25 March 2009

It's a funny world

Here's what Mr Obama says about the idea to roll out something like Medicare to all :

“It gives consumers more choices, and it helps keep the private sector honest, because there’s some competition out there.”

How very odd. Our government wants to introduce private providers to increase choice and provide competition. The US government wants to introduce a public system to increase choice and provide competition and keep the private system honest. The US government seems convinced that their private system has its problems (honesty apparently) and our government seems convinced that our public system has its problems. Those connected with private healthcare in the US seem worried about the US proposals. Dr Grumble is worried about the UK proposals.

What is the common purpose here? It is that on both sides of the Atlantic this has been driven by managers with a common mantra whose chant goes:



Contestability (which is, of course, newspeak for competition)

But the real aim in the UK is for the government to divest itself of all healthcare organisations. What our government really wants is a multiplicity of providers and it wants to be directly responsible for none of them.

Bizarrely, given our recent economic woes, freeing organisations to do as they please is still seen as a success. Yet we know that as the reins were eased in Stafford the management focus was instantly transferred from patient care to matters of money. It may seem odd but it is a sad truth that organisations generally value money more than lives.

Just as bankers were freed from tight constraints we now have the formerly highly regulated healthcare professionals being freed from their traditional boundaries. Nurses and pharmacists are missing from Dr Grumble's ward because they are on prescribing courses though how they can they prescribe when they are not trained to diagnose is not clear. And who is to look after the ward or the pharmacy if they are doing the doctor's job? Blurring is of course the management aim. It's about plurality and contestability - words whose meaning is vague except to those who coined them. There's a name for this. It's semantic deception. The nurse and the pharmacist will bit by bit compete with the doctor. There's a name for this too: gradualism. The patients won't know any different because you cannot recognise who is who any more. The doctor's white coat, a relic of the days when hospitals were scrupulously clean, has been banished - paradoxically on grounds of cleanliness. Nurses and healthcare assistants are already indistinguisable to the average punter. There is a theme to all of this. It's the same deregulatory theme that was used on the bankers. But government never learns from its mistakes.


Julie said...

Absolutely, Dr G. The other name for it is dilution.

Anonymous said...

The trouble is that the government is listening to lunatics.