America seems to be drifting back in history in a sort of time machine. The backlash against admittedly rather limited free market reforms by George W. Bush, exerted by the status quo left, is gaining momentum. If the polls in the run up for the presidential elections are correct, the 'ownership society' could soon be hit by a severe blow. If one of the Democratic hopefuls gets elected, Santayana’s rule is unlikely to be escaped: those who ignore historic failures are prone to repeat them. Such is the case with the old whore of universal health coverage, favoured vigorously by Hillary Clinton, John Edwards and only haphazardly rejected by Barack Obama.
Remember, this is a policy introduced in Britain in 1908 at a time when socialist movements were surging through Europe. Leading Democrats are advocating this concept hundred years late. Is this what Americans get from the collapse of the Soviet Union? The current concept seems even more collectivist than the collapsed HillaryCare of 1993, which nearly derailed her husband's presidency.
Compulsory and comprehensive health insurance for everyone is expensive and would likely deepen the financial crisis in health care even further. It is also inadequate in times when Americans are in perfect control of up to 50% of their health risks, which renders comprehensive insurance obsolete. What is really needed is catastrophic, no-frills health insurance for everyone. That's the kind of safety net the late 19th century European reformers had in mind. And it would be much cheaper and therefore more affordable for consumers.
However, in the freest country in the world compulsion is unlikely to work. Look at car insurance: Despite being compulsory up to 15% of drivers in the US – depending of the state, but higher in the West – don’t care about car insurance. Ironically that is about the same percentage of 'free riders' in the yet not compulsory US health system!
The government's suggestion - however tentative - that people who are overweight or won't quit smoking shouldn't get treated by Britain's state-run National Health Service is outrageous.
These people have paid their taxes - smokers have probably paid more than most - for what we're told is a state 'insurance' system. What commercial health insurer would be allowed to take your money and then refuse to pay out on the grounds that your lifestyle was politically incorrect?
Health ministers say they're simply trying to encourage people to live more healthily. And indeed, plenty of commercial insurers are doing just that - reports this week reveal that they are willing to give discounts of 75 percent to people who use the gym regularly, and provide supermarket points to
clients who purchase lots of fruit and vegetables.
That's fine. The difference is that people have no choice but to contribute their tax 'premium' to the NHS. If ministers were saying that fat smokers wouldn't get NHS treatment but they'd get their taxes back, then they might have the basis for a deal.
My true love sent to me: six geese a-laying. In the song, this seems to refer to the six days of creation.
But talk of geese or turkeys makes me think rather of destruction - the destruction of birds due to bird flu, and indeed cattle due to BSE and foot & mouth. I don't know how much of these disasters should be put down to the diseases themselves and how much should be put down to government incompetence. When you have officialdom closing down agriculture for months on end and slaughtering tens of thousands of animals; viruses escaping from government research centres; Edwina Currie putting the nation off its eggs; Sir Liam Donaldson scaring us with the prospect of 50,000 human deaths from bird flu, then maybe government is the bigger threat.
That, of course, and the interest groups. These scarces are all very useful material for those who want us to give up eating meat entirely, those who want to protect UK agriculture from foreign imports, and those who are just against the modern international economy and want us to stop flying, stay at home, and live quietly in cabins on our smallholdings. In the scheme of things, AIDS, malaria, filthy water and road accidents are all bigger killers. Why don't we focus a bit more attention on them?
News this week that a key mental health unit in Surrey is to close is yet another hallmark of a disturbing reality that plagues the National Health Service.
The principle behind the NHS is that politicians motivated by a desire to win elections will have an incentive to provide good healthcare to the public at large. This glib and simplistic and view – typical of the naive school of thought that forged the UK's public sector culture – overlooks a key clash of values between politics and health.
Politics is an industry that is essentially based around popularity, while healthcare is one based around necessity. It is because of this fundamental contradiction in values that the unholy nationalisation of British health has resulted in healthcare priorities being set by ill-informed politician under pressure from a largely ignorant populace. The end result is that a government's performance in health is measured in terms of how much money is spent rather than how much suffering is alleviated. Indeed, health and education must be the only industries on earth where rising costs and falling productivity are considered signs of success.
When healthcare is run by the state and driven by a desire for headlines, it is not surprising that NHS provision of mental healthcare remains shockingly low, with minimal funding and appalling disregard for the needs of the patient.
The government would be better to measure progress in new ways, for no matter how much money they say they have spent, when a priority patient still has to wait up to 3 months to see a psychiatrist it is time to start asking how many vulnerable souls have been allowed to fade from lack of available help.
It is unlikely that any government will be able to prioritise such 'unexciting' areas whilst still keeping up the required level of media-hype to stay popular, so perhaps it is time to consider the ultimate humbling of the NHS – to acknowledge that the present model reeks of failure and that it is time to try something new.
People in medieval times were healthier than modern Britons because
they did not suffer from cholesterol related diseases, it has been
claimed.
It's a remarkable claim, isn't it? We know that people then were shorter than we are, that there were instances of starvation, of nutritionally related diseases like ricketts, pellagra and so on, but because they weren't dying in their 70s of heart attacks they must have been healthier.
While those living in the Roman and Tudor periods faced hazards such as
the "pox and plague", it seems that their daily diet lacked foods which
could lead to heart disease.
Or perhaps it's that because they all died of disease they didn't have time to die of cholesterol?
The research also claimed that daily exercise has decreased by at least
an average of 96 per cent since Roman and medieval times from eight
hours a day to less than 20 minutes due to increasingly sedentary lives.
Or perhaps they were all being worked to death?
Research by Lloyds pharmacy, the chemist chain, found that the daily
diet consumed by Britons in the Roman period of fruit, fish, whole
grains, vegetables and olive oil washed down with red wine amounted to
approximately 120g of fat, 80g of protein and 600g of carbohydrates.
That is indeed a healthy (and often scrumptious) diet but the most important point is this:
Dr Henderson said: "The Roman diet was healthy provided you were wealthy enough to afford..."
Ah, that's the point of the modern world. You don't have to be wealthy to be able to enjoy this diet, it's available to all. That's what is really valuable about this liberal capitalism thing, that it brings what were previously the luxuries of the rich into the reach of everyone. And who could resist an opportunity to post this?
The European Commission has delayed making a controversial announcement which could see the state health plans of one Member State paying the costs of patients who opt to be treated in another EU country.
The idea of the plan was that British patients, say, could travel to Spain or Hungary for their treatment, as many do - with Britain's National Health Service picking up the tab. Part of the argument for this is that some countries have more efficient healthcare sectors, with shorter waiting times, for example, and EU citizens should be able to benefit from the competition between them. Following the case of Yvonne Watts, who had a hip operation in France and sent the bill to the NHS, Britain's High Court ruled that the NHS should pay for treatment abroad if patients otherwise had to wait too long. Quite right, I would say.
Already UK doctors are whingeing because they know that lots more people would indeed go abroad for treatment if the NHS was forced to pay for it, rather than put up with the sink service they get in the UK. The British Medical Association's Dr Vivienne Nathansan said that if people started travelling for operations there might 'not be enough need' for that treatment in the UK, which could lead to closures. Yes, well that's competition for you, Vivienne.
Meanwhile Nigel Edwards of the NHS Confederation complained that the EU plan was a stalking horse to create a 'free market' in European Healthcare. Oh, if only it were. We're talking about harmonizing state health plans here. If the EU actually created the conditions for a proper, open market in healthcare - one that wasn't dominated by doctors and politicians - I think we'd all be a lot fitter.
According to a front-page story in yesterday's Sunday Times, "A woman will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug."
Preventing patients from topping up their NHS care privately is standard practice in the UK, and in accordance with Department of Health guidance. The Department seems to think that you have to be either a private patient or an NHS patient, and that any mixing is unacceptable: "Co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS."
I find it sickening that the government persists in putting their Soviet-era ideology ahead of the health of patients (which is surely the ultimate principle and value of the national health service). Rather than challenging the wholly artificial and enormously damaging public/private divide in health services, they would rather we simply received a lower quality of care. Their position is immoral and impractical.
It is also incoherent. People can already pay for private rooms in NHS hospitals, and for other non-clinical benefits. If it's ok to pay extra for your own television set, why on earth should you not be allowed to pay extra for a better drug?
Most importantly, their position may be illegal. I was recently at a luncheon addressed by one of the UK's leading medical lawyers. His position was as follows: the NHS Act entitles you to receive care that you reasonably require. You can only be refused that care if there is some legitimate reason to do so. Limited resources is such a legitimate reason. But if you are willing to pay for an additional treatment yourself, resources are not an issue and no legitimate reason to deny the reasonably required treatment exists. Thus you should be free to top-up your NHS care with privately purchased treatment, without being forced to foot the bill for the NHS services as well.
Immoral, impractical, incoherent and possibly illegal. This is just the kind of thing we've come to expect from government.
The two leading democratic presidential candidates, Hilary Clinton and Barack Obama, have begun a war sure to last through the primary season and into the nominations. While fighting over policy and personality, many attacks concentrate on their respective plans for universal healthcare. Clinton criticizes Obama, claiming that his plan will fail to cover everyone in the nation. Obama argues in return that her plan will also leave some out. The New York Times thinks neither of the plans goes far enough, approvingly citing an economist who thinks people should be fined for not having insurance.
These policies, and the fights and commentaries that stem from them, indicate an unfortunate trend in politics – a faith in the abilities of the government and the idea that programmes like universal care will mean more freedom, not less. Many falsely view government provisions as a release from economic hardship, rather than an intrusion into individual choice. Obama should be defending his plan because it allows people to opt out, not in spite of it.
The Democrats are fighting over the wrong issue, and pandering to the belief that the success of a government programme rests on the number of people forced to abide. One would think that the voters of a party meant to be the champion of individuality should be wary of any policy which forces all citizens into anything, and candidates from a true party of freedom would argue over the openness offered by their programmes, not the coercion.
As in the last campaign for a Clinton presidency, which Hillary nearly derailed with ill-advised health reform proposals, she has once again missed the point in her insults on private medicine.
On the campaign trail in New Hampshire she accused the US health insurance industry of spending $50 billion to avoid paying claims of their clients. But she has got the numbers wrong. Currently private health insurers are paying claims worth about $600 billion a year and spending $30 billion to adjudicate those claims, actually only denying claims worth $3 billion – not $50 billion. The cost of scrutinizing claims represents good value for money, because it keeps the premiums at bay by rejecting fraudulent and frivolous claims.
However, the ideological thrust of Clintons argument is targeting at gradual replacement of private with public insurance – in other words to expand Medicare for all Americans, with alleged administrative cost of only 3-6 percent. Her followers claim falsely that the administrative costs of private insurance (11-14 percent of premiums) alone would be enough to fund coverage for all presently uninsured Americans.
Fortunately, a meticulous actuary enquiry by the Manhattan Institute has recently dismantled this myth. Administrative costs for public insurance such as Medicare do not reflect the hidden cost of tax collection and other government functions for the administration. Under the "lowest plausible assumption about the excess burden engendered by the federal tax system" the total Medicare administrative costs would account to a minimum of 24-25 percent of all outlays. However:
A more realistic assumption raises the true cost of delivering Medicare benefits to about 52 percent of Medicare outlays, or about four to five times the net cost of private health.
According to Saturday's Times, the government's new 'five-year plan' for the future of NHS cancer services (due to be released today) admits for the first time that the UK has poor survival rates compared with Western Europe, the US and Canada. Long waiting lists for radiotherapy and chemotherapy, as well as rationing which means too few sessions of treatment are given, are at the heart of the problem.
Money isn't the issue here. Since 2000 the government has tripled spending on cancer, and the UK no longer lags behind Europe or North America on this front. The problem is structural. As Karol Sikova, the former head of the cancer programme at the World Health Organisation, told The Times, most of the extra money lavished on the health service has gone towards the salaries of people who don’t work with patients:
We have funded mangers to deal with targets while in France, Germany and Italy that bureaucracy just does not exist.
Unfortunately, the government’s approach to improving cancer services does not appear to have taken this on board - doctors are simply being ordered to increase radiotherapy doses and, no doubt, there will be new targets for waiting times, and more mangers to make sure the targets are met.
The government's addiction to targets is understandable, and, I think, based in a genuine desire to improve customer service. In the absence of competition and market forces to drive up standards, targets and regulation are the obvious option. Trouble is, they just don't work and have significant unintended consequences.
The only way to really improve the National Health Service (assuming its continued existence) is to create the freest and most extensive internal market possible. That probably means breaking the NHS up into smaller, more localized commissioning units which would fund patients (at a set treatment price) to go to the doctor or hospital of their choice (whether state or private), as well as the introduction of a capped co-payments scheme for treatment (like those that exist elsewhere in Europe).
Sadly, the government is not still not prepared to think that radically.
America seems to be drifting back in history in a sort of time machine. The backlash against admittedly rather limited free market reforms by George W. Bush, exerted by the status quo left, is gaining momentum. If the polls in the run up for the presidential elections are correct, the 'ownership society' could soon be hit by a severe blow. If one of the Democratic hopefuls gets elected, Santayana’s rule is unlikely to be escaped: those who ignore historic failures are prone to repeat them. Such is the case with the old whore of universal health coverage, favoured vigorously by Hillary Clinton, John Edwards and only haphazardly rejected by Barack Obama.
The government's suggestion - however tentative - that people who are overweight or won't quit smoking shouldn't get treated by Britain's state-run National Health Service is outrageous.
The European Commission has delayed making a controversial announcement which could see the state health plans of one Member State paying the costs of patients who opt to be treated in another EU country.
According to a front-page story in yesterday's 
As in the last campaign for a Clinton presidency, which Hillary nearly derailed with ill-advised health reform proposals, she has once again missed the point in her insults on private medicine.