February 16, 2015

THE ONLY ALTERNATIVE TO UNIVERSAL HSAs:

Take it from an American - Britain's NHS is as good as it gets (JASON HICKEL 16 February 2015, OpenDemocracy)

Some might rush to conclude that this surprisingly positive experience is probably due to the fact that I live in a posh white part of London. But I don't. I live in Kilburn, and the clinic in question is adjacent to a number of council estates. The vast majority of the clinic's patients are working class, and only about half of them are white.  The first-rate care I receive is the care that every resident receives, regardless of their race or class - as a basic human right, as part of the social contract, as a feature of the collective solidarity that Clement Atlee's Labour government forged in the 1940s from the ashes of World War II.

And it's not just that this clinic happens to be a good apple in a barrel of bad. I've been referred to specialists in other units - including large hospitals - on a number of occasions, and each time I've found myself amazed at the efficiency of the service.  At one point I was referred for a possible case of melanoma. I was seen by a dermatologist at the first break in my schedule.  So much for languishing in line for treatment.  Why so efficient? Because there's a powerful incentive at work: the NHS saves money by catching cancer early.

And it's not just life-threatening illnesses that call forth the best of the NHS. The mundane phlebotomy lab I had to visit recently at the Royal Free Hospital was run like a well-oiled machine, caring for fifty patients an hour at peak time without a glitch.  The system just works. We needn't rely on anecdotes to prove this. The Commonwealth Fund recently released a report comparing the health systems of 11 highly industrialized countries. In the category of efficiency, the UK ranked number 1. The US, by contrast, ranked last. So much for the theory that profit stimulates efficiency. The UK also ranks well above the US in terms of timeliness of care, contrary to Fox News propaganda.

I suppose I shouldn't be surprised; while living in the US I spent an astonishing amount of time waiting for appointments and sitting in receptions, even as a paying customer. I sometimes caught myself wondering if things might be different if I were able to pay more.

And it's not just in the areas of efficiency and timeliness that the UK performs so well. It comes first in almost every other category - equity, access, quality, etc. - making it the best overall healthcare system in the world. As for the overall ranking of the US: dead last, again. The Commonwealth study didn't measure bureaucracy, but I suspect that here too the UK would win handily.  While living in the States I was regularly frustrated by the amount of time I had to spend not just filling out forms, but reviewing costs, interpreting bills, paying fees, comparing coverage plans, and badgering my insurance company over the phone to shell out for their fair share (an obligation they routinely shirked).  

It's no wonder that 30% of healthcare spending in the US is absorbed by bureaucracy - nearly twice the proportion that other industrialized countries spend. This is rather strange, given that the chief justification for private healthcare is that it suffers less bureaucracy. It turns out that exactly the opposite is true.


The advantage of a Third Way system is that it will universally build personal wealth.  But the Second Way does achieve the other two main things we're looking for : universality and cost control.  The only remaining question is whether the GOP is willing to settle for the latter instead of aspiring to the former.

Posted by at February 16, 2015 9:54 AM
  

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