Anorexia Nervosa & Safety Net: The NHS.

In The Cockroach Catcher, in the opening chapter I recalled an Anorexia Nervosa patient that has been “dumped” by her Private Health Insurer.

Girl in a Chemise circa 1905 Pablo Picasso (1881-1973)
Tate Collection

This patient’s father works for a medical supplies company that continued to insure the family. Even then the Health Insurer chose to limit her treatment to 18 months.

Why? Because there is a safety net: The NHS.

Health Insurers write their own rules.

Why? Because there is a safety net: The NHS

“….Ethics in medicine has of course changed because money is now involved and big money too. What was in dispute in this case was that the private health insurance that sustained Candy through the last eighteen months had dried out. The private hospital then tried to get the NHS to continue to pay for the service on the ground that Candy’s life would otherwise be in danger. The cost was around seven hundred pounds a night….’

Let us not forget that many private hospitals can make more money from the NHS because the NHS does not exclude. The NHS pay for everything including those Private Health Insurers chose to exclude.

“……A quick calculation gave me a figure of over a quarter of a million pounds per year at the private hospital.  No wonder they were not happy to have her transferred out.  Before my taking up the post, there were at one time seven patients placed by the Health Authorities at the same private hospital. Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting anorectic patients and nobody else. It is a multi-million pound business. Some of these clinics even managed to get into broadsheet Sunday supplements.  I think Anorexia Nervosa Hospitals are fast acquiring the status of private Rehab Centres. Until the government legislates to prevent health insurers from not funding long term psychiatric cases, Health Authorities all over the country will continue to pick up the tabs for such costly treatments……”

I did not agree to that patient staying on at the private hospital paid for by the NHS. That hospital did not like me!!!

The Obama Health reform is dealing a big blow to Health Insurers as by 2014 they will have to take all comers and cannot exclude pre-existing conditions not to say dumping someone like my Anorexia Nervosa patient. Until then, the State or the Federal Government steps in.

Gov. Arnold Schwarzenegger of California, a Republican gave a rousing endorsement of President Obama’s health plan.  New York Times reported today.

The new government in a week’s time should take the first step in legislating against Health Insurers “dumping” patients because of psychiatric diagnosis or so called chronic conditions. That way, private hospitals and insurers can fight it out amongst themselves. At least  the small pot of NHS cash would be safe. That would be a first step.

I doubt if any government would follow Obama’s extremely courageous move of legislating against excluding pre-existing conditions but we could watch what happens in a few year’s time. If we can at least secure the position of those already insured we could save the NHS a great deal of money.

Unlike the US we have a safety net: the NHS.

Let us protect it.

The Times:  The internal market has been a costly disaster

Obama Health: Health Insurance Reform

Obama Health Reform: Lessons For The NHS.

Obama Health & The NHS: Patients Trading

An Entrepreneur!

A Brief History of Time: Anorexia Nervosa

The Cockroach Catcher: full review on Amazon, Reader’s views.

Education: Why? Why? Why?

This actually happened:

Teacher: How many 10s are there in 165

Child: 6

Teacher: Wrong

Child: Why

Teacher: There are 16 10s

Child: No, 1 100, 6 10s and 5 1s

Teacher: We haven’t done 100s yet

NHS: A New Disease & An Unpleasant Truth

“Bureaucratic self-protection is not confined to state bodies. But the NHS is suffering from an especially virulent form of this particular disease.”    Andrew Gilligan writes in The Telegraph:

NHS bureaucrats care for themselves, not the patients

 “Yet it is politics which may, in the end, prove the service's undoing, because political, rather than clinical, priorities are coming to the fore. More and more cases are emerging of the malign effect on patients of highly politicised management.”

 “In my encounters as a journalist with the management of the NHS, I have found a secrecy, paranoia and defensiveness which I seldom met in my previous incarnation as a defence correspondent. Great Ormond Street, that world-famous institution with the heart-warming smiley kid logo, has twice given me statements which were provably untrue and which it was forced to retract.

Read about the new disease here >>>>

Then an anonymous consultant in the NHS wrote in the same paper:

NHS: here's the unpleasant truth

“We have assimilated a quarter of a million extras, literally supernumeraries, within the voluminous tent of the NHS.

Just outside the tent is the sand into which billions of taxpayers' money soaks without trace.

“Identification of these individuals is easy; look at the hospital telephone directory, and note how often the following descriptions occur: coordinator, commissioner, facilitator, compliance, liaison, outreach, project, regulator, controller. All of these staff require computers, salaries, paid holidays and final-year pensions.

“A responsible government must initiate a thorough review of the financial efficiency of the NHS by senior clinicians. The moral responsibility of running the NHS rests with those who know what treatment and care can be provided with the resources determined by ministers. We will accept that responsibility because someone has to lay out in front of society what is being spent in its name.

“To the current annual bill must be added the cost of the Private Finance Initiative, an enormous confidence trick played on the taxpayer, and the pension expectations of the tens of thousands of NHS staff.

“Politicians cannot continue to be economical with the truth. We treat all-comers, from malnourished infants of economic migrants to octogenarians seeking care at the end of a long hard life.

“We do our best, and we need a rapid clear-out of the non-essential bureaucracy which is slowing patient care and diverting funds needed for the care and cure of sick citizens.”

Read the full article here>>>>

Related:

NHS Wales-Why? Why? Why?

New Zealand, Wales & England: NHS

PPP & London Mayor: PFI & NHS

NHS, PFI, SATS......: A Revolution!!!

London Marathon & Re-hydration

As runners get ready for the London Marathon, I am putting up links to my previous blog posts on re-hydration.

 

Drowning and The Marathon

As the New York Marathon went underway, I am reminded of our much respected professor in medicine, Old Mac.

“It took 5 minutes to drown and 20 days to die from dehydration.”

Ancient Remedy: Modern Outlook

When the first public golf course was opened on the beautiful island of Kau Sai Chau in Hong Kong,drinking water was provided along the course. One player drank so much that he nearly died of water intoxication (result of drinking excessive amounts of plain water which causes a low concentration of sodium in the blood leading to amongst other problems: ‘brain’ swelling---cerebral oedema). Marathon runners are at greater risk than most as reported by the New England Medical Journal. There have been other notable cases of water intoxication elsewhere. I remember one of my professors telling us: the body survives dehydration much better than drowning. How right he was, as water intoxication is in a sense a kind of drowning.

NHS, PFI, SATS......: A Revolution!!!

Stop Sats in schools!

Scrap PFI!

Abandon the internal market in the NHS!

Impose tough social housing policies!

This is not delusional thinking nor some election manifesto from some unknown party: it is happening in Wales!!!

“The Welsh Assembly government, where Labour is the senior coalition partner, has stopped Sats in schools, scrapped the private finance initiative, is abandoning the internal market in the NHS, has imposed tough social housing policies, helped set up a network of credit unions and – belatedly – more or less killed new opencast mining.”

No, I did not write that, it was written by George Monbiot

The Guardian:

Wales's unreported revolution:

 Monday 19 April 2010

“For the past few years a quiet but momentous revolution has been taking place. That this has passed largely unnoticed in England reflects the media's lack of interest in Wales. English progressives know more about the political transformation in Bolivia than the similar shift happening over the border. Perhaps this is just as well. The Welsh have been left to get on with it, and nobody in England cares enough to try to stop them.

“It was Plaid Cymru that led the attempt to impeach Tony Blair over the invasion of Iraq. It opposed the conflict in Afghanistan from the outset. It wants to scrap Trident and cancel the aircraft carrier and Eurofighter contracts. It would break up the banks, ban short selling, tax foreign exchange transactions, raise capital gains tax, raise income tax for the rich while reducing it for the poor. It would set a maximum wage and give workers seats on corporate boards.

“It seeks to renationalise the railways and curb the power of the supermarkets. It wants a living pension for everyone over 80, to raise benefits in line with average earnings and to scrap tuition fees. It would abandon ID cards, stop detaining asylum seekers and shift sentencing away from prison and towards restorative justice.”

Read all about it here>>>

Related:

NHS Wales-Why? Why? Why?

New Zealand, Wales & England: NHS

PPP & London Mayor: PFI & NHS

Habit of Art, or of Sex? The Rights & Wrongs

Auden and Britten, late 1930s. 

Photograph: Britten-Pears Library

The First Emperor of China was worried about the influence of books on his subjects and he chose to burn them and bury those that wrote them.

We generally like to think that we live in a more tolerant society and yet we cannot pretend that books or writings do not exert great influence. It is only natural that the more famous you are the more influential you become. Can fame become an excuse to blur the boundary between right and wrong?

I will not pretend to know the answer but a recent play at the National got me thinking.

Could being as famous as W.H. Auden give him the right to urinate into his sink at Christ Church, Oxford?  We know pop stars trash hotel rooms regularly.

The greater shock followed: he mistook a BBC journalist to be his rent boy. Rent boy at Christ Church!   People seem to be horrified by the sexual behaviours of Presidents and Prime Ministers.   Is it any different with the cultural elite?

Can Britten’s interest in boys detract from some of the greatest music by an English composer, or is it so important to reassure us that his interests were never overtly sexual?             Britten’s Children: The Telegraph

The Play: The Habit of Art by Alan Bennett

The Habit of Art by Alan Bennett, directed by Nicholas Hytner. 

With Richard Griffiths as Fitz (W H Auden), Alex Jennings as Henry (Benjamin Britten)

Photo: Geraint Lewis/The Independent

It was one of the most thought provoking plays I have seen for a while and perhaps because of his fame, The New Statesman had this to say:

 “This is so nearly Bennett's coming-out play that one wonders if an opportunity has been missed or a catastrophe avoided. Perhaps he knew that if he really argued what he hints at in The History Boys and now in The Habit of Art - namely that older men having sex with teenage boys is not necessarily wrong - he would be stripped of his listing as part of the national heritage quicker than you could say Daily Mail.”

The Habit of Art:

The Times

The Guardian

The Independent

Love’s a little boy


Others:

Rosamund Strode

Related:

The Ring: Child Psychiatry & Human Behaviour

Goldman Sachs, SEC & The Greatest Trade Ever

The New York Times: April 16, 2010

S.E.C. Accuses Goldman of Fraud in Housing Deal:

The focus of the S.E.C. case, an investment vehicle called Abacus 2007-AC1, was one of 25 such vehicles that Goldman created so the bank and some of its clients could bet against the housing market. Those deals, which were the subject of an article in The New York Times in December, initially protected Goldman from losses when the mortgage market disintegrated and later yielded profits for the bank.

As the Abacus portfolios in the S.E.C. case plunged in value, a prominent hedge fund manager made money from his bets against certain mortgage bonds, while investors lost more than $1 billion.

According to the complaint, Goldman created Abacus 2007-AC1 in February 2007 at the request of John A. Paulson, a prominent hedge fund manager who earned an estimated $3.7 billion in 2007 by correctly wagering that the housing bubble would burst. Mr. Paulson is not named in the suit.

Goldman told investors that the bonds would be chosen by an independent manager. In the case of Abacus 2007-AC1, however, Goldman let Mr. Paulson select mortgage bonds that he believed were most likely to lose value, according to the complaint.

Goldman then sold the package to investors like foreign banks, pension funds and insurance companies, which would profit only if the bonds gained value. The European banks IKB and ABN Amro and other investors lost more than $1 billion in the deal, the commission said.

Wall Street Journal: OCTOBER 31, 2009

It was the fall of 2007, financial markets were collapsing, and Wall Street firms were losing massive amounts of money, as if they were trying to give back a decade's worth of profits in a few brutal months. An investor named John Paulson somehow was scoring huge profits.

His winnings were so enormous they seemed unreal, even cartoonish. His firm, Paulson & Co., would make $15 billion in 2007.

Mr. Paulson's personal cut would amount to nearly $4 billion, or more than $10 million a day. That was more than the 2007 earnings of J. K. Rowling, Oprah Winfrey and Tiger Woods put together. At one point in late 2007, a broker called to remind Mr. Paulson of a personal account worth $5 million, an account now so insignificant it had slipped his mind.

The Wall Street Journal’s Gregory Zuckerman in his book, “The Greatest Trade Ever” wrote:

Paulson & Co. had bet against about $5 billion of CDOs and made more than $4 billion from these trades—including $500 million from a single transaction—according to the firm’s investors and an employee of the firm. One of the biggest losers, however, wasn’t any investor on the other side. It was the very bank that worked with Paulson on many of the deals: Deutsche Bank. The big bank had failed to sell all of the CDO deals it constructed at Paulson’s behest and was stuck with chunks of toxic mortgages, suffering about $500 million of losses from these customized transactions, according to a senior executive of the German bank.

These were some of Paulson & Co.’s largest scores.

Mr. Paulson bought a $41 million home in early 2008 in Long Island and he lives with his wife and two daughters on the Upper East Side of Manhattan.                                            The New York Times.

Latest Updates: Live Blog on Senate, Latest News

Huffington Post: AIG Story.

WSJ.


Others:
Newsweek, The Guardian

Others Posts:

NHS & the Repeal Of The Glass-Steagall Act

To Intervene Or Not: A Colossal Failure Of Common Sense.

Corruption: Three Doctors and a Professor.

NHS: Business Model? Spare Us Please!!!

Dr Am Ang Zhang is the author of The Cockroach Catcher.

Learning from History: Lavoisier

Antoine-Laurent Lavoisier (1743–1794) and His Wife

Jacques-Louis David (French, 1748–1825)

The Metrpolitan Museum of Art

"The Republic needs neither scientists nor chemists; the course of justice can not be delayed."   Judge sentencing Lavoisier to the guillotine, 1794.


To me, one of the joys of foreign visits is that of visiting art museums. At the New York’s Metropolitan Museum one of my earliest discoveries was that of a painting called Antoine-Laurent Lavoisier (1743–1794) and His Wife by Jacques-Louis David (French, 1748–1825). It was an unusual painting because of the story behind Lavoisier.

On my first visit to the Met, I bought a newly published book called The Metropolitan Museum of Art, Favorite Paintings by Hyatt Mayor and in it he wrote:

“His lasting achievement was to establish modern chemistry by drawing up the first list of elements and by analyzing the character and function of air and other gases”

“The intimate grandeur of this painting would alone make it one of the greatest portraits of its century, while its human associations surcharge it with a shiver of wonder."

It is comforting to note that the likes of Dr Grumble were only warned not to blog during the run up to the election. How lucky we are, really! Think guillotine! Think Cambodia!

Metropolitan Museum of Art: Antoine-Laurent Lavoisier

Related:

New Zealand, Wales & England: NHS

NHS Whistleblowing: Unbelievable! Unbelievable! Unbelievable!

Public Enemies: Three Doctors, Patients Association & The NHS

An Entrepreneur!

NHS: Business Model? Spare Us Please!!!

BMJ Analysis: Allyson M Pollock

PPP & London Mayor: PFI & NHS

Houses of Parliament ©2010 Am Ang Zhang

"In other countries this would be called looting, here it is called the PPP."                                       Boris Johnson: Mayor of London.

"Londoners will also be outraged that the Tube upgrades promised to them are now threatened," said Johnson. The mayor claimed that Tube Lines's co-owners, Ferrovial, the Spanish owner of Heathrow airport, and Bechtel, the US project management specialist, will be paid £400m in management secondment fees by 2017.

Public private partnerships

Public private partnerships (PPPs) are arrangements typified by joint working between the public and private sector. In the broadest sense, PPPs can cover all types of collaboration across the interface between the public and private sectors to deliver policies, services and infrastructure. Where delivery of public services involves private sector investment in infrastructure, the most common form of PPP is the Private finance initiative

PFI

Private Finance Initiatives are intended to harness private funding for public building projects, such as schools and hospitals.

Under the schemes, introduced in the 1990s and expanded under Labour, private firms pay for work on buildings, then lease them back to local authorities on a contract of up to 25 years.

PFI: £23 Billion in 30 years

PPP London Underground

Metronet calls in administrators: Cost to Taxpayers £410 million

PFI: The Enron of the NHS

“PFI makes me particularly angry. It is a guaranteed loan to property investors, where high-rate mortgage payments are kept off-balance to reduce the country’s declared debt. In other words, it’s the Enron of the NHS. This is money the NHS has committed to leave frontline healthcare for the next 35 years.”

Dr Helena McKeown

Christmas Island: Red Crab Migration

>

Red Crab
Christmas Island National Park

Photo: Max Orchard  

Red crab Migration

Christmas Island National Park  
Photo: Max Orchard

"At the beginning of the wet season (usually October/November), most adult red crabs suddenly begin a spectacular migration from the forest to the coast, to breed and release eggs into the sea. Breeding is usually synchronized island wide. The rains provide moist overcast conditions for crabs to make their long and difficult journey to the sea. The timing of the migration breeding sequence is also linked to the phases of the moon, so that eggs may be released by the female red crabs into the sea precisely at the turn of the high tide during the last quarter of the moon.

"It is thought that this occurs at this time because there is the least difference between high and low tides. The sea level at the base of the cliffs and on the beaches, where the females release their eggs, at this time varies the least for a longer period, and it is therefore safer for the females approaching the water's edge to release their eggs. Sometimes there are earlier and later migrations of smaller numbers of crabs but all migrations retain this same lunar rhythm.

"The main migration commences on the plateau and can last up to 18 days. Masses of crabs gather into broad columns as they move toward the coast, climbing down high inland cliff faces, and over or around all obstacles in their way, following routes used year after year for both downward and return migrations. Movement peaks in the early morning and late afternoons when it is cooler and there is more shade. If caught in open areas, in unshaded heat, the crabs soon lose body water and die."  

You can read more about it here:  Christmas Island National Park

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Related:

The Crab Catcher

The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US

FREE eBook: 


Email: cockroachcatcher (at) gmail (dot) com.