Thursday, 21 November 2013

The Export And Import Of Health

Over in the USA the long and intricate story of Obamacare is unfolding as the realities of providing mass health services impact on the funding and costing structures.  As ever in reform and reorganisation there are winners and losers.

In health matters, however, there are not supposed to be any losers, especially in complex cases.  It appears that this is happening at an early stage in paying the bills according to the linked article in the Washington Post.

What seems to have happened is that the US Government has become at one and the same time an insurance company impacting on the insurance sector adversely and a health provider injecting administrative uncertainty and unpredictability into provision.

Add to that the software issues about who got the contract, how and did they know what they were doing.  But this has happened at a time when software engineering itself is in the process of transformation. 

It seems that the software issues in many fields are now becoming too big to deal with as this Naked Capitalism piece suggests.  It is a long post and interesting but scroll down to the last two paragraphs if you do not have the time.

Here in the UK we are having our own health care problems, mainly deteriorating health and very patchy care.  There has been a stream of people going to the US of the past and coming back with this idea or that initiative.  Given the organisation of the NHS this has led to centralisation and micro control.

The fundamental of UK health services in the long past were quite different from those of other nations which would always make attempted "transplants" difficult.  The more we try it the worse it gets.  And now we have exported some of it to the USA.

Lately we have taken to appointing people to the top of the NHS who know little about medicine or health and a lot about targets and fancy accounting.  In the present grotesque fiasco over the Co-Operative Bank and its leadership it is not being mentioned that if Labour won the 2015 election the two men concerned had been in the frame to take over the NHS.

As the US looks to the NHS and our NHS looks to the US we may be exporting to each other the worst rather than the best features of our services.  At least this would be consistent with recent government performances.

But there is a real scenario in which we all lose and it may be arriving.  If it does then we are going back to the future and it will be from a past that was very different.  I remember that past and it was not a good place to be if you were ill.

Keep taking the pills, for as long as they last.

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