The NHS

[clovehitched]

Word of this is getting around - apparently in order to discredit the, as I understand it ,somewhat limited reforms that President Obama is proposing for the US's very expensive, and not all that effective health care system, right wing pundits in the US have been using the NHS as a scare story about all the bad things that can happen under "socialised medicine". The problem is, they're not being overly accurate about their claims, with perhaps the most priceless example being this massive goof about Stephen Hawking, where it was claimed, by one publication, that he would have had no chance for survival had he been British.

Apparently the writer of the article in question didn't realise that Stephen Hawking is, in fact, British, and has been the recipient of quite a lot of NHS care. The article was hastily rewritten to remove any mention of Professor Hawking, but the Internet noticed and the epic LULZ are now spreading.

The Guardian (yes, I know) has noticed too, and if you feel like grabbing some popcorn the comments thread here makes for a wonderful piece of "can't stop looking at the car crash" style Internet browsing.

Anyway, I want to make a personal point. When I was eight years old I was walking home from school one day. I was crossing the road at the centre of this Google Maps page from north to south, to walk into the lane running south, which was part of my walk home. The school gates had those zig zag yellow "School, No Parking" lines on them, which were being duly ignored by the parents picking up my schoolmates. There was no pavement on the south side, so I had no choice but to cross there, and an illegally parked truck (I even remember whose parent it was parked there) was blocking my view along the road.

I edged out to look round, and at that moment I'm told someone stepped out from one of the garden gates on the opposite side. A car which was travelling along the road swerved to avoid them, and narrowly missed the truck I was peering out from round.

I experienced this as a screeching of brakes, at which point I guess I must have had a ton of adrenaline dumped into my system. Time slowed down, and I turned to face the sound. The world streaked across my vision, as if shot with a poor quality video camera with too much persistence, and I heard a bang. The lateral streaks of the world became a swirl, and in slow motion I watched the swirl as I turned upside down, and then felt a sharp pain as my left knee struck the asphalt. The swirl continued as I came to rest on my back, pretty much back where I'd started crossing the road, and then time returned to normal speed.

As it did, I felt a pain more intense than anything I've ever experienced in my stomach - far more pain than an eight year old should have to deal with. I looked up to see a circle of faces looking down at me. The events of the next 15 minutes are confused in my memory - someone ran home to get my mother, someone else came from across the street saying, "I've called an ambulance". Others were exclaiming that I was alive. Someone, perhaps the car driver, got me a blanket and laid me on it. My mother arrived in tears - I found myself consoling her (ah, irony). One of my teachers arrived and with my mother picked me up to move me back inside the school (I don't think this is recommended practice). As they did, the weight of my legs hanging below me made the pain intolerably worse, and I'm not quite sure how I managed to avoid passing out.

In due course an ambulance arrived. It took my to the Chesterfield Royal Hospital where I spent a week on the Nightingale Children's ward in a lot of pain, being fed through an IV line in my arm, feeling deeply sorry for myself. When it was clear that I didn't need to be hospitalised any longer, a week later (when I was able to eat food again and get out of bed), they allowed my parents to take me home. I spent several more weeks off school before returning, having made a full recovery. By some miracle I had "escaped" the impact of the car with "only" haemorrhaging into my stomach, despite the initial fears that my ribcage was smashed, that my lungs were punctured, that I might die. I guess I would have done without medical attention.

The car driver sent me a jigsaw in hospital - I understand he was really cut up about what had happened. It wasn't his fault - it was just one of those things.

Through all of this there were no insurance companies involved, nobody ever asked how the x-rays, the doctors, the medicine, the bed, etc. were to be paid for, no questions were ever asked about whether we had "coverage", they just sent an ambulance, took me into hospital, looked after me for a week, and got me back in a fit state to be sent home. When I was eight years old the system the US right wing wants to portray as some kind of socialist dystopian disaster simply did its job and saved my life.

So yeah, thanks for that NHS, and don't believe everything you see on the television, especially if there are political lobbyists involved.

Originally posted at http://auntysarah.dreamwidth.org/207629.html - you can comment here or there.

Comments

[turkishb.livejournal.com]

Thank you for this!

I saw today a photo of a placard which read:

You can only choose one:
[ ] Universal Healthcare
[x] Freedom

In the States, I get the sense that our notion of equality is antithetical to our notion of freedom. I wonder lately if this is due to an assumption that exchange value (a specific non-real entity) is the true source of equality. For the state rather than the market to mandate an entity of equality which isn't exchange value based, suddenly people start flipping shit about it being an unnatural replacement for the notion of market equality. How people can believe this while having enormous problems getting medical coverage is a mystery to me.

[turkishb.livejournal.com]

Shoot, that wasn't well stated. Let me try again: in the States we believe all equality, and thus all freedom, are functions of our market. Why we hallow the institution of the market over the state is all down to our notion of exchange value, and how natural it is for the extreme of exchange value to outstrip the consequences of use value. I'm not trying to be a complicated git, I swear.

[juggzy.livejournal.com]

The reason is that the Republican party essentially propogates a feudal state of mind. Those who vote Republican against their better interests are basically voting for 'their' overlords as opposed to 'the other overloards' because they are 'their' overloards. It's a lot closer to non democratic African tribalism than they realise. They will vote for 'their gang' even if it goes against their own self interest.

[turkishb.livejournal.com]

The following is a study carried out upon two dogs:

Both were taught to perform a trick for a treat.

When either was not given a treat, though both had performed the trick, the subject would no longer perform the trick after it stopped expecting a treat.

When one subject was given a much bigger treat for the same trick than the other subject, there was no difference reported in repeated performance of the trick.

The moral of the story according to me:

The gains we make by rationality are immense, yet if irrationality makes even the slightest gain, it continues happily right alongside a better approach to life.

[juggzy.livejournal.com]

Well, quite. Similarly, when I was mashed up in Tanzania, my medical insurance flew me home, but it was the NHS that took care of me, with quality care.

I would not mind paying higher taxes in order to insure that we retain such a wonderful system, and I am sure that I am not alone in that.

[auntysarah.livejournal.com]

I would not mind paying higher taxes in order to insure that we retain such a wonderful system, and I am sure that I am not alone in that.

The NHS has problems - money is wasted, and there are better healthcare systems out there, but AIUI we spend around half what the Americans do as a proportion of GDP on healthcare and we live longer.

People in glass houses...

[juggzy.livejournal.com]

I'm not with you on the money wasted. Sure, we can always fiddle around the edges of systems to save a penny here or there, but I'm fairly content that the money is fairly spent and that those who are employed by the NHS are, on the whole, intent on giving value for money.

[auntysarah.livejournal.com]

When I was fighting Cambridgeshire PCT about funding my surgery, I got the prices they paid to the West London Mental Health Trust for appointments at Charing Cross GIC.

They were *three times* what the private sector was charging for equivalent services.

Cambridgeshire PCT apparently didn't care.

[juggzy.livejournal.com]

OK. I'm obviously not privvy to that information. My first reaction is to ask about economies of scale - whatever it was that affected location, numbers of people wanting similar surgery (which would affect cost of consultants). In your case it was specialised surgery which might well cost less if done in one centre, as opposed to distributed around non specialist centres (costs being expenses for consultants as well as consultant and specialist fees). I'm also fairly certain that the surgery you underwent would have involved a long period of consultation with you in the first place to ensure that this was what you really wanted to do. Do the private places factor in these costs?

If it was like for like then that's shocking. My experience is that private clinics for whatever pick people up after profiling and consultation is done by the NHS, thus raising costs for the NHS. However, you say equivalent, so maybe it was like for like.

In which case, how could the NHS costs have been reduced?

[auntysarah.livejournal.com]

My first reaction is to ask about economies of scale - whatever it was that affected location

NHS clinic is in Hammersmith. Private clinic operates out of premises in the West End.

numbers of people wanting similar surgery

This was for assessment appointments prior to surgery (i.e. seeing the consultant). The price for the actual surgery was within about 10%.

Do the private places factor in these costs?

Yes. That's the difference I'm referring to - appointments with consultants. At the time, the private sector was charging about 200 pounds an hour, the NHS around 600 pounds an hour.

If it was like for like then that's shocking

It was definitely like for like. Walk in the door to see a gender specialist and if you go private (in 2006), you'll pay 200 quid. Use the NHS, and your PCT would have had to pay around 600 quid for a first assessment.

Norfolk PCT is wise to this - they subcontract to the private sector. I pointed this out to Cambs as well, and furnished them with a copy of Norfolk's policy, as an example of better practice. To go with their figures provided to me under FOI, I pointed them at the online price list for seeing a private consultant for exactly the same service at around a third of the cost per appointment.

Their response made it clear that they hadn't even bothered to look.

In which case, how could the NHS costs have been reduced?

Some PCTs have seized the initiative and subcontract to the private sector for these services. I mentioned Norfolk, I understand there are others. Over the course of a typical treatment this would save them thousands of pounds per patient, and because waiting times are shorter in the private sector, patients would be expected to spend less time on very expensive chemical castration drugs (100 pounds a month - the NHS did fund that bit in my case, possibly because my GP never actually told the PCT).

The Scottish PCTs have their heads screwed on properly in this regard too - they offer services inhouse where it makes sense, and subcontract where that makes sense. Most of the English PCTs seem happy to pay vastly over the odds to subsidise the West London Mental Health Trust. Were I a betting woman, I'd put money on most of that price differential not actually reaching the Charing Cross GIC, so god only knows where it goes.

[juggzy.livejournal.com]

That does appear to be ridiculous. The Scottish model is the one that I had assumed that the NHS used universally.

Still, let's keep the pressure on the NHS to be more efficient, rather than assuming that no NHS is the solution to this.

[auntysarah.livejournal.com]

That does appear to be ridiculous. The Scottish model is the one that I had assumed that the NHS used universally.

When it comes to gender services, there appears to be some resistance. There are some of us actively engaging to try and make some of these points, but we're not numerous or interesting enough for NICE to take the time to have a proper look, it seems.

Still, let's keep the pressure on the NHS to be more efficient, rather than assuming that no NHS is the solution to this.

Quite. As creaky as the system is in this regard, things are far worse in general in the US.

[phonemonkey.livejournal.com]

There are some of us actively engaging to try and make some of these points, but we're not numerous or interesting enough for NICE to take the time to have a proper look, it seems.

Sad to say, I think NICE is afraid of the tabloid factor when it comes to gender services, because it'll be easy for the papers to demonstrate what they consider "worthy" and "unworthy" patients by digging up somebody who wanted to use a very expensive cancer drug that NICE rejected. Especially because it'll take about five minutes before a sub-editor realises that you can rhyme "grannies" with "trannies".

[auntysarah.livejournal.com]

Especially because it'll take about five minutes before a sub-editor realises that you can rhyme "grannies" with "trannies".

I find your cynicism to be a thing of beauty, and probably absolutely spot-on.

[phonemonkey.livejournal.com]

You cannot hope to bribe or twist
(Thank God!) the British journalist
But seeing what the man will do
Unbribed, there's no occasion to.

- Hilaire Belloc

[auntysarah.livejournal.com]

I should add, I think the root of the problem with the gender stuff is because they're trying to run a central service (London handles much of the country's work) as if it were a local service, and the way the disconnect gets managed ends up being rather Byzantine.

If a GP could just refer someone to the specialists in London, a lot of the problems might be cut, but as it is a GP can't make that referral - it has to come from local MH services, who quite often haven't got a clue what they're actually doing, and then the PCT have to agree funding. My view is that a lot of this stuff is just pointless obfuscation, and not only would the system work better if the middlemen (local MH services - do you *really* need a consultant psychiatrist to write a letter saying, "this person says they're transsexual, will you have a look at them please?" and the PCT) were removed from the equation, it would probably cost less too.

not exactly true

[auslanderin01.livejournal.com]

My GP referred me directly. He said that there'd been yet another change in the rules.

[darkwaterfairy.livejournal.com]

*nod*

At the heart of it, it's the self-serving misdeeds of the doctors and managers inside the NHS (and politicians outside) that are the only problem with the NHS. And like they've never suffered professional bastardry in the U.S. *rolls eyes*

[ailbhe]

When I was 19, I had a miscarriage. I bled very heavily for six weeks. I couldn't afford to see a doctor, and investigation showed the cost of A&E style care would also have been too high. I didn't know it was a miscarriage, of course. I spent a considerable portion of my budget on the Pill, so I was really surprised when I had my first confirmed pregnancy years later and realised that it wasn't my first really.

When my baby was 11 weeks old she stopped breathing. She and I were in hospital overnight for monitoring. It was nothing; she had baby sleep apnea, and a monitor that beeped when she stopped breathing managed it well until she outgrew it. No-one asked me to pay for a damn thing.

When I had PTSD and thought I might kill my baby, I had weekly visits lasting one hour each from the health visitors until I made it to the top of the waiting list for therapy and counselling.

When I had an allergic reaction to an antibiotic, and after a few can't-breathe hoops an *ambulance* came to monitor my breathing for fifteen minutes in case the reaction got bad enough to merit serious intervention (they had some needles handly, I don't know what was in them!). They were completely polite and poo-pooed my apologies (which they more or less had to lip-read) for having called them when not actually dead. They didn't ask me to pay for anything *even though I hadn't needed them in the end*.

I can't swear they saved my life - it's possible I might have survived a suicide attempt, for example. But they saved my daughter at least once, and perhaps twice.

[jasmine-koran.livejournal.com]

I had extremely severe asthma when I was a child. Some of my earliest memories are of waking up in the middle of the night, unable to breathe, and being rushed to the hospital. I remember sitting in a hospital bed, breathing pure oxygen through a mask strapped to my face, studiously working on a "M.A.S.H." colouring book one of the doctors had given me. We'd usually be there past the break of dawn. We were not charged a dime.

Funny, woulda thought I'd be euthanized or something. Weird, isn't it?

[auntysarah.livejournal.com]

This was in Canada, right? I understand the pundits have been trying the same trick with your system too?

[jessie-c.livejournal.com]

Worse, our Torries want to swap our system for a US "for profit" model. They don't seem to understand why we get all upset about it.

[amokk]

Which is heralded by the conservatives in the US as evidence that Canada's system is a failure because they're obviously switching to a "true American" system.

Gah! Formatting fail : (

[jessie-c.livejournal.com]

Take two:
Which is kind of " the tail wagging the dog" because our Conservatives have their noses shoved so far up Bush's model themselves very closely on the Rethugnicans' ideals.

[angelofsith.livejournal.com]

I've always said that the NHS do a sterling job, even if they are under paid, under staffed, and over worked. If it wasn't for the NHS, well, I might not be here today.

[kajyann12.livejournal.com]

I help out occasionally on a support site for people who have had ostomy surgery for some reason. I would have died in 1992 if I had not had mine, and I know many people on different continents who are in the same position. Whereas, when I need supplies, I phone up a nice guy in Solihull and he delivers me all I need to make sure I can live happily, some of my compatriots in the US have to fight to obtain bags, and even then are limited as to how many they are allowed under the 'system'. Consequently we have people coming to us using 'ziplock bags and duct tape'(an actual quote), or asking us how they can re-use their bags.

How disgusting and humiliating is that? No-one should be put in that position - its like asking someone to re-use soiled toilet paper. The sooner the US gets a proper healthcare sytem the better - and I dont begrudge the NHS one penny of the money I pay.

kaj
xxx

[tekalynn.livejournal.com]

Hear hear! Thank you for all the wonderful work you do.

[phonemonkey.livejournal.com]

I've heard a lot of US healthcare stories lately, but this one is the worst. That is a travesty.

[shelleybear.livejournal.com]

I seem to be one of very few Amerikans replying to this comment.
So let me state for the record, the country of my birth is full of assholes who are driven by fear and hatred rather then reason.

[fyremane.livejournal.com]

yup

[fyremane.livejournal.com]

ive thought we needed a medical system closer to yours for a long time

[tekalynn.livejournal.com]

There are unsubstantiated claims going around that "socialized medicine" (bring it on, I say!) would lead to "more bureauracy" and "longer waiting times".

Well, hell. I scheduled my annual checkup in March (March, mind you) and the soonest they could fit me in was JULY. The doctor said, when I told her my symptoms, "Why on earth did you wait so long?" and I said "This was the earliest I could get an appointment with you." She was horrified.

She also said, while we were going over my medical history, "I don't understand. What was your medical care between [year] and [year]? There's a blank." I looked her straight in the eye and said "I didn't have insurance." She looked back at me sadly. Point taken.

[tekalynn.livejournal.com]

Whoops, I should point out that this was in the US and I'm an American. That does make a difference.

Whereas when I was in Britain one year, I terrified myself by waking up with a blocked ear (first, though definitely not the last time it happened). Booked an appointment with a doctor through the hotel, got seen the next day, got my ear cleared up, didn't cost a penny (US or UK).

Now ask me again. Which health service would I rather use?

[paulathomas.livejournal.com]

Have I got this right, is there a proposal on the table in the US to allow Health Insurance Companies to take up to 35c profit from every premium dollar (that's more than the casinos in Vegas)? And the Insurers profits have increased by 1000% (ie multiplied by 10) over the last few years. Why would anyone want such a system (other than health insurers that is)?

[austinthecowboy.livejournal.com]

There are unsubstantiated claims going around that "socialized medicine" (bring it on, I say!) would lead to "more bureauracy" and "longer waiting times".

Seriously, when I hear people say this, I wonder what the last time they went to the doctor was. The massive clusterfuck of private insurance companies create an impossible amount of bureaucratic red tape. I guess if you're a rich white Republican with expensive private health insurance it's not as much of a problem, but for the rest of us it seems like the system is already plagued with the same problems (and more) that universal health care will supposedly bring.

hooray for the NHS

[auslanderin01.livejournal.com]

In 2003 I worked in the national implementation team for the Independent Sector Treatment Centre programme, a £2.5bn initiative to bring in 100,000 privately provided routine operations alongside those provide by Acute Trusts (who took every opprtunity to rubbish the programme as, I believe, it threatened their cosy monopoly). I believed in the ISTC programme because I think the NHS needs a kick up the arse. I love the NHS but I hate its confusion, arrogance and complacency.

In 2001 I snapped my patellar tendon (the elastic band that connects one's quadriceps to the lower leg) not once but twice. I could've gone private but knew that A&E stuff is best dealt with by NHS surgery. Julian Jessop, consultant orthopaedic surgeon at Watford General, did me up both times. Staying on an NHS ward kept my spirits up (I can't stand my own company). And the NHS physio that followed had me rapidly walking again. Together, they have left me with a knee joint that functions perfectly and a leg that is actually more flexible than its healthier companion. I have walked the width of Scotland on it: God bless the NHS!

Which is one of the reasons why I, quite blindly and with nothing more than a bloody-minded faith in the NHS, am sticking to CHX. I want to believe in the NHS because, like fairies in Peter Pan, I am worried if we stop believing, it will start to die.

Re: hooray for the NHS

[paulathomas.livejournal.com]

My father who is 88 has been treated by Watford General twice recently. Once after he collapsed in the street (he was fitted with a pacemaker the next day) and once for a nosebleed that wouldn't stop (he had the vein cauterised). And the wingnuts accuse the NHS of not treating old people except to kill them!!

[cmcmck.livejournal.com]

I too owe the NHS my life. I had gastroenteritis as a baby and without the high dependency care I received, I would certainly have died. As a child of a working class family we couldn't have paid for the treatment. AND the family GP drove me to the hospital................

[kasumi-astra.livejournal.com]

I've thankfully never been in a life-threatening situation.

I'm now in the system of the Porterbrook GIC in Sheffield, and I've never felt more reassured than being told that I could expect to plan SRS sometime in 2010. Four years ago it seemed like the most remote possibility, and now it's been said to me in the most matter-of-fact way (obviously there are the usual disclaimers, but this is a completely new experience).

My brother had pneumonia when he was very young. I never knew how serious it was, and I still don't know most of the details, but it was serious enough to spend the night at a friend's house as my parents took him to the Royal Berkshire in Reading. I wasn't picked up until close to midnight. As serious as it was, my parents never had to worry about the long-term repercussions of my brother's treatment. The only question was: would he get better? He did, and today I can be grateful.

At the same time, I've seen the kind of money wasting that goes on in the NHS. I've followed AuntySarah's story with the Cambridgeshire PCT and I've worked in the National Program for IT. The NHS is hemorrhaging money at every level because it is so bad at valuing services.

I've also written to my own PCT who bluntly told me that funding for GICs in Sheffield is based solely on cost and "competing priorities" (read: high-profile treatments such as Cancer treatment) - no clinical need was evaluated. NHS managers can keep patients at arm's length and neglect their treatment to appease the tabloid media and middle England, and that makes me profoundly sad.

I've always wanted to make the kind of effort I've seen some transpeople make in the UK to improve services for transpeople in-particular, but always frustrated by not knowing what to do when hitting the brick-wall-effect.

But for now I'm proud and happy that I'm finally in the NHS system. I can echo sarahwilson01's feelings about wanting to believe in the NHS - I simply cannot afford not to. I believe people in Britain moan about what truly matters to them most, and I think the NHS is no exception. The events of this week have overwhelmingly shown what people will do to defend it - and good on them :-)

[moonspark.livejournal.com]

I know a lot of lower-income people in the US who have to worry all the time about health and affording the doctor.

I visited people in Canada who made approximately the same amount of money as my lower-income US friends. Never once did I hear them mention affording healthcare, even though one of them had sustained injuries at her workplace. They talked about not having /time/ to see the doctor, not not having money.

It was an interesting experience...

[cmcmck.livejournal.com]

The point these fascist slimeballs never seem to understand is that while I grew up in a working class and pretty impoverished family (best let them die, eh?) I also grew up to be a qualified teacher, academic researcher and writer and a net contributor many times over.

Then again, I also grew up to be a feminist, socialist, quaker, pacifist trans woman (y'know- someone with a brain she actually knows how to use?) and that must REALLY scare the shit out of that sort of person ;o)

[(Anonymous)]

Hi Deanna from th US first I would like to apologize for the undeserved bad press about you health system. Second my largest problem with all of this is why (in what we hope is a modern society) is a public need such as health care is a "for profit" system in the first place. I have no problem with the people working for the system the drug companies and the health care systems making a living. But the system should not be based on making a profit for the share holders but instead should be based on providing a service to its patients

[gkn.interbrainz.com (from livejournal.com)]

The car driver sent me a jigsaw in hospital - I understand he was really cut up

…into lots of little interlocking pieces?

To the anon poster

[auntysarah.livejournal.com]

Thanks for your comment. I'm afraid I don't think I can unscreen it because it contains allegations which I worry might expose me (as a potential "publisher") to a possible libel action. However, I do wish you all the best and I'm sorry to hear about what you've been through.

[angharads-house.livejournal.com]

Having been the recipient of health-care services in China, Russia, England, Japan, the States and Canada I would hazard to rank England the very best, Canada a close second, then Japan, Russia, the States and China in absolute last place.

America offers lots of shiny doo-dads and machines that go 'bing', but they also offer filthy wards, unspeakable loos on those wards, and constant demands for payment guarantees if not actual credit-card swipes.

Also, utterly off-topic, for GRS-related work, Japan is the very best (although in my day they only did secondary procedures like clitoroplasty and the like), England okay once you jump through the hoops, and Canada stuck somewhere in the Dark Ages.

Am presently in the States, where the radio programmes are full of scare-stories about nasty evil incompetent socialisitic public health-care systems. I just keep asking myself, "cui bono?".

[meegosh.livejournal.com]

I can stand up and be counted as someone who's received treatment at the NHS that wasn't "vital".

When I was diagnosed as being Turners as a small child they made a prediction of my height based on receiving growth hormones and not receiving them. Despite the years of horror that went with the daily injections I only came in at the predicted "without hormones" height. There wasn't that much between the two height ranges really. One just under and one just over the 5 foot mark. But the doctors thought it worth treating with expensive drugs. When puberty hit early (I had my first period at aged 10) they then took the decision to delay my puberty with hormones so that a little more height could be eeked out. It was thousands of pounds spend on treatment simply so I could potentially fit in better. There was the drugs themselves, the x-rays, the consultants' and my GP's time, the genetic tests, the ultra sound scans etc etc. And my parents only had to worry about finding the money for fuel to get me to appointments.

On the flip side. My grandmother had an emergency hip replacement back in March. She's back home (she refused to stay in hospital to die) but with being house bound, with little sight or hearing she's very confined. So my father decided to sort her out with a hearing aid so she could still listen to the radio and to audio books. The NHS GP insisted that to be checked for one she had to go to him. She can't get up and down the stairs into her flat, she can't get to an appointment at the GPs. Paying for a private consultation meant that someone came to her.