Posts Tagged ‘Sickness’

William Blackley’s 19th Century Plan for ‘National Insurance’

March 14, 2016

Looking through Pauline Gregg’s book, The Welfare State, I found this very interesting passage discussing William Blackley’s scheme in 1878 for setting up something very much like the National Insurance that forms part of the Social Security system set up as part of the welfare State. She writes

It [the 19th century movement for social reform] included the suggestions of a Church of England clergyman, the Reverend William Lewery Blackley, who, in the last quarter of the nineteenth century, advanced the notion of basing social security upon an insurance principle. His scheme was startlingly simple. There would be a compulsory levy on all wage- or income-earners from the age of about seventeen, the total amount payable by each person to be assessed according to his earnings by a National Friendly Society or Club. But though the total payment was fixed, the time taken to pay it was at the payer’s discretion, with an outside age limit of twenty-one, and there might be a reducation for rapid payment. It is remarkable how much of the scheme later adopted by the Government was anticipated by Blackley. Arguing that the instrument of the National Friendly Club would need to be present in every parish, he seized upon the Post Office as the executor of his plan. Going to the source of income, as the National Insurance Acts to, he put the onus on employers to deduct the instalments of the national tax from wages, and he made proof of payment depend upon stamps stuck upon a card. The amount paid was thus readily ascertainable, and when a card was fully stamped the holder was exempt from further payments. In return for the sum of £10, which Blackley tentatively suggested as an average amount of levy, claims of something like 8s. a week for sickness and 4s a week as pension over the age of seventy were proposed. Not only would his scheme take away the stigma of Poor Law relief from the old and the sick, but, since the rich would be paying higher contributions and would not claim benefits, funds would accumulate and the National Friendly Club remain permanently solvent. In anticipating the actual words ‘National Insurance’ in the title of one of his articles in the Nineteenth Century Review in 1878 Blackley was in some doubt. “I have long hesitated”, he wrote, “before fixing on such a title as I have chosen for the present writing, from a knowledge that its very sound may induce most readers to pass it over as a matter so extravagant, impracticable, and Utopian, as to be unworthy of serious consideration.”

(Pp. 8-9).

Unfortunately, few people did consider his scheme worth considering. It’s a pity, because if the plan had been put into action, much of the squalor and suffering of the Victorian age could have been alleviated, and the foundation of the welfare state put in place forty years early.

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Robin Cook’s Attack on Private Health Insurance for the NHS

March 15, 2015

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I’ve blogged several times about the threat to the NHS from the Tories and the Lib Dems. There are 92 Conservative and Lib Dem ministers, who advocate the privatisation of the Health Service, and who stand personally to gain from it. They include Iain Duncan Smith, the current minister for culling the poor, the sick and the old. Andrew Lansley, the current health minister, has openly stated he is in favour of privatising it. So has Nigel Farage, and the Unterkippergruppenfuhrer, Paul Nuttall.

I blogged earlier today about the Fuhrage’s forked tongue about the NHS, and how he follows the Tory policy going all the way back to Thatcher of promising to defend it while secretly plotting how to sell it off. In the 1980s, Thatcher set up a review into the NHS and its funding. This so alarmed Labour’s Robin Cook, that he wrote a Fabian pamphlet, Life Begins at 40: In Defence of the NHS, attacking possible proposals to privatise the Health Service.

Previous reviews had given the NHS a clean bill of health. The extremely high quality of the NHS and its doctors was recognised by the heads of American healthcare firms: Dr Marvin Goldberg, chief executive of the AMI health group, told a parliamentary select committee that the Health Service provides ‘outstanding health care and British NHS hospitals are at least as good as those in America while British doctors are better.’

The then Conservative MP for Newbury, Michael McNair-Wilson, also testified to the effectiveness of the NHS. He had suffered kidney failure. He had private health insurance, but it did not cover operations such as the one he needed because of the expense. He said ‘I have cost the NHS tens of thousands of pounds – much more than I could have afforded privately … Had my treatment depended on my ability to pay, I would not be alive today.’

Pre-NHS Britain: Some Areas Completely Without Hospitals

Cook’s pamphlet also graphically described the patchwork state of healthcare in Britain before the NHS. In London, where there were plenty of paying customers, there could be hospitals in neighbouring streets. Out in the poorer British provinces, there were hardly any, and many operations were carried out not by surgeons but by GPs. He cites Julian Tudor Hart’s book, A New Kind of Doctor, to show how bad this could be. Hart described how he joined one of those practices in Kettering. One patient was left under anaesthetic as the London specialist operating on him was called away to continue a stomach operation on a London patient, which the operating GP had been unable to complete.

Cook was deeply concerned that the Tories’ review would not be at all interested in improving quality, only in opening up the NHS to the market and privatisation.

Cook on Private Health Insurance

One of the issues he tackled in the pamphlet was the possibility of the introduction of private health insurance. This covers two pages and a column and a bit in the original pamphlet. This is what he wrote, though emphases and paragraph titles are mine.

The mechanism proposed to square the incompatibility of health care with the market is insurance. All market approaches to the NHS submitted to the Review stress the case for much wider private insurance and almost as frequently propose subsidies to boost it.

Insurance-Based Systems Encourage Expensive Treatment

The first thing to be said is that private insurance does not offer to health care the alleged benefits of the discipline of the market place. At the point when the individual requires treatment he or she has already paid the premiums and has no incentive not to consume as expensive a treatment as can be reconciled with the policy. The position of the doctor is even more prejudiced in that he or she has every incentive to obtain as much as possible from the insurance company by recommending the most expensive treatment. Both patient and the doctor are in a conspiracy to make the consultation as costly as possible, which is a perverse outcome for a proposal frequently floated by those who claim to be concerned about cost control.

Insurance-Based Systems Encourage Unnecessary Surgery

The compulsion in an insurance-based system to maximise the rate of return is the simple explanation why intervention surgery is so much more often recommended in the United States. For example, the incidence of hysterectomy there is four times the British rate. This is unlikely to reflect higher morbidity rates but much more likely to reflect the greater willingness of doctors on a piece-work basis to recommend it, despite the operative risks and in the case of this particular operation the documented psychological trauma. I can guarantee that an expansion of private insurance will certainly meet the objective on increasing expenditure on health care, but it is not equally clear that the money will be spent effectively.

Insurance-Based Systems Require Expensive bureaucracy to Check Costs

One direct diversion of resources imposed by any insurance-based scheme is the necessity for accountants and clerks and lawyers to assess costs and process claims. The NHS is routinely accused of excessive bureaucracy, frequently I regret to say by the very people who work within it and are in a position to know it is not true. Expenditure in the NHS is lower as a proportion of budget than the health system of any other nation, lower as a proportion of turnover than the private health sector within Britain, and come to that, lower than the management costs of just about nay other major enterprise inside or outside the public sector. I am not myself sure that this is a feature of which we should be proud. ON the contrary it is evidence of a persistent undermanaging of the NHS, which is largely responsible for its failure to exploit new developments in communication, cost control and personnel relations. Nevertheless, there is no more pointless expansion of administrative costs than the dead-weight of those required to police and process and insurance-based system. These costs would be considerable.

Forty per cent of personal bankruptcies in the US are attributable to debts for medical care

Part of this additional cost burden is incurred in the task of hunting down bad debts, which does not contribute in any way to the provision of health care. Forty per cent of personal bankruptcies in the US are attributable to debts for medical care, a salutary reminder of the limitations set to insurance cover. These limitations have three dimensions.

Insurance Cover Excludes Chronic and Long-Term Sick, and the Elderly

First, insurance cover generally excludes those conditions which are chronic and therefore expensive or complicated and therefore expensive. Standard exclusions in British insurance policies are arthritis, renal dialysis, multiple sclerosis or muscular dystrophy. Most people do not require substantial medical care until after retirement. Most insurance cover excludes the very conditions for which they are then most likely to require treatment. Short of retirement, the most expensive health care required by the majority of the population is maternity care, which is also excluded by the majority of insurance policies.

Private Healthcare Limits Amount of Care due to Cost, not Need

Secondly, insurance cover is generally restricted by upper limits which are arbitrary in every sense other than financial. I recently met a psychiatric consultant to a private clinic, who was prepared to discuss candidly the ethical dilemmas of treating patients whose financial cover is fixed at five weeks of residential care, but whose response to treatment may indicate that a longer period of hospitalisation is desirable.

Private Health Care Geared to Selling to Healthy not Sick

Thirdly, insurance cover is further limited by exclusion of those most likely to claim on it. I am often struck at the sheer healthiness of the patients who illustrate the promotional literature of BUPA and PPP who appear in such pink of good cheer and fitness that it is difficult to figure out why they are in a hospital bed. These models are though in a sense most suitable for the purpose as the objective of insurance companies is to attract the healthy. They therefore claim the right to screen for the unhealthy and reject them from cover. This discriminatory approach was defended earlier this month by the managing director of WPA, Britain’s third biggest health insurer, on the principled grounds that it meant ‘essentially healthy people are not penalised by unhealthy people.’ This statement has the advantage of originality in that it perceives healthy people as the vulnerable group and proposes a market remedy that protects them from the inconvenient costs of the unhealthy.

Given this limited character of health insurance in Britain, the private sector is patently not in a position to substitute for the NHS and to be fair most directors of BUPA or PPP would be horrified at the notion of accepting the comprehensive, open-ended liabilities of the NHS. It is therefore perplexing that so much effort in and around the Review appears to be addressed to the issue of how the private sector may be expanded rather than how the public sector may be improved. Two major devices are being canvassed to boost private cover-tax relief on private cover or opt-out from public cover, or for all I know both of them together. Both would be a major mistake.

Tax Relief on Private Healthcare

Tax relief is open to the obvious objection that it targets help most on those who need it least – the healthy who are most likely to be accepted for private cover and the wealthy whose higher tax rates make relief most vulnerable. These are curious priorities for additional health expenditure.

Tax Relief Does Not Create Higher Spending on Health Care

Moreover, even in its own terms of stimulating higher spending on health, tax relief is likely to prove an ineffective mechanism. If for example the average premium is £200 pa the cost of tax relief for 6 million insured persons will be £300 million. The numbers under insurance need to increase by a third before the increased spending on premiums matches the cost of the subsidy and provides any net increase in health spending. Up to that point it will always produce a larger rise in health spending to increase the budget of the NHS by a sum equivalent to the cost of tax relief.

It is apparently being mooted that these objections could be circumvented by limiting the tax relief to the elderly. At this point the proposal moves from the perverse to the eccentric. This restriction targets help for private insurance on the very group for whom private cover is most inappropriate as their most likely health needs are the ones most likely to be excluded from cover. Only a moment’s reflection is required on the multiple ways in which we need to expand our health provision for the elderly to expose the hopeless irrelevance of tax relief as the solution for them.

Opt-Out Penalises those who Remain in the System

Opt-out is even more objectionable. The basic problem with opt-out is that it requires the payment towards the NHS of every individual to be expressed in a manner that gives him or her something to opt-out from. The principal attraction to Leon Brittan of his proposal for an NHS insurance contribution appeared to be precisely that it paved the way for opting out ( A New Deal for Health Care, Conservative Political Centre,, 1988). Nor is this inconvenience confined to the need for a whole new element in the tax system. If one in ten of the population chose to opt out, it would be remaining nine out of ten who would have to prove they were not opted-out when they went along to seek treatment. With the new contributions comes a requirement to maintain a record of payment of them, and presumably a mechanism for credits to those not in work but who do not wish to be counted has having opted out of the NHS.

Private Healthcare Undermine NHS as Universal System

The more fundamental objection both these proposals is they explicitly threaten the NHS as universal health service catering for everyone. Moreover, they threaten its universality in the worst possible way, by encouraging those with higher incomes and lower health needs to get out, leaving behind the less affluent and the less fit. In this respect such an approach to the NHS would be a piece with the Government’s strategy of erosion towards the rest of the social services-housing, pensions, and now education, where the Government has encouraged those who could afford it to opt-out of public provision, leaving behind the poor who could be expected to put6 up with a poor service.

This is the reality of the private healthcare system which Cameron, Clegg, Farage and the rest of the Right wish to introduce. It is expensive, bureaucratic, does not stimulating further spending, and excludes those with the most acute and expensive medical need, especially the elderly.

And the Tories and their counterparts in UKIP and the Lib Dems know it. Why else would the Tories spend their time trying to deny what they’re doing? Why does Farage appear to be advocating retaining the NHS, while arguing for an insurance based system, like America? It’s because they know that private medicine does not provide the solutions they claim. It is only source of further enrichment to them and their corporate donors.

And since Cook wrote that pamphlet, more than 20 per cent of all Americans can no longer afford their healthcare. It’s why the firms are trying to get their feet under the table over here.

Don’t let them. Miliband has promised to reverse the privatisation of the NHS. Support him in the coming election.

Vox Political: Terminally Ill Woman Placed on Workfare

December 16, 2014

Mike over at Vox Political has another example of the Tories’ and their workfare contractors’ absolutely vile attitude to the extremely ill. It’s a message he received from a woman dying of cancer. The lady is extremely ill, but nevertheless is glad to be alive. Despite numerous disabilities that in any sane society would be recognised as making her genuinely unfit for work, she received a letter from the workfare provider, Prospects, telling her that she must attend a work placement. Mike’s article has a photo of the letter.

The article’s entitled Dying woman ordered onto the Work Programme, and can be read at http://voxpoliticalonline.com/2014/12/16/dying-woman-ordered-onto-the-work-programme/.

This is just one of a continuing number of cases where seriously ill people have been told that their benefits are being stopped, as they have been judged ‘fit to work’. This farcically has even included messages sent to those, who died of their various diseases after being so assessed by ATOS. Which shows you that ATOS are a bunch of quacks, who if they weren’t hired by the government would be one step away from multiple malpractice suits. It also shows you that the assessment process itself is also a load of pseudo-medical bunkum every bit as fraudulent and pernicious as some of the medical frauds the BBC filmed peddling dubious ‘New Age’ healing techniques a few years ago.

Mike, Jayne Linney, Stilloaks and many other Left-wing bloggers have covered similar cases, which have also attracted the cynical attention and scathing comments of Pride’s Purge and Johnny Void. Private Eye in their pages published similar stories of people with terminal cancer being declared ‘fit for work’, including one man with a brain tumour on life support.

As for Prospects, if I remember correctly, they have a policy of treating their staff absolutely appallingly with no respect whatsoever for their own illness. A friend of mine told me of someone he knew, who took up a job with them. This person continued to work for the company during the time they had a stinking cold, for which most other firms would have allowed them time off to get over it. And, of course, not infect the rest of the staff.

Not so Prospect. They don’t like their workers going ill. You can take days off sick if you work for them, but the next day when you come back, you’re called in for an interview and asked how see your future with the company.

Which looks very much like the threat of the sack.

So the company is basically run by a bunch of bullies, who bully their staff into bullying the unemployed and terminally ill in an expanding pyramid of contempt and harassment. Which more or less typifies this government’s entire attitude to the poor and the working class.

Vote them out in 2015. All of them.

Welfare to Work Hits Sickness Benefits

February 10, 2014

I’ve just reblogged Mike’s post over at Vox Political on the government’s plan to set up a service to the long term sick off benefit and back into work. Mike found the plans on the BBC’s website yesterday. They were also announced on the Andrew Marr Show that morning. Marr did not, however, provide any details except that it would help employees and employers get back into work, and gave the statistic of the number of days lost due to sickness. In fairness, Marr did actually say that we had the lowest rate of long-term sickness in Europe.

In my comment to the piece I’ve already stated my opinion that it looks like the government is introducing a similar scheme to long-term sickness as they have with disability and unemployment. The emphasis will be getting people back into work, regardless of whether they are fit or well, and the possible effects to their long term health. It’s supposed to be voluntary at the moment, but as the commenter’s on Mike’s blog have pointed out, this was also how Universal Jobmatch was introduced, and now it’s very compulsory if you sign on benefit. I also have absolutely no doubt that legislation will also be introduced to deprive the sick of benefit if they don’t follow the back-to-work regime offered by this private company.

And I also have very severe reservations about the competence of whichever company they choose to run this service. Atos’ questionnaire for assessing whether someone is well enough to return to work is, quite frankly, so unscientific that it my view it constitutes medical fraud. The doctors and other medical professionals that administer it are merely window-dressing. They are not required to use their own, personal medical knowledge or initiative to declare whether or not you are fit. The assessment could be carried out by an ordinary civil servant with exactly the same results. Moreover, Atos and its employees have repeatedly shown themselves to be mendacious. They have lied and lied again to meet the government’s targets for people thrown off benefits. What are the odds that this new crew will be any different? Any takers?

One of the best comments on the situation comes from Florence, who has posted this on Mike’s piece:

What about the existing “pilot” scheme that is compulsory for those claiming sickness benefits? SOund just like what they are supposed to be promoting on this “service” to the disabled and chronically ill.

https://www.gov.uk/government/news/pilot-schemes-to-help-people-on-sickness-benefits-back-to-work

The official site says:-

“People on sickness benefits will be required to have regular meetings with healthcare professionals to help them address their barriers to work – or face losing their benefits……….(they) will have regular appointments with healthcare professionals as a condition of receiving their benefit, to focus on helping them move closer to being able to get a job!

So there is a choice, – attend or starve? So no choice, then? It continues:-

“The regular discussions with healthcare professionals – which will be provided by Ingeus UK – will not replace someone’s GP, but can promote health support and help a claimant to re-engage with their GP if they are struggling to adapt to their condition. They will also signpost claimants to activities and information to help them manage their condition to improve their readiness for getting a job, and work with local services to provide a holistic approach to health interventions.”

So what will be the “help” to “adapt”?

Experience says it will be a form of crude behavioural abuse, sorry, help called CBT. We all know how the Nudge Unit has worked before in ignoring all professional standards about coercion to participate. CBT has been proven (in published MEDICAL papers) to be worse than useless for people with long-term illnesses such as arthritis, and especially fibromyalgia and other chronic immune system problems with associated fatigue, and depression. The main study showed that for the first few weeks of CBT all seemed much better in treated group but 10 months later the untreated group – who had been left to manage their own illness – were in fact much better, more able to cope with pain, and more had achieved better mental & physical functioning.

The most telling remark came from someone who had been referred for CBT for fibromyalgia (aka complex regional pain syndrome). She said that it was tantamount to physical and mental torture, and in the end she agreed to everything that she was expected to, including doing exercise programmes that were causing extreme pain & distress, just so they would sigh her off from the programme. After, she needed treatment for depression.

Crude abuse seems the right description. The government seems to have outsourced motivating the long-term unemployed back into work to various forms, which now ring them up at home to harass them, demanding to know why they have not found work. One of my friends has been subjected to this, and when he asked them what they were doing, the person at the other end of the line claimed that they were ‘motivating him’. No, it’s not motivation. It’s simple abuse. But it’s in line with a government that has no solutions except to blame and persecute the poor and the sick.