Nurses for Reform Blog

I have a chapter on Comparative Effectiveness in this this new publication by the Hoover Institution.  In it I discuss the problems faced by Western Europe from government led Health Technology Assessment  describing lessons learned from such institutions as NICE in the UK that has denied women with breast cancer Herceptin, people with Altzheimer’s disease Aricept and MS patients Beta Interferon to name but a few.

I suggest the following three courses of for America;

America should reject the statutory creation of any organization that seeks to centralize government control of patient access to drugs, devices, medical technologies, treatments or procedures.

Comparative Effectiveness research in healthcare and health technology assessments should be undertaken only by the private sector and not governmental bodies.

Comparative Effectiveness research should be patient-centered and supportive of quality and value, not focused simply on cost-containment.  In this respect, it should promote scientific advances, health information technology, and the emerging science of personalized medicine.

I conclude;

As is clear from the British experience and other example from Western Europe, a comparative effectiveness strategy that relies on central planing and coercion will not only be counterproductive in the long run – because it will undermine the incentives for medical innovation – but it will also lead to the imposition of cost constraints that will worsen patients’ medical conditions and damage the quality of their lives.

Those with an interest in the provision and funding of healthcare should definitely add this book to their reading list.

It is one of the best books written about health, science, politics and the medical establishment.

Or as The Times review put it ” An astute critic of modern medical humbug… devastatingly accurate”

I know that I have recommended this book before, but I make no apology for doing so again.  Working Class Patients and the Medical Establishment: Self-Help in Britain from the Mid-Nineteenth Century to 1948 written by Dr David Green of Civitas, is one of the most influential books that I have read on the provision of healthcare before the establishment of the NHS.

Given the changes that are coming our way with the NHS reforms proposed by Andrew Lansley, many opinion formers and indeed Union Officials could do with brushing up on some history!

The time has come for me to share with you another paper that I found invaluable while studying for my PhD.

The Private Supply of “Public Goods” in Nineteenth Century Britain by Dr. Stephen Davies gives a fantastic overview of how so-called public goods, such as policing, healthcare and sanitation, were being successfully supplied by the private sector in Georgian and early Victorian Britain.

It goes on to show how the public were hoodwinked in to believing that government knew best and that only the state could provide these services.

We have examples every day of how successful the state has been at providing these so-called “public goods”.  So has the time not come to look back to the late Eighteenth and early Nineteenth Centuries to give us some ideas for the future?

The Tax Payers’ Alliance (TPA) has just published the UK’s public sector rich list for 2006 .

While the 12 most highly paid people in the NHS earned more than £183,000 each, the research also points out that the starting salary for an NHS nurse is around £19,000.

On average, the 170 public sector rich surveyed had a pay rise of 8.4 per cent between 2005 and 2006. This is double average earnings growth (including bonuses) across the country – which was 4.2 per cent over the same period.

The average total pay of the 170 people on the list is £259,701 per annum – or just under £5,000 a week!

While I have no problem with people in the private sector reaping the rewards of success I despise the public sector fat cats who parasitically spout their egalitarian waffle but then absorb vast amounts of money which we have to pay at the barrel of a gun – i.e. taxation.

I have just read Allyson M. Pollock’s book NHS plc – The Privatisation of Our Health Care . I like this book a lot as it provides a great overview of the extent and scope of the privatisation now underway across the NHS.

Although the author hates privatisation and the private sector’s involvement – not surprisingly she has all kinds of self marginalising admirers on the Marxian left - she nevertheless provides free marketeers with great hope and cheer. After all, this is a book that clearly demonstrates that consumerism is winning and that the NHS as a fully nationalised system is in total collapse. Best of all, it shows just how the political class are trying to get themselves off the hook of past promises by involving the private sector in ever bolder ways.

As regular readers of this blog will know, I was recently awarded my PhD in health economics. As such, I thought I would share with you one of the books that most influenced my thinking not least because it gives great insights in to the real history and political economy of British healthcare.

Working Class Patients and the Medical Establishment: Self-help in Britain from the mid-nineteenth century to 1948 was written by Dr David Green, Director of the think tank Civitas . The book chronicles the history of healthcare provision via the Friendly Societies and other mutual aid organisations. Crucially, it recognises that:

“The working classes of nineteenth century Britain organised for themselves an extraordinarily effective scheme of medical care. Through the local friendly societies and medical institutes, they engaged doctors to care for them, and did so with a degree of success which this pioneering study reveals for the first time. A surprisingly high proportion of working men were covered.”

This is a truly great book which opens up a much neglected area.  It also has great implications for the controversy over the de-institutionalisation of welfare which is going on throughout the Western world today.

Sadly, while it is no longer in print I recently bought another copy from here . If you are minded and able to obtain one you will not be disappointed.