NHS: Let No Good Hospital Go Unpunished

This one’s about a month old, but still worth comment. In early August, Telegraph.co.uk reported that Britain’s National Health Service (NHS) is punishing hospitals that don’t make patients wait for care.

Since the NHS is bleeding money, the bureaucracy wants hospitals to observe minimum waiting times for non-emergency care (e.g., 122 days) as a way of limiting expenditures. Hospitals that do not impose those minimum waits – i.e., that treat each patient as soon as they can – lose funding. According to the Telegraph, “One gynæcologist said that he spent more time doing sudoku puzzles than treating patients because of the measures.” One hospital was penalized £2.4 million for eliminating their waiting lists. All this is happening while the Labor government has promised to reduce waiting times.

It’s not that the minimum-wait policy is so outrageous – given the task of the NHS. It’s that the task itself is outrageous and guaranteed to produce such perverse results. As the Telegraph editorialized:

This bizarre situation arises from the Government’s pseudo-market system, which creates conflicting objectives for “purchasers” (PCTs) and “providers” (hospitals).

In a real competitive market, increased demand can allow prices to rise, thus increasing profits, which allow the market to grow. Efficient producers can then reduce their unit costs and their prices, and so give a better deal to the consumer. The prevailing logic is that the more customers who are served - or products that are sold - in a given period of time, the better the business does.

But PCTs have budgets that are predetermined by Whitehall spending limits, and there is no way for them to conjure extra revenue out of the air or to grow their market. As a result, the hospitals that are most successful in providing prompt treatment are running through the finite resources of their PCTs at an unacceptably rapid rate.

So the NHS is faced with a perverse outcome: hospitals providing precisely the kind of immediate access to treatment that patients want and that Government ministers profess to demand, are punished financially by another arm of the Whitehall machine. Any government that wants to reform NHS funding will have to address this conundrum that lies at the heart of a tax-funded monopoly healthcare system.

Britons are lucky that they can opt out of such a perverse system – but that’s only if, as Jacques Chaoulli observes, they are lucky enough to be able to pay twice.

State Department Stretched Thin, Too

For fear of revealing how tall the “to be read” stack on my desk is, this August 24 article from the Washington Post reveals how it isn’t just the military that’s stretched too thin as a result of the Bush administration’s policy of purposively destabilizing the Middle East; the State Department is feeling the crunch, too. Citing “increasing international turmoil,” Foreign Service Director General George M. Staples outlined a plan to push more FSOs into “hardship” postings, as opposed to cushy appointments in Europe and other traditional focal areas. The planned changes

are intended to shake up the State Department culture so that overseas service becomes more frequent and more focused on global hot spots.

The changes come as the number of overseas positions that prohibit accompanying children – and sometimes spouses – has increased from 200 in 2001 to more than 800 today. Secretary of State Condoleezza Rice, who ordered the new approach, has already begun shifting personnel from Europe to the Middle East and Asia.

More than 200 foreign service officers are required each year in Iraq, and already 1,000 of the roughly 11,000 foreign service officers have voluntarily served there. The number of foreign service officers needed in Iraq will grow as Rice pushes forward with a plan to establish provincial reconstruction teams across the country.

Moving folks from Brussels and Berlin into Baghdad and Basra makes sense on its face, but that ignores the fact that the administration is also currently hell-bent on trying to twist European arms into coming along with us to confront Iran over its nuclear program. Arm-twisting requires diplomacy, and diplomacy requires diplomats. Take diplomats out of Europe, decrease your chances for diplomatic breakthroughs.

And about those provincial reconstruction teams (PRTs): State’s been having a hell of a hard time finding folks to fill them. There’s been a long-standing dispute between DoD and State as to who is going to protect these folks (DoD finally acquiesced to doing it). Moreover, State made a pretty measly request for its folks to apply to PRTs in the first place–it posted 35 available positions early this year, and by April, it had only received applications for 12 of those positions, only one of which was deemed qualified. Even when State finds folks to staff a few dozen PRT positions, it’s hard to believe that 50 diplomats are going to fix Iraq.

All of this points in one direction: if you want to have an empire, you’d do best to put yourself together a colonial service and do it right. If you don’t want to have a colonial service, maybe you’d best pare back your imperial ambitions.

Schwarzenegger Will Veto Single-Payer Bill

In yesterday’s post, I worried about whether California Governor Arnold Schwarzenegger would follow through on his promise to veto a single-payer health care bill in that state. It now appears that he will do so. That’s good news for the people of California. But the fact that the nation’s largest state came so close to a government-run health care system should serve as a wake up call. Unless health care is reformed in a free market direction, a government takeover is only a matter of time.

Don’t Count on China

Following on from the visit last month of United States Trade Representative Susan Schwab, the Director-General of the World Trade Organization, Pascal Lamy, is visiting China this week to drum up Chinese support for reviving the Doha round of multilateral trade negotiations. He appears to have been given the same non-response as the USTR.

The Chinese have put the ball squarely back in the court of the EU and the United States, saying it was up to the major developed countries to take the lead in reviving the talks. (full story here).

China has so far kept very quiet in the trade talks, limiting their participation to argue for a ‘time out’ from trade liberalization for newly-acceded members. Having given major “concessions” to join the club, they figure they’ve paid their dues and should be given time to soak up the atmosphere. And given the often poisonous rhetoric surrounding China’s role in the world economy (not least from certain U.S. Congressmen), one can hardly blame them from keeping their heads below the parapet in the negotiations proper.

It is true, as Ambassador Schwab and DG Lamy have argued, that China has gained a lot from joining the WTO (although many of those gains would have been realized anyway as a result of unilaterally liberalizing their economy) and would stand to lose from a failed WTO. Similarly, China should be held to account for the commitments it made upon joining the WTO. But expecting China to take a more active role in the negotiations, and reverse their stance of the past five or so years, is a bit much. And, as they have proved on the currency issue, the Chinese won’t be bullied.

The “quiet diplomacy” to revive the round will likely continue, including at the IMF and World Bank shindigs later this month. But if a miracle occurs and the Doha round is concluded, it won’t be because of China’s efforts.

Eat, Drink, and Be Merry, for Tomorrow We Die

James Lovelock, the author of the “theory known as Gaia, which holds that Earth acts like a living organism, a self-regulating system balanced to allow life to flourish,” has a new message for us: Never mind, it’s too late, Gaia can’t handle industrialization. Earth will be at least 10 degrees hotter in a decade or two. It’s irreversible. “We are poached,” the Washington Post reports.

So we might as well enjoy ourselves. Burn those fossil fuels. Build those McMansions. Eat those cheeseburgers. We’re doomed anyway.

Or you could recall an earlier doomsayer, Professor Paul Ehrlich of Stanford University, who wrote in 1968, “The battle to feed humanity is over. In the 1970s, the world will undergo famines. Hundreds of millions of people are going to starve to death in spite of any crash programs embarked upon now.” He was slightly off. But he kept his job at the prestigious university, he made a bundle on his bestseller, and he still writes for publications like Scientific American. He’s even quoted praising Lovelock in the Post article.

As for Lovelock, he’s the subject of a huge, lavish, sales-boosting two-page profile in the Washington Post. Not to mention respectful reviews in major papers on both sides of the Atlantic. He’s speaking Friday at the respected Carnegie Institution of Washington. Why are people like Lovelock and Ehrlich treated seriously?

Crossposted from Comment is free.

Liberal Media?

Interesting to see that the influential Time magazine endorses an “all imperialist, all the time” approach to looking at the five year anniversary of 9/11.

Time draws on the broad range of experts from Max “Case for American Empire” Boot all the way over to Niall “The United States Is and Should Be an Empire” Ferguson, who is, frighteningly, a foreign policy adviser to John “Sophisticated Plan for Iraq” McCain.

Time really went out of its way to get at both sides of the issue there!  You can have it either way: Empire or Empire!

California Single-Payer?

It’s been largely under the media radar screen, but California may be on the verge of establishing a single-payer health care system.  Late last month, the California Assembly passed legislation establishing a Canadian-style, government-run health care system.  The legislation had earlier passed the California Senate, and while there are small differences that will have to be reconciled, there is no doubt that the bill will be sent to Governor Schwarzenegger.  The question now is whether Schwarzenegger will veto the bill.  In the past he has said he would, but it’s an election year and he is under big pressure from unions and others to sign it.   Schwarzenegger has caved in other issues recently, from prescription drug price controls for MediCal to vehicle emission controls to state budgeting.   If he signs this bill it will be bad news for Californians and a terrible precedent for the nation.

Under the bill:

  • Private health insurance would be abolished.  The state would become the sole payer for all health care services.  The bill does not specifically prohibit paying for a procedure “out of pocket,” although it states several times that its intent is to have “a single payer.”  We will probably have to wait to see how this would be interpreted by the commission established to oversee the new program, and later by the courts.  The bill does, however, require that doctors take all patients and in the order that they apply for service.  Thus, you couldn’t jump the queue by paying cash.  Nor could a doctor set up a cash-only practice.
  • The bill establishes global budgets for health spending in the state.  If the budget is exceeded the state could cut reimbursements to providers or prohibit capital expenditures.  The latter would impact the quality of health care nationwide, limiting research and development and undermining many of the nation’s top hospitals.
  • The bill contains no funding mechanism (beyond using federal Medicare, Medicaid, SCHIP, and VA funding).  Earlier versions of the bill proposed funding the proposal with a 3 percent income tax hike and a job-killing 8 percent hike in the payroll tax.  The latest version would have a commission decide how to pay for it.

Interestingly, the Assembly amended the bill to strike out the words “health care consumer” wherever they appeared and replaced them with “patient.”