Instead of brooding over 1.350 pages of a new physician fee schedule I decided to take a trip abroad, to find out about better places to practise the art of healing. What I found didn't make me happy. The problems we are facing here seem to be just an echo of what happens elsewhere. Unefficient healthcare systems. Political and individual abuse of social security. Planned economy grinding to a standstill. Unforgettable lyrics by happy bureaucrats. Tendecies towards a deprofessionalisation of healthcare professionals, i.e. doctors.
First, the NHS. While retrieving information about the british "Connecting for Health" project I couldn't avoid to stumble upon Dr. Rant. Dr. Rant seems to be a General Practitioner in the UK, who sounds dissatisfied with the conditions of the local healthcare system. And he dares to utter his dissatisfaction in a quite open fashion, so to speak:
The Government are a bunch of cunts. And they are cunts who hate doctors.
This one startled me. Why on earth should any government hate doctors? I mean, doctors are the ones that provide service to those who elect this government which, in turn, promises to provide exactly these services. No doctors - no service - no government. It's as simple as that. But according to Dr. Rant:
The jewel in the crown of the NHS was the continuity of care that primary care could provide. New Labour wants to replace this jewel with a turd; this turd being an amalgamation of walk-in centres, Polyclinics, NHS direct, community noctors, and all other forms of faeces devised to turn GPs from the gatekeeper of primary care into a politically expedient wage-slave.
The term "Polyclinic" indeed reminds me of something happening in Germany at the time being. Seems to be a european phenomenon, then. And for being a wage-slave: we already have our Federal Wage-Slave Association, although I'd never dare to compare them to "the spineless cowards in the BMA".
Rant comes to the conclusion that for doctors it is time to fight against what he calls a disaster:
The involvement of private companies in Primary Care (...) will be proven to be the disaster for patients, the taxpayer and healthcare workers that we all knew it would be.
Thats one of the points we're raising in our debate against the industrialisation of healthcare and the deprofessionalisation of medical professionals. There might even be a riot.
By pure chance I then visited the page of the NHS Blog Doctor. This is what I found:
Last year, we received lots of complaints because there was not enough vaccine to go round. That was because we stole half the NHS allocation of vaccine and re-sold it to the private sector making a huge personal profit. It is hard to get by on £250,000 a year particularly when, with our two day week, we have so much leisure time. Or that is what the government would have the public belief. Forget the rumours that Patricia Hewitt (remember her?) had miscalculated the amount of vaccine required.
This kind of misinformation seems to be spread worldwide, too. Is there a method to it? But let's read on:
And Gordon Brown is promising them all that they can have what they want, where they want, when they want. It is not possible. What we need is a politician who can find a way of explaining that to the electorate without committing political suicide.
Same over here. Politicians primarily stick to power, so primarily they screw up. No answers to the essential questions, no quality management, neither efficacy, nor efficiency. And that's what they blame us for. That's projection (in a psychiatric manner of speaking).
Which leads me to Grunt Doc, Texas. He seems to be annoyed about the fact that the british government has a “plan to save billions of pounds from the NHS budget" via encouraging patients to carry out "self-care". He wonders, though
if these are the target populations that are overutilizing the system, or if this isn’t a relatively subtle way of rationing care a little more for those with chronic conditions.
But even in the USA there might be difficulties providing services necessary for social security:
We’re getting more and more transfers as outlying hospitals have more and more trouble getting specialists to be on call for ED patients.
He also made a nice multiple choice thingie about the basic problems of contemporary health care:
- Price
- Quality
- Access
Pick any two.
It's your choice now!
I choose to find out more about the situation in the US and next stumbled upon The Medical Quack, where I found some awesome insights about utilisation and financial background of health care systems.
According to the Census Bureau, of the 47 million uninsured, nearly 10 million have household incomes of at least $75,000. They probably can afford coverage but have chosen not to buy it.
There also were some hints about the frustrating efforts to control burdens of disease over there, which reminded me of what I'm forced to see and hear about similar efforts Made In Germany:
Martin is one of many doctors who have come away shaking their heads after payers have rated the efficiency and quality of their practices based only on claims data and then have shared the results with patients. The goal of the approach, which some call "tiering and steering," is to cut costs and encourage quality. Martin just calls it frustrating.
And what happens if payers even take over clinical decisions?
But remember each phone call takes 15-30 minutes of productive office time that would be better spent with patients. Today, the doctor says, “..despite my best efforts, I failed my patient.”
I had to dig deeper into the fascinating abyss of Medicare and Medicaid und went over to The Happy Hospitalist. And although I had assumed the US healthcare system to be a capitalist heaven and a patient's hell I had to find out that the allocation of resources there is as misguided as here:
Medicare is not a free market; it is a gigantic welfare program in which the taxes people pay as workers to support the program are completely disconnected from the benefits they receive as Medicare recipients.
Freeriders worldwide united. Just like our 100+ year old Bismarck system. The universal conclusion is:
To be effective, markets require not only competition among producers seeking to maximize profits but also consumers with skin in the game and incentives to optimize product quantity and quality while minimizing their expenditures. Competition among producers without consumers with skin in the game is the economic equivalent of one hand clapping.
Finally, I payed a visit to Panda Bear, MD. Again the similarities betwen here and there struck me with awe:
Primary care is dying in this country, largely because the the government which sets both the amount that doctors are reimbursed for their time as well as pattern by which private insurance reimburses, has decided that cognitive skills are less valuable than throwing a lot of procedures at the patient. Most of this is a lack of trust by parsimonious bureaucrats who reflect the general American character trait of preferring action to deliberation.
Well, this does not reflect the American character alone. Every single one of these above problems is on my agenda for more than two years now.
Now we should unite. How about a worldwide memorial day, with all doctors on strike at exactly the same time? In the end, we are the providers.
