National Health or National Wealth?

OK, so yet again, there's a big debate brewing in the United States about the possibility of having universal healthcare; and yet again, there seems to be more wringing of hands and gnashing of teeth about the sort of plan that would benefit all citizens in the United States. More importantly, the President seems to be backtracking and slipsliding on so much of what was promised to the public during his election campaign. I watched the debate in which healthcare was mooted, and I'll be damned if - watching him now - he doesn't sound more and more like John McCain in that particular debate.

For someone who's always been progressively left of centre in her politics, I find that frustrating, so you can imagine my surprise last week, when my ueber-hero, Bill Maher (whom I'm convinced must have been the twin separated from me at birth), expressed my feelings exactly in Obama's domestic performance so far.

Look, I get politics - or at least, I get the politics of democracy. It's debate and haggle, compromise, give-and-take, you-scratch-my-back-and-I'll-do-the-same-for-you; and in the end, the people never get 100% of what they wanted, only some watered-down version that your local politico will inform you, in increasingly nannyistic terms, how much better the end result is for you than anything John Q Public could ever fathom for himself. Been there, done that - and on both sides of the Atlantic.

When I was growing up in the States, in the late Sixties and Seventies, my father worked at a textile mill. The place smelled up the local town, but it paid well and as part of the perks of the job, he got dental and medical insurance cover. His employer paid my dad's premiums, and for about an extra $15.00 per month, my mother and I benefitted also. The healthcare plan paid for braces to straighten my teeth and for surgery to remove my wisdom teeth before they even began to grow because X-rays showed they were impacted and would undo all the work braces had done. It paid for two stints my mother spent in hospital due to a stomach ulcer. I was covered by the plan until I was 21, because I attended university.

When I graduated and began teaching in Virginia, Blue Cross came as an offset to what, then, was a paltry wage for teaching in the public school system. Again, my county, which employed me to teach, paid the health premium. On the eve of my wedding, it covered extensive tests for lower back pain, the cause, it turns out, being gallstones.

During the late Sixties and early Seventies, all the horror stories you heard, concerning doctors and insurance, revolved around the doctors as the bogeymen. We were always told that doctors, especially specialists, loved to see people who had health insurance. It meant a plethora of unnecessary tests etc, which resulted in more money in the quack's back pocket; in fact, I remember various parents of friends of mine, encouraging them to examine employment packages as they searched for jobs after college, to see which one had the best health plan.

But something seems to have happened in the Eighties and Nineties. Looking at it from afar, it seems as if the insurance companies bit back, and now it appears to be a competition of collusion between the healthcare providers and the medical profession, with the poor, innocent sufferer bearing the brunt. Healthcare, from both ends, has become big bucks for Big Pharma.

Now, in 1981, I left the States because I married and moved to my husband's home country of Great Britain. This is where I've lived since then, so I'm well familiar with something that seems to be either the heart's desire or the feared red menace of various and sundry citizens in the United States, who are desperate for subsidized healthcare - socialised medicine, or rather, the single-payer system.

On the one hand, based on what I'm reading on various fora (because the Internet is really a lifeline between me here in Europe and my country), loads of people are clamouring for a single-payer scheme to be introduced, and, equally, as many are crying out against it because ... because it reeks of socialism (bad word), it means people have no control over the doctors they see, the treatment they have or when they have it, it's medical treatment rationed, and - worst of all - it's European. In fact, those latter, pejorative arguments are what the legislators opposing universal healthcare (in other words, the Republicans), are the ones being bandied about in debates, discussions and media propaganda.

So, sitting here where I am, who better to explain to the American people the intricacies of the single-payer system, known here in the UK as 'The National Health' (NHS, for short).

I'll be the first to admit, I'm not impressed with its quality, but then, I'm not impressed with much in the UK, as a whole; but at the end of the day, I don't pay to see my GP, I never see a bill for hospital or treatment costs, and - at most - a prescription costs roughly the equivalent of about $10.00. To be fair, the NHS is lots, lots better than I found it 28 years ago. The hospitals have improved, around 1990 or so, they decided that state registered nurses ought to really be able to do everything their Trans-Atlantic counterparts were doing for years, and so the Brits upgraded nursing to a degree course.

This is basically how a single-payer scheme works, based on the British example.

First of all, the Ministry of Health gets allocated whatever millions of pounds from the British Treasury every year. This money is then meted out to the various primary healthcare trusts, throughout the land. It's they who decide how the money is spent regarding healthcare in the region they cover. Doctors and nurses are all de facto employees of the State - GPs earn roughly about $210,000 per annum and nurses around $30,000 (more for nurse practitioners and specialist nurses - e.g., midwives). The basic gist is this:- The quality of healthcare you receive is related to the ability or inability of the primary healthcare trust to manage its budget.

A lot of times, this calls for skilfull manoeuvering of funds here and there. The administrator needs to be accurately assessed of patient needs in the area covered by the trust. For example, I live on the South Coast, which is a popular area for retired people, so here you see a lot of care homes and doctors specialising in geriatric medicine. All well and good, except the demographic is changing. More and more younger people are moving into the area, and it's becoming, basically, a series of bedroom towns; because housing is cheaper and the commuter line is reliable. So, over the years, we've seen more pediatricians, obstetricians-gynaecologists etc appearing on hospital registrars. Sometimes the monies allotted to healthcare trusts really have to be juggled, and this means that, in some cases, various wards and services in certain hospitals are shut and transferred to neighbouring hospitals. There are three major hospitals in my trust - in Dover, in Ashford and in Canterbury. Surgery is done at all three, but one type of surgery done at Ashford, might not be done at Canterbury, so resources are pooled. My boss, two years ago, discovered he had bladder cancer. His surgery and chemo were done at the main hospital in Canterbury. His daughter-in-law, later that year, gave birth to his granddaughter at Ashford.

Basically, here in the UK, everyone has to be registered with a medical practice located in your primary healthcare trust area. Usually, people register with the practice nearest where they live. Sometimes a GP operates on his own in a converted house, but mostly now, we have proper medical centres, with between 8 and 10 GPs, a couple of nurse practitioners and a physiotherapy department. The procedure is, if you're ill, you ring up on the day, usually in the morning, and you're given an appointment; mostly, you do get to see the doctor with whom you're registered. Practices are open Mondays through Fridays from 8:30AM until 6:00PM. House calls, I'm afraid, are a thing of the past. If you need a blood or urine test, usually this can be done at the practice and you get results back within a week. You can also arrange for repeat prescriptions to be done and delivered to the pharmacy of your choice, so all you have to do is turn up and collect it (after paying the requisite $10.00, for it).

It's difficult to change practices, if - for example - you're dissatisfied with you GP. That's a snag, but it can be done, albeit it's not easy; and it can only, at most, be done once. It's not a system that lends itself easily to shopping around for doctors.

Specialist doctors or surgeons are allowed private practices - this is what you see on Harley Street - but they can also opt to work as well for the NHS. These are your superdocs, who make a lot of money. If someone needs specialist treatment, your GP consults the rota for the healthcare trust and you're assigned to such a specialist as you need, who's next up on the rota - or, if you need rather immediate attention, your GP may try to assign you to the specialist with the shortest NHS waiting list.

Here's what's scaring some people. Yes, non-emergency treatment/surgery does usually incur waiting - maybe a several weeks, maybe several months. This usually concerns things like bunions, hip replacements, tonsilectomies, herniae etc. If you're in need of emergency attention - appendicitis, heart attack, diagnosis of cancer etc - you're admitted to hospital forthwith. Usually, however, the wait is no longer than about 2 months.

If you need outpatient treatment, that's immediate too. No cancer patient needing chemo or radiation therapy ever has to endure a waiting list.

Oh, yes, and the gulag wards are gone. I was hospitalised six months after my marriage due to a motorbike accident in 1981, and I woke up to find myself in what can only be described as a Third World hospital, with a ward of 20 beds in a scene out of something last seen in the US in the 1920s. Two years ago, my husband accidentally slammed the bedroom door on my middle finger and sliced the tip off. I went immediately to hospital in Ashford. As it was a hand injury, it was deemed plastic surgery and I was admitted to the ward - the NHS plastic surgery ward: private room with a bathroom/shower and toilet, all the mod cons. I was in hospital three days total and I was suitably impressed with the treatment and the facility.

Yes, here we have c-diff and MRSA, but who doesn't?

And we do have our problems with the NHS here as well. It's always underfunded, and - especially in the past 10 years - it's been horribly oversubscribed, due to unfettered immigration allowed by the Labour government. The UK has an ageing population, and as people get older, they need more medical care; add to that, a great number of immigrants from the Indian subcontinent, Africa and the old Eastern Bloc countries are showing up with urgent medical problems and the arteries of the NHS are being clogged. Five years ago, tuberculosis was unheard of in this country; now it's increasing 20% each year, and all cases are immigrants recently arrived. Hepatitis B is on the rise, again traced to the African immigrant community. These problems strain the health resources, resulting in longer waiting lists; but they are problems that could be resolved if only the current or future government would grow a pair.

The result of all that is that some of the services will have to be cut or altered in the next two years (aided and abetted by the economic climate as well) - and make no mistake, Big Pharma does operate here too.

Now, could this system work in the US?

I'd like to think so; albeit, I'm more inclined to think that perhaps the legislators might look more to France than to Britain for an example - although I know anything French is still viewed with disdain over there. They employ mainly a government funded health service, but require that employers, through heavily regulated private healthcare insurers, offer employees and their dependent families, top-up private healthcare insurance. This offers people more of a choice in who treats them and how they are treated. It even covers alternative medicine and stays for up to one month in health spas. Unemployed people, pregnant women, children and pensioners are covered 100% by the government, as is any citizen with cancer or heart problems.

But either plan means something that the President is not being totally honest with you about. Oh, I don't mean he's dishonest. Obama's probably one of the more honest politicians in the world (at least at the moment, she says, with a jaundiced eye). I think he's trying six ways until Sunday to find another option, rather than admit that he's going to have to raise taxes.

That's right. Across the board. That's the way ALL the universal healthcare programmes are funded. People in those countries pay higher taxes. They pay higher taxes and their health needs are taken care of by the government. Maybe this is why Obama & Co are unwilling to look at any government option in universal healthcare - that and the fear of offending the medical/medical insurance lobby. And then comes this absurd notion of taxing existing Medicare and Medicaid benefits to raise the proposed $1.6 trillion to fund the scheme.

Oh, my godfathers! It's not rocket science. It's simple.

If you have a universal healthcare scheme, Medicare and Medicaid become, in and of themselves, redundant. Unnecessary. De trop. Kaput. Not needed. Because universal healthcare is just what it says: universal. For everyone. Men. Woman. Children. Old people. Everyone.

My solution is simple: Let's try the single-payer option. Or let's not. Let's go with the French-Continental plan; but either way, let there be an element of government option in this plan; and let's scrap Medicare and Medicaid, free up the monies put into their budget to plow into our new all-singing, all-dancing national health service. And let's raise taxes. Come on, you have to ask yourselves ... Do I want to pay higher taxes and not worry about someday incurring a $50,000 hospital bill which could bankrupt me if I had to pay it myself? And while we're worrying about the intricacies of this new plan, let's do something about immigration too. Someone somewhere else wrote that in Canada, only Canadian citizens were allowed to avail themselves of the health service; anyone immigrating there for work, however temporary, simply wasn't covered. In order to ensure that our health service isn't oversubscribed, make sure the service only covers citizens and legal aliens with a Green Card.

I want to see a health service. I want something to be legalised and in place, at the earliest, by autumn. I don't want to see the Party of No, aided and abetted by Democrats who should really be thinking about forming a new Republican Party, stymie this agenda, which has to happen now, must happen now. Any delay, any diversion, and it just becomes another thwarted attempt at something with which we should be leading the world.

And if Obama's going to do anymore backtracking on this subject, I'd like him to grow a pair and backtrack to the people who elected him and demand that the legislators cobble together a health service that includes a public option.

If that can't be done, I'd like to know who the hell castrates anyone and everyone who suddenly finds himself at the helm of a nation?

Weapon of Mass Distraction

I'm a huge fan of Bill Maher's wit and observations, so here’s a New Rule for Bill to ponder: The government must use reality television and use it relentlessly and exclusively as a weapon of mass distraction in order to divert the public’s attention from the nation’s major problems at the moment. They must take their lead from Great Britain, the old Mother Country and master colonizer; because the Brits have got this mojo down to an art.

We’re all familiar, by now, with Susan Boyle, the dowdy, little Scotswoman who tottered onto the television screen weeks ago on the reality freak show-cum-talent search called Britain’s Got Talent. She’s the one who looked like the back end of a bus and sang like a canary, the one who secured instant and worldwide fame from millions of hits on YouTube. No less than NBC News, amongst other entities, billed her dream-come-true performance as a fairytell feel-good factor for these troubled times. Bill even did a parody of her fame path a few weeks back on Real Time.

Within days of her first televised appearance, the public had an information overload about Susan Boyle. In fact, we knew more than we needed to know – that she was a 48 year-old virgin who lived alone with her cat, that she’d never had a boyfriend, that she’d never been on a date, that she’d never been kissed, and – most tellingly – that she had a crush on one of the two male judges on the programme, Piers Morgan. Once this was public knowledge, Morgan, ever the outwardly courtly gentleman and even more the self-publicist, stepped forward and volunteered to take her out for a meal, rounding off the evening with a courtly kiss.

Now, in the weeks afterward, the great British public has been daily apprised of Boyle’s activities, including the press-inspired rivalry for the winning spot in the show between her and a 12 year-old boy who sang like Michael Jackson (not that Michael Jackson and 12 year-old boys should ever be juxtaposed, mind you). And so the populace was duly distracted, and, lo, they thought no more of things like soaring unemployment, wage stagnation, the absolute tanking of General Motors (whose subsidiaries here employ a large number of the British workforce in certain areas of the country), a significant increase in violent crime directly related to the economic turndown … things like that. You know, things that matter.

Then, a few weeks ago, a British newspaper discovered and reported the fact that the officials the people had elected to serve them were robbing them blind – claiming taxpayers’ money for everything from lightbulbs to horse manure to moat-cleaning services right on up to mortgage payments on houses whose mortgages had been redeemed years ago. They were, they discovered, being conned. And, lo, the righteous public became indignant with anger and vented their venom on the politicians in whom they’d placed their trust.

The scandal widened. The hole became a veritable breach, a crevice in which, not only the elected government, but also the loyal opposition, threatened to fall and vanish without a trace. This bothered the public greatly. They thought about and discussed it constantly. In the pubs. At the hairdresser’s. In the gym. At the dinner table. They talked of nothing else, not even soccer (or football, as they call it), which is the religion by which the most of the male population lives.

Until last week.

Last week, attention was turned, by the tabloid press, back to Susan Boyle, but in a slightly sinister way this time. Whilst watching an episode of the competition in a public venue, Boyle heard her favourite judge and one-time date, Piers Morgan, praise her rival, intimating that he thought the lad might win the competition. In a New York minute, Boyle went beserk, screaming obscenities at the television screen, slamming crockery and glasses about the table at which she sat – she had to be escorted from the premises. The following day, when out and approached by some fans, she screamed at them also. People began wondering if she were cracking under the pressure of the competition.

As we all know now, in Saturday night’s final, she lost out to a bevy of youthful boy dancers, whereupon she thanked the show’s sponsors gratefully, hiked her gown up to her thigh and shimmied suggestfully in Morgan’s direction before retreating backstage, throwing a glass of water over a stagehand and screaming her distaste for the show. The following day, police and medical officials were called to her hotel, after she again threw a tantrum. She was sectioned, whisked away and admitted to The Priory Hospital, a private mental hospital in London. She’s due to remain there, at least, until the end of the month.

At first, two of the three judges, Simon Cowell and Piers Morgan, were at pains to reassure the public that Susan was ‘just tired and needed a bit of rest.’ But then the ugly truth started to emerge.

Susan Boyle wasn’t just a lonely spinster from a remote Scottish village. She was a woman with learning disabilities who’d been brain-damaged at birth. She was the youngest of a family of largely articulate people, and she’d been sheltered at home because of her disability and her erratic behaviour. So the date with Morgan, in Susan’s eyes, was seen in a completely different perspective than the condescendingly kindly gesture the man, himself, meant it to be.

Now there are three things to glean from this:-

1. In the midst of all this turmoil, when questioned about his sister’s health, all her brothers could think to say is that she would ‘bounce back’, but that he and she were both worried … because the promised recording contract had yet to materialize. However, he revealed, yesterday, a representative from Simon Cowell’s recording company was due to meet with Susan and discuss some terms. In a mental hospital. Even in the depths of mental and emotional despair, the greedy side of our nature, that desire for fame and fortune, never leaves our side. Perhaps it’s actually the last conscious feeling to leave us as we throw off this mortal coil. Who knows?

2. At the end of the day, everyone now admits what was previously inadmissible: that Susan Boyle really wasn’t a great talent, that her voice wasn’t astounding or exceptional. Merely good. What was astounding, mostly to the self-proclaimed experts by whose surprised reactions we allowed ourselves to be led, was the fact that the three judges were so unequivocally surprised that a woman who – by the perceived standard of the day – was no physical beauty, could pleasantly carry a tune in a strong voice. Of the three judges in question, I might add, two were privately-educated schoolboys, one of whom had been summarily dismissed from his position as the editor of a national newspaper for libel, and the third was an actress of dubious talent whose initial claim to fame was her very public dumping of her much older entertainer husband for a younger man. Indeed, why should any of us – and I never watched the programme – be surprised that someone who looks like Susan Boyle can sing? Look at opera singers. Devoid of slap (British slang for make-up) and costumery, most of them are plain, overweight women, who happen to have magnificent voices. Are we so shallow that we can only attune ourselves to a person’s outward appearance before examining the talents which lie within?

3. And finally, amidst all this kerfuffle, which has been dominating news media here, we’re missing the fact that the leaders of some of Britain’s biggest industries, in a year of recession, awarded themselves the equivalent of $750,000,000, in bonuses; that a professional soccer team here signed a player whom they’ll pay the equivalent of $225,000 a week and whose fans will see that salary reflected in price hikes for admission; that General Motors, which employed more than 300,000 people in the British workforce, has declared bankruptcy; and, that, as I write this the government is tanking and right wingnut parties are appearing ominously on the horizon.

And throughout all of this, the nation ‘prays’ (that’s right, Britain ‘prays’) for Susan Boyle’s recovery, almost with the intensity of a torchlight vigil. How touching.

So, the proof is in the pudding for Obama. In order to divert the public’s attention from the any serious worries about things that really matter - you know jobs and banks and home foreclosures and health care and Detroit - the President must appoint Simon Cowell as Special Advisor on Adversity Diversion, with a brief to utilize reality television to its fullest freak-show capacity.

You know, three hundred years ago, insane asylums hung the inmates outside their walls in cages, in order that they might entertain the passing public, who would see these poor unfortunates and forget about the pressing problems of the day. We really haven’t progressed so far, have we?

And, yes, in case you hadn’t guessed, I am having a bad day, so I apologise for the rant.

Keep well.