Thursday, August 13, 2009

The Big Healthcare Debate

The US is currently in the midst of heated and controversial debate as President Obama tries to introduce big changes to the healthcare system. I am not qualified to criticise the US healthcare system but I do wish the President well in his efforts to introduce radical change.

We too need change in the National Health Service in this country. Change is constant and the demands for healthcare continue to outstrip supply worldwide.

What has been very irritating on this side of the pond (to me at least) has been the barrage of myths and scaremongering about the NHS from politicians and media in the US who clearly know very little about our NHS. There are numerous right wing doomsayers trying to scare people in the US about the 'dangers' of universal health care.

I am always the first to admit the NHS has its faults and I am as critical as anyone when things go wrong for patients and families.
On the other hand I have yet to see evidence from any credible healthcare research organisation that shows a universal healthcare system anywhere in the world that is better than the UK National Health Service. Universal is the key word.

The following quotes highlight why we in the UK can be proud of our service despite its deficiencies.

"In the US-based Commonwealth Fund's 2008 healthcare rankings of six top developed nations (Australia, Germany, Canada, New Zealand, United Kingdom and United States):

The United Kingdom ranks top overall - and ranks above the US in all but one measure - yet has the lowest healthcare spend per head of population.

The USA ranks sixth overall - ranking bottom on five of the nine measures along with having the lowest life-expectancy and highest infant mortality rates by far - despite spending more than twice what any other country spends on healthcare (and, at $6,102 vs. $2,546, almost three times the spend in the UK), per head of population."

Source: http://voices.washingtonpost.com/ezra-klein/2009/08/how_stehpen_hawking_proves_tha.html

And yesterday from world famous Professor Stephen Hawking in the Daily Telegraph:

"Professor Stephen Hawking defended the National Health Service from attacks by the American Right, claiming that he would not be alive without it. The British physicist spoke out after Republican politicians lambasted the NHS as "evil" in their effort to stop President Barack Obama's reforms of US health care which will widen availability of treatment but at a cost to higher earners who will pay higher insurance premiums. "I wouldn't be here today if it were not for the NHS," he said. "I have received a large amount of high-quality treatment without which I would not have survived."

Source: http://www.telegraph.co.uk/news/worldnews/northamerica/usa/6017878/Stephen-Hawking-I-would-not-be-alive-without-the-NHS.html

I don’t think the people of the US need fear universal healthcare if it comes your way. Even David Cameron the leader of the Conservative Party in the UK said this today:

Tory leader David Cameron, who has pledged to protect the health service from public spending cuts, also sought to distance himself from Mr Hannan's comments when he was tackled about them on a walkabout in his constituency.

He told BBC News: "I support the NHS 100% and the Conservative Party supports the NHS 100%.

"We are the party that gives the biggest amount of support to the NHS. It is incredibly important to my family. It is incredibly important to this country."

He vowed to "nurture the NHS" if he came to power, "and improve it and make sure it is there for everyone in this country".


Source:http://news.bbc.co.uk/1/hi/uk_politics/8199615.stm




Finally I want to say that this unusually long post is not meant to try and persuade US citizens about anything. Clearly it is the decision of the people of the US and those who govern to design their new healthcare system.


I would just ask my many friends in the US not to believe the nasty, unfair, unjustified and often simply untrue madness that is being written by right wing media and politicians on that side of the pond about our National Health Service in the UK.

All my friends in the US are rightly concerned about the crisis facing their healthcare system and I hope that by sharing the best practice on both sides of the pond we can mutually find the right answers to what is actually a world crisis in healthcare.

Regular readers of Simplicity Blog know that I will I will defend the principle of universal healthcare with my last breath because I think it says a lot about my country that access to healthcare is not dependent on wealth.


37 comments:

John O'Leary said...

Thanks for weighing in on the matter, Trevor. In the US we're being bombarded with apocrypha about what's being proposed in Obama's current health care bill AND the poor quality health care of other industrialized nations, especially Canada and the UK. Lately I've been hearing about long waits for dentists in the UK. True or false?

Ken D said...

liked your blog re NHS

US system is rubbish but they don't realise until its too late & they are needing to use it

NHS has many faults,mostly down to politicians who don't understand,don't care as long as there are votes in it &/or are publicly dishonest about what it can do for what cost BUT I know which health care system I prefer

US is great if you are rich & in work & need high tech intervention

Good luck to Obama

regards

Ken D

Trevor Gay said...

Hi John - The film of the queue for the dentist was a well known historical scenario and needs to be seen in context. That news report was about a new dental surgery opening in an area of England where there had been a history of under-provision of NHS dentists. When the new surgery opened there were obviously many people wanting to register as new patients. Take it from me John that was an exceptional situation that happened probably 4 years ago. Access to free NHS dentistry now is far better all over the UK – there may be the odd hot spot here and there but all dental provision is increasing. Take our family for instance –all 4 of us use an NHS dentist. I have a 3 monthly dental check up. Annie and the two children have 6 monthly check ups. There is no problem for us to access NHS dentistry and we are very typical. All Dentist services on the NHS are free to people under 16 and over 65 or if people have disability and various other exemption status. Others like me pay a small amount compared to private dental care which is astronomical cost.

All other healthcare services on the NHS are completely free and for instance every patient with a suspected cancer upon visiting their family doctor is now guaranteed to see a cancer specialist within 2 weeks.

I could write all day about this my friend but my bottom line is please don’t believe all you read or see on TV in right wing propaganda about the NHS in the UK. Talk to patients from the US who have used our service after they have moved here to live and get them to compare it with the US healthcare system.

Trevor Gay said...

Ken - thanks my friend - you won't find me disagreeing with you about our beloved National Health Service

I think it is very telling that even Mr Cameron has publicly come out in favour on the NHS - the leader of the Conservative Party for goodness sake - there is hope!!!

John O'Leary said...

Trevor, I'm surprised more of your US readers aren't joining this discussion. In the meantime, I have another question. John Mackey, the CEO of Whole Foods, recently commented in a Wall Street Journal article: "In England, the waiting list [for patients to get medical treatment] is 1.8 million." True?

Trevor Gay said...

John - things are quiet at the moment in blogosphere - even on Tom Peters Blog! - I'm sure it will pick up.

That 1.8 million waiting list figure is intriguing - I need to know more about it. Suffice to say there will always be a wait for treatment but in the last 10 years there has been phenomenal improvements in getting treatment.

I am not doubting the person who has reported that 1.8 million figure but frankly it looks like a scaremongering statistic consistent with right wing politics and media.

All I now is that anyone with a serious health problem (and many not serious or urgent)get very quick treatment in the NHS and things are improving dramatically year on year.

Trevor Gay said...

John - maybe the guy you quote should read this report in the Independent Newspaper at the tail end of 2008.

Waiting lasts are rapidly disappearing.

Click here for report

hucknjim said...

Hi Trevor,

As one of your U.S. readers and as someone who works in health care, how could I not comment? Our system is broken. Only the most fanatical right wingers deny that. Unfortunately, they have very loud voices. This small minority has managed to drown out the civil debate because the media loves drama, and TV or newspaper stories featuring people who are shouting so loud that their veins are bulging or they get red faced are certainly dramatic. All this yelling about "death panels" and rationing care are demonstrably false, but that hasn't stopped the shouting. I really feel that President Obama needs to step up and truly lead on this issue. His reasoned arguments resonate with me, but to silence the shouters he needs to go into preacher mode and inspire people to demand reform.

I should also add that in addition to you in England, I have a friend in Canada. He too loves the cradle to grave coverage his government provides. Admittedly anecdotal, but it's good enough for me to rebut another canard that the far right is espousing.

Thanks for the great discussion.

John

Trevor Gay said...

Hi John – happy Sunday and thanks for your comment.

Right wing media and politicians love to capitalise on anything to undermine a sense of community or social responsibility.

Life is not all about money and profit in my opinion. I just don’t think the trickle down theory of wealth works at all. I am not into strict government control either but I do want to see rights given to the most frail and vulnerable in our society.

I am very proud that in the UK we retain the principles of the great Nye Bevan – founder of the NHS in 1948.

Ignore the scaremongering right wingers John and you will get an accurate picture of the UK National Health Service my friend

Best wishes

Trevor

Trevor Gay said...

John O' and John

You may both like to read this report from your fellow US citizen about her experience of the UK National Health Service. Her summary is as follows:

"I can sum up my experience of the British and American healthcare systems in one simple sentence: given a choice between the two systems, I’d choose the NHS in a heartbeat. And though this is the experience of only one single person out of millions, unlike so much of the propaganda and hysteria surrounding the current healthcare debate, it is the absolute Gospel truth."
Click here for her full report

hucknjim said...

Hey Trevor,

Just wanted to share a quote from Winston Churchill that I heard on television this morning in regards to the health care debate.

"Trust the Americans to do the right thing, after they've exhausted all the alternatives."

He was speaking about WWII of course, but it was very amusing just the same. It made me laugh and applies to our current debate over health care reform.

John

Trevor Gay said...

Thanks for that John - Churchill was certainly a master wordsmith!

If you're interested I have set up a new Facebook Group and you can join at this link:

Join new Facebook Group "I'm Proud of the NHS"

David Wike said...

I haven’t really been following the debate in the US but I’ve heard the extreme scare stories put about. As the director of a well respected newspaper said to me, “Don’t believe all that you read in the press!”. The media thrives on bad news and scare stories. Even the ‘heavyweights’ tend to use headlines that can lead to inaccurate perceptions.

I don’t quite agree with Trevor about dentistry on the NHS. The cover does seem patchy and I made the decision to go private some years ago. It is expensive but not that much more expensive than the NHS, which is not free unless you are in certain categories.

With respect to the rest of healthcare it is a different debate. If you have private health insurance, which I did when I was in corporate life, you get the convenience of having more flexibility in terms of when you are treated and generally in smaller, less ‘factory-like’ hospitals. HOWEVER …

If you need treatment for something major, the NHS has the facilities and the expertise to treat you. Yes it has many flaws, some quite serious, … like most large organisations, public or private. I am sure that it is inefficient in the way it spends money … like most large organisations. I suspect that there is disconnect between the frontline and the senior management … like most large organisations. My wife works in the NHS and several family members have used its services in recent years, so I’m not saying this from a completely uniformed perspective.

In 1947 when the NHS was set up I am sure that there was the same outcry in the UK as we are hearing from the US now. Whilst the various political parties here may want to shape it in different ways, not one of them is suggesting that we would be better off with a privatised health service. So I would say to all Simplicity readers in the States, don’t listen to the scare stories, don’t be afraid of change. And if all else fails, you can always move to the UK!

David Wike said...

I haven’t really been following the debate in the US but I’ve heard the extreme scare stories put about. As the director of a well respected newspaper said to me, “Don’t believe all that you read in the press!”. The media thrives on bad news and scare stories. Even the ‘heavyweights’ tend to use headlines that can lead to inaccurate perceptions.

I don’t quite agree with Trevor about dentistry on the NHS. The cover does seem patchy and I made the decision to go private some years ago. It is expensive but not that much more expensive than the NHS, which is not free unless you are in certain categories.

With respect to the rest of healthcare it is a different debate. If you have private health insurance, which I did when I was in corporate life, you get the convenience of having more flexibility in terms of when you are treated and generally in smaller, less ‘factory-like’ hospitals. HOWEVER …

If you need treatment for something major, the NHS has the facilities and the expertise to treat you. Yes it has many flaws, some quite serious, … like most large organisations, public or private. I am sure that it is inefficient in the way it spends money … like most large organisations. I suspect that there is disconnect between the frontline and the senior management … like most large organisations. My wife works in the NHS and several family members have used its services in recent years, so I’m not saying this from a completely uniformed perspective.

In 1947 when the NHS was set up I am sure that there was the same outcry in the UK as we are hearing from the US now. Whilst the various political parties here may want to shape it in different ways, not one of them is suggesting that we would be better off with a privatised health service. So I would say to all Simplicity readers in the States, don’t listen to the scare stories, don’t be afraid of change. And if all else fails, you can always move to the UK!

Dan Gunter said...

Trevor, on the heels of your (as always) thoughtful and thought-provoking post, I find myself thinking about "Doctors Without Borders." One would think that if we can find the energy and resources to provide needed medical care to underserved populations in foreign lands, it is indicative of the fact that we have resources available for providing more and better health care within our own borders, too. By no means am I against providing aid such as medical care to those in need abroad. But it begs the question: why are there so many people going without medical care, food, and shelter at home while we export free services and goods? Humanitarian efforts are still in great need here in the U.S., too.

mark jf said...

Trevor - as ever, I think your love of and loyalty to the NHS cause you to see it through rose-tinted spectacles. On the whole, it is a very good service and I prefer it to the American model. But in parts, as with many organisations, it's diabolical.

Dentistry: c'mon! There simply are not enough NHS dentists. Some years ago (during a Labour government at that!) most of them went private. Now they're earning big time, they graciously condescend to do a bit of NHS work, too: http://news.bbc.co.uk/2/hi/health/8183788.stm BTW, my local NHS dentist has a 4 month waiting list for a basic hygiene visit!

There's a difference between the policy on cancer checks and the inconvenient actualite. There's still too many people who don't get seen in 2 weeks. If I remember correctly, the late celebrity Jade Goody wasn't seen in 2 weeks...

What I find bizarre about the NHS is the amount of elective treatment that is dished out while there are waiting lists for life threatening problems. I for one would ban cosmetic surgery, fertility treatment, anti-smoking patches and a host of non-essential practices in all but the most extreme cases. I do resent my tax £ being spent on this sort of thing (as upsetting as it might be for those concerned) while elsewhere people are dying.

But I also think it should be more commercial. We should be tougher about making non-citizens pay for treatment. If your problem is a direct result of lifestyle or your own abuse and you don't change your behaviour after treatment, any further treatment should be payable.

There is also a problem with a 'free at the point of delivery' service: people don't value something that's free. If they had to contribute directly, they would. I really don't know what the answer is here but there is too much of an entitlement and dependancy culture built up around the NHS and we need to make people not just value it more, but respect it more.

Trevor Gay said...

David thanks for your comments – I like thius in aprtoicualr of course

“I suspect that there is disconnect between the frontline and the senior management … like most large organisations.”

Amen!

I have always acknowledged there are problems in the NHS – there always will be – there is no such thing as perfection in large, labour intensive organisations. This is not unique to the NHS, the public sector in general or the private sector – it is always about people.

The big issue for me - that we should fight to retain - is the right we have in this country for free treatment regardless of wealth status and based on clinical need no ability to pay.

People can and do still opt for private healthcare and I don’t have a problem with that – it is a choice and I am pro choice.

Trevor Gay said...

What a great point Dan and a philosophical position I grapple with all the time.

For instance - Why do we spend more on ice cream in Europe each year than it would cost to provide a primary school education to every child in the world?

Such questions are wider humanitarian issue we all like to avoid. All politicians love to avoid these questions because the answers would be politically unacceptable.

I know we have lots of problems with our NHS service in this country but I equally accept my wider responsibility as a human being to provide for those people who are significantly less fortunate than even the poorest citizen in the UK.

I suggest REAL poverty is wondering whether you will have any food tomorrow to keep you alive.

Rest assured Dan both the US and the UK can easily afford to help out in countries where there is REAL suffering and REAL poverty and we wouldn’t even notice the difference.

Dan Gunter said...

Trevor,

Sandy and I make it a habit to share in prayer each morning and each night. I often include in that prayer a request that we keep in mind the fact that we often complain about things not going our way... not having this thing or that thing... people not doing things on our schedule or going along with our agendas, etc. We so easily find ourselves voicing such complaints, not thinking about how many people don't have a home, a bed, food on the table, basic medical care, so many things that we DO in fact take for granted so easily.

50% of the world's population survives on less than $2 a day. 20% on less than $1 a day.

When I think seriously and prayerfully on that, I realize that I am actually quite blessed and technically "rich" when I look at myself within the context of the world's population.

I will be the first to admit that I complain and bemoan what I don't have WAY too often. I have much to be thankful for.

If I hit the 99-cent menu at the local drive-thru instead of ordering the $4 deluxe burger for myself because things are a little bit tighter financially this week, instead of saying "God, I wish I could afford that burger with three beef patties, bacon, and all the trimmings," I should instead be saying "Thank you for providing me the car, the gas, and a little money -- all of which make it possible to have the choice between throwing together a sandwich at the house, microwaving a TV dinner from the freezer, or driving a few blocks to grab a burger."

For far too many, there is no choice beyond "Do I lay down and starve to death and die of disease, or do I die propped up against a tree?"

Trevor Gay said...

Hi Mark - Rose tinted spectacles? – Yes to some degree but I am always the first to criticise poor service within the NHS where patents are not treated well as customers or corporate ineptitude – and you are right there are sometimes examples of both – I will never defend this.

Dentistry access is definitely improving from a low base and the recently published “Independent Review of NHS Dental Services in England” led by Professor Jimmy Steele gives a fair and balanced picture as at June 2009. This covers the strengths and weaknesses of the Dental Service. This is an interesting extract from that report on access:

“Overall the large majority of those trying to get an NHS appointment managed to do so; the recent Which? survey showed that 68% of people had tried to get an NHS appointment in the last two years and 88% of these had been successful. There was also regional variation, with 65% of patients in urban areas able to make an NHS appointment with the first dentist they telephoned compared with only 44% in rural areas.

Research by Which? supported this – 29% of dentists in rural areas and 46% in urban ones were taking on new NHS patients. This varied by region, from 78% in the West Midlands down to just 12% in Yorkshire and the Humber. So while the vast majority of people were successful in finding an NHS dentist, for the 12% who were not the experience is of great concern.

All PCTs run dental helplines. Citizens Advice last year “mystery shopped” 55 of these with the aim of finding out how effective they were at putting patients in touch with dentists. The survey found a mixed picture. A total of 71% of callers were given details of local dentists taking on new patients and 84% of these were given a choice of two or more practices. But 18% of callers had to be put on a waiting list and in 2.5% of calls the callers were told that no local dentist was taking on new patients and were not offered a place on a waiting list. Those PCTs with the best access had the best helplines. PCTs in most need of an effective helpline were the least likely to have one”

The cancer referral to treatment promise is light years ahead of most alleged civilised countries and we should be very proud of that Mark – it may not be total yet for everyone everywhere quite yet but it a brilliant guarantee that no other country can offer.

The investment in preventative health measures versus the treatment end is always a thorny issue. There is little doubt that investing in health promotion and ill health prevention makes economical sense in the long term but I agree with you that urgent health care issues must take priority. I would not be as draconian as to ban preventative work.

Making judgments about other people’s lifestyle is a difficult one. For instance Mark where do you draw the line? - Do you suggest people who play sport as amateurs should not get treated in the A and E Debarment because their injury was self induced as a result of their chosen lifestyle? – We have to be very careful about generalisation on this matter.

Trevor Gay said...

Hi Dan – You, Sandy, Annie and me (and millions of others) in fact are co-conspirators but we are also looking after ours and our own. I am not critical of us for doing that – it is a perfectly natural human coping mechanism kicking in.

What irritates me most is how politicians are very parochial and narrow minded about ‘pulling up the drawbridge in our own little corner of the planet. That culture is oblivious to the fact the rest of the world have problems far greater than the ones on our own doorstep. The one thing we all have in common on this planet is that we belong to one race.

Marilyn Jess, DTM said...

What's missing in the heated and scripted discussions here is that health care in the USA is ALREADY rationed.

Just try to get a primary care or dental appt. here if you have Medicaid. Try to pay your bills that aren't covered by your insurance. Many have had to resort to bankruptcy.

Try to get reimbursed for services you provide at a rate that earns you a living wage. I can't offer health coaching to those in my town who need it most because it isn't covered by insurance.

This dysfunction is due, in part, to insurance companies making enormous profits.

The NHS may not be perfect, nothing is.

Do we orget in all of this that the BEST healthcare is the care we give to our own bodies?

No one can fix a machine that has been allowed to rust out. Without that loud and clear message, take the best care of yourself that's possible, any system won't work well.

Dan Gunter said...

Excellent points, Marilyn. I know a teenager who started having pain in a tooth. She was scheduled for a cleaning in a couple of days, so she decided to wait and see about it then. They did her cleaning, but told her she would have to come back in a few days for a relatively minor filling for the troublesome tooth. WHY? Because she's covered by Medicaid. They wanted to bill the treatment for the tooth as a second visit, as opposed to doing the work while she was there already (they admitted they could have.)

Greed and dysfunctional system don't combine for the benefit of the patients, to be sure.

Trevor Gay said...

Thanks Marilyn and Dan - it is brilliant to hear from US folks who can offer us some insight to your system. Very educational indeed.

The NHS has faults but equality of access is a right worth fighting for and I maintain it says a lot about the values of a country.

I admire the Presidents efforts to tackle the problems.

Dan Gunter said...

Trevor,

That is indeed a good barometer of the values of a country. My question is whether the development of a "universal" health care methodology in the U.S. will bring up the lowest (the uninsured, Medicaid beneficiaries, etc.) to a higher level, or actually end up lowering the overall quality of health care. I envision it "squeezing" the system in the name of creating a "one size fits all" model, which rarely ends up fitting ANYBODY well.

I'm not saying that I think it's impossible for us to develop a universal system that ALSO evolves into higher overall quality than ever. But my visceral instinct tells me that with our government involved, the QUALITY of care for all will take a backseat to politicians pushing for ACCESSIBILITY. Their rhetoric seems to be about achieving the latter. And history tells me that most politicians want to do what they "said" they would. Their words speak volumes, but you have to listen closely.

I think there is a verse in the Bible that says something to the effect of "From the abundance of the heart, the mouth speaketh."

I'm hearing "Access." Yes, that's a MUCH needed start. But access to what, pray tell? Quality of care had better be an up-front, high priority, or a lot of people will end up dying from poor quality health care faster than they might have died without any care at all.

Trevor Gay said...

Dan - people in the UK have a universal system and also have the choice of going for private healthcare - only about 10% of the population take up that option.

I think that a totally private system offers no guarantee to the frailest and most vulnerable members of our society and that is what I fight to keep.

I cannot get my brain around the equation: Greater wealth = better health

We should be aiming to bring up standards for the poorest and frailest and if that means the wealthier have to give up something or pay for the right that's fine by me.

John O'Leary said...

Wow, I gave up on this thread too soon. Well today it looks like Obama and Congress are already giving up on the "public option" in the current health care bill, which means there won't be a government-funded alternative to private healthcare policies. We'll see what else gets tossed to get it through Congress. The House bill has its problems, to be sure, but disingenuous claims from several prominent politicians about it funding "death panels" (Sarah Palin's words) who will "pull the plug on grandma" as well as assertions that it will "mandate abortions" and fund "healthcare for illegal aliens" are just not based in reality. I think the fundamental integrity of these politicians is now in question. But if you strip away the hysteria there is a legitimate and welcome debate to be had in the US on the pros and cons of increased government involvement in health care - as well as banking, energy production, etc. I, for one, could learn a lot from that.

Ken D said...

there is no doubt that the NHS offers a far better service to the UK.The US has a service that has evolved from its pioneering roots,favouring entrepreneurship,gotta be tough to survive etc.Trouble is all folks ain't tough & the UK is a little more mature in its looking out for fellow human beings.
A combination of the two systems,offering a safety net & restricting the influence & profiteering of insurance companies,could be an ideal compromise.
The US has a wonderful opportunity to design & build an enviable health care service right now that is being endangered by hysteria & disinformation.Grab it with both hands while you have the chance!
Waiting lists in the NHS are a thing of the past-3mths max for routine.Immediate for urgent.It has choice.It fails in places in quality but that is improving.But it costs a shedload & where we went wrong is in offering everything to everyone.Pulling the plug on some services now is extremely difficult & too hot for most politicians so we will continue the fruitless argument about financing.
The NHS is comprehensive,cradle to the grave,free at the point of delivery & available to all.These are principles that American folks should be aspiring to.The debate should be about how comprehensive it should be,not about whether to introduce it or not.

Trevor Gay said...

John - this one has clearly captured the imagination of a lot of people!

Another friend of mine Rob on another thread said this about the NHS:

"Seriously, its funny how everyone moans about it constantly, but if you threaten it, watch the millions come forward to defend it!"

All I can say John is thank God you folks in the US were intelligent enough to reject that Palin woman as your vice President!

She sounds right of Genghis Khan :-) and makes Margaret Thatcher look like a pussy cat.

Trevor Gay said...

Ken - nice and moderate comments as always my friend - next time don't be so diplomatic :-)

Trevor Gay said...

By the way I've set up a new Facebook group called "I'm Proud of the NHS"

Please tell your friends - I've already got a few US folks signed up!

That must be telling me something I guess :-)

Click here to join new Facebook Group "I'm Proud of the NHS"

Scott Peters said...

Trevor,

Nice to see that the blog is warming up on the discussion of healthcare in the States and ideas of NHS. Personally, I've heard good reports about care, in general, across Europe and in UK. While I haven't experienced the care firsthand, I know of people that have traveled abroad and needed services for a ruptured appendix or other "need it now" services.

I'm not sure if the American people know what to believe anymore. In parallel with the healthcare debate, the media (mostly left) continues to carry on about a recovery brewing and the recession ending in the States. The following night, many of these news agencies will report on the desperation of tent camps in America and the hardship of the recession. The problem is, you don't need to walk much further than the retail stores and diners to see that people aren't spending money in the US. Frankly, I don't think many people believe in Obama, Congress, or the media. I don't mind Obama, but he seems to want to wrap his paws around everything and not focus on specific issues. The economies of the States and the world need to be front and center to stop the bleeding of unemployment first. Unemployment in the States leads to loss of coverage and options that are too costly. As our nation continues to bleed out 300-500,000 jobs per month, we won't get our arms around anything.

If we look at social security (government run), and I received a statement yesterday, they are indicating that payroll taxes collected will be enough to pay about 78% of scheduled benefits by 2041. I'm not sure if they've even factored in the losses to payroll taxes of the past 2 years which have been devastating. They also indicate that the law can be changed anytime to account for the impending shortfall in coverage. With the economy at its current state, the States will likely see issues well before 2041.

I would prefer our government didn't do anything else with money until they can balance a budget or cut the deficit. Here in the States, the state governments run differently than the national government because they are not allowed to run deficits. States have been cutting to the bone by 10's of millions of dollars to "try" and stay within budgets. The federal government just spends whatever it wants without recourse. In my mind, the spending is out of control. If you add up all the taxes: Fed, State, County, sales taxes, corporate taxes, property taxes, auto registrations and taxes, and whatever I'm missing, we probably pay just as much as many European countries anyway.

I'm not sure how Obama can pay for programs by not raising taxes on the middle class and offering universal health care? Outside of Clinton, we've had decades of deficits. If you do this in the private sector, you go out of business, get your credit trashed, foreclosure, and a whole host of other bad things.

Priorities for me: quit spending and less taxes, unemployment, the health of economies, Iraq and Afgan, healthcare, and education. Education being last indicates how great things are right now!

I'm tired of the "chicken in every pot" & and "car in every garage (clunkers)" promises that we get day in and day out.

If I was Obama, I'd focus on very specific issues and cut with razon precisions to move us in the right direction.

Analogy: When the transmission in your car begins to crap out (even though it still drives), you don't go out and buy a new car (unless you're participating in the clunkers program), you fix the transmission. Obama needs to quit buying new cars for problems that need real and less costly repairs.

Trevor Gay said...

Hi Scott and thanks for your comment. I am learning so much about how our countries are governed so differently.

As far as healthcare is concerned we are starting at distinctly different places. I think to tackle your healthcare challenge is a massive task.

It is quite a challenge over here too but I guess the advantage we have is 60 plus years history of a universal health service. Despite the cynics and doom spreaders over here from the right wing the average punter in the street in the UK reacts when the NHS is at risk. Suddenly millions of people come out of the cupboard and defend the NHS to the hilt.

I have noted many angry reactions over here to criticism from right wing politicians and media in the US about our NHS. These people have no knowledge or experience of our service and yet they spread untruths and myths based on limited information that is usually taken completely out of context.

From afar it seems to me President Obama has real challenges to make meaningful change - there is much for him to do.

I hear what you say about focusing on achievable deliverables. I certainly had high hopes when he was elected and I wish him well – sounds like it is going to be a long uphill struggle for him.

Thanks again my friend - I hope you and your family are well :-)

Scott Peters said...

Thanks for the response. TrueLove is having another field day on TP. Anybody that is familiar with NHS knows that it has strengths and opportunities, much like anything else. We can learn a lot from NHS, our current system, and other alternatives around the world.

The family is well and getting back into school. Thanks for asking and take care. By the way, Richard is getting pounded on his very leftist post about Whole Foods on TP. Whole Foods is a very well run outfit that charges a premium for its services.

Trevor Gay said...

Hi Scott- True love is a ral character – I am beginning to understand how to handle his ‘humour’ – he likes to find negative publicity about the NHS in right wing newspapers and then use it as if it were fact. The NHS has its problems but it is still regarded as one the best – if not the best universal system in the world as shown by the Commonwealth Report in 2008. This was objective hard research from a world renowned healthcare research organisation and the irony of ironies is that the organisation is based in the US! – True Love ignored my comment about that I notice – its all good fun!

Good to hear the family is well and your children go back to school earlier than over here – it is early September when they go back – I’ve currently got my Grandson staying with us a few days – he is now four and a half – going on 18!!

Richard King as a good man but you are right he is getting lots of stick on that posting!

Take care Scott - always good to hear your comments

Scott Peters said...

I love what Jesus said about taxes:

Give back to Cesar that which belongs to Cesar...or something like that.

The reality is, and simply put, many of us are blessed beyond others and have wonderful lives on this planet. A majority wishes to have it so good and starves away each day without food and water.

When I walked away from the executive ranks and a six figure income, I gave back to the company what belonged to the company. They hadn't defined me, owned me, or convinced me to become unethical to line my own pockets and wealth. I just couldn't do it and live with myself.

I merely walked away...Regardless of the debate on healthcare and what the outcome may be, I'm very blessed to have what I have, and that's enough.

Trevor Gay said...

Hi Scott - Give to Caesar what is Caesar's are some of Jesus’ most famous words. I accept my duty to pay my taxes which go toward supporting the health service for everyone n the UK. Unfortunately in every system there are people who abuse the tax system or those who do not pay taxes for whatever reason. We cannot control the actions of others but what Jesus was saying is that we should always pay our debts.

I think you did an amazing thing walking away form the well paid executive job and good luck to you my friend. I know from reading your book it was a matter of principle and integrity and I admire you for that. Not many people are brave enough to do that.

We are having a few days with my Grandson Sebastian and just being with him makes me realise the true meaning of being blessed.