The NHS is a single payer system, albeit unlike in the USA and many other nations, fully socialized. To put it mildly: It. Is. A. Mess.
When economics strain single payer systems, the marginalized and most expensive for which to care are the ones who usually suffer the most. We see that paradigm playing out in the very poor treatment many elderly receive in the NHS. From the story:
A study of pensioners who suffered appalling treatment at the hands of doctors and nurses says that half were not given enough to eat or drink. One family member said the maltreatment amounted to “euthanasia”. Some were left unwashed or in soiled clothes, while others were forgotten after being sent home or given the wrong medication. In several cases considered by the Health Service Ombudsman, patients died without loved ones by their sides because of the “casual indifference” of staff and their “bewildering disregard” for people’s needs. The damning report warns that extra money will not help the NHS meet required standards of care and that more problems are likely as the population ages.
Ann Abraham, who as health ombudsman carries out independent investigation of complaints against the health service, said: “The findings of my investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism. “The reasonable expectation that an older person or their family may have of dignified, pain-free end of life care in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.”
There are several morals to this story. Foremost–as noted in the quote above–bioethicists and administrators need to focus continually on human exceptionalism and universal human equality. Alas, bioethics–particularly in the UK–has taken a decidedly utilitarian turn in which “quality of life” judgmentalism is rampant. In such a milieu it becomes all too easy for hard pressed medical professionals to see the feeble and profoundly disabled as “the other,” people who make their work more difficult and emotionally taxing. That isn’t the intent, to be sure. But I think it is an effect, which a patients’ rights advocate noted:
Katherine Murphy, of the Patients Association, said: “Attitudes need to change. Older patients need to be treated with respect and compassion, not as an inconvenience. It is a sick joke that we have an NHS constitution that tells us what rights we have when being treated by the NHS – but it is clear that to the majority of older patients it is not worth the paper it is written on.”
The NHS’s agonies are also a warning against the U.S. system from ever falling prey to the seduction of a system-wide single payer approach. Our existing single payer programs, such as Medicaid and Medicare, demonstrate that taxpayers can’t fund everything. (Medicare only pays for about 50% of care, which is about right–although I think we should do means testing to increase co-pays and premiums for those who can afford it.) But Medicaid usually tries to provide very broad coverage. We can’t afford it and will need to triage what taxpayers have to pay to ensure that we don’t balance budgets on the backs of those who need care the most–as we see happening now.
Yes, of course that is rationing! That’s what you get with single payer health care. Which is why I think we should look into reforms that fundamentally rethink how we provide health care for the poor. These can include a mix of approaches including community based clinics to provide basic needs combined with vouchers for private insurance to pay for more expensive care, perhaps with government (I am thinking aloud here) on the hook in catastrophic cases.
HT: A. F-S
February 15th, 2011 | 1:22 pm
I’ve been following the NHS’s record on things such as this since Co-President Clinton’s attempt to ram her healthcare plan down our throats — and it only gets scarier and scarier.
Meanwhile, a local hospital which has laid off workers twice in the last five years is sill going ahead with its plans to build a new a hospital with approximately 400 rooms – ALL PRIVATE.
My prediction is that, unless Congress repeals Obamacare, within five years of completion, that shiny new facility will have 2-4 beds in each of those supposedly private rooms.
February 15th, 2011 | 1:58 pm
[...] This post was mentioned on Twitter by Vince Humphreys and J. Robert Howell, Wesley J. Smith. Wesley J. Smith said: NHS Meltdown: Shameful Treatment of the Elderly » http://bit.ly/hzifJw [...]
February 15th, 2011 | 7:13 pm
The Democratic left has long argued for a British-style “single payer system”, believing that a government-run, taxpayer-supported plan would ease pressure on wages, eliminate the problem of the uninsured, and generate enormous savings from economies of scale. (Nothing that has happened in the past century has shaken the left’s belief in bureaucratic central planning.)
But there has never been broad political support for such a plan, and even Democrat Obama with a Democratic Congress could not hope to pull it off. So they cobbled together a plan that required (“mandated”) the uninsured to buy insurance, subsidized part of the cost for them, and paid for it with two highly questionable elements.
First, they claimed to save money by requiring the health care and insurance industries to embrace a range of cost-control measures which the industries are already pursuing, and have been gradually implementing for years. Beyond any real management innovation, this amounts to the ever-popular scourging of “waste, fraud, and abuse” – the last refuge of every over-promising, over-spending politician.
Second, and most cynically, they proposed saving $500 billion from Medicare (equal to 10% of Medicare’s current total cost over 10 years), by similar cost-control measures. And they plan to use the Medicare savings to pay for the premium subsidies for the uninsured.
They plan to cut 10% from their most underfunded, out-of-control entitlement, and use it to pay for…a new entitlement.
February 15th, 2011 | 7:41 pm
The crafters of Obamacare know perfectly well that past efforts to control Medicare costs by limiting doctor’s fees have been met with public outcry, especially from the bedrock of health care, the general practice physicians. And every time it has happened, Congress has (at least partially) backed down.
They also know that Medicare underfunding is already driving many doctors to refuse service to Medicare patients, because the reimbursements are already too low.
And they refused to make any serious effort to restrict the one cost driver that all health care providers agree could be easily restricted – the cost of medical malpractice insurance, which in turn is driven by the parasitic lawsuit industry. Tort reform remains the one cost-cutting approach which triggers the Democratic gag reflex, or something like the kick under the table from the party’s most generous friends, the trial lawyers.
So we are left to conclude that the party, while serious about insuring the uninsured, is not very serious about cost control.
But what about the opposition? Do the Republicans have a plan for cost control? If so, I haven’t seen it. Health Care Savings Accounts are all very well, but we know that most people who need them won’t use them (see IRAs). A national market for insurance would help some. Republicans embrace tort reform, but that alone won’t do enough.
So, what will it take to tame the exploding costs of health care?
This is a trick question. I know the answer, you know the answer, even Obama knows.
Rationing. There. I said it. Rationing. The only sure-fire way to control the costs of medical care is by controlling the amount of medical care.
The ironies are enormous. The left claims that private insurers already ration care, by denying coverage for some services. But state governments already have their hands on that, through mandated coverages. Your plan won’t pay for your contraceptives? Lobby your state legislature. You are a chiropractor, and your patients’ insurance won’t pay for your services? Hire a lobbyist.
But with the left’s preferred single payer system, the government IS the rationer, and no one can mandate limits on such government systems. Government oversight never really works when it is overseeing government (see Fannie and Freddie). So the outcome, as in Britain, is cost control through medical care control without restriction. Rationing.
Both parties expect it. Democrats know it must happen, but won’t admit it. Republicans suspect that Democrats plan to do it (the real meaning of their poorly-put concern over “death panels”), but can’t prove it. Republicans prefer rationing through cost and individual responsibility, and relying on the government for the oversight function.
February 16th, 2011 | 12:15 am
I would still rather prefer the British NHS Health System than the systems operating in the USA where estimates consider as many as forty million people have no private health insurance cover at all.Here in Australia there is a mixed system of private and public health cover.
February 16th, 2011 | 9:04 am
Wes said, “That’s what you get with single payer health care.”
That’s what they got in England with their underfunded socialized medical system during the worst economic meltdown since the Great Depression.
Your conclusion exceeds your evidence.
If England had the political will they could easily fund perfectly adequate healthcare for all there, depriving right-wing American bloggers of anedcotes. And their healthcare would still cost much less than ours (where 10,000+ Americans die each year for lack of access to adequate care).
Wes, why do you focus on the worst examples from England, but not discuss healthcare systems in Finland, France, Japan or, as John Tobin points out, Australia?
That’s rhetorical. We know the answer.
February 16th, 2011 | 9:19 am
John, we don’t have scores of senior citizens rotting to death in hallways. When there is abuse at institutions here, it makes the nightly news and they get nailed to the wall. Over there, you can’t just nail parliament to the wall, and the only thing that seems to get done is a meaningless patient’s bill of rights.
Perhaps the biggest victim in a single-payer system is a charitable mindset. I only found these figures on a quick search, take them for what you will, but a government-run system saps the vigor of the people: http://www.philanthropyuk.org/resources/us-philanthropy. Though we give twice as much, 2.2% is still appallingly low.
Why give (or really care) when the government is taking your fair share to take care of it for you? What attitude does that give people, a “let’s fix this approach” or a “outsource my empathy to Washington” approach? I think it’s the difference between giving a man a fish and teaching him to catch it himself. And after 60 years of just giving fish to people in the US, does society seem any better off? Does throwing money at poverty really fix it?
February 16th, 2011 | 10:00 am
I would still rather prefer the British NHS Health System than the systems operating in the USA where estimates consider as many as forty million people have no private health insurance cover at all.
I’ve been one of those “uninsured”. I have actually used low-income clinics designed for uninsured people – not as nice as the Cleveland Clinic, but it gets the job done. And yes, they do exist.
Also, no ER can turn you down.
Also, for serious illnesses, you can get free health care by volunteering. That sounds really ghastly, but there are actually a number of safeguards in place. It sounds bad when compared against the top-notch treatment everyone feels they’re entitled to, but let’s face it, the sorts of diseases I’m talking about are the sort that we’re not going to be covering for anyone at all once we have central medical planning – because Obamacare and its variations are not based on growing the resources available, they merely redistribute the resources available.
If anything the available resource pool is going to shrink, not grow.
Right now, who does and does not have coverage is largely a response to personal initiative. I was uninsured and I took actions to gain insurance. I was able to do that. If I weren’t able to do that. I am not disabled. If I were disabled, and unable to take the actions needed, I would be able to get coverage through disability.
The people who are uninsured are either (a) people who are in transit (the real problem) and (a) people whose behavior needs to change.
We need to do something about the real problem, which is the gaps in medical coverage that come when you leave your parents’ plan or you leave a job or somehow or another you stop being covered.
The solution for the second group – those who are not covered because of their own behavioral choices – involves addressing the reasons for their behavior, not just simply giving them free coverage (which is a bad idea).
We need to fix the transitory coverage gap problem – and its evil uncle, the “pre existing conditions” problem – and we need to make sure nobody is going to actually die from a treatable disease.
Beyond that, we not only do not need to, but we should not provide free medical care, because we need to tie things like medical coverage together with productive behavior. We need to do this.
There comes a point when needs – real, legitimate, “if this doesn’t happen there will be consequences” types of needs – must outweigh wants and desires and “well I don’t think that sounds fair to me”.
What we really need aren’t grand new entitlement programs we can’t afford, but real solutions to how we can reduce the costs associated with medical care without sacrificing anything important (like granny).
February 16th, 2011 | 2:10 pm
The NHS had its funding significantly increased in the last two decades, from about 40 billion pounds in 1990 to just under 110 billion pounds this year. Things haven’t gotten better despite funding more than doubling – there’s no reason to think they’ll get better by throwing more money at the problem.
Generally speaking, increasing the budget of dysfunctional organizations just lets them be dysfunctional on a larger scale.
February 16th, 2011 | 3:50 pm
Wes said, “That’s what you get with single payer health care.”
That’s what they got in England with their underfunded socialized medical system during the worst economic meltdown since the Great Depression.
And hard times are a-comin’, here, too.
February 17th, 2011 | 12:42 am
SparkVark,
Are the numbers you supplied corrected for inflation and population?
The expenditures in the UK on healthcare increased from 6% of GDP in 1990 to just over 8% of GDP by 2007. During that same period US healthcare expenditures increased from 12% GDP to 16% GDP. Is our healthcare system twice as good as England’s?
http://en.wikipedia.org/wiki/File:Health_care_cost_rise.svg
February 18th, 2011 | 9:19 am
Jeffery,
Do we have more than half less senior citizens dying in sq
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