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What Having Polio Taught Me About Immigration and Healthcare
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I caught polio at the age of six in an epidemic in Cork in 1956 and was taken to St Finbarr’s hospital in the city where I was well treated by the doctors and nurses. The fever passed but the virus had crippled the muscles of my back and legs so I was moved to another hospital nearby called St Mary’s at Gurranebraher, where the patients, mostly young children, were appallingly mistreated.

The nurses viewed the polio victims they were supposed to help as the irritating cause of them having to work and were angry when crippled patients asked for anything. I remember one nurse screaming at a small boy who had defecated in his bed because he was too weak to move and her saying that, if he did so again, he would be forced to eat his own excreta. I listened in terror and feared the same thing might happen to me.

The nurses maintained a rough barrack-room discipline, but I was bullied by older boys who smashed the toys brought by my parents. Years later I met Maureen O’Sullivan, a tireless volunteer nurse who drove a Red Cross ambulance during the epidemic, and she told me that the problem at the hospital was that “it lacked professional staff and there was a shortage of trained people. Many of the nurses looked at it just as a job and not a vocation. The main problem was always lack of resources.”

I stopped eating and speaking and my parents believed, almost certainly rightly, that I was dying. The doctors, who were a rather distant and ineffective presence in the hospital, believed that my deterioration was somehow connected with the polio. They noticed that the care of patients was poor, but they were told by the senior matron that she had great difficulty in recruiting nurses though untrained carers were easy enough to find

After 13 weeks at Gurranebraher, my parents brought me home where I rapidly recovered my spirits, though I was confined to a wheelchair.

A year later, I went to the Whitechapel hospital in London for an operation on the surviving muscles in my legs, which would enable me to walk again. I was surprised to find that many of the nurses in Whitechapel were Irish. In sharp contrast to what I had in Gurranebraher, they were kind, attentive and well trained.

The problem in Ireland in the 1950s was not so much a lack of nurses, but the fact that so many of the best of them had gone to Britain because of better pay, conditions and prospects. In coping with a rapidly spreading polio epidemic, the Irish health authorities had concentrated their best-trained and most experienced personnel to treat those who had just been diagnosed with the disease in St Finbarr’s, and had left the other hospitals to get by as best they could.

This problem has not gone away in the following 60 years. The British healthcare system remains extraordinarily reliant on attracting doctors and nurses from poorer parts of the world, notably Africa and South Asia, with damaging – and at time disastrous – consequences for the health of people in countries denuded of their best trained health workers.

“In the UK, over a third of the registered doctors are not originally from the UK and nearly half of nurses are from overseas,” says Rachel Jenkins, Professor Emeritus at the Institute of Psychiatry at King’s College, London, in an editorial in the journal International Psychiatry prefacing detailed papers on the brain drain of medical specialists from the poor to the rich.

Jenkins writes that – in a similar way to the polio epidemic in Ireland that I had experienced – “the dangers are exemplified by the recent outbreak of Ebola in West Africa, which was able to spread so rapidly because of weak health systems. Those systems would have been significantly stronger had it not been for health worker migration to the UK.”

The numbers involved are strikingly large. Out of a total of 255,141 doctors registered in the UK, no fewer than 82,866 or 36.4 per cent were trained elsewhere. Put simply, the UK population depends for its high standard of healthcare on health professionals trained elsewhere and the demand for which can only rise with the ageing of the British population.

The economic gain to Britain, and the proportionate loss to some of the poorest countries in the world, is very high. Jenkins points out that it costs £220,000 to train a doctor in the UK and £125,000 to train a nurse. If the training is done elsewhere, this implies a saving to the benefit of the UK of £65m from the employment of 293 Ghanaian doctors and £38m from the employment of 1,021 Ghanaian nurses, a sum that exceeds the annual UK aid to Ghana.

This unrecognised subsidy to Britain by poor countries has produced great dollops of hypocrisy about the recipients of aid. The Department for International Development (DFID) in the UK said in a report this summer that “our focus is on helping Ghana to end its reliance on aid and become a strong trading partner for the UK”.

Solutions to the present toxic situation in which the poor subsidise the healthcare of the rich – and thereby deplete their own health systems – are twofold: wealthy countries like Britain should build up their own training of doctors and nurses to a level that meets demand. Poorer states, for their part, should improve pay and conditions for their own health professionals to the point that emigration ceases to be such an attractive option.

Such a change in British government policy is unlikely because the current deeply unfair system is, from its point of view, too good a deal. Jenkins argues that the situation will only change for the better “when rich countries assume some responsibility for reimbursing the country of origin for each foreign-born health worker”. This would give such countries the money to rebuild their healthcare systems.

ORDER IT NOW

Western states all benefit from siphoning off health professionals: some 23 per cent of the doctors in the US were trained abroad and 64 per cent come from low- or middle-income countries. This is not a statistic likely to be mentioned by President Trump as he denigrates immigrants in general as parasites taking jobs from native-born Americans.

The advocates of Brexit in Britain, conscious that opposition to immigration has been the core issue driving their success, have never wanted foreign health workers to be emblematic of immigration, perhaps conscious that a YouGov poll shows that 76 per cent of the British population welcomes them or would like more to come.

There is some understanding of how necessary this migration of doctors and nurses is to ill people in Britain, but little knowledge of the damage it does to the countries they come from. Foreign aid would be more popular if it was presented as compensation for the huge hidden benefits the UK gets from this sort of immigration, giving poorer countries the money to fill the gap in their own healthcare systems that the migrants leave behind them.

(Republished from The Independent by permission of author or representative)
 
• Category: Ideology • Tags: Immigration 
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  1. fnn says:

    New problems would arise if you created a privileged high income caste of health care workers in Third World countries. For example, criminals and bureaucrats would find ways to get some of that money for themselves. Also family members, as Theodore Dalrymple explains:

    http://takimag.com/article/rule_reversal_theodore_dalrymple/

    When I worked briefly as a junior doctor in Rhodesia, as it then still was, under a settler or colonial regime, I noticed something else whose significance it took me years to appreciate, being far less an observer and thinker than Leys.

    Black doctors were paid the same as white doctors, unlike in neighboring South Africa; but while I lived like a king on my salary, the black doctors on the same salary lived in penury and near-squalor. Why was that?

    The answer was really rather obvious, though it took me a long time to realize it. While I had only myself to consider, the black doctors, being at the very peak of the African pyramid as far as employment was concerned, had to share their salary with their extended family and others: It was a profound social obligation for them to do so and was, in fact, morally attractive.

  2. We are ill served by foreign-trained doctors and nurses who, lacking empathy for our people, do not do their best. They are cruel and neglectful of our people because they are–like everyone–consciously or subconsciously, racists. They are less talented and well trained to begin with as the number and frequency of malpractice suits bear out.

    We and they would be better served if they remained in their home countries. Let their own civilizations learn to produce their own doctors utilizing their own notions of medicine as their culture interprets it. Leave our’s to do so as well.

    As usual, meddling in the natural order of things makes things worse by creating more problems than it solves. Respect people’s differences and the uniqueness of cultures.

    • Agree: densa, YetAnotherAnon
  3. Citizens of the USA are about to learn a lesson about the relation between polio-like diseases and immigration.

    Right now the USA is suffering the first stages of an epidemic involving a polio-like disease most likely associated the entero-virus EV-D68. Prior outbreaks of diseases associated with EV-D68 in the USA correlate highly with locations to which the Obama administration directed immigrants from Central America, a region where EV-D68 has always been endemic, although until recently it was non-existent in the USA.

    I worked in a state public health department when this pattern first emerged. For purely political reasons the obvious epidemiology was ignored. The MSM also did their part to cover up this public health issue. Even now the cover-up continues.

    Mr. Cockburn is correct when he notes that emigration of third-world countries’ health care workers to the developed countries has had a disastrous impact on third-world health care. But he fails to note that the impact on the health care in the countries receiving these immigrant doctors and nurses has also been negative. By the medical standards of developed countries many, if not most, of these immigrant nurses and doctors are ill-trained and provide sub-standard – often dangerously sub-standard – levels of care. Horror stories are common but beyond these there has been an overall deterioration in the level of care provided. Cultural issues abound, for which the issue of sexual harassment of patients by third world doctors in the UK provides abundant evidence.

    Finally, Mr. Cockburn carefully elides the reason why such deleterious importation of medical personnel continues despite its negative impacts on both countries of origin and destination. The socialized medicine provided by, e.g., the UK’s National Health Service, is gradually bankrupting countries with such medical systems. The countries with these medical systems cannot support paying sufficient, fully qualified staff to man their systems. The salaries and working conditions have drastically reduced the numbers of fully qualified medical personnel willing to work within these systems. Without massive and probably unsustainable increases in government funding only the subsidy of poorly trained immigrant medical personnel, drawn from third world countries, keeps these failing medical systems in operation.

    • Agree: Sarah Toga
    • Replies: @densa
  4. MarkinLA says:

    This is the outcome when the money is the primary source of resource allocation and everything is viewed through the lens of economics. The stories of foreign doctors cheating the system or being incompetent or lying about their capabilities are endless. However, they are cheaper than the home grown entity.

    Of course doctors and nurses should make a good living – some should even get rich if they invent truely revolutionary therapies. But a country is always better off developing it’s own talent no matter what it costs.

  5. the UK population depends for its high standard of healthcare on health professionals trained elsewhere

    A 2014 study by University College London found that ‘Half of foreign doctors are below British standards’, so health professionals trained elsewhere are actually dragging the standard down.

    • Replies: @llloyd
  6. densa says:
    @Jus' Sayin'...

    I notice that current outbreaks are prefaced with disclaimers such as it’s not a new disease, but that’s not true. It’s being called a reemergent virus, one that is mutating and can be polio-like and deadly now instead of only respiratory.

    Rejoice in our ‘diversity’ because we’re ground zero for breeding new strains. It may have come from African immigrants or Central American immigrants our Asian immigrants but it is American now.

  7. “wealthy countries like Britain should build up their own training of doctors and nurses to a level that meets demand”

    Absolutely. We managed pretty well without them in the past.

    “The economic gain to Britain… is very high.”

    Is it? Surely it would be a lot higher if we trained more of our own doctors? Plus overseas doctors and nurses are hugely over-represented in “fitness to practice” disciplinary hearings, for reasons ranging from corruption through incompetence to sexual assault.

    One thing you fail to mention is that the student medic cohort in the UK is now more than 50% female, a huge change from the days when you were a in a London hospital. Now there’s nowt wrong with that, except that male doctors tend to work full time and female doctors don’t, especially once they have children (I don’t know any female GPs with kids who work full time). So you need maybe 3 female trainees to produce one full time doctor. Perhaps this is why we import doctors.

    • Replies: @James N. Kennett
    , @Altai
  8. Well, at least if the UK paid for the training of Third-World doctors and nurses, it would be a better use of its foreign aid budget than the usual “helicopters for tyrants”.

    However, the problem has a flip side. The NHS has difficulty retaining staff. The problem is not that doctors and nurses are underpaid, but that they must work in an environment that is understaffed, underfunded, chaotic, and likely to demand much greater personal commitment and flexibility than most other jobs.

    One of the results is that many British doctors and nurses emigrate to other countries – Australia, Canada and the USA. The NHS then replaces them with staff from Africa and the Middle East.

  9. @YetAnotherAnon

    One thing you fail to mention is that the student medic cohort in the UK is now more than 50% female, a huge change from the days when you were a in a London hospital. Now there’s nowt wrong with that, except that male doctors tend to work full time and female doctors don’t, especially once they have children (I don’t know any female GPs with kids who work full time). So you need maybe 3 female trainees to produce one full time doctor. Perhaps this is why we import doctors.

    This is true. The Primary Care service is in grave difficulty, and this is one of the reasons. It is even worse than you say because when male GPs see their female colleagues achieving a better work/life balance, they are likely to do the same. The enforcement of gender diversity is one of the factors that has destroyed the expectation that a newly qualified doctor would work full-time for 40 years.

    On top of this, GPs were given an extraordinarily generous contract in the Gordon Brown years. They were paid a lot more, but with no increase in the permitted size of their pension pot. Many doctors maxed out their pension and then immediately took early retirement. For new recruits the message was “we don’t expect you to work full-time for 40 years”.

    These changes show that well-meaning ideas, and more generous funding, can have adverse consequences.

  10. Altai says:
    @YetAnotherAnon

    One thing which is never mentioned is the artificial constriction of medics in a lot of Western countries. This serves to keep medic wages high. (Though junior doctors in the modern era aren’t earning what they used to, perhaps due to foreign doctors being so much more numerous now, originally they used to be sidelined for promotions and native doctors stepped up on them keeping them from competing with the native doctors, but I’m not sure if this is still the practice.)

    The argument is that this also ensures a higher level of professionalism, but when you look at the test scores and other details of the rejected medical school applicants, you have a long way to go before you hit any noticeable drop in credentials. You could increase the output of medics considerably.

    Tight labour markets and professional unions (Sorry, associations, unions are for proles.) for me but not for thee.

    • Replies: @Jus' Sayin'...
  11. Blacks make bad health care workers generally because they are generally dumb and lazy, African doctors, (because they are a lot more intelligent than the majority of their race) are arrogant and lack the desire to learn anything new. Same goes for healthcare workers from the Indian subcontinent. Health care workers from the far east tend to be much better. Automation will take the place of many of the nastier jobs in health care in the next 20 years and the dependence on foreign labor will be lessened. Automation will take the place of many doctors also with machines automatically diagnosing disease and recommending a course of treatment.

  12. @Altai

    The US medical system was last reformed over a century ago, in response to critiques made in the Flexner Report https://en.wikipedia.org/wiki/Flexner_Report. Many of the resulting reforms of the USA’s medical system were ultimately adopted by other countries. But since then a great deal has changed and another major review and reform of the medical system is in order.

    Currently there are two major drains on medical system resources in developed countries: (1) use of primary care physicians and hospital emergency rooms for services that could best be performed by less expensive staff and facilities; and (2) waste of resources keeping very sick – often terminally ill – patients alive and in discomfort, when there is little if any hope of their recovery and return to a normal life,

    The first issue could be readily resolved. The US military’s medical system provides a possible model. The military system employs filtering at every level. Patients start by seeing a corpsman who evaluates their symptoms and either provides appropriate, low level care or refers the patient to an appropriate higher level of medical evaluation and treatment, e.g., a nurse or nurse practitioner. Costly medical resources are reserved for those patients truly needing them. The medical system is bottom heavy with medical staff below the level of MDs rather than top heavy with MDs and MD specialists as is the case with the civilian system. The military’s medical education establishment is designed to staff their medical system appropriately.

    The second problem is less easily resolved. It requires reeducating the public and the medical professions that a comfortable and dignified death is often a far better medical treatment for elderly and failing patients, terminally ill patients, and even many patients whose continued existence is possible but only at enormous cost and discomfort. It also requires a refocus in the medical community away from “heroic” measures and towards the alleviation of pain, dignified care for patients, and a recognition that death is the natural end to life.

  13. llloyd says: • Website
    @Johnny Rottenborough

    Presumably the other half are above. That is the same as the UK doctors. I am being a little facetious. I read two completely contradictory versions of foreign health workers. There seem to be spectacular cases of corrupt and ill qualified foreign health workers, and many more superior and kinder foreign health workers. I guess it’s a lottery.

    • Replies: @Johnny Rottenborough
  14. “The British healthcare system remains extraordinarily reliant on attracting doctors and nurses from poorer parts of the world ….”

    Replace “attracting” with “strip mining.”

  15. @llloyd

    llloyd—On one hand, ‘many more superior and kinder foreign health workers.’ On the other hand, the newspaper report in my comment says: ‘…foreign-trained doctors…make up almost a third of all NHS doctors but account for approximately two thirds of those struck off each year.’ A more recent report says: ‘…doctors from every country apart from South Africa were more likely to face an incompetence investigation than their British counterparts.’

    • Replies: @jim jones
  16. anarchyst says:

    Columnist John Myers, a Canadian who often visits the United States wrote this about the Canadian vs. American health care system:

    United States: “My wife picked me up from the pool and took me to Rockwood Clinic. In minutes, I had a cardiologist hooking me up to an EKG machine and a nurse giving me an aspirin and testing my blood to see if I was having a heart attack. I got the results while I was there and was told nothing to worry about. I was suffering tachycardia, which is when the heart beats dangerously fast.”

    Canada: “I couldn’t catch my breath, so my wife rushed me to the emergency room at the Rockyview General Hospital. Even as I gasped for air, the triage nurse would not look at me. When my wife, who had once worked at that hospital, complained, she was told that the emergency room was ‘very busy.’

    “I didn’t want to die on some cot in a hallway. And that kind of thing happens too often in Canada. In Winnipeg, Manitoba, a man named Brian Sinclair died during his 34-hour wait to see a doctor at an emergency health clinic. The medical examiner said that he had been dead for a couple hours before the clinic staff even noticed him.

    “Because of such stories and my own personal experiences with socialized medicine I begged my wife to take me home. Once she measured my pulse at a reasonable 110 beats per minute, she did take me home. I continued to improve throughout the night. The next morning, we lined up for two hours at a nearby doctor’s clinic. I was one of the 60 or 70 patients the doctor would see that day. The good news is that the doctor said my heart seems to be ‘OK,’ whatever that means. And he gave me an appointment to go see a cardiologist – in February”

    This took place in September, and an example of what we Americans will soon be subjected to. Anyone who says otherwise needs to explain how it’s going to work when 40 million new recipients of Obamacare come into the system without an attendant rise in doctors. He or she needs to explain how there WON’T be rationing of health care. You will be standing in long lines behind the third world to receive American health care.
    How’s that Hope and Change working out for you Obama voters now?

    As a Canadian, I don’t think my country’s health care system is really that good at all. It’s harder and harder to get health care that is ‘free’. If I want to see a dentist, I can see one tomorrow, but I pay either out-of-pocket or via private insurance coverage. If I want to see a doctor (which unlike a dentist is ‘free’), I have no choice but to go to a walk-in medical clinic and wait hours for a surly doctor who doesn’t even listen to me and ushers me out as fast as he/she can. Contrast this with a visit to the dentist, who is invariably chatty and pleasant and provides top-quality care. That’s what free health care is about – hardly anything is free, and getting that which is free is invariably not a pleasant experience to go through at all!

    A relative of mine in Canada died while waiting for his chemotherapy to begin. As in waiting months for the treatment to start after his diagnosis. Besides, the media in the US and Canada simply post poll information that’s made up – “adjusted” – in many cases. I know this from having actually worked as a television news writer for several years. I was just a kid, and thank heaven I woke up and made a run for it. The “news directors” all seemed to come from the same mold; fat, messy hair, grimy beard, slovenly, Marxist to the core, self-deceptive hate filled red diaper babies from New York. And when I say hate, I mean an easily discernible hatred of Whites, America, and the West in general. Self satisfied pigs, all of them. Tom Wolfe would have had a field day watching what went on.

    • Replies: @llloyd
    , @JackOH
  17. anarchyst says:

    There are problems in the American health care system, BUT, comparisons to other countries is off-base. If you need a CT scan or other high-tech procedure here in the USA, you will get one, almost immediately.
    In addition, ANYONE who shows up at a hospital emergency room WILL be treated without consideration of “who will pay the bill”. This is the case in ALL medical facilities that have emergency rooms and urgent care centers in the United States, and is mandated by law.
    Our neighbor to the north, which has excellent medical staff, routinely rations CT scans and other high-tech procedures, as these machines and procedures are far less available due to cost considerations. You might have to wait 3 months for the same CT scan in Canada. A number of years ago, Canadian hospitals were caught providing CT scans for veterinarians’ animals, while humans were on waiting lists for use of the machines. You see, veterinarians paid cash “up front” for use of the machines.
    A dirty little secret of Canadian health care, is that some patients are referred to American border-city hospitals for treatment if they squawk loud enough. In addition, Canadian politicians and movers and shakers routinely come to the United States for medical treatment.
    Look at Great Britain’s National Health Service which routinely rations health care as well as exacting death sentences on humans because of cost. Recently, a British subject (baby) was refused potentially life-saving treatment not only in Great Britain, but also in the United States. The parents had the money to pay for the treatment here in the United States, but Britain’s National Health Service would not allow the baby to leave. A similar situation is unfolding, as the “National Health Service” refuses to allow the parents to take their child to Italy for treatment. What kind of health-care is that?
    Socialized health care is fine for cuts, scrapes, and bruises, but when it comes to high-tech procedures, there are always cost considerations. Anyone can see that government-imposed solutions almost never work.
    It is interesting to note, that in Canada, Great Britain, and other “socialized medicine” countries, private supplemental health insurance is necessary in order to receive decent medical treatment.
    The problem is not health care, but health INSURANCE which artificially masks the true costs of health care.
    Going back to a “fee for services” like in the pre-HMO days of medicine would be an improvement as there would be competition for health care services.
    Two good examples of successful “fee for services” medicine are plastic surgery and laser refractive surgery (eyes). Both plastic surgeons and ophthalmologists offer discounts for their procedures. In fact, prices for these procedures are constantly dropping.
    A good distinction can be made between HMOs and automobile insurance.
    Automobile insurance pays for accidents and damage to vehicles, nothing more. If automobile insurance were run like HMOs, they would pay for vehicle maintenance,oil-changes and the like.
    Yes, the American health-care system needs improvement, but socialized medicine is not the right approach.

    • Replies: @Logan
  18. Cockburn and his ilk is a great argument for keeping the Irish out of Britain. The Irish are obsolete excavating equipment.

  19. It is good to see a look at this problem from the supply side. I assume the situation isn’t much different in other European countries and in the United States. Are the native doctors lobbying to keep their numbers down or is the cost of education the principal cause? In any case, it is outrageous that modern Western countries cannot or will not pay for the schools to supply themselves with the doctors they need.

    • Replies: @MarkinLA
    , @anon
  20. Sean says:

    The Irish have a high rate of schizophrenia, that might explain some of the unhappy childhoods there. I dare say their best and least cold and difficult people left for Britain, and many of those remaining were irascible.

    I think it is not so much the cost of training doctors as paying them. The BMA, which is in effect a doctors’ trade union, is responsible for restricting the number of doctors trained in order to keep the pay of a doctor high. Simple supply and demand dictates that the British national health service can save money by bringing doctors from aboard. It is difficult to get into medical school in Britain now, and that selectivity does mean that the doctors from abroad really are of a significantly lower standard.

  21. anon[199] • Disclaimer says:

    The nurses viewed the polio victims they were supposed to help as the irritating cause of them having to work and were angry when crippled patients asked for anything. I remember one nurse screaming at a small boy who had defecated in his bed because he was too weak to move and her saying that, if he did so again, he would be forced to eat his own excreta. I listened in terror and feared the same thing might happen to me.

    i saw mistreatment of an old man in a U.S. hospital about 10 years ago

    it still goes on

  22. MarkinLA says:
    @Tono Bungay

    It has to do with the way doctors are trained in the US. There are not enough slots in either medical schools or for residency at hospitals that train the doctors.

  23. llloyd says: • Website
    @anarchyst

    In China, it appears quite simple for a billion and a half people. Medical health clinics are in every neighbourhood within generally walking distance. No general practioners. You go straight in and at most within a few hours to a specialist. You are immedately tested. Some times excessive there. I was blood tested for blocked ears. All medical care for citizens and non nationals is 50 percent subsidised by the Government. People still with financial difficulty can borrow without interest from a bank or their family or friends. It greatly helps the Chinese are thrifty and generally healthy. Tradional diet still mostly, and Chinese are not risk takers. The medicine as in real socialist countries works for the people for long term health. No vast bureaucracies and mega paid CEOs. No third world medical staff . I have only ever seen Chinese staff. Now wouldn’t that be nice in capitalist countries!

    • Replies: @anon
    , @MarkinLA
  24. MEH 0910 says:

  25. JackOH says:
    @anarchyst

    anarchyst, you’re seeing the front end of American health care, which indeed appears very good for those to whom it appears very good. The back end is very bad, e. g., the 89th Congress pretty much gave away the Treasury to overcome the medical establishment’s opposition to Medicare.

    America’s unique group health insurance is an excise tax on labor, which strongly incentivizes outsourcing, off-shoring, and bankruptcies to get out from under the health care burden that employers imposed on themselves in the 1940s to block national health care, thought to be a precursor to even more government intervention in the private sector.

    IOW-the clock is and has been ticking on America’s profligate health care schemes.

    • Agree: densa
    • Replies: @anarchyst
  26. anon[174] • Disclaimer says:
    @Tono Bungay

    Are the native doctors lobbying to keep their numbers down or is the cost of education the principal cause? In any case, it is outrageous that modern Western countries cannot or will not pay for the schools to supply themselves with the doctors they need.

    its a created shortage, probably so they have an excuse to bring in foreign “doctors”

  27. anon[174] • Disclaimer says:
    @llloyd

    The medicine as in real socialist countries works for the people for long term health. No vast bureaucracies and mega paid CEOs. No third world medical staff . I have only ever seen Chinese staff. Now wouldn’t that be nice in capitalist countries!

    you left out one part – no mexicans and blacks clogging up the Emergency Rooms with their sore throats

  28. MarkinLA says:
    @llloyd

    Medical care in Japan is quite good based on what I have seen in the media. The problem is that doctors and hospitals don’t make a very good living as compared to their contemporaries in the rest of the industrialized world.

    Every system has it’s Achilles heel. In the US it is affordability. In other places it is quick access to various specialties or doctors making little more than some low level engineer.

    Any medical system can be made cheap and available if you just remove expensive heroic therapies like we have for end of life and near death procedures. During the Civil War if you were gut-shot you had some time to sit down and write the last letter to your family. If that was the prevailing policy toward terminal illnesses we would save tens if not hundreds of billions of dollars a year as well as the time of the doctors and nurses. Of course, there wouldn’t be millionaire doctors either.

    • Replies: @JLK
  29. anarchyst says:
    @JackOH

    You are correct that the “health insurance system” in the United States was a result of “price and wage controls” instituted during WW2 to try to restrain inflationary effects of massive increases in wartime production. Since wages were controlled, health insurance was the benefit used by employers to attract workers.
    However, Teddy Kennedy’s “HMO” (Health Maintenance Organization) was the scam that affects us to this very day. The intent was to use the medical system to “keep patients well”, but has been an utter failure.
    If we went back to a “fee for services” system, you would see health care expenses drop, as competition would be a part of the health care marketplace.

    • Replies: @JackOH
    , @MarkinLA
  30. JLK says:
    @MarkinLA

    Medical care in Japan is quite good based on what I have seen in the media. The problem is that doctors and hospitals don’t make a very good living as compared to their contemporaries in the rest of the industrialized world.

    It’s even worse in the post-Soviet countries like Ukraine. I’ve read that checkout clerks at the grocery stores make more than the doctors who work for the national health service.

  31. JackOH says:
    @anarchyst

    “You are correct that the “health insurance system” in the United States was a result of “price and wage controls” instituted during WW2 to try to restrain inflationary effects of massive increases in wartime production. Since wages were controlled, health insurance was the benefit used by employers to attract workers.”

    anarchyst, buddy, that’s not quite what I said, but the idea of group health insurance as a work-around wage and price controls is a shibboleth that awaits a more enlightened government to dispel.

    Employers didn’t drop group health insurance at all after wage and price controls were lifted in 1946, and the population covered by group health continued to expand until it reached a bit more than half of all Americans in the late 1950s, which is where it’s stayed at.

    • Replies: @anarchyst
  32. MarkinLA says:
    @anarchyst

    If we went back to a “fee for services” system, you would see health care expenses drop, as competition would be a part of the health care marketplace.

    Don’t bogart that joint, my friend.

    Competition as a panacea for healthcare costs is a pipedream. Even price, as a “voluntary” limiting factor, is unrealistic. The bottom line is that everyone wants all the healthcare they can get. They want to be as healthy as possible. Everybody knows that once you have lost your health, you have effectively lost your life, you are simply waiting for the grim reaper. Just visit any old folks home.

    The only reason why the prices for elective uninsured voluntary procedures drop is because the market is limited in who actually has the money to do it and nobody needs it. However, the really good ones don’t compete on price. You don’t see the plastic surgeons to the stars cutting their prices.

    The vast majority of medicine is already fee for service. However the fees are beyond what anybody without insurance can pay. Why do hospitals bill you for 50,000 dollars when they know the insurance company will only pay 10,000? If you don’t have insurance, it is entirely up to them how much of that 50,000 you will have to pay. They don’t have to negotiate with you if they don’t want to. If you have the money, the only thing you have is the threat of holding them off until the court issues a judgement against you.

    Now they might argue that if the bill were 10,000 the insurance company would only want to pay 2,000 but that is ridiculous. The insurance companies know what these things cost and know what it takes to make a reasonable profit – the same as they know what the real price is for au auto body repair. Som have told me it is to be able to write off that 40,000 as a loss on their taxes. That doesn’t make much sense to me especially simce many are non-profit to begin with. I don;t see how you can argue that somebody who’s insurance settled with you for their contracted amount is also a charity case.

    Hospitals and doctors are not competing for you business. They don’t have to or did you think waiting an hour to see a GP or waiting 2 months for a non emergency appointment is just some trick they pull on you? They have a limited resource (their time) and an unlimited demand.

    Maybe automation will help remove some of the mundane stuff like the use of Nurse Practitioners is doing but we are a long way off from that.

    Where automation will really help is in all the advanced tools that need trained technicians. There is no reason why a robot cannot do an ultrascan on somebody and have the results ready for the physician. The same is true for a CAT scan or MRI. Using the same techniques as facial recognition the automated machine can tell the sibject where to go and how to move so there is no need for a technician doing it.

    • Replies: @anon
  33. Alfred says:

    This article assumes that one doctor from Nigeria, Pakistan or India is equivalent to one doctor from Imperial College, London. That is pure nonsense. Many excellent British doctors (including my ex-wife) emigrate to places like Australia. Working in the UK has become too stressful and the game is no longer worth it to them.

    The reality is that British politicians are essentially socialist lawyers who have absolutely no idea how to organise a complex system and they are constantly looking for short-term fixes that exacerbate the problem. The training of British doctors and nurses has not increased for decades while the population has increased in numbers and has aged. Instead of remedying this situation by increasing the capacity of the teaching hospitals, it is appears to these idiots that importing “doctors” from the 3rd world will solve the problem. Socialist thinking by bureaucrats.

    The number of malpractice cases against foreign-trained doctors is a multiple of that of locally-trained doctors – and I do not mean doctors trained in France and Germany. Recently, a “doctor” from the Asian subcontinent decapitated a baby during delivery – she is still working at her old job.

    “Baby ‘accidentally decapitated inside mother’s womb’ during delivery”

    https://www.independent.co.uk/news/uk/home-news/decapitated-baby-doctor-mothers-womb-delivery-death-vaishnavy-laxman-tribunal-ninewells-hospital-a8344696.html

  34. All nurses are like this nowadays. Got parents in a nursing home? Guess what? They are getting the treatment alright. It doesn’t matter what race they are. The white trash ones are just as bad as the others. The problem is the generation. The young are taught sociopathy in their mother’s milk. They just do not care if anyone other than themselves lives or dies. More important is thumb-typing and computer-shopping. While your parents care for themselves. After all, god helps those and all that. Isn’t that what you believe? I think, actually that patients have a lot of gall expecting treatment. Let them pull themselves up from cancer by their own bootstraps. That’s the freemarket way!

  35. Logan says:
    @anarchyst

    Health care always has been and always will be “rationed.” By time, by money, by insurance, by “connections.” By something.

    It is a good for which demand is nearly infinite, but for which supply is by definition limited. As such, there has to be some way to decide who gets what and therefore who doesn’t.

    Take Canada. In theory everybody gets the same health care. But in the real world a star hockey player, politician or wealthy businessman will simply not receive the same level of care as a homeless guy.

    In fact, as our technological abilities continue to increase, the spread between the “best possible medical care” and our ability to pay for providing that level of care to all will grow. Which gets us back to figuring out how to distribute the available resources.

    But everybody on all sides likes to pretend that their preferrred way of organizing and paying for health care will avoid the need to make hard choices.

    • Replies: @anon
  36. JackOH says:

    I think it’s worth noting that humans have been around for millennia without anything like modern health care. Self-care, prayers for divine intervention, spontaneous remission, and the like. Once past perinatal age, and barring disease, accident, and trauma by violence, one stood a pretty good chance of living into old age.

    Many diseases have been curbed and lives extended, not by individual practitioners, but by good science and energetic and relatively inexpensive public health measures.

    • Replies: @anon
  37. RodW says:

    Having watched U.K. healthcare being destroyed by brown doctors, I say send them all back. In comparison to U.K. medicine, Japanese healthcare is far superior. Of course there are no brown doctors in Japan yet, although experiments with brown nurses for the elderly have predictably not gone well.

  38. anarchyst says:
    @JackOH

    Employers did not drop health insurance because prospective employees got “used to it” and expected it to be an employee benefit, which employers used to entice prospective employees. Let’s not forget that labor unions also had a big interest in these plans.
    Before Teddy Kennedy’s foray into “health maintenance organizations” health insurance was for CATASTROPHIC situations, NOT for routine health care expenses.

    • Replies: @MarkinLA
  39. APilgrim says:

    Lots of British physicians have moved to the USA.

    England, Ireland, Wales, & Scottish doctors are everywhere. Also physicians from Canada, Mexico, and India. Not just doctors from 3rd world Sheetholes. Most of their care is excellent.

    A large number of Muhammadan physicians provide substandard care, & are thieves, IMHPO. But some Muhammadan physicians are dedicated to their patients.

  40. anon[112] • Disclaimer says:
    @MarkinLA

    there is a hospital or surgery center in Oklahoma that posts its prices online and only takes cash or check etc iirc and the prices are relatively inexpensive, maybe 50% less or so

    i think a few of the problems facing hospitals are the paperwork problems with insurance and also the large amount of illegals that dont pay and thusly have to be subsidized by the other customers

    • Replies: @MarkinLA
  41. anon[112] • Disclaimer says:
    @JackOH

    better than any of these “healthcare” plans would be to grow your own garden with fresh vegetables year round

  42. anon[112] • Disclaimer says:
    @Logan

    Take Canada. In theory everybody gets the same health care. But in the real world a star hockey player, politician or wealthy businessman will simply not receive the same level of care as a homeless guy.

    so?

    what does the homeless bum contribute to society? nothing

    he’s lucky others are paying for him

  43. MarkinLA says:
    @anon

    That may be true but why the 400% markup on what they contract with heath insurance companies?

  44. MarkinLA says:
    @anarchyst

    When you are billed 2000 dollars for an MRI just to determine what is wrong with your hip, it is not something the average person can pay for by himself.

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