Occasional reflections on Life, the World, and Mathematics

Posts tagged ‘healthcare’

Up from disaster

US Senate majority leader Mitch McConnell had this to say about the Senate’s attempts at a “healthcare” bill:

“Obamacare is a disaster,” said McConnell, according to video captured by the Louisville Courier-Journal. “No action is not an option. But what to replace it with is very challenging.”

It makes you wonder: If current policy is unquestionably a “disaster”, why is it such a challenge to find an alternative that is superior? It’s like, “Living in a hole in the ground covered by a board really sucks, but it’s challenging to find good housing…”


This graphic from the US Department of Health and Human Services has been getting a lot of attention.

Mainly, people have commented on the egregious deceptiveness of the content. The government’s plan is to increase the number of uninsured by 22 million. It’s like Hitler fulminating against Soviet barbarity (which he did — and was probably sincere). But I am fascinated instead by the Trumpification of official US government communications. Leaving aside the sheer novelty of government agencies putting out propaganda against current laws, the first “informational” slogan ends with an exclamation point! Is that normal? And am I merely fantasising the phallic-impotence imagery of the second one? (I mean, it’s hard to imagine why that image is there. Who thinks of mercury thermometers as a symbol for medical care these days? How many people have even seen one? And if that is a thermometer, did Obamacare fail by not getting the fever high enough?)

Contorting with reality

People misspeak all the time, and there’s usually no point to mocking them for it.

But in this quote from an article about dissatisfaction among Congressional Republicans with the way the Congressional Budget Office is likely to evaluate their healthcare proposal, Senator Roger Wicker reveals too much about the true basis of their disagreement

Sen. Roger Wicker (R-Miss.) said he has “never been one who worried too much about scores because there are constraints that the bean counters have to operate under that don’t necessarily contort with reality.”

At least we don’t get ID cards

… because that would be fascism! Instead, we’re likely to get the NHS checking people’s passports and utility bills (for proof of address) before they can get medical treatment.

As I’ve commented before, the British seem obsessed with not having national ID cards — when they came into power one of the first things the Conservatives did was to cancel a Labour programme that had been in the works for about five years to provide ID cards — because carrying an ID card is inimical to Anglo-Saxon freedom. They don’t object to round-the-clock video surveillance, police stopping foreign-looking people on the Tube to ask for proof of right to be in the country, or now checking nationality documents at the hospital.

They just object to providing people with the documents they need to meet the authorities’ demand (given that one in six Britons has no passport, and they cost about £80). Instead, they leave it up to easily falsifiable electric bills to attest their address.

Nationalist health service

I’ve been appalled at the leaflets delivered to our home by the Leave campaign. 16-06-2016, 11 44 37

They prominently use the blue and white NHS logo, as though this were official health-service literature, rather than being a political message from people who have never been friends of the NHS before, and are unlikely to be so in the future. It amazes me that they would be permitted to use the logo, or more likely are simply so brazen as to use it without permission.

Their argument, if we can call it that is that without spending on the EU, the UK could build a new hospital every week. Of course, they don’t have enough nurses to adequately staff even the hospitals they have, much less the 200+ new hospitals they promise to build by 2020, and without the East Europeans the staffing crisis will only get worse.

16-06-2016, 11 43 18

Change of venue

In the most recent Republican debate this exchange occurred:

TRUMP: If people — my plan is very simple. I will not — we’re going to have private — we are going to have health care, but I will not allow people to die on the sidewalks and the streets of our country if I’m president. You may let it and you may be fine with it…

CRUZ: So does the government pay for everyone’s health care?

TRUMP: … I’m not fine with it. We are going to take those people…

CRUZ: Yes or no. Just answer the question.

TRUMP: Excuse me. We are going to take those people and those people are going to be serviced by doctors and hospitals. We’re going to make great deals on it, but we’re not going to let them die in the streets.

Obviously, Trump recognized the trap of promising the great expense of keeping people from dying on the streets and sidewalks, so he quickly fell back to this compromise position: During the Trump presidency, poor people will be permitted to die on the sidewalks, but not in the streets. This leaves open the question of whether they will receive medical attention or merely cited by medical personnel to the sidewalk. It’s a win-win, since the dying would no longer impede the free flow of traffic.

It’s quite a bit like UK asylum policy: it would be unconscionable to send civilians back into a war zone, and we can’t just let them fend for themselves on the streets of London. So we need to make sure that as many as possible drown at sea, pour décourager les autres.

Of course, this may increase pressure to build barriers between the streets and sidewalks, at least in the vicinity of hospitals. Jobs!

How to do it: Medical testing edition

I was commenting just recently on the cult of big ideas, where people whose life experiences have given them hierarchical power are suckers for “ideas” that are mostly blather, lots of words about the irrelevant bits of the problem, distracting attention from the real difficulties. And now Theranos is in the news. I read about this company, started by the obviously charismatic Elizabeth Holmes, in The New Yorker about a year ago. My immediate reaction was, this must be a joke. It was very much in the spirit of Monty Python’s How to do it.

Theranos, a Silicon Valley company[…], is working to upend the lucrative business of blood testing. Blood analysis is integral to medicine. When your physician wants to check some aspect of your health, such as your cholesterol or glucose levels, or look for indications of kidney or liver problems, a blood test is often required. This typically involves a long needle and several blood-filled vials, which are sent to a lab for analysis… [Theranos] has developed blood tests that can help detect dozens of medical conditions, from high cholesterol to cancer, based on a drop or two of blood drawn with a pinprick from your finger. Holmes told the audience that blood testing can be done more quickly, conveniently, and inexpensively, and that lives can be saved as a consequence.

Sounds wonderful. Quick. Convenient. Inexpensive. Saving lives. How is she going to do all that? Well, she wears “a black suit and a black cotton turtleneck, reminiscent of Steve Jobs”. She dropped out of Stanford. She has a board of directors full of highly influential aged former politicians, but no scientists, so far as I can tell. She “is in advanced discussions with the Cleveland Clinic. It has also opened centers in forty-one Walgreens pharmacies, with plans to open thousands more. If you show the pharmacist your I.D., your insurance card, and a doctor’s note, you can have your blood drawn right there…. A typical lab test for cholesterol can cost fifty dollars or more; the Theranos test at Walgreens costs two dollars and ninety-nine cents.” (more…)

Up is down

I mentioned in an earlier post George Lakoff’s work on metaphorical language. One fascinating issue is the way same metaphorical target can be mapped onto by multiple conceptual domains, and sometimes these can come into conflict — or a metaphor can come into conflict with the literal meaning of the target. When the figurative-literal target conflict is particularly succinct, this tends to be called “oxymoron”. One of my favourites is the 1970s novel and subsequent film about a burning skyscraper, called The Towering Inferno.

This particular one depends on the conflict between the “UP is GOOD, DOWN is BAD” metaphor (an indirect  form of it, since it goes by way of DOWN is BAD is HELL is BURNING), conflicting with the literally towering skyscraper. Anyway, the UP-DOWN dichotomy gets used a lot, creating lots of potential confusion. For example, UP is DIFFICULT and DOWN is EASY, inspiring the famous allegory of Hesiod that inspired so many devotional images:

Vice is easy to have; you can take it by handfuls without effort. The road that way is smooth and starts here beside you, but between us and virtue, the immortals have put what will make us sweat. The road to virtue is long and steep uphill hard climbing at first.

Hence the uncertainty of the phrase “Everything’s going downhill.” Is it getting worse, or getting easier?

There is a triple ambiguity when numbers get involved. LARGE NUMBERS are UP (“higher numbers”, “low number”) when we are counting the floors of a building, but SMALL NUMBERS are UP when ranking (#1 is the winner and comes at the top of the list).

This brings us to the example that inspired this post. The BBC news web site this morning told us that “A&E waiting times in England have fallen to their worst level for a decade.” It’s hard to feel much sense of urgency about the fact that waiting times have “fallen”.

BBC website A&E morning



Presumably that’s why the text had changed in the afternoon:

bbc website afternoon

What people don’t know about the NHS

… is that it is incredibly cheap. I was speaking recently with a British colleague, who asked how I liked being back in the UK after a year on sabbatical. I mentioned that there are things I really appreciate about living in California, but one of the things I like best about the UK is the NHS. Even without any significant health problems in the family, the incomparable irrationality of the US healthcare system (though even calling it a “system” seems overly generous) is palpably unnerving, at the very least since you’re occasionally confronted with the question of whether this or that problem is significant enough to go to the hospital for, and then you have to consider whether it’s worth entering into a multiyear negotiation over fictional bills for thousands of dollars.

Anyway, I remarked that I wish the UK would just raise its health spending to the European average, that it would be far and away the best in the world, as opposed to limping along as it does now, being the best for equality, but clearly overstretched, and not quite matching the top national healthcare systems. I thought this was simply a platitude, but he seemed genuinely surprised by the claim. On further questioning, he said that he would have thought the NHS was relatively expensive compared with healthcare in western Europe generally.

In fact, UK health expenditures are low, not just compared with the wealthy countries of western and northern Europe, but with respect to the EU generally — including the relatively poor countries of eastern Europe. They would have to spend an additional 6 billion pounds — about a 5% increase — to match the EU average. In 2011 the UK was below average healthcare spending for the OECD, and was still only average after removing the exceptionally high spending USA. (The US, despite the notoriously expensive private healthcare system of which its right-thinking populace is so proud, has considerably more public healthcare expenditure per capita than the UK, on top of the private system. And life expectancy is still several years shorter.)

I wonder if the public would demand more spending on the NHS, rather than accepting the government line about necessary efficiencies and the magic of privatisation, if they knew how efficient the NHS already is, and how little they are spending on healthcare compared with their European neighbours, not to mention the profligate Americans and Canadians.



“Not infinite”

From The Guardian:

British nurses are planning to debate whether GPs should start charging patients for appointments.

The Royal College of Nursing’s (RCN) annual conference in Liverpool will discuss whether the union backs the idea of charging people a fee to see their family doctors.

Traditionally the RCN has stood behind the belief that the NHS should be free at the point of delivery. But nurses have put forward the motion, saying that NHS finances are “not infinite”.

“Not infinite” sounds like a sensible observation. Neither are the funds available to the police infinite, which is why we charge people a fee to report a burglary, with extra hourly charges for the investigation. And schools. And that’s why when the smoke alarm klaxons you out of bed, the first thing you need to do is grab enough cash to pay the firefighters who show up. Because their finances are not infinite.

Obviously, the RCN is just trying to make the point that healthcare workers are having their salaries squeezed up against the free-at-the-point-of-delivery. But this argument is made often, and it’s ridiculous. If you want to advocate patient fees, as opposed to all the other ways that the nation could increase funding of the NHS, it can only be because you think that the service that is now free is being overused, and you want to encourage ill people to do something else, besides visiting their GPs. In any case, the cost of administering the £10 fee would probably be more than the fee would bring in.

Here’s what charging for fire and rescue services looks like.

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