Britain must put health before political philosophy

Sick

It is sometimes said that the NHS is the closest thing the increasingly secular British have to a religion. And, like a religion, when questioned its defenders react with accusations of evil and heresy. When Daniel Hannan criticised the NHS in 2009 then Health Secretary Andy Burnham branded him “unpatriotic”.

The dogged defenders of the NHS are wedded to the idea upon which it was founded – the provision of healthcare to all, free at the point of use. In their love of this egalitarian idea they forget that the NHS exists to take care of people’s health, not to advance a political philosophy.

And so, when evaluating a healthcare system, what matters is not the political philosophy but how effectively it cares for your health. The NHS is just a tool, no more, no less, to be employed towards the actual goal of health care. The NHS is useful only so long as it achieves that goal more efficiently than an alternative system. It makes no more sense to get emotionally attached to the NHS then it does to get emotionally attached to a spanner.

Perhaps the revelations from the Alexandra Hospital in Redditch, of patients left screaming in pain, wallowing in their own faeces, starving to death, and receiving cruel treatment from nurses, will finally force the dogged defenders to wake up, grow up, stop relying on unthinking emotion, and critically evaluate our 64-year-old health care system.

It is almost impossible to say anything critical of the NHS without someone accusing you of wanting an American system where, as healthcare expert (sic) Russell Brand puts it, “people die on the streets” for want of an NHS. Indeed, in the UK they die in the hospitals from starvation or lack of hygiene and the consequent deaths from easily preventable infections like C Diff or MRSA.

The idea is that, rather implausibly, the USA has (or had) a profit driven, unregulated market for healthcare. In truth, even before Obamacare, the health care system in the USA was, along with finance and housing, one of the most regulated, government-driven sectors of the US economy. And what do all those markets have in common?

Secondly, it is utterly false to pretend that the mythical capitalist free-for-all of the US is the only alternative to the NHS. This is a falsehood born either of dishonesty or an ignorance of the variety of healthcare systems.

In Japan patients can go to any doctor or facility they choose and they pay 30 percent of the costs. In Italy patients co-pay with the state for drugs and visits to doctors but can opt out completely into a fully private alternative. In France people pay an insurance premium to one of a number of competing companies, pay when they visit a doctor, and are reimbursed the majority of the costs. Across the world in fact a mixture of public and private is the norm in health care.

The World Health Organisation ranks each of these systems above the NHS. In fact, the WHO ranks the health care systems of 11 out of 34 OECD member countries above the NHS. Yet we continue to tell ourselves that “the NHS is the envy of the world” like some catechism. Well, it isn’t the envy of Japan, Italy, and France.

The NHS model of a single monopoly producer and central planning was a major factor in the disgusting lack of care at the Alexandra Hospital. Under the NHS the health care providers, doctors and nurses, work to satisfy targets handed to them by a central, unitary authority. It is these targets they must meet, these bureaucrats they must satisfy, not the patients who have little if any choice over the care they receive.

The NHS killed 1,200 people in Staffordshire. Can you imagine any other organisation in the country killing 1,200 people and trying to cover it up without serious, fundamental questions being asked about whether that organisation ought to continue?

Blindly defending this system does not make you noble, good, or compassionate. We must stop prioritising political dreams over people’s health.

This article originally appeared at The Commentator

Time for an economic Nuremberg for the last Labour government

The guilty men

ike an iceberg, the extent of the damage wrought by the last Labour government is still becoming apparent.

One of the wheezes Labour used to camouflage its vast spending spree was the Private Finance Initiative. These had been brought in by John Major’s Conservatives (to criticism from the then Labour opposition) and involved a private sector entity building something and then selling it or leasing back to the government over a number of years, usually decades.

Upon winning the election in 1997 however, Labour performed a volte face and embraced PFIs. They appealed to Gordon Brown because the liabilities taken on under PFIs would not show up on the government’s balance sheet. In other words, they wouldn’t be included in the national debt figure.

Labour signed up to an estimated £229 billion of PFI projects. That’s almost two and a half times the entire projected budget deficit for 2012 – 2013, or 16 percent of GDP.

And all of it was off the books. This enables Labour supporters to argue that “Public sector net debt (as a percentage of GDP) FELL from the start of Labour’s time in government until the beginning of the global financial crisis”. But, if you include the PFI liabilities the Labour government signed us up to, any fiscal improvement during their time in office vanishes and this already thin argument does likewise.

Perhaps Brown was stupid and/or hubristic enough to believe he really had banished “Tory boom and bust”. Perhaps he calculated that he would be long gone before the bills for PFI landed on the mat. Either way, while in the long run Brown is (thankfully) politically dead, we taxpayers are not.

Last week it emerged that six NHS trusts were facing bankruptcy thanks to the PFI deals struck by the Labour government. As the Telegraph reported

“The total value of the NHS buildings built by Labour under the scheme is £11.4bn. But the bill, which will also include fees for maintenance, cleaning and portering, will come to more than £70bn on current projections and will not be paid off until 2049…Some trusts are spending up to a fifth of their budget servicing the mortgages…Across the public sector, taxpayers are committed to paying £229bn for hospitals, schools, roads and other projects with a capital value of £56bn”

Indeed, like the cat who leaves little ‘presents’ around the house for you to discover when you return from holiday, the Labour government of 1997 to 2010 is the gift that keeps on crapping on your carpet. We will be discovering fiscal turds left by Labour for literally decades to come.

If you were being charitable you would ascribe the fiscal incontinence of the Blair/Brown governments to some sort of Keynesian economic theory, though that fails to explain why they applied fiscal ‘stimulus’ for seven years to an already growing economy.

If you were being slightly less charitable you might ascribe it to incompetence of a quite staggering degree. The last Labour government, after all, were probably the biggest set of mediocre idiots ever to govern this country.

And, if you were being even less charitable, you might ascribe it to something more sinister – Brown poisoning the wells when he heard opposition tanks at the end of his strasse.

The architects of this national disaster have moved on. Blair is swanning around the globe earning millions. Brown is off brooding somewhere and probably enjoying it. Ed Balls, Brown’s right hand man through all this, is now, incredibly, Labour’s shadow minister for the economy!

We will have to live with the consequences of their mismanagement for years, why should they get away scot free? When we look at the continuing harm the Blair/Brown governments did to Britain shouldn’t we consider some sort of economic Nuremberg for these people? To punish them, Blair, Brown, and Balls, for the harm they have done to the British public?

Of course, you could argue that the electorate is responsible for electing these dangerous cretins. After all, every single majority Labour government in history has left office (in 1931, 1951, 1970, 1979, and 2010) with the economy in meltdown. Assuming that Labour voters aren’t so stupid that they don’t know this you have to conclude that they simply don’t care if the economy collapses.

In the wake of the Barclays rate fixing scandal, Ed Miliband has called for a full public inquiry into the banking industry, saying, “If you go out and nick £50 from Tesco, you are punished, at least we hope that you are punished – if you fiddle, lie, cheat to the tune of millions of pounds, you should also have the full force of the law brought against you.”

As Britain’s economy continues to smoulder isn’t it time for Miliband’s former colleagues in the wretched Labour government of 1997 to 2010, Tony Blair, Gordon Brown, and Ed Balls, to face a reckoning for the continuing damage they wrought upon the nation?

 

Unhealthy Obesession

Dean Acheson famously said that Britain had “lost an Empire and has not yet found a role”. That was in 1962. In 2009 it seems we Brits have finally found one; looking down our noses at the Americans.

Russell Brand recently took time off from making offensive phone calls to old men to weigh into the debate on US healthcare, proudly announcing at the MTV Video Music Awards (a novel setting for a policy pronouncement) that in the UK , unlike the US , “instead of letting people die in the street we have free healthcare!”

You probably shouldn’t expect someone’s eyesight to be too sharp when they’re peering down their nose from astride their high horse but even so, Brand managed to fit two glaring errors into just 12 words.

First, the National Health Service is not free. Doctors and nurses aren’t volunteers and neither are the 2 administrators for every single bed in the system. The NHS consumes 18% of all government spending. That comes from taxes. Secondly, he is right that people rarely “die in the street”. In the UK you die of poor treatment or hygiene in the hospital.

That’s if you get in. As a centralised, socialised system the NHS is driven not by profit and loss in competition but by a deluge of ever changing targets and directives from central government. One target mandates the maximum amount of time a patient should wait after arriving at the hospital before receiving treatment. But targets invite fiddling and ambulances are kept waiting outside hospitals so as not to start the clock ticking. A letter obtained under the Freedom of Information Act from Chairman of the Ambulance Trust Graham Meldrum reveled 7,600 instances of this in October last year alone.

Once inside the NHS cannot even keep its premises clean. One result is Clostridium difficile, a bacterial infection. In England in 2007 C Diff was mentioned on 5,465 death certificates being listed as the main cause of death on 2,298 of them. By contrast, in the same year, 47 British soldiers died in Iraq . Then there is Methicillin-resistant Staphylococcus aureus, MRSA for short. In 2007 MRSA was mentioned in 1,593 death certificates being given as the cause of death in nearly 500. Again, in 2007, 42 British soldiers died in Afghanistan.

If the unsanitary conditions don’t get you the treatment, or lack of it, might. For example, for all cancers 66.3 % of American men and 63.9 % of women survive more than five years. In Europe just 47.3% of men and 55.8% of women survive that long. Breast cancer mortality is 88% higher and Prostate cancer mortality is 604% higher in the U.K. Neither do these treatments bankrupt poor families. Out-of-pocket expenses by American patients are 12.6% of national health spending, lower than in Germany, Japan, Canada and most of Europe.

These are the facts that get lost in the debate about ‘Obamacare’. The primary aim of ‘reform’ is not to improve the health of the people, though its supporters no doubt believe this would follow, but to introduce ‘equality’. These moral considerations are far less quantifiable.

Earlier this year Conservative MEP Daniel Hannan was interviewed about the NHS on Fox News and called it a “60 year mistake” which he “wouldn’t wish it on anyone”. For this saying this the Health Secretary of the UK government branded Hannan “unpatriotic”. He didn’t say he was wrong, and any attempt to debate the NHS in the UK invites the charge that you want to see poor people die. Its often said that in secular Britain faith in the NHS is the closest thing we have to a religion these days. Indeed, to see the venom directed at Hannan was to see something not a million miles from the denunciations of the medieval church. But blind faith, even in socialism, is no substitute for reason.

The same thing is being tried in the US in the current debate; the smearing of opponents of socialization as uncaring and elitist, or, as Jimmy Carter tried to put it recently, racist. That is why it is so vital to look at the statistics behind the socialists empty rhetoric.

Florida Congressman Alan Grayson said 44,000 Americans (out of a population of 300 million) die each year as a result of not having health insurance. But no system will be perfect. Leading oncologist Karol Sikora estimated 10,000 cancer deaths (out of a population of 60 million) in the UK every year because we have the NHS as opposed to another, more efficient system.

One of the most honest and insightful commentators on socialized medicine in the UK, James Batholomew put it this way; “I certainly do not hold up the USA as a model healthcare system. It is deeply flawed. But it is still much better at saving the lives of the greatest possible number than our, far more deeply flawed system. It depends what you want: a flawed system that saves more lives or a disastrous system that people feel is virtuous. This is a secular version of creationism. Many people in Britain love the NHS. They don’t care about evidence. They don’t care how many die. Believing in the NHS makes them feel good about themselves. I find it appalling that people are so self-indulgent and so uncaring about the reality.”

For more information on James Batholomew and his thoughts please refer to his book “The Welfare State We’re In” at http://www.amazon.co.uk/Welfare-State-Were-James-Bartholomew/dp/1842750631

A reply to ‘National Socialist Health System?’

In the US this summer everywhere I went the second thing people said upon finding out I was British (after ‘thanking’ us for Dancing With the Stars) was to ask about the NHS. The debate over healthcare reform is raging in America.

The debate is raging here too it seems as evidenced by the article ‘National Socialist Health System?’ in the last London Student. Like many contributions to the debate, it contained some fallacies.

The first fallacy came with the assertion that the controversy over nationalizing 1/7th of the American economy was “essentially manufactured and delivered by some of the most toxic elements of the American right-wing press.” I spent two weeks in Minnesota, one of the most social democratic states in the US (the only state never to vote for Reagan). Contrary to the articles assertion, the people quizzing me about the NHS were not raving right wing lunatics but ordinary Americans understandably concerned about the vitally important question of what happens when they get sick.

Next the article referred to the “46 million Americans without any health-care cover whatsoever”. First, the figure of 46 million contains 35 million who could afford insurance if they wanted to but choose not to. They may be young, sporty, don’t drink and smoke. Like a man who lives on top of a mountain doesn’t take out flood insurance, these Americans decide the chances of them needing healthcare are so small it’s not worth the cost.

Also the author didn’t mention Medicaid, the government insurance scheme for Americans on low incomes. Medicaid spent $204 billion in 2008 and will be bankrupt in the next decade.

The article mocked the “Freedom to suffer and to die prematurely due to inadequate health-care access”. But this sarcastic freedom doesn’t hold up. For example, for all cancers 66.3 % of American men and 63.9 % of women survive more than five years. In Europe just 47.3% of men and 55.8% of women survive that long. Breast cancer mortality is 88% higher and Prostate cancer mortality is 604% higher in the U.K. Neither do these treatments bankrupt poor families. Out-of-pocket expenses by American patients are 12.6% of national health spending, lower than in Germany, Japan, Canada and most of Europe.

Finally the article said that the NHS does not have “Orwellian death panels or bureaucratized guidelines on the worthiness of treatments for various categories of people”. This ignores the existence of the National Institute for Health and Clinical Excellence (NICE). This is the body which decides whether the NHS can afford this or that treatment, such as memantine for the treatment of Alzheimer’s disease and various drugs for treating renal cell carcinoma, both of which NICE refused to provide as not being “cost effective”.

American healthcare is clearly not perfect. Florida Congressman Alan Grayson said 44,000 Americans (out of a population of 300 million) die each year as a result of not having health insurance. But neither is ours. Leading oncologist Karol Sikora estimated 10,000 cancer deaths (out of 60 million) in the UK every year because we have the NHS as opposed to another, more efficient system. Discussing these issues makes you a concerned citizen, not a foaming nutcase.

(Printed in London Student, vol 30 issue 3, 19/10/09)