Tuesday, 30 March 2010

So you think Britain is a Nanny State? Random thoughts on Obamacare.

Well Britain is a nanny state.  And it's pathetic.  And it looks like America is heading down that road as well. 


Seems unrelated but I you'll see a lot more of this real soon. I wonder how much worse this is going to get when young healthy people who don't want to buy insurance are forced to buy into Obama's corporate/government co-op or under the threat of IRS bullying and fines if they don't comply.   The system will swell with expensive bureaucrats and lawyers (the only people who can even make an attempt to understand all the ins and outs of the new legislation) and the common people will be punished with restriction after restriction to "keep costs down".

The poorer states are already freaking out now that they are realising the cost of Obamacare, which is being  imposed on them by the feds in a very unconstitutional manner. Some of the states supported leftist reform.  But now that they are seeing just how high the costs are going to be, and realising that state funded services such as foster care, education etc are going to have to take major cuts they are trying to back pedal a little bit.   The country is already broke.  Americans are in for a shock if they don't think that Obamacare is going to restrict individual freedom.  The fat cats will line up at the government trough and manage to get richer as always.  But I think more than anything they should blame the republicans for all of this.  US healthcare needed reform but it was ignored completely for too long and the democrats saw their chance to expand the federal government and gain more control over people's lives using the guise of "protecting people from corporate evil" to achieve their goals..  In my opinion "reform" should have gone in a different direction entirely.  The left (like most groups) hates a monopoly where the rich get richer unless it's their own monoploy.  Now they have theirs.


Anonymous said...

Disagreeing with socialist health care, I cannot believe a prole would engage in such behaviour, its like a cow advocating the eating of beef.

Nurse Anne said...

You have got to be kidding. I have lived in both the USA and the UK and the deal I had in the USA was completely amazing. I was much more able to care for my disabled child there, rather than being forced to rely in the state as happens here.

I am not necessarily against socialised medicine. I just don't think it works for me.

Nurse Anne said...

Which is why we have been working on getting back.

Nurse Anne said...

and I wouldn't want to see the UK move away from it's socialised model. It's too ingrained in the culture, has existed for generations. The public here wouldn't be able to handle taking care of themselves.

Prisoner of Hope said...

Sorry to hear about the difficulties you experience caring for a disabled child in the UK at the same time as fighting the clipboard matrons at work. No one system of health care will work for everyone but I think it is not fair to compare the current provision in the UK with that in the US if only because successive governments here have tried to move away from socialised medicine without fully embracing a free market model. We have ended up with a dogs dinner of a mess as the swelling ranks of local officials follow orders to play at health care markets.

When Mrs T came to power she wanted a more efficient NHS and asked the Civil Service to compare the costs of managing health care along NHS and US lines. Despite being told (to her and Nigel Lawson's disbelief) that a US style market based approach would require at least 15% - 25% of management overhead costs compared to 4% for the NHS, the die was cast. 20 years of Tory and NuTory/NuLabour consensus and we have arrived at US levels to support ersatz markets, along with box ticking, understaffed and under qualified wards. This is not socialised medicine – it is the result of 20 years damage caused by self serving career politicians who combined an excess of faith with a total lack of intellectual rigour.

Just over 20 years ago - by the end of an International Health Executives Course at Cornell University - I had learnt a lot about the US health care system including the role of the federal HFA (Hospital Finance Administration) which had been introduced to control the costs of treatment provided to the elderly (under Medicare) and the poor (under Medicaid). I also heard a lot about how former US Military were cared for by the Veterans Hospital Service. The real losers were those who were not covered in this way and who could not afford the cost of health insurance. The numbers trapped in this way were reckoned to be around 50 million. It was a shocking revelation to a European. Also shocking was the realisation that uninsured medical costs were then the largest single cause of personal bankrupcy in the country. Furthermore industrialists like Lee Iacoca were astonished to find that health insurance was the single largest component cost of every motor car produced. Families faced with selling possessions to afford the cost of hospital care for an ageing member, asked hospitals to place Do Not Resuscitate (DNR) signs above their relative's bed. How sad then that just as President Obama tries once again to extend, what President Johnson started with Medicare, we in the UK seem hell bent on trying to recreate a US health care model of a quarter of a century ago appealing to envy, fear and greed instead of the altruism, benevolence and charity that underpinned our own socialised medicine for so long.

Only yesterday - on Woman's Hour - another shocking outcome of the US system was discussed. Even with "adequate" insurance cover, women in the US are dying or experiencing near misses during pregnancy at 3rd World levels what is more these rates have been increasing for many years.

Heart complications following undiagnosed pre-eclampsia resulted in one "adequately" insured woman being in debt and unemployed after waking up from a coma to be told her baby had been born without her having any knowledge or memory of the event - because these complications of an avoidable event were classified as "catastrophic" illness by her insurers.
Even if Obama's reforms do take root in the US it will only be after years of resistance. During this time neither the US nor UK systems will represent anything other than the wasteful triumph of short term opportunism and individual greed over compassionate, caring and cost effective social insurance.

Simon said...

Are you all complete nutbags blind to the massive failures of the US healthcare system? As it stands, they spend more per capita than anyone else for poor health outcomes, including a pitiful child mortality rate and dreadful primary prevention. Better hope you don't develop a "pre-existing condition" like a benign tumour or lose your job because then you're fucked for insurance.

While I disagree with Obama's reforms, I disagree with them because they don't go far enough. Every single country that ranks up the top of different healthcare metrics has some form of UHC, whether through compulsory insurance or single payer. America's reforms don't go far enough towards addressing the health needs of their populace and little will happen to improve upon things.

If you're honestly going to argue in favour of the free market in healthcare then you're fucked in the head and shouldn't be allowed near patients.

Nurse Anne said...


"During this time neither the US nor UK systems will represent anything other than the wasteful triumph of short term opportunism and individual greed over compassionate, caring and cost effective social insurance"

I agree with that, in a sense.


Calm the hell down.

Nurse Anne said...

And POH,

I'd like to respond more but I am on my way out now. I wouldn't send my pet hamster in for treatment at a VA hospital.

How do you expect government and politicians to NOT screw up a socialised model? They will always run any such system into the ground. If I did not believe that to be true, I would be a socialist.

Prisoner of Hope said...

Much harm has been done to our previous social insurance based health care over the last 20 years.... including the growing belief that it is government and politicians alone that are responsible for the screw ups.

Many hospitals were set up from public donations as memorial hospitals - they belonged to "us" not "them". Just like the greed of some resulted in the take over of the old mutual societies and co-operative based building societies by venture capitalists and greedy bankers, so ownership of the NHS estate has been allowed to be transferred from communities to for profit corporations. There is no longer any meaningful engagement of local communities on the running of their local health care. (I have tried - boy have I tried!)

In a way the complacent culture of contentment that we have all allowed to fester for the last 20 years has been to blame. The weak "politicians" (at national, local and yes even at hospital management level)have merely responded to rather than challenged this public mood.

As my "nom d'internet" suggests I remain a prisoner of hope - I do not expect everyone to be a socialist but do hope that people might some day return to mutual self help and co-operation based on altruism rather than individual gain based on envy and fear.

That way we might yet avoid both the exploitation of a growing functional underclass (required to service the complacent better off majority) and the vision of the nanny state that prompted your initial thoughts.

Anonymous said...

"The left (like most groups) hates a monopoly where the rich get richer unless it's their own monopoly."

This is why the right-wing BMA, which has a monopoly of supply, has jumped into bed with the Socialist Workers' Party in order to try and prevent privatisation of the NHS. If only we had a social insurance system of healthcare like France, Germany and Holland whre patients' interests come first.

Nurse Anne said...

"I do not expect everyone to be a socialist but do hope that people might some day return to mutual self help and co-operation based on altruism rather than individual gain based on envy and fear."

Yeah me too but the government/ corporations won't ever let that happen.

Julie said...

Prisoner of Hope,

There is hope yet. In Scotland we are test running a system of health elections, where local people can be elected to the health board and take part in the decision making. We'll see how it pans out in Fife, but some folk from our group, the Scottish Health Campaign Network, plan to run and we are made up of a large number of old and bold rebels from the NHS, so I think it could work. We'll see..

Nurse Anne said...


That is exactly what is needed. More control at the local level.

Prisoner of Hope said...


Thank you for the encouraging news about attempts in Scotland. I did allude to the need for for local communities to regain control and not be content to leave the running of health care to politicians and corporations. As a former Patient Governor of the local Foundation Trust, member of the local PCT "Patient Forum", lay member of its Clinical Audit Patient Panel and Pharmaceutical Planning Committee, I find there is much lip service to the idea of "engagement" but a total inability to listen. (Oh in additon I also undertook a thematic analysis of comments received on the PCT's half hearted "consultation" on a future strategy. The 20 Questions that emerged formed an appendix to their report but to date has elicited no answers!)

My solution? - Democratic control through locally elected officials. If this was part of a re-organising of regional and local government all the better. At least there would be true local interest and engagement and we could express displeasure in a meaningful way - by voting people out of office now and again.

How will this happen? Answer it will not until there is some sort of rebellion from below ..... or perhaps Scotland shows the rest of the UK the way. Good luck :-)

Anonymous said...

I have never been in favor of the mandated insurance. To me, this is not real reform. It will cost more and people will still fall through the cracks. I want single payer or at least a strong public option. I am shocked that so many of my liberal friends are applauding this legislation as a coup. It's not. With what it's going to cost to put all this mess forward, we could have financed single payer. It's a cluster. But the insurance companies have a lot to celebrate..as usual.
Casey in the USA

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