The Parish Magazine May 2024

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28 The Parish Magazine - May 2024 HEALTH — 1 Dr Simon Ruffle writes . . . Comparisons Recently I wrote about comparing the NHS to other healthcare services. While researching that article I fell down the USA rabbit hole of healthcare. I had some vague notions of USA healthcare but this was skewed by the bankruptcy issues caused by medical bills. Recent American Journal of Public Health figures for 2019 estimated that medical problems contributed to 66.5% of bankruptcies in the United States. I thought that the Affordable Care Act, (ACA) colloquially known as Obamacare, addressed this problem in 2010. Obviously it hasn’t. ACA was introduced to cover people who couldn’t afford or weren’t given insurance as part of their employment. Opposition to the Act includes similar arguments against the NHS, although not being constitutional is not one. Stifling innovation and choice, it is overly bureaucratic and costs the consumer and tax payer as it attracts tax payment. NHS has the same finance issues. It also leaves some uncovered, which, cannot happen in the UK but variability in quality and accessibility remain in both systems, and affect deprived areas the most. INSURANCE Most Americans are covered by insurance schemes. Some are provided by employers, others by the federal government such as Medicare. This covers over 65s and disabled peopledepending on disability. Medicaid is another scheme designed to help those with low incomes and there is a Children’s program called CHIP. This is essentially gap insurance for children of those who cannot afford insurance but do not qualify for Medicaid; what about the parents? Most of these insurance policies do not allow the American — home of the free — to choose their hospital. Health Management Organisations (HMO) that provide the policies have their own network of doctors, hospitals and allied services. Similar to the NHS the patient must see their primary care physician (PCP) to obtain a referral. Again these GP-like doctors are within the HMO’s network; step out of that network and you will receive an out of pocket expense, more on that later. UK GPs, unlike USA PCPs, have their own specialist pathway for training which is more extensive and thus provide a more comprehensive service that reduces the number of referrals to secondary care. Many HMOs look to the UK model and more and more North American systems are aggressively recruiting UK GPs. UNTOLD PROBLEMS Hospitals in the States can be public, private, for profit and not for profit organisations but receive their funding from payments for activity. The drive to reduce costs is huge. Some payments are from private people and companies ‘supporting’ the hospitals and there are church and charity funds. This still doesn’t create a universally covered system. Despite insurance other out-ofpocket expenses are often required. These cause untold problems. As mentioned, out of network services occur. For example, if you need treatment or elect to have treatment in a hospital or clinic that isn’t in ‘your’ network, you are liable for the cost out of your pocket. Co-insurance for some people may be part of their insurance. Essentially, the patient is gambling on not getting sick to the tune of a percentage of the cost of treatment, not dissimilar to choosing a cheaper insurance policy and a higher excess instead. Co-payments can be part of your insurance. For example a fee every time you use your policy; essentially encouraging you not to seek help. Then we come to deductables. This is the amount of payment you have to pay before your cover kicks in, again. It's a like our excess policies on car insurance. These are often contentious as the condition and onward costs may not be covered either, as described. Like the UK there is a prescription cost to a certain percentage of the drug costs. However, in the UK this is a fixed costs per item and not a fixed percentage of the cost. In general in the UK, the patient is in a better position having a mixed cost but if you receive more than 13 monthly prescriptions a year there are schemes to pre-pay this and there is a list of conditions that exclude any payment at all: children, those in permanent education and over 60s also pay no prescription charge. MANY LAWS The charges go straight to the treasury so are a tax and not as a lot of people think that they are paying for their medication. Often the medication cost is way above the prescription fee. In the USA Annals of Internal Medicine in 2017, 'nearly 20% of new prescriptions are never filled, and approximately 50% of medications TURN TO PAGE 29
FROM PAGE 28 HEALTH — 2 Comparisons for chronic conditions are not taken as prescribed.' Finally, the HMO has the last way in if the treatment is covered, or they could cover one treatment rather than another. The UK also has a system to regulate this via NICE, but this doesn’t have shareholders. Although there is no specific law in the USA that forces shareholder primacy there are laws that protect investors in publicly floated companies, such as the Securities Exchange Act of 1934 which aims to protect investors and the integrity of the securities markets. Many laws applied to these companies do not protect them trading overseas. So, while the USA and the UK have different systems of funding healthcare we face the same problems of cost, accessibility, choice, fairness and political interference. Both nations need to have a grown up apolitical discussion on their futures. This is likely to be more difficult in the USA as the corporate involvement is higher than the UK, but this is changing. Our outcomes are not dissimilar but the costs to the tax payer are as follows: Per Capita: UK 2020: $4300 Bankruptcy: 0% of cases USA 2020: $11582 Bankruptcy: 66.5% of cases While there is no one perfect system the principles of ‘do no harm’ must surely extend away from the medical issue at hand to the societal responsibilities of those in charge or those having the most influence on how the systems are run. Phil Mason HOME AND Garden The glory of May Maia, Greek goddess Pinterest.co.uk with Roman numbers. Traditionally, Wisteria is one of May's floral glories. I once spent four years coaxing a 10-year-old wisteria into flower only to be asked if I could remove half the flowers as it was too gaudy for a Cambridge university professor! Many plants have juvenile and adult growth — Ivy is a classic example — and wisteria flowers on ‘adult’ spurs. To promote spurs regular pruning is required. Train main branches horizontally and tip when they reach the correct size, this will generate a flush of side shoots. Prune these side shoots back to 3/4 buds to encourage spurs and repeat annually and after flowering. Japanese wisterias (floribunda) have shorted broader racemes, and twine in a clockwise direction. They more readily have a second flush of flowers. Chinese wisterias twine in an anticlockwise direction and have narrower longer flowers. How to control greenfly (aphids) is another question that regularly pops up in May. They are an important food source for smaller nestlings, especially sparrows and tits. Instead of using insecticides I recommend leaving them and The Parish Magazine - May 2024 29 By Ray Puddefoot Wisteria tree Valeria Sangiovanni, dreamstime.com The first 6 months' names are associated with Roman gods except May, which is named after Maia the Greek goddess of growth and fertility. Followed by two months named after Roman emperors and four vacant waiting months APHID CONTROL accepting a few distorted flowers. Alternatively, washing them off with a soapy water or a hose with the nozzle on a jet setting. MAY TIPS — Prune early flowering shrubs like forsythia, ribes and Japanese quince. — Remove seed heads from hellebores, stake perennials and tie in climbers as required. — Apply liquid feed around spring bulbs and top dress your borders and roses with granular fertilizer. — Prepare and plant up your summer pots with summer bedding. — Always use fresh compost ideally one designed specifically for summer pots incorporating a wetting agent and water retentive granules. — Check hose pipes and fittings for leaks and if necessary, replace the washers, it is far cheaper than buying new connectors.
Page 1 and 2: The Parish Magazine Magazine Parish
Page 3 and 4: Serving the communities of Charvil,
Page 5 and 6: The Parish Magazine - May 2024 5 Th
Page 7 and 8: the parish noticeboard — 1 Easter
Page 9 and 10: Corinne's column The Lord has risen
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Page 13 and 14: parish noticeboard —4 THE PERSECU
Page 15 and 16: feature — 1 EXPLORING The Parish
Page 17 and 18: feature — 2 FROM PAGE 15 Someone
Page 19 and 20: feature — 3 Why May 2024 is impor
Page 21 and 22: feature — 5 Maiden Erlegh Rotary
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Page 25 and 26: around the villages — 12 Where di
Page 27: around the villages— — 31 Inner
Page 31 and 32: FASHION BY HARRIET NELSON A girl ca
Page 33 and 34: THE ARTS — 1 The Stabat Mater Rev
Page 35 and 36: THE ARTS — 2 Book Reviews Jesus a
Page 37 and 38: THE SCIENCES 'Pain that is not expr
Page 39 and 40: PUZZLE PAGE — 2 CROSSWORD 1 2 3 4
Page 41 and 42: CHILDREN'S PAGE The Parish Magazine
Page 43 and 44: Please mention The Parish Magazine

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