Posts Tagged ‘healthcare’

Every new policy this fucking government comes up with seems to be about taking money away from those who have the least of it to start with, or undermining the infrastructure of an organisation currently delivering something of value to the public. And here they’ve found themselves a great two-for-one deal.

In addition to a series of real-terms pay cuts over the last few years, public sector health workers are now going to be made to hand over a huge chunk of their earnings to the government, to pay for the training that’s no longer being funded. That is, those who even bother training any more, given the lack of support or respect they’re being told they’ll be given.

Still I suppose it’s not like healthcare is a vitally important provision to literally everyone alive or that there’s already a dangerous staff shortage in this field OH WAIT IT’S EXACTLY LIKE THAT

Oh well. At least we’ll have plenty of nuclear weapons for the next decade or so.

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This is your sporadic reminder that allllllllll the intellectual property and copyright can get tae fuck.

Snakebite victims in the US can be charged tens of thousands of dollars for a single vial of snakebite venom.

And no, it’s not that the stuff requires rare and exotic ingredients, or takes an especially skilful and labourious process to create, or even that there had to be a huge up-front investment of years of research and development to come up with it. The system is just so utterly fucked, and seemingly geared toward everything but providing people with healthcare with any kind of efficiency.

The cost of making the antivenom, including research, development, animal care and plasma harvesting… A mere 0.1 percent [of the ultimate expense]. 70.1 percent… was due to hospital markups used in negotiations with insurance companies. [emphasis mine]

Jesus fuck. It’s not actually fair to blame this all on IP, that’s just my hobby-horse. This goes deeper in terrifying and unfathomable ways.

Although on that note, the insane Warner/Chappell copyright claim on Happy Birthday To You is finally no more after a ruling this week. While this does not mean the song is now in the public domain, this is a step 90% of the way toward sanity in this one isolated case.

So on balance, between those two news stories and that other shithead gouging prices on AIDS medication, September can still pretty much suck it.

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As I was saying, healthcare staff went on strike today, and in case I hadn’t been clear, I strongly support their actions and their goals.

I left off somewhere around here a few days ago: In a poll of RCM members, 94% of respondents supported, if not a strike, then taking some form of industrial action regarding their forthcoming real-terms pay-cut. I was a little perturbed by the remaining 6%. In a room full of 16 midwives, statistically one of them thinks they should all keep working without being paid, because to do otherwise would be to cause an unnecessary fuss over the steady decline in remuneration for the work they do get paid for.

This highlights the odd role which “work to rule” plays in the lives of many public sector workers. That continuing to do the job agreed with your employer, and going no further beyond what you’re being compensated for, can constitute a form of protest, is itself slightly bewildering, and notably one-sided. If my bosses regularly paid me to take extra-long lunch-breaks, and only withdrew this privilege when they wanted something from me, then… well, then I don’t know what. But it’d be weird. Though maybe I’d be a bit less down on this whole capitalism thing.

(Maybe I’ve figured out why the Guardian didn’t want to commission me to write about this. Actual journalists need to be able to finish a sentence. Also they’ve kinda got it covered.)

When a serious objection to working conditions needs to be raised, however, it may eventually come time to down-forceps entirely, which might get a little more attention. Even then, they’ll do their best to make sure that nobody will suffer serious harm from want of their services, but whatever measure they take, the backlash is inevitable from certain quarters, castigating and condemning them for the arrogance with which they put the public at risk for their own gain.

Some of our general national wariness over public sector strikes is reasonable and worth considering, notwithstanding the extent to which it’s drummed up and over-hyped by certain self-interested tabloids – and bearing in mind that a stronger majority of everyday folk support the 1% pay rise in contention than have provided a mandate for any government in the last I’d have to do some actual research to find out how many years. Healthcare workers have a unique power over us when we’re at our most vulnerable and in need of help; if they chose to wield this power irresponsibly or selfishly, we could all find ourselves held to ransom by a surgeon who charges extra to sew us back up again, or hostage to a paramedic whose defibrillator doesn’t seem to be working right now but might just power back up and be able to get granddad’s heart beating again with the right amount of “persuasion”.

But although this is theoretically conceivable, back in the real world a far more likely danger of social blackmail is faced by healthcare workers themselves, who are expected by many to continue working constantly and tirelessly, regardless of the conditions of their remuneration, with threats of being held responsible for whatever happens to those who need their services in their absence, if they ever dare let up their efforts for a moment. (I saw someone on Twitter earlier ask what would happen to “the lives that would have been in the hands” of a particular nurse who was on the picket lines today if she’d been working. That’s not the half of it – I hear some of them forego work to sleep and have social lives too, you know. The nerve of it! People could be dying!)

Of course, implicit in any complaints about the terrible peril that we all face if NHS staff stop doing their jobs, even for a few hours with several weeks’ notice, is the acknowledgment that the jobs they’re doing are pretty fucking important – and often urgent and extremely time-sensitive. In certain paranoid fantasies, this means we could all fall foul of the above-imagined surgeon hostage-taker at any moment; in practice, the end result of this aspect of the job is all that unpaid overtime I was so bewildered by earlier.

If you’ve reached the end of your thirteen-hour shift and your colleague who’s supposed to be taking over hasn’t turned up to relieve you, working to rule would imply that you sod off regardless once it’s time for you to clock out, potentially leaving whoever you were caring for without anyone actively attending to them (or dumping responsibility for their care on someone else who’s around but who already has an overflowing case-load of their own). So what often happens is that you just have to keep working, beyond the time you’re getting paid for, and well beyond the point at which my knees would’ve buckled and brought on my third emotional breakdown of the night.

The same thing that makes it hard for them to take industrial action without risking harm to innocent bystanders, also makes it clear why industrial action is such an important option when they go so unappreciated. And yes, I mean they should be appreciated with money. If you expect someone to save your life, and deal with drunk idiots turning up in A&E night after night, and not complain when they’re regularly demonised for objecting to their pay being cut again, and to love what they do so much that they’re not even doing it for the money anyway, then I think not making it even harder for them to get by while they earn a salary in the stratospheric levels of slightly above the country’s median income is the least you can fucking do.

Be glad that nurses and midwives aren’t full-on going Galt. We’d miss them more than if every CEO in the country fucked off to join their money in the Caymans.

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Midwives are going on strike. Sorry babies, back inside you go. I know you’re ready to emerge from the womb and take your first breaths of air marking the start of your lifelong journey in the outside world, but that’s officially a picket line you’re trying to cross. Did you just rupture that amniotic membrane? Scab! Scab!

Yeah, so, that’s kinda obvious and has all been done. But there’s some serious bullshit going on here which has driven tens of thousands of medical professionals to vote massively in favour of industrial action in a recent ballot. It’s clearly something they don’t do lightly, since in the case of the Royal College of Midwives it’s literally never happened before, and the last NHS strike due to issues with their pay was over thirty years ago.

Frankly, I’m a little alarmed by the levels of patience and professionalism that midwives, nurses, paramedics, and others appear to have consistently shown about this. I’ll let the Chief Executive of the RCM explain why something’s finally being done now:

Each year, the independent NHS Pay Review Body (the PRB) takes evidence from the government, employers, trade unions and others about how much staff in the NHS should be paid, and based on all that it makes a recommendation. It takes a range of factors into account, including what’s affordable. This system takes the setting of pay out of the hands of politicians, and places it in the hands of independent experts. Every year since the PRB was founded in the early 80s, its recommendation has been accepted. Some years the government and employers grumbled that the pay rise was too high. Some years the unions grumbled that it was too low. But every year it was accepted by all sides. This year, that fair, independent, long-established way of doing things was ripped up when the government took the unilateral decision, now being implemented by employers in the NHS in England, not to honour the PRB’s recommendation of a 1% across-the-board rise in NHS staff pay.

Midwives’ pay was frozen for a couple of years recently, before rising 1% last year. Due to an obscure economic phenomenon called “inflation”, though, what this actually means is that everybody in this job took a real-terms pay cut, and then another, and then another. This year, they were expecting to take another, and this would have been considered acceptable, because it was the formal recommendation of an independent body.

Which still sounds like magnanimity taken to a frankly foolhardy extent in my book, but apparently the government weren’t happy even with this, and are planning to cut healthcare workers’ wages even more than they were already going to. Because austerity. Times are tough. We’re all in it together.

This is the same government, by the way, which doesn’t seem to be worried about finding the funds for a new high-speed rail line, a 9% pay-hike for its own members (taking their basic salary to £74,000, before expenses), and FUCKING TRIDENT.

But no, efforts to make sure women don’t die while they give birth to children is totally where we should squeeze financially. Some of those midwives start on nearly £25,000 a year, you know.

Way more of the public want to see NHS workers get the 1% pay increase they’re asking for – which, remember, is a real-terms pay cut – than wanted to elect this government that’s trying to slash their pay even further. Way more.

I don’t have time tonight to get into my whole other rant about the weirdness of “working to rule” as a form of industrial action, but I have to highlight the latter half of this statistic from the RCM ballot, quoted by Cathy Warwick in that article I linked to earlier:

82% voted in favour of strike action, with 94% voting in favour of taking action short of a strike (for example, refusing to work overtime unless paid for it).

94% voted in favour of “refusing to work overtime unless paid for it”.

Take a room full of 16 midwives facing a pay cut for the fourth consecutive year. Statistically, one of them wants to keep on working without being paid so as not to cause a fuss.

Not even sure how to start thinking about that one.

Give medical professionals some decent fucking money for saving all your lives all the time.

Thank you.

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Astonishingly enough, it turns out that, if your strategies for saving money are inhumane and uncaring, you’ll just end up making things more difficult, more painful, and more expensive for everyone.

In this particular case, spending a little less now to help people with mental health problems means we have to spend a lot more later when those mental health problems become more serious.

(See also needle exchange programmes, which demonstrably reduce harm caused by compulsive drug use in a remarkably cost-effective way, but which have an iffy history of interaction with government at best, and are rejected by many politicians on some kind of moral “principle”, regardless of how much they help.)

I guess there’s no inviolable natural law as to why, in theory, governments mightn’t be capable of rising above this kind of short-termism, and responding to a troubled economy by taking actions that would actually save money rather than making everyone’s lives worse. But it’s not how things often seem to work in practice.

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Here’s one of them “half-assed and barely worth it but at least I’m typing” posts I promised you. Clearly I need to work on the self-promotion at least as much as the writing itself.

The Co-operative Bank has been greatly “troubled” in recent months, to put it euphemistically. There’s been no shortage of opportunity to read about what a nightmare they’ve been having, especially from the BBC.

There have no doubt been some serious management problems which need addressing. Much of the criticism thrown Co-op’s way, even if it has been largely dealt out by superfans of one narrow and specific conception of capitalist economics revelling in apparent vindication of their own ideology, is surely valid.

And yet, for all the public dissection of this failure of the ethical investment model, it does make me wonder why, when HSBC – a bank with a more rigorously capitalist doctrine – made a killing over the course of decades by laundering billions of dollars for drug barons and terrorists, I had to read about it on a comedy website specialising in dick jokes.

After wondering this for a while, I decided I may have just not been paying much attention.


So that was just a thought I had in my head, and so I got it out of my head, as per yesterday’s new policy. It’s not much, but it’s a thing. As it wasn’t much, here’s another one.

I don’t know by what piecemeal process something becomes so twisted, distorted, wasteful, counterproductive, and utterly unfit for purpose as the current US healthcare system. I suspect it takes many minds, spread over many different layers of competing bureaucracies, all at differing levels of competence and malevolence, and all failing to communicate with each other meaningfully, acting largely in whatever short-sightedly self-interested way will best keep them afloat in the immediate future without making too many waves.

What’s the purpose behind a healthcare system? Something idealistic and obvious like, I don’t know, making sure people’s health is cared for? Look at the state of the pharmaceutical and insurance industries in the States. That’s not even in the top five.

Maybe it doesn’t matter how things got this bad. Or maybe it’s important to understand so that we can avoid repeating the same mistakes next time. I just know that my gut instinct when I read about shit like this, that inner voice which burns with furious, urgent need, is howling burn it all to the fucking ground.

That’s not “just a metaphor”, by the way. Saying that would make it sound like my anger at this is some momentary thing, that I’ll be thinking more clearly once I’ve calmed down, that sure I’m frustrated but I’m not actually advocating dramatic and severe and complete change in a way that annihilates the status quo.

Possibly the worst part – because it both gives me hope and also makes the whole thing so unbearably tragic – is that the system is filled with well-meaning people working hard to do good. And the structure they’re working in is built in such a way that anxiety, misery, destitution, and immeasurable unnecessary suffering are the direct result of their commendable labours. We’re trying so hard to make it better and it’s still completely fucked.

Now I’ve just made myself sad before bed. I knew this writing words thing was a bad idea.

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Saying that Fox News killed Hallie Culpepper may not be hyperbole, but it feels like an unnecessary reinforcement of the partisan divide.

It’s a horrible story. She was an elderly woman who had a fall, and refused medical treatment, because she was scared of what “Obamacare” might do to her. She specified in her will that she didn’t want her money going to “the Muslim Brotherhood”, a terrifying organisation about which I’d lay money Ms Culpepper could not have provided a single fact, beyond that the President was all tied up in their evil affairs somehow.

She died because of ignorance and confusion. The “death panels” she was so frightened of simply don’t exist. None of her poorly understood and incoherently articulated worries had any bearing on reality. She didn’t have to die.

Ms Culpepper watched Fox News “religiously”. There’s no doubt a lot of the misinformation in her head, not least the nonsense that scared her out of accepting medical help that could have saved her life, was shoved in there by one of the most hatefully biased and unjust television channels in America. It might be true for Tracy Knauss to say that Fox News killed his mother.

But that fails to tell the whole story. The problem isn’t Fox News in itself. Fox News are a pustular symptom of the illness of modern politics. They’re among the most virulently efficient institutions at abiding by one of the few remaining rules of the political game: pick a side, stick to your guns, dehumanise and destroy the opposition, and loyally rationalise whatever’s being done by the people on your team who you find yourself having to defend.

If we don’t get out of this tribalistic mindset, there’s always going to be channels to watch or papers to read religiously out there, willing to assure us that only they know what’s best for us, and they’ll teach us how to watch out for those others who wish us ill.

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– What’s at the centre intersection of this Venn diagram of silliness? Catholic doctors curing gays with homeopathy. What exactly do they plan to dilute?

– Pretty much everyone except politicians seems to understand by now that the war on drugs is a disaster. Maybe we should just put TV writers in charge and things might start getting better.

– Winner of the Nobel Prize for awesome Paul Krugman has been schooling dishonest Republicans in healthcare lately, which has been quite fun to watch. One, two, three, four.

– BREAKING NEWS. These women have FEET.

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It might be old news, but I saw one of these in a shop for the first time today. A Boutique edition of Monopoly, coloured entirely in different shades of pink. The focus is shifted from ruthlessly trading in real estate, to having lots of girly fun going shopping. Chance and Community Chest are replaced with Instant Message and Text Message. And it’s very pink.

My gut reaction was to call it the most depressing thing I’ve ever seen, and maybe if I were in a grumpier mood I’d have stuck with that. But actually, I don’t think there’s anything objectionable here. There are dozens of Monopoly spin-offs, and I don’t really see a problem with tailoring the specifics of a game so that a particular demographic can more easily relate to it. I know I’d rather play a version with £’s on the money and bits of London I’ve been to, than with dollars and a bunch of American places I’ve never heard of. The uber-pink theme is just an extension of that.

I know it’s the obvious thing to say that anyone or anything attempting to update itself by mentioning text messaging is tragically unhip, like an embarrassing dad trying to be “down with the kids” and failing hopelessly to get any of it right. But here it just seems like good sense. If I’ve won second prize in a beauty contest, sure, text me about it. But what the hell is a community chest?

The old-fashioned form isn’t “better” just because you’re nostalgic for it, and if somebody else’s childhood didn’t heavily feature Old Kent Road and a little stainless steel model of a dog, you can’t blame them if their current tastes don’t match up with your own personal fond memories. Sure, I’d miss the battleship if it was replaced by a handbag, but this game really isn’t meant for me.

I gather some people are concerned about the unhealthy gender stereotypes it could be reinforcing. If it was called “Monopoly: Girls’ Edition”, I think you’d have a point, but I think it’s just a version for people who like this sort of thing. Which seems fine.

If you like this, Amazon recommends Pink Yahtzee. Now that’s just retarded.

Moving on.

Not that I necessarily needed to be reminded, but this is why Crispian Jago is one of the highlights of the skeptical movement. I never got around to actually finishing my own attempted Pythonesque parody, but I should probably just stand back and let the maestro show us all how it’s done. (“SUSCEPTIBILITY attracting MIASMS? What kind of talk is that?”)

The Perry in that sketch, incidentally, is Simon Perry off of the Leicester Skeptics in the Pub, who had an article about homeopathy in Boots published in the Leicester Mercury paper lately. Less funny, but more informative, and kinda important.

Also, I got to chat to Adam Baldwin earlier. Yes, that one. Okay, it wasn’t exactly a chat, if I’m honest. He posted a link on Twitter to a political cartoon, which depicts a pampered government representative sitting with his feet up on a barrel of money, while several (white) men representing taxpayers are literally picking cotton and singing Nobody Knows The Trouble I’ve Seen. The government guy is talking to them about healthcare, and the scene is said to describe “the big issue of freedom vs. socialism. Or, in other words, freedom vs. slavery.”

Yes, the political philosophy of public ownership of the means of production is being equated to the way black people used to be white people’s property.

I made a comment to the effect that this was pretty damn classy.

And whatever else you want to say about Adam Baldwin, you can’t say that he’s totally oblivious to overpowering sarcasm.

He sent me a message back, directing me to this video, in which some US politician I’ve barely heard of asserts that Republicans have historically not been especially progressive, and gets a few significant facts wrong according to the captions. This, I’m told, provides some much-needed “context”. Context to the cartoon in which, if you remember, white people whose tax dollars might have to cover a comprehensive healthcare plan for a few million people who can’t afford insurance, are having their hardships compared to the suffering of the black people who were owned as property by white people a few decades ago.

If this context somehow sheds new light on that, and is supposed to be making me see it in a whole new non-crazy perspective, it’s not working.

I guess there was no particular theme to any of this, but that’s enough for today.

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Yep. I’m talking about politics again.

In theory, I did have a more-sort-of-guideline-than-an-actual-rule about not doing that any more. But apparently that’s being abandoned almost as soon as it was established. I’m not going to get very in-depth or academic, but I feel on fairly safe ground when I ask:

What the fuck, America?

Yeah, it’s the healthcare thing. It’s the retarculous fuckosity that’s dominating what could be a useful national conversation.

It’s the mindless, droning repetition of mantras like “greatest healthcare system in the world”, based on the inviolable rationale that “USA = #1”, without any noticeable consideration of what factors might actually make a country’s healthcare system “great” or less so.

It’s the unimaginative and lackadaisical slapping of a Nazi label onto any policy that displeases you in any small way, restricting any counter-arguments to bellowed accusations of “HITLER HITLER HITLER“.

It’s the way that all of this is reported nationwide, constantly, as if it were really representative of the convictions and actions of a substantial and significant proportion of the country.

It’s the even scarier idea that that might actually be the case.

This piece sums a lot of it up pretty well, and the phrase “death panels” really does neatly encapsulate the problem. Anyone actually referring to these things, as if they were anything but figments, either knows the origin of the phrase and the real details of the policy it describes, or they don’t.

If they don’t, then they’re cluelessly parroting someone else’s ideas, probably because the anti-Obama sentiment suits them fine and that’s all they need. If they do, then they’ve abandoned all pretence of intellectual honesty, and appear not to care how much bullshit they have to make up to win.

The disingenuous nature of Fox News in particular is staggering. Last night’s The Daily Show demonstrated brilliantly what an important role Jon Stewart and his team are playing. They’re at the front lines of the battle to at least keep the debate internally consistent, and to some degree reasonable, enough that the rest of us aren’t head-desking so hard that splinters are stabbing us in the brain.

After the hilarious bollocks some Conservatives have been throwing out about institutions like the National Health Service in the UK in an effort to discredit the idea of socialised healthcare, comedy writer Graham Linehan started a campaign on Twitter. He asked people to report some of the NHS’s success stories that they’d experienced, the care they’d received, and the benefits that had been provided for them by the state, tagged with #welovetheNHS. It took off massively. It was the biggest thing happening on Twitter for several days straight, and produced thousands of stories about people whose parents or children or friends wouldn’t be alive today without the free help provided by the state.

There was a backlash, obviously, but the criticism that was actually interesting came mostly from UK people, in favour of the NHS, who simply didn’t find this form of debate constructive. After all, wasn’t it just countering useless, anecdotal data with more useless, anecdotal data?

I’m still inclined to think that #welovetheNHS does serve a valuable purpose, but we shouldn’t start thinking that this collection of stories amounts to the whole of the opposing side of the argument. It demonstrates the vacuity of certain conservative claims, perhaps, but a debate on public healthcare should be about much more than that. @jackofkent started a new hashtag (at least he’s the first person I remember seeing use it, and I think it began with him), called #wehaveahealthyscepticismabouttheNHS. Ideally, this would be a much better description of the tone of the conversation. It didn’t take off in quite the same way on Twitter, but I think there are a lot of people out there who want to have that healthily skeptical discussion. Maybe even a few right-wing American conservatives who have reasonable points to make, but are reduced to head-desking even harder than I am at seeing the lunacy of those perceived as speaking for them.

The question it seems to come down to, as is often the case in so many other areas of discussion, is: What’s the best approach to take to this loud, persistent, resourceful, and (perhaps irredeemably) irrational onslaught of zealots?

I guess there are parallels to religion in here, which you’ve probably thought about in more depth than I have. There’s much division among atheists about the best way to talk about religion and its adherents, and how to interact with them. Some are merciless and unapologetic in their promotion of science and critical thinking in every area of life, regardless of the danger of religious folk being “offended” by the awkward facts that contradict their arbitrary beliefs. Others decry that group as “shrill” and “militant”, and tread far more carefully as they seek out common ground, aiming to gain acceptance by appearing non-threatening.

I tend to side with the likes of Richard Dawkins and PZ Myers on the militant atheism front, who are both very firmly in the former camp. I’m much less sure of the politically equivalent position, and whether I’d advise Obama taking such a firm stand in quite the same way. But judging by Barney Frank’s recent crowning moment of awesome, I’m tempted to think maybe a little bluntness would go a long way. Would it really do more harm than good to their popularity, if once in a while the White House would just call someone a moron and have done with it?

This is way more than I meant to write about this. I’ll stop now. But you guys carry on. Take this wherever you like, I anticipate the politics getting way over my head soon anyway.

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