Saturday, November 24, 2012

NHS & Obamacare: Opposite directions!


Opposite directions?
©2012 Am Ang Zhang

Now that Obama is re-elected for his second term, Obamacare looks like having a good chance of moving health care in the US in quite the opposite direction to where our NHS is moving.

There is little doubt that a system based on insurance will need smart legislation to control the insurers. If the NHS is going to make use of wealthier individuals to use Health Insurance, then the same smart laws will need to be enacted for the regulation of Insurers. We should have learnt through the banking failures that in business, there is no such thing as self regulation.

The following was published just before the election:

The Affordable Care Act's benefits are hidden beneath the alarmist rhetoric
Nov 5, 2012


Columnist Wendell Potter Robin Holland

Wouldn’t it be great if our candidates had to take a dose of truth serum every morning before hitting the campaign trail? If they did, those of us who will be voting tomorrow wouldn’t be nearly as confused about what Obamacare is and what it isn’t, what it will do and what it won’t.

Since there is no such truth serum requirement, I believe that many of us will actually be voting against our own best interests. Many Americans will vote for candidates who have scared them into believing that Obamacare is a government takeover of health care that it will bankrupt the country while slashing Medicare benefits.

In the event that you or someone you know might benefit from some truth-telling, here, then, are a few things you ought to know before pulling that lever tomorrow:

·         The Affordable Care Act is not a government takeover that has put us on a slippery slope toward socialism, or even toward a single-payer system like the one in the People’s Republic of Canada.
·         The legislation is not going to add trillions to the deficit, even though it will expand Medicaid and provide subsidies to low-income individuals and families to buy private coverage.
·         The Affordable Care Act will not cut Medicare benefits.

One of the reasons the hospital industry endorsed Obamacare is that by bringing more people into coverage, hospitals will not have to provide nearly as much uncompensated care, which hits their bottom lines very hard. So hospitals were quite willing to go along with a reduction in future payments from the government because they know they will more than make up for it by having far fewer uninsured patients.

Here are some things the law will do:
·         It will prohibit insurance companies from refusing to sell coverage to people simply because they have one or more pre-existing conditions.
·         It will also prohibit them from cancelling our coverage when we get sick just to avoid paying for our care.
·         It will prohibit insurers from charging women more than men for comparable coverage and will not allow them to charge older folks more than three times as much as younger folks.
·         It will require them to spend at least 80 percent of what we pay in premiums actually paying claims and improving care.
·         It will allow young adults—who comprise the largest segment of the uninsured—to stay on their parents’ policies until age 26.
·         It will reduce the number of uninsured Americans by at least 30 million if all the states agree to accept federal dollars to expand their Medicaid programs.

That said, Obamacare is not a panacea for all that ails the U.S. health care system. I view it as the end of the beginning of reform. We will have to do more as a nation to bring everyone into coverage, to control costs and to improve the way we deliver care. But Obamacare does not resemble the law that many politicians have spent millions of dollars trying to persuade us it is.  Don’t be fooled into voting against your own best interests tomorrow.

Saving NHS: Control Health Insurers!


Wednesday, November 14, 2012

Central Park: Hello Autumn!

© Am Ang Zhang 2012


NHS: Looking Sinister!



My friend wrote asking if I have read a recent blog post about our new Health secretary and a former one.

“It is looking sinister!”

 ©2012 Am Ang Zhang

The one-word secret of Hunt’s success: NEPOTISM His relationship to Virginia Bottomley…..his dealings with the British Council….his inheritance of the SW Surrey constituency….

…..So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector……



The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.                       Janinie R. Wedel
               

                                                    From:    Shadow Elite: Public-Private Players & The NHS

        
        
I think there is something fundamentally scary about our democracy…. 
Because I think people have a sense that the system is rigged, 
and it’s hard to argue that it isn’t.
                            
Michael Lewis: The Big Short

Thursday, November 1, 2012

NHS & Railway: Specialists & JFK


Seeing the light:


© 2012 Am Ang Zhang

There is little doubt that the privatisation of the NHS is following the privatisation of British Rail in a perverse fashion. The separation of Track and Train operation is now being applied in an inverted fashion to health care in England.

The money is “given” to GPs via CCGs and health care will now be “bought” by them from anybody they wish to buy from. Most of us can see the flaw and unnecessary cost of such a market system and with a limited pot of money, the wastage on administration will approach that of the US system not to mention gaming and fraud that will lead to unnecessary treatment and its consequences.

In health care, death is irreversible.

The tension between GPs and Hospital Consultants in this country is historic and the success of Andrew Lansley and the Health Bill is more or less the result of the tactical play of that tension.

It is undeniable that the change of GP contract leading to a very skewed financial reward has meant that the average Hospital Consultant is lagging behind in financial rewards. This is most unusual in the Western world.

Many medical graduates will try and pick a specialty that may promise a better private practice reward if they want to become a specialist or else emigrate if generate practice is not their scene.

England leads the world of medicine for many years and most of us from Hong Kong came to receive our specialist training here. After all an English Physician did managed to diagnose JFK’s Addison’s disease (1947)when the best of America couldn’t.


A Hospital based health service:



The Cockroach Catcher has many medical friends working in different health care systems and most of my friends find our GP system ‘unique’. They see that progress in medical science has meant that it is difficult for a generalist to be able to do everything. Many medical procedures require specialist training.



Growth in most other countries has been in the area of specialist doctors.

The UK is the only country in the Western Word that is defying the trend. The serious side effect is that soon we might be running out of specialists in this country: well trained specialists.

So, what would be so wrong with a Hospital based integrated NHS.


My suspicion is that it will happen but it would be the privateers that will be doing it to have full control of cost that would be escalating. 


It is already happening in the US and believe you me, it will here. By then it will be too late as the specialists would have left the state run NHS.




The Light: For those who thought Labour would repeal the HSC Act, you have a shock coming: Labour never re-nationalised the Railways, so they would never re-nationalised the NHS.  Looks like next time too, it would not be an English Physician that would help to diagnose an American President.

Mayo Clinic: Disincentive system that works.

Disincentive system that works.
Virtually all Mayo employees are salaried with no incentive payments, separating the number of patients seen or procedures performed from personal gain. One surgeon refers to this tradition as a ‘‘disincentive system that works.’’ Adds another surgeon: “By not having our economics tied to our cases, we are free to do what comes naturally, and that is to help one another out. .  .. Our system removes a set of perverse incentives and permits us to make all clinical decisions on the basis of what is best for the patient.”

These are values that can be traced directly back to William Mayo and Charles Mayo, who, together with their father, William Worrall Mayo, founded Minnesota’s Mayo Clinic in 1903. The Clinic was one of the first examples of group practice in the United States. As Doctor William Mayo explained in 1905: “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary…it has become necessary to develop medicine as a cooperative science.”