Socialized Medicine: The British View

[poliphilo]

We Brits love our NHS.

Many of us (including Professor Stephen Hawking) think we owe our lives to it.

Universal healthcare, free at the point of delivery- brilliant, eh?  No worries about keeping up with the payments, no women in labour being turned away from hospitals because they don't have the insurance, no-one suffering or dying because they can't afford the drugs.

Sure we have our complaints:  the NHS has been mismanaged, over-managed, underfunded- there are constant scandals and controversies- but no politician would dare suggest dismantling it- not even those on the far, far right.  The battle for socialized medicine was won in the 1940s- and now there's no British institution- not the monarchy, not the BBC, not the "mother of  parliaments"- that's more highly regarded or more firmly bedded in.

We understand you Americans are being offered a system of socialized medicine similar to ours and that some of you, instead of dancing around in your pyjamas and firing off skyrockets, are actually campaigning noisily against it. This surprises us. It fact it bewilders us.  If we didn't regard you Americans as cousins we'd be going "Foreigners, eh?" and doing that thing where you hold your forefinger level with your temple and twirl it round and round.

Comments

[veronica-milvus.livejournal.com]

Did you see that very illuminating short TV series where some captain of industry - Geoffrey Robertson? - investigated what was wrong with the NHS?

I remember these things:

No culture of innovation - if somebody has a bright idea, there's no forum to evaluate and implement it.

Too much unionised demarcation - they showed a bit where the guys painting the walls had to paint round radiators because they weren't in the right union to take them off the walls to paint behind them.

The role of doctors - as I recall they are not employed directly by the NHS but are self-employed contractors. Because of their "clinical judgement" they would not recognise the authority of hospital trust managers and would bloody well do what they liked - at consultant level they seemd to have no bosses. Thus the hospitals were run for their benefit and not for the patients. This attitude is very prevalent in the British medical establishment and is a direct result of the way they are trained to be arrogant.

After 60 years, those problems are entrenched in the mindset and cause no end of inefficiencies, but there's no reason why an American system should reproduce them, they could have a universal medical system and avoid all of those issues. I hope they do.

[poliphilo.livejournal.com]

I've noticed doctors- GPs anyway- becoming noticeably less arrogant over the years. We had a doctor about ten years ago who was brusque and dismissive in the approved style; she went away on a retraining course and came back nice as pie. Since then all our GPs have been darlings.

Personally, I've nothing but praise for the NHS. Our local hospital- Oldham Royal- has a proud record (it's where Steptoe "created" the first test tube baby) and it treated Ailz wonderfully when she was rushed in- some years back- with an exploding gall bladder. On the other hand, Ashton General- the flagship hospital for the authority next door- has a terrible reputation.

[jackiejj.livejournal.com]

The noisy campaign against NHS is deliberately attempting to inflame and frighten ignorant people, and is being orchestrated (heavy sigh) by the far right zealots, probably the same group that refuses to believe Obama won the election! The latest hysteria: so-called Death Panels, which, so say the inflamers, are committees that triage the worthiness of people to live or die--one wag said, "What about bored people? Whiners? People with unpleasant birthmarks?"

[lblanchard.livejournal.com]

As one of the people who opposes the Obama plan, I hope you aren't calling me ignorant. Reasonable people can disagree on issues. EDIT: And I don't think there's a group that refuses to believe Obama won the election. There is a group of crazies who believes that Obama was born outside the U.S. and thus ineligible, but craziness isn't the province of only one political party -- about the same number of people on the other side believed that George W. Bush had advanced notice of the September 11, 2001 attacks and suppressed it for... well, they were never completely clear on that.

[jackiejj.livejournal.com]

Laura, I am certainly not calling you ignorant. I referred specifically to a group that is deliberately trying to inflame and frighten ignorant people.

I know, of course, that thinking people will not always agree with my own opinions.

[poliphilo.livejournal.com]

Re death panels: I believe the inflamers have picked up on the fact that some British National Health trusts have refused to buy very expensive new drugs for sufferers from terminal cancer. These drugs don't cure cancer, but are claimed to slow down its progress. These claims are disputed. The debate- as to whether it's worth the huge expenditure to keep very sick people alive for a few extra months- seems to me to be eminently worth having.

People are free to opt out of the National Health Service- and those who are rich enough can buy themselves any treatment they like. Most people are happy to stay inside the fold- even right-wing people. The Conservative leader- David Cameron- makes a point of using the NHS for himself and his family (even though he could afford private medicine) and gets political kudos for it.

[frumiousb.livejournal.com]

I've also seen the Dutch rules around Euthanasia put forward as evidence of socialist European death panels. Which misses the point, of course. (I *do* have some questions around how it is applied here but this does not have anything to do with rationing.)

[poliphilo.livejournal.com]

At present Brits who want "assisted suicide" have to go to Switzerland to get it. This is allegedly illegal, but no-one has yet been prosecuted as an accomplice.

I don't have very clear views on the issue myself, but I'm glad that we're having the debate.

[daisytells.livejournal.com]

I have seen some of the results of life-prolonging drugs. All that they do is prolong suffering. If the patient wishes to discontinue such treatment, family members, overcome by guilt/compassion work on the patient to not "give up". In some cases, when a patient dies the family overrides the living will. They demand that resuscitation be administered, so that the sick person can suffer a little more in the hopes that a cure will be discovered during the interim.
There is such a thing as "quality of life" -- I opt for quality over quantity, and believe that there is a point at which the medical establishment ought to stop "selling" patients and their families on experimental treatments and/or "cures", and allow them to die with dignity.
Yes, I believe the time has come for a National Health Service in the USA. Why? Because for much of my young life I could not afford to seek medical or dental care due to the need to either pay up front or present evidence of insurance (which I could not afford). I have seen others delay medical care to the point where a simple problem escalated into a serious, life-threatening one.
"Health care, free at the point of delivery" -- Yes!

[poliphilo.livejournal.com]

I agree about life-prolonging drugs. I don't want to live forever.

There may be cases where a person wants to live long enough to witness some important event- like a birth or a wedding- and I can see the point of dragging out the dying process- otherwise I'd have thought the best thing was to get it over with quickly.

[veronica-milvus.livejournal.com]

There's a sense in which all of us in the west have become detatched from death and believe it should not happen. But, I digress. What I was going to say is that healthcare is rationed everywhere. Yes, there are some things that NICE argues against in the UK (and NICE is odd because it doesn't take the cost of social care into account).

In America, people's insurance runs out at a certain point, or as is the case for 15% of the population, they've got no insurance at all. At least the British system has a greater degree of equity.

On my LJ I copied a very eloquent piece from todays' London Evening Standard, written by a Brit who has lived in the States. He's got it right, I think.

[poliphilo.livejournal.com]

That article says it all.

I know, simply from reading my FL how much anxiety and suffering the US health system causes. The NHS isn't perfect, but it's so much more humane.

[ideealisme.livejournal.com]

Count me in as another who doesn't get the opposition in the US. Our healthcare system is terrible, riven as it is by parish-pump politics, unionisation and vested interests (and everyone blames the minister who, they forget, actually volunteered for the job!) but still, Jonathan's mother owes her life to their care.

[poliphilo.livejournal.com]

I don't suppose any national healthcare system is perfect, but I'm very glad I live with the British and not the American set-up.

[daisytells.livejournal.com]

That seems to me a simple choice, with the UK system winning every time.

[poliphilo.livejournal.com]

It surprises me that opponents of the Obama plan are holding up the British NHS as an example of How Not To Do It. This seems to me to disregard all the evidence. The NHS isn't perfect, but it does offer healthcare, free at the point of delivery, to every citizen, whereas (according to a news report I heard just now- can I really have been hearing right?) something like 40 million Americans have no access to healthcare whatsoever.

[jenny_evergreen]

The really sad thing is that we aren't being offered anything close to real socialized medicine. We're basically being offered a heavily expanded version of Medicaid, with a few ridiculously obvious changes to what is legal for insurance companies to do (like making it so they can't rule people out for pre-existing conditions)...as I understand it.
I wish desperately that we WERE being offered proper socialized medicine.

[poliphilo.livejournal.com]

Well, one step at a time.

I can understand people being critical of aspects of the Obama plan, but I find it hard to see how anyone can be opposed to the basic idea.

[jenny_evergreen]

It seems to be mostly the generation that grew up with The Red Menace, who fear descent into *sarcastic shudder* Communism. Bah.

[poliphilo.livejournal.com]

Yes, as someone who has lived with the NHS all my life- under governments of both left and right- the idea that socialized medicine means the advent of Big Brother is barely comprehensible.

[daisytells.livejournal.com]

I never believed in the "red menace" and I grew up in the McCathy era of the 1950's, hiding under the desk at school in order to avoid being killed by an atomic bomb. Honest to God! People were so gullible back then, believing there was a communist hiding under every bed, hell bent on taking over the United States and making slaves of us all!

[jenny_evergreen]

What's truly disturbing is how many apparently still believe it! *shakes head* I'm usually very optimistic about the human race, but this healthcare thing is having an alarmingly negative effect on me.

[dadi.livejournal.com]

I think it is also a question how this national health service is managed.. in the UK it DOES work, but in Italy for example, it is a major, total desaster.. though "officially" you do have health service guaranteed, no matter if you are a homeless 90 year old or a rich banker, de facto if you don't have the money to either afford private insurance or pay for extra services, you often can as well up and die if you need anything out of the basic "survival" stuff. I have several female friends who, when pregnant, went to their doctor for the "usual" pregnancy examinations and were told that the waiting list for free ultrasounds and other necessary things were, like, 9 months into the future, so yeah, if you are 3 months pregnant, what do you do? yep, pay through your nose for your ultrasound, done by the same bloody structure who does the national health service, paid by national health money, but done out of national health service time (usually 4 hours a day) by the same doctors, privately. And a lot of Southern and Eastern European countries with nationalized health systems are exactly the same. Poor people continue to die in the ER waiting rooms, run around without teeth and live their old age blind and deaf, while the tax paying population pays absolutely absurd amounts of money into this bloodsucking system. I have no idea if that would be the case in the US, but I have seen too many of these systems FAIL to not be doubtful about them.

[poliphilo.livejournal.com]

Oddly enough, the US opponents of the scheme are holding up the British system, not the Italian system, as an example of how things can go wrong.

A reasonably well-run country ought to be able to run a National Health Service reasonably well. Knowing what I know of Italian politics- not much, but all of it lurid- I'm not entirely surprised the health service is chaotic.

Our system does makes mistakes. It has pockets of excellence and pockets of fail. Fortunately I seem to live in one of the former.

[daisytells.livejournal.com]

I never could understand why ultrasounds have become routine for pregnancy. If an ultrasound detects an abnormality in the fetus, then the parents to be have to decide whether to abort and try again. If an ultrasound detects twins, so what? Later in the pregnancy there would be evidence of two heartbeats -- same result. What about learning the sex of the unborn? It never seemed to be terribly important until the invention of this expensive procedure. This does not seem to be an important enough consideration to warrant a very expensive and possibly risky-to-the-fetus procedure.
As for the ER problem: Recently one of our elderly gentlemen in my building who is quite well off and has private insurance waited 14 hours to be seen in the ER at one of Boston's finest hospitals. He was suffering from penumonia, and at his age there was a very real danger of death. When he was finally admitted to a bed "upstairs" - more than 24 hours later, he had to spend over four weeks in the hospital.

[sovay]

and that some of you, instead of dancing around in your pyjamas and firing off skyrockets, are actually campaigning noisily against it.

Yes, and it is bewildering to me, especially that subset of the opposition that is filling the airwaves with paranoid noise about death panels and eugenics and demands to know what happened to their America, which seems to be some imaginary construct of picket-fence nicety where a black man knew his place and it wasn't in the White House. All the radio static about socialism is, I think, the smoke and mirrors of this particular trick. There are real currents of racism in the argument and it appalls me.

[poliphilo.livejournal.com]

It is paranoid. The European reality is nothing like the fantasy picture they're painting of it.

I guess it's progress of a sort when even the worst bigots know there are certain opinions too disgusting to speak in public.

[sovay]

The European reality is nothing like the fantasy picture they're painting of it.

I am growing very tired of living in a culture where facts are not only dismissed as irrelevant to a debate, but actively to be shunned. It's like being trapped inside someone else's schizophrenia.

I guess it's progress of a sort when even the worst bigots know there are certain opinions too disgusting to speak in public.

Right now it just seems to mean they find new codes to couch it in. Attacking the American-ness of Obama's proposals, insisting he's not an American citizen, demonizing socialized medicine—it all comes down to not one of us. For which I can only think thank God, because their vision of America is not somewhere I feel at home, but I worry that far too many people in this country do.

[poliphilo.livejournal.com]

One of the oddest manifestations of the blindness to facts was the assertion that Stephen Hawking would have died under the British system, when he is in fact a British citizen who credits the NHS with having saved his life.

There are two Americas. One that has led the rest of humannity over the past century- and another that has dragged far behind.

[sovay]

One of the oddest manifestations of the blindness to facts was the assertion that Stephen Hawking would have died under the British system, when he is in fact a British citizen who credits the NHS with having saved his life.

Yes. That was impressive. I wanted to revoke the author of that article's right ever to open their mouth in public again.

There are two Americas.

Well, tell me when I can go back to living in the sane one!

[poliphilo.livejournal.com]

They are interpenetrating parallel universes. You never know when you're going to flip from one to the other.

American screwyness

[(Anonymous)]

One American blogger said that "universal health care is theft". Weird foreigners? I don't think that kind of thinking is from a foreign country, it's from another planet, another galaxy even. The cultural gap is enormous.

I posted something about it on my blog, and someone said it wasn't healthcare they were objecting to, it was the taxes taken from them at gunpoint. I thought those Westerns with the guy coming into town armed to the teeth were fiction, but it seems that that's how they collect taxes over there. But strangely enough I don't see those people protesting that roads and bridges and sewers and rubbish removal services are theft.

Re: American screwyness

[poliphilo.livejournal.com]

At gunpoint? Wow!

The spirit of the old west is still alive- in some respects admirable, in others barking mad.