Australia Ethics Personal Politics Scotland

Letter from Australia 18 – The NHS vs the AHS

The NHS vs the AHS

2nd December 2019

Dear Brothers and Sisters,

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It doesn’t feel a lot like Christmas.   Being in Australia, with summer now officially started, its strange to see Christmas trees, shopping centres with Santa’s and even the beginnings of some Christmas music (although I have noted the comparative lack of the endless piped music – I still havn’t heard ‘I wish it could be Christmas everyday’).

 

 

This week we also said goodbye to Peter and Jodie Blair – who after four years of studying at Moore College are returning to work with the Anglican church in Belfast. It is encouraging to see people going from here to work in the UK – I met with another couple who are planning to go to Scotland as missionaries. We need them!

I also had the opportunity to get out on my bike for the first time in Sydney. It was

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Part of my cycle route

wonderful. There is no better way to get to know a city than to cycle it.   My impressions so far? It’s hilly and sweaty but absolutely beautiful. I’m not sure that drivers here are any more bike aware/tolerant than in the UK – so where there are cycle paths they are appreciated. For those who always nagged me about not wearing a bike helmet in Dundee – your worries are over. I have to wear one here or face a $344 fine! https://www.abc.net.au/news/2019-10-27/nsw-bike-helmet-fines-too-expensive-researchers-argue/11640722

A Dental Bill Shock

Cycling will certainly improve my health (providing I don’t get knocked over). Which brings me on to the whole question of health care. I had to go to the dentist this week and ended up paying a bill of $375 (about £200) with more to follow! It was a real shock to the system because in Scotland I would only have paid £20 for the same treatment. Every time we go to the doctor here it costs $70 (with about half that coming back through Medicare). At home it was free.   There is something deeply ingrained within me which says that this is wrong. Surely healthcare should be ‘free to all at the point of need’ – the basic principle of the NHS?

Having experienced the American health care system – one of the most expensive and inefficient in the world – I am fully in support of what some of my American friends call ‘socialised medicine”. I love the NHS and owe it my life!  However I am having to rethink some of my views because of my experience of both the UK and Australian systems. And thinking is what our politicians and media generally do not do (at least out loud!), because the NHS is the nearest thing secular Britain has to a religion – to dare to question any of its doctrines is to commit blasphemy and electoral suicide. But think about this.

Paying for Health Care?

Why should those who can afford it not pay for health care? We pay for many other things – why not health care? The problem is that a universal health care system comes at a cost. Firstly there is the financial cost – and with an ever aging population and an ever increasing bureaucracy it is very doubtful whether the UK can afford to continue the NHS in its current form. The system is already breaking down and I suspect if people are not willing to pay for health care directly with their own money, they won’t appreciate the government indirectly paying by raising taxes and crashing the economy!   The numbers being banded about are just nonsensical – the Tories promise 50,000 more nurses and to build 40 more hospitals. Labour state that the government plans to sell the NHS to American Pharma – with the nonsensical claim that £500 million per week will be sent to American drug companies. Given that the total NHS bill for drugs is ‘only’ $18 billion this, to say the least, seems unlikely! (do the maths!). The SNP have an appalling record on the NHS and their only defence is the disputable claim that ‘it’s better than England!”.   All the parties promise that they are the only ones who will save the NHS. None of them will.

But even more importantly there is the people cost. Firstly for the patients. What’s the point of having a service that is ‘free at the point of need’ if the service is poor or even unavailable?   Take our experiences here at three levels.

The Doctor –

I don’t have to queue in the freezing cold to get one of the few ten minute appointments available. I can phone up and get an appointment if not the same day, probably the next. And its for a lot longer than ten minutes. If I require a scan I don’t have to be put on a waiting list for six months – I will get it within six days. The level of service is way higher than anything I experienced in Scotland’s NHS. When you have had friends who died because they were diagnosed far too late because of waiting lists and lack of resources it makes you question whether the cost is worth the ideology.  When you think of the waste that is caused by missed or unnecessary appointments (in some areas 30%) it makes you realize that paying for something would greatly reduce that inefficiency.

The Dentist –

My dentist in Dundee (who is an excellent dentist) warned me that when I came to Sydney they would probably laugh at the level of treatment I had received. I thought he was joking. He wasn’t. When the dentist here opened my mouth I saw the look on his face – so I told him what my dentist said. His reply? “I can see why! I was trying hard not to laugh”!   Even in my one visit – the consultation was a guaranteed hour;  equipment and machinery was used which I had never seen before. It felt like I had come from some primitive tribe in comparison. Please note that I am not blaming my dentist. Health workers in the UK can only work with the resources and equipment they have.

The Chemist –

Our local chemist is incredible. When we pop in to get our prescriptions he/she gives advice, checks if we would be better with something else and takes time with us. I regard it as an absolute nonsense that in Scotland millionaires and middle class people get free prescriptions. When I come home to Scotland I could stock up on drugs – at the expense of the cash strapped NHS. Here I am much more careful about how I use medicine because I have to pay for it.

Can the NHS Change?

There are lots of problems with the Australian system. I’m sure that there are people who suffer because they do not have enough money and somehow slip through the net. But I am also sure that the NHS cannot survive in its present form. It’s too bloated, too expensive, too much a machine and not people-centred enough.   It’s becoming both an ideological fantasy and a bureaucratic nightmare – far removed from its original Christian roots. As a result both patients and staff both suffer.

I find it interesting that when you suggest that perhaps private insurers should be involved there is outrage  – and yet this is the system that prevails in most European countries.  In fact it is fascinating to compare and contrast how different countries in the world seek to deliver healthcare. https://www.theweek.co.uk/nhs/87658/the-nhs-vs-global-healthcare-systems

When you have a health care system that is supposed to cover all, but is not, and cannot be adequately resourced out of the public purse, then it is not the wealthy (who can afford to go private) or the middle class (who know how to work the system) who suffer. It’s the poor. Why can’t we have a system where the poor get free or subsidized health care and others have to pay according to their ability? From each according to their means to each according to their needs!

And yet the NHS won’t change – except through decay and implosion. Because none of the political parties will be honest and face up to the challenge. They will all do the soundbites, make the promises, blame each other and bury their heads in the sand.  But the bigger problem is with the electorate. It is deeply ingrained into us that somehow health care should be free – and someone else pay for it. Why? Why is that not true for servicing our cars? Or eating food?   Why should we not pay towards our own health care? My own view is that we either pay directly or there should be a specific and progressive healthcare tax – where the wealthy pay more.

I will reflect on this more. But its strange having one of your most profound convictions challenged in such a way that you feel compelled to change!

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The sky at night – from our balcony this week….

Unsubscribe

One other change is that finally I have ‘unsubscribed’ from the DCA (Dundee Contemporary Arts Centre). It was a Friday night tradition for myself and Annabel to go to the DCA and I still liked seeing what was on. But the time has come when, in their words, I no longer ‘wish to hear from them’.   Sometimes I come across Christians who are struggling because they have stopped reading their bibles – its as though they have said to the Lord “I want to unsubscribe…I no longer wish to hear from you”…and they are surprised when he gives them what they want!

I hope none of us are like that. Hope you had a great Lord’s Day and that you will have a blessed week,

Yours in Christ

David

Letter from Australia 17 – Joy in Serving

The Christian Heart of Modern Medicine

Save our NHS!

 

 

11 comments

  1. David

    I know what you mean about the NHS being a secular religion for the UK – it was cited as a high point in the opening ceremony of the London Olympics in 2012. It is good that you have experienced as too few who comment in the UK that there are more models than the US system or the NHS.

    What you describe sounds very similar to the insurance based system we have in Belgium, where you can choose which GP and specialist you are treated by, all without rationing. Our GP visit currently costs 26 euros (about 23 pounds), of which we get 85% back. That also applies to dentistry, eye glasses and hearing aids. Our health care system is excellent, and we have one of the leading oncology centres in the world in our local town (Leuven). Everyone has insurance, including the non-salaried. The health care system is not a sacred cow or false god, but a public good.

    I also remember when I lived in Sweden in the 80s, at the time Neil Kinnock was hailing it as a model for the UK to follow. I was shocked then that everyone had to pay to visit a GP. The NHS model is followed nowhere else, which made we wonder if it was quite so brilliant as we were told.

  2. So glad to hear your analysis. I was having a conversation with my nephew a couple of years ago about the NHS and how it needed changing. He was shocked because as you say this “free” healthcare is so ingrained. He challenged me with “what would you replace it with? I said that I would like our country to have sensible look at other systems around the world like Australia and Europe to see if we could take the best from these. He then said “Oh it’s good in Australia” as he spent a year over there 20 years ago!
    You are right – something has to give as it is failing and is a black hole for money and a poor work environment. I have met so many nurses who have left the NHS, quite a few move into the Private hospitals like Spire.

  3. As immigrants to Australia it took us a while to understand the Medicare system. You might ask about “bulk billing.” It was not explained to us for ages. The medical practice I attend (and there are many of them) does not charge above the Medicare rate so I do not pay anything to see a doctor. One might think that they might be inferior doctors but that is not the case, in my experience. The government suggested at one stage that we should all pay $7 for a medical consultation to stop unnecessary visits. In my opinion it was a good suggestion. because the wonderful standard and ease of access to medical help here is not sustainable in the long term. The suggestion was met with outrage from the opposition parties using typical hyperbole about pensioners dying for lack of the $7.

  4. Interesting post David. It is fun to hear of your new and different experiences down under.

    Drug patents last 20 years here, and in the UK the patent is also 20 years but if the cost of development hasn’t been met, they can be extended by 5 years to 25 years. This is a huge driver of health care costs in America because 95% of all new drugs that enter the market are developed in America. The problem for us is that for those new medications to enter health care systems in other countries that have national healthcare the costs are driven down by what a country is willing to pay for each new medication. Currently, drugs that come from America to the UK that cost is $0.10 on the dollar to what Americans pay for the drug, and it is the same for nearly all countries that universal healthcare; Americans are left to pick up 90% of the development costs and the average cost of developing a new prescription medicine that gains market approval is estimated to be $2.6 Billion dollars. When it comes to medical technology, Americans again lead the way in development but the hurdles for approval by the FDA are staggering and both cost and time inefficient. Medical devices made in America gain approval by regulatory agencies in the EU in less than half the time and at a quarter of the cost as gaining approval through the FDA; and once again the cost of development is largely picked up by American healthcare patients.

    Is the cost of healthcare in American unnecessarily high? This all depends on who you ask and how level the playing field is. Estimates are that if development costs of American made drugs and technology were the same in each country that health care costs in America would be one-third of what they are now.

    How do the poor fair with healthcare in America? It depends on which state you live in. But in 32 states a family of 3 who earn $30k a year get free healthcare (medi-caid); an individual who earns less than $17.3K receives free healthcare; In California the income levels are twice that for free healthcare. Seniors and the disabled get medi-care at no cost and low-income seniors and disabled get the necessary supplemental insurance at no cost. I am disabled and have had some serious medical conditions where I was hospitalized for extended periods of time in Intensive care and my bill was $0.00. When I need to take any medication, it costs me $0.90 cents for 30-day supply.

    The only people who really have any significant wait times are when conditions are not life threatening, not painful, or if you live in a rural area – in those cases you may wait 2 weeks.

    The biggest financial drain on the US healthcare system are the 26 million undocumented aliens in the country illegally. They don’t have health insurance and they know that if you want to see a doctor you just go to the ER because by federal law an Emergency room cannot turn you away under any circumstance. This has caused many hospitals to shut down because they went bankrupt. Now states like California will give Medicaid to undocumented aliens because they believe that it will at least provide partial payments for costs at clinics and hospitals to prevent them from shutting down. But most undocumented aliens won’t even apply because they are afraid they will be deported. In California, the state now subsidizes health care insurance for high income earning individuals and families as well.

    When it comes to the discussion about nationalized healthcare in America there are a couple persuasive arguments against it:

    1. The loudest voices against it are people who have migrated from EU countries that have it. They find our healthcare system to be the gold standard for care.
    2. Very few Americans want the government to manage it. Many would agree if they were guaranteed the Swedish model in which the government collects the taxes from every citizen regardless of income level and then puts all the care out to bid from private sector providers to get the best costs and best management (pretty much a total capitalist competition for the contracts).
    3. Because the Government Accounting Office has made it clear that government management of healthcare would be a complete disaster that the country cannot afford. They showed that when the average American citizen needs a new hammer, they go to Home Depot or some other store and pay an average of $16 for that hammer. If a building contractor wants to buy 100 hammers, they buy them wholesale at $12 each. The US government put a bid out a couple years ago for nearly 1500 hammers and the bid that was accepted as the Low Bid – the hammers ended up costing $78 each. And that is a HUGE problem with all purchasing done by both federal and state government. America cannot afford that health care, and the only things that will change that are changing the laws for government contractors and to put a complete ban on lobbying. And neither of those things is going to happen. Government contracts are how elected officials pay off their big donors; and becoming a lobbyist is the profession that nearly all elected members of congress go to when they leave office.

    So that leaves 4 solid ways to make health care more affordable in America –
    1. Remove the state carve outs for health insurance so that all companies can compete in every state and not be restricted to small areas.
    2. Set a worldwide price for all drugs and med tech made in America so they cost the same in every country, and change the FDA approval laws so that once a medical device made here is approved in another substantial market like the EU it is automatically approved here.
    3. Open up the insurance market so all companies compete in every state; competition always brings down pricing.
    4. Get Big Food and Big Pharma out of the dietary guideline process. Prior to the US Food Pyramid that came out in the 1970s, less than 10% of Americans would have a metabolic syndrome related disease such as high blood pressure, hypertension, PCOS, type 2 Diabetes, insulin resistance, central obesity, elevated triglycerides, small LDL cholesterol particles caused by a diet that contains processed seed oils, glucose intolerance, endothelial dysfunction, oxidative stress, inflammation, Non-Alcohol Fatty liver disease, and gout, IBS, leaky gut.

    Today, because of the food pyramid and the high carbohydrate – processed fat diet it recommends, metabolic syndrome is the main drivers of disease and medical expense worldwide because other countries took our food pyramid as the gold standard without knowing that it was developed by Big Food, Big Pharma, and Big Agriculture; none of it was based on hard science.

    America is currently going through the process of developing new dietary guidelines and once again are failing our citizens because the advisory board is made up of pro-vegan Seventh Day Adventists, members of big food and big pharma and a couple of senators and a couple registered dieticians-SDA trained because the leading textbooks used for teaching dieticians are produced by SDA authors. Thankfully, the Nutrition Coalition was able to make a presentation to them asking for a Dietary policy based on rigorous science, and I am hoping that they actually paid attention to the fact that metabolic syndrome related illnesses cost $650Billion a year to treat in America.

    Thankfully, there are doctors now all over the world advocating for a ketogenic diet (LCHF) to their patients who are every day reversing all the illnesses caused by the standard high carb processed oil diets. Doctors like Dr. David Unwin in the UK -an amazing man; Dr. Gary Fettke in Tasmania, Dr. Jason Fung in Toronto, Dr. Andreas Eenfeldt in Sweden, and so many more who every day are changing people’s lives – getting them off of all medications, reversing type 2 diabetes, and dozens of other diseases. The science is rigorous, the outcomes amazing, and people are restoring health so they no longer need medications, and it is a fight against the lobbying power of big food and big pharma.

    Just changing the dietary guidelines to a LCHF diet could save every country billions of dollars in healthcare spending.

    1. @Robin

      … failing our citizens because the advisory board is made up of pro-vegan Seventh Day Adventists,

      And yet, ethical issues regarding the slaughter of billions of animal for consumption ) the cost of raising and feeding animals (clearing of land for grazing and growing crops for feed, pollution from waste etc) is contributing to the negative effects of climate change.

      Not quite sure how being a 7th Day Adventist would impact negatively on one’s health?

  5. I agree with a lot of what you say. A small charge at the time of seeing a GP for those who could afford it could significantly decrease unnecessary demand on services. One other factor leading to you having difficulties getting a GP appointment in Dundee is the brain drain of established GPs and junior doctors who head to the antipodes for better working conditions and work/life balance…

  6. Much of what Robert says is interesting. There are one or two errors.

    Depending on definitions it is clear that the percentage of drugs developed by American companies is way below 90%. Germany, Switzerland, Japan, France and the UK all have significant domestic pharmaceutical firms. On a very crude assessment the last 10 new drug approvals in the EU went to the US firms four times, UK firms twice, Canada, Germany, France and Japan once each.

    The suggestion for a single worldwide price would not be supported by any pharmaceutical company. There is a recognition that pricing needs to take into account the economy, healthcare budget and degree of medical need in different countries. It is true that the US essentially subsidises healthcare research for the rest of the world and other wealthy countries should probably pay more for their drugs.

    Lastly a comment to David. Yes, the NHS is one of the religions of the UK (a localised cult) and for Europe’s biggest employer to survive lots of thought needs to be given on how to avoid wastage and provide quality healthcare. The inability of our politicians to grapple rationally with this in the face of the NHSism does no one in the UK any favours.

  7. The NHS is an utter mess. If the SNHS is “better than England” then my heartfelt sympathies and prayers are with the English.

    If I hear “what are you complaining about, prescriptions are free in Scotland, this is free, that is free” again… It doesn’t matter if it’s wrapped up in bonny paper with a bow on top if it isn’t the actual treatment that people need. As long as they’ve seemed to do something it doesn’t seem to matter whether the something has anything to do with making an actual diagnosis and treating the patient accordingly. And pity help you if you dare point it out.

    Have heard of a couple of instances of Polish nationals refusing the “try this tablet and see if it works” approach – they go home for a visit, pay for the tests that will rule the relevant conditions in or out, then pass the results on to their consultant here.

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