Tag Archives: health care

Is the UK’s NHS collapsing?

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Here in the USA, we hear talk of imperial collapse. In the UK, everyone pretty much agrees that the empire collapsed 70 years ago, and yet the nation/republic seems to march on. They seem to be in a foul mood though. Consider this blog post, “(Why) The Death of the NHS Is a Parable of Civilizational Collapse“:

You can’t get a doctor’s appointment, unless you’re really lucky, or incredibly persistent — you’ll get an automatic message telling you no appointments are available. Ambulance? Good luck with that — they can take hours to arrive, if at all. Think about that, though, in larger terms. What does it mean to…be this painfully, jaw-droppingly, infuriatingly stupid? To give up an NHS? 90% of humanity, maybe more, would kill to enjoy such a thing. The Roman and the Gaul and the ancient Egyptian could scarcely have dreamt of such a, to them, miraculous institution. But Brits…LOL. What the…

Umair Haque, Eudaimonia and Co

So that’s a blogger’s opinion. Let’s look at two British papers, the Independent and the Guardian.

Dr Phil Banfield, chairman of council at the British Medical Association, described the “frighteningly common” situation where dying patients are forced to sleep in a corridor or on a chair while “hospitals (are) failing and falling apart and ambulances (are) stacked outside emergency departments”.

Independent

Okay, so it sounds like a series of political administrations has been underfunding it, and outcomes are not living up to the high standards and expectations of the past. But the article goes on to say they have a plan to fix it.

The NHS has lost its prestigious ranking as the best health system in a study of 11 rich countries by an influential US thinktank. The UK has fallen from first to fourth in the Commonwealth Fund’s latest analysis of the performance of the healthcare systems in the nations it studied. Norway, the Netherlands and Australia now provide better care than the UK, it found. The findings are a blow to the NHS, which had been the top-rated system in the thinktank’s two previous reports in 2017 and 2014. The US had by far the worst-rated system, despite spending the most on care.

Guardian

So it’s still in the middle of the pack of the most functional modern countries, but slipping. If your benchmark is the laughably cost-ineffective and inequitable U.S. system, it is still pretty good.

If the UK can’t do it, should the U.S. even consider the model? We do have the Veterans Administration which gets pretty high marks, and we have a system for active duty military, I guess, although I don’t know much about that. (It would be interesting for someone to compare just the VA to other countries’ systems if nobody has done that. Somebody probably has.) And then we have Medicare, which is a massive direct subsidy to the private health care system (which does nothing but complain about it), which gets reasonable marks, and Medicaid, which is a massive indirect subsidy that gets terrible marks. Still, the U.S. government does better when it is just handing out money than when it is trying to build enduring public institutions. My proposal would be to scale up Medicare to everyone (but we voted against the politician who would really have fought for this). The government could also just create a standardized medical records and billing system and force private industry to use it, or just force everyone to use whatever is used for Medicare. This would take a lot of inefficiency out of the system and maybe reduce the bureaucratic overhead of the private system down closer to the public system (yes, I meant what I said there!) while keeping whatever benefits we think the profit motive provides (those ambulances sure do arrive fast in the U.S.!), and eliminating the insane inequities in the system. This would also get preventive medicine, addiction and mental health treatment out to the people who really sorely need it, which might go a long way toward improving our intolerable drug overdoses, suicide, and even violence problems. So it would really be a win-win for almost everyone EXCEPT the finance industry, which of course owns our corrupt politicians and makes sure we can’t have nice things.

U.S. life span inequality

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We hear a lot about health and life expectancy differences between ethnic groups and income levels in the U.S. This article shows those same numbers by county. Not too surprisingly, Appalachia and the southeast have some of the lowest average life expectancies. Heart disease and drug overdoses are major reasons why. The most shocking numbers though are from heavily Native American areas.

The article prescribes more exercise, healthier food, blood pressure and cholesterol control, and lower health care costs. Sounds good. In my opinion, high cost is certainly an issue, but it is really a proxy for access. We need a health care system that provides access to everyone, at least starting with basic preventive care. This is not particularly high tech. Let’s do it.

Our World in Data Global Health Explorer

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Our World in Data has a new Global Health Explorer. I’m going to pick a few metrics and see where the United States stands according to a somewhat random set of peer countries. I think it would be interesting to see where we stand as a percentile among OECD and non-OECD countries, but that would require work.

Peer countries: I’m going to pick six highly developed countries and six middle income countries: Canada, Germany, Japan, Brazil, Indonesia, Malaysia.

I’m going to pick 10 metrics.

  • Life expectancy at birth: We’re #4! (Japan, Canada, Germany, US, Brazil, Malaysia, Indonesia)
  • Child mortality: We’re #4! (Japan, Germany, Canada, US, Malaysia, Brazil, Indonesia)
  • Maternal mortality: We’re #4: (Japan, Germany, Canada, US, Malaysia, Brazil, Indonesia)
  • Homicide rate: We’re #6! (Japan, Germany, Indonesia, Canada, Malaysia, US, Brazil)
  • Deaths from road injuries (rate): We’re #4! (Germany, Japan, Canada, US, Indonesia, Brazil, Malaysia)
  • Suicide rate: We’re #6! (Indonesia, Malaysia, Brazil, Canada, Germany, US, Japan)
  • Death rate from all infectious diseases: We’re #2! (Canada, United States, Germany, Brazil, Indonesia, Malaysia, Japan)
  • Death rate from alcohol use: We’re #5! (Indonesia, Japan, Malaysia, Canada, US, Brazil, Germany)
  • Death rate from drug use: We’re #7! (Indonesia, Japan, Malaysia, Brazil, Germany, Canada, US)
  • Death rate from cardiovascular disease: We’re #6! (Brazil, Malaysia, Canada, Indonesia, Japan, United States, Germany)

There’s a lot more to glean from the graphs in terms of how much separates countries in these metrics, and of course there are many more metric and many more countries. But one thing is clear, USA USA! is not #1. And in this peer group of highly developed countries (Canada, Germany, Japan), we are not even average, we are dead last on most metrics. Asian countries tend to beat western countries on metrics related to life style, such as alcohol and drug use, and are significantly less violent. Germans are no saints when it comes to healthy life style – they drink a lot and have a lot of heart attacks. And Brazil is downright violent.

common vaccines provide some protection against Covid-19

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This makes some sense to me. By getting jabbed with needles as much as possible, we train our bodies to deal with a wide range of diseases, including ones it hasn’t seen yet.

How can a vaccine designed to protect against one disease be effective against a different disease?

Researchers think the vaccine trains the body to respond more quickly and more effectively to any pathogen it sees, Bruxvoort said…

One hypothesis is that different viruses have common characteristics that apply to all, said Dr. Lara Jehi, the Clinic’s chief research information officer and co-author of the Clinic-Brigham and Women’s study.

Cleveland.com

I remember reading about the BCG vaccine, which is a vaccine given to babies in tropical countries where tuberculosis is common. It leaves a scar, unfortunately, but I wonder if it could be part of the reason tropical countries in general seem to have been more resistant to the disease. Although I think another possible factor could be that people in tropical countries and poorer countries (which often go together) are just more used to and accepting of disease and their experience with Covid was not as thoroughly reported.

Universal health care would have saved lives in the pandemic

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This article in PNAS estimates that a universal health care system in the United States could have prevented 212,000 deaths in 2020 alone. That is a big fraction of the total Covid deaths that year – I don’t have the number at my fingertips but total deaths over the whole pandemic (and caused by the pandemic) recently passed one million. I assume this does not count all the deaths from other causes that a health care system could have prevented. This sounds like a pro-life policy to me!

what’s new with cancer?

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This article is critical of the focus on new treatments for cancer, saying prevention should be more of a focus.

Up to 40% of cancers could be prevented by reducing the consumption of highly processed foods, high-calorie diets, and certain fats, increasing consumption of fresh fruits and vegetables, and getting people to be more physically active. Alcohol consumption increases the risk of several types of cancer and accounts for 19,500 cancer deaths a year. Air pollution is a major cause of lung cancer and may also increase bladder and breast cancer. And one study found that pollution in U.S. drinking water could have caused 100,000 cancer cases between 2010 and 2017…

The human costs of allowing businesses rather than scientists and doctors to shape cancer research are high. By pursuing cancer treatment options that are the most profitable rather than the most effective for the largest number of people, the medical enterprise misses opportunities to make more substantial progress…

By proposing additional measures to make prevention the priority, tackle commercial determinants of cancer, and avoid the technological quick fix suggested by war and moonshot metaphors, those seeking to reduce the burden of cancer can develop more effective and equitable approaches.

STAT

I had the impression that, smoking, air pollution, and lack of sunscreen aside (okay, those are actually three big ones), the causes of cancer were still murky, with a suspected role for various chemicals in consumer products, food, water, and the environment, but not much known for sure and luck still playing a big role. This article seems to suggest a lot more is known about the causes of cancer than I thought. That big business has captured and corrupted our government is not news, however.

Drug violence and the Netherlands

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A lot of the violence in the U.S. and around the U.S. border if fueled by the drug trade. With drugs illegal, there is just so much money to be made that it is worthwhile for organized crime to form, heavily arm itself and take large risks to move those drugs and make that money. South of the border, organized crime is so heavily armed it is able to intimidate the authorities. North of the border, law enforcement has become militarized and heavily armed in response. This results in a balance of power but also one of the world’s most violent countries that is also prosperous and supposedly peaceful.

That’s my view of the U.S. But is it happening elsewhere. Yes, according to Der Spiegel, in the Netherlands. This might seem surprising, because the Netherlands is known for decriminalizing soft drugs (cannabis, hashish – wait, isn’t that just a kind of cannabis? – and now apparently synthetic drugs like ecstacy.) What is left though is hard drugs, specifically cocaine. Cocaine smuggling and trading is leading to similar violence to what we see in the U.S., although on a much smaller scale. If I read the article correctly, they have around 20 drug related murders per year. That is 20 too many, but it also happens in a month in any sizable U.S. city, so there is no comparison.

I think the U.S. should legalize, regulate, and tax soft drugs right away. We should get a health care system that provides physical and mental health care to people with drug problems. But what to do about the hard drugs? I don’t know, but I still think the violence may be more evil than the drug-related social problems. Just take the market away from the criminals first and then go from there.

August 2021 in Review

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Most frightening and/or depressing story: The U.S. is not prepared for megadisasters. Pandemics, just to cite one example. War and climate change tipping points, just to cite two others. Solutions or at least risk mitigation measures exist, such as getting a health care system, joining the worldwide effort to deal with carbon emissions, and as for war, how about just try to avoid it?

Most hopeful story: The Nordic welfare model works by providing excellent benefits to the middle class, which builds the public and political support to collect sufficient taxes to provide the benefits, and so on in a virtuous cycle. This is not a hopeful story for the U.S., where wealthy and powerful interests easily break the cycle with anti-tax propaganda, which ensure benefits are underfunded, inadequate, available only to the poor, and resented by middle class tax payers.

Most interesting story, that was not particularly frightening or hopeful, or perhaps was a mixture of both: Ectogenesis is an idea for colonizing other planets that involves freezing embryos and putting them on a spaceship along with robots to thaw them out and raise them. Fungi could also be very useful in space, providing food, medicine, and building materials.

the U.S. health care system is not just below average, it is the worst

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This is getting tiresome. Do we need any more evidence that the U.S. has slipped below average and is now bringing up the rear in many categories among developed countries? This is the 2021 Mirror, Mirror report from The Commonwealth Fund, a non-profit generally considered to be competent and non-partisan.

The U.S. ranks last out of the 11 countries included. But the ranking understates the case, because the other countries are somewhat clustered in terms of cost and outcomes, and then the U.S. is a point far away from the cloud with much higher cost and much worse outcomes. It’s not an Anglo-American failure, because the UK, Australia, and New Zealand all do well. Canada is ranked second worst, but again it is on the lower right edge of the cloud and the U.S. is way out on its own.

I do think they picked a group of very high performing countries here. There have to be other developed countries, particularly in Asia, that could have been included. But somehow, I doubt including Japan, Taiwan, etc. would make the U.S. look any better.

I wonder though what would happen if they tried to compare just the over-65 U.S. population served by Medicare to the over-65 population in the other countries. If Medicare does much better than the U.S. health care “system” (i.e., cluster-you-know-what) as a whole, it would be an even stronger argument for Medicare for All. Should the U.S. maybe try to establish a health care system before the next pandemic arrives?

June 2021 in Review

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Most frightening and/or depressing story: For every 2 people who died of Covid-19 in the U.S. about 1 additional person died of indirect effects, such as our lack of a functioning health care system and safe streets compared to virtually all our peer countries.

Most hopeful story: Masks, ventilation, and filtration work pretty well to prevent Covid transmission in schools. We should learn something from this and start designing much healthier schools and offices going forward. Design good ventilation and filtration into all buildings with lots of people in them. We will be healthier all the time and readier for the next pandemic. Then masks can be slapped on as a last layer of defense. Enough with the plexiglass, it’s just stupid and it’s time for it to go.

Most interesting story, that was not particularly frightening or hopeful, or perhaps was a mixture of both: The big U.S. government UFO report was a dud. But what’s interesting about it is that we have all quietly seemed to have accepted that something is going on, even if we have no idea what it is, and this is new.