Lapdog healthcare

March 23, 2011 4:03 PM

Coalition health reforms will spell the end for the NHS and lead to U.S. style system, claim researchers. 'Prof Allyson Pollock, from the Barts and The London School of Medicine, and David Price, senior research fellow at its Centre for Health Sciences, write in a paper published on BMJ.com that the legislation “amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery”. They say the Government “has repealed the health secretary’s duty to provide or secure the provision of comprehensive care” in order to create a commercial market in care. Instead, under the new system the state "finances but does not provide healthcare", in “equivalent to Medicare and Medicaid schemes in the US”'. Meanwhile, Dr Kim Price, claims 'the UK coalition government's planned NHS and welfare reforms, and their use of 'nudge' theory, hark back to ideas on welfare and recession from the end of the nineteenth century, according to studies by a University of Leicester historian whose research paper has recently been published in the Lancet'.

In his paper in the Lancet, Dr Price argues that the UK's Coalition Government has begun to tackle the annual deficit with the language and policy aims from the recession of 1870.
In the late 19th century the Conservatives instigated a policy to cut back welfare expenditure and lessen reliance on poor law out-relief. This included cutting medical extras and payments to lone mothers, widows, the elderly, the chronically sick, and people who were disabled or had mental illness.

The result, Dr Price believes, lowered the health of many families and increased the number of people who could no longer be supported at home.
Dependency was criticised by both government and ratepayers, until by the 1880s the Victorian obsession with thrift and self-help had taken hold throughout the voting classes. Philanthropy and charity, however, could not compensate for government aid, and institutional care drove up national expenditure.

posted by VikingSword (33 comments total)

It's the normalization of healthcare.
posted by ChurchHatesTucker at 4:09 PM on March 23, 2011

This FPP is overly editorial. People have been complaining for years that too much money was being spent on administrators and decisions taken out of the hands of doctors, and also that doctors were underpaid. Now the government proposes firing a lot of administrators and putting more power in the hands of doctors, who stand to make more money, and it's called an attack on hard-working NHS administrators. Both of these papers sound very tendentious.
posted by anigbrowl at 4:19 PM on March 23, 2011 [2 favorites]

Huh. I would've thought educational would need to go first, amirite?

Oh, wait.
posted by Sys Rq at 4:41 PM on March 23, 2011

er, educational
posted by Sys Rq at 4:42 PM on March 23, 2011

There's something oddly thrilling about living in the dystopia other countries warn themselves about.
posted by Doublewhiskeycokenoice at 5:11 PM on March 23, 2011 [21 favorites]

I like how Republicans warn us we could end up with Europan healthcare while European politicians are warning their voters that they could end up like the US in the healthcare department.

Of course, it's more nuanced than that. For one, the Europeans know what they're talking about.
posted by mccarty.tim at 5:15 PM on March 23, 2011 [23 favorites]

Funny you say that, anigbrowl, because The Telegraph is usually seen as the most conservative of the British national newspapers. Of course, that doesn't preclude this particular article's bias in the other direction.

I don't know how wasteful Primary Care Trusts are. However, I do know that my PCT got me to the nearest possible dermatologist in the fastest possible time after my GP admitted that he wasn't familiar enough with the area to recommend a psoriasis expert.
posted by dumdidumdum at 5:32 PM on March 23, 2011 [1 favorite]

it's abundantly clear that the massive off-manifesto drive for nhs "reform" is privatisation in reality. The doctors are already threatening revolt. But the Tories are not as thick as they are nasty. My immediate thoughts about the budget speech today were dominated by the proposal to merge NIC and income tax. For those not versed in UK politics, National Insurance Contributions are inextricably linked with the nhs in the minds of the electorate. The plan to merge them is clear evidence to me that this is a long term plan by the Tories to divorce the nhs from the taxpayer by breaking that link. And who wants to pay alimony after a divorce? The Tories are dirty conniving fuckers who hate the poor, and no one is going to convince me otherwise
posted by Jakey at 5:45 PM on March 23, 2011 [20 favorites]

The Telegraph is usually seen as the most conservative of the British national newspapers.

Yes, that leapt out at me as well. But frankly, this has been covered across the spectrum. What's notable, is that the usual suspects on the right are not at all downplaying this - at least not in a way that's obvious to me. Heck, I had a choice of including a link to the Daily Mail on this story, but I refrained... but note the comments!
posted by VikingSword at 5:55 PM on March 23, 2011

This is the final swing of reaction. Capital pressing for the last advantage.
posted by Ironmouth at 6:48 PM on March 23, 2011 [2 favorites]

Put another way, parties of the right have spent the last 60 years only arguing to keep taxes down while making token gestures towards spending. Those policies have come to roost. All they can do is argue unpopular cuts now. Time for tax increases on the vast wealth of the few.
posted by Ironmouth at 6:59 PM on March 23, 2011 [3 favorites]

Coalition health reforms will spell the end for the NHS and lead to U.S. style system, claim researchers.

Is Britain now importing its health care researchers from Canada? Any attempts to make change to our broken, unsustainable health care system are automatically shouted down by a large constituency that is strongly invested (either ideologically or financially) in the status quo as being the first step to an American-style health care system. In Canada's case, it totally ignores that the best health care systems in the world, like the French, mix private and public care, while Canada is almost alone in banning private insurance. In Britain's case, well, it just sounds like more lazy ideological research. Nobody outside of the United States wants an American-style health care system. But most public health care systems are struggling with unsustainable cost increases as the baby boomers age, unions soak up untold new investments in wage increases, and patients demand expensive procedures like hip replacements that didn't exist 40 years ago, to say nothing of the cost of new drugs.
posted by Dasein at 7:22 PM on March 23, 2011

One thing I found interesting about the health care debate is the importance of language in determining how "free" a particular market is.

Canadian doctors are perfectly able to migrate down from Canada and put up their shingle here, while the same easy escape from the more tyrannical (in terms of proft-controls) Japanese system is not available to Japanese doctors, unless they went to Keio or something.
posted by mokuba at 8:03 PM on March 23, 2011

it's abundantly clear that the massive off-manifesto drive for nhs "reform" is privatisation in reality.

I remember being in London last summer and it was obvious to me then that this was what was happening, and I very much hope the citizens of the UK stand up and prevent this from happening.
posted by The Emperor of Ice Cream at 9:04 PM on March 23, 2011

Nobody outside of the United States wants an American-style health care system.

Au contraire
posted by pompomtom at 9:11 PM on March 23, 2011

Punter: ...is your health care system a go-er? Eh? Nudge, nudge, say no more.
Doctor: It sometimes goes, yes.
Punter: Ooh! I bet it does, eh? I bet it does. Nudge, nudge Is it "comprehensive," eh? He asked knowingly.
Doctor: Well, it's publicly accountable...
Punter: I bet it is! I bet it is in public, eh? Nudge, nudge. "Free at the point of delivery" eh?
Doctor: Look, what's all this about?
Punter: Well, you're a doctor. You've uh... done it. Practiced medicine on an actual patient.
Doctor: Yes?
Punter: Well, my arm hurts from nudging and I don't have any insurance.
posted by Smedleyman at 9:34 PM on March 23, 2011 [4 favorites]

That is a shame. Hands down the best healthcare I've ever had in my life was the 2 years I spent living in the UK. Competent doctors, wait times were not existent for primary care and for specialists were similar to those in the US under Blue Cross/ Blue Shield or Kaiser (ever tried to see an OB/GYN at Kaiser? ye gods), decent administration (again compared to US companies) and up to date treatments. And I was paying the same in taxes that I do in CA.
posted by fshgrl at 10:11 PM on March 23, 2011 [3 favorites]

Funny you say that, anigbrowl, because The Telegraph is usually seen as the most conservative of the British national newspapers. Of course, that doesn't preclude this particular article's bias in the other direction.

Oh, I meant the academic papers. I know all about the Torygraph; I used to work at the Grauniad. I still have my fat editor's pencil from the hand of Peter Preston. That the Telegraph and the Mail and so forth are reporting this as opposed to cheering it as a Tory reform does not mean a great deal, in my view; newspaper sell the most copies by loudly demanding change and then loudly complaining about it when it arrives. A controversial paper about the future of the NHS is guaranteed to get people's interest, but vague enough to prevent them reaching any sort of meaningful conclusion - you notice none of the papers have bothered to pay for the reprint rights or do a detailed analysis of the arguments. The reports are all about who said this and who said that about what the first person said - gossip, in other words. There is very little of substance here.

I haven't made up my mind about the viability of the proposed changes yet, but they do strike as coming from a markedly different place from those of previous Tory governments. The 80s and 90s saw the rise of the MBAs and the creation of NHS trusts, to be replaced under Labour with a variety of quangos designed to supervise another, slightly different set of targets. I've been a bit surprised by the Cameron government's willingness to both invest more money and to give doctors much more control over clinical decisions and a stake in the outcomes. Now how that turns out in practice remains to be seen, but I'd hazard a guess that the outcome for the NHS will bear a greater resemblance to New Zealand than to the US. If so, I'd consider that a plus. Administrative costs in the NHS had gotten far too high - partly thanks to previous 'reforms' which were thinly-disguised cost-cutting exercises, and which resulted in yuppie management theorists using the savings to feather their own nests. Giving GPs more authority to oversee treatment puts treatment decisions back on a clinical footing, while at the same time giving them a guarantee of adequate financial resources to support that transition. Turfing out a bunch of rent-seeking middle managers with zero clinical experience strikes me as a distinct improvement.

The Tory-Lib alliance is a mixed bag so far, but David Cameron is no Margaret Thatcher.

And who wants to pay alimony after a divorce? The Tories are dirty conniving fuckers who hate the poor, and no one is going to convince me otherwise

So the government proposing making well-off people (usually men) pay for the upkeep of their ex-spouses (usually women) instead of leaving them to subsist on welfare, and this shows they hate the poor? They cut corporate taxes for all business except banks and oil firms, as well as cutting the cost of petrol, and I don't see how that's an attack on the poor. NHS staff face a 2 year pay freeze - except those making under 21k a year, who get a pay rise instead; they've fired ~2500 managers from the NHS over the last year but added about 5000 doctors and nurses as full-time staff instead. How is that an attack on the poor?

Oh, nobody is going to convince you otherwise? Then I guess looking at the numbers is just a waste of time. Carry on, do.
posted by anigbrowl at 10:56 PM on March 23, 2011

I don't know how wasteful Primary Care Trusts are.

I was talking to the chair of a big PCT last week and she reckoned that they could have easily been halved in size without any significant impact on services or patient care.

She also thinks that current Tory plans are utterly insane.
posted by PeterMcDermott at 11:46 PM on March 23, 2011

After education fee increases this year, there's enough anger in society. So whist the 1p per litre (!) tax relief was a generous gift, the NHS remains even more so the third rail of politics -- touch it and your dead.
posted by nickrussell at 1:46 AM on March 24, 2011 [1 favorite]

I was at a pub with a friend of mine when all the planes were grounded due to the volcano in Iceland. I expressed mystification at the fact that they were keeping all of them grounded, and consequently losing mountains of money.

"You're such an American" he said ( true, born and bred in NY, living in the UK ).

He explained that was why I couldn't understand how any society would value human life over profit. A valid point.

Now I see the government introducing Univeristy fees, and I know that by the time my children grow up it will be as bankrupting as it is in America, and it'll never come back.

Now I see them wanting to "reform" the NHS and the welfare system, and read about how they consulted leading american republican strategists to figure out how they could get the underclass off the public agenda.

They'll continue to take things away from everyone and call it something else. They'll privatise public services to make their corporate sponsors wealthier and everyone will bear the cost.

I wish I didn't know better. I hate this shit.
posted by Hickeystudio at 2:14 AM on March 24, 2011 [7 favorites]

The Tories hate, and have hated the NHS ever since it was created, and for many of them, this bill represents the delightful, joyful, destruction of the NHS. See a quote from Oliver Letwin in 2004: 'NHS will not exist under Tories' - http://goo.gl/xcLlV

And they're probably quite content that they don't know exactly how it's going to end. See: "Tory MP calls for local government planning to be replaced by 'chaos'": http://goo.gl/fcb7M

Many of them are really quite far right wing ideologues, Adam Smith free-market loons, who see no problem with free-market chaos in our health service.

If this lot get their way, and I see no reason why they won't, the UK will be a radically different place in ten years, and alot worse for it.

The only thing that will matter will be money. Nothing else.
posted by rolandroland at 2:42 AM on March 24, 2011 [2 favorites]

anigbrowl: "So the government proposing making well-off people (usually men) pay for the upkeep of their ex-spouses (usually women) instead of leaving them to subsist on welfare, and this shows they hate the poor?

If you're talking about the proposed CSA reforms, your erstwhile colleagues at the Graun have a thing or two to say about that.

They cut corporate taxes for all business except banks and oil firms, as well as cutting the cost of petrol, and I don't see how that's an attack on the poor.

After completely rolling over on just about all of the banking reform commitments of their manifesto, are you seriously suggesting that sticking by the banking levy is some sort of crusade on behalf of the poor? How long do you think the levy will be on the books? You can be sure the tax cut will be here for a while. It won't take the banks long to make up the difference. As for the petrol price and oil levy - that's clearly a middle class crowd pleaser. I'm pretty sure that the majority of those on benefits would prefer that the benefits were not frozen or cut, as opposed to cheaper petrol for a car they don't have.

NHS staff face a 2 year pay freeze - except those making under 21k a year, who get a pay rise instead; they've fired ~2500 managers from the NHS over the last year but added about 5000 doctors and nurses as full-time staff instead. How is that an attack on the poor?


Forgive me if I'm not excited about the idea that low-paid workers are losing ground against inflation a little more slowly than everyone else. And while on the face of it the management cuts appear good, I suspect those 2.5k managers will be back soon at a GP-led healthcare consortium near you, with a wedge of their redundancy still in the bank and no doubt a nice uplift in their new salary.

So no, nothing you've said so far has done anything to convince me otherwise.
posted by Jakey at 2:47 AM on March 24, 2011 [1 favorite]

Few more links.
Burying good news to justify change?
Doctors association BMA votes against change even though doctors pay could double.
Spinwatch: How government found doctors to support them (via).
And of course, the Andrew Lansley rap.
posted by TheophileEscargot at 3:09 AM on March 24, 2011

March for the Alternative on Saturday!
posted by knapah at 4:39 AM on March 24, 2011

long term plan by the Tories

I know it's a long time to the next election, but the thought the Tories and Lib Dems are both going to get trounced by Miliband in a few years is the only thing that's keeping me going through all this. And I don't even like Labour.
posted by Summer at 5:10 AM on March 24, 2011

It's nice to think they will get a hammering in some future election, but how much of what they dick around with will be reversible? Certainly not the uni fees, which Labour initiated but which now will basically mean a 9% tax on graduates for the first 30 years of their working lives. (I just find it astonishing that they could get away with that, 9%!, Can you imagine if Osborne put 9% on income tax?) Labour aren't going to turn around any break up of the post office, since they spent years trying to initiate it. Will they do anything about academies? Clearly not. Despite what the Daily Mail says we hardly saw a big swing back to increasing union power under the last Labour government so we're not going to see worker protections come back too much stronger.
posted by biffa at 7:50 AM on March 24, 2011 [1 favorite]

This FPP is overly editorial. People have been complaining for years that too much money was being spent on administrators and decisions taken out of the hands of doctors, and also that doctors were underpaid. Now the government proposes firing a lot of administrators and putting more power in the hands of doctors, who stand to make more money, and it's called an attack on hard-working NHS administrators. Both of these papers sound very tendentious.
posted by anigbrowl at 4:19 PM on March 23 [2 favorites +] [!]

It might depend which doctors you're referring to, but I haven't heard anybody complain that GPs are underpaid in the last 5-10 years. I know that a lot of the talk about just how big their incomes can be is exaggeration, but they're definitely not in the poorhouse.
posted by Jehan at 12:04 PM on March 24, 2011

If you're talking about the proposed CSA reforms, your erstwhile colleagues at the Graun have a thing or two to say about that.

The first link is a balanced report, summing up the potential costs and benefits pretty fairly. Zoe Williams article is complete bullshit. She talks about 'part of the enthusiasm for the CSA in the 1990s...' - what? The Tories created the CSA in 1993 and everyone hated it. In the name of chasing down deadbeats, any existing maintenance arrangements between a divorced couple were thrown out if one of them applied for any kind of state benefit and recalculated by the CSA. From the outset the agency had a reputation for being unresponsive, unsympathetic, and inaccurate, holding the benefits of single parents hostage and so on. Over time matters gradually improved, got worse, improved, got worse again...look back through news coverage of the last 17 years and see the near-continuous ebb and flow of complaints about it.

petrol price and oil levy - that's clearly a middle class crowd pleaser. I'm pretty sure that the majority of those on benefits would prefer that the benefits were not frozen or cut, as opposed to cheaper petrol for a car they don't have.
[...]
Forgive me if I'm not excited about the idea that low-paid workers are losing ground against inflation a little more slowly than everyone else.

So basically, anything that doesn't align with the narrative of the Tories being motivated purely by greed is irrelevant? Foolishness. I'm not a fan of the Conservative party and would have preferred a Lab-Lib coalition or a much larger Liberal representation in parliament if I were still living and voting in the UK. But the Tories were out of power from 1997 until the last election, can't really be blamed for cocking up the UK economy given the size of Labour's past electoral mandates, and treating the current government as Thatcherism 2.0 is as silly as the conservative fringe right treating the Labour party as if it were the plaything of the 1970s militant tendency.
posted by anigbrowl at 3:18 PM on March 24, 2011

Forgive me if I'm not excited about the idea that low-paid workers are losing ground against inflation a little more slowly than everyone else.

They're not though, I'm just under the higher tax rate and apparently this budget will leave me about £180pa better off, about the same as the budget last June did. It's absolute nonsense that some people are in this position with the cuts that are poised to devastate our society.
posted by biffa at 3:42 PM on March 24, 2011

So basically, anything that doesn't align with the narrative of the Tories being motivated purely by greed is irrelevant?

That's not what I said*. Are you disputing the assertion that the petrol price giveaway is a sop to the so-called squeezed middle?

biffa already answered the second part.

treating the current government as Thatcherism 2.0 is as silly as the conservative fringe right treating the Labour party as if it were the plaything of the 1970s militant tendency.

No. It isn't. New Labour were so far to the right of 70's Labour that they implemented policies that Thatcher would have danced a jig had she got away with them. Tuition fees, PFI, NHS "competition", city deregulation. They were diametrically opposed to 70s Labour ideals, which is why they fucked us up the way they did.

By contrast, Call-me-Dave's mob are harking back to the days of patronage and you get what you pay for. The Orwellian doublethink inherent in the dismemberment of the voluntary sector under the banner of the Big Society no doubt has Margaret "No such thing as society" Thatcher turning cartwheels. And that's why they'll fuck us up even more.

If you're not in the UK, I'm not sure that you grasp the mood of the place. The Liberal and wet Tory voters are like a bunch of kids who set a small fire to liven the place up. They're starting to look at the flames catch hold and beginning to get that what-the-fuck-have we-done feeling. The arsonists, of course, are in their element. The rest of us are praying like fuck for a thunderstorm, or a Bobby Ewing moment, and doing what we can to save what we have in the meantime.


*It may** be what I think

**By "may," I mean "is."
posted by Jakey at 4:47 PM on March 24, 2011 [1 favorite]

the best health care systems in the world, like the French, mix private and public care...most public health care systems are struggling with unsustainable cost increases as the baby boomers age

The French system costs considerably more than the British in absolute terms, per capita and as a proportion of GDP*. Whether its outcomes are actually measurably better seems to be less certain. This piece in the BMJ suggests the data are more complex than most healthcare Francophiles would lead you to believe.

*BMJ piece claims 29% more in 2008
posted by howfar at 5:35 PM on March 24, 2011

Are you disputing the assertion that the petrol price giveaway is a sop to the so-called squeezed middle?

giveaway: something is going to people who don't deserve it
sop: it's a bribe of the easily pleased
so-called squeezed middle: those bourgeois bastards

I'm sorry you're so worried, and I certainly hope things turn out better than you appear to expect. On the other hand, if by 1970s Labour ideals you're referring to the militant trade unions and widespread strikes (which eroded support for the Callaghan government and its platform of controlling inflation), then I think that was a massive political own goal and practically assured Thatcher's electoral success in 1979. Whoever thought the best way to stand up to the IMF was to stop burying bodies or collecting rubbish had a hole in their head.
posted by anigbrowl at 6:49 PM on March 24, 2011