Woomeister
Well-Known Member
web.wm.edu/cwa/Pellegrino.pdf?svr=www SEE PAGE 16
economics.harvard.edu/faculty/.../The American Healthcare System.pdf
economics.harvard.edu/faculty/.../The American Healthcare System.pdf
The Truth About The American Health Care System
- Thread starter Woomeister
- Start date
Woomeister
Well-Known Member
bumpppppppppppppppppp.
Woomeister
Well-Known Member
exactly the problem we have here.
CrackerJax
New Member
You can't get more doctoring and less administration with socialized medicine. it works the other way round....
Britain: Enron-style accounting conceals financial collapse of health service
By Jean Shaoul
13 August 2002
Britain’s Labour government boasts of its increased spending since April 1999 on the National Health Service (NHS), but a recent report by the National Audit Office (NAO) reveals a very different picture. Far from increasing resources in ways that increase and improve front line services, the government’s actions have only postponed the NHS’ financial collapse while at the same time reducing access to healthcare.
The NAO’s annual report into NHS’ finances shows that only one of the 99 Health Authorities in England had failed to balance its budget for the financial year 2000-2001, compared with 59 in 1999-2000 and 48 in 1998-99. The number of NHS Trusts (which provide acute, specialist and community health care) that were in “significant financial difficulties” had also fallen. But even after increased funding, 10 percent of all NHS secondary healthcare providers had accumulated deficits greater than one percent of their annual expenditure and in some cases deficits were nearly ten percent of total income.
The Health Authorities have in effect balanced their budgets by shifting the burden of adjustment onto the healthcare providers, the Trusts. Even this was only achieved after a record level of Trust mergers, rationalisations, hospital and ward closures. Twenty-six Trusts and parts of 3 others merged and 2 were dissolved after 1999-2000. As of April 2001, a further 48 Trusts, parts of 13 others and 2 special hospitals merged. In 2002, 17 Trusts were dissolved and the rationalisations have continued apace. It is these closures that lay behind the ever-increasing time it takes for patients to receive treatment.
A recent report by health economists at the London School of Hygiene and Tropical Medicine examined the merger of nine NHS Trusts in London between 1998 and 1999 and showed some of the disastrous consequences. Far from improving finances, quality of services, and the ability to recruit and retain staff in the most expensive city in Europe, the researchers found that Trusts had saved barely £320,000 in two years, damaged staff morale, made team working more difficult and delayed improvements in patient services.
These deficits have been fuelled in part by profiteering by pharmaceutical corporations, clinical negligence claims due to staff shortages, an increase in workload, demoralisation and errors, and a rise in staff wages to bring the NHS in line with the European Union’s directive on a maximum working time for junior hospital doctors. More recently, there has been a miserly 3.6 percent pay increase for nurses. For decades, the NHS has run on the back of the most poorly paid healthcare workforce in Europe. Fed up with their pay and conditions, nurses have left the NHS in droves. The NHS has been forced to recruit staff from private nursing agencies at a cost of nearly £1 billion and bring in nurses from developing countries.
These deficits are also the result of the financial regime imposed by the former Conservative government in 1990, and not repudiated by the incoming Labour government in 1997. The Trusts are required by statute to operate as financial businesses and make a 6 percent return to the Treasury on the value of their assets. As these assets have risen in value alongside the frenzied property boom, so too have the required returns that the hospitals must pay.
By 1999, these factors had combined to lead to a massive accumulated deficit of £1 billion that meant that more than half the Trusts were technically insolvent. The Treasury was forced to step in, employing a creative accounting trick that makes Enron look like child’s play. As the National Audit Office reports show, the Treasury sanctioned non-cash increases in revenue that were used to offset a write down of their assets, thereby reducing their future payments to the Treasury, and recycled back as “dividend” payments to the government.
The scale of the government’s massaging the books can be gauged by the following example. The fifth largest Trust in the country, the South Manchester University Hospital Trust with two huge teaching hospitals both larger than the average hospital, had such a massive deficit that the government had to provide a fictitious £40 million, a 35 percent increase on its normal funding. This took place at the same time as the Trust closed one of the two sites, concentrating all its facilities at the less accessible site, with a huge reduction in capacity.
That the government was forced to resort to such widespread chicanery illustrates the scale of the crisis facing the NHS.
In recognition of the mounting public anger over the NHS, the Chancellor of the Exchequer announced last April an extra £42 billion in funds over six years. He proudly claimed that it would take Britain’s spending on health as a percentage of GDP up to that of the European average by 2008. Even then, Britain will still be well below Germany and France. Moreover, the rise comes after years of under funding, estimated in the recently published Wanless report to be £267 billion between 1972 and 1998 compared to the European average that includes the poorer Mediterranean countries. The consequences are stark. Hospitals have a £3.2 billion backlog of maintenance and repairs, and many are nothing short of disgusting, with more than half the beds in accommodation built before 1914.
Many of the Health Authorities have produced budgets that show that they can either meet the increased costs and sort out their deficits, or satisfy the government’s new health initiatives to cut the time patients wait for hospital treatment and operations. The government has stipulated that waiting times for operations must fall from a maximum of 15 months at present (in reality these can be very much longer since it can take that long just to get an out-patient appointment) to 6 months by 2005 and 3 months by 2008. The government has told Health Authorities that at least £40 million of the £50 million earmarked for waiting list initiatives has to be spent in the private sector. But the Health Authorities say that there is simply not enough money to do it all.
The government admits that most of the new money will not go on base line services. It will be used firstly to train new health professionals—although the government does not say where the capacity to train more doctors will come from. By 2008, there will have to be more than 15,000 GPs and consultants, 30,000 therapists and scientists, and 35,000 more nurses, midwives and health visitors. Yet the rising wage bill has not been factored into the government’s allocation for the NHS.
Secondly the new money will go on new hospitals, the government says. Since new hospitals are to be financed under the Private Finance Initiative, essentially a leasing arrangement with private sector corporations who provide the hospitals, and will be paid for out of the Trusts’ existing budget, this is fundamentally dishonest. It is tantamount to saying that the Trusts’ income is equal to both their revenue and the cost of the new hospital. Thus, even this £42 billion increase has only been achieved by cooking the books.
The looming bankruptcy of the NHS means that millions will be left without access to affordable quality healthcare, with disastrous implications for public health and an incalculable cost in human suffering. With its one million employees the NHS is the largest single employer in Europe. Workers could find that like clinical staff in “Third World” countries, their pay comes late, if at all.
The NHS was one of the most important of a series of measures taken by the post-war Labour government, meant to placate the demands of millions of workers for social improvements at a time of political unrest on a world scale. The then Labour government’s various measures of social reform were crucial in restabilising British capitalism and none more so than the NHS, which replaced a fragmented workplace-based insurance system that provided inadequate coverage for those that were insured and left the overwhelming majority of the population: women, children, the elderly, poor and unemployed, without access to healthcare unless they paid for it up front.
In as much as the NHS was a universal and comprehensive healthcare system, free at the point of use, and provided as a right to all who resided in Britain, independently of any financial contribution, it marked an important landmark. It set a benchmark for the right to healthcare provision all over the world. In the 55 years of its existence, no government was able to privatise or dismantle the NHS for fear of the political uproar that would follow. While New Labour has long renounced its reformist programme, its fading appeal to the British public now rests largely upon its perceived role in establishing the NHS. If a Labour government, so long associated with its birth and its defence, allows the NHS to collapse, then it will suffer the political consequences.
Britain: Enron-style accounting conceals financial collapse of health service
By Jean Shaoul
13 August 2002
Britain’s Labour government boasts of its increased spending since April 1999 on the National Health Service (NHS), but a recent report by the National Audit Office (NAO) reveals a very different picture. Far from increasing resources in ways that increase and improve front line services, the government’s actions have only postponed the NHS’ financial collapse while at the same time reducing access to healthcare.
The NAO’s annual report into NHS’ finances shows that only one of the 99 Health Authorities in England had failed to balance its budget for the financial year 2000-2001, compared with 59 in 1999-2000 and 48 in 1998-99. The number of NHS Trusts (which provide acute, specialist and community health care) that were in “significant financial difficulties” had also fallen. But even after increased funding, 10 percent of all NHS secondary healthcare providers had accumulated deficits greater than one percent of their annual expenditure and in some cases deficits were nearly ten percent of total income.
The Health Authorities have in effect balanced their budgets by shifting the burden of adjustment onto the healthcare providers, the Trusts. Even this was only achieved after a record level of Trust mergers, rationalisations, hospital and ward closures. Twenty-six Trusts and parts of 3 others merged and 2 were dissolved after 1999-2000. As of April 2001, a further 48 Trusts, parts of 13 others and 2 special hospitals merged. In 2002, 17 Trusts were dissolved and the rationalisations have continued apace. It is these closures that lay behind the ever-increasing time it takes for patients to receive treatment.
A recent report by health economists at the London School of Hygiene and Tropical Medicine examined the merger of nine NHS Trusts in London between 1998 and 1999 and showed some of the disastrous consequences. Far from improving finances, quality of services, and the ability to recruit and retain staff in the most expensive city in Europe, the researchers found that Trusts had saved barely £320,000 in two years, damaged staff morale, made team working more difficult and delayed improvements in patient services.
These deficits have been fuelled in part by profiteering by pharmaceutical corporations, clinical negligence claims due to staff shortages, an increase in workload, demoralisation and errors, and a rise in staff wages to bring the NHS in line with the European Union’s directive on a maximum working time for junior hospital doctors. More recently, there has been a miserly 3.6 percent pay increase for nurses. For decades, the NHS has run on the back of the most poorly paid healthcare workforce in Europe. Fed up with their pay and conditions, nurses have left the NHS in droves. The NHS has been forced to recruit staff from private nursing agencies at a cost of nearly £1 billion and bring in nurses from developing countries.
These deficits are also the result of the financial regime imposed by the former Conservative government in 1990, and not repudiated by the incoming Labour government in 1997. The Trusts are required by statute to operate as financial businesses and make a 6 percent return to the Treasury on the value of their assets. As these assets have risen in value alongside the frenzied property boom, so too have the required returns that the hospitals must pay.
By 1999, these factors had combined to lead to a massive accumulated deficit of £1 billion that meant that more than half the Trusts were technically insolvent. The Treasury was forced to step in, employing a creative accounting trick that makes Enron look like child’s play. As the National Audit Office reports show, the Treasury sanctioned non-cash increases in revenue that were used to offset a write down of their assets, thereby reducing their future payments to the Treasury, and recycled back as “dividend” payments to the government.
The scale of the government’s massaging the books can be gauged by the following example. The fifth largest Trust in the country, the South Manchester University Hospital Trust with two huge teaching hospitals both larger than the average hospital, had such a massive deficit that the government had to provide a fictitious £40 million, a 35 percent increase on its normal funding. This took place at the same time as the Trust closed one of the two sites, concentrating all its facilities at the less accessible site, with a huge reduction in capacity.
That the government was forced to resort to such widespread chicanery illustrates the scale of the crisis facing the NHS.
In recognition of the mounting public anger over the NHS, the Chancellor of the Exchequer announced last April an extra £42 billion in funds over six years. He proudly claimed that it would take Britain’s spending on health as a percentage of GDP up to that of the European average by 2008. Even then, Britain will still be well below Germany and France. Moreover, the rise comes after years of under funding, estimated in the recently published Wanless report to be £267 billion between 1972 and 1998 compared to the European average that includes the poorer Mediterranean countries. The consequences are stark. Hospitals have a £3.2 billion backlog of maintenance and repairs, and many are nothing short of disgusting, with more than half the beds in accommodation built before 1914.
Many of the Health Authorities have produced budgets that show that they can either meet the increased costs and sort out their deficits, or satisfy the government’s new health initiatives to cut the time patients wait for hospital treatment and operations. The government has stipulated that waiting times for operations must fall from a maximum of 15 months at present (in reality these can be very much longer since it can take that long just to get an out-patient appointment) to 6 months by 2005 and 3 months by 2008. The government has told Health Authorities that at least £40 million of the £50 million earmarked for waiting list initiatives has to be spent in the private sector. But the Health Authorities say that there is simply not enough money to do it all.
The government admits that most of the new money will not go on base line services. It will be used firstly to train new health professionals—although the government does not say where the capacity to train more doctors will come from. By 2008, there will have to be more than 15,000 GPs and consultants, 30,000 therapists and scientists, and 35,000 more nurses, midwives and health visitors. Yet the rising wage bill has not been factored into the government’s allocation for the NHS.
Secondly the new money will go on new hospitals, the government says. Since new hospitals are to be financed under the Private Finance Initiative, essentially a leasing arrangement with private sector corporations who provide the hospitals, and will be paid for out of the Trusts’ existing budget, this is fundamentally dishonest. It is tantamount to saying that the Trusts’ income is equal to both their revenue and the cost of the new hospital. Thus, even this £42 billion increase has only been achieved by cooking the books.
The looming bankruptcy of the NHS means that millions will be left without access to affordable quality healthcare, with disastrous implications for public health and an incalculable cost in human suffering. With its one million employees the NHS is the largest single employer in Europe. Workers could find that like clinical staff in “Third World” countries, their pay comes late, if at all.
The NHS was one of the most important of a series of measures taken by the post-war Labour government, meant to placate the demands of millions of workers for social improvements at a time of political unrest on a world scale. The then Labour government’s various measures of social reform were crucial in restabilising British capitalism and none more so than the NHS, which replaced a fragmented workplace-based insurance system that provided inadequate coverage for those that were insured and left the overwhelming majority of the population: women, children, the elderly, poor and unemployed, without access to healthcare unless they paid for it up front.
In as much as the NHS was a universal and comprehensive healthcare system, free at the point of use, and provided as a right to all who resided in Britain, independently of any financial contribution, it marked an important landmark. It set a benchmark for the right to healthcare provision all over the world. In the 55 years of its existence, no government was able to privatise or dismantle the NHS for fear of the political uproar that would follow. While New Labour has long renounced its reformist programme, its fading appeal to the British public now rests largely upon its perceived role in establishing the NHS. If a Labour government, so long associated with its birth and its defence, allows the NHS to collapse, then it will suffer the political consequences.
Woomeister
Well-Known Member
7 years ago......
CrackerJax
New Member
So, you think it has miraculously gotten better?? 
Remember mt latest article where your own medical doctor assoc. president admits to an impending implosion? canada is ahead of you in that race, but ALL the NHS's are headed into reduced care at higher cost...a backwards equation, but with a noble purpose. Reality will intersect no matter how noble however...... reality is coming to the UK.....it is coming.
Remember mt latest article where your own medical doctor assoc. president admits to an impending implosion? canada is ahead of you in that race, but ALL the NHS's are headed into reduced care at higher cost...a backwards equation, but with a noble purpose. Reality will intersect no matter how noble however...... reality is coming to the UK.....it is coming.
Woomeister
Well-Known Member
Well that just leaves the private option then, oh yes we have options!!!So, you think it has miraculously gotten better??
Woomeister
Well-Known Member
How many times in the past 20 years have you heard some American politician proclaim, "the American healthcare system is the best in the world." Too many, I fear. But let's face it. People tend to speak most fervently from their own personal experiences. Maybe those politicians, medical or otherwise, actually believed what they said. One could make the case that "the American healthcare system is the best in the world if:
- You have full, comprehensive, in-depth health insurance coverage with low deductibles and copayments, and no exclusions for pre-existing conditions;
- You live in a major metropolitan area;
- You have a long-term relationship with a physician who serves your primary care needs, seeks specialist attention when needed, and finds the right specialist;
- You speak and understand good English and so does your doctor, and you are neither sight- nor hearing-impaired;
- You are well educated;
- You have money and transportation capability;
- You are white;
- You are naturally skeptical and questioning;
- You personally access the internet to help you take charge of your life; and, until recently
- You are male.
CrackerJax
New Member
You have now shown you don't understand how insurance works over here.
The insurance pools have NOTHING to do with where you live density wise. The market pools are confined within a state....but anyone can join any insurance pool from their state...no matter the location, no matter their ethnicity.
One of the main reasons why our health insurance premiums are artificially high (yes they are artificially high) is because the GOVT. won't permit its citizens (permit?) to have access across state lines for insurance. This raises the prices for customers. This links up with the problem say of New Jersey vs. Kentucky. New Jersey has all kinds of mandates upon the insurance companies to meet. This forces the pools to be enlarged with costs that normally wouldn't be there and are then foisted upon folks who will not use those health services, and yet, still must pay for them. Kentucky has hardly any mandates required and the insurance is 1/2 that of New Jersey's. Once again, the Govt. Is the price raiser, not the insurance company.
Lastly, the entire problem with govt. options is that is poisons the pools. Anyone who is sick will join in on these "free" programs, so the pool gets sicker and prices rise. healthy ppl drop out of these pools because of the rising costs, getting the pool sicker and sicker.....which keeps the costs spiraling upwards for those still trapped in the pool.
Opening up and connecting the pools is the BEST way to drop prices for everyone and the GOVT. knows this all too well, but refuses to fix the problem. Why? Because they have their own ideas. Not better ideas, but different. Ideas that give them control.....no matter that it isn't going to work in the long run...they'll just raise taxes...and it's off to the races again of rising prices, except the service is being cut at the same time.
So right now, we have riing costs, BUT rising quality. If the Govt. gets their way, we will have rising costs, but with LOWER quality. I prefer the former over the latter. So does the majority of Americans.....and rightfully so.
The insurance pools have NOTHING to do with where you live density wise. The market pools are confined within a state....but anyone can join any insurance pool from their state...no matter the location, no matter their ethnicity.
One of the main reasons why our health insurance premiums are artificially high (yes they are artificially high) is because the GOVT. won't permit its citizens (permit?) to have access across state lines for insurance. This raises the prices for customers. This links up with the problem say of New Jersey vs. Kentucky. New Jersey has all kinds of mandates upon the insurance companies to meet. This forces the pools to be enlarged with costs that normally wouldn't be there and are then foisted upon folks who will not use those health services, and yet, still must pay for them. Kentucky has hardly any mandates required and the insurance is 1/2 that of New Jersey's. Once again, the Govt. Is the price raiser, not the insurance company.
Lastly, the entire problem with govt. options is that is poisons the pools. Anyone who is sick will join in on these "free" programs, so the pool gets sicker and prices rise. healthy ppl drop out of these pools because of the rising costs, getting the pool sicker and sicker.....which keeps the costs spiraling upwards for those still trapped in the pool.
Opening up and connecting the pools is the BEST way to drop prices for everyone and the GOVT. knows this all too well, but refuses to fix the problem. Why? Because they have their own ideas. Not better ideas, but different. Ideas that give them control.....no matter that it isn't going to work in the long run...they'll just raise taxes...and it's off to the races again of rising prices, except the service is being cut at the same time.
So right now, we have riing costs, BUT rising quality. If the Govt. gets their way, we will have rising costs, but with LOWER quality. I prefer the former over the latter. So does the majority of Americans.....and rightfully so.
Woomeister
Well-Known Member
I have actually shown no such thing, I have never said I understand your system, as you dont ours. I have just done a bit of research, as is my nature, and found this article written by an American Doctor.
CrackerJax
New Member
I understand numbers...and socialized medicine numbers are not to be modeled....
Woomeister
Well-Known Member
Why dont you become politically active CJ? To much dirt they can dig? You are obviously passionate every conversation you enter and you Love spin!!! You are getting socialised health care, whatever you say, FACT!!!
CrackerJax
New Member
I do love spin.....spin tells me where the herd is going to go. I can either get there first, or bet against it. usually it's a combination of the two. The herd arriving makes it work, until the details start to unfold and everyone realizes...oops, we're in the wrong field! It takes a keen eye and timing, but right then you pull out and bet against it. Bingo....
Politics? Let me tell you about politics. It's friggin dirty as all get up and the local stuff may be the worst, perhaps because it isn't as polished as D.C., because like any field of competition, the talent rises to the top. In politics....the higher up you go, the slicker you need to be. Now I am slick, but only in the grasping of concepts and issues and numbers (love numbers), but not so slick at social deception and screwing ppl knowingly. My principles are my downfall. I have had ppl from my town talk me up for so and so office.....I go cold immediately. No thanks....not even a thanks, but no thanks.... just no thanks...
But no, no dirt on me. One of my political aspiration PROBLEMS...
But no, I haven't corrupted myself if that's what you mean.
Politics? Let me tell you about politics. It's friggin dirty as all get up and the local stuff may be the worst, perhaps because it isn't as polished as D.C., because like any field of competition, the talent rises to the top. In politics....the higher up you go, the slicker you need to be. Now I am slick, but only in the grasping of concepts and issues and numbers (love numbers), but not so slick at social deception and screwing ppl knowingly. My principles are my downfall. I have had ppl from my town talk me up for so and so office.....I go cold immediately. No thanks....not even a thanks, but no thanks.... just no thanks...
But no, no dirt on me. One of my political aspiration PROBLEMS...
But no, I haven't corrupted myself if that's what you mean.
medicineman
New Member
"I nominate the above for joke of the day"I do love spin.....spin tells me where the herd is going to go. I can either get there first, or bet against it. usually it's a combination of the two. The herd arriving makes it work, until the details start to unfold and everyone realizes...oops, we're in the wrong field! It takes a keen eye and timing, but right then you pull out and bet against it. Bingo....
Politics? Let me tell you about politics. It's friggin dirty as all get up and the local stuff may be the worst, perhaps because it isn't as polished as D.C., because like any field of competition, the talent rises to the top. In politics....the higher up you go, the slicker you need to be. Now I am slick, but only in the grasping of concepts and issues and numbers (love numbers), but not so slick at social deception and screwing ppl knowingly. My principles are my downfall. I have had ppl from my town talk me up for so and so office.....I go cold immediately. No thanks....not even a thanks, but no thanks.... just no thanks...
But no, no dirt on me. One of my political aspiration PROBLEMS...
But no, I haven't corrupted myself if that's what you mean.