Saturday, December 13, 2008

An Example of How Well Socialized Medicine Works

Since President-Elect Barack Obama seems hellbent on nationalizing healthcare in this country, it's always good to see how it works in other places. Of course, I've covered women giving birth at home because the hospital was full, the new fad of health tourism, where people travel halfway around the world to have procedures done that they can't get at home, ambulances idling in hospital parking lots because of overcrowded emergency rooms, and the inability to get life-saving medications but encouragement to off oneself. Because socialized medicine is great...if you don't get sick.

Now comes news of NHS dentists who don't want to work. (H/T Brothers Judd)

I can save Alan Johnson some time. The Health Secretary announced that he was setting up an inquiry into why 1.2 million people have “lost” their NHS dentist. I know why. It all went wrong in 2005, when the Government’s time and motion people devised a whizzy “New Dental Contract”. Barry Cockcroft, the chief dental officer, endorsed it as “carefully considered, fully consulted and rigorously trialled”.

Oh yes? Dentists’ NHS pay was henceforth rebranded as their annual contract value (ACV), based on their income in the year before the contract was introduced. For this ACV, they were to provide a set quota of units of dental activity (UDA) for NHS patients.

Dentists call these “udders”. The system is so tightly micromanaged that it’s as impossible to explain as a Budget book. But two things were immediately clear: if a dentist didn’t do enough udders in the given year, his money would be cut. But if he did extra udders, he would earn no extra pay. Two thousand dentists immediately left the NHS.

People don't work harder if there's no reward for it. That's just human nature. And when your system is rigged to encourage you to work just as much as last year--but no more--that's exactly what you get.

But wait. The story gets better.

The other thing is that “a filling” counted as three udders, whether it was actually one filling or five, and dentists had to charge accordingly. Patients started saving up their cavities and coming in, high on codeine, with their mouths full of holes. If I need three fillings, my (private) dentist makes three appointments. Afterwards, he chucks away such of his endodontic burs and Gates Glidden drills that can’t be sterilised for reuse, and bills me for it all. But NHS dentists can’t add any “extras” to an udder.

Dentists quickly noted the disconnect between the cost of filling a multiplicity of historic cavities for the chap with the problem, and the gross remuneration to the chap with the Gates Glidden. A very nice dentist wrote to me ruefully in 2007, pointing out that no dentists would want to stay in the NHS. So it goes.

In other words, it's more cost-effective to make someone wait until he or she has many cavities rather than filling them as they occur. Obama has promised this brand f healthcare for all. Is dentistry far behind?