Ask Militant Ginger

It's that time again! When I trawl through the 'keyword analysis' to answer the questions that somehow drove search engines into recommending this blog:

Why are so many Americans against the NHS?

Lies, damn lies and statistics. Depending on who you go to, you'll find that the majority of Americans want to keep the health care system exactly as it is, or adopt a single-payer system like they have in most industrialized countries. In February, polls put that figure as high as 59%.

Recently, the National Health Service of Great Britain has received a lot of flak, being held up by conservatives as an example of how 'terrible' a single-payer system would be if it was implemented here in the United States. Admittedly, there are some horror stories about the NHS, many of which I've perpetuated right here on Militant Ginger!

But conservatives neatly side-step the fact that the British health care system is ranked considerably higher than Americas - and the UK has a lower infant mortality rate and higher life expectancy. While American health care at it's best is undoubtedly superior to that of Britain - at it's most mediocre, it's arguably worse.

Sadly, there will always be a compromise between quality of care and breadth of coverage. In many ways, the NHS and the American system are the two most polarized examples of each philosophy - and many Americans will rail against 'nationalized health care' simply because of that reason.

How does the American private health care system work?

Very, very confusingly.

In America, health care is 'private.' That means, unlike in the UK, the government don't own and operate hospitals, ambulances, doctor's offices or laboratories. They're all independent businesses out there to make a profit.

When you visit a doctor, or get a test done, you get billed for it personally. As these medical bills can add up incredibly quickly, most people buy 'health insurance' to pick up some or all of the costs. For example, health insurance will generally cover as much as 90% of the cost of an operation, with the private individual paying the 10% difference.

The problem is that health insurance itself is quite expensive, since the bills are so high. It can easily cost $300 or $400 a month to cover a small family. Therefore, employers often offset the salary they give their employees by offering health care coverage instead. They can get group discounts for using the same company to insure all of their employees - and that means the individual gets a keener rate.

Companies cover either the entire cost of health insurance, or a portion of it.

If you're self-employed you can buy your own health insurance, although you have to pick up the entire cost, instead of a company covering all or part of it. Also, because you don't get the 'group discount' you tend to pay a higher rate.

Finally, health insurance is like car insurance - it costs more or less depending on your coverage. For example, you can get cheap insurance that only covers emergencies, or more expensive coverage that covers the bulk of medical costs. Likewise, you can adjust the percentage of the medical bills you're expected to cover 'out-of-pocket' with higher or lower premiums.

The problem with this system is that health care costs are continuing to rise. In the last decade, health insurance premiums have doubled. That means more and more of a percentage of people's salaries are going towards covering their families.

Even worse, more and more coverage is being dropped by the health insurance companies to keep their costs down. This means the consumer is paying more and getting less - and it's a generally accepted fact that there's not enough competition between health insurance companies to keep prices keen.

It's a system that has both major advantages and serious flaws. The problem with 90% of the people who argue about how to improve the current setup, however, is that they're not fully cognizant of both.

What is a derogatory term for a life-long politician?

A 'Democrat'*.

America's longest standing Senator - and former Ku Klux Klan member - Robert Byrd

*Nod to Tom - Editorial Bear

How do you start writing erotica for money?

Let me get one thing straight- nobody got rich writing erotica.

The opportunities for making money writing sauce, smut, erotica and pornography are increasingly elusive, as more and more people attempt to get in on the act. There's a misunderstanding going on that writing erotica is somehow easier than writing anything else. That's really far from being true.

I have made my fair share of money writing smut - but it quickly lost it's novelty value. The pay is low, the competition is high and it's a fairly thankless task.

But the opportunities are out there. A good place to start is with Hustler Fantasies, who publish about twelve or fourteen stories every month (and pay $25 for each one.) You can find out more here.

Alternatively, you can aim for a higher-brow audience, by submitting something to the queen of Erotic fiction, Alison Tyler, or a high-class magazine like Jacques. Just be aware that they have excruciatingly high standards and you'll either be expected to submit your first few works for free, or share royalties with dozens of other writers.

If I haven't talked you out of it, though, I still recommend writing commercial erotica simply to become a better writer. Why? Because it's surprisingly good training for 'real' writing.

1. Magazines like Hustler have a specific style - and getting a story accepted involves developing incredibly self-discipline to keep within the expected guidelines.
2. Erotic teaches a writer brevity. Exposition isn't foreplay. Word limits can be brutal. Keeping your writing focused, curt and efficient is an excellent habit to get into.
3. Most readers are looking for a specific genre - sometimes a specific sex-act - so writers need to learn to cater to their audience. This is the single most important lesson a writer can learn.

It's also excellent training for the simple habits of writing commercially - letters to editors, keeping track of submissions. If you take up writing erotic for money, I can promise you two things. Firstly, if you sell even one story, you will have become a better writer. Secondly, by the time you've sold that story, you'll probably have grown utterly, utterly jaded about how 'easy' and 'fun' writing erotica really is!

Why do women die their hair red?

Because unlike in the UK, where red hair is seen almost as birth defect, most civilized countries consider red hair to be attractive and distinctive, especially on a woman.

In France especially, many women dye their hair red (or some close approximation thereof) and 'the redhead' is a staple of film noir and hard-boiled fiction over in America. A redheaded woman, like the one Bruce Springsteen wailed about, is seen as passionate, sexy, emotional and just a little bit dangerous.

The only problem? You really can't fake it. Because red hair is normally accompanied by pale skin and beautiful green or blue eyes, most women who attempt to mimic a natural Titian end up failing. It can look pretty, but it never looks natural.

And, as I've found out by going both black and blond, that is true the other way around, too!

(This beautiful redhead is Kristen Carter, whose profile on Model Mayhem can be found here.)

What’s the connection between Erica Henderson and Pete Abrams?

Pete Abrams is the incredible brain behind Sluggy Freelance, my favorite webcomic and my first port-of-call when I do the Internet rounds each morning.

Erica Henderson is the sublimely talented cartoonist, artist and all-round everything from I Fail At Life, who I just think is the Bee's Knees.

For a short time, Erica stood in as 'Saturday girl' for Pete's webcomic - allowing him to take a day off from Sluggy to concentrate on his family.

The result was some wonderful artwork that took the wonderful creations of Pete's comic and put Erica's unique spin on them.

Sadly, she's not doing the Saturday art any more - but those filler strips certainly stand out as some of my favorite of all time.

Redux: NHS vs. American Health Care

A reader pointed out that my post yesterday was very, very long - which is fine, apart from when you painstakingly dissect facts and figures and suffix it all with a statement like 'but that's all irrelevant to the matter at hand.' So, because Shakespeare said that 'brevity is the soul of wit' here is the same column with the fluff removed:

72% of NHS patients complain that the stethoscope is too cold

Comparing the British NHS to American Health Care
Now with 50% less superfluous exposition!

Comparing the NHS and the current health care system in the United States isn't really fair or helpful.

On the one hand, the American system can be criticized for being monstrously expensive and not covering enough of its citizens. Per capita, it costs twice as much to offer health care to the population of the United States - yet Fox News reports that 13.4% of Americans are still left without coverage.

The United Kingdom, on the other hand, has universal coverage, a lower rate of infant mortality and a longer average life expectancy. The cost of giving medical coverage to Britain's citizens is also several thousand dollars less per person than in America.

But while Britain's health care is cheaper and covers the whole population, many people argue that this is only possible thanks to the indirect benefits of America's privately funded system.

It's a fact that many of the worlds leading pharmaceutical companies are based in the United States - and most of the new and exciting drugs and treatments emerge from the American health care system. The US system absorbs the related costs of researching and developing these new treatments (perhaps explaining why their health care costs so much more.)

And without having to pay for 'inventing' them, British patients benefit from these new drugs and treatments - just not immediately. Most commonly prescribed medication is as much as a decade 'behind' the new and exciting drugs available in America.

But at least British patients don't have to pay for that development - and that cuts a huge chunk out of the related costs of running a universal health care system.

Perhaps that's not a fair analysis - but it does offer an explanation for the gross disparity between the costs of universal health care in Britain and America's privately funded system.

America's race to develop new treatments also explains why some areas of medicine - like the treatment of cancer - are notably 'better' in America than in the UK.

Some British people have to come to America to get the medical treatment that's simply not available to them at home. Meanwhile, drugs developed in America make a huge impact when they're eventually adopted by the NHS.

So it's fair to argue that the two systems are inextricably linked - and the discussion about changing the way America looks after the health of her 300 million citizens actually affects far more people than just those with a US passport.

How the NHS rates against American Health Care

72% of NHS patients complain that the stethoscope is too cold

The inimitable Siger forwarded an article to me about a recent report by the UK's Patient's Association - which claims that hundreds of thousands of patients have suffered 'neglectful, demeaning, painful and sometimes downright cruel' treatment at the hands of the NHS doctors and nurses.

"The report disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff."

It's a fascinating article and one that will no-doubt yield bundles of ammunition for American conservatives intent on criticizing Obama's much-lauded 'public' health care option (even though what he's proposing is very far from the almost Soviet-style National Health Service in the UK.)

But what interested me was in the conclusion of the article.

Chris Beasley, Chief Nursing Officer at the Department of Health, is quoted in defending the NHS, citing that: "...recent patient experience surveys show that 93 percent of patients rate their overall care as good or excellent."

Why is this so interesting?

Because Fox News, that bastion of 'fair and balanced' reporting, recently cited that 89% percent of Americans had been similarly satisfied with the most recent treatment they'd received. This actually increased to 93% for those patients who'd recently suffered a serious illness.

Which is, somewhat coincidentally, the same percentage as those satisfied with their treatment from the NHS.

You can take that observation how you will - either as an indication that both systems are comparably successful, or to allege that both the NHS and Fox News are using conspicuously slanted statistics to support their agenda!

But what's really interesting is looking at the other end of these much-touted facts and figures - like the Fox News analysis which concludes that 'only' five million Americans are both uninsured and 'very dissatisfied' with the quality of health care they receive - roughly around 2% of the population.

According to the NHS article, the patients receiving what they determined as 'poor' care extrapolated to over one million people - also roughly about 2% of the population.

The same figure. Again.

To my mind, it just goes to reinforce the fact that there isn't a right and a wrong answer to providing health care for a nation's citizens. The best and worth of both seem comparable - whereas we really know they're not.

On the one hand, the American system can be criticized for being monstrously expensive and not covering enough of its citizens. Per capita, it costs twice as much to offer health care to the population of the United States - yet Fox News reports that 13.4% of Americans are still left without coverage.

The World Health Organization rank the United States as having the 37th best coverage in the world; not exactly a figure to boast about.

The United Kingdom, on the other hand, is ranked 18. Britain also has a lower rate of infant mortality and a longer average life expectancy. The cost of giving medical coverage to Britain's citizens is several thousand dollars less per person than in America (and, of course, covers everybody and costs its citizens nothing.)

But in many ways, such statistics tell us nothing.

Because while Britain's health care is cheaper and covers more people, many people argue that this is an indirect benefit of America's privately funded health care system.

It's a fact that many of the worlds leading pharmaceutical companies are based in the United States - and most of the new and exciting drugs and treatments emerge from the American health care system. The US system absorbs the related costs of researching and developing these new treatments (perhaps explaining why their health care costs so much more.)

And without having to pay for 'inventing' them, British patients do eventually benefit from these new drugs and treatments - just not immediately. The NHS generally offers only 'generic' medication, the copyrights of which have expired, meaning that most commonly prescribed medication is as much as a decade 'behind' the new and exciting drugs available in America.

But at least they don't have to pay for that development - or the research, marketing or related bumf. That cuts a huge chunk out of the related costs of running a universal health care system.

Perhaps that's not a fair analysis - in many way, it makes the NHS seem like a parasite, sucking drugs, treatments and developments from better funded health care systems - but it does offer an explanation for the gross disparity between the costs of running universal health care in Britain and the price of America's privately funded system.

America's race to develop new treatments also explains why some areas of medicine - like the treatment of cancer - are notably 'better' in America than in the UK.

So there's a truth we don't discuss much in the health care debate - that no nation's policy towards medicine exists entirely in a vacuum.

Some British people have to come to America to get the medical treatment that's simply not available to them at home. Meanwhile, drugs developed in America make a huge impact when they're eventually adopted by the NHS.

Because of that, the two systems are inextricably linked - as are the health care systems of Canada and other nations with a publicly funded system that benefits from America's private one.

This means that the discussion about changing the way America looks after the health of her 300 million citizens in reality affects far more people than just those with a US passport.

Curing America's Health Care

A while ago, I wrote about how America's 'private' health care system currently costs the taxpayer almost as much as running the British National Health Care service - and then charges the consumer even more than that on top!

Well, the fact that American health care costs too much is no longer under debate. Today, Price Waterhouse Coopers' Health Research Institute listed money-wasting problems that cause the American health care industry to pour $1.2 trillion down the drain every year (roughly half of the money spent on medicine.)

What were these financial hemorrhages? Here are some of the worst ones identified by Price Waterhouse Cooper:

1. Two many tests. Making an informed diagnosis is one thing. Running unnecessary tests is another. Capping malpractice suits and encouraging 'evidence-based' diagnosis could cut the amount of expensive tests performed in half - and save insurance companies billions.
2. Insurance company bureaucracy. I've already argued that the insurance companies are almost criminal in their bureaucratic incompetence, but the proof is finally here. Doctors report that 40% of their revenue is spent filling in insurance company certification - simply getting the money for the services they've performed. Price Waterhouse Cooper argue that standardized forms and a computerized database system (as touted by President Obama) could shred this waste of time and money - cutting doctor's overheads dramatically and lowering costs for both insurance companies and patients.
3. Paper prescriptions. It's not just the insurance companies who are behind the times. Many doctors can send 'electronic prescriptions' to a patient's chemist almost instantly, but over $4 billion a year is wasted by doctors who still insist on writing their prescriptions the old fashioned way.
4. 'Free' medical care for the uninsured. No, I'm not arguing that people without insurance shouldn't receive care. What is causing a problem is them using the Emergency Room as a primary care provider. Illegal immigrants and the uninsured go to the ER for strep throat and other 'regular' health problems, which a GP would normally deal with. A GP visit would cost around $70. A trip to the ER costs $700. At the end of the day, those costs are passed along to the paying customer (i.e. us) if the hospitals or doctors don't get reimbursed.
5. Over-prescribing antibiotics. It's estimated that prescribing antibiotics for conditions they simply can't treat (like coughs, colds and flu) costs over a billion dollars in wasted medicine and contributes to the development of antibiotic-immune MRSA bacteria, which in turn add an additional $3 billion worth care-associated infections. Doctors need to start practicing the medicine they studied and not give out antibiotics as placebos.
   
6. Hospital Bed Churn. It's estimated that $25 billion is spent every year on providing medical care to patients who are discharged from hospital too early. The pressure to get 'em in and churn 'em out inspires doctors and hospitals to discharge patients before they're ready - and the added cost of ambulance trips, re-admittance and recovery hurts all of our wallets.
   

The grand total, Price Waterhouse Cooper argue, is a whopping $1.2 trillion in wasted expenditure. Just imagine if we slashed that spending.

If you could, you might arguably maintain the current system on taxpayer dollars alone (according to this Economist report.) Alternatively, you could dramatically slash insurance premiums for the majority of us with coverage.

But identifying the waste and actually dealing with it are two starkly different things. One's got to wonder if either party will actually use this information, now that Price Waterhouse Cooper has made it available. I'm skeptical.

The Republican party is currently gunning to maintain the current system - bitterly fighting against any of Obama's suggested health care reforms whilst simultaneously failing to provide any worthwhile alternative suggestions of their own.

Meanwhile, many Democrats are still wound up in fantasies of 'universal health care' and demolishing a private industry which provides almost 20% of the United State's GDP - all for the sake of a government-run system that's been proven not to work in half a dozen other countries.

In Defence of Barry Obama #2

America's talk radio is dominated by the conservatives - and when they're attacking Barack Obama (which is pretty much all the time) they love to throw words around like 'socialist' and 'Marxist.'

As a Brit, I find the whole idea of labelling Obama a socialist to be laughable. These poor Republicans have no concept of what a real socialist is.

Back when I was a boy (before Tony Blair made the Labour Party all cute and fluffy) there was a real socialist movement in the UK. The sort of thing that would have driven the likes of talk radio presenters Sean Hannity, Mark Levin and Mike Reagan running for cover.

Fear Comrade Obama

Part of the right wing campaign of mischaracterization stems from the conservative's desire to frighten voters.

Although 'the Red Menace' disappeared when the Cold War did, America still remembers the days of the McCarthy witchhunts and the fear that your next door neighbour could be a 'red.'

Socialism and Marxism are dirty words (whereas in England, they just make you think of angry young students trying to flog you copies of The Socialist Worker.)

There are two pieces of ammunition the right wing use to label Obama as a socialist. One of them is his call for 'Universal Health Care.'

The Spectre of the NHS

To the conservatives, the idea of 'Universal Health Care' is interpreted as some kind of nationalized health program akin to the National Health Service we have in the UK. The only problem is that Barack Obama isn't advocating anything of the sort.

'Universal Health Care' does not mean government run health care. It simply means 'health care for all.' And that's the crux of his health care policy. Obama wants to make affordable health care available for everybody, with guaranteed eligibility for those with 'pre-existing conditions.'

In addition to giving the 'uncoverable' access to medical treatment, he also wants to reduce the overall cost of health care by an average of $2,500 per family. He intends to do this by cutting the costs of actual medical treatment and reducing drug costs by eliminating patents pharmaceutical companies have.

I'm not in agreement with Obama's ideas. The idea of eliminating patents has the disadvantage of removing any incentive pharmaceutical companies have for developing new drugs, so like many of Obama's policies, it's blissfully naive. I think John McCain's health care strategy is more realistic and practical.

However, nothing Obama proposes could be interpreted as 'socialised' health care - even the government sponsored health coverage for children and those with pre-existing conditions.

What the conservatives attack as 'nationalised' government health care for the uninsured is nothing of the sort. In fact, Barack Obama isn't advocating anything that doesn't already exist.

Despite all the propaganda, America does offer free medical treatment to millions of uninsured people every single year - hospitals are forbidden by law from turning away the sick or injured. Because hospitals have to absorb the costs of treating these uninsured people, treatment costs go up and, as a result, so do insurance costs. We pay for it in our high premiums.

By actually organising and regulating health care for the people who fall through the cracks of the current medical system, Obama will hopefully save hospitals millions of dollars and those economies will be passed on to us, the consumer. Sure, we still have to pay for giving these people health care - but I'd rather pay less through taxation than more through health insurance premiums.

Misrepresented

Barack Obama is a lot of unlikeable things - misguided and idealistic in some respects (the other 'socialist' strategy the right wing attack him for, taxing the oil companies and redistributing that money to the tax payer, is certainly some kind of off-colour social engineering program.)

But he's not a socialist - no matter how much the right wing try to convince us he is.