Saturday, June 20, 2009

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?

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