Health Reform

A friend of mine who is a doctor suggested I do a blog about the health service. Apparently 1,600 doctors have applied for the option to work abroad in the last week. Normally 5,000 apply each year. The BMA says this is response to the government's renegotiation of their contracts. I can't pretend to be an expert on health, but as an over-educated know-it-all I have opinions. Like arsheholes, everyone's got one. In the case of health I have more than one opinion, which does not mean I have multiple anuses as that is a serious medical condition requiring corrective surgery; the kind of surgery that might be under threat if doctors' fears about the NHS prove true.

The doctors I know fear that the current government is planning to privatise the NHS by stealth. Jeremy Hunt might have a name lends itself to insults, but I'm willing to bet that an administration with a majority of 12 is not in the business of taking unnecessary risks. Privatising the NHS or even the suspicion that they were seeking to do so would be politically lethal to the Tories. Even if Cameron were caught committing a sex act with a pig live on camera, suggesting that the alleged university indiscretion was the start of a career in porcine-orientated animal interference; the PR consequences would be less severe than the charge he was selling off the NHS. Yes, he could act out Charlie Brooker's famous Black Mirror episode on The News at Ten and it would have minimal impact on the polls, compared to tampering with the Brit's beloved health service.

True, the Labour party is doing everything it possibly can to render itself unelectable, even from an voter base comprised exclusively of Guardian readers. But the changes to the NHS predate Labour's act of political hair-kiri a.k.a electing Corbyn leader. The Tories may be celebrating; it didn't influence health policy. So what is so uniquely sensitive about health care reform and why are doctors so upset? I think it's worth remembering why anyone trains as a doctor; it's definitely not for the money. Top consultants may be well paid, but when you consider the lifetime of training it takes to reach that position and the comparable salaries in private business, money is not the reason you become a doctor, at least not in the UK. Perhaps in the US, where plenty earn millions, the medical professions might attract more self-interested types, the lion-shooting dentist psychopath ones who are in it just for the Benjamins. In my experience the UK is different, everyone I know or have met working in medicine does so for the belief in public service and the desire to treat and heal the sick. And they don't shoot lions. Possibly the odd pheasant, but there's plenty of them.

So I can understand why if you have made your life's vocation to serve the public good, the idea that health care be reduced to a matter of markets, spreadsheets and cost-benefit analyses is anathema. But the fact remains that the NHS model as it currently stands is unsustainable. This is not a party political or ideological point; a rapidly ageing population with a rising dependency ratio cannot support a health system funded out of general taxation indefinitely. The money will run out, doesn't matter whether you are Cameron or Corbyn, the demand for NHS services will outstrip the ability of its funding model to pay for those services. That's where, with all due humility to doctors, I would say they are wrong, the NHS has to be reformed. Now Jeremy Hunt may be about to wreck the system, in which case he'll become a new addition to Cockney Rhyming slang. The contract changes may add to junior doctors' workload; although the government claims it will reward those who complete their training soonest. I'm not qualified to comment on the specifics, other than to note that changing doctors' contracts is not privatisation.

As it stands, health care in the NHS is free at the point of demand. Unfortunately the demand for health care is to all intents and purposes limitless. The NHS deals with the mismatch with a Soviet style queuing system - we have healthcare, but you'll have to wait for it. You might die in the meantime, in which case the next in line takes your place. From what I've seen, Soviet-era lies and distortions are built into the system. My local GP practise claims that it has a rate of only 5% missed appointments, on the occasions I've been waiting for a doctor I've counted several missed ones -crudely the rate was 20%. On the very few times I've needed a hospital appointment there were also so several no shows, friends and family report a similar experience. This doesn't necessarily prove anything. But I also know from producing live events, when you give out tickets for free, you get a lot of people who don't turn up.

So in the area of GP and hospital appointments, it might be worth considering a French-style approach where you are charged for the booking, refunded if you turn up. Of course you'd exempt those on very low incomes etc, yet the idea of making people aware of the cost of health care is not the same as privatising the NHS. We do after all pay for prescriptions; eye tests and dental work are no longer free. Standards of dental hygeine have improved since the introduction of charging.

Likewise increasing the scope of private provides within the NHS model is not the same as switching the US model, where if you get hit by a car and you are uninsured, you are hit with $50,0000 bill. It's not a binary choice. The options are not just Cuba or America; European nations, South Korea, Japan and a host of other countries operate a variety of healthcare models. Hyperbolic scaremongering does no one any good and pretending that any reforms to the NHS mean it has five years left are OTT.

There's no scope in this blog from a rank amateur to engage in detailed discussion of health reforms. But we can talk about a general principle. Health care isn't free. It's very expensive, we should be grateful for its provision. Creating a system when people understood the costs involved and were incentivised to minimise those costs is not privatisation, it's just good house-keeping. Altering contracts and working hours of staff to improve patient access is not the same as flogging the NHS to private equity. Moving to a European style system of social insurance with greater use of private companies is also not a privatised health service. No one apart from a handful of extremist libertarian headbangers is suggesting abandoning the concept of universal healthcare according to need, provided by the state. A & E departments are not about to install chip and pin machines, whatever the BMA says.

Unfortunately, the NHS has acquired a quasi-religious status in Britain, as if no other developed nation in the world had a universal health system funded by the state. It's worth remembering that no one else has copied our funding model, which suggests it may not deserve such unqualified admiration. There are lessons we could learn from other countries, there are better ways of doing things, it's not treason to say so.

None of this has anything to do with doctor's contracts and for all I know junior medics have be asked to assume the position and received a nasty surprise. Nonetheless more of the same is not the answer. The NHS ran out of money this year, has used its contingency and has an insatiable appetite for funds. With a stubborn deficit and health accounting for a rising share of spending, any government would have to explore other ways of financing healthcare and rationing resources. But that is not a message anyone wants to hear.

Oversize Me

England's Olympic Squad

Britain is officially great, not economically or militarily, but when it comes to waist size we are in the first rank of flab. According to a recent survey, sixty percent of the UK's population are overweight; the other forty percent tried to eat the census taker...with chips and a  bottle of Lambrini.

Never fear though, Andrew Lansley, the health minister, is here to the rescue, proposing that we count the calories and display them in fast food restaurants. Unlike his Great Leap Forward for the health service, focusing our growing guts makes some sense. Although we may live as long as our grandparents, we will be doing so unable to leave the house without a flatbed truck and winch, reminiscing about the time we could see our feet without a remote camera.

Except we know lecturing people won't work. When a cigarette company marketed a brand called 'Death' with a skull and crossbones on the front, their  sales soared; the pack of 200 was even coffin-shaped. Back in the days when Tower Records existed, 'Death' had a display in their Piccadilly branch with skeletons and gravestones. I bought a pack at once and smoked it like cancer was just a star sign.

At American state fairs, stands advertise their high calorie wares such as deep fried butter with a picture of   paddles they use to shock a stopped heart; the public loves it. Humans seem to be hard wired to crave sugar and fat, a relic of our wandering days on the savannah. Unfortunately, what makes sense for hunter-gatherers who rarely if ever encounter sugar or fats is a bad strategy for desk-bound office potatoes whose sole exercise is moving a computer mouse or other mono-hand pursuits. Maybe if you did have to dodge marauding lions on the way to KFC you would burn up the calories, but all it would take is one fatal mauling and the scheme would have to be abandoned. Health and safety gone mad.

There are, however, other ways to fight the obesity crisis that don't involve releasing large carnivores into urban areas or lecturing people like naughty children. Try limiting the number of fast food outlets in the high street. Insist that every outlet be located at the top of a steep hill or fitted with running machines at the entrance, like that Ok Go video except with annoyed customers.

Install this in front of every junk food restaurant.

Do not, repeat do not get the likes of Cadbury's to sponsor some retarded idea of exchanging chocolate bars for sporting equipment, making the direct association in children's minds of junk food with athletics. Oh hang on, that's exactly what the Blair government did.  Learn the lesson of that mistake and do not what ever you do make official sponsors of the 2012 Olympics the likes of Coke or build the largest ever McDonald's in the world at the Stratford site. Oh hang on...

The same government and local authorities lecturing us on calories are busy turning every high street in Britain into one uninterrupted branch of Subway-KFC-Pizza Hut-McDonalds-Burger King-Greggs-Chicken Cottage -Kombo Feeding Warehouse. It's not the calories that need counting. After all, how many branches of Subway does the world need? The answer is any number less than one in case you're interested.

Now, where's that takeaway?