Good grief, this is ridiculous

We’re not sure that people understand what they’re letting themselves in for here:

The vast majority of people believe alcohol abusers should pay for their own treatment rather than get it free on the NHS, a survey has found.
More than half said the NHS should not fund treatment if the illness was a consequence of smoking and patients should be forced to pay for it themselves.
The report questioned 4,000 UK adults about the cost of common procedures in the UK and whether it should be publicly funded.

Boozers, smokers and fatties save the NHS money: the costs of treating these various diseases unto death are lower than the lifetime costs of treating people who succumb to other diseases or even just old age. So the basic concept is wrong in itself.

However, there’s another problem here. Which is that the health establishment, or at least the majority of the public health bit of it, is convinced that all diseases are caused by someone “doing something”. In fact, if you tot up all the numbers, the people who have got cancer, or diabetes, or heart disease, from sugar, salt, smoking, boozing and donuts you end up with more people than there are people actually ill.

Meaning that if this principle were taken seriously, that you don’t get NHS treatment for something you’ve done to yourself, there would be no free NHS treatment at all. Which would be fine for the bureaucracy of course, nirvana in fact: £120 billion a year without having to do anything. But it’s not really the point of having an NHS, is it?

Somewhat ghoulish but interesting all the same

Another one of those reports telling us of the terrors of inequality:

The death rate among preschool children in the UK is almost double that of Sweden, with social inequalities being partly to blame, according to researchers.

We have to say that we’re not convinced. We could imagine poverty contributing to such things, but simple inequality we have a hard time believing.

The researchers found there were 614 deaths per 100,000 of the under-fives population in the UK, compared with 328 in Sweden. The primary causes of death in the UK were problems associated with premature birth, congenital abnormalities, and infections, with the mortality rate for the first of these factors being 13 times higher than in Sweden.

The study’s co-author Imti Choonara, emeritus professor at Nottingham University’s academic unit of child health, said: “The major cause of death is prematurity, and social economic inequalities are one of the causes [of prematurity]. A society with large inequalities inevitably results in worse health outcomes.”

But they’re adamant that it is that inequality. Which is interesting because other studies of premature birth and survival rates don’t think that’s it at all.

Rather, they think that the Swedish health care system, despite it costing about the same as the NHS, is rather better at dealing with all of this than the NHS is.

That is, the usual finding on this subject is that the NHS isn’t very good. Bit of a surprise that, isn’t it?

If you think for profit health care is expensive wait until you see not for profit…

One of the battle cries during the set up of the ACA, aka Obamacare, was that for profit health insurers were way too expensive. Because, you know, profit. It’s obvious to all that the profit must make things more expensive, innit? So, a series of cooperatives to provide that health care insurance were set up.

There’s two problems here. Much as we love cooperatives ourselves the obvious feature of hem is that they’ve not got any capital. They thus need to grow into a market position rather than just leap into trying to be a large player in a capital hungry industry like insurance. For their capital comes from retained earnings, rather than having some capitalists providing capital: that’s rather the point of them. That these coops did try to leap in and become large players in a capital intensive market means they’re all going bust.

Nonprofit co-ops, the health care law’s public-spirited alternative to mega-insurers, are awash in red ink and many have fallen short of sign-up goals, a government audit has found.

Under President Barack Obama’s overhaul, taxpayers provided $2.4 billion in loans to get the co-ops going, but only one out of 23 — the one in Maine — made money last year, said the report out Thursday. Another one, the Iowa/Nebraska co-op, was shut down by regulators over financial concerns.

The audit by the Health and Human Services inspector general’s office also found that 13 of the 23 lagged far behind their 2014 enrollment projections.

The probe raised concerns about whether federal loans will be repaid, and recommended closer supervision by the administration as well as clear standards for recalling loans if a co-op is no longer viable. Just last week, the Louisiana Health Cooperative announced it would cease offering coverage next year, saying it’s “not growing enough to maintain a healthy future.” About 16,000 people are covered by that co-op.

Wise observers like Dennis the Peasant were predicting that this would happen. But they’re also not cheap:

Separately, the AP used data from the audit to calculate per-enrollee administrative costs for the co-ops in 2014. It ranged from a high of nearly $10,900 per member in Massachusetts to $430 in Kentucky.

Wouldn’t everyone prefer a few rapacious capitalists trying to rape the citizenry for profit than admin costs per scheme member of $10,900 a year? Further, can you actually imagine a for profit company allowing bureaucracy to balloon out to such an extent?

Yes, we really do need to start paying kidney donors

We have long been pointing out that the solution to the shortage of kidneys available for transplant is to offer to pay those donors who might be willing to donate one. Adter all, it’s not exactly a new insight that increasing prices brings forth more supply. And the sort of levels of payment necessary are in fact cheaper than the cost to the NHS of dialysis. The New York Times has a nice piece on how this works elsewhere:

Iran’s system has many deficiencies — not least that the very idea clashes with ethical norms observed in many other countries — and the program varies greatly from region to region. But its chief advantage is this: People who need kidneys get them rapidly, rather than die on the waiting list.

In the vast majority of cases, donors know in advance what they will be paid and receive appropriate screening and good medical care before and during the operation. And by getting patients new kidneys instead of keeping them on dialysis, the society saves a lot of money and avoids much misery.

Whatever anyone’s doubts about whether people ought to be paid for organ donation there’s no doubt that it does actually work.

“We should ask ourselves why some people find accepting money to donate a kidney and save a life repugnant, but accepting money for being a policeman or miner or soldier — all of which are statistically riskier than donating a kidney — is O.K.,” said Mohammad Akbarpour, a research fellow in the Becker-Friedman Institute of the University of Chicago. “Is there a fundamental difference?”

It could be that people simply don’t understand how low that relative risk is.

Commercializing kidneys calls up images of a filthy, makeshift clinic, a rich traveler with a wad of cash, a desperately poor donor tricked into selling an organ, and a broker who keeps 90 percent of the money. India, Pakistan, the Philippines, South Africa and Indonesia, among other countries, are known for this type of trafficking in organs, and wealthy Americans, Israelis and Europeans are known for buying them.

But in Iran, the legal market pre-empts these abuses. To prevent kidney tourism, recipients in Iran have to share the nationality of their donors, and Iran recently banned kidneys for all foreigners except refugees in Iran from Afghanistan. “The rate of people who die in surgery is much, much lower in Iran than in other developing countries — all the transplants are under supervision,” said Farshad Fatemi, an assistant professor of economics at Sharif University of Technology in Tehran, who studies the kidney market. “If this regulated market weren’t in place, we might have organ trafficking here. We might be more like India or China and have illegal clinics, a black market where nobody looks after patients and donors.”

And there we have something that we have again been saying repeatedly. Markets are going to exist where human desire is great enough. It happens with sex, it happens with drugs, it is happening with organ transplants. In all three we argue that said market will be safer, will work better, if the activity itself is legal so that regulation, if that’s necessary, is possible. Insisting that these things are illegal is part of what makes them so dangerous.

So, given that we’ve got the example of the one and only place in the world where people do not die waiting for a transplant, when are we going to institute our own paid market in them? For it really is true that people die, in great pain, each and every year simply because of some squeamishness about introducing filthy lucre into the proceedings.

As ever, there really are some thing so important that we must have markets in them.

To solve the organ donation problem

Once again we’ve got the medical trade telling us that more lives could be saved if only more people would donate their organs. We agree entirely that more lives could be saved (and significant sums of money saved too) if more organ transplants took place. But the solution is, at least in part, to purchase organs for transplant, not to continue to rely upon the gift economy.

New statistics released today in the annual Organ Donation and Transplantation Activity Report shows the number of transplants has decreased from 4,655 last year to 4,431 in 2014/15. This is a five per cent decrease on last year and means that 224 fewer people received an organ transplant.
At the end of March 2015, there were 6,943 patients on the transplant waiting list with a further 3,375 temporarily suspended from the list, because they were too ill to survive the operation.
The NHS Blood and Transplant service is calling for everyone in the UK to discuss organ donation with their family so that they are aware of their wishes.

Of that four and a half thousand transplants, some 3,000 were kidney transplants. And obviously there’s not much chance of a live donor offering a heart transplant, but both kidney and liver (and obviously bone marrow) can be done from a live donor. And the obvious way to encourage more people to offer organs while they are still alive is to pay them to do so.

This would save the NHS considerable amounts of money too: a kidney transplant is expensive, yes, but it’s cheaper than dialysis over any significant period of time and those with those transplanted kidneys tend to survive a decade or so.

It’s worth noting that there’s only one country in the world that doesn’t have a backlog of people on f#dialysis, dying as they wait for a scarce kidney. That’s Iran. It’s also worth noting that there’s only one country that has paid live donation of kidneys. That’s Iran again.

No, there’s not a line of people hawking their bodies outside the clinic: the government pays a set fee for a donation on the grounds that, as above, it’s cheaper to do that than pay for the years of dialysis. So, given that this is a system that works, saves lives and money, we should be doing it.

And as we so often point out around here, there are some things that are simply too important for us not to have markets in them.