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TALLRITE BLOG
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ISSUE #164 - 28th October 2007 [557 + 231 = 788]
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“Death to the Two-Tier
Health System” A debate has been raging in Ireland for the past couple of years or so about the poor quality of the state-provided healthcare system. Similar complaints are heard from the UK to Canada to France - litanies of substandard service coupled with financial constraints. I am not going to contribute to these tales of woe for the simple reason that on the very few occasions I have had to avail of Ireland's public hospitals (and indeed, many years ago, Britain's), I have been very happy with the experience. But I have no doubt the negative stories are true - people wouldn't routinely lie about such things. In Ireland, much of the blame is laid at the door of the so-called “two tier” health system, that is the public system and the privately insured system, which run side by side. A recent tragic case involved a 40 year old mother who was sent by her GP for a colonoscopy but since she was a public patient she had to wait seven months for it. It eventually revealed she had bowel cancer which by then had become fatal. She died last month. A man who was given a similar referral was diagnosed within three days, received timely treatment and therefore survived. The mother relied on the public system, the man was privately insured. In essence, private insurance not only gives you a better bed in the hospital (to my mind a trivial gain) but allows you to jump the queue of public patients to get attention of medical consultants, specialist analyses and necessary treatment, faster. There is a very simple explanation for this:
If you can't afford insurance, this already feels unfair. It is exacerbated when the same consultant works both in the public sector (for a fixed stipend) and the private sector (for patient fees), the moreso when private patients occupy beds in public hospitals. Public patients end up feeling like second class citizens, which to some degree they in practice are. But if, as they contemplate a seven-month waiting list, they suddenly front up the money, they miraculously find they can see the very same consultant tomorrow. Talk about an upgrade to business class. For these kinds of reasons there is a large lobby, which in the mantra of free healthcare for all regardless of means, calls for the abolition of the two tier system, in favour of a single system of which everyone from hobo to billionaire would avail depending solely on medical need. Then, only then, would equity prevail with the poor no longer dying young while the rich prance on to their dotage. It is an appealing picture, but like all utopias fundamentally flawed and intrinsically totalitarian because it prevents people spending their own money as they might wish (eg on health). It is, furthermore, designed to hide the defects responsible for the existing poor performance of the public sector. If you go to the supermarket, you are confronted with a choice of dozens of types of bread for which you personally and unencumbered can make your selection. Why, then, would anyone think that when it comes to life and death issues - arguably of greater import than bread - people should be permitted no choice at all? That the state alone should be empowered to make such a choice and to choose in every instance itself? For that is what the utopian one-tier system would entail. Private healthcare gives better outcomes (and it certainly does, otherwise no-one would use it) for the simple reason that it is incentivised to do so. It is run as a business. Patients are customers who pay (whether personally or via their insurance) for their procedures. The bigger the number of sick patients, the more revenue. The more revenue, the greater reinvestment and expansion, and the better quality of care available. It's the simple capitalist mechanism. When I put this to a very senior (very wealthy) doctor and a medical journalist a couple of weeks ago, both haughtily told me that healthcare was not a commodity like bread that could be bought and sold. It is somehow above tacky trade. And the hobo-to-billionaire mantra was repeated: “death to the two-tier health system”. But healthcare is a traded commodity.
Indeed, the doctor himself is a walking example. All his life he has
traded his undoubtedly excellent medical skills to the benefit of his
patients, for €uros he can now count in the millions. And it is a
thoroughly honourable exchange which benefits both him and his All the evidence, not just in the supermarket, is that where quality is rewarded, quality goes up. This is the source of the great embarrassment caused to state health systems - which do not reward quality - when they operate side by side with private ones that do. But rather than the state trying to emulate the private one, and in fact compete with it, many simply prefer to eliminate the private, so that care is dumbed down for everyone and poor service is no longer embarrassing because that's the only service there is. If the state wants to provide free healthcare to some or all of its citizens, that is no case whatsoever for it to own and run hospitals. The state should simply buy such care on the open market, obtaining the best value for money, making hospitals compete for lucrative contracts, and giving public patients the power to choose between providers.
Indeed, in Ireland this actually happens on a limited scale, via a hugely successful body called the National Treatment Purchase Fund launched in 2002. If you are a public patient who has been waiting more than three months for your operation, the NTPF will pay for a private facility to do carry out your procedure - cataracts, varicose veins, hernias, gall bladders, prostate operations, tonsils, plastic surgery, cardiac surgery, hip and knee operations - you name it. 75,000 patients have been delighted with their treatment. Yet the NTPF, far from being seen as a successful role-model for an entire health system, is viewed with resentment and suspicion by the public health service. Extended to encompass all health care, something like the NPTF would truly give rise to a single-tier system, but one reaching for the the highest levels of care, not engaged in a race to the bottom. But, for current employees of state-run institutions, it would also mean the end of
Each individual's salary, pension and job-continuity would be determined solely by his/her skills and effort. Just as it is within the private sector of health or of any other enterprise which has to pay its own way by persuading satisfied customers to part with their money. And that is what is really behind the call for “death to the two-tier health system”, because the existence of the private sector threatens the sinecures of those hundreds of thousands who work in the public. It is nothing to do with the welfare of patients.
News From Iraq Can Also Be Good
Reports of bad news from Iraq are endemic. This is not to say that bad news itself is endemic, only that the conventional print and TV media seem so singularly loth to report good news that you could be forgiven for thinking that there is none.
But sometimes you do come across snippets of the positive, so I would like to share this little one.
According to conservative radio jock Hugh Hewitt (minutes 10-12 in this audio clip), the White House recently reported the following as of 18 October, with regard to a 93 sq km sector of north-west Baghdad with a population of a million people, a sector controlled by the US army -
US forces are partnered by ten Iraqi army battalions and two national police battalions across the security districts of Mansour and Katayama. These areas are commanded by highly competent patriotic Iraqi brigadier generals who are consistently demonstrating their unbreakable will to deliver security, reconciliation and reconstruction to NW Baghdad. But that is not to deny that dreadful news is happening in parallel, most recently the murder of 24 Iraqi police officers and recruits in Baquba, north-east of Baghdad. I wish I had a better handle on the balance of positive and negative news.
Five Times More Fun Than Soccer If you want to know why soccer seems, to rugby enthusiasts, such a dreary game, have a look at these statistics. Last year I, being a nerd, collected, calculated and analysed them for the Soccer World Cup (and wrote a post, “World - (Yawn) - Cup”).
In the table below, I compare the results of these two sets of analyses in a world exclusive revelation. They are divided into
The thrill of these matches, at least from the spectators' point of view, comes from making scores. In soccer, that means goals - though obviously not penalty shoot-outs because they're not football. In rugby it's mainly tries (five points), but to a lesser extent penalty goals and drop-goals (three points). Of course, near-misses and valiant defences can also exhilarate, but ultimately it's actual scores we want to see. Moreover, near-misses occur in roughly similar proportion to actual scores - so again, more scores mean more near-misses mean in aggregate more fun. Thus a good measure of the excitement a game generates is how long you have to wait between scores. You can see how soccer and rugby contrast with each other in this table showing what happened in the 2006 and 2007 respective World Cups.
So in the final analysis, it's 51 minutes versus nine. You can therefore see how, broadly speaking, rugby is five times more fun to watch than soccer. So why is soccer not rugby the world's most popular ball game, and by a mile? I have no idea. It makes no sense to me at all. Meanwhile, I await the next World Cup with bated breath - the Seven-a-Side Rugby World Cup, to be held in a single stadium over a single long weekend in February 2009 in Dubai. In this fast, furious and foreshortened version of the game, scores will mount up at an even more astonishing rate, measured more in seconds than in minutes. Be there!
New Wine for Seniors California vintners in the Napa Valley area, which primarily produce Pinot Blanc, Pinot Noir and Pinot Grigio wines, have developed a new hybrid grape that acts as an anti-diuretic.
It is expected to reduce the number of trips older people have to make to the bathroom during the night. The new wine will be marketed as ...
“PINO MORE”
I heard it through the grapevine. [Groan - Ed].
Issue 164's Letters to the Press Neither letter published this week, despite my usual witterings.
- - - - - - - - - - J I H A D - - - - - - - - - - Quote: “There is a tendency ... to believe [the Iranian regime] are as they are because we have provoked them and if we left them alone they would leave us alone. I fear this is mistaken. They have no intention of leaving us alone.”
Tony Blair, warmongering as ever, Quote: “The US administration is like a madman running around with a razor blade.”
President of Russia, Vladimir Putin, in
typically feisty form, - - - - - - - - - - E U R O P E - - - - - - - - - - Quote: “[It is] a vote for climate change, a vote for environmental policies, a vote for the Common Agricultural Policy, a vote for social Europe, that is a vote for the Reform Treaty.”
Bertie Ahern, Ireland's Taoiseach (prime
minister),
It is of course, as Mr Ahern noted last June,
Fearful of further popular rejection,
Poland's former Prime Minister Jaroslaw Kaczynski, one of the indistinguishable “potato twins”, pulls a gun on his rival Donald Tusk in a parliamentary corridor. Or so Mr Tusk, in a pre-election TV debate, alleged occurred in the 1990s. Mr Tusk soundly defeated Mr Kaczsynski in the election last week. But how does he know it wasn't
Quote: “I hope you won't be giving grants to too many one-legged Lithuanian lesbians.”
Tory would-be prime minister David Cameron
“I thought we just have, haven't we?” Meanwhile, one-legged Lithuanian lesbians are outraged. - - - - - - - - - - I R E L A N D - - - - - - - - - - Quote: “That's bullshit. Nobody saw me. I had a balaclava and gloves!” Killer and serial thug Leigh Crowe,
However, this rum defence did not stand up in his trial. Happily, Mr Crowe was sentenced to life for
manslaughter The murder/manslaughter law works in curious ways. Quote: “I do wish I did come to Dublin more often - to evangelise the heathens.” Rev Ian Paisley,
First Minister of Northern Ireland and rabid Protestant, - - - - - - - - - - R U G B Y W O R L D C U P - - - - - - - - - - Quote: “The [England world cup rugby] squad spent yesterday in recovery mode, the physios kept busy nursing bruises, many of them caused by players pinching themselves.” Daily Telegraph journalist Mick Cleary,
Quote (heard in a Sky News interview): “Blimey, it can't happen to us, can it, what happened to them [Australia and France]. Can it?” England rugby coach Brian Ashton
Quote : “They say in politics a week is a long time, but in rugby, I tell you, 80 minutes is a fantastic thing.” Jake White, manager and coach of
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ISSUE #163 - 18th October 2007 [527+236= 763]
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Burma and How to Boycott the Chinese Olympics
We have all been alternately
The litany of Burmese grievances is familiar to us all; the fuel price hike is just a symptom.
The Junta is a vile regime, whose only saving grace is perhaps that it does not have aggressive designs on its neighbours. The generals merely wish to consolidate and hold their own power in perpetuity and thereby to continue pillaging the national treasure for their individual personal enrichment and pleasure - as this wedding of Than Shwe's daughter illustrates.
The world community is outraged by the Junta's latest antics against the monks, but outrage is pointless unless you also take action. And there's the rub. The US has imposed sanctions on Burma since 1990, directed mainly at the individual generals, but they have had little effect. The generals, few educated beyond primary school level, are just not interested in foreign travel, so barring them from shopping in New York doesn't do much. Meanwhile, China and India have been delighted to carry on trading, and they have kept the regime economically propped up. So the soldiers have remained ensconced in power, Ms Suu Kyi locked up, and democracy a distant dream. China has long been Burma's de-facto defender. Stronger action by the Security Council has up to now been firmly vetoed by China, egged on by (of course) Russia. For obvious reasons, these two states are distinctly uncomfortable at the thought of having to encourage democracy anywhere. However, the latest crackdown has embarrassed even China, to the extent that the UN Security Council at last, unanimously, “strongly deplores [Burma's] use of violence against peaceful demonstrations”, as does the UN Human Rights Council (the original text said “condemns” but China and Russia negotiated this down to the weaker “deplores”). However, the UN statements are pretty toothless. The two Councils urge the Junta to fix Burma's political, economic, humanitarian, and human rights issues, talk to Ms Suu Kyi, blah, blah, blah, but with absolutely no action to follow should the generals do nothing. There is a brutal truth about Myanmar that few want to acknowledge. Justice will only visit Burma once the generals are gone from the scene forever. But they are never going to voluntarily relinquish their power. It's going to have to be prised from their clenched fingers, and there are only two ways to do this.
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