Health

What If Gordon Won’t Go?

Health, UK politics
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castlereagh_death1

I have cardiology appointments and a dialysis session for the rest of the day and no access to wifi so no blogging from me till much later, if at all and anyhow the media, especially the BBC, seem to have cold feet and have backed off Gordon Brown.

For the moment only. Nick Brown, PM’s top henchperson and Labour chief whip, must surely be running out of nasty little journalistic secrets by now. It won’t be long before the hounds start baying again.

It also can’t be long before Gordon has another phone-throwing tantrum or does himself or someone else a mischief. Even the loyalists might jump if he’s visibly cracking up. But would they? The line from no 10 this morning is that he’ll “have to be carried out of No. 10 in a box”.

It wouldn’t be the first story of ministerial madness in British constitutional history: this morning I’ve been reading about the early 19th century war minister, the notorious Viscount Castlereagh, of whom Byron quipped:

” Posterity will ne’er survey
a Nobler grave than this:
Here lie the bones of Castlereagh:
Stop, traveller, and piss!

The man who ordered the Peterloo massacre suffered from a form of severe paranoia that first led him to challenge the then Foreign Secretary George Canning to a disastrous duel and eventually to cut his own throat in despair.

But Lord Castlereagh wasn’t a serving PM, only a minister. There was no constitutional crisis as such. That got me wondering – what is the precedent should a British PM become sectionable while in office? Who makes the call? The Cabinet? Parliament? What about the Queen? What if he were to refuse to even see a doctor? What should happen then – should psychiatrists be sent to No. 10 to forcibly examine a Prime Minister?

A patient can be sectioned if they are perceived to be a threat to themselves or other people. Generally, a patient can only be sectioned if two doctors and a social worker or a close relative of the patient believe it is necessary. One of these doctors is usually a psychiatrist. The other is often a doctor who knows the patient well. However, in an emergency one doctor’s recommendation may be sufficient. An approved social worker also has to be involved in the assessment, and has to agree that being sectioned is the best course of action for that patient. The social worker then makes the application for a place in secure accommodation for the patient.

What if Brown were to refuse to leave office at all? The convention is that a PM can hang on for up to 15 months after a general election would have been due, but it’s only a convention and he’s always got the Civil Contingencies Act, which allows the government of the day to declare an emergency – it decides exactly what an emergency is – and to suspend democracy, override normal checks and balances and all local democracy – to rule by fiat, essentially – as the nuclear option. What could be done against that?

It’s an interesting constitutional problem and one I need to do a lot more reading about.

You Can Polder If You Want To. You Just Have To Want To.

Dutch politics, Economy, Health, Oh Those Crazy Cloggies
Published on 1 Comment on You Can Polder If You Want To. You Just Have To Want To.

nederlandtulpen_1
Should America follow the Dutch social model? Ask that of any US pundit, the conventional reply will be “Nooo, the socialism, it burrns! 52% tax!”

But just maybe, maybe they should think the unthinkable, says American exiled in Amsterdam Russell Shorto, in a fascinating article in the NYT magazine. Americans pretty much pay an equal amount in cumulative taxes, to much less effect:

…in talking both with American expats and with experts in the Dutch system, I hear the same thing over and over: American perceptions of European-style social welfare are seriously skewed. The system in which I have embedded myself has its faults, some of them lampoonable. But does the cartoon image of it — encapsulated in the dread slur “socialism,” which is being lobbed in American political circles like a bomb — match reality? Is there, maybe, a significant upside that is worth exploring?

It’s a biggish read but worth it as a primer on how the country works:

I spent my initial months in Amsterdam under the impression that I was living in a quasi-socialistic system, built upon ideas that originated in the brains of Marx and Engels. This was one of the puzzling features of the Netherlands. It is and has long been a highly capitalistic country — the Dutch pioneered the multinational corporation and advanced the concept of shares of stock, and last year the country was the third-largest investor in U.S. businesses — and yet it has what I had been led to believe was a vast, socialistic welfare state. How can these polar-opposite value systems coexist?

[….]

…water also played a part in the development of the welfare system… The Dutch call their collectivist mentality and way of politics-by-consensus the “polder model,” after the areas of low land systematically reclaimed from the sea. “People think of the polder model as a romantic idea” and assume its origins are more myth than fact, Mak told me. “But if you look at records of the Middle Ages, you see it was a real thing. Everyone had to deal with water. With a polder, the big problem is pumping the water. But in most cases your land lies in the middle of the country, so where are you going to pump it? To someone else’s land. And then they have to do the same thing, and their neighbor does, too. So what you see in the records are these extraordinarily complicated deals. All of this had to be done together.”

[…]

IF “SOCIALISM” IS THEN something of a straw man — if rather than political ideology, religious values and a tradition of cooperation are what lie beneath the modern social-welfare system — maybe it’s worth asking a simple question of such a system: What does it feel like to live in it?

Sholto answers that question by interviewing a number of other US expats, which is a bit lazy of him though he does admit it:

Indeed, my nonscientific analysis — culled from my own experience and that of other expats whom I’ve badgered — translates into a clear endorsement. My friend Colin Campbell, an American writer, has been in the Netherlands for four years with his wife and their two children. “Over the course of four years, four human beings end up going to a lot of different doctors,” he said. “The amazing thing is that virtually every experience has been more pleasant than in the U.S. There you have the bureaucracy, the endless forms, the fear of malpractice suits. Here you just go in and see your doctor. It shows that it doesn’t have to be complicated. I wish every single U.S. congressman could come to Amsterdam and live here for a while and see what happens medically.”

It’s not quite as simple as that – it’s all in Dutch, for a start – but close. I’ve experienced the health and social care systems of the US, UK and NL personally and up close, and the Netherlands’ is the one I’d go for every time. Once you get past the impenetrable bureaucracy, (which Shotto doesn’t really mention, but it is a massive obstacle) and the language/cultural issues, it seems to work on the whole.

It’s certainly rare to see anyone truly, visibly poor here, unlike in the US and the UK, and to be sick or disabled here is not the automatic life-sentence to poverty and exclusion it is there. Sholto goes on to back this up with numbers:

A study by the Commonwealth Fund found that 54 percent of chronically ill patients in the United States avoided some form of medical attention in 2008 because of costs, while only 7 percent of chronically ill people in the Netherlands did so for financial reasons.

Read more….

Enough said. Case proven.

Does he take sugar?

bigotry, Health, Uh? WTF?
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As Dave Hingsburger found out, If you’re in a wheelchair, obviously you’re leaving your luggage unattended:

Suddenly, I lost existance.

I was waiting patiently in the airport, quietly watching people go by. My luggage was stacked up next to me and I felt that I looked like quite the world traveler. Suddenly this illusion was shattered when a security type guy came with a luggage cart and began loading my luggage. I sputtered a protest, ‘Hey, that’s my luggage.’

He looked at me, annoyed and said, “Luggage can’t be left unattended.”

“I AM attending it,” I said incredulous.

“You don’t understand, SOME BODY needs to be in possession of the luggage,” he said and I didn’t get his implication, not yet, I was still too startled.

“I am in possession of this luggage, it is MINE,” my voice is rising.

He looks at me with exaggerated patience, “SOME BODY (long pause) needs to be attending the luggage.”

I got it then, I wasn’t SOME BODY, “Are you suggesting that I can’t supervise my own luggage because I’m in a wheelchair?”

Meanwhile, in good old Blighty, the National Health Service let a man with Downs Syndrome starve to death. I’ve never been so glad to be as priviledged as being a healty, temporarily able white bloke as after hearing that news.

The Future’s Not So Bright But At Least It’s Oranje

Amsterdam, Health, Meta
Published on 2 Comments on The Future’s Not So Bright But At Least It’s Oranje

Sorry about the terse posting lately; despite the avalanche of fast breaking political news I’ve been more than a little self absorbed, because I’m waiting to hear the results of blood tests. As long time readers will know I’ve been quite ill for a long time and I need a kidney transplant. These tests will show whether I can absorb the anti-rejection drugs or not. If not (which is a distinct possibility given my medical history) there’s no transplant, so as you can imagine the results are pretty crucial. I’m stressing a bit.

I lie. I’m stressing a lot.

That this is going on against a background of spiralling global economic political and social chaos and a general feeling that it’s all spinning horribly out of control is not helping, dammit. What do you mean, solipsistic? Of course the whole world’s naturally arranged around my own personal affairs…

We’ve been lucky so far with the credit crunch but we’re no more secure than anyone else, and because of my health we’re a little more insecure than most. At the moment the economic crisis is not an immediate threat (one of the upsides of bank mergers is the need to merge IT systems) though of course that could change at any moment; however, I think we’re as well prepared as anyone can hope to be. Which is to say not really.

What it’s actually boiling down to for me on a personal level right now, as it is for so many others, is insomnia and rabid anxiety. Sitting in the dark, wondering with sick dread what will happen next -will our health insurance company fold? What about the mortgage? What about the bank – shall I take out all the loose cash and hide it? Shit – what if the hospital has its funds in Iceland? But most of all, like every parent ever, I worry about my kids. What will happen to them? No generation can hope to know the future they bequeath to their kids; they can only do their best and hope, but we’ve done much, much less than our best and the future we’re giving our kids is potentially no future at all.

Because the future is here already. We’re in it now. This is it. We made it, aren’t you proud? Every trope of dystopian speculative fiction, every grimy Ridley Scott image and mad Gilliam fantasy is coming true – just look around. Political balkanisation, religious schism-driven conflicts, financial fractures, mass debt peonage and slavery, permanent war and the emergence of an an ultra rich, oppressive global elite – it’s all there. We’re using fiction as a handbook, not as entertainment.

It comes as no surprise that many of the foremost proponents of waterboarding are ’24’ fans; neither is it surprising that wingnuts are into transhumanism or that they love Arnie in The Terminator; nor is it a coincidence that Joe Haldeman’s ‘The Forever War’ is about to made into a movie. Art reflects life and vice versa, egg, chicken, chicken, egg…. Such are the trite observations one’s led into at 3am.

But I know all this meandering is just so much displacement; what I’m really worried about is dying. Not the actual dying itself – it’s a wonder I’m still here as it is, having so very nearly shuttled off this mortal coil so many times before through cancer and heart failure and what have you. I take a licking but I keep on ticking, but even I’ll have to go at some point. (The doctors writing ‘terminal kidney failure’ on all my test forms might also have given me a clue.)

No: what I’m concerned about is not death itself but how long will it be, and when and where. I want some certainty; what happens if I do this or what happens if I do that? A person needs to make plans. However, trying to pin down Dutch doctors is like nailing jelly to a wall. No-one will make a decision, everything’s by consensus, no one’s ever definite about anything. There are no guarantees about anything, I know, but I would like some sense of the odds, at least.

It boils down to this: if I don’t have a transplant, I’ll die, either slowly as a prisoner of dialysis machines or more quickly of kidney failure if I can’t have dialysis (which is also a possibility given my medical history). Even a transplant itself, should it be possible, is not a miracle cure; were I to survive big surgery again and the kidney not be rejected, it would nevertheless mean a short lifetime of strict adherence to medical protocols and a rigid treatment regime, and the ever-present possibility of infection and/or rejection at any point thereafter, this in addition to potentially fatal preexisting conditions. So if I do have a transplant I’ll die, just less soon and with more hassle.

Not a good place to be in a world falling apart, if indeed that’s what’s happening, though it’s certainly how it looks from the perspective of a cold and dark autumnal early morning.

But at least I do have choices. For the moment all my medical care, prescriptions, surgery and hospital costs are all covered by insurance that’s still reasonably priced. For a sick woman I’m probably one of the most privileged there is; I have access to clean water, adequate food, power and good medical care. Millions don’t, even in what passes for the developed world; looked at rationally I haven’t really got anything to complain about.

Also, this being Holland I have the option, should I wish it, to make the choice to leave the world at a time and by a method of my own choosing. That’s something that gives me an enormous amount of comfort. But sufficient unto the day is the evil thereof; it’s not a consideration yet. But until I get those test results, or at least some certainty of sorts, I’ll be awake at 3am again and again, and millions of others with me. They need certainty too, if for different reasons.

Edited slightly 18/10 for grammatical sense and speeling. Any remaining mistakes just go to show my illiteracy.