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.
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.
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?"
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.
Edited at 2009-08-14 11:52 am (UTC)
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.
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.
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.
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.
2009-08-14 01:35 pm (UTC)
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.
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.
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.
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.
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.
2009-08-14 05:33 pm (UTC)
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.
2009-08-14 07:24 pm (UTC)
Re: American screwyness
At gunpoint? Wow!
The spirit of the old west is still alive- in some respects admirable, in others barking mad.