Collapse of emergency healthcare in England may be costing 500 lives every week • Hacker News Board

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#241

Post by throwaway049 » Tue, Aug 23, 2022, 9:32 PM UTC

xtracto wrote: post #124

oliwarner wrote: post #116

This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door. Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards ha…

It is too bad that corrupt government officials keep systemically defunding Social Health programs with the objective of pushing private for-profit healthcare (which just doesn't make sense). Then they point to the deficient healthcare and blame the "socialized" aspect of it for the issues. Here in Mexico we've seen it all play out: We had an amazing social healthcare system (in the form of the IMSS) in the 70s and 8…

In 2004 when I worked in NHS emergency care we had such a problem with no space in ED to unload ambulances that the ambulance service threatened to put a mass casualty tent in the hospital car park.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#242

Post by WalterBright » Tue, Aug 23, 2022, 9:33 PM UTC

MichaelCollins wrote: post #230

imtringued wrote: post #216

Earlier quoted context omitted.

The Soviet Union seems to have failed that game by collapsing through external debt.

The Soviet Union accrued massive debt due to internal production inefficiencies caused by corruption and mismanagement. Russia has extraordinary natural resources, by all rights they should be one of the most wealthy countries on earth.

The same goes for South America. Yet they remain mired in poverty thanks to their predilection for socialism.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#243

Post by Ferrotin » Tue, Aug 23, 2022, 9:35 PM UTC

oliwarner wrote: post #116

This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door. Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards ha…

It’s almost as if centralized control of resources doesn’t allocate them optimally.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#244

Post by asdff » Tue, Aug 23, 2022, 9:36 PM UTC

WalterBright wrote: post #227

asdff wrote: post #226

Earlier quoted context omitted.

How can people benefit when in the free market system consumers are seen as a resource to be exploited?

Because the seller, in a free market, has to please is customer. The way to please the customer is to have the customer benefit from the transaction. For example, how long do you think McDonald's would last if its McBurgers tasted bad? McDonald's success is extremely tied to customer satisfaction. Tossing the ball back to you, under socialism, why would the socialist service care if you're pleased with the service or…

Because a socialist system is ran by the public. It is beholden to the public as its shareholders. Mcdonalds needs to taste tasty, but only to get you hooked enough to choose mcdonalds over other foods. You think the shareholders would rather their customers actually eat healthy which means limiting consumption of Mcdonalds? No, they are practically in the business of selling cigarettes but in the form of fats and sugars. They want you addicted. The goal of the capitalist isn't to make their customer happy, its to extract as much of their available disposable income as possible.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#245

Post by notahacker » Tue, Aug 23, 2022, 9:37 PM UTC

dekhn wrote: post #218

notahacker wrote: post #205

Earlier quoted context omitted.

I agree that this sort of thing needs a study. Fortunately the previous tweet linked to the original source, a published study of 5 million ER visits which appears to have a full set of controls and specifically measures time to inpatient transfer in excess of 5 hours as a mortality risk factor https://emj.bmj.com/content/emermed/39/3/168.full.pdf

A retrospective, observational (IE, after the fact data analysis from a population without controls) study found a risk factor (association). That's not enough to make any real conclusions as to whether this is causal.

It may not be conclusive on the subject of whether the 16% additional deaths were specifically influenced by the additional wait, but in light of that data point, you're going to need a whole lot more evidence to justify your original claim that the cohort that dies 16% more than the baseline population in the days that follow were, without exception, not in any urgent need of medical care...

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#246

Post by missedthecue » Tue, Aug 23, 2022, 9:39 PM UTC

rich_sasha wrote: post #69

bananapear wrote: post #45

But what has caused the collapse of emergency healthcare in the UK? A lack of supply or an increase in demand?

NHS has been underfunded for years. These issues are, in a way, not new. But it just kept getting worse and worse, COVID added burnout and a huge backlog of treatments and missed diagnoses. It probably doesn't help that a lot of the medical staff were from the EU and just before COVID were PTFO. I'm still waiting for those hospitals to be built by all the money saved by Brexit.

How do you know the problem is in fact underfunding? The UK seems to spend as much on healthcare as many other first world countries, but with worse results.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#247

Post by MisterBastahrd » Tue, Aug 23, 2022, 9:42 PM UTC

pookha wrote: post #183

nobodyandproud wrote: post #164

Earlier quoted context omitted.

Compared to the cesspool that is the US system? The NHS was amazing. We don’t talk about it, but people still die for non-COVID emergencies because hospitals in the Us are routinely full in 2022. Privatization of hospital systems in the US have lead to very warped incentives, where C sections are the norm because it’s faster and more money for the hospital and Drs.

Here in the US I had stage III cancer. I was receiving full blown cancer treatment(s) less than a week after I went to the ER with symptoms (chest port + three types of chemo drugs). And that's routine. The US health care failures are mostly the fault of administrators and insurance companies gaming the public. The care is fast + extensive and it's not a cesspool. And the "full hospital" meme isn't entirely accurate.…

While it's nice that you were able to get quick treatment, there are tons of people who never receive any or adequate treatment because they are absolutely terrified of what the cost will mean for themselves and their families.

Hospital capacity depends on the number of staff capable of supporting it. You could have a room with a thousand beds, but if you've got two nurses, your capacity is a tiny fraction of that.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#248

Post by standardUser » Tue, Aug 23, 2022, 9:42 PM UTC

buscoquadnary wrote: post #198

I don't think it is coincidental that there is also now a large push in England for State sanctioned suicide. Especially after reading how administrators in Canada are treating it.

Decriminalization of physician-assisted suicide is becoming more popular in a lot of places because it is far more humane than the status quo.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#249

Post by rdl » Tue, Aug 23, 2022, 9:43 PM UTC

mattlondon wrote: post #234

As a UK tax payer, and as a UK tax payer that winces every time they see how much they lose to taxation in their P60 each year (six figures in tax), what are people's solutions to this? It seems like the NHS budget keeps on going up and up and up [1], as does the number of doctors and nurses (while "managers" has either declined or stayed relatively static) [2]. So NHS is getting more funding, and there are more doct…

The best thing about NHS (from my perspective as a US person, although I lived in the UK for a while) is the use of QALYS to allocate budget, rather than spending huge sums on a small number of interventions at extreme cost and limited benefit. Has that focus shifted?

(My personal belief is there should be a level of universal medical care funded by some public entity, probably the nation state currently, but it should be capped at a relatively low level, probably closer to 1% of GDP and allocated on a QALYS and emergency or communicable biased, with private care in a relatively unregulated market outside of that. Probably would end up in the 5% range overall, but with universal access to basic and cost-optimized care and probably a wider variety of private, charity, experimental care.)

We should not spend excessively on medical care vs. other interventions -- it's absurd that in the US we can have homeless people on the street with extremely limited assistance on housing or lifestyle interventions, but as soon as they develop some medical condition, they get essentially unlimited much higher cost intervention to remediate those things, but still nothing to address the underlying cause. There are a bunch of cases where we could shift $1k out of medical spend for $10 in other spend and achieve a better outcome for the person and for broader society.)

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#250

Post by LorenPechtel » Tue, Aug 23, 2022, 9:43 PM UTC

nradov wrote: post #78

SketchySeaBeast wrote: post #58

Earlier quoted context omitted.

Isn't that 10% stat potentially hiding issues of co-pay, deductibles, network range, and actual level of coverage?

Nothing is being hidden. High deductible health plans have been popular, especially among younger consumers. The federal government has specifically promoted those as a way to hold down healthcare expenses, and enrollees receive income tax benefits. https://www.cdc.gov/nchs/products/databriefs/db317.htm Health plans are required to meet network adequacy requirements. https://www.kff.org/health-reform/issue-brief/netw…

Observation: There's adverse selection at work. People do the economics and look at their expected medical spending with both low and high deductible plans--those not expecting substantial bills generally choose the high deductible plans. Insurance companies observe the results of this--those who choose low deductible plans end up costing more.

I've done the math most years and I have yet to find more than a narrow window where you're better off with the low deductible plan than with a high deductible plan and putting aside the savings. Typically there's no window at all, the high deductible plan is always superior. (Note that this generally changes in situations where you pay a *percentage* of your premium, such as subsidized ACA plans.)

If we want to move away from high deductible plans the only way is for Congress to impose it, market forces will always drive it as high as it can legally go.