Privatise the NHS

[Park Life 71]

I was at ASCO a couple of weeks ago and it was scary how political it was. The underlying theme for everything being discussed outside the science was healthcare reform from republican and democrat constituents. (very amusing to listen to an ex-Reagan administration aide defending the right of docs to make 600k a year and a democrat talking about the UK system as a beacon of rational healthcare ). One of the speakers said 'the reform is going through, its all being done in secret and once they have ironed out the details, it will happen and happen quickly'. Dont doubt Obama too much, this boy is taking on the medical and insurance industries face on.

 

I reckon one of my colleagues got it right when he tried to simplify the US system into one issue; all of the actors in the system are profit makers.

 

Taken by itself, it probably suggests that each one charges a lot of money to provide it's service but its more complicated than that. Its not the fact they make profit, its how they make profit that is the issue. Docs are paid on a fee for service basis, meaning that each time the doc says you need to have something, you agree with him and he gets paid from the insurance company. Therefore, they are incentivised to provide services with margins, rather than those that meet medical need. The example cited at ASCO was the use of expensive radiological imaging technology to track the development / progression of tumours. These imaging processes earn the docs thousands of pounds a year each, yet none have been shown to lead to better patient health. If they were incentivised to provide better patient outcomes, rather than being paid to perform activity as if it were some proxy for productivity, they'd be able to attain much more for much less.

 

Its the way you pay em, thats the trick.

 

To this threads orginal idea, public funding of healthcare is now even more fucked, we need to dredge up even more cash to offset the fiscal deficits in the pipeline. Of course at the same time ensuring that the costs dont runaway like in the US.

 

A major negative effect of the American health care system is over-medicalisation of benign conditions, as you allude to re: imaging. Americans tend to be very interventionist, preferring to treat conditions with a shit load of drugs when its not really warranted. It makes my job a lot harder as I have to interpret their guidelines and review papers with an extra large pinch of salt.

 

That's not to say their top end healthcare isn't excellent, because it is - if you can afford it.

 

Is it cause they make more money that way?

[Renton 21404]

I was at ASCO a couple of weeks ago and it was scary how political it was. The underlying theme for everything being discussed outside the science was healthcare reform from republican and democrat constituents. (very amusing to listen to an ex-Reagan administration aide defending the right of docs to make 600k a year and a democrat talking about the UK system as a beacon of rational healthcare ). One of the speakers said 'the reform is going through, its all being done in secret and once they have ironed out the details, it will happen and happen quickly'. Dont doubt Obama too much, this boy is taking on the medical and insurance industries face on.

 

I reckon one of my colleagues got it right when he tried to simplify the US system into one issue; all of the actors in the system are profit makers.

 

Taken by itself, it probably suggests that each one charges a lot of money to provide it's service but its more complicated than that. Its not the fact they make profit, its how they make profit that is the issue. Docs are paid on a fee for service basis, meaning that each time the doc says you need to have something, you agree with him and he gets paid from the insurance company. Therefore, they are incentivised to provide services with margins, rather than those that meet medical need. The example cited at ASCO was the use of expensive radiological imaging technology to track the development / progression of tumours. These imaging processes earn the docs thousands of pounds a year each, yet none have been shown to lead to better patient health. If they were incentivised to provide better patient outcomes, rather than being paid to perform activity as if it were some proxy for productivity, they'd be able to attain much more for much less.

 

Its the way you pay em, thats the trick.

 

To this threads orginal idea, public funding of healthcare is now even more fucked, we need to dredge up even more cash to offset the fiscal deficits in the pipeline. Of course at the same time ensuring that the costs dont runaway like in the US.

 

A major negative effect of the American health care system is over-medicalisation of benign conditions, as you allude to re: imaging. Americans tend to be very interventionist, preferring to treat conditions with a shit load of drugs when its not really warranted. It makes my job a lot harder as I have to interpret their guidelines and review papers with an extra large pinch of salt.

 

That's not to say their top end healthcare isn't excellent, because it is - if you can afford it.

 

Is it cause they make more money that way?

 

Basically, yes. They're incentivised to treat and follow up for $$$$.

 

It's not just that though, the consequence of the different medical philosophies has led to an ingrained cultural difference, it's a positive feedback cycle. Here if you get an infection, your GP will probably say 'take paracetamol and we'll wait and see' (which is sensible given the rise in bacterial resistance etc). There it's more 'hit it with everything we've got'. Sometimes this is a better approach, but not usually.

 

I think this interventionist mindset has also spilled into their foreign policy too .

[ChezGiven 0]

Is it at all feasible for the Americans to shuffle closer to the "socialist" appearance of the NHS given a core of their voters read socialist and run for their rifle and ma's chewing t'baccy?

 

Yes, they are looking to expand medicare and medicaid, increase their power to negotiate physician rates (what docs get paid per consultation) and other payments (like the NHS has the power over e.g. vaccines). The NHS is just a block purchaser, you already have this in the US with the Veterans Association, Kaiser Permanente and the existing social programmes i mentioned.

 

Obama has also made $1.1bn available for what is known as 'comparative effectiveness research', which is what Rents does for a living. Unbelievably, there is opposition to having a research agenda on comparing which drugs are the best.

 

Obama's challenge is in contracting a sector where private interests are so strong. To reduce costs, someone has to get paid less. He will therefore probably try to freeze health expenditure growth, grow the economy and thus shrink the share of GDP it takes up. Would be my guess on how this will play out anyway.

[Tom 14011]

I must admit I have had great experiences with the NHS all my life.

 

I have never had a bad Doctor and the times I have been in accident and emergency I have been looked after superbly.

 

One time my brother got beaten up on a Saturday night and I had to spend 6 or 7 hours with him (I hate A&E) with all the other late night piss heads, teenagers who had too much drugs etc and you realise that the job is never easy and sometimes the general public are the problem as opposed to a superb national health service.

[Park Life 71]

I must admit I have had great experiences with the NHS all my life.

 

I have never had a bad Doctor and the times I have been in accident and emergency I have been looked after superbly.

 

One time my brother got beaten up on a Saturday night and I had to spend 6 or 7 hours with him (I hate A&E) with all the other late night piss heads, teenagers who had too much drugs etc and you realise that the job is never easy and sometimes the general public are the problem as opposed to a superb national health service.

 

For me a democracy isn't a democracy unless they have summat like the NHS.

[snakehips 0]

For me, the NHS is the golden egg. We have it, and we should do everything to keep it.

 

Of course it has it's wastrels, scoundrels and genuine lazy bastards, but we get that in all walks of life. Keep it, or forever rue the day we lost it.

[Park Life 71]

For me, the NHS is the golden egg. We have it, and we should do everything to keep it.

 

Of course it has it's wastrels, scoundrels and genuine lazy bastards, but we get that in all walks of life. Keep it, or forever rue the day we lost it.

 

It's a beautiful thing alright.

[Guest alex]

For me, the NHS is the golden egg. We have it, and we should do everything to keep it.

 

Of course it has it's wastrels, scoundrels and genuine lazy bastards, but we get that in all walks of life. Keep it, or forever rue the day we lost it.

Well said.

[The Fish 10793]

Is it at all feasible for the Americans to shuffle closer to the "socialist" appearance of the NHS given a core of their voters read socialist and run for their rifle and ma's chewing t'baccy?

 

Yes, they are looking to expand medicare and medicaid, increase their power to negotiate physician rates (what docs get paid per consultation) and other payments (like the NHS has the power over e.g. vaccines). The NHS is just a block purchaser, you already have this in the US with the Veterans Association, Kaiser Permanente and the existing social programmes i mentioned.

 

Obama has also made $1.1bn available for what is known as 'comparative effectiveness research', which is what Rents does for a living. Unbelievably, there is opposition to having a research agenda on comparing which drugs are the best.

Obama's challenge is in contracting a sector where private interests are so strong. To reduce costs, someone has to get paid less. He will therefore probably try to freeze health expenditure growth, grow the economy and thus shrink the share of GDP it takes up. Would be my guess on how this will play out anyway.

 

From Republicans who's election war-chest has been fattened by pharmaceutical interest groups?

 

We think our politicians are bad for claiming £3000 for a moat cleaning, but over their politicians are to all intents and purposes, bought.

[Fop 1]

Is it at all feasible for the Americans to shuffle closer to the "socialist" appearance of the NHS given a core of their voters read socialist and run for their rifle and ma's chewing t'baccy?

 

Yes, they are looking to expand medicare and medicaid, increase their power to negotiate physician rates (what docs get paid per consultation) and other payments (like the NHS has the power over e.g. vaccines). The NHS is just a block purchaser, you already have this in the US with the Veterans Association, Kaiser Permanente and the existing social programmes i mentioned.

 

Obama has also made $1.1bn available for what is known as 'comparative effectiveness research', which is what Rents does for a living. Unbelievably, there is opposition to having a research agenda on comparing which drugs are the best.

 

Obama's challenge is in contracting a sector where private interests are so strong. To reduce costs, someone has to get paid less. He will therefore probably try to freeze health expenditure growth, grow the economy and thus shrink the share of GDP it takes up. Would be my guess on how this will play out anyway.

 

In fairness they have heard about Renton over there, which probably explains it.

[NJS 4375]

Tories to end Welsh free prescritptions

 

This is the kind of thing that sounds sensible at first glance - those who can afford should pay goes the argument.

 

This then becomes a thin end of a wedge - why shouldn't people in work pay a fee to see a GP like they do in Ireland? etc etc.

 

More to come if/when they win the Westminster election.

[Renton 21404]

For anyone interested, there's a documentary that follows the process of how NICE appraises new drugs on tonight, in this case a drug for myeloma I think. It's called 'The Price of Life' and is on BBC2 at 9pm. No idea what it will be like.

[Fop 1]

For anyone interested, there's a documentary that follows the process of how NICE appraises new drugs on tonight, in this case a drug for myeloma I think. It's called 'The Price of Life' and is on BBC2 at 9pm. No idea what it will be like.

 

They decide if a new drug is a Bentley or a Kia and only go for it if its the Kia.

[Park Life 71]

For anyone interested, there's a documentary that follows the process of how NICE appraises new drugs on tonight, in this case a drug for myeloma I think. It's called 'The Price of Life' and is on BBC2 at 9pm. No idea what it will be like.

 

They decide if a new drug is a Bentley or a Kia and only go for it if its the Kia.

 

If the NHS was ever privatised there would be no way back. It's one thing we have over most of the world, basic regard for the needs of our fellow men.

[ChezGiven 0]

For anyone interested, there's a documentary that follows the process of how NICE appraises new drugs on tonight, in this case a drug for myeloma I think. It's called 'The Price of Life' and is on BBC2 at 9pm. No idea what it will be like.

 

The price NICE is willing to pay is roughly 30k for a year of perfect health.

[The Fish 10793]

Am I the the only person who titters when hearing a newsreader spell then enunciate NICE?

[Renton 21404]

For anyone interested, there's a documentary that follows the process of how NICE appraises new drugs on tonight, in this case a drug for myeloma I think. It's called 'The Price of Life' and is on BBC2 at 9pm. No idea what it will be like.

 

The price NICE is willing to pay is roughly 30k for a year of perfect health.

 

I thought it was an excellent documentary which coherently presented the argument from every side - the patient and patient groups, the PCT manager, NICE, the pharmaceutical companies, and some external opinion thrown in (the author of the 800 miilion dollar pill - have you read this/worth reading?). Controversially, the QUALY of £30,000 has been raised by a factor of 1.4 for people with terminal diseases, but typically no extra money has been supplied to pay for this - basically its a case of the government bowing to pressure from patient groups and is not a good use of resources. It was interesting how the author and presenter of the program went from supporting the individual patients involved, to supporting NICE when he fully understood the issues. Good watch, anyone who can watch it on repeat or replay/iplayer really should if you want to know more about the real issues facing the NHS.

[Fop 1]

For anyone interested, there's a documentary that follows the process of how NICE appraises new drugs on tonight, in this case a drug for myeloma I think. It's called 'The Price of Life' and is on BBC2 at 9pm. No idea what it will be like.

 

They decide if a new drug is a Bentley or a Kia and only go for it if its the Kia.

 

If the NHS was ever privatised there would be no way back. It's one thing we have over most of the world, basic regard for the needs of our fellow men.

 

 

As much as Chezzy want to see it die, there's absolutely no reason it must. Just like water privatisation models, it's simply an "accepted" truth because people get rich.

 

 

There are issues about what (and indeed who - with the best will in the world the NHS can't be the world's health service) it actually treats though.

[Fop 1]

For anyone interested, there's a documentary that follows the process of how NICE appraises new drugs on tonight, in this case a drug for myeloma I think. It's called 'The Price of Life' and is on BBC2 at 9pm. No idea what it will be like.

 

The price NICE is willing to pay is roughly 30k for a year of perfect health.

 

I thought it was an excellent documentary which coherently presented the argument from every side - the patient and patient groups, the PCT manager, NICE, the pharmaceutical companies, and some external opinion thrown in (the author of the 800 miilion dollar pill - have you read this/worth reading?). Controversially, the QUALY of £30,000 has been raised by a factor of 1.4 for people with terminal diseases, but typically no extra money has been supplied to pay for this - basically its a case of the government bowing to pressure from patient groups and is not a good use of resources. It was interesting how the author and presenter of the program went from supporting the individual patients involved, to supporting NICE when he fully understood the issues. Good watch, anyone who can watch it on repeat or replay/iplayer really should if you want to know more about the real issues facing the NHS.

 

 

That's the same with everything, take any individual "sob" story (be it health, be it asylum, be it economic migrant, be it drug user) and in the individual case it's impossible not to have sympathy.

 

 

 

Looking at the bigger picture though and lines have to be drawn, even if in some cases they cause great individual distress.

 

 

 

On the other hand let the accountants control too much and you end up with Auschwitz.

[ChezGiven 0]

Two points fop, the number of active and inactive demographically over the next few years means there will be a funding crisis. Have a look at the EPC's graph in this link.

 

http://www.egagenerics.com/gen-economics.htm

 

If you look back over the arguments, its been about the greater use of social insurance and the invetiability of a two-tier system. Its because more old people = more demand, whilst at same time less working people = less funding. Its not that hard to get.

 

Secondly, NICE doesnt present a sob story, its a rationale body with a constitutionalised set of decision-making criteria, the exact opposite of the shroud-waving patient / vested interest groups.

[Fop 1]

Two points fop, the number of active and inactive demographically over the next few years means there will be a funding crisis. Have a look at the EPC's graph in this link.

 

http://www.egagenerics.com/gen-economics.htm

 

If you look back over the arguments, its been about the greater use of social insurance and the invetiability of a two-tier system. Its because more old people = more demand, whilst at same time less working people = less funding. Its not that hard to get.

 

Secondly, NICE doesnt present a sob story, its a rationale body with a constitutionalised set of decision-making criteria, the exact opposite of the shroud-waving patient / vested interest groups.

 

 

 

Firstly it's all about profit in the end, there's bound to be a billion ways to "rationalise" to that end - just as there is for the water privatisation model. But in neither does it mean it is the only way, the right way or indeed the best way.

 

 

Secondly Fop never said NICE presented a sob story (although in a way they do - when they aren't comparing getting life-extending drugs to buying a Bentley anyway ), the opposite in fact.

Edited June 18, 2009 by Fop

[Happy Face 29]

The FBI says it has uncovered a $50m (£30m) scam involving the US healthcare system, making arrests in Florida, Michigan and Colorado.

 

Fifty-three people have been charged with defrauding Medicare, the government insurance scheme providing care to the elderly and disabled.

 

Doctors allegedly gave cash to patients to sign paperwork claiming to have had treatments which they were never given.

 

Medical staff, patients and company executives are among those charged.

 

A day earlier, police arrested eight people in Miami involved in a separate scheme using fake clinics to generate fraudulent bills of around $100m.

 

Federal agents say they are investigating almost 2,500 other cases and that fraud is costing American taxpayers billions of dollars every year.

 

Those in the administration and Congress now working on wider healthcare reforms say building better safeguards will be central to any new system.

 

President Barack Obama is currently seeking to overhaul the US healthcare system.

 

http://news.bbc.co.uk/2/hi/americas/8117991.stm

 

[ChezGiven 0]

http://news.bbc.co.uk/2/hi/health/8117561.stm

 

Dr Tony Moran, lead researcher from the North West Cancer Intelligence Service, said elderly cancer patients did not appear to be benefitting from the improvements in treatments in the last decade.

 

He calculated that if the UK was performing as well as Western Europe in the age group 75-84, and as well as the US in the 85 and over age group, there would be 15,000 fewer cancer deaths among the elderly every year.

 

At present, 75,000 over-75s die every year of cancer.

 

Most worryingly, UK cancer deaths in the over-85s went up by 2% over an eight-year period, while in Western Europe they went down by 16%.

 

We should keep this about the NHS HF, not the problems in the US.

[Park Life 71]

Really don't want to live to 75.

[Fop 1]

We should keep this about the NHS HF, not the problems in the US.

 

 

Good plan, think about the profits.