In August, the Wall Street Journal Europe published an article exploring the difference in health care received by domesticated animals and humans. (see “Man Vs. Mutt: Who Gets the Better Treatment?” in WSJ Europe, August 8, 2009) The editorialist, Theodore Dalrymple (pen name for outspoken British physician and NHS critic, Dr. Anthony Daniels) argued that dogs and other human pets in his country receive much better routine and critical healthcare than humans: their treatment is “much more pleasant than British humans have to endure.”
Dalrymple outlines just why this is so: pets in the U.K. actually have it better than their owners since: a) they receive immediate treatment with no waitlists or postponed operations “(and) not because hamsters come first”; b) there is no fear that somehow they are being denied the proper treatment for economic reasons: there is “no tension, no feeling that one more patient will bring the whole system to collapse…; (no one is) terrified that someone is getting more out of the system than they.”; and c) pets in veterinary facilities have more options and flexibility for choosing a healthcare practitioner: “if you don’t like him, you can pick up your leash and go elsewhere.”
British humans, on the other hand, have to deal with navigating the rapids and swells of NHS bureaucracy, which requires the skills of a “white-water canoeist”. They must also endure interminable wait-times for prostheses and life-improving operations. Often they receive sub-standard administrative services, nursing assistance and meal provisions.
As President Obama continues to promote a Europeanization of the American healthcare model, the WSJ Europe editorialist beckons us to listen to such howling in the twilight of the Old Continent’s rapidly aging nationalized healthcare systems. Part of this howling is caused in the less dignified forms of public health services and treatment of human patients. Yet, there is plenty of loud barking over the mismanagement and abuse within nationalized healthcare across Western Europe, particularly in terms of mishandling budgets and sources of revenue.
The looming failure of European nationalized healthcare can be spelled out in some facts and stories from around Europe. Below are some examples of cracks within the systems of five prominent economies: the United Kingdom, France, Spain, Germany and Italy.
UNITED KINGDOM (Source: Association of American Physicians and Surgeons)
Stuck in Ambulances: “To meet government targets, which require emergency department patients to be treated within 4 hours, thousands of patients are kept in ambulances outside the department for hours. Last year, more than 43,000 patients waited for more than an hour before being allowed into the emergency room.Ambulances that are being used as “mobile waiting rooms” are unavailable to take fresh calls.”
Unworthy Patients: “British patients are being denied certain operations because of lack of worthiness, based on smoking, obesity, heavy drinking, or age. Officials are urging patients to turn to “self care” instead of physician visits. The threat to cut benefits to the old and the unhealthy in Britain is a clear confirmation that health care can never be free…. The threat also shows that health care can’t be truly universal, at least not for the long term, because it becomes too costly to maintain as such.”
No Private Subsidies: “One way to relieve strains on the system is to allow patients to pay privately for portions of their care—while still receiving “basic” care from the NHS. For example, patient Debbie Hirst, who (had) metastatic breast cancer, was attempting to raise $120,000 to pay for Avastin, a drug widely used in the U.S. and Europe but not available to NHS patients, at least not until the cancer is so widespread that treatment may be hopeless. Such arrangements have tacitly been allowed before, but in this case the doctor delivered the news that he was getting his wrists slapped by the higher-ups. If the patient paid for Avastin, she’d have to pay for all of her treatment—far more than she could afford… “
FRANCE (Source: David Gauthier-Villars “French Woes Color U.S. Health Debate”, in WSJ Europe, Aug. 7, 2009)
Rising Annual Shortfalls: “France spends 11% of national output on health services, compared with 17% in the U.S…The problem (is) Assurance Maladie has been in the red every year since 1989. This year the annual shortfall is expected to be €9.4 billion ($13.6 billion), and €15 billion in 2010, or roughly 10% of its annual budget.”
Reimbursements Only for Cost of Generics: “In recent years, Assurance Maladie has focused on reducing high medicine bills….France’s national health insurer is promoting the use of cheaper generic drugs, penalizing patients when they don’t use them by basing reimbursements on generic-drug prices.”
SPAIN (Source: “Health and Policy Planning“, 14 (2): 164-173, Oxford University Press, 1999)
Limited Professional Freedom for Physicians: “In 1985. the PSOE government passed a bill to prevent physicians from holding two full-time jobs (in the public and private sectors combined), or more than one job in the public sector. The implementation of the so-called bill of ‘incompatibilities’ took place amidst a bitter battle between the government and the medical organizations, which considered it a direct attack on their professional freedom’. In addition, the government has tried to control the growing number of physicians by introducing barriers of entry into the admission requirements for medical schools.”
Feigned Illness: “In (public) outpatient clinic and ambulatories, physicians complain that 75% of those who seek care are not ill. It seems that people distressed by personal and/or socioeconomic circumstances are using primary care centres for relief of symptoms that, while not related to medically defined illnesses, are equally disabling to the optimal functioning of the individual.”
GERMANY (Source: Simon Gabar’s Reforming Germany’s health care system: The question of keeping solidarity)
More Exams, More Doctors Earn: “(One) factor on the doctors’ side contributing to the health care systems problems is the way the doctor’s salary is calculated. Doctors are paid for each examination: the more they do, the more money they accumulate. So far, ideas to stop the collectively based system of negotiations between the physicians’ and the health insurance providers has not been changed; since the doctors’ side seems not to be willing to end their ways to get the money.”
Monopoly Among Medical Suppliers: “Another factor contributing to increasing costs in the health care system is medicine producers. Some medicine seems to be more expensive in Germany than in other countries. The market acts like a monopoly where participants do not have to fear market pressures–everyone dealing with medicine receives its own share if the expensive medicine is sold–and paid by the collective.”
ITALY (Source: Michael Day’s: “Mafia corruption puts Italian healthcare system in ’state of emergency'”” for Mafia News.com and ANSA newswire service.)
Health Care Influenced by Bribes, Political Corruption (ANSA): “Abruzzo Governor Ottaviano Del Turco was arrested Monday [ July 14, 2008 ] in connection with an alleged public health scam in the eastern Italian region. Del Turco, 63, a former Socialist trade union leader and ex-finance minister, was arrested with nine others on suspicion of fraud, corruption, embezzlement and money laundering involving some 14 million euros. Del Turco is suspected of taking a bribe of almost six million euros, police sources said. As well as the 11 people arrested, 25 others were placed under investigation for suspected kickbacks. Most of the officials involved are members of the Democratic Party (PD), Italy`s largest opposition party. Del Turco, one of Italy`s most prominent former Socialists, is a member of the PD`s 45-strong national council. After a career in trade unionism Del Turco rose to the top of Bettino Craxi`s Socialist Party before it was swept away in the Bribesville scandals of 1992-94. He stayed on the centre left and served as head of parliament’s Anti-Mafia Commission between 1996 and 2000, when he was named finance minister.”
Public Healthcare Rife With Mafia Ties (MafiaNews.com): “The Mafia has been accused of bleeding Italy’s health system dry, following a series of deaths linked to the crumbling state of hospitals in the south of the country. The Governor of the Calabria region, Agazio Loiero, today closed wards and declared a ‘state of emergency’ in his health system. He is calling on state intervention to combat corruption, boost treatment standards – and prevent further needless deaths. The latest victim, 16-year-old Eva Ruscio, died at the Vibo Valentia Hospital on 5 November (2007) just two days after a routine tonsil operation. A confidential report into health system’s missing millions by the Guardia di Finanzia, the police attached to Italy’s finance ministry, is said to conclude that the mob hasn’t simply infiltrated the Vibo Valentia Hospital – it effectively runs it.…According to senator Ignazio Marino, who is leading a parliamentary investigation at the request of health minister Livia Turco into events at the hospital, “a lack of adequate equipment” played a part in Eva’s death. But according to leading mafia observer, Francesco Grignetti, writing in La Stampa newspaper, “the thing that plagued Eva has a precise name: ‘Ndrangheta’ [the feared Calabrian crime syndicate].” “In Calabria, healthcare absorbs 80 per cent of public funding; it’s obvious that ‘Ndrangheta is going to be involved,” he said. Several other managers have faced similar charges….Around 100 more are still thought to be employed by the region’s hospitals, however….The mob creams off most of the money by ensuring that lucrative contracts go to companies it runs or owns – often in exchange for poor quality goods or services, or sometimes nothing at all.”