Err, yes Mary, this is the point

Behind yesterday’s furore over those who may have died needlessly in hospital lie blunders that should be as alien as smallpox and diphtheria to a modern health service.

So we had better try reforming that health service so as to make it more modern, eh?

Most sinuously of all, Mr Hunt is aiming to downgrade the NHS from national religion to a somewhat dodgy cult liable to fail its disciples or, in extreme cases, kill them. Ending that sacred status is, in Labour’s fear, the prelude to softening up the public for a mass privatisation of health services.

If the old way of doing things really has been topping people left right and centre then perhaps something should be done?

By focusing on the past, and on Labour’s record, he and Mr Hunt hope to avoid the awkward question of the present and the future. Over-65s are set to triple by 2074, social care for the elderly is in chaos and NHS spending, which has averaged a four per cent annual rise since its inception, is flat-lining.

Yes, this special inflation rate is exactly why we do want to bring in some semblance of markets. For such Baumol\’s Cost Disease inflation and productivity increases are the flip sides of each other. If we don\’t have rising productivity then we will indeed, in a service, have higher than general inflation. The solution to which is to try and raise productivity. Which is best done in a market rather than planned environment.

And yet, with demography and demand stacked against it, it accounts for 9.6 per cent of GDP, compared to 17.9 per cent in the US for far worse care.

And the 9% average of GDP across Europe where the care is far better. It\’s the method of organisation at fault, not the budget.

14 thoughts on “Err, yes Mary, this is the point”

  1. “compared to 17.9 per cent in the US for far worse care”

    Is it really “far worse care”, for most people? The insurers can evidently be a nightmare, but is the care really worse? One reason it’s more expensive is that the US doctors will use technology like scanners frequently, and perhaps a little casually, that the NHS rations.

    She concludes “Ed Miliband is sitting on the big idea which might just save the health service. He should back it.”

    Which “big idea” is that?

  2. ‘ And the 9% average of GDP across Europe where the care is far better.’

    Is care far better across all of Europe or just some bits of it? Is the nine percent figure brought done by some places we wouldn’t really wish to emulate?

    (Not sure why journalists make US care the standard point of reference, it’s not a very relevant comparison and nobody is planning to introduce it here. On the other hand, why Lefties have such a horror of the French or German systems beats me!)

  3. ” for far worse care”

    Come to think of it, it’s hard to think of much worse care than needlessly killing off thousands, and institutionally out-doing Shipman.

  4. At least he’s clear-cut: “in 2004 the new Consultants’ Contract (negotiated by the BMA with the Labour government) gave us all a decent pay rise. It also sharply defined what we actually do at work, for the first time. I’m obviously biased, but its effect was to bring us nearer to what we should be earning. Pay had lagged behind other groups badly (as it is right now, with austerity). This inevitably lead to the accountant’s attitude mentioned above, in judging output and outcomes.”

  5. I thought that quotation was interesting because I’ve worked for many decades now, without ever having any notion of “what [I] should be earning”. There is what I can earn, which varies with each contract, and I have to compete for those. That and the “lagging behind other groups badly” seems a curiously presumptuous attitude.

  6. American “worse” care has, I believe, twice the survival rate for throat cancer (for example) than the lovely NHS.

  7. RM:

    From a letter attached to your link–speaks for itself.

    “In their Perspective article (Jan. 14 issue),1 Murray and Frenk review a number of indicators of the relatively poor state of the population’s health in the United States. Most, if not all, of this information is well known to readers of the Journal, and the authors’ use of it is not objectionable. However, Murray and Frenk begin their discussion by referring to the World Health Report 2000, Health Systems: Improving Performance, from the World Health Organization (WHO), which ranked the U.S. health care system 37th in the world, and this is objectionable. (I was editor-in-chief of the World Health Report 2000 but had no control over the rankings of health systems.) Fully 61% of the numbers that went into that ranking exercise were not observed but simply imputed from regressions based on as few as 30 actual estimates from among the 191 WHO member countries. Where the United States is concerned, data were available only for life expectancy and child survival, which together account for only 50% of the attainment measure. Moreover, the “responsiveness” component of attainment cannot be compared across countries, and the estimates of responsiveness for some countries were manipulated. This is not simply a problem of incomplete, inaccurate, or noncomparable data; there are also sound reasons to mistrust the conceptual framework behind the estimates, since it presupposes a production function for health system outcomes that depends only on a country’s expenditure on health and its level of schooling, ignoring all cultural, geographic, and historical factors.2

    The number 37 is meaningless, but it continues to be cited, for four reasons. First, people would like to trust the WHO and presume that the organization must know what it is talking about. Second, very few people are aware of the reason why in this case that trust is misplaced, partly because the explanation was published 3 years after the report containing the ranking. Third, numbers confer a spurious precision, appealing even to people who have no idea where the numbers came from. Finally, those persons responsible for the number continue to peddle it anyway. To quote Wolfgang Pauli’s dismissal of a theory opposed to quantum mechanics, “Not only is it not right, it’s not even wrong!” Analyzing the failings of health systems can be valuable; making up rankings among them is not. It is long past time for this zombie number to disappear from circulation.

    Philip Musgrove, Ph.D.”
    Health Affairs, Bethesda, MD

  8. MyBurningEars,

    > Not sure why journalists make US care the standard point of reference, it’s not a very relevant comparison and nobody is planning to introduce it here. On the other hand, why Lefties have such a horror of the French or German systems beats me!

    Well, quite. Firstly, the British propaganda about US healthcare is ridiculous: talk to anyone in Briton and they’ll tell you they know someone whose friend’s neighbour needed treatment in the US and was chucked out of the ER for not having insurance or was told by the ambulance driver he’d turn the siren on for fifty dollars or whatever. Secondly, all judgements of the US system are based on that propaganda, rather than, say, the fact that they have a higher survival rate for every single type of cancer than we do. And finally, everyone insists that we have just two options: the NHS or the US. So we’re left with this absurd pseudo-debate where anyone who says “How about having a system like Germany’s?” is met with screeches of “But we don’t want to be like America where they kill the poor!”

    And that’s before we even get into the fact that — pre-Obama, at least — there is no US healthcare system; there are thousands of hospitals operating under dozens of systems in at least fifty different jurisdictions. Making generalisations about the whole shebang makes as much sense as talking about the EU healthcare system.

    It’s interesting to look up the websites of French and German hospitals. Many have pages in English, specifically aimed at British people, with details of travel and accommodation and so on. Then see if you can find any British hospitals who actively market their services to the French. Ahahahahaha.

    My wife had to go to hospital in Germany a couple of years ago. To someone used to the NHS, it was like visiting a more advanced planet.

  9. CHF: “She concludes “Ed Miliband is sitting on the big idea which might just save the health service. He should back it.”

    Which “big idea” is that?”

    Well, if he’s sitting on it, it’s clear just which orifice he’s going to pull it from…

  10. the 9% average of GDP across Europe where the care is far better.

    9% is the average across Europe because various Eastern European countries spend a much lower proportion than that. Would you really choose to be treated in Romania rather than the UK?

    France and Germany, your favoured comparisons, spend over 11% of GDP.

    It’s genuinely difficult to compare the effectiveness of healthcare in different countries – there are so many other factors affecting outcomes. But roughly speaking, you get what you pay for, except in the US which is horribly inefficient.

  11. Are there figures available for health and social care cobbled together? I don’t think it makes a lot of sense to separate them.

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