NHS health debate is more heat than light
As opponents turn their fire on to President Obama’s health plan, a gross mischaracterisation of Britain’s tax funded National Health Service has become the weapon of choice to attack it.
In response British politicians from Gordon Brown, the prime minister, downward have resorted to all of the 140 characters available on Twitter to defend it – implying that all is beautiful in the British NHS, and the US system with its 47m uninsured, its monumental costs, and its ability to bankrupt individuals is the approach that is “evil” – to use Sarah Palin’s description of the UK’s NHS.
This is a debate being driven by blind prejudice on both sides. For a start, what Mr Obama is proposing is not a British NHS. There is no proposal that a government backed insurer would run hospitals, as is still largely the case in the UK.
Second, half of the mighty 17 per cent of gross doemstic product that the US spends on health care – roughly double the level in the UK – is already funded by tax dollars through Medicare, Medicaid and the Veterans Health Administration, which incidentally does run medical facilities and provides some of the best health care in the US.
Third some of the charges levelled against the NHS are plumb wrong. That Teddy Kennedy would not get treatment for his brain tumour in the UK. That the NHS indulges in forced euthanasia. That people over the age of 59 do not get coronary artery by-passes.
The fractious British political classes have united in defence of the UK’s healthcare system after it has become a byword for the failings of universal, state-funded provision among the US Republican right.
Gordon Brown, prime minister, and David Cameron, leader of the Conservative opposition party, have both declared their commitment to the National Health Service.
The US right has used the NHS as an example of the potential pitfalls facing President Barack Obama as he tries to push through a healthcare reform bill.
Some Republicans have ridiculed it as a bureaucratic and “Orwellian” system that often denies care to the elderly – with Sarah Palin, the former Republican presidential candidate, decrying it as “evil”.
But in Britain, where since 1948 all citizens have enjoyed free healthcare from birth to death, the attacks are widely seen as wrong and insulting.
Some are true. The UK does have a lower dialysis rate for kidney disease than the US. Some of its cancer survival figures look appreciably worse and quite probably are worse: “probably” for a bunch of reasons, which include comparability of the data and the fact that five-year survival figures are by definition what was happening then, not what is happening now.
The NHS does indeed have waiting lists for non-emergency surgery, although after a doubling in spending in real terms over the past decade they are much shorter than they were. And, in contrast to the impression of “socialised medicine” held by some in the US, people can by-pass those queues by going private.
About 10 per cent of the population has some sort of private insurance, paid for indivdually or by their employers. The proportion has barely shifted over a decade, implying at least some sort of satisfaction among Brits at what they get.
In response to the worst of the UK performance, Brits can also pluck selective statistics from the US showing it has much poorer overall results for diabetes and a bunch of other chronic conditions where Britain’s primary care physicians treat patients well in the community, reducing complications and avoding costly hospital care.
A balanced view of the two systems might go like this. The US has some of the very best medicine in the world, particularly hi-tech medicine, notably in its leading academic health centres, and it has more of it than in the UK.
But study after study shows that overall the highest level of health spending in the world does not deliver anything like the best results.
A recent study, for example, looked at deaths in those aged under 75 that are amenable to treatment – for example, infections, cancers, diabetes, heart and vascular disease.
Overall, the US had the worst record among 19 industrialised countries, and the rate at which those deaths had been declining had slowed over the previous five years against the declines seen in other countries.
The US record was worse than that not just of the UK, but for example Portugal and Ireland. Martin McKee, of the London School of Hygiene and Tropical Medicine, one of the study’s authors, says: “If the US performed as well as the top three countries in the study” – France, Japan and Australia – “there would have been 101,000 fewer deaths per year.” There would also have been tens of thousands fewer in the UK if it had done the same.
Both systems have their strengths and weaknesses. But rather than presenting a caricature of the NHS, US opponents of reform might ask why. The US spends half as much again as almost any other country on healthcare, yet it still gets overall results that are nowhere near the best. One contributory reason, although only one, is the quality of care received by the uninsured. And that should be the real focus of the debate.