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Land of the free – but not for health
Rubbishing our National Health Service is nothing new in the US.
Yet Americans spend twice as much on health care as we do and still can’t cover everyone, explains Theo Blackwell
OVER the past two weeks a transatlantic battle has raged first on the web and then in the print and broadcast media, sparked off by a series of slurs against the National Health Service by opponents of President Barack Obama’s plans to extend full healthcare to the 46 million Americans who are uninsured.
I’ve seen the debate from both sides: as someone who had to consider a care package for my seriously ill father in New York – and as a democratic-appointee to an NHS board (and a user of the NHS).
Seeking to scare voters against a “public option”, the Republican right has sought to label Obama’s plans as akin to the state-run NHS, therefore “evil” and “Orwellian.”
More widely Sarah Palin labelled state decisions of healthcare, like the National Institute of Clinical Excellence, “death panels”. This is nothing new.
In the US NHS-rubbishing has been going on unanswered for years. But last week the spat took on a direct significance when Conservative MEP Daniel Hannan glibly disparaged the NHS on Fox TV as “Marxist” and “not something I’d wish on anyone.”
This prompted a massive reaction from people here to defend the record of the NHS against unfair attacks.
Challenge to these smears is important, as it also may concern us in the future as US providers look at how they can expand into the UK market. On both sides of the Atlantic, the Cold Warriors on the right drive at the “bureaucracy” of publicly-funded systems, solely equating private care with personal freedom and public system as opposed to it. (As if private insurance companies aren’t themselves bureaucracies and don’t seek to control eligibility or costs in order to secure their returns). The first thing to say is that US healthcare system is an extremely complex mechanism, provided by many separate private, state and charitable bodies. There are also thousands of insurance firms, with different rules and eligibility criteria. There is good and bad in the system. I will focus mainly on the bad, but for those with good health cover, the system is considered the best in the world.
For these patients, access to the latest technology and drug therapies is possible and doctors I have talked to rave about some of the facilities on offer. But, of course, private insurance has its own dynamic before you see the doctor. Broker insurance companies don’t like paying bills any more than you or I like paying taxes. Terms like “pre-existing conditions” are often used to restrict the ability to purchase insurance on the open market. It is also inefficient.
Americans spend twice as much on healthcare as we do, and yet can’t cover everyone. Annually, 31 per cent of US healthcare costs go to administrative costs, far in excess of the NHS.
Key are issues of equity and coverage. In 1996 a staggering 5 per cent of the population accounted for more than half of all healthcare costs. Meanwhile over one in 10 children in the US have no insurance. Unlike the UK there is no nationwide system of publicly-owned medical facilities open to the public. What exists is a profusion of local medical facilities open to people based on private or employer insurance, coupled with the stop-gap cover of the Medicaid and the social entitlement of Medicare for seniors, a state/personal contribution scheme.
Low-income families can seek the protection of Medicaid for certain treatments, which vary according to where you live. It is a means-tested, needs-based safety-net where eligibility is determined largely by income. However, poverty alone does not qualify a person to receive Medicaid benefits unless they also fall into one of the defined eligibility categories such as age, pregnancy, disability, blindness, income, and citizenship. This leaves many uninsured. For these, and many more, direct payment for treatment is a reality. Think about going along to a hospital, getting treated, and paying a bill at the end and you get the message. Walk into any high street bookshop in the USA and you will see shelf upon shelf of advice books on how to fund your medical insurance. Unpaid healthcare bills were cited by about half of US bankruptcy filers in 2001. Nearly 90 million people, about one-third of the population below the age of 65, spent a portion of either 2006 or 2007 without health coverage. And 29 per cent of people with coverage were “underinsured”, with coverage so poor they chose to postpone care.
Having a job helps, but is no guarantee for cover.
In 2007, 37 million workers were uninsured because not all businesses offer health benefits. Many employees in lower-paid jobs cannot afford their share of the health insurance premium even when coverage is easy to access. It’s worse in times of recession. If your coverage is dependent on work, as it is with most Americans, losing your job, or going part-time will often mean less coverage. Not having insurance and affording healthcare if something goes wrong is a major personal worry.
Everyone knows that the NHS can be improved, and made more efficient – and there are always lessons to learn. But to move to a model where private insurance dominates, as some on the right advocate, is not an expression of “freedom” over “Stalinism.” It is for very many, the reverse.
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