Obama's healthcare dream

Baroness Murphy

Snowed in at home in Norfolk on Saturday, a slight rise in the freezing temperatures means we are now able to slide a car slowly down the lane to the main road rather like steering a boat. I had some sympathy with Senators in the US yesterday, trying to get into their crucial vote on the Healthcare Bill with Washington covered in two feet of snow and major delays in public transport. It is said that Government jets were commissioned to get some senators there.  I wonder if Baroness Royall would commission a helicopter for me from Norwich International to get the Equality Bill through? Probably not I fear.

The Senate Health Bill is quite substantially modified from President Obama’s original universal coverage bill; it omits the notion of a public insurance system to cover those who do not have any cover at all and fall outside Medicaid and Medicare but nevertheless it is a triumph of last minute deals and some unseemly ‘incentives’ but will provide cover for another 30 million people out of the 47 million who at present fall out of the system. It’s expected that the final vote on Christmas Eve will ratify the current shape of the Bill.

Opposed on grounds of costs by Republicans, opposed by many doctors on the grounds that obligatory insurance schemes curtail freedom of clinical practice (and hence their potential remuneration) and the insurers themselves, it is the best that can be achieved at the moment, and a step that it is unlikely any future government can undo. If Obama does nothing else this will be an important legacy. Now they have to find ways to curtail health care spending, just like other western democracies.

I was surprised to see that the Senate vote was at 1.00 a.m. What is it about politicians that they like to legislate at unseemly hours of the night? Having endured the Equality Bill marathon to 11.00 p.m. last week, I think it’s time to start a campaign for parliament working ordinary hours. Nothing we do is so urgent that a decision needs to be made when many of us are too tired to stay awake.   As a junior doctor I knew that when I worked long hours and through the night it really was because people’s lives depended on me being there. I find the whipped up false deadlines of political life rather absurd, a reflection of the egotism that makes politicians feel self-important. Staying up all night to staff A&E or an ambulance can be good; staying up all night to vote on fox hunting is simply balmy.

25 comments for “Obama's healthcare dream

  1. Gareth Howell
    22/12/2009 at 5:43 pm

    I wonder whether Baroness Murphy thinks Obama has had a lot to learn from The NHS of the UK of how NOT to run a Health service by comparison with others in the EU, from whom/which he might have taken some useful models?

    • 23/12/2009 at 12:32 pm

      The NHS is significantly better than the US system of healthcare, and I know a number of Americans who would have bitten off his arm had he presented such an all-encompassing and cheap system, rather than a massaging of the current expensive, convoluted and spotty system.

      While none of us seem to be as good as France, by God the NHS is at least value for money!

      • Nick
        24/12/2009 at 11:28 am

        The NHS by its own admission contributes to 20,000 deaths a year.

        Is that value for money?

        When you say value for money, you must know what price you pay for the NHS.

        So, I presume you are one of the workers in the UK. How much do you pay a year in tax for the NHS? ie. What’s the cost side before we discuss the value side

      • 24/12/2009 at 4:12 pm

        You again?

        People in the UK spend an average of US$2600 per capita per annum on healthcare. Of this the vast proportion is tax. This is around 80% of the EU average, and less than any comparable industrial nation. Citizens in the USA spend an average of US$6000 per capita. Of this around US$2800 is tax, paying for Medicare and Medicaid, which most taxpayers do not have access to, the rest is private insurance, which constitutes a significant market distortion in the USA.

        Where does the 20000 deaths a year come from? Are you talking MRSA, which came up with a number of around 20K between 2004-2008? Are you factoring in lives saved by preventative care? To me this seems like another cherry picked, absurd number, quoted entirely out of context in order to prove some political point or other.

        Numbers I am aware of paint a much different picture. Our healthcare outcomes are broadly comparable to the rest of Western Europe. Where we fall behind tends to be the places you’d expect a cheap, centralised healthcare system with a heavy emphasis on preventative care and childcare. The older and richer you get, the better off you’d be moving to France if you get heart disease. If you’re under 20 your health outcomes are as good as France and better than the USA, for less cost. If you earn less than the median wage your health outcomes are considerably better here than they are in the USA.

        I know exactly what I pay and what I get for it, sir. If you can bring me a comparable western economy that gets better baseline health outcomes for an equivalent amount of money I will gladly accept any advice that their health minister has to offer us. Until that point, I’ll suggest that we do pretty damn well given how cheap we are.

        However, I suspect that actual knowledge and numbers are not something you are interested in at all. You merely wish to harangue people for some perceived mismanagement which you take personally.

        I hope you’re not this bitter with your family over Christmas, sir.

  2. 22/12/2009 at 5:48 pm

    O/T: vote for 2009 politicians, national and international via Iain Dale’s site HERE.

    Nominations wanted for Peer of The Year, Politcs Blog of Year etc.

    Please excuse the interruption.

    A very happy Christmas to all the peers, and the peerless commenters. See you in 2010, possibly.

    • Gareth Howell
      23/12/2009 at 4:45 pm

      “The wind horse is an allegory for the human soul in the shamanistic tradition of Central Asia”

      That is a very good plan Tizzy. The other place has a very good, and amusing, “MP of the year” which is done by the Guardian perhaps, in about June.

      The last time I saw it, I felt I was among old friends, although they would not so much as remember me, by now.

      But looking at the cultural traditions of
      Central Asia perhaps we could have, instead of a psychiatrist of the year, a “Wind horse man”, allegory for the human soul, who would not only be concerned with the human soul but Wind power and the ecological habitat as well?

  3. 23/12/2009 at 12:34 pm

    If 11pm in the Lords is balmy, which I have always understood to mean soothing, calming and mild, I can understand the incentive to remain. 😉

    Homophones are the bane of the editor’s life, aren’t they?

    • 23/12/2009 at 12:39 pm

      Ahah! I have to apologise immediately. It turns out that Balmy is indeed an alternative spelling of Barmy, even though their meanings are opposed.

      Ah, the gloriously winding roads that the evolution of English leads us down. I’m pretty sure this is one of those corruptions I’d be opposed to, but I can’t claim it as incorrect I’m afraid!

  4. Senex
    23/12/2009 at 6:41 pm

    Baroness Murphy: On a recent tour promoting his health care reforms the President said with some exasperation that if the Senate was tasked with changing the name of a post office they would find themselves operating the filibuster. He went on to explain that a majority of 60 votes was more often than not needed these days to pass legislation.

    To no surprise the filibuster was indeed operated again on this occasion. A graph “Cloture Voting, U.S. Senate, 1947 to 2008” in the link shows what he meant.

    Merry Christmas!

    Some breaking news from Reuters Lapland: Father Christmas’s wife Mary is saying that her husband is concerned that there may be cuts to the National Elf Service in the New Year. In a separate statement the Gnomes of Zurich said they would offer what little assistance they could.

    Ref: Filibuster: United States
    http://en.wikipedia.org/wiki/Filibuster

  5. baronessmurphy
    24/12/2009 at 11:17 am

    First of all McDuff, yes you are quite right barmy is normally spelt that way but I know why I got it wrong. It was often said that the word ‘barmy’ (almost certainly incorrectly), but originally spelt balmy, was derived from the nick name of Balmes House, a famous 18th century private madhouse in East London. I spent a fair bit of time researching into this and other east London madhouses of the 18th and 19th century and it slipped out of my keyboard in its old form.

    Gareth Howell, I agree with you there is a lot wrong with the NHS and most of us want something different from our GPs and hospitals. But it has the great advantage of providing basic coverage for all at point of need, something that we take so much for granted it’s now hard to envisage a system where a fifth of the population can’t access even basic care. McDuff, France doesn’t provide especially better care if you look at the co-ordinated care of long term conditions and mental health services. It also probably over investigates and prescribes far more drugs than we do. On the other hand the population famously likes it, so that is good. All western health systems have good and bad parts to them, and it’s especially difficult to compare outcomes, one measure of quality of care, as is often done in cancer care for example. Different populations, different populations accessing care, different diagnostic systems, all lead to a misleading international picture. Few would want to recreate the NHS in its existing monolith form, certainly successive governments have tried to move away from that, regrettably with some recent backsliding, but the social compact that the NHS brings to the UK, now so sadly lacking in education, has preserved something that many of us find precious. An alternative system would need to think hard how to preserve that. Obama will have a system where the providers of care are independent but the funders of care are a mix of independent and public purchases, that seems to me to be an excellent basis to provide good care if they can co-ordinate their acute and community systems better.

    How did windhorses get into all this Lady Tizzy?

    Merry Christmas everyone, thanks for a great year of comments and challenges.

  6. Gareth Howell
    24/12/2009 at 7:13 pm

    “Wind horse man” is an allegory for the human soul in Sufi Islam. People in the west country must have a better understanding of the soul than those in the east,according to that allegory, and in south west England they certainly live longer! I am interested that there are different measures of success for the various National Health services in Europe, but I wonder how much comparative literary and investigative work has been done. It is surely a useful exercise.

    I am sorry there is a spat between Nick and McDuff, but the folksy “killing of the patient to cure the disease”
    and “killing with kindness” may be more of a problem than McDuff is prepared to concede. If one wants to make a proper analysis of any problem, or an organization, surely a radical approach is needed? My own rant above is based on what happened to me after being scraped up from the road using Coroner’s rules, the excessive coercion used to require me to have a superfluous operation, which itself crippled me. I have come across a good many who say the same.

    A new hospital in this region had any number of negligence and malpractice suits against it within months of opening, much to the delight of local solicitors.

    In my own case, had they attempted to kill with cruelty instead of with kindness, according to their definitions of the terms, I would have been on my feet within days if not hours, rather than two or three years.
    Personal anecdote is not a good guide!
    I eventually went to a Private consultant and he gave me the …… radical alternative! ARISE AND WALK! I did, but not to Lourdes as yet!

    This could get like a Doctor at a cocktail party so I shall stop!

    • 27/12/2009 at 6:06 pm

      Gareth

      It is not my intention to paint the NHS as being perfect or beyond reproach. My aim is simply to point out that the standard litany of complaints about the NHS are quite generally out of sync with the known facts. It may cost a lot of money, but it is very cheap when compared to other systems of healthcare around the world. It may be huge and unwieldy, but overall the bureaucracy has far less impact on the average British citizen than in other nations where a visit to a doctor or hospital can be accompanied by a raft of paperwork and followed by incomprehensible billing systems.

      We should absolutely be working out where the NHS is not working adequately and where it can be made better, but we should not be led into the kneejerk situation of believing that the NHS is by definition “rubbish” and wasteful and should be thrown out wholesale. We would probably not design it this way today, but I rather suspect that if we threw it out and started again that we would not come up with anything much better.

      • Nick
        28/12/2009 at 3:11 am

        My aim is simply to point out that the standard litany of complaints about the NHS are quite generally out of sync with the known facts.

        The known fact is that the NHS itself says that it contributes to the deaths of 20,000 to 80,000 a year. (Personally I suspect the lower figure is the more accurate)

        Now I suspect that you even doubt these numbers, but sit back and think before you post. Is this a realistic estimate? I’ll give you somethings to ponder.

        1. Shipman. The NHS didn’t discover him for a long time, and he was killing his patients. What makes you think they will discover errors that kill patients?

        2. Maidstone and Tunbridge Wells Hospital. http://news.bbc.co.uk/1/hi/health/7037657.stm

        From one cause alone, C-Diff, look at the death rates. Are they going to be killing from other causes? You bet. Are they an isolated case? Not a hope in hell. You need to scale it up across the NHS.

        3. Basildon and Thurrock.

        http://www.guardian.co.uk/society/2009/nov/26/essex-hospitals-deaths-hygiene-inquiry

        Another hospital, another set of deaths.


        It may cost a lot of money, but it is very cheap when compared to other systems of healthcare around the world.

        It’s always interesting. No one puts a figure on it. What does the NHS cost you personally McDuff? Surely you know, because you’ve said it’s cheaper than elsewhere? Have you the figures for elsewhere so we can compare?

        Now I’m pretty certain what you’re reply will be. It will be measured in percentages of GDP. That’s politicians deceiving you. It’s the political answer.

        No one in this country pays a percentage of GDP for anything. They pay in pounds and pence.

        So what does the NHS cost you in terms of pounds and pence as an individual?

        What’s the figure for a family of four?

        Have you included paying for all the people who don’t pay tax?

        What about the compensation for those injured by NHS errors? People are arguing that the victim pays. No compensation. Go home and get on with life without legs. We know we chopped the wrong one off, so had to take off both as a consequence.

        Nick

    • Nick
      27/12/2009 at 6:50 pm

      I’ve just spent 3 days in hospital. Not for me, but for the new one.

      We had two midwives at the start. First was good. Second very good. Both immigrants. The second was a Nigerian woman, and just spot on. Calm and assertive when it was needed, after the birth very relaxed and we were left in quite unless needed.

      Interestingly, we did have a political discussion. She was horrified at a large number of mothers in the UK and the state of the benefit system. If only there were more like her.

      When it came to dealing with the aftermath of the birth, there was a doctor on her rotation doing her bit. Interestingly, she wasn’t running it, it was the midwife who was in charge. On the quite I was told she wasn’t going to sign the doctor off because they weren’t there for long enough.

      What were the problems? I had do some cleaning in the first room, and on the post natal wards, they were clearly short staffed. Getting help with things took being assertive. Follow ups from the health vistors, or even a call are non existant.

      In some ways we are lucky. We have family friends who are doctors, and so can get advice, even from a neo-natal doctor for a couple of issues.

      Otherwise, on the way out, he’s already met his MP, on Christmas day.

      It’s pretty representative of the NHS. Good it parts, bad in others. You have to know what you are doing to get results. Many won’t.

      The usual comparison people want to make with the NHS, is the NHS now versus Victorian Britain. In reality, the comparison is say the NHS versus the French or the Swiss. ie. A modern 1st world health system with universal coverage. On that measure the NHS is pretty dire.

      Out of all the systems, it does pay to look at which health systems work and which don’t.

      Personally, I favour the Swiss model for lots of reasons. It’s pretty close to the same cost as the UK with far better results and service. It wins on value for money.

      Separation of insurer from provider from regulator matters if you want to improve quality. Otherwise the obvious conflicts of interest come into play.

      Nick

    • 28/12/2009 at 5:05 pm

      Is it better to re-read a book with the eyes of an older and more wise person, or open a new book, or even write your own?

      * * * * *

      The problem with liability has been exacerbated by this gvt’s decision to all but scrap legal aid whilst gifting the no-win-no-fee legal reps with civil cases of negligence and malpractice. Today’s numbers can not be compared with those of, say, 10 years ago.

  7. Croft
    27/12/2009 at 1:38 pm

    Millions of people don’t work ‘ordinary hours’. I find calls for change just a little too much like parliamentarians’ special pleading.

    On the 1am votes, I agree there is an element of ‘egotism that makes politicians feel self-important’ but I suspect it owes much to simple maths. I often disagree with Lord Tyler but he has a point that the Lords’ attendances can be pretty well corolated with the hour of the day. Though it’s hard to quantify the explanation between:

    – Peers don’t attend late sitting because, they usually occur where ping pong is occurring and the late sitting has resulted from earlier defeats of the government and many ultimately feel that they will only defy the elected house so many times

    – Peers aren’t ‘paid’ enough for many of them, especially those of advanced years, to engage in all night sittings.

    Whatever the balance between the options the government clearly exploits it.

    • 28/12/2009 at 6:46 pm

      Millions of people don’t work ‘ordinary hours’.(/i>

      Pedantically and practically, there have always been differences between paid time at a place of work, time spent working, and paid time on official duty outside of the place of work where work may or may not actually occur.

      The practice of paying a firefighter to polish the brass (no euphemism intended) whilst waiting for a fire to happen was considered a waste of public money. But this type of correlation collapses when considering the special expertise brought in by one peer over another for a particular debate.

      Put another way, is it desirable to poulate a second house with lawyers and shop stewards?

  8. Adrian Kidney
    27/12/2009 at 2:28 pm

    I sympathise Baroness, but I’m not confident that a legislature can easily be made to work ‘normal’ hours. It’s an unusual occupation and is likely to stay that way.

  9. baronessmurphy
    27/12/2009 at 4:20 pm

    Croft
    I’m going to take issue with you about the late night sittings; I don’t think it’s special pleading to want normal hours, so do most working people. I don’t stay myself unless I am involved in a bill and either can’t avoid it or feel strongly that i want to vote. But it seems to me that parliamentary working hours including evening sittings are a hangover from the days when men came up to town from their estates and sat around the Palace of Westminster as an alternative to repairing to their monday-thursday residential clubs. There is no public service reason for working unsocial hours in parliament as there is for the huge numbers of people who work unsocial hours in transport, shops and other public services. Of course you could say it makes us more sympathetic to those that do work unsocial hours but it also tends to put off women who have families from participating in politics; it’s not just the hours, it’s the sense that Westminster has its priorities wrong. Age is also a factor. At 25 I was content to work long unsocial hours in medicine but as the years have passed it feels as if precious time for family is being taken up by matters which could perfectly well have been done during the the day. Sorry if I’m whingeing again but like many other peers I fail to see the up-side of evening sittings. You are right the Government exploits our reluctance although all political parties know that if they don’t call their major votes by 6.00pm there’s a big risk they won’t get their own supporters there to vote.

  10. 29/12/2009 at 1:03 pm

    Nick,

    I do not know exactly how much the NHS costs me down to the penny, no. Nor do i know how much the military costs in pounds and pence. But why on earth should such data be relevant? I already posted above what the NHS costs the average UK citizen, as well as how that compares to other healthcare systems.

    if you choose to ignore relevant data in favour of harping on about some absurd standard of personal knowledge about the exact breakdown of my personal tax bill, i can only assume you are not interested in the numbers except as a diversion tactic from your overall political stance.

    in citing problems that occur in the NHS, i would personally think it would better serve your point if you could also show that the problems are specific to our system, that other systems avoid or significantly reduce the risks, and that those systems do not come with other problems which we manage to avoid. Without context, data is meaningless. It should also be noted that the singular of data is not anecdote.

  11. mr David Fredin
    29/12/2009 at 3:29 pm

    To Rt Hon baroness Murphy.

    Dear Lady, You wrote that the republicans
    opposed mr Obama’s healthcare program for costs among others. I read in an swedish journal that the conservative christian right in the US also opposes the bill because it proposes free abortion of
    the unborn upp to the nith month! Which is
    is barbaric at least to say. Pleace make further investigations on behalf of the House of Lords, this should not pass by un-noticed, even if its not in the UK.

    The swedish main press has as usualy not comment on this issue, as it is political correct and even not forfilling its basic
    democratic duties to the woters. It took months before the state-televission even started to comment and show the opposition to mr Obama’s programs in the US. Off the topic allow me to tell this anecdote.

    I recall that a swedish frend of mine once at a dinner next to, now Lady Thatcher, was asked about the book by Roland Huntford “The new totalitarians” (wich describes Sweden)if it indeed was that bad. My friend answered:
    “No mrs Thather it is not so, it is much worse!”

    Yours sincerely
    mr. David Fredin

    • 29/12/2009 at 6:13 pm

      Indeed, a similar anecdote is often told by all Northerners when asked about the Thatcher years…

      If you’re talking about the Stupak-Pitts debacle, there’s a reasonable neutral analysis here. In my own, not-at-all-unbiased view, however, anyone who claims that the bill would offer “free abortion up to nine months”,is clearly grossly distorting what is actually going on in the bill. We see, again, another example of the religious right hijacking the legislative process in America with its perverse obsession with what women do with their vaginas.

      Abortion is a medical procedure. It’s only thanks to the insane hissy-fits the right throw that we need to consider it differently from any other medical procedure. And the nutters got their wish – as they so often do in America – so don’t worry, the meddlers can still get the legislature to poke around in poor people’s underwear drawers, as you wish.

  12. baronessmurphy
    30/12/2009 at 9:51 am

    Lead on McDuff (a misquotation I’m afraid but seems just right here).

  13. Gar Hywel
    02/01/2010 at 8:53 am

    “Christian right in the US also opposes the bill because it proposes free abortion of
    the unborn upp to the nith month!”

    So if the SYSTEM changes, the Law changes as well?

    Examination of the UK NHS would never be able to verify whether this is so, or not.

    I agree with the Christian right of the USA that is is likely to do so, that the more sophisticated, and advanced the “National” Health service pretends to become, the more barbaric it really is, in its every day practices.

    There is a right to live(no to abortion)and a right NOT to die(assisted suicide)

    • 03/01/2010 at 1:26 am

      What is it about right wingers that they can edit for brevity but not apparently for clarity?

      UK law provides a right to an abortion up to 24 weeks of gestation. If you choose to interpret that as a “right to kill” then I guess there’s no stopping you.

      However, since you brought up assisted suicide, it’s worth noting that the concept of “brain stem death” is usually used to decide when turning off life support goes from the category of “assisted suicide” to the category of “a waste of good organs”, at least up to 12 weeks gestation a foetus isn’t anything that would be medically recognised as a live human individual in any event. Ascribing rights to human tissue without any discernible brain activity is rather more than even the most terrifying Republicans in that American backwater, the US Senate, are prepared to go.

      Also, as mentioned, not only was the description of “right to an abortion up to 9 months” an almost painfully transparent lie – I find falsehood to be such a gentle word, and I’m not a member so I’m allowed to call other commenters liars – it also has exactly zero relevance to the policies of the British NHS. Indeed, while that body may have many faults, very few of them can be traced back to the Democratic Party of the USA, as mendacious as you so obviously believe it is. Your jerking knees are indicative of what your particular buttons are, not of any problems or otherwise with medical policy on this or the other side of the Atlantic.

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