What doctors know - in England and in America

The NHS was set up to ensure doctors put patients before profits. But that is now being rapidly undermined in favour of a US-style system.

Paul Hobday
23 December 2014

What English doctors know

I was a GP for 30 years. I only ever wanted to work in Britain. The NHS was set up so that doctors had no direct financial interest in clinical decisions made about you.

But the elephant in the consulting room is now money.

Since the Health and Social Care Act, your GP may have a financial interest in the care delivered - not just in what is clinically best for you.

The doctor you trust to be your committed advocate acting in your best interests, may now be rationing your care, limiting investigations, treatments, and referrals either because of  pressures from managers - or for their own financial gain.

If you get through that barrier, conversely, you may find yourself over-investigated or over-treated - again, because of the way the market operates and the pulling power of money.

If you do get referred, it may not be to the most appropriate specialist but one where there is a financial link.

Some Clinical Commissioning Group Board members have a financial interest in the companies winning contracts.

When private companies are involved, shareholder profits come before good quality care. They have to. It’s the law.

You will be will be unaware of all this, and why shouldn't you be?

The NHS logo is above the door of the private companies.

What American doctors know

The American system ranks 47th in the world. Pharmaceutical and insurance companies rule and control prices. Over-the-counter medicines are expensive. Medicines we in the UK regard as ordinary household remedies are only available - at high price - if you consult a doctor.

Employers organise insurance. Lose your job and you lose your cover. Most of the time it doesn’t reimburse the full costs. Patients are left with expensive ‘co-payments’ to top up. Failure to pay affects your credit score. Medical co-payments are the source of most personal bankruptcies in the US.

Frequent expensive “medicals” are mandatory for everything from getting your routine blood-pressure pills, to your child being allowed to attend a Scout camp.

Hospitals won’t start treatment with expensive cancer drugs until they have a down-payment .But they will charge you $7 for a swab which they buy for 19 cents, or $157 for a blood test costing £11.

The bureaucracy is breathtakingly inefficient.

But it gets worse.

Any doctor in America can give you examples of poor treatment and abuse.

The paramedic who, uninvited, attended a child who fainted whilst out to lunch with his doctor parents. He recovered immediately but the paramedic told the parents if he wasn’t allowed to take the child to his hospital, they would be arrested for child-neglect.

The old people kept in hospital, getting daily multiple “opinions” from a variety of specialists - and an invoice for them all. One cardiologist was seen performing a 30 second examination with a stethoscope without bothering to put the ear pieces in .His bill was $500.

Expensive tests are conducted more than once - and billed for each time. Seven billion tests a year are performed in the US, at a cost of $70 billion. That’s an average of 16 medical tests for everyone, each year, at $223 each.

The safeguards are useless. A hospital is fined if they readmit a patient with the same diagnosis within 30 days. So they make sure the patient has a different diagnosis. The fine anyway is far outweighed by money they make. They do more tests to compensate.

Annual screening (for example prostate and stool screening) despite being discredited as having no clinical relevance. These fishing expeditions benefit nothing but the bank balances of the doctors who get more work on the back of them.

The insurance system means families are under financial pressure to collude with the over-treatment and over-testing. They may get a benefit or insurance cheque when their relative is in hospital but not when transferred elsewhere.

Mark-ups of up to 1000% are not uncommon. An ECG costs the patient about $800, though its actual cost to the provider is under $10. A heart stent costs the provider about $1000, but the patient is charged $10,000. It is estimated overcharging costs Americans $750 billion a year. Medical fraud costs $95 billion.

Psychiatric patients are a nuisance. A seriously ill schizophrenic was escorted off hospital premises in Los Angeles and abandoned on the street corner, as he would be uneconomic to treat. Supposedly he signed an AMA (“Against Medical Advice”) discharge form. He signed it Simba. He thought he was the Lion King.

For hospitals, doctors who bring the money in are the “blue-eyed boys”. Errors can be overlooked - they are gold-mines.

Overpriced, ineffective - and over here

The US system is corrupt and dangerous and may be in a town near you soon. It probably already is.

How long before the insurance companies take over in England? Not long if it goes unchallenged.

There are already hints of how the NHS is being reduced to core essentials or ‘entitlements’ under an NHS banner. Top-up insurance is being introduced for “extras”, initially voluntarily. But over time the number of services paid for by ever increasing insurance premiums expands until the rump of a state service for the very poor is all that is left. Job done.

They’ve won, you’ve lost, unless you have shares in healthcare companies and don’t mind your clinical care being inappropriate, financially driven and sometimes dangerous.

I am proud I was an NHS GP. I believe the way a society delivers its healthcare defines the values and nature of that society.

In the USA healthcare is not primarily about looking after the nation’s health but a huge multi-company money-making machine. It greatly enriches some, but neglects millions of its citizens.

We are being deliberately dragged in that direction.

We end up with an expensive, bureaucratic, unaccountable, unfair, irreversible and less effective health care system replacing the

most cost-efficient system in the World..

This is one of the biggest failures of democracy in my lifetime.

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