Monday, March 19, 2007

Basic Economics

Let’s play a game. Roll time forward a bit…universal healthcare has arrived and you are now a Regional Head of the Healthcare System. You have an annual budget that you absolutely can’t exceed. The medical expenses for your region have been increasing and this year you’re going to exceed your budget. What do you cut? Medical staff? Drug expenditures? Or do you defer maintenance and maybe cut back on some housecleaning?

Want to see something interesting? Do a search on Google for “Canadian Hospitals filthy.” Then do the same thing for American hospitals filthy” and “NHS filthy.”

The Canadian search produces a stream of articles decrying deplorable conditions in their hospitals. The American search turns up articles on the VA system and, more interestingly, quite a few articles on the England’s National Health Service. At the time I ran the search, no civilian American hospital was mentioned on the first couple of pages of the search results. And the search on NHS produces an appalling number of hits.

According to the articles, both the NHS and the Canadian systems have one thing in common – both systems have cut back on cleaning as a way of saving money. In many cases, the cleaning staff has been replaced by subcontractors…I assume by the lowest bidder willing to agree to the contractual terms. Thing are so bad that, according to one of the articles, one dying patient left money in his will to clean the windows of his ward.

The result has been predictable… the incidence of secondary infections has increased to hundreds of thousands of cases per year. Antibiotic-resistant bacteria are flourishing (click on the link) and killing thousands of people annually. All in all, it sounds like many hospitals are equivalent to what you’d expect in a Dickensian novel.

Take a look at these articles:
And here
And here
The environment that is described is truly disgusting.

Can this happen here?

Absolutely. It’s basic economics…a question of resource allocation. All it will take is the establishment of a centrally managed non-competitive health care system. When budgets are tight and somebody has to decide between purchasing medicine and having an “extra” janitor, guess which one will lose out. The lack of medicine will have an immediate measurable impact. The loss of a janitor? Well, I guess the other ones can just work a bit harder.

You disagree? Need another example? Look inside of one of California’s public school bathrooms. The same principle applies. With no extra money, sanitation isn’t high on the priority list…just ask my kids.

To be continued…
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