England’s Misplaced NHS Pride

Published July 30, 2012

Consumer Power Report #337

If you happened to watch the opening ceremonies of the Olympic games in London, you may have been surprised at the degree to which the bizarre performance turned into a defense of the National Health Service, taking some odd-looking forms. As Tim Blair writes at the Telegraph, “World War II didn’t rate a mention, apart from the briefest possible glimpse of Winston Churchill, but government-run hospitals sucked up a whole nine minutes.”

Let’s leave it to John Fund to describe the scene:

The Boyle ceremony got underway with images of a bucolic Britain being swept away by a cigar-chomping elite that builds satanic mills filled with oppressed workers as steeplejacks hang from the towering chimneys. Later, 600 doctors and patients recruited from National Health Service hospitals were featured in a bizarre tribute to socialized medicine, with children bouncing up and down on 320 hospital beds arrayed in front of a giant Franken-baby wrapped in bandages. Villains from British children’s literature, ranging from Cruella de Vil to Lord Voldemort, sweep in on the children, in an apparent reference to conservative forces seeking to reform the tottering NHS. The 15-minute sequence ended with a series of red lights triumphantly spelling out “NHS.”

Left-wingers were thrilled. “Brilliant that we got a socialist to do the opening ceremony,” tweeted Alastair Campbell, former communications chief for the Labour party. Boyle denied he was promoting a political agenda. “The sensibility of the show is very personal,” he told reporters. “We had no agenda other than … values that we feel are true.” At a news conference beforehand, he explained that one of the reasons he “put the NHS in the show is that everyone is aware of how important NHS is to everybody in the country. One of the core values of our society is that it doesn’t matter who you are, you will get treated the same in terms of health care.”

But is that really true? Not at all. The vast bureaucracy of the NHS–the fifth largest employer in the world–actually isn’t all that appetizing to Britons who can afford better care.

Sunday’s British papers report that a study by the research firm Lloyd’s TSB Premier Banking found that nearly two-thirds of Britons earning more than $78,700 a year have taken out private health insurance because they don’t trust the NHS. A survey by the British health-care organization Bupa found that two-thirds of its customers cited the risk of infection from superbugs as a top reason for buying private insurance. Shaun Matisonn, the chief executive of PruHealth, says that “patients today are sophisticated consumers of health care. They research the treatments they want, but cannot always get them through the NHS.”

So why would the wealthy want to escape the NHS? Perhaps because the NHS system has the worst cancer survival rates in the Western world. The U.K. trails well behind its fellow European countries in survival rates from some of the most common cancers according to the King’s Fund think tank, often because of systemic delays that prevent people from seeing an oncologist until the cancer has progressed to more serious stages.

Catherine Foot, Senior Fellow at The King’s Fund and a member of the International Cancer Benchmarking Partnership, said: ‘England still has a way to go to reach cancer survival rates that are ranked with the best international performers.

‘The evidence points to early diagnosis as being key to improving outcomes. We hope urgent priority is given to closing the gap in survival rates between different groups in society.

‘We found that older people are particularly burdened by this, being more likely to have cancer, to be diagnosed later, to be under-treated and to experience worse outcomes.’

Indeed, the problem of “ageism” in cancer treatment is more pronounced in Britain than almost anywhere in the Western world. Consider these horrific statistics regarding breast cancer treatment:

New figures show that women over 70 are almost a fifth less likely to have surgery on breast tumours than younger ones.

Among the over-80s, the situation is even worse with only half of sufferers being operated on …

The latest figures, presented on Thursday at the National Cancer Intelligence Network (NCIN) conference, are based on the records of 23,000 women who were diagnosed with breast cancer in the West Midlands, Yorkshire and North East of England between 1997 and 2005. In total more than 48,000 women are diagnosed with the disease in Britain every year and about one in four dies.

The researchers found that women who had other illnesses were less likely to undergo a mastectomy, but even taking this into account chances of having surgery dropped with age.

Over 85 per cent of those aged between 65 and 70 had surgery but this figure fell to 70 per cent among women in their seventies and just 50 per cent among the over-80s.

Some people never get seen because the wait times are too long. Some don’t get care because bureaucrats bollix their paperwork. And still others, some NHS doctors allege, don’t get care because they are put on a cost-saving pathway toward death. But whatever the reasons, the outcomes are stark.

According to this Lancet Oncology survey in 2008, 91.9 percent of American men diagnosed with prostate cancer were still alive after five years. In the U.K., just 51.1 percent were still alive. And another study around the same time found that among women diagnosed with breast cancer in 2000–02, 90.1 percent were still alive five years later–while only 77.8% were still alive in England, even after massive investments in closing that gap.

The point here is a simple one. Some in England would rather have everyone receive equally bad care–care that offers pain pills in place of surgery or seeking a cure–just so long as it remains equal. And it doesn’t even do that. Maybe it’s time for people to ditch the nationalist pride and wake up to the reality of the systems they’ve created, one where cancers that are perfectly treatable elsewhere end up being a death sentence.

— Benjamin Domenech



Wait a minute, says the New York Times–is this even going to work?

In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”

As Michael Cannon of Cato notes, “But isn’t the important thing that they’ll have a piece of paper that says ‘health insurance’?”

SOURCE: New York Times


An update from the Washington Post:

The Supreme Court may have declared that the government can order Americans to get health insurance, but that doesn’t mean they’re going to sign up.

Nowhere is that more evident than Oklahoma, a conservative state with an independent streak and a disdain for the strong arm of government. The state cannot even get residents to comply with car insurance laws; roughly a quarter of the drivers here lack it, one of the highest rates in the country.

When it comes to health insurance, the effort to sign people up isn’t likely to get much help from the state. Antipathy toward President Obama’s signature health-care overhaul runs so deep that when the federal government awarded Oklahoma a large grant to plan for the new law, the governor turned away the money–all $54 million of it.

The idea that the federal government will persuade reluctant people here to get insurance elicited head-shaking chuckles at Cattlemen’s Steakhouse, an iconic old restaurant in the Stockyards City neighborhood, which is lined with street banners reading “Where the Wild West still lives.”

“That kind of frontier mentality maintains in Oklahoma, and it’s not a bad thing. It’s a good thing,” said Mark Cunningham, 64, an Army veteran having breakfast with a couple of friends in a dimly lighted booth recently. Considering the car insurance statistic, he said, “I suspect they’re going to run into the same kind of trouble on health insurance.”

SOURCE: Washington Post


So you better get on it, like Connecticut just did–unless, of course, you’re refusing to implement:

Insurers participating in the exchange, or otherwise selling individual and small group coverage in Connecticut, will have to offer, at a minimum, the coverage offered in the benchmark plan.

To come up with their plan, board members decided to add a few things that ConnectiCare HMO does not provide, including prescription drug coverage and pediatric dental and vision services.

The ACA requires states to offer essential benefits in their benchmark plans, such as preventive care and mental health and substance abuse treatment as well as basic doctor and hospital care.

But Connecticut’s plan would also include other benefits, including in-vitro fertilization treatments and special autism care.

Abortion services are also part of the benchmark plan. But federal law prohibits federal money to be used for abortions, so those receiving federal subsidies to purchase health insurance will be required to pay for abortion services out-of-pocket, Counihan said.

Mickey Herbert, a member of the exchange board, said he raised concerns about the benchmark plan at a health exchange board meeting held Thursday.

“My question was ‘what’s this all going to cost’ and nobody knew,” Herbert said.

SOURCE: Connecticut Mirror


From Chris Jacobs:

Hidden in CBO’s updated analysis of Obamacare in light of the Supreme Court decision is new information about a little-known provision of the law that will have major effects on how much millions of Americans pay for government-mandated health insurance.

At issue is an Obamacare provision, added during the reconciliation process, that slows the growth of Exchange insurance subsidies, beginning in 2019, if federal spending on said Exchange subsidies exceeds a pre-determined limit. In its analysis last week, CBO concluded that the Supreme Court’s ruling means fewer people will obtain insurance through Medicaid, and more people will utilize subsidized insurance on Exchanges instead. As a result, projected spending on Medicaid fell by $289 billion, and projected spending on Exchange subsidies rose by $210 billion.

These changes mean the indexing provision slowing subsidy growth is virtually bound to be triggered beginning in 2019. The statute calls for the indexing provision to kick in if subsidy spending exceeds 0.504% of gross domestic product in the preceding year. As the below chart demonstrates, in CBO’s March 2012 baseline, Exchange subsidy spending was just slightly above the 0.504% of GDP level – meaning that while it was possible the indexing provision would be triggered, it was also possible it would not be, depending upon general cost trends, how many people enroll in Exchanges, etc. However, the projected 20-25% increase in Exchange subsidy spending as a result of the Court ruling now virtually guarantees the subsidy indexing provision will be triggered beginning in 2019.

SOURCE: Chris Jacobs


Don’t worry, they’ll only use it to chase fraud, I’m sure.

In the past, privacy laws have prevented such a partnership, but the Department of Health and Human Services and the insurers will scrub out patients’ personal information from the bills to address privacy concerns. They can then look for fraud trends and use those to stop recurrences …

The data exchange means private insurers and the government can share prevention tools that work, as well as alert everyone if they spot a fraud scheme, Sebelius said.

Attorney General Eric Holder called it another step in a buildup of fraud-fighting. “The reality is, we have more to do,” he said. He touted the administration’s record-breaking progress, including recovering $4.1 billion in health care fraud cases in 2011. He said that’s about $7 for every $1 spent in fraud prevention, up from about $5 for every $1 spent from 1997 to 2008.

The new effort brings in 21 health insurance companies. Karen Ignagni, president of America’s Health Insurance Plans, said the partnership will allow the group to share information, spot identity fraud early and protect patients.



Via email, the folks at the National Center for Policy Analysis want to hear from you about those political ads you see:

The National Center for Policy Analysis is embarking on a new project called Reality Check. With fewer than 100 days until the Nov. 6 elections, Reality Check will serve as a fact checker on presidential and pivotal congressional health care ads. The NCPA is using social media to sift through true and untrue claims, and promote free market, private sector solutions. But we need your help! Please alert us to any controversial health care ads running in your state and we will verify their accuracy. Submissions can be e-mailed to us at [email protected].

SOURCE: National Center for Policy Analysis