THE QUEST FOR A ROOT CANAL AND THE MESS IN NHS DENTISTRY

Recently we met at a cafeteria with several friends and one of us complained about his difficult time after a sudden toothache. He visited a local NHS dentist who was able to provide an emergency treatment and resolved the acute pain;  but then he was told that he needed a Root Canal Treatment, that this is a complex procedure, and the options were limited: being referred to a public hospital, where the waiting list is of about eighteen months, or visit a private specialist at a fee of 8/900 pounds. We were all outraged and a general consensus emerged against the greed of the dental professionals.

Interestingly, one of the person sitting at the table was a dentist, and after taking his fair part of bitterness and sarcasm, he gave us all few insights about being a dentist in UK today.
More than twenty years ago it was no possible to mix NHS and private dental treatment. The huge majority of UK dentists had an NHS contract and the amount of money the government spent was enough to provide decent care to everybody. Unfortunately the trend to cut public spending, started in the eighties, hit hard the NHS dentistry, in favour of keeping the quality of service in more life threatening sector. The dentists compensated the lack of funding increasing efficiency and seeing more and more patients a day, with an inevitable decrease in the quality of treatment. At a certain points, when the business was not viable anymore, an historical barrier was broken, and NHS dentists were allowed to provide private treatments , when they were not approved by the NHS. In this way most dentists used private dentistry to somehow compensate the lack of funding from the NHS, and could still run a profitable business.
The mess started in 2006. The government, in order to plan in advance the money to be spent for the NHS dentistry, came out with a reform where the dentist is paid a fixed contract, not related to the number of treatments performed: if he does a small filling, or five root canals, plus three extraction and twelve fillings on one patient in the same course of treatment, he gets paid exactly the same. The effect was a general run away of dentists from the complex treatments, a huge boom of teeth extractions, and a situation that leaves abandoned those patients who need treatment badly. If you want to know more click here.
Of course the blame was directed at the dental profession: I watched myself a TV show where somebody claimed that the average salary of a NHS dentist is £ 160,000, when in reality this is the value of the average contract, including the cost of rent, equipment, staff salaries, and materials per year: easy to do the math.
A Root Canal Treatment is one of the procedures that, if done properly, requires long sessions, and it is paid about fifty pounds. Fortunately the market quickly adapts and a huge number of dentists left the NHS and started private practices, that now meet the increasing demand of quality dental treatments at cost that is more and more affordable. It is not impossible to   find a fair Root Canal cost.
That leaves unsolved the problem of those ones who cannot afford any private dentistry and are left with no option but being let down by a system that is clearly failing.

So what can be done?
If you ask the dentists the answer is the easy and pragmatic: if we cannot afford a quality NHS for everybody let pay the private dentistry to those who can afford it ( they are already doing it anyway ), and concentrate the scarce resources on those people who do not have a choice.
But that involves a strong political choice that will not be popular with many. Who will have the guts?

THE MIGRANTS CRISIS AND THE EUROPEAN HYPOCRISY

I enjoy reading the morning papers in a cafeteria with a hot drink, preferably coffee.
The last few weeks the overwhelming number of pages where about the migrants crisis, the inevitable invasion, and who is to blame: the war, the countries who started the war, the countries who are not willing to accept not even a minimal number of refugees or those ones who are not able to properly patrol the common borders?
This is where it gets intricate…
The US, the UK and France, countries with an history of, “exporting democracy”, even if with a different level of reluctance, praised unconditionally the Arab Spring on the southern border of the Mediterranean sea. And when the bloodbath started did not hesitate to take part in forcefully removing tyrants and dictators. At the time both, the British and French leaders were pretty low in the opinion polls, therefore being tough with thugs such as Ghaddafi and Mubarak looked a very good idea. Unfortunately the results did not match the expectations. In Tunisia there is now a very weak but democratic government; in Syria mr Assad , who has powerful friends, such as Russia and Iran, is still there, but half of his country is now part of the Islamic state; in Egypt, the democratically elected Islamic government has been toppled by a military coup, and all the exporters of democracy hurried up to shake hands with the new president Al Sisi (I cannot remember he was elected !); in Libya, where apparently Ghaddafi did not make many friends , we have a total chaos, with the country split in three parts, one being a self proclaimed member of the Islamic state.
The final effect is dozens of millions of people displaced from their homes, trapped under bombing from Mr Assad, the Isis, or the often not so “surgical” western countries antiterrorist coalition. No surprise if they run for their life toward the only possible escape: Europe.
Now it is when it gets even more complicated…
Most of these people arrive, when they do not sink aboard of incredibly crappy boats, on the coast of Italy and Greece, two countries not exactly with flourishing economies, in number of hundreds of thousands, and become rapidly unmanageable.
When those country appeal to the EU solidarity, as it happened for the Greek financial crisis, the reply is : it is none of our business.
The toughest guys in the bunch being the UK, France, Germany, Austria and the ex soviet union block. All countries with a problem of growing Euroscepticism and far right protest. Funnily enough Mr Cameron promised to put a cap on immigration to UK from the other EU members, essentially the east European nations that are backing him in his hard line approach on extra European immigrants.
The Italian and Greek response is dodgy, pragmatic and predictable: according to the Dublin Treaty, they should, at their own expenses, find out where those migrants are from, offer asylum to those ones who are entitled, and deport the rest. What practically happens is that they offer an initial basic support and then wait for those people to disappear, continuing their journey towards Germany, France, the UK or Scandinavia.
In a matter of weeks the pressure starts to mount on the French and Austrian borders, the Calais port and the Eurotunnel, the Hungarian and Greek borders. It is suddenly clear that, one way or the other, the problem is going to affect everybody.
And here is where we are now. The well known series of European leaders meeting is about to start:

God help us all.

THE GREEK CRISIS AND WHY YOUR MORTGAGE IS NOT LIKE NATIONAL DEBT

Few weeks ago it happened to have around a table and, of course, in front of few cups of excellent coffee, a group of people of different nationalities, and a Greek guy among the others.
The conversation focused on the Greek public possible default and the consequences for the euro zone.
Some interesting insights emerged that are not so obvious for everybody.
A vast majority of us stated the obvious : we have to repay our mortgages every month, or repossession is behind the corner, so why this rule should not apply to a country that has clearly cheated on the national budget for years?
But is this the right question?
A less easy one is : what is the purpose of national debt? Is it to be repaid?
Apparently not, given that nobody around the table had knowledge of a single country in History that repaid his national debt at any time. The investors themselves would not be happy to get their capital back and not producing any profit. They rather prefer not to see a penny of their capital as long as a fat interest is paid.
So when and how the mechanism breaks?
It happens when, due to some turmoil in the economy, the country stops growing and therefore enters in a vicious circle of increasing borrowing, not to support the economy, but to repay a raising level of interest on the existing debt debt. That triggers an unstoppable race between interest rate on the national bonds and the amount of debt which is necessary to keep the boat afloat.
The irrational solution adopted so far has been to loan further money to the Greek banks in order to buy the increasing risky national bonds (relieving therefore the foreign banks from their so far lucrative investments), in exchange for imposing to the general population a set of draconian measures that further depressed the already shrinking economy. The results: a famishing population, a spiralling interest rate on the national bonds and a public debt out of control (to know more about damage caused by austerity click here!).
But who started the financial crisis that depressed the economy of the world for five or more years, making the public debt of several countries, such as Greece, Spain, Italy and others, all of a sudden, “not sustainable”? The same financial institutions who profited for years on the fat interest paid on those country bonds, and managed to transfer the cost of the crisis to the general population when the storm hit.
They obtained virtually free bailout from governments all over the world, not a single banker being fired, waited for the storm to pass, started again to make huge profits in a still unregulated market, and left the tax payers to deal with the national debt increase they caused in the first place.
And they are going to be ruthless as ever if we skip a payment on our mortgage.
Not a bad deal! Not at all.