I still haven't figured out which tea leaves I'm supposed to read to interpret an Obama election as anything like a step to the left.

By  B. Dewhirst, at Sunday, November 09, 2008 5:48:00 pm  

Given the decline of Dutch healthcare engineerd by the insurers and their politico henchmen (I'm a Dutch citizen), the development of an adequate medical system---with universal coverage---in the USA is a subject that I shall follow with interest. I am hoping for the best.

By  George Berger, at Monday, November 10, 2008 6:31:00 am  

@ George Berger: We're seeing the same process of insurers dismantling the social system here in Canada. It's infuriating, isn't it?

By  Steven Alleyn, at Monday, November 10, 2008 7:43:00 am  

I am very sorry to hear that, Steven. I knew that your system was under threat but did not know about the Canadian insurers. As a American by birth I appreciated the systems of European and Canadian public health immensely. what's going on now is a damned shame and a disgrace. In this country-the Netherlands- I am galled at the ease with which the insurers kidnapped almost the entire system; the rest is now being slowly given to them by horrid politicos. If you are interested I can supply details as a warning. I'll only say here that people quite close to me were victims of this betrayal of many values of our civilization. I hope that the new President will be able to do something in the USA, but having seen Sicko and read a lot (too much) I will believe in US "change" in healthcare when I see it. Here too, Alas.

By  George Berger, at Monday, November 10, 2008 10:08:00 am  

I don't know about anyone else, but I would be interested, given the way that the current UK gvt is continually trying to privatise and destroy the NHS, and has built in massive budget holes by using the PFI/ PPP method of investment.

By  guthrie, at Monday, November 10, 2008 10:56:00 pm  

Guthrie, I think that the Dutch horror is applicable to the PFI/PPP schemes. Here, the insurers were given almost complete control over healthcare. They dictate all sorts of things. The financing is from insurance premiums and Government subventions, with the latter decreasing each year. Privatization is the not-so-hidden agenda. One Amsterdam hospital is now in private hands and a 2nd may well suffer that fate too. The combination insurer+subventions is close to your Public-Private schemes. But I know nothing about the role of PRIVATE INSURERS in the UK. I hope it's minimal.
Other matters are involved. The above leads to shambolic practices and facilities, MDs work to fixed salaries with little regard for their patients, and many avoidable deaths result (perhaps my best friend!). A bit later on the often complicit hospital management starts "complaining" loudly. They make it look like they are grasping at privatization as a last straw. It's a fraud. I'm dismayed to see similar things happening to the old, reliable NHS, which helped me for free in 1971 even though I was a tourist. Good luck.

By  George Berger, at Monday, November 10, 2008 11:55:00 pm  

It's all sorts of little things.

I don't want the NHS to tell all and sundry all my medical data.

I'd like the hospital to be able to reliably inform the doctors what they have done, and why.

Does it matter when, in a hospital stay, a particular change in medication happened? Maybe, maybe not, but the hospital doesn't tell the doctor. The systems throw away data.

By  zhochaka, at Tuesday, November 11, 2008 3:02:00 pm  

My impression is that the NHS 'internal market' combined with an internal regime of what appears to be arbitrary and inflexible target-setting is increasing the level of stress on the frontline staff (apart from anything else).

A British libertarian insider told me years ago that he'd been told by the architects of then-recent NHS reforms (the Adam Smith Institute or some such) that the reforms were designed to screw up the NHS and make privatization look like a way out of the mess.

By  Ken, at Tuesday, November 11, 2008 4:27:00 pm  

Ken- interesting, yet not surprising. I'd like to see how they were involved in the original reforms in the first place, but given that was pre-internet, I bet theres not much more than peoples memories about it all now.

The NHS thing is interesting to me in part because my generally non-political and kind of boring sister is being radicalised by it. She works as a radiotherapist, and is pissed off with what she has seen over the last 8 years. Funnily enough the problems with big projects exactly mirror those I have seen at my workplace, a wholly owned subsidiary of a private company...

George- the finance in the UK comes from us taxpayers via the gvt. The problem is that the gvt, being in thrall to its own weird twisted ideology, (Which includes a large chunk of having your cake and eating it too) gives billions away to It consultants to try to re-invent the wheel. It has falsified returns and fixed the game so that the PFI/ PPP is the only game in town. What happens with the PFI is that a developer is chosen to build a new hospital, they own it, often run it, we pay through the nose for it and even after 30 years we still don't own it. If you want to change anything, it costs you money to the developers. You pay more for the money the developers have borrowed to finance the deal in the first place. And various other things. Not to mention spending vast sums of money on private companies providing healthcare that could be provided cheaper in the NHS.

By  guthrie, at Tuesday, November 11, 2008 7:08:00 pm  

Ken, your friend was and still is right on target. Screw up is the right phrase indeed! It's very similar here. It's a bloody shame. It is clear that what I said above applies to the UK as well: the approach to privatization was well-thought-out years ago. And BTW, something similar happened in Stockholm, of all places, when the center government got into power.
Guthrie, thanks for the details about how PFI works out in the hospital world. I knew only about the Tube. I discussed the insurers, but the privatised hospital in Amsterdam was bought up by some rich businesswomsn's firm, hence not by the insurers. So the end result of PFI and what's going on here is almost the same. One difference is that the Dutch insurers keep on raking in premiums after privatization. Take it from me: they've got this all planned out, every step.

By  George Berger, at Tuesday, November 11, 2008 8:44:00 pm  

george - thankfully, private health insurers are not much involved in the NHS. While they do provide some services to the NHS, treatment etc is still funded and specified by state bodies. And I say that as an employee of a private health insurer!

By  Anonymous, at Tuesday, November 11, 2008 10:11:00 pm  

I'm glad to hear that, Anonymous. Keep it that way. it's late at night, so let me only say (by way of example) that the insurers dictate the quality of care. They demand, e.g., that cataract replacement lenses of LOWER quality than those PREVIOUSLY used must now be employed in ALL cataract operations. The reason is cost-cutting = higher profits for the insurers, lower subventions from the government. It was my wife's eye doctor who told us this. This specialist quit because of this. Note that almost all specialists here work for hospitals and are paid by deals between those places and the insurers. Not to mince words, it's criminal.

By  George Berger, at Tuesday, November 11, 2008 10:51:00 pm