At 03:21 17/07/01 +0000, Pete Vincent wrote:
(Prof Norman Barry)
>>How is it that the fourth biggest economy in the world has such a poor
>>health care system? The figures speak for themselves: in contrast with the
>>UK's 7 per cent, the US spends 14 per cent of gross domestic product on
>>health, Germany 11 per cent and France 10 per cent. When it comes to
>>measures such as doctors per 1,000 of population, Britain is almost a
>>third-world country, having about the same number as South Korea or Turkey.
(PV)
>What a goofball comment. Only someone with a really twisted agenda
>would offer the US rate of spending on health care as a goal to
>emulate, considering how poorly actual care is delivered there for
>anyone outside the wealthy elite.
On reflection, I think you're right. Merely quoting % GDP figures on health
expenditure is not a sound argument. I understand from our newspapaers that
in Germany someone can have a non-emergency operation, whether trivial
(hernia, say) or serious (hip replacement, say) within a day or two of
presenting to a local doctor. In England, a patient will have to wait
anything from 6 months to 2 years for such operations. But I'm also sure
that if the NHS in England were to spend 11% of GDP (as is the present
government's intention over the next few years) instead of 7% (as now),
then the waiting times for operations would not be greatly reduced. It's
much more to do with "culture-set" within an organisation, job
protectionism, degree of centralisation and bureaucracy and so forth,
rather than finance alone. Indeed, because Germany has a much more federal
structure (L�nder) than England, it may be that the health services are
variable in efficiency over there and in some parts pateints may have to
wait longer.
(PV)
>And the guiding philosophy of
>the private health industry in the US is "charge what the traffic will
>bear, cuz folk will part with their last dime when their health is
>at stake".
I see nothing wrong with this in principle. Folk will part with their last
dime for food or water if they're desperate, but both goods are supplied by
private companies at prices that satisfies even the poorest.
As mentioned before, 100 years ago three-quarters of the population in
England paid into local insurance panels and received the fullest medical
attention (of their time) when necessary. Only the rich and the very poor
were not involved. But, normally, a doctor would charge the rich hugely and
subsidise treatment of the poor. Local councils and charities also ran
hospitals for the poor. Charles Darwin's father, for example, made an
immense fortune as a doctor, but he would also turn out at 2.00 am at night
to treat a poor person, not expecting any payment except perhaps a bag of
potatoes some months later. We couldn't expect quite the same ethic today,
of course, because we live in a much less patronising society. But there's
no reason in principle why the voluntary insurance principle should not
work today -- and, indeed, still works in many countries.
As for the situation in America, I have no first-hand information. Two
FWers tell me privately that they receive excellent service, one complains
about it. Being a Canadian, and being closer to the US, you may have more
objective knowledge than I have.
(PV)
In my work, we often make use of devices originally
>intended for the medical field, and I encounter various examples
>of spectacularly overpriced hardware in the trade catalogues. I'm
>sure this is no news to anyone - that 14% is not being wisely
>spent in any measure of the term. The process is similar to the
>oft cited excesses of military contracting: if the word "medical"
>is attached, the price of hardware seems to magically quadruple.
>Not to say the UK system is beyond criticism, but at least make
>it sensible. Lots of countries are delivering better _overall_
>care for all their citizens without coming near that 14% mark.
>Heck, if we in Canada were to spend that much, our medical system
>would be gold-plated.
Equipment prices: not only a quadruple difference, but probably 10- or
20-fold. I've already mentioned that from my scientific and engineering
experience (of long ago!) I would judge that the US$2million+ X-Ray machine
that treated me could be made for US$250,000, the price of a luxury car, if
made in sufficient numbers. Being a monopoly, the NHS maybe has no more
than a hundred or so in the major hospitals in the whole country whereas
(I'm told) large numbers of doctors in America have their own machine. I
would love to know the difference in price in the two countries.
But I think that job mystification, protectionism and credentialism in the
traditional professions of the law and medicine is endemic in many
countries, and it is this, rather than anything else, which prevents the
functioning of the free market -- as opposed to the supply of food.
Keith Hudson
___________________________________________________________________
Keith Hudson, General Editor, Calus <http://www.calus.org>
6 Upper Camden Place, Bath BA1 5HX, England
Tel: +44 1225 312622; Fax: +44 1225 447727;
mailto:[EMAIL PROTECTED]
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