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By Merekat (Wed Oct 06, 2010 at 09:11:27 AM EST) (all tags)
It appears I have a special talent. The ability to look in a mirror without looking in a mirror.


For a year or so, I didn't actually have a mirror at all. Well, there was one downstairs as something to bring more light to a part of a room. But I never used it as a mirror and we didn't get around to hanging a bathroom mirror because there was an issue with the plaster for about 18 months. I now have two, as there is one for each sink in the bathroom. Yet it seems as I brush my teeth and hair and floss and apply moisturiser in the morning, I am still not actually looking in the mirror.

Just now, I caught sight of my reflection in the ladies'. I look like something that has been dug up from a grave and punched in both eyes long enough ago that it has faded to that slightly reddish look (but the hair is ok!). This is proving to be the worst jetlag recovery week I can recall. I think I need to spend a full day in the mountains in daylight to clear it. My diary says I can do that in....December.

This is broken. Not just that it happened, but the response. Particularly the mocking of compassion. Without a state compelling these things, compassion has to pick up the tab for those who cannot afford it if society is to be a decent place. Charity has historically been a big part of that type of conservatism, I thought. A somewhat redeeming feature of it. This small stater, though, seems to miss out that bit.

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yikes | 102 comments (102 topical, 0 hidden) | Trackback
Fire insurance by georgeha (4.00 / 1) #1 Wed Oct 06, 2010 at 09:26:54 AM EST
One point I read on kos was that the Fire Department might have voided their insurance if they had fought Cranick's fire and gotten injured or killed. I don't know if that's true, but it changes the perspective, why should a fireman risk his family's well being for someone who wouldn't pay for protection? The Fire Department has said they would have risked it to rescue people.

Also, Cranick started the fire buy burning trash in barrels near his house. Life is hard when you're stupid.


The rescuing people part is critical. by Merekat (2.00 / 0) #2 Wed Oct 06, 2010 at 09:31:57 AM EST
Why should people die over money? Why are firemen firemen?

Anyway, my problem with this isn't so much the not-rescuing of an idiot's property. It is the total trashing of the concept of compassion and help for your fellow man as a rule, not as an exception. It is just nasty. But what do I know, I'm just a godless leftie yerpian atheist;)

[ Parent ]
burning barrel by clover kicker (2.00 / 0) #8 Wed Oct 06, 2010 at 12:26:25 PM EST
We burned trash in a barrel every few days for years growing up, never had a problem.

[ Parent ]
Near your house with fire protection? by georgeha (2.00 / 0) #10 Wed Oct 06, 2010 at 12:31:19 PM EST
Granted, I'm not sure how close to the house his fire barrels were.


[ Parent ]
maybe a hundred feet from the house by clover kicker (2.00 / 0) #30 Wed Oct 06, 2010 at 01:26:24 PM EST
And I don't think that kind of firefighter non-coverage would happen in Soviet Canuckistan, they'd just crank up the taxes to pay for universal service.

[ Parent ]
Whoa, dude, scroll down to marvin's post by georgeha (2.00 / 0) #31 Wed Oct 06, 2010 at 01:28:31 PM EST
or is this some sort of Canuckistani prejudice about BC not being part of Canada.


[ Parent ]
yeah I see that now by clover kicker (2.00 / 0) #33 Wed Oct 06, 2010 at 01:40:32 PM EST
I've never heard of anything like that here on the other coast, even the remote hillbilly towns have a volunteer FD.

But of course you never would hear anything about that kind of thing until something went up in smoke.

[ Parent ]
Having worked in a fire dept by Phil the Canuck (2.00 / 0) #38 Wed Oct 06, 2010 at 03:32:38 PM EST
I will tell you that the answer is likely holy-fuck-what-were-you-thinking inches away.

[ Parent ]
This is Tennessee by georgeha (2.00 / 0) #39 Wed Oct 06, 2010 at 03:58:32 PM EST
so the odds of Cranick saying "hold mah beer and watch this" before lighting the barrels is high.


[ Parent ]
Refuse to pay protection? by Breaker (2.00 / 0) #11 Wed Oct 06, 2010 at 12:34:23 PM EST
Nice house you got there.  Shame if anything happened to it...

(Not that I am suggesting these firefighters had anything to do with the fire, BTW, just illustrating a potential weakness in the set up).


[ Parent ]
Welcome to the land of the free by georgeha (2.00 / 0) #12 Wed Oct 06, 2010 at 12:38:47 PM EST
If you don't think you'll ever need a fire department, or get sick, why pay for insurance?


[ Parent ]
Indeed. by Breaker (2.00 / 0) #15 Wed Oct 06, 2010 at 12:42:58 PM EST
Just don't come crying when the wheels come off.

What if the only insurance you can get is priced out of your reach though?


[ Parent ]
Pray by georgeha (2.00 / 0) #16 Wed Oct 06, 2010 at 12:47:06 PM EST
There must be something inherently wrong with you if you can't afford health, car and fire insurance.


[ Parent ]
Or with the insurers by Breaker (2.00 / 0) #21 Wed Oct 06, 2010 at 12:57:40 PM EST
Or with your government.


[ Parent ]
I never took you for a Commie by georgeha (2.00 / 0) #26 Wed Oct 06, 2010 at 01:08:48 PM EST
if a handful of health insurance companies (broken down into state wide units) can negotiate deals with health care providers to get services at a tenth of what the providers would charge someone without insurance, and still give huge bonuses to their executives, while trying to weasel out of paying claims, that's wrong? It sounds like Capitalism to me!


[ Parent ]
But if those insurers by Breaker (2.00 / 0) #41 Wed Oct 06, 2010 at 05:45:08 PM EST
Then collude together to crank up the premiums and deny care based on trivialities...

Which is capitalism at its heart, not corrupted capitalism.


[ Parent ]
You're telling me. by ambrosen (2.00 / 0) #27 Wed Oct 06, 2010 at 01:10:05 PM EST
Luckily, my employer pays all my healthcare costs, which are equal to about 60% of my salary. This is because, as you mentioned, there is something wrong with me.

[ Parent ]
It's nice to have persistent health problems by georgeha (2.00 / 0) #28 Wed Oct 06, 2010 at 01:14:35 PM EST
I'e had wingnuts talk about the poor, uninsured having health care, because they can go to Emergency Rooms.

I'm like "Really, those ER's will go blood tests and give me a sed rate so I can keep taking my auto-immune meds? I guess I'm a sucker."


[ Parent ]
I thought they'd come and put it out by georgeha (2.00 / 0) #13 Wed Oct 06, 2010 at 12:40:32 PM EST
even if you hadn't paid your $75, but I was wrong.

It would have contributed to moral hazard if the FD had put out the fire, even if he offered $75 on teh spot.


[ Parent ]
It would by Breaker (2.00 / 0) #19 Wed Oct 06, 2010 at 12:53:15 PM EST
But pour encourager les autres they had to let it burn.

Pretty shabby humanity from the firefighters though.  Then again with times being what they are, directly disobeying order would probably lead to being off the rota, so no more earnings.

Which then leads to their chain of command, giving the orders not to put the fire out.  This seemed to go up to mayor level, who I assume is elected.

So really if the people of this town are that incensed, they only have themselves to blame, and will vote differently next time elections come around.

There should be an alternative though to letting the house burn.  Charge a punitive fee ($5K?  $10K?) to put the uninsured's fires out.

That way the left are satisfied as there's a mechanism for the uninsured to keep their house, and the right are happy because there's no freeloaders.

Hmm, any holes in that?


[ Parent ]
There was a county wide fire vote by georgeha (4.00 / 2) #23 Wed Oct 06, 2010 at 01:02:25 PM EST
from straight dope or Mother Jones, I can't find the primary source, but it was defeated at the polls, no one wanted a tiny tax increase.

The mayor is elected, but is the mayor of the nearby city, which apparently taxes all the residents for fire protections. The Cranicks lived way out, with lower taxes! Woo-hoo, lower taxes!

This has apparently happened before, and they would have intervened if lives were at stake, but for property, too bad, you gambled, you lost.

They also mention charging the cost of the call to the uninsured, but only half paid up in the past. We're talking a double wide trailer (caravan?) in rural Tennessee, it's not worth much.

I haven't seen any more mentions of the liability concerns, but it sure would suck to be injured or killed fighting a fire you're not support to fight, and then get nothing from the insurance company.

I think the Libertarians should celebrate Cranick's Galtitude, but not give him any money, that's a moral hazard.


[ Parent ]
Ah the details out. by Breaker (2.00 / 0) #42 Wed Oct 06, 2010 at 05:55:46 PM EST
Why weren't the uninsured pursued further?

An interesting part of the situation would be if I had insurance but you, my neighbour didn't.  I start a fire to burn some leaves or whatever off, and your place goes up.

Am I now liable for your damage or does the fire insurance cover my stupidity?

Still, if the people voted for it not being compulsory, had provision to access the insurance and didn't take it, then tough titties, really.

Still a bit cold for the firefighters to turn up and do nothing, but if the terms of their insurance and engagement with the fire prevented them, then that's a tough one all round.


[ Parent ]
blood from a stone I imagine by georgeha (2.00 / 0) #46 Wed Oct 06, 2010 at 09:18:11 PM EST
Why weren't the uninsured pursued further?

Again, we're talking about rural Tennessee, the propeties may not be worth all that much, unless you're running a meth lab.


[ Parent ]
Hmmm by Breaker (2.00 / 0) #49 Thu Oct 07, 2010 at 05:42:56 AM EST
Cheaper just to let houses burn then.


[ Parent ]
No difference. by Tonatiuh (2.00 / 0) #101 Sat Oct 09, 2010 at 10:35:10 AM EST
A social system in which there is no space for common sense is utterly broken.

The fire department should put off any fires in the community, the accounting department should take care of the late payers and take them into account when budgetting (any business does this in a regular basis).

Insurance should cover all work of the firefigthers, it is ludicrous that they should care if any quotas are paid or not by potential fire victims, since this does not reduce or increase the risk for the firefigthers in any way.


[ Parent ]
Maybe by Phil the Canuck (2.00 / 0) #3 Wed Oct 06, 2010 at 10:26:46 AM EST
Some neocon can explain to me how a user fee paid to a public service isn't a tax.

Because by hulver (4.00 / 2) #4 Wed Oct 06, 2010 at 10:39:09 AM EST
You can choose not to pay it.
--
Cheese is not a hat. - clock
[ Parent ]
Yes, I see that difference by Phil the Canuck (2.00 / 0) #6 Wed Oct 06, 2010 at 10:42:21 AM EST
I was about to say something about people in their right mind not going without fire service, then I got a mental image of some Tea Party nutters. Point taken.

[ Parent ]
well.. by sasquatchan (2.00 / 0) #7 Wed Oct 06, 2010 at 11:10:36 AM EST
The mefi discussion pointed out that the city residents pay tax to the city (property tax), and thus get coverage.

The county residents do not pay a tax to the city. Thus, the city fire department, shouldn't be obligated to cover the county residents, unless the county residents chip in.

Same as if you live in town A, and expect town B's public services to be made available for you.

(And lots of discussion about why there isn't a volunteer FD, should the county charge some property tax and "buy-in" services from the city, etc)

[ Parent ]
Yet if you live in Town A . . . by ammoniacal (2.00 / 0) #37 Wed Oct 06, 2010 at 03:19:22 PM EST
and drive drunk in Town B, the Town B Police Department will glad to be of service and arrest you and lock you up in Town B's expensive jail. It's also amazing when pigs from Towns A & B serve on the county-wide Joint Drug/Gang/Rights Removal Task Force. Hell, fire departments don't have to deal with jurisdiction. They should serve those in need when it is reasonable to do so.

"To this day that was the most bullshit caesar salad I have every experienced..." - triggerfinger

[ Parent ]
They're not serving you when they lock you up by Phil the Canuck (4.00 / 1) #40 Wed Oct 06, 2010 at 04:23:20 PM EST
They're serving Town B, who don't want jackasses driving drunk in their town.

[ Parent ]
Town B is rehabilitating Mr. Town A by ammoniacal (2.00 / 0) #45 Wed Oct 06, 2010 at 06:53:27 PM EST
at the expense of the citizens of Town B. The costs are fungible, therefore it's not different than a house on fire 20 feet outside of Town B's fire district. Just do the job, stop grousing and put the fire out.

"To this day that was the most bullshit caesar salad I have every experienced..." - triggerfinger

[ Parent ]
while I see your argument by bobdole (2.00 / 0) #68 Thu Oct 07, 2010 at 02:17:38 PM EST
the risk and cost to Town B for not putting out a fire outside jurisdiction is approximately 0. However, letting a drunk driver roam free in your town has a risk/cost factor of more than 0.

As it is decided that people need to be punished to not repeat this feat of stupidity, Town B chooses to spend money on rehabilitating Mr. Town A - as an investment in their own future safety. They couldn't care less if he keeps on DUIing in Town A - as their rehabilitation is only to keep him from DUIing in Town B. The fact that the rehabilitation is similar to what they do in Town A is a coincidence.

To extend this to an international frame, why put any foreigner in prison - when you can deport them and it will only cost you a fraction of rehabilitation?
-- The revolution will not be televised.

[ Parent ]
In non-capital cases, when they are by ammoniacal (2.00 / 0) #70 Thu Oct 07, 2010 at 04:48:17 PM EST
unlikely to be able to make restitution, then I say deport them instead of prison. It's the practical thing to do.

"To this day that was the most bullshit caesar salad I have every experienced..." - triggerfinger

[ Parent ]
neocon! by Breaker (2.00 / 0) #14 Wed Oct 06, 2010 at 12:40:34 PM EST
NT


[ Parent ]
(Comment Deleted) by aggressive cyclist (4.00 / 1) #5 Wed Oct 06, 2010 at 10:40:56 AM EST

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don't do makeup by Merekat (2.00 / 0) #9 Wed Oct 06, 2010 at 12:27:56 PM EST
Life is too short.

[ Parent ]
Or possibly a rebalancing? by Breaker (2.00 / 0) #17 Wed Oct 06, 2010 at 12:48:53 PM EST
In some areas the reach and remit of public services has gone too far, at too big a cost to be sustained.

This isn't one of them, mind you.


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #18 Wed Oct 06, 2010 at 12:51:57 PM EST

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[ Parent ]
They do. by Breaker (2.00 / 0) #20 Wed Oct 06, 2010 at 12:56:27 PM EST
Never thought I'd hear you argue for cutting the size and reach of the state, a_c.


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #22 Wed Oct 06, 2010 at 01:01:16 PM EST

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[ Parent ]
It does. by Breaker (2.00 / 0) #43 Wed Oct 06, 2010 at 06:06:36 PM EST
Are they really worth the money?  Nope, not IMHO.  That could be 4 extra nurses, a couple of teachers or some coppers instead.

Same as the diversity outreach mediation engagement 5 a day non-jobs.  Give me more people doing actually useful things, like hardnosed procurement officers, estate maintenance, housing officers, case workers for the genuinely vulnerable...


[ Parent ]
(Comment Deleted) by aggressive cyclist (4.00 / 1) #48 Thu Oct 07, 2010 at 04:19:13 AM EST

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[ Parent ]
Oh don't get me started on consultancy fees by Breaker (2.00 / 0) #50 Thu Oct 07, 2010 at 05:52:00 AM EST
Lavished on E&Y, Accenture, Crapita et al.  Greasing those wheels so the budget holders are rewarded later with those non exec posts...

As a consultant myself, we always get knocked down on price when tendering. 

That never seems to happen when the public sector get involved, there's never any oversight, making sure that the consultancy firms are doing what they're charging for. 

Contracts are poorly negotiated and hugely favour the consultancy firm. Look at the NHS SPINE system - there's a few blogs about written by people who've worked on it and the extortion demanded is shocking.  Move a text box on a form?  Oooh, a thousand pounds please, it's in the contract you signed.

If I signed up to a contract like that senior management would have me out the door so fast my feet wouldn't touch the ground.  You ever see that in the public sector?

And for the record, my clients are banks and hedge funds, so surely the more I extract from them the better, no?

Now, back to non jobs.  Aside from the cost, the objection I have for the non-job is the stultifying and pernicious effects on society. 

Too many snoopers, prodnoses and nannys who do not improve the quality of our lives but destroy it.  Don't smoke, don't drink, don't eat salt, eat your five a day, don't eat junk food, fear the coming enviro-apocalypse, avoid saturated fats, take some exercise, celebrate diversity, report your neighbour if you see them drop a crisp packet and so on and so on. 

Nope, stop intruding into my life with your endless barrage of interference. 

And how many of those expensive projects doled out to the consultancy firms originate from the prodnoses, the snoops and the nannies?  If the state does less, the consultants get less.


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #53 Thu Oct 07, 2010 at 08:58:09 AM EST

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[ Parent ]
No by Breaker (2.00 / 0) #57 Thu Oct 07, 2010 at 10:17:38 AM EST
That's a failure of government, which in turn is a failure of us who elect them.  Unless of course, the revolving doors involve unelected top officials. 

The government should have clamped down on this back scratching long ago, but where is the public outrage that brings votes if politicians were to address it?  I'll bet a pound to a penny you heard something about Hague and some SPaD and a shared hotel room; did you hear about this MP trying to shine some light on those revolving doors?

Stultifying, yes.  Do you want someone to intrude into your privacy and heckle you, or someone to make sure your elderly Mum is alright?  Which is of more value, if you have to pick only one? 

I'm fairly sure having someone monitoring sea levels and raising the alarm before the Thames swamps us all is a good thing. 

Employers and banks intruding on things that are none of their business are also not acceptable. 

The difference being, I can go to another bank if I don't want to give a blood test and a hair sample. 

Can I go to a different UK government?  Oh.

For your stated 17% figure I'd ask to see the numbers.  The anti smoking lobby has form in statistical manipulation.


[ Parent ]
Connecting for Health was of course by ambrosen (2.00 / 0) #55 Thu Oct 07, 2010 at 09:25:56 AM EST
ordered by central government. I suspect it's the Blair regime's poor eye for detail that makes it so absurdly costly. Also, a generally hostile environment for the idea of having medical details stored electronically. After all, you don't get the option to have a bank account that's not stored electronically. At least, not a useful one.

But connecting for health is focussed on improving the delivery of all healthcare, the meat & potatoes and what you deem to be fluff alike.

[ Parent ]
Still funded from taxation. by Breaker (2.00 / 0) #56 Thu Oct 07, 2010 at 10:00:07 AM EST
How often do we need medical records stored centrally, electronically?  If it truly is deemed a "good" then why not put them on an encrypted USB drive?

If my bank are careless with my electronic details and authorisation they're liable for restitution and I can sue them seven different ways until Sunday. 

When that happens in the public sector who got sacked?  One resignation and that was it.  Even when private firms cock up with state mandated data their contracts are not terminated either. 

And because of the nature of the contract, Citizen->State->Private Company the citizen has no contract with the private company and can't hammer them direct.


[ Parent ]
I don't know exactly how often they're used. by ambrosen (4.00 / 2) #69 Thu Oct 07, 2010 at 02:35:21 PM EST
So, say my colleague in the liaison service at [redacted] general hospital is called in on-call on a Sunday morning as someone's been found in a state of distress having driven 150 miles to jump off the [redacted] bridge. The patient is not engaging with them, but they do have a name and date of birth.
How do you suggest they find out that patient's background, and whether, say they were recently discharged from care near to their home?

Or maybe your problems is with patient records being stored electronically at all.
In that case, what do we do with patients who are, I don't know, seen by different members of staff on different sites for different purposes within the same treatment episode?

I mean, those are a couple of use cases that come to mind straight off. They take a fair while to write up, though, so you'll excuse me for not putting more in.

Likewise, I hope you'll forgive me for not going into too much detail about information governance within the NHS, and what safeguards and standards and auditing are kept to, because, well it takes quite a lot of work to write it all up, and I guess it's all there for you to find if you want. ‘Caldicott Guardian’ is a decent phrase to start your research on.

I guess your complaint about lack of accountability may or may not be valid. I have no idea what penalties central government would apply if there were a data leak, because, well, my employers have never had one. I don't doubt penalties would be applied, though.

I have been involved in organising large scale transfers of patient data between NHS organisations, though, and I regularly use the government secure intranet to email patient identifiable data where necessary, and use fax machines if there's no secure end-to-end email path to the person I need to contact. Of course, using a fax machine's a pain, because you need to find out from the person at the other end who has access to it, and confirm that they will pick it up as soon as it arrives at the machine, etc. Fortunately, these procedures are all carefully documented within the organisation, and I'm sure the national guidelines are on the Department of Health website. And if I were to put a USB stick in my computer at work, I'd be getting a phone call straight away, and an uncomfortable meeting with the head of information governance before I could use my computer again.

And as for what goes on at HMRC, it was the chairman of the organisation who resigned. I don't know if there were sackings further down the chain of command, but your link certainly doesn't prove "one resignation and that was it".

[ Parent ]
I am heartened by your commentary by Breaker (2.00 / 0) #73 Fri Oct 08, 2010 at 05:05:51 AM EST
On data security in the NHS.

Your regard of the use case for electronic records is pretty thin edge case stuff though.  MBW has a big red book for the bairn, which we take to the doctors and hospital whenever we need, and a folder for her progress in pregnancy.

It's not that big a deal to hold on to these documents and bring them with us.  Bearing in mind most people when they're going to the NHS are quite interested in giving the medics all the information that is possible.

Out of your normal GP / hospital, how many times does that happen and was it worth the expenditure?


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #75 Fri Oct 08, 2010 at 05:33:47 AM EST

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[ Parent ]
Nope. by Breaker (2.00 / 0) #76 Fri Oct 08, 2010 at 05:40:49 AM EST
I'm arguing against the unsecured electronic transmission of data, and the utility vs cost of managing it.

Government has proved time and time again it cannot be trusted to keep our data safe.


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #77 Fri Oct 08, 2010 at 06:09:46 AM EST

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[ Parent ]
Pretty sure the HMRC loss by Breaker (2.00 / 0) #78 Fri Oct 08, 2010 at 07:46:39 AM EST
Was in house.

Not that I'm excusing the private sector, mind.


[ Parent ]
Unsecured? by ambrosen (2.00 / 0) #80 Fri Oct 08, 2010 at 08:55:42 AM EST
Funny, I was sure my access to the Spine was restricted to being from an NHS computer to which I was logged in to under normal conditions, and then I log in to the Spine with my smartcard and passcode for that.

And, of course, it's only the summary care record that's actually on the Spine.

Here's what it contains:

http://www.nhscarerecords.nhs.uk/summary/

[ Parent ]
Yes. by Breaker (2.00 / 0) #85 Fri Oct 08, 2010 at 09:15:46 AM EST
HMRC data was unsecured.  I am pleased that the NHS Spine does have an attempt at security.

Now, what's stopping you[1] having a look at my health records?  Pretty benign, you[1] can post details of my[2] hilarious chronic haemorrhoid condition under a new anonymous account name.  Just for teh lulz, of course.

Or as part of a vetting procedure for employment or health insurance, what if the reference agencies offered you[1] a hundred quid for a screenshot of my SCR?  Might have details of my former heroin addiction[2], or mental health issue etc.

[1] For "you" read anyone in your position; I'm not accusing you personally of ever considering doing this. 
[2] for "me" read anyone with an electronic record; I don't have piles nor any history of heroin use.


[ Parent ]
HMRC data was insecurely secured. by ambrosen (2.00 / 0) #88 Fri Oct 08, 2010 at 10:00:22 AM EST
The Chairman of HMRC resigned as a consequence. This is the point of having national programs and standards. It was on a disc using WinZip password protection.

What stops me looking at your health records is that I only have access to demographic data on the Spine. And, should you have a mental health issue, and should it have been treated by my employer, I will soon have access to slightly more than that, on the local implementation National Program for IT system (RiO, in our case, there's about 10 different systems, IIRC). But because my role's fairly unusual, it's taking a while to work out what access I need.

That is to say, data access is granular to the extent that it can be, normal access is audited, and unusual access is flagged (for example, if I don't have enough patient information to pin down the exact patient, I can click to be shown a list of the patients which match, and that will be flagged, and followed up with me if it happens too often).

So it's relatively fine-grained. There is trust involved, but the medical profession has always had to deal with patient confidentiality.

[ Parent ]
You should do a diary post on this by Breaker (2.00 / 0) #92 Fri Oct 08, 2010 at 10:57:30 AM EST
Detailing how well the system is set up and how the opportunities for abuse or negligence are minimised.


[ Parent ]
Ooops by Breaker (2.00 / 0) #93 Fri Oct 08, 2010 at 10:57:57 AM EST
Forgot to say thanks for the information; much obliged.


[ Parent ]
Thanks. by ambrosen (4.00 / 1) #102 Mon Oct 11, 2010 at 08:02:49 AM EST
I'm not sure I'm good at ever getting round to unprompted writing, but yeah, it's an issue that's important to me.

I'm not saying it's perfect, but it seems OK to me.

The article I'd rather have written was the one on the changes to the English NHS that involve GPs commissioning services. I might try to do that some time, especially as I get to know more about how things work in Wales and Scotland.

[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #89 Fri Oct 08, 2010 at 10:02:06 AM EST

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[ Parent ]
Very little. by Breaker (2.00 / 0) #91 Fri Oct 08, 2010 at 10:56:33 AM EST
Differnce being I have to sign a data consent form if BUPA want to store that info; for now, the NHS I have to sign a form to opt out.

How long before that becomes compulsory?


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #94 Fri Oct 08, 2010 at 11:15:16 AM EST

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[ Parent ]
Nah. by Breaker (2.00 / 0) #95 Fri Oct 08, 2010 at 11:17:20 AM EST
Opt in > opt out.

End of.


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #96 Fri Oct 08, 2010 at 11:32:21 AM EST

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[ Parent ]
Can I opt out by Breaker (2.00 / 0) #97 Fri Oct 08, 2010 at 11:33:32 AM EST
Of the state sector?

Can I opt out of the private?


[ Parent ]
(Comment Deleted) by aggressive cyclist (4.00 / 1) #98 Fri Oct 08, 2010 at 11:35:39 AM EST

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[ Parent ]
By omission, you answer by Breaker (2.00 / 0) #99 Fri Oct 08, 2010 at 11:38:43 AM EST
I can't opt out of the state.  Or start my own state.

But you're right, the weekend is indeed calling and I believe it's the boss's first round for the company meeting t'neet.

Have a good weekend, a_c, hope you have a blinder.


[ Parent ]
Given that the key focus is on IT within trusts by ambrosen (2.00 / 0) #81 Fri Oct 08, 2010 at 08:58:34 AM EST
Enough that the cost of the Summary Care Record is worth it, I guess.

I didn't give other examples of where the Summary Care Record can be useful because I was only using examples from my day-to-day life.

And I know that I definitely miss out elements of my healthcare history when I'm telling it to new professionals.

[ Parent ]
of course by Merekat (2.00 / 0) #82 Fri Oct 08, 2010 at 09:00:52 AM EST
And that's in the best case scenario where you're conscious enough to forget...

[ Parent ]
For conditions that actually count in by Breaker (2.00 / 0) #83 Fri Oct 08, 2010 at 09:06:42 AM EST
Unconciousness cases, you're already carrying enough to let the A&E professionals know - you'll have the scar. 

The only thing you won't have is allergy notes, and for the most part the allergies are either an irritant or unnecessary to bring you back to consciousness.


[ Parent ]
Or by Merekat (2.00 / 0) #84 Fri Oct 08, 2010 at 09:09:52 AM EST
can kill you.

[ Parent ]
Unless treated quickly. by Breaker (2.00 / 0) #86 Fri Oct 08, 2010 at 09:18:56 AM EST
Which seeing as you're in a hospital with people who know that anaphylactic shock or cardiac / renal failure is possible after administering drug X, will monitor you if they give you any kind of drug X that can provoke life threatening reaction Y.


[ Parent ]
So, I was giving my history to a doctor by ambrosen (2.00 / 0) #90 Fri Oct 08, 2010 at 10:11:49 AM EST
in ER/A&E in Canada, because I got heatstroke. So I said I had Crohn's and she was palpating my abdomen, and she said "I see you've not had surgery though". So I pointed out the long, but neat scar running the length of my linea alba (basically, the length of my abdomen) which she had somehow missed.

[ Parent ]
Funny how you believe it's a non-job if you don't by ambrosen (4.00 / 1) #54 Thu Oct 07, 2010 at 09:20:02 AM EST
understand it.

Who exactly should be in charge of making sure that, for example, mental health care is as accessible to black people as it is to white people? Because at the moment, even when you control for socioeconomic status, white patients get vastly more community treatment and, conversely, black patients are admitted for treatment far more. It's easy to see how equalising access to community treatment could quickly save the salary of a diversity officer (probably £25 - £30k).

And I was at a talk by a dean of medicine earlier this year, and he said plenty of people become doctors to save lives, but if you really want to save lives, where you really want to be focussed is in public health. e.g. five-a-day coordinators

Anyway, must go: there's treatment costs to be calculated.

[ Parent ]
(Comment Deleted) by Breaker (2.00 / 0) #58 Thu Oct 07, 2010 at 10:34:37 AM EST

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(Comment Deleted) by aggressive cyclist (2.00 / 0) #59 Thu Oct 07, 2010 at 10:37:19 AM EST

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(Comment Deleted) by Breaker (2.00 / 0) #61 Thu Oct 07, 2010 at 10:38:24 AM EST

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(Comment Deleted) by aggressive cyclist (2.00 / 0) #62 Thu Oct 07, 2010 at 10:42:38 AM EST

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Hehe. by Breaker (2.00 / 0) #63 Thu Oct 07, 2010 at 10:48:27 AM EST
Because of course, no one's ever hit post on an incomplete reply.

Or made a fake post and deleted it for teh lulz.

Or indeed, ISTR some other user a while back who'd periodically go through their old posts and delete them as a matter of personal policy.


[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 2) #64 Thu Oct 07, 2010 at 10:51:30 AM EST

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[ Parent ]
Most of them are extremely tedious, though by ambrosen (4.00 / 2) #66 Thu Oct 07, 2010 at 11:48:16 AM EST


[ Parent ]
Umm by Breaker (2.00 / 0) #60 Thu Oct 07, 2010 at 10:37:49 AM EST
So you're saying as long as the department offers treatments a,b,c equally to anyone who crosses their door in need of help, we can save up to 30K on a non job?

Hmm, until there are no further deaths from hospital acquired infections I'm fairly sure that the medical profession would be better off spending money sorting that out than hectoring people, based on some spurious "it's for your own good" rationale.


[ Parent ]
Yep, hectoring with a spurious rationale is wrong by ambrosen (4.00 / 1) #67 Thu Oct 07, 2010 at 01:57:15 PM EST
Point a):

Sadly, even though there is no overt discrimination in the way treatment is offered, and access remains the same in all areas, the actual uptake of treatment is much poorer by black people.

Which has direct costs, because hospital stays are very expensive, and indirect costs, because people are living in poor health when they shouldn't be. Just for the record, it's fairly common for a patient's treatment costs to reach £30k in the mental health sector.

Point b):

That's absurd. As long as the improvements in public health are measurable, support and engagement with people who have unhealthy lifestyles and who already have a relationship with a given public service can easily be a cost effective way to keep people healthy. Yes, of course it's counterproductive and unpleasant to nag people. That's why I said support and engagement.

Yes, it also costs money to reduce healthcare acquired infections, but the standard isn't either/or, it's cost per quality adjusted life year*, same as everything else. Obviously real life means that relatively clean environments are a very cost effective way to improve outcomes. That's been known since 1847. Environments where it's almost impossible for healthcare acquired infections to happen (shall we say that your standards equal less than one infection incident per ten billion hours in the environment)? Well, that's starting to sound quite expensive. Maybe it'd be better to have another 500 doctors (or insert other 'real' medical professional) saving 100s of lives than to save those last 5 lives a year which could have been saved by treating hospitals like semiconductor foundries.

And how come the same mentality that ridicules campaigns for healthy eating isn't all over the idea of the "ridiculous waste of money" involved in all NHS staff (with patient contact) having "handwashing lessons"? I mean, that's got to be nanny-state stuff. Everyone knows how to wash their hands, right?

*that is, cost per QALY is the dominant factor. I agree that it would be absurdly utilitarianist not to spend proportionally more on preventing never events and other adverse outcomes than it would on improving outcomes with medical interventions, and proportionally more on those than on directed public health measures.

[ Parent ]
You're joking, right? by ammoniacal (4.00 / 1) #71 Thu Oct 07, 2010 at 05:24:48 PM EST
Because I see food handlers here scratch their heads and faces with their "sterile" plastic gloves and nonchalantly return to serving food ALL OF THE FUCKING TIME and I don't trust healthcare "professionals" to exceed that level of "care."

Yeah, bring on the daily pre-shift sanitation refresher training, damn the cost, because they NEED IT.

"To this day that was the most bullshit caesar salad I have every experienced..." - triggerfinger

[ Parent ]
I was using scare quotes. by ambrosen (4.00 / 2) #72 Thu Oct 07, 2010 at 07:34:56 PM EST
I was saying that training in infection control measures up pretty similarly to other public health measures, so if you're ridiculing the one, you could easily be ridiculing the other.

Yep, I do believe infection control's important. And I do a full 6 stage handwash every time I wash my hands.

[ Parent ]
That's not diversity then. by Breaker (2.00 / 0) #74 Fri Oct 08, 2010 at 05:21:39 AM EST
That is outcome cost management.

It's not support and engagement though is it?  It's hectoring and chin raising, with a little sniff and a kiss of the teeth. 

In a cost restricted world, should the money be spent on preventing those never events, or beating people in to healthier lives?

Everyone does indeed know how to wash their hands.  Does everyone know how to wash their hands clinically to remove hard to kill bacteria, though?


[ Parent ]
Yes, but that's shifting the goalposts. by ambrosen (2.00 / 0) #79 Fri Oct 08, 2010 at 08:49:46 AM EST
Because that outcome cost management is performed by a diversity officer. I didn't read the titles of the last (triennial, I think) diversity conference our trust had, but I'm sure it was focussed on improving access to care for people who aren't white, or who have a physical disability or learning disability.

You call it hectoring and chin-raising, I call it support and engagement. If it's the former rather than the latter, then that's a local management problem. 5-a-day officer is meant to be an approachable name for dietetic assistant, I presume. Unfortunately approachable job titles can be turned into names mocked by tabloid hacks. If they improve the health of the people that they treat by enough to make it worth their salary, then the money is well spent.

The example of hand washing was given exactly to make that point: ridiculing jobs because "they're only common sense" doesn't work, because most things that are just common sense don't actually get done properly.

[ Parent ]
I suspect by Breaker (2.00 / 0) #87 Fri Oct 08, 2010 at 09:21:04 AM EST
We're chewing the same sausage just from different ends.

things that are just common sense don't actually get done properly.

And yet we waste money on things that don't make sense, for the tabloid headlines and to further the capture of client minority groups.


[ Parent ]
the fire scene by MillMan (2.00 / 0) #25 Wed Oct 06, 2010 at 01:08:47 PM EST
in Gangs of New York was pretty amusing - in a I'd rather laugh than cry sort of way.

"Just as there are no atheists in foxholes, there are no libertarians in financial crises." -Krugman

[ Parent ]
(Comment Deleted) by aggressive cyclist (2.00 / 0) #29 Wed Oct 06, 2010 at 01:19:43 PM EST

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[ Parent ]
it's worth checking out by MillMan (4.00 / 1) #36 Wed Oct 06, 2010 at 02:46:09 PM EST
Basically two competing private fire companies show up at a house on fire and proceed to fight each other for the right to loot anything of value in the house before it's gutted.

"Just as there are no atheists in foxholes, there are no libertarians in financial crises." -Krugman

[ Parent ]
Seen similar by marvin (4.00 / 3) #24 Wed Oct 06, 2010 at 01:04:37 PM EST
My brother-in-law is the assistant fire chief in the neighbouring town of 5,000 people in which my wife grew up.

There is a nearby development with a few streets containing expensive waterfront homes that is outside of town limits. These streets have no fire protection, as they are outside the boundaries, and do not pay taxes to the town. I believe that they had the opportunity to be included inside the boundary, but they chose in the past to keep lower taxes and remain outside.

The last time a structure fire occurred on that street a few years ago, the town's fire department went out, likely at the request of the provincial forest ministry under a mutual aid agreement. They stopped the fire from spreading to adjacent structures or the surrounding forest. They would have gone into the house for a person.

The house was left to burn to the ground, however. The same will happen the next time, until those people decide that fire protection is more important than saving a few thousand dollars a year in taxes. Odds are, their home insurance would drop by the same amount that their taxes would go up, but cost/benefit analysis isn't a strength of the people who live on that road, I guess.

There is a strong feeling about this policy among the town firefighters, and they fully support it. My brother-in-law nearly died in the Okanagan Mountain Park forest fire in 2003, in a firestorm in Kettle Valley on a night that around 100 homes were burned, as flame walls hundreds of feet high swept over the area. That was in a neighbouring town, but there was a mutual aid agreement which pulled firefighters from all over the province. I'm pretty certain that he would risk his life again in a situation like the 2003 fire, just as readily as he would watch another house burn down to the foundations on that road of freeloaders.

There is no ethical dilemma in his mind. He feels the same about them as most of us would about people who choose to not buy home insurance, or car insurance. The town doesn't plough the snow from freeloader roads in the winter, and it doesn't send firefighters to protect their house. Fire protection and road maintenance are both municpal services, and are delivered only to the people who pay for them.

This is in Soviet Canuckistan, where we do believe in universal health care, etc, and where demagogues like Glen Beck are not held in wide esteem.


Similarly by garlic (2.00 / 0) #32 Wed Oct 06, 2010 at 01:31:37 PM EST
I think something similar should be considered for people who rebuild in natural disaster alleys -- State or Federal compensation for someone to rebuild in a natural disaster prone area without something to mitigate the natural disaster doesn't make sense. I recall one town on the Mississippi River that didn't want to build flood walls because it'd ruin their pretty view of the river. But every decade or so, the river would flood and destroy the town, and state and federal monies would go to helping the town rebuild, but not demand a flood wall go up.


[ Parent ]
yeesh by clover kicker (2.00 / 0) #34 Wed Oct 06, 2010 at 01:48:20 PM EST
I'd sooner go without fire coverage then without gov't snowplows, do they get plowed by the province or something? Anything over a foot of snow and you'd be screwed, no matter how big your 4x4.

[ Parent ]
Province by marvin (2.00 / 0) #35 Wed Oct 06, 2010 at 02:44:17 PM EST
They pay some property taxes to the province with a token amount for policing and roads, nowhere near enough to cover actual costs. Some of that is given by the province to the regional district, which offers a limited array of municipal services such as zoning, building permits, dog control, and parks.

Same trucks that do the highways though, so it takes a bit longer because they're lower priority in a big snowstorm, and the snowplows might not visit as frequently. We're a bit warmer and drier, get less snow than you too. It is not uncommon to have a green (well, brown) Christmas, especially at lower elevations down by the lake.

[ Parent ]
PETA will probably become involved by tuscoops (2.00 / 0) #44 Wed Oct 06, 2010 at 06:29:24 PM EST
Because allowing these people's pets to die is inhumane. Likewise, where does the fire department draws the line, such as if there were children inside (ie- anyone that could be harmed/killed who had no control over the fact that the owners didn't pay the bill)? And would a commercial business that failed to pay with customers inside their burning building be treated the same? I can't imagine they're going to continue to keep things status quo.


I don't think PETA will get involved by lm (2.00 / 0) #52 Thu Oct 07, 2010 at 07:42:16 AM EST
In PETA's view, it isn't letting them die that was inhumane but keeping them in the house in the first place. Animals are meant to run free, not be victim to house arrest by a petty tyrant whose only claim to mastery is being human.

There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
[ Parent ]
Very close by Scrymarch (4.00 / 2) #47 Wed Oct 06, 2010 at 11:42:20 PM EST
To life imitating Onion

http://www.theonion.com/articles/libertarian-reluctantly-calls-fire-department,4651/

Iambic Web Certified

Compassion for those who cannot afford it by lm (4.00 / 1) #51 Thu Oct 07, 2010 at 07:38:52 AM EST
So far as I can tell, Crannick can afford having his house burn down. In at least one interview he mentioned having it insured. In others, he mentioned being willing to cut a check for tens of thousands of dollars if the firefighters were to put out the fire. So, I think this is less a case of having compassion on those who need it and more a case of having compassion on those who choose to be stupid.

I would think this to be a tragedy if Crannick were so poor that he had made a choice between buying food for his family and paying the fire service fee in favor of feeding his family. But I have no reason to think that such is the case.

That said, Beck's public persona is that of an asshat. In this particular case, he's basically chiding Crannick for following through on Beck's own state philosophy of rugged individualism. It's also pretty rich for a man who can apparently cry on cue and whose rants are filled with emotional invective and precious little rationality to explain why only those driven by raw emotion might have pity for Crannick.


There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
"Free rider problem" by ucblockhead (2.00 / 0) #65 Thu Oct 07, 2010 at 11:36:30 AM EST
Neocons love to talk about the efficiency of voluntary payments, but this is exactly what it leads to because if it isn't done this way, a large subset just won't pay,

The alternative is to make it a tax.

This same debate is far larger and causes far more strife in health care.
---
[ucblockhead is] useless and subhuman

Diaries with 100 comments are rare these days. by ammoniacal (1.00 / 2) #100 Fri Oct 08, 2010 at 01:22:21 PM EST

"To this day that was the most bullshit caesar salad I have every experienced..." - triggerfinger

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