Farewell. The Flying Pig Has Left The Building.

Steve Hynd, August 16, 2012

After four years on the Typepad site, eight years total blogging, Newshoggers is closing it's doors today. We've been coasting the last year or so, with many of us moving on to bigger projects (Hey, Eric!) or simply running out of blogging enthusiasm, and it's time to give the old flying pig a rest.

We've done okay over those eight years, although never being quite PC enough to gain wider acceptance from the partisan "party right or wrong" crowds. We like to think we moved political conversations a little, on the ever-present wish to rush to war with Iran, on the need for a real Left that isn't licking corporatist Dem boots every cycle, on America's foreign misadventures in Afghanistan and Iraq. We like to think we made a small difference while writing under that flying pig banner. We did pretty good for a bunch with no ties to big-party apparatuses or think tanks.

Those eight years of blogging will still exist. Because we're ending this typepad account, we've been archiving the typepad blog here. And the original blogger archive is still here. There will still be new content from the old 'hoggers crew too. Ron writes for The Moderate Voice, I post at The Agonist and Eric Martin's lucid foreign policy thoughts can be read at Democracy Arsenal.

I'd like to thank all our regular commenters, readers and the other bloggers who regularly linked to our posts over the years to agree or disagree. You all made writing for 'hoggers an amazingly fun and stimulating experience.

Thank you very much.

Note: This is an archive copy of Newshoggers. Most of the pictures are gone but the words are all here. There may be some occasional new content, John may do some posts and Ron will cross post some of his contributions to The Moderate Voice so check back.


Monday, January 16, 2012

HCR -- Private and Public Healthcare in the UK

By John Ballard

Dr. Bob Wachter has put up several posts at The Health Care Blog telling his observations of the NHS, private practice and insurance as they operate in the UK.  Anyone interested in ignoring the fountain of ignorance spewing in the US about socialist gubmint healthcare should take a look at some of his posts.The Awkward World of Private Insurance in the UK is a good place to start.

The average specialist in the UK augments his or her income by about 50 percent through private practice, but there are wide variations. Specialists operating in the countryside, where few patients have private insurance, may have no opportunity to practice privately. On the other hand, some London specialists double or triple their salaries through private work. I asked several prominent specialists why they didn�t just ditch the NHS and switch to full-time private practice. The answers varied, but usually included some version of �I take my obligation to participate in the NHS seriously� (this may sound a bit too idealistic for jaded Americans, but I found this credible in the UK, where belief in the NHS can be near-religious) and, more pragmatically, �It is my NHS practice that allows me to be prominent enough to attract patients to my private practice.�

The latter rationale is no doubt true, and it led several NHS administrators I spoke with to bemoan the fact specialists can create a name for themselves in the public system, and then trade on this �brand equity� to enrich themselves� while the public system starves. One CEO told me that the NHS made a major strategic error by allowing a completely independent private sector to spring up. He was enthusiastic about a recent trend � promoted by the Cameron government � to encourage NHS hospitals to tap into the private market; many have responded by building their own private wings. �At least we keep a portion of the income generated by this work, as opposed to it all going to the specialists and the private clinics and hospitals,� he told me. Whether the private facility is freestanding or connected to an NHS building, the amenities in British private hospitals and clinics are more like what we�re accustomed to in US hospitals and boutique practices: fluffy pillows, single rooms, fresh gardenias, and marble floors. It�s the first class to the NHS�s middle seat in economy.

Interestingly, while the care is clearly more patient-centric, it�s not a slam dunk that the quality of care is better in these private facilities (particularly the freestanding ones) and there are even legitimate concerns about whether it�s as good. Sure, the thread counts are nice, and who wouldn�t prefer to stay in a single room rather than the six-bedder typical of many NHS wards. But there have been poor outcomes born of understaffing, the lack of on-site resources to manage critically ill patients, or limited availability of the specialists (who may pop in to see their patients once a day but then rush back to their NHS hospital across town). The accreditation process for private hospitals and clinics has been far more lax than in NHS facilities, though it has tightened up recently. When a patient crashes in a private hospital, he or she is transferred to � you guessed it � the nearest NHS facility.

Of the many things that surprised me about the British health system during my six months in London, this parallel world of private healthcare was high among them. In a system predicated on a communal, tax-based insurance pool, I wondered whether the emergence of a vigorous private sector would threaten the viability of the NHS. It is a perennial worry: in 1983, one analyst fretted, �Will a one-class universal national health care system survive, or is there danger of serious, possibly fatal, mutation?� From what I saw, I�m not too worried. Most people � even patients who have private insurance and doctors who practice in the private sector � believe strongly in the NHS. I met no one � including senior executives at BUPA, the country�s largest private insurer � who felt the UK would be well served by a much larger private sector if it meant a diminished NHS.

He makes a very interesting comparison with the US system of public versus private education.

...I finally had my aha moment when one NHS manager likened the situation to that of US private schools operating alongside our underfunded tax-based public school system. �All the people using the private system have already paid their taxes, so they are siphoning volume out of the NHS that the system otherwise would have to manage,� he said. �The NHS would come to a grinding halt if private practice went away.�

Private schooling in America, -- whether it be home school, upscale private academy or tax-payer supported so-called charter schools -- would fold up like cheap ironing boards if they were expected to educate all our children. When these exclusive environments skim the most promising students from a much larger population of their peers, better outcomes are virtually guaranteed. And like the private hospitals in the UK have the NHS safety net for emergency case patients, private educators in the US deselect students who don't make the grade, tossing them back to public schools in the same way that fishermen pull in a net and sort through the catch. 


  1. our NHS does have it�s failings in some sectors, but the fact is that everyone, no matter how poor they are, can get treatment at a facility without worrying they cannot be able to afford it.

  2. And as Dr. Wachter pointed out, for a serious emergency private hospitals are not the first choice.
    When I read that I recalled years ago when our children were born my wife and I were choosing a pediatrician and hospital. We knew a lot of people whose children were delivered at Northside, so I mentioned to the doctor that here in Atlanta it was one of the best places in Atlanta. He surprised me when he said "Unless there are complications. The best place for neonatal problems is Grady."
    Atlanta's Grady hospital is one of the largest in the Southeast but is known to be the place where poor people and others without insurance go for treatment. It also happens to have one of the best trauma centers around and because of volume, the most experienced staff dealing with all kinds of emergencies, including new baby delivery issues.