a former nurse, said:“For far too long now, the Patients Association has been receiving calls on our helpline from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.

“I am sickened by what has happened to some part of my profession of which I was so proud.

“These bad, cruel nurses may be – probably are – a tiny proportion of the nursing work force, but even if they are only one or two percent of the whole they should be identified and struck off the Register.”

The charity has published a selection of personal accounts from hundreds of relatives of patients, most of whom died, following their care in NHS hospitals.

Now I have no idea how the government bureaucracy which is charged with hiring and firing medical personnel in the UK works, but it is a bureaucracy and I’m sure it has a very long and difficult procedure that is required before anyone can be let go. Additionally, my guess is that the UK suffers from a nursing shortage just like most of the rest of the world. So it is my guess – and that’s all it is – that the nurses cited in the report, which they claim are probably a “tiny proportion”, have been complained about for years. I’d further guess that should another report be authored in another 5 years by the Patients Association, the same complaints received now will be received then because, given the shortage and difficult procedure necessary to fire a nurse, the same nurses will be working and performing just as they have in the past.

But that’s just me guessing based on my experience with government bureaucracies. And, I’d further assert that it is and always will be a systemic problem with any government bureaucracy.

~McQ


Central Planning And Health Care

One of the little discussed but probable consequences of making health care both universal and less rewarding monetarily for doctors is an inevitable shortage of doctors. The UK has had such a problem for years. They recently raised compensation for doctors by 50% in hopes of attracting more (the average salary is now 108,000 pounds). They also hoped that the raise in pay would see more British doctors working the odd shifts and weekends.

Apparently the opposite has happened:

The NHS is having to rely on doctors from overseas because a lucrative new contract for British GPs has resulted in more than 90 per cent opting out of responsibility for their patients in the evenings and at weekends.

Consequently, one-third of the primary care trusts (PCT) are flying in foreign doctors (from Poland, Germany, Hungary, Italy, etc) to treat patients “off hours” and on weekends. That obviously drives up costs, and the exhausted doctors have been killing patients, unfortunately.

So there’s a lot of hand wringing going on about the use of foreign doctors. But for anyone who has studied markets, what has happened there is a natural reaction to centrally imposed salaries. If the average is now 108,000 pounds and it is a 50% raise, you can figure that doctors previously were making less than a good auto mechanic. Why spend the time and effort to become a doctor for such mediocre compensation?

Probably more interesting is the fact that the same doctors now making better money for their type of work, have opted not to participate more in “off hours” and “weekends” figuring they’re still not being compensated enough to do that. Call it a passive but effective way of protesting their wages.

The NHS feels that its increase in wages will help solve the problem of the internal doctor shortage:

A spokesman for the Department of Health said: ‘The NHS has always used professionals trained abroad because until recently we did not train enough for our own needs.

The phrase “until recently” implies that now they are. And it stands to reason the new wage will attract more to the profession than the old wage did. However, will they be “enough”? And will they too “opt out” of “off hours” and weekend care? If so, the problem remains – central planning will decide their work is worth “X”, the doctors will decide it is worth “Y” and until they get “Y”, they will continue to opt out.

That of course means the importation of foreign doctors will continue to grow as it has in recent years. The money that could be going to British doctors will go to the foreign ones. And British doctors will continue to refuse work on off hours and weekends while foreign doctors kill their patients.

A lovely system, wouldn’t you say?

~McQ


Government Health Care, Please

Another anecdote that makes you want government run health care so badly you can just taste it:

The full extent of the horrific conditions at an NHS hospital where hundreds may have died because of ‘appalling’ care was laid bare yesterday.

Dehydrated patients were forced to drink out of flower vases, while others were left in soiled linen on filthy wards.

Relatives of patients who died at Staffordshire General Hospital told how they were so worried by the standard of care they slept in chairs on the wards.

The ‘shocking’ catalogue of failures was released yesterday after an independent investigation by the Healthcare Commission.

It found Government waiting time targets and a bid to win foundation status were pursued at the expense of patient safety over a three-year period at Mid-Staffordshire NHS Trust.

The commission’s report – revealed in yesterday’s Daily Mail – said at least 400 deaths could not be explained, although it is feared up to 1,200 patients may have died needlessly.

Nice. And I’m sure, somewhere, some politician or bureaucrat will claim that the problem, naturally, is “lack of regulation”.

And by the way, if you’re wondering how much the American version will cost, here’s the first estimate.  Remember, when looking at it, how often these sorts of estimates are so low they’re not worth the paper they are written on – figure anywhere from 2 to 4 times the figure once the government gets done being “efficient”:

Guaranteeing health insurance for all Americans may cost about $1.5 trillion over the next decade, health experts say. That’s more than double the $634 billion ’down payment’ President Barack Obama set aside for health reform in his budget, raising the prospect of sticker shock at a time of record federal spending.

Thus the nice “downpayment” with money we don’t have. 

~McQ

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