Friday, 14 August 2009

...the case for the defence.

I have no wish to add fuel to an all ready blazing fire, but I have been receiving some misinformed email traffic on this subject.

This article from tonight's London Evening Standard seems to sum up my feelings quite well - I too have experienced the US and UK systems and let's be honest, no system is ever perfect.

What a combination - Fox News and our very right wing Tory MP, Daniel Hannan !!! He can't even get on TV here.

Why America’s medical industry hates the NHS

Andrew Neather
Under normal circumstances, the spectacle of Gordon Brown using ­Twitter would offer the enticing prospect of more YouTube-style pratfalls.

But I'm glad the PM has twittered in defence of the NHS, following attacks on it from US Conservatives trying to discredit President Obama's health reform plans. And to those British Right-wingers chiming in, such as the Tory MEP Daniel Hannan, I'd just ask this: have they actually tried American healthcare?

Because I have, and for me that makes the choice between a US-style, largely private system and a socialised one such as the NHS very simple.

When I think of American healthcare, I think of my friend Andrew, gravely ill with a brain tumour, in a Houston hospital. He was in pre-op with his head shaved when the medics got a call from the accounts department: his insurance money was about to run out. So they got him up and dressed again.

He did get his operation a few days later-accounts had screwed up — but the money ran low soon afterwards. They gave him his X-rays and told him to get on a bus across town to a cheaper hospital. He died the following year, age 31. I had a similar, bare-bones student-health package to Andrew: his ordeal didn't make me feel any safer.

Then I think of my uncle John in ­Cheltenham, who succumbed to oesophageal cancer early this year. At his age, 79, and with the disease far advanced and spreading into his lungs by the time he realised there was a problem, there wasn't much the ­doctors could do. Still, he got pain relief, and soon after getting the ­diagnosis he had a stent put into his throat to help him eat. He died peacefully a month later in a hospice.

That for me is an eloquent refutation of the rubbish about the NHS now being peddled by US industry lobbyists and their Republican allies through TV attack ads and the like. They claim that our doctors let old people who could be treated die, that those over 59 are ineligible for heart treatment, that the NHS is “evil” and “Orwellian”.

They need treatment. At present in the US, 45 million people, nearly 15 per cent of the population, have no healthcare insurance at all. Some get basic care under the means-tested Medicaid scheme, while since 1986, everyone has in theory been eligible for emergency treatment, although if you try it, you're liable to be harassed for payment. Meanwhile, the elderly are paid for by Medicare and there is better treatment for military ­veterans.

Yet what most foreigners to the US don't realise is that even for those with health insurance, the US medical industry delivers a poor deal. Getting and keeping employer health insurance is a constant concern, especially for anyone changing jobs, or worried about their job security in the recession. Even then it's often not free, and insurance premiums have been rising rapidly in recent years. At least one couple I know tied the knot in a “blue card marriage”, so that one who was jobless got on their employed partner's health plan.

Everyday healthcare for most ­middle-class professionals is usually provided by a health maintenance organisation (HMO). HMOs effectively run private GP surgeries. I suffer from asthma: while I was working as a journalist in Detroit, my HMO would give me a brief appointment in a bare office with a clock-watching physician's assistant (a kind of glorified nurse — you rarely get to see an MD). It was similar even at my US university, Duke, home of a leading American teaching and research hospital: GP care consisted of a long wait to see a physician's assistant.

By contrast, my London GP is a real doctor, as are the rest of the GPs in the practice (indeed, she is a senior university lecturer in general practice). I can see her within a few days, or if it's for one of my children, the same day. She has come to our home to do the post-natal checks on all three of them.

It's the kind of personal care that most Americans can only dream of. It's not surprising that when, for example, I recount the excellent midwife care that my wife had for her three births, all at home, American friends' reaction is invariably: “And you didn't have to pay?”

The campaign against Obama's health reforms is straightforward and entirely self-interested. It is powered by private health industry dollars: the industry stands to lose a lot of money if it is forced to loosen its stranglehold on the nation's health. The US spent $2.2 trillion on healthcare in 2007, more than $7,400 per head of population, almost double the average for developed nations.

Somebody's getting fat off that wasteful spending and it's not ordinary Americans or the companies that employ them, for whom the cost of their health insurance contributions is often second only to their wage bill.

The same scare tactics worked last time — in 1993-94, when a multi-million-dollar lobbying and advertising campaign sank Hillary Clinton's modest health reform proposals. This time, the private health industry has already spent $1.2 million on TV ads alone, while its lobbyists pack out town-hall meetings.

Of course, the NHS is far from perfect. It took my uncle several worrying weeks to see a specialist. And the first hospital ward he ended up in was pretty grim, sharing with four other men.

At the same time, Tony Blair's o­bsessive urge to give more business to the private sector has created distortions, as has the culture of targets. Yet most waiting times have plummeted. It has cost more than it should have but the NHS, at least up until the spending crunch, had got steadily better.

Having experienced private US healthcare first-hand, I'm always a bit puzzled that people here aren't more worried about the chipping away of free NHS care by the whackier Blairites or Tories. I think it's because most Brits can't remember the pre-NHS era, now more than 60 years ago, and simply wouldn't believe just how crass ­fully privatised healthcare can be.

The poison now being spread in the US should be a reminder of the ­cynicism of much of the American health industry, poised to become one of the biggest private-sector players here. However bad the mags in the GP's waiting room, I'll take my chances with our brilliant NHS.


  1. EXCELLENT article, Michael. Thanks for sharing it with us.

  2. Hear, hear Michael. Well, said. Waiting for care is by no means exclusive to government run health plans either. My ex had to wait to get approval on an antibiotic that might have prevented his foot from partial amputation. The insurance company had approved that but was not ready to pay for a $2000 script (available in Canada for $200).

    And it is interesting that while they have different names like Etna and Blue Cross most health insurance companies are one big mega corp. So it is really a hoax when they decline to pay for a pre-existing condition that was covered by one of their branches under another name.

    We are 49th in health care and in the top three for costs. We cannot compete in manufacturing jobs because of the health care costs corporations have to pay.

    The insurance monopoly is trying to beat Obama's plan down with lies and scare tactics.

  3. I add my compliments to those above. This is an excellent article which rightfully points out the forces behind the anti-healthcare campaign we are witnessing. It turns my stomach that people who stand to lose the most are so easily manipulated and will stand up and scream against the thing that they and their families desperately need.

  4. I totally agree with what is said above Michael - people are always ready to knock our Health Service but I have had nothing but excellent care when i have needed it for my family. Our GP is always available by phone and is a pillar of strength.

  5. Well said, Michael, and Mr Neather.