Sunday, July 08, 2007

SICKO misrepresents the NHS

Comment from Britain

The film is Sicko, a two-hour take-down of the mighty US healthcare industry directed by and starring the potato-faced Michael Moore (he of Bowling for Columbine, Fahrenheit 911 and subject of too many right-wing diatribes to count). In it, Rick is an uninsured sadster who loses two fingers to a chainsaw and has to talk hard cash with an accountant before his general anaesthetic. It'll be $12,000 to reattach the easy finger, he is told; $60,000 for the pair. Rick goes for the budget option.

Fully half of Sicko is devoted to envious glimpses of better-run, more equitable and more compassionate healthcare systems in other countries, such as Canada (where another power-saw victim gets all five digits reattached for nothing) and Britain, where Moore would clearly choose to live if he didn't have such an avid following and such comprehensive health insurance at home. "Keep your British health system," he told one of our reviewers after a screening on Skid Row in LA. "Never get rid of it. It's a wonderful thing." He has also made the mistake of calling British healthcare "free".

Let us be clear: Michael Moore is amiable, fearless and funny, especially when provoked. He is also a brilliant film-maker who has transformed his genre in the US, where documentaries now pack out cinemas from coast to coast. You can take this as official. I have met him and liked him and am entirely trustworthy. The same cannot be said of Moore, of course. He is routinely denounced as a misleading, self-serving propagandist by critics who fail entirely to grasp that these are his great strengths.

When Moore barged his way into General Motors headquarters, and American culture, while making Roger & Me in 1988, it was about time. Here at last was a booming, populist, shamelessly blinkered voice from the American Left to answer those that had boomed unanswered from the Right throughout the Reagan years. Small wonder that he found a far-from-fringe constituency and became embarrassingly rich.

Moore's European critics, in particular, continue to misunderstand his challenge and his audience. They delight in exposing his crafty way with "facts", as if the corporate interests he attacks weren't just as crafty. They worry that the millions of Americans who pay to see his output might actually believe everything he says, as if, being Americans, they lack the power of critical thinking. And they forget that many of those millions of Americans do in fact, quite reasonably, share Moore's view that GM ignored its social responsibilities when Japanese competition hit home; that Kmart never had any business selling lethal handgun ammo to kids; and that when Charlton Heston raised a rifle in defiance a few days after the Columbine high-school massacre, he was a berk.

Moore, by contrast, was the man-grizzly who stood up to the idiot president of the NRA and lived to tell the tale. He was my hero. But now he has started spouting nonsense about the NHS, and he should know it's nonsense, and know that we know. It goes without saying that healthcare on the NHS isn't free. But just how unfree it is gets too little attention. We pay for it through our noses, every month.

Next year's NHS budget will be about 104 billion. That's roughly 1,733 pounds per man, woman and child. Multiplied by four for a typical two-child family, then divided by 12, that equates to median monthly family healthcare expenditure of 577, or $1,155 in American money. I can buy some very respectable US health insurance for $1,155 a month. In fact, on a quick and painless stroll through the website for Kaiser Permanente, a leading nonprofit US healthcare provider, entering my basic family details and the Beverly Hills zipcode, the most expensive family policy I can find that does not depend on contributions from the state or an employer costs $400 less than the sum Gordon Brown currently chooses to spend from my taxes, each month, on the NHS.

Being honest, I must add a few hundred to my US bill to cover "deductibles" and the portion of my US taxes going to federal schemes like Medicare and Medicaid. But I must also cop to earning more than the UK average, which means I pay more than average for my NHS care; through the nose, as I say.

American roadworks tend to be adorned with signs announcing, "Your Tax Dollars at Work". There should be signs saying "Your Tax Pounds at Work" at the entrance to every NHS hospital and surgery, and whenever "at work" fails to describe what goes on inside them, taxpayer-patients should whinge like hell. They may not like it. They may not think it British, but nothing else is working and in the meantime they are being royally ripped off.

Really? But aren't waiting lists down, as Mr Blair used to tell us every Wednesday? I would refer the Right Honourable gentleman to a recent ruling by the Canadian Supreme Court in favour of a man who sued to be allowed to buy insurance to speed up an operation. "Access to a waiting list," the court found, "is not access to healthcare."

Forty-seven million Americans are uninsured. This is a problem. Several million more are inadequately insured. Another problem. But that leaves more than 200 million fully insured Americans who've never heard of waiting lists. I envy them.


NHS shuffles the deckchairs again

The Government sought to regain the initiative over the NHS yesterday by announcing another review. It was heralded by Alan Johnson, the Health Secretary, as "unprecedented", and will be conducted by Sir Ara Darzi, a distinguished surgeon who has been drafted into the Department of Health as a junior minister. The main aim of the review seems to be to win over NHS staff to the reform agenda, but critics are interpreting it as a sign of weakness.

Mr Johnson promised that the review would be different from the one two years ago that led to the White Paper Our Health, Our Care. He acknowledged that staff morale was low and affecting the public's perception of the NHS. "We've put a lot of money in, but that hasn't led to a lot of happy bunnies," he said. "If there's a problem with morale, it's our responsibility, and it's our responsibility to put it right. The bit that has gone wrong is taking the public with us." Sir Ara, who will travel round the country gathering information, has been given four tasks:

* Putting clinical decisions at the centre of NHS care;

* Improving patient care, particularly for those with long-term and life-threatening conditions;

* Making care more accessible and convenient;

* Establishing a vision for the next decade based "less on central direction and more on patient control".

His problem will be that the reforms of Tony Blair were not intended to make staff happy, but to change the NHS culture, inctroducing market forces and the private sector. Persuading staff that further reforms are in their interests may be difficult. In a statement to the House of Commons, Mr Johnson said that Sir Ara's review represented a "once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable". But the announcement provoked a sceptical reaction.

The British Medical Asociation and the Unison union welcomed the review. The pressure group Keep Our NHS Public said that it did not go far enough. Nick Bosanquet, Professor of Health Policy at Imperial College, London, and consultant director of the Reform think-tank, said: "It is not clear why another review is needed to go over these general issues again which have been well covered in two reviews in the last five years. A year-long review risks damaging delay when practical solutions are needed now. "Urgent problems include the redefinition of [the Private Finance Initiative] to a more local programme, the need to empower local staff to get value for money and the [removal of] barriers to the involvement of independent sector companies. All these issues need clear action and a way forward in weeks rather than years."

Andrew Haldenby, director of Reform, said: "This is exactly the wrong moment to kick health policy into the long grass. The evidence is mounting that the Department of Health's reform drive has lost momentum just as the service's big funding increases come to an end. "The focus of government should now be on delivering reform rather than reopening a debate on the direction of policy that was actually resolved years ago."

Niall Dickson, chief executive of the King's Fund think-tank, said that the proposed review must be not be a signal to reverse important reforms to the service and that the terms of engagement must be clear. "It is important that the Government does not raise expectations among staff or the public that cannot be met," he said.

Andrew Lansley, the Shadow Health Secretary, told the Commons: "The only thing the Secretary of State seems to have understood is that morale in the NHS is at rock bottom. Where is the autonomy and accountability that the NHS is so calling out for? Where is the leadership and direction that the NHS so badly needs?"

* Mr Johnson also announced another 50 million pounds to help to tackle infections such as MRSA and Clostridium difficile. This will be used to double the size of the department's infection improvement team [More bureaucracy is going to solve anything?], groups of experts who advise NHS trusts on developing plans to cut infections.


False heart disease diagnoses?

Are people really diagnosed just by statistics in Britain? Surely, it should be an investigation (with scans etc.) that is decisive! Amazing!

Heart disease medication is being massively over-prescribed with thousands of people being wrongly told that they are in danger of developing cardiovascular problems, according to a study. A new and sophisticated approach to calculating risk has shed radical new light on the issue. A British Medical Journal study says that there are flaws in the traditional method and suggests that current estimates of the number of people in danger of the disease are 1.5 million too high. Using the new test, the BMJ estimated that the number of people at risk had been overpredicted by 35 per cent.Consequently, many patients have likely been prescribed unnecessarily anti-cholesterol drug statins, inflating the annual 2 billion bill to the NHS.

The study prompted fears that the wrong type of people were being targeted for treatment with its discovery that white middle-aged men had a lower risk than previously thought and women from poorer backgrounds had a significantly higher risk. It also found that one in three women in their 60s are at risk of heart disease. That figure was previously thought to be one in four.

Julia Hippisley-Cox, lead author of the study, told The Guardian: "We are potentially missing the right people for treatment. "If we use this new score it would increase treatment to deprived areas and especially to women. They are being under-treated across the board."

The researchers tracked 1.28 million healthy men and women aged between 35 and 74 over 12 years to April this year and used GP records from 318 general practices. The overblown estimates of heart disease were derived from the traditional way of calculating risk, which involves a score based on smoking, blood pressure and "good" and "bad" cholesterol, along with age and sex. The BMJ study used a new measure which also takes social deprivation [Steady on there! We are not loking at social class at long last are we?] , genetic factors and weight into account, reducing estimates.

As a result, it has concluded that 3.2 million adults under the age of 75 are at risk of developing cardiovascular illnesses compared with the 4.7 million previously estimated. A separate study by the Healthcare Commission says the number of people reported as having heart failure issues was 140,000 fewer than expected.


Raise British educational standards through increase in grammar schools, thinktank urges

More grammar schools [i.e. academically-oriented schools that select on the basis of scholastic ability] and low-cost private schools are needed to raise the "dire" standards of the education system, a report by one of the most respected economic think-tanks says today. Millions of people cannot read, write or count and millions more can barely do so because of the "socialist" state-directed system and comprehensive education, the Economic Research Council says.

Better off parents have escaped the worst aspects of comprehensive education by paying private fees, buying tuition or moving home to be close to the best schools, says the report. It is families on the lowest incomes that have suffered from the progressive theories and dumbing down of standards.

The Economic Research Council, Britain's oldest economic think-tank, says it is "rotten schooling" and not grammar schools that has harmed social mobility. Prof Dennis O'Keeffe, the report's author, says leading Tories who claim grammar schools no longer offer a ladder of opportunity for poor, bright children fail to understand the importance of selection. "Unlike David Cameron's parents who sent him to Eton, certain members of the modern Conservative Party appear not to understand the dramatically effective way competitive education encourages, identifies and rewards talent and consequently increases social mobility," he says.

"Comprehensive schools with soft and easy access for all have not served the community well. They have served only to eradicate upward mobility, and done so, perversely, in the name of eradicating privilege," adds Prof O'Keeffe, the professor of social science at Buckingham University.

Mr Cameron has pledged to preserve the existing 164 grammars but backed David Willetts, the shadow education secretary, when he blamed the schools for entrenching social advantage. In a speech last month that led to a rebellion in the Tory ranks, Mr Willetts said that changes in society since the 1950s meant that the middle classes now monopolised grammar school places.

Prof O'Keeffe wants the law to be changed so that education authorities can choose to re-introduce the 11-plus or provide more academically selective schools. "Today's comprehensive schools claim to eradicate privilege, but in reality they have only eradicated upward mobility," he says. An education elite in the Civil Service, universities and teacher training colleges had pushed ideas of "children thinking for themselves and owning the curriculum" as part of "socialist control" of the state system.

To help break down the monopoly system, there should be more cheap, private schools and tax relief on the fees.

Mr Willetts said last night: "One of the reasons for shockingly low social mobility is that it is very hard for someone from a modest background to get into our academically most successful schools. That is why we are proposing real reforms so that there are more good schools with more streaming and setting and tough discipline."



The NHS is the nearest thing to a religion that the British now have. For half a century the British have convinced themselves that the NHS is the envy of the world. It is - for the third world. And it is the third world's doctors and nurses who keep alive this socialist cult of security from cradle to grave.

No politician dares to reform the NHS, which is still run by its white-coated medical priesthood. Even Margaret Thatcher, who was fearless with terrorists, quailed before the doctors and nurses. "The NHS is safe in our hands," she said. But the question has long been: are we safe in the NHS's hands?

Aneurin Bevan, the man who created this monster, explained how he had persuaded the senior doctors to submit to the state: "I stuffed their mouths with gold." But training our own doctors is expensive. Today, the agencies that supply the NHS with doctors recruit their staff throughout Africa and Asia. Many are Muslims and, inevitably, some of them are Islamists.

The origins of the eight suspects arrested so far are diverse - Iraq, Jordan, India, Saudi Arabia - but all spent time at NHS hospitals or medical schools. One of them, who drove a blazing Jeep into an airport terminal and set fire to himself, is now being treated for burns that cover 90% of his body in the same hospital that unsuspectingly employed him. If he survives, he will owe his life to his intended victims.

Anybody with medical qualifications has been able to enter Britain with few questions asked. Of the 277,000 doctors in the NHS, some 128,000 - that is nearly four out of 10 - were trained abroad. It was a loophole that should have been obvious, given Al Qaeda's declared strategy of recruiting highly educated professionals. The cell that launched last week's attacks is probably not the only one.

After a slow start, the security operation has moved quickly, using information gained from the cell phones that failed to detonate. The net was cast widely enough to catch one suspect in Australia just as he was about to fly to Pakistan. The only Anglican clergyman in Baghdad, Canon White, was apparently warned by an Al Qaeda operative: "He said the people who cure you would kill you."

What, though, has been the political response to this potentially devastating conspiracy - one of dozens that are believed to be active in Britain alone at any one time? Gordon Brown's new government has been eager to contrast itself with Tony Blair. To this end, it has excised three terms from the official vocabulary: "Muslim," "Islam," and "the war on terror." There is to be no mention of the wider context in which Al Qaeda and other Islamist terrorists operate. The new home secretary, Jacqui Smith, laid down the new doctrine: "Terrorists are criminals who come from all religious backgrounds." I am sure one or two are Quakers.

Compared to Mr. Blair, Mr. Brown looks like a man in manic denial. But his conservative opponent, David Cameron, is determined to out-deny him. First, he insisted that the word "Islamist" should be censored from political discourse. Then, after two Muslims were made junior ministers last week, Mr. Cameron promoted Sayeeda Warsi to be a member of his shadow cabinet, with the title of "community cohesion secretary." Having failed to be elected, she is to be ennobled and will sit in the House of Lords. Ms. Warsi is thus the most senior Muslim in British politics.

Yet Ms. Warsi turns out to hold views that are not only at odds with her party's, but also with any "community cohesion" except the Islamist kind. She not only opposed the Iraq war, but also welcomed the election of Hamas. She opposes anti-terror laws and rejects the idea that extremism is a problem for British Muslims: "When you say this is something that the Muslim community needs to weed out, or deal with, that is a very dangerous step to take." Mr. Cameron has taken a dangerous step by handing over his policy on Islam to a person who appears to be part of the problem.

"Don't mention the war" was the catchphrase of the manic hotelier, Basil Fawlty, played by Monty Python actor, John Cleese, in the BBC comedy series "Fawlty Towers." While serving his German guests, he goose-stepped around the room. Now that the war in question is a holy war unleashed against Western civilization, the joke is on us. Jihad may be preached from British pulpits, but the word has gone out from Downing Street: "Whatever else you do, don't mention the war on terror."


Richard Littlejohn on the new British Prime Mionister: "As I said a couple of days before Gordon got the job, this column doesn't do honeymoon periods. But, wary of getting submerged in the glow of post-coital adulation, I thought I'd give it a week before putting the boot in. The usual bunch of crawlers are doing their best to flatter him, but the simple fact of the matter is that when it comes to being Prime Minister, Gordon just doesn't cut the Colman's. He's certainly not what Napoleon would have called a lucky general. Since he took over last Wednesday, he's had dead soldiers in Iraq, Muslim maniacs on the rampage in London and Glasgow and a rise in interest rates, as a basis for negotiation. So why on earth has the elevation of Gordon Brown been hailed as if it were the second coming of JFK? Quentin Letts has already remarked on the BBC constantly referring to the 'new government'. This isn't a 'new' government - it's a collection of has-beens, placemen and people who weren't good enough to be in the last Cabinet. You'd be hard-pushed to find such a weird array of incompetents, dullards and social inadequates this side of the flight deck of the Starship Enterprise. The Miliband brothers even look like Vulcans. Hilariously, we're asked to believe that Gordon has assembled a government of 'all the talents'. If this is as good as it gets, God help us."

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