Greg Nicholaides

Medical staff walks through a corridor inside Royal London Hospital.

Nearly a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons. More than 36,000 have been in treatment queues for nine months or more.  Long waits for care are endemic to government-run, single-payer systems like the NHS. Yet some U.S. lawmakers want to import that model from across the pond. That would be a massive blunder.

Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. That’s well below the country’s goal of treating 95% of patients within four hours – a target the NHS hasn’t hit since 2015. Now, instead of cutting wait times, the NHS is looking to scrap the goal.

Wait times for cancer treatment – where timeliness can be a matter of life and death – are also far too lengthy.  According to January NHS England data, almost 25% of cancer patients didn’t start treatment on time despite an urgent referral by their primary care doctor. That’s the worst performance since records began in 2009.  And keep in mind that “on time” for the NHS is already 62 days after referral.

Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America.

The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of “limited clinical value.”

It’s hard to see how a surgery that can prevent blindness is of limited clinical value. Delaying surgery can cause patients’ vision to worsen – and thus put them at risk of falls or being unable to conduct basic daily activities.

“It’s shocking that access to this life-changing surgery is being unnecessarily restricted,” said Helen Lee, a health policy manager at the Royal National Institute of Blind People.

Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same “limited clinical value” label on them.

Patients face long wait times and rationing of care in part because the NHS can’t attract nearly enough medical professionals to meet demand. At the end of 2018, more than 39,000 nursing spots were unfilled. That’s a vacancy rate of more than 10%. Among medical staff, nearly 9,000 posts were unoccupied.

These shortages could explode in the years to come. In 2018, the Royal College of General Practitioners found that more than 750 practices could close within the next five years, largely because heavy workloads are pushing older doctors to retire early.

The NHS recently announced that, in a desperate attempt to shore up its doctor workforce, it would pay British general practitioners working abroad more than $24,000 in “relocation support” to come back to the country. The Service is also trying to encourage doctors to come out of retirement.  Great Britain’s health crisis is the inevitable outcome of a system where government edicts, not supply and demand, determine where scarce resources are allocated.

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We at ‘Greg Says’ share the concerns of many healthcare professionals that a “Medicare for All” approach to healthcare in the USA poses several risks borne out by the results experienced in Canada and Great Britain.

The Cleveland Clinic

Jan. 18, 2019

Have you resolved to slim down in 2019? Chances are you already know the health and beauty benefits of losing weight, but there is one more area that stands to gain when you lose: your brain. Losing belly fat, in particular, is linked to better brain health.

Researchers weigh-in: body shape and the brain

A recent research study of more than 5,000 adults age 60 and older showed that a large waist-to-hip ratio (“apple shape”) was more often aligned with poor scores on memory and thinking tests than was overall weight or body mass index.

Another group of researchers took a look at body mass index (BMI), waist-to-hip ratio and brain size of 9,600 people around the age of 55. By comparing brain scans (MRIs), they linked both high BMI and bigger belly size to smaller brain size.

What does belly fat have to do with your brain?

A big, bulging belly, or more affectionately called a “beer belly” or “spare tire”, is made of visceral fat. This troublesome fat develops from consuming too many calories and is located inside organs and between the organs of your stomach. It can produce harmful hormones and inflammation in the body leading to an increased risk of many health problems including heart disease, type 2 diabetes, high blood pressure, high cholesterol and possibly dementia.

While scientists continue to explore the belly-brain connection, it’s a good idea to keep your weight, blood sugar and heart-related medical conditions in check to support brain health.

How do you whittle your waist?

The good news is that visceral fat breaks down more easily than other fat, so it will most likely be the first to go when you start to lose weight. According to experts sit-ups alone won’t cut-it. Eating a healthy diet with reasonable portion sizes and getting regular exercise, especially cardio and strength training, is the best way to lose belly fat.

Nearly one-quarter of Americans say they never plan to retire, according to a poll that suggests a disconnection between individuals’ retirement plans and the realities of aging in the workforce.

Experts say illness, injury, layoffs and caregiving responsibilities often force older workers to leave their jobs sooner than they’d like. According to the poll from The Associated Press-NORC Center for Public Affairs Research, 23% of workers, including nearly 2 in 10 of those over 50, don’t expect to stop working. Roughly another quarter of Americans say they will continue working beyond their 65th birthday.

According to government data, about 1 person in 5 age 65 and older was working or actively looking for a job in June.  For many, money has a lot to do with the decision to keep working.

“The average retirement age that we see in the data has gone up a little bit, but it hasn’t gone up that much,” says Anqi Chen, assistant director of savings research at the Center for Retirement Research at Boston College. “So people have to live in retirement much longer, and they may not have enough assets to support themselves in retirement.”

When asked how financially comfortable they feel about retirement, 14% of Americans under the age of 50 and 29% over 50 say they feel extremely or very prepared, according to the poll. About another 4 in 10 older adults say they do feel somewhat prepared, while just about one-third feel unprepared. By comparison, 56% of younger adults say they don’t feel prepared for retirement.

Among those who are fully retired, 38% said they felt very or extremely prepared when they retired, while 25% said they felt not very or not at all prepared.

“One of the things about thinking about never retiring is that you didn’t save a whole lot of money,” says Ronni Bennett, 78, who was pushed out of her job as a New York City-based website editor at 63.

She searched for work in the immediate aftermath of her layoff, a process she describes as akin to “banging my head against a wall.” Finding Manhattan too expensive without a steady stream of income, she eventually moved to Portland, Maine. A few years later, she moved again, to Lake Oswego, Oregon.

“Sometimes I fantasize that if I win the lottery, I’d go back to New York,” says Bennett, who has a blog called Time Goes By that chronicles her experiences aging, relocating and, during the past two years, living with a pancreatic cancer diagnosis.

Meanwhile, Americans have mixed assessments of how the aging workforce affects workers: 39% think people staying in the workforce longer is mostly a good thing for American workers, while 29% think it’s more a bad thing and 30% say it makes no difference.  A somewhat higher share, 45%, thinks it has a positive effect on the U.S. economy.

Working Americans who are 50 and older think the trend is more positive than negative for their own careers — 42% to 15%. Those younger than 50 are about as likely to say it’s good for their careers as to say it’s bad. Just 6% of fully retired AP-NORC poll respondents said they left the labor market before turning 50.

But remaining in the workforce may be unrealistic for people dealing with unexpected illness or injuries. For them, high medical bills and a lack of savings loom large over day-to-day expenditures.

“People like me, who are average, everyday working people, can have something catastrophic happen, and we lose everything because of medical bills,” says Larry Zarzecki, a former Maryland police officer who stopped working in his 40s after developing a resting tremor in his right hand and a series of cognitive and physical symptoms he at times found difficult to articulate.

At 47, he was diagnosed with Parkinson’s disease. Now 57 and living in Baltimore, Zarzecki says he has learned “to take from Peter and give to Paul, per se, to help make ends meet.”

Zarzecki has since helped found Movement Disorder Education and Exercise, a nonprofit organization that offers support and treatment programs to those with similar diseases and certain traumatic brain injuries. He has also helped lobby state and national lawmakers to address rising prescription drug prices. He receives a pension and health insurance through the state, but he spends more than $3,000 each year out of pocket on medications.

“I can’t afford, nor will my insurance cover, the most modern medication there is for Parkinson’s,” he says. “Eat, heat or treat. These are decisions that people in my position have to make. When it’s cold out, or if it’s real hot out, do you eat, heat (your home) or treat (your ailment)?”

Posted By Mary Kuhlman, Ohio News Service on Thu, Sep 19, 2019

COLUMBUS, Ohio – Prescription drug price hikes have surpassed the rate of general inflation for more than a decade, according to a report just released.

The research – from the AARP Public Policy Institute’s “Rx Price Watch Report” series – shows that between 2006 and 2017, prescription medications widely used by older Americans increased in price 4.2%.  That’s double the price increases for other consumer goods and services.

Report co-author Leigh Purvis, director of health services research for AARP’s Public Policy Institute, attributes the findings primarily to increases for brand name and specialty drugs, which she says more than offset price decreases among generic drugs.

“There’s really nothing in the U.S. health care system to stop drug manufacturers from setting very high prescription drug prices and then, increasing them pretty much any time they want,” she states. “And unfortunately, what we’re seeing is the repercussions of that, where we have these incredibly high priced products that also are increasing in price every year that they’re on the market.”

The report found in 2017, the average annual cost of one widely used drug was roughly $20,000.

Purvis says that cost would have been about $12,000 lower if price changes had been limited to the inflation rate between 2006 and 2017.The research predicts if these trends continue, people could struggle to access and pay for medications they need, which would in turn lead to poor health outcomes and higher health care costs. Purvis adds it’s an issue that affects everyone – even those who don’t take prescription medications.

“So, you’re either paying for them as a patient at the pharmacy counter, or you’re paying for them through your health insurance, because they’re built into your premiums and your cost-sharing,” she points out.

“And you’re also paying for them as a taxpayer. Public programs pay for prescription drugs, and these high prices are being paid for with your taxes.”

The average cost of one commonly prescribed drug in 2017 was about 20% higher than the average annual Social Security retirement income and almost one-third of the median U.S. household income.

At ‘Greg Says’ we believe it’s time to allow Medicare the ability to negotiate drug pricing with the pharma industry just as private group insurance companies do.