Dying For What They Believe In

Backbencher November 6, 2012 5
Dying For What They Believe In

Guest Post by Atlas

To say that healthcare is a touchy subject in the UK is akin to saying that Israeli-Palestinian relations aren’t particularly cordial. The NHS was once described by Nigel Lawson as the closest thing we have to a national religion, and, if you’ve ever tried to propose changes to the system, you’ll understand why it’s described this way.

An accusation recently banded around by Labour is that the Tories want to privatize the NHS. It’s worth baring in mind that the Conservatives (rightly or wrongly) were the only party who offered to — and subsequently proceeded to — ringfence the NHS budget; but the slogan “You can’t trust the Tories with the NHS” is one of the big soundbytes of our times.

We’re led to believe that we have the greatest healthcare system on earth. Conservative MEP Daniel Hannan was publically reprimanded by David Cameron over suggestions that it was failing. But is this based in fact, or in fiction?

Well, if you ask any informed member of the Church of NHS, they will probably point you to a study by the Commonwealth Fund[1] which ranked the NHS second-best overall from the seven systems they studied. Of course, the committed worshipper will not have taken the time to read the study, or (s)he would have realised just how flawed the rating system really was.

The study ranked the services based on 63 different statements. It then weighted each statement equally, and drew an average score for each system. One would assume, of course, that these questions were about the provision of care, suitability of medicines administered, doctors’ manner and — critically — healthcare outcomes?

Here are some examples of statements from the study:

– Practice routinely uses written guidelines to treat diabetes
– Practice routinely uses written guidelines to treat hypertension
– Practice routinely uses written guidelines to treat depression
– Primary care practices that routinely provide patients with written instructions

Yes, that’s four statements about written instructions. Do we believe that doctors with seven years’ medical college need a written list of things to do in common scenarios? Is this a good criteria to rank our healthcare system on? This would be like Michelin awarding stars to restaurants which keep good cookbooks instead of restaurants which produce good food.

– With same doctor 5 years or more
– Regular doctor often encourages you to ask questions

Neither of these are really an issue with healthcare provision. Your doctor is likely to change if you move house, so the first one is likely to measure the amount of movement in the country rather than any malpractice. The second seems redundant, you’re not going to sit silently if you have questions about your health, so whether or not the doctor asks whether you have questions, you’re likely to pose them.

– Did not fill a prescription, skipped recommended medical test, treatment or follow-up, or didn’t visit a doctor for a medical problem, because of cost
– Patient had serious problems paying or was unable to pay medical bills
– Physicians often think their patients have problems paying for medication or out-of-pocket costs
– Out of pocket expenses of $1,000 or higher in the past year (US equivelant)

This is where a real ideologically-driven problem with the study lies. There are four statements to do with cost, and none of them measure the actual cost of healthcare provision (which would include the amount you pay for the service in taxes), instead they measure perceived cost. The myth that the NHS is free is one of the greatest battles to be overcome. Something you pay hundreds or thousands of pounds a year for in tax is not free.

A point of note about the statements:
– Three of them directly mention health outcomes: life expectancy, infection rates in hospitals and mortality. Less than five percent of the criteria on a study about healthcare have anything to do with health outcomes.
– Six of them are about computerized prompts & written procedures. Procedure is worth twice as much in this study as outcomes.
– Nine of them are about costs, fees and disputes arising from billing. According to The Commonwealth Fund, it is three times as important to have low costs & easy billing procedures as to have good outcomes. What happened to not being able to put a value on human life?

Between 1997 and 2010, Labour doubled the health budget in real terms. Yet, after this huge expansion in funding, a release from Civitas[2] advising President Obama about healthcare systems around the world, suggested that the NHS “follows rules which guarantee failure”, and that “if the United States is serious about health reform and providing universal coverage, it should look to Europe, where systems are more competitive, responsive and patient-led than the NHS”.

Indeed, the president did overlook the NHS when planning Obamacare, instead looking to continental Europe, where state-supported universal access (for those who can’t afford insurance) is paired with competitive private provision, avoiding many of the pitfalls of the big-state provision of health. Even this committed left-winger couldn’t bring himself to support an ideological system which just doesn’t result in the outcomes the population wants.

For example, the CONCORD study of 2008[3] studied cancer survival rates around the globe and came to some shocking conclusions. Comparing the United Kingdom to a few other countries on cancer outcomes (measured by relative five-year survival) unearths a crushing amount of evidence against the NHS.

Our system falls behind the USA, a consistent underperformer on the first study, behind Italy, behind Finland and Ireland across the board. Our breast cancer survival rates are more than 14% below the rates in the US. Our lung cancer survival rates are around half of theirs.

Perhaps most shockingly, on prostate cancer, in the USA, 91.9% of men survive five years after detection. In the UK, your chances are 51.1% — about fifty-fifty. Even nations like Italy, Iceland and Spain have significantly better outcomes than we do, despite not spending any more money on health. This throws a spanner in the works of the left, who will just perpetually blame under-funding.

We are running a budget deficit of £100 billion a year but we’re providing free healthcare to millionaires. Whilst people die of treatable cancers because they’re “denied drugs that may be clinically effective”[2], we have others claiming plastic surgery because they’re depressed about their breast size[4]. We have IVF available, at a cost of up to £15,000, for couples and women who could adopt a child, reducing the cost of that child’s care and giving him/her a loving family.

Poor priorities, poor efficiency and poor outcomes are the legacy which is leaving the far-left defending the undefensible. Isn’t it about time that we stopped dying for what they believe in?

[1]http://www.commonwealthfund.org/usr_doc/site_docs/slideshows/MirrorMirror/MirrorMirror.html
[2] http://www.civitas.org.uk/press/prObamaNHS.php
[3] http://www.ncbi.nlm.nih.gov/pubmed/18639491
[4] http://www.telegraph.co.uk/news/uknews/1424677/Women-seek-NHS-breast-enlargement.html

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