Socialised Medicine

We recently had a child in England … a brief summary of the process is below
In England there is no prenatal care, there is antenatal care (which I thought when I first heard it that they were against babies). And you only see the doctor once in the process, the rest is handled by midwives. Socialised medicine is strange in what they do for you.
For instance, patients keep their own records, there doesn’t appear to be a copy at the doctor’s office (though this cannot really be the case it is much too absurd for a bureaucracy not to keep data), much less a digital version (and their project for that, the world’s largest civilian IT program seems to be having difficulties and … more difficulties (and its leader has come under some amusing scrutiny (his mom notes he failed computers in college) though they are still trying).
The fact that it is a centralized 10 year program already shows why it is doomed to fail, and that no lessons from the failure of transportation mega-projects and ITS or the success of the internet have been learned.
However, there are several home visits by the midwives, I suppose so the nanny state can check you out at home. They don’t do ultrasounds either except when something appears to be a problem, those you must acquire privately. And for your blood work they give you Lucozade) rather than a special sugar drink (which I am sure is cheaper). Given the lack of doctors, lack of ultrasounds, lack of drugs, lack of malpractice insurance and lawsuits, lack of billing, kicking you out of the hospital in one day etc., it should be cheaper, one wonders why National Health Service are running a deficit.
The “A team” of doctors is at the hospitals (My wife actually only saw one doctor prior to the day of birth, and that was only to do the birthing plan, and he didn’t even lay hands on). The procedure was only delayed 4 hours, not too bad on the whole. The nursing staff/midwives is largely immigrant, though I guess the US is moving that way as well. The midwives also seem to have less training than US midwives. The doctors seemed quite good (more competent than their US counterparts).
One doesn’t get a private room. There is a ward with about 6 mothers, though there are privacy curtains. This seems to be more for the convenience of the nurses/midwives monitoring everything than to actually save money, the amount of space difference is minimal, and the hospital (Chelsea and Westminster) has plenty of enclosed open space. I don’t know its utilization, it seemed higher than Fairview-Riverside.
Post-natal care involves 3 home visits by midwives, basically to collect data, again they don’t lay hands on or even look closely at the baby unless asked to. They do weigh it once or twice. There is also a health visitor who comes by.
The at-home visits are nice in principle especially for late in pregnancy and just after child-birth when mobility might be constrained. In practice, there didn’t seem to be too much point, the medical system just asking the same questions over and over again without actually treating anything. You get a team of midwives, so you may never see the same midwife twice.
The child-birth was much smoother this time, probably because a planned c-section is much preferrred to an emergency c-section. The lack of billing (or especially the infuriatingly time-wasting and tree-killing “this is not a bill” statements) is fantastic.

Missing your forecast

From today’s Sydney Morning Herald: Cross City Tunnel receivers put tollroad on sale block . The tollroad tunnel went under (so to speak) in part because they missed their forecast, getting 30000 travelers per day instead of 90000.
Another article on this in Toll Roads News The firm responsible for the forecast was Hyder Consulting who remarkably still claim credit for the project on their website.
Forecasting traffic is not easy, but there are established methods that should get freeway demand estimates within 20-30% or better (i.e. one lane) of actual values (not 300% off) and one is not convinced these guys used them. In fact, even with no tolls, traffic was still only 60% of the predicted flow.
Unfortunately, there is really no liability for poor forecasts, at least not for the forecasters.
Of course this points out the advantages to private sector assuming the risk, the public is not on the hook for a bailout. It also argues for higher returns to compensate for the risk, otherwise projects won’t get built.

Ethanol-blend auto emissions no greener than gasoline

According to CBC, a Canadian study says Ethanol-blend auto emissions no greener than gasoline. Of course, using farm products for energy will drive up the price of food, a point the keen economic analyst Fidel Castro makes .
An interesting book on the consequences of energy extraction is Peter Huber’s Hard Green . The book makes the point that the consequences of oil extraction on the land are quite small, as an oil drill is not large, compared with the visible environmental consequences on the land of extracting energy from other sources.

From Today’s The Guardian

From Today’s The Guardian:
No Not Coal:
Coal comeback pushes up UK emissions | Climate change | Guardian Unlimited Environment
No, Not Biofuels:
Castro warns poor will starve for greener fuel | Energy | Guardian Unlimited Environment
Yes, let’s get a soccer coach to spread the word …
Sir Alex Ferguson joins Gore’s climate A-team | Climate change | Guardian Unlimited Environment
The Oblivous
BMW unveils assembly plant in India | | Guardian Unlimited Business
So if Britain has an annual uptick in carbon despite long term progress (presumably because of trends not government policy), there is a round of self-flagellation. If the western countries think about substituting bio-fuels for petroleum, there is condemnation (from Fidel Castro, what else is he going to say, the US is pursuing the right policy?), and if Al Gore meets with a football (soccer) coach to propound his messianic (Cassandric) propaganda campaign, there are cheers. But if BMW builds a car factory in India, a country 20 times the size of England which is growing quickly and will eventually consume more cars, produce more pollution, and be stuck in traffic far longer, nary a peep on the environmental consequences is mentioned.

London’s only 24-hour pharmacy

Can it possibly be that London, England, a city of about 7.5 million people, has only one 24-hour pharmacy. London News : 24-hour London. For a city that is a contender for “capital of the world”, this is surprising. The reason this question comes up is the birth of our daughter Olivia, and the need for some medical equipment for my wife on a Sunday evening. Coming from the United States where the “I want it and I want it now” culture has produced a significant *spontaneous* 24-hour expectation, I was surprised to find that all of the typical suspects in pharmacy: namely Boots and Superdrug were closed, not merely in Putney, but almost everywhere.
Fortunately Zafash Pharmacy (near Earl’s Court at 233 Old Brompton Road SW 5) was open, and I got from home there, did the transaction, and got back in 67 minutes via transit (The 22 bus and walking there, the 74 and 22 buses back). Google Maps puts it at 3.4 miles via road, and says 8 minutes (not a chance, even if I were in my car, even at 7 pm on a Sunday night).
One could talk about Zafesh, run by immigrants or maybe 2nd generation Londoners who have a unique entrepreneurial spirit, and how great that is. Though of course it would be par for the course in the US. In my mind the question isn’t why they are open, but why the others are closed.
Perhaps regulation has something to do with it, I don’t know the extent to which neighborhoods have imposed zoning regulations limiting hourly openings. Perhaps it is the costs of paying overtime. Perhaps is is the draining of the entrepreneurial spirit in this home to capitalism. In the US pharmacies are in fierce competition with supermarkets (which have been 24 hours in many locales for a couple of decades now, starting since they were doing overnight stocking anyway).
While I could understand why the local card shop isn’t 24 hours, cards are not an emergency item, medicine is.
In addition to being bad for customers, it seems that business here is leaving money on the table.

by David Levinson


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