A Lesson In Free Universal Healthcare

This was posted a few months ago but news of recent times has made it more pertinent.

America beware. Under the stewardship of President Obama, it has been suggested that this may be a route that needs pursuing - free universal healthcare. In Britain, we have the National Health Service (NHS), which was established over 60 years ago in 1948. Before this people were generally forced to pay for their healthcare, although free treatment was available from some teaching and charity hospitals. It was common to pay money into friendly societies that operated insurance schemes and from 1911 onwards, National Insurance contributions paid by employees and employers led covered treatment but not medications, in some ways this is comparable to the NHS now refusing to pay for the most expensive of drugs purely on a cost basis. Furthermore, prescription charges must be paid even if the medicine costs less without a prescription.

Time to crunch some numbers. The NHS employs 1.3 million staff. You probably now have the image of doctors and nurses running around in white coats, but you are sadly mistaken. These are mostly middle managers and administrators. The NHS is the 3rd biggest employer in the entire world. Shockingly, Britain is ranked 55th in the world when it comes to number of people per doctor, with 2.2 per 1000 - even Mongolia has more! It costs the tax payer on average £2000 per year to run the NHS. This is a staggering sum of money. Great, you say, this should comprehensively take care of me. Try getting an NHS dentist; due to the lack of willingness to upgrade equipment and improve working conditions, you have got more chance of witnessing an apology from Gordon Brown for his economic mismanagement than you do of finding an NHS dentist. Since 1997 the current regime has increased NHS spending by 80%. This is massive injection of cash, yet has it honestly gone to the right places? There are now less General Practitioner working hours than before this regime, largely due to the fact they were given a major pay rise (this is not a criticism in any way of GP's, I feel they are underpaid for performing a difficult job) however, due to the large hours they were forced to work they naturally can keep the same money and go part time and have a better lifestyle. This is an inherent problem with socialist principles; simply throwing money at a problem in an uncontrolled manner does not make it go away. If you visit an NHS hospital and compare it to a private hospital the differences are staggering. The private hospital will have private en-suite rooms with three decent (well, maybe not Gordon Ramsay-esque) meals a day. The main difference is the cleanliness. By going into an NHS hospital for a minor procedure you run the risk of catching a super bug, such as MRSA. Even then you have been lucky to have made it that far. The waiting lists for minor procedures are massive. Only if you are seriously ill will NHS treat you quickly. A recent visit to an accident and emergency room showed firsthand how the service is clogged up by dealing with drunkards who are on first name terms with staff that treat everybody with contempt as they are solely concerned with shifting numbers, leading to poor, impersonal service. It was obvious that there was a lack of hygiene at the hospital, and it was surprising to see so many uniformed staff just stood around doing nothing. Strangely the staff was keen for you to choose your ethnicity from a list. Does this really have any bearing on your treatment?

You may think, “Private medical insurance must cost the earth if the service is infinitely better.” You will be pleased and surprised to know that is not the case. For an average person, £1000 a year will get you the top level of cover. This is arguably essential as your health is your most important asset. It is fair to categorise the NHS not as a healthcare system, it never has cared for you when you are in good health, but rather a fairer term would be 'illness care', as that is the time it actually kicks into effect. Even then you may not have access to the latest cutting edge drugs that private cover could get you as they are regarded as too expensive. With the increased funding provided by the Labour regime it is interesting to note that according to a BBC report in March 2008, the average waiting time for treatment on the NHS had risen from 41 days in 1997-1998 to 49 days in 2007, once again proof that a huge injection of cash in the system has not improved matters.

The problems seem to be more deep rooted than simply a lack of funds; it seems there is a complete lack of structure. I believe that the true purpose of the NHS at government level may now be simply to provide even more public sector jobs, which have now swollen to such an incomprehensible size that it would be nearly impossible to streamline in one swoop due to the large increase in unemployment. But is this seriously a good reason to stick with a second rate health system? A better alternative would be to take the control completely out of the incompetent hands of the government and to have compulsory medical insurance either provided by the employer, with a tax break as an incentive, or paid for by the employee, tax free, unlike the present system, whereby you have to pay tax on this cover because you are helping the government by removing a burden – how generous of them! The Institute of Employment Studies in 2001 stated, “The majority of companies are spending between 2% and 16% of their annual budget on sickness absence alone. Private Medical Insurance will probably only cost around 1% of payroll and could save the employer thousands of pounds of down time.” Robertson Cooper Ltd, in conjunction with 87 major companies, in 2001 found, “The full impact of absence costs UK private sector employers about £1,550 per employee per year - or around 9% of their annual payroll.” For those genuinely unable to work as well as the retired the government should pay the cost of the private cover as this would work out more cost effective, while providing much better facilities, equipment and services than are on offer at present. The more people who have the private cover, the cheaper it will become (think of it as bulk buying). It would be necessary to regulate the profit margins allowed by the provider, or maybe better still, to make sure there is genuine competition in order to keep prices low and quality high, which is the inverse of the current system. Who knows, with these savings, maybe the spare money could be used to shorten the 23 years predicted to dig Britain out of its masses of debt or even to provide the workforce with a tax reduction?

America, if you need a lesson in how not to provide universal healthcare, then the NHS is your role model. President Obama is probably aware that free, universal healthcare in America is unlikely to ever be introduced. America is a country where the government is small and thankfully trusts the individual; it is unlikely that the people would trust government to run such an organisation.

The War in Afghanistan: Obama's policy towards Pakistan

Afghan President Hamid Karzai, US President Barack Obama and Pakistani President Asif Ali Zardari, 6 May 09

The Obama administration's policy towards Pakistan, as outlined in this white paper, focuses on the need to improve cooperation between Afghanistan and Pakistan, the ability of Pakistan to fight extremists and how to strengthen the Pakistani government through increased American support. Whilst the administration's objectives for Afghanistan appear more detailed, achieving its goals for Pakistan will be far more arduous. Before the 2008 US presidential elections, Obama's staff asserted that it would be necessary to stabilise Pakistan before its neighbour could be stabilised. This however, would have required the assistance of India in diplomatically reassuring Pakistan, which remains concerned at New Delhi's encroachment into what it regards as its sphere of influence, namely over countries such as Iran, Afghanistan and the central Asian republics. As can be expected, Pakistani security concerns are linked to its poor relationship with India and its neighbour's potential to disaggregate the state, as it did following the conflict fought in 1971 as a result of the genocide in East Pakistan that ultimately led to the territory declaring independence.

President Obama appointed Richard Holbrooke as special envoy to the region which was to include India. However, following the pressure from influential Indian lobby groups, his mandate covered only Afghanistan and Pakistan. India was keen to avoid any presumption that its policy towards Kashmir and Pakistan could have anything to do with Islamabad's behaviour in the region. Nevertheless, the Indian government assured the US that it would not tolerate the involvement of Pakistan in the security issues of Afghanistan. Therefore, as India's status as a regional power continually grows, Pakistan has felt compelled to address the balance of power through the only instrument at its disposal; the military. The US has so far been incapable of dissuading Pakistan from considering its military as a tool for foreign policy. Pakistan has been reluctant to adopt adequately restrictive measures against its military option and cannot fight effectively against militants that have decidedly sided against the state. Pakistan is now also convinced that its nuclear arsenal would allow it to engage in unconventional warfare.

The US' options for Pakistan are limited. Congress has sought to introduce various legislative modifications to enhance American assistance to Islamabad in the area of security or attempt to increase funds to strengthen the debilitated civil and political institutions of the country. Current laws are deemed restrictive as they bind American security assistance to the Pakistani president's guarantee that Pakistan does not support terrorism and that it does not harbour anyone that has dealt with the nuclear black market. The Obama administration fears that these conditions could push Pakistan to seek new allies and thereby deny Washington the strategic opportunity to monitor and determine Pakistan's behaviour and political choices. The US is still in great need of Pakistan's logistical support in Afghanistan, because, even though they admit that the Northern Route into the country can no longer be used and that Iran's border provides the best entry routes into Afghanistan, any formal involvement of Iran in the conflict remains impossible.

In summary, Washington and the international community do not know what course of action to take with Pakistan. Until a real solution is found, Pakistan will continue to represent one of the greatest threats to the region and the wider international community.

Daniel Hannan on the American Constitution

It is amazing that Britain and the British people see themselves as a beacon of democracy, when there is no constitution, Lords are unelected, seats and lobbying can be purchased, there is no guarantee of free speech (the Home Secretary has now decided to ban more outspoken people) and our civil liberties are being further eroded on a daily basis.

A Lesson in Free Universal Healthcare

America beware. Under the stewardship of President Obama, it has been suggested that this may be a route that needs pursuing - free universal healthcare. In Britain, we have the National Health Service (NHS), which was established over 60 years ago in 1948. Before this people were generally forced to pay for their healthcare, although free treatment was available from some teaching and charity hospitals. It was common to pay money into friendly societies that operated insurance schemes and from 1911 onwards, National Insurance contributions paid by employees and employers led covered treatment but not medications, in some ways this is comparable to the NHS now refusing to pay for the most expensive of drugs purely on a cost basis. Furthermore, prescription charges must be paid even if the medicine costs less without a prescription.

Time to crunch some numbers. The NHS employs 1.3 million staff. You probably now have the image of doctors and nurses running around in white coats, but you are sadly mistaken. These are mostly middle managers and administrators. The NHS is the 3rd biggest employer in the entire world. Shockingly, Britain is ranked 55th in the world when it comes to number of people per doctor, with 2.2 per 1000 - even Mongolia has more! It costs the tax payer on average £2000 per year to run the NHS. This is a staggering sum of money. Great, you say, this should comprehensively take care of me. Try getting an NHS dentist; due to the lack of willingness to upgrade equipment and improve working conditions, you have got more chance of witnessing an apology from Gordon Brown for his economic mismanagement than you do of finding an NHS dentist. Since 1997 the current regime has increased NHS spending by 80%. This is massive injection of cash, yet has it honestly gone to the right places? There are now less General Practitioner working hours than before this regime, largely due to the fact they were given a major pay rise (this is not a criticism in any way of GP's, I feel they are underpaid for performing a difficult job) however, due to the large hours they were forced to work they naturally can keep the same money and go part time and have a better lifestyle. This is an inherent problem with socialist principles; simply throwing money at a problem in an uncontrolled manner does not make it go away. If you visit an NHS hospital and compare it to a private hospital the differences are staggering. The private hospital will have private en-suite rooms with three decent (well, maybe not Gordon Ramsay-esque) meals a day. The main difference is the cleanliness. By going into an NHS hospital for a minor procedure you run the risk of catching a super bug, such as MRSA. Even then you have been lucky to have made it that far. The waiting lists for minor procedures are massive. Only if you are seriously ill will NHS treat you quickly. A recent visit to an accident and emergency room showed firsthand how the service is clogged up by dealing with drunkards who are on first name terms with staff that treat everybody with contempt as they are solely concerned with shifting numbers, leading to poor, impersonal service. It was obvious that there was a lack of hygiene at the hospital, and it was surprising to see so many uniformed staff just stood around doing nothing. Strangely the staff was keen for you to choose your ethnicity from a list. Does this really have any bearing on your treatment?

You may think, “Private medical insurance must cost the earth if the service is infinitely better.” You will be pleased and surprised to know that is not the case. For an average person, £1000 a year will get you the top level of cover. This is arguably essential as your health is your most important asset. It is fair to categorise the NHS not as a healthcare system, it never has cared for you when you are in good health, but rather a fairer term would be 'illness care', as that is the time it actually kicks into effect. Even then you may not have access to the latest cutting edge drugs that private cover could get you as they are regarded as too expensive. With the increased funding provided by the Labour regime it is interesting to note that according to a BBC report in March 2008, the average waiting time for treatment on the NHS had risen from 41 days in 1997-1998 to 49 days in 2007, once again proof that a huge injection of cash in the system has not improved matters.

The problems seem to be more deep rooted than simply a lack of funds; it seems there is a complete lack of structure. I believe that the true purpose of the NHS at government level may now be simply to provide even more public sector jobs, which have now swollen to such an incomprehensible size that it would be nearly impossible to streamline in one swoop due to the large increase in unemployment. But is this seriously a good reason to stick with a second rate health system? A better alternative would be to take the control completely out of the incompetent hands of the government and to have compulsory medical insurance either provided by the employer, with a tax break as an incentive, or paid for by the employee, tax free, unlike the present system, whereby you have to pay tax on this cover because you are helping the government by removing a burden – how generous of them! The Institute of Employment Studies in 2001 stated, “The majority of companies are spending between 2% and 16% of their annual budget on sickness absence alone. Private Medical Insurance will probably only cost around 1% of payroll and could save the employer thousands of pounds of down time.” Robertson Cooper Ltd, in conjunction with 87 major companies, in 2001 found, “The full impact of absence costs UK private sector employers about £1,550 per employee per year - or around 9% of their annual payroll.” For those genuinely unable to work as well as the retired the government should pay the cost of the private cover as this would work out more cost effective, while providing much better facilities, equipment and services than are on offer at present. The more people who have the private cover, the cheaper it will become (think of it as bulk buying). It would be necessary to regulate the profit margins allowed by the provider, or maybe better still, to make sure there is genuine competition in order to keep prices low and quality high, which is the inverse of the current system. Who knows, with these savings, maybe the spare money could be used to shorten the 23 years predicted to dig Britain out of its masses of debt or even to provide the workforce with a tax reduction?

America, if you need a lesson in how not to provide universal healthcare, then the NHS is your role model. President Obama is probably aware that free, universal healthcare in America is unlikely to ever be introduced. America is a country where the government is small and thankfully trusts the individual; it is unlikely that the people would trust government to run such an organisation.