Is US healthcare so bad that it needs a lesson from Britain?
Q&A By Nigel Hawkes
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Independent Minds
Q. Why the passion over healthcare reform in the US?
A. In Europe, the arguments over universal healthcare were over decades ago: all that remains is a polite discussion over the best way to fund them. But in the US, the idea that Government should have any place in the relationship between doctor and patient remains controversial to many, and a red rag to a few.
Town hall meetings to discuss healthcare reform have been turned into fights, one Congressman has had a death threat, posters denouncing reform are proliferating. Bill Clinton's attempt to reform US healthcare failed; President Obama's is in trouble. Doubts about the cost of the project at a time when many think the Obama administration has been profligate in its economic stimulus have combined with old antipathies to "socialised medicine" and overwheening government to create a potent cocktail.
Q. Is US healthcare really in such a mess that it needs wholesale reform?
A. Less than 20 per cent of Americans believe their healthcare system is in crisis – a proportion that has not changed in 15 years. Based on health insurance, supplemented by Medicare for the over-65s, and Medicaid for the poor, the system at its best provides good care. But premiums are rising fast, and deductibles (the equivalent of an "excess" on a UK insurance policy) are also rising. For almost 20 per cent of those insured, deductibles exceed $1,000.
A large number of people, 47 million out of a population of 300 million, have no insurance. That means they must pay for healthcare out-of-pocket. Medical costs accounted for 60 per cent of US bankruptcies in 2007 – and this includes many people who were insured. Since insurance is often part of an employment contract, it can disappear if illness causes unemployment.
Q. That sounds bad. Why don't Americans welcome a reform that would provide universal coverage?
A. Most question whether it would benefit them personally – 84 per cent are insured and say they are satisfied with their care. They fear government involvement would make things worse, not better. While nearly 80 per cent think healthcare costs too much, almost half think a reformed system would cost more.
Q. But aren't they right to argue that medical standards in the US are higher than ours?
A. This is a tricky comparison. At its best, US medicine is outstanding. But as a system judged on quality, access, efficiency, equity and healthy lives, US medicine lags behind the UK, Australia, Canada, Germany and New Zealand, according to the Commonwealth Fund. It scores well on rapid access to elective treatment (second only to Germany) and on preventive care, where it is the best of all – largely as a result of managed care plans trying to save costs by keeping people out of hospital. The UK and the US rank last in death rates from conditions amenable to healthcare.
Q. If that's so, why are so many Americans opposed to reform?
A. Because they don't put the criteria of equity, access and efficiency as high on their list of priorities as does the Commonwealth Fund (a private foundation rather like the King's Fund in the UK). They would argue that a comparison of this sort is designed to make their system look bad. And they are unaware that their expensive system doesn't deliver good results.
Q. What is President Obama's plan?
A. He doesn't really have one, but is leaving Congress to bring forward proposals that meet three objectives: reducing costs, guaranteeing that every American has the freedom to choose their own health plan (including a public plan to compete with private insurers) and ensuring that all Americans have quality and affordable healthcare. Insurance would still be the basis of the plan, not tax as in the UK. But that need not be an obstacle, as countries such as France and Germany have universal insurance-based systems that in general work well.
Q. How does he propose to control costs?
A. That's a bit vague. In 2007 the US spent $2.2trn (£1.34trn at then prevailing exchange rates) on healthcare, against the UK's £118bn. The UK's spend was 8.4 per cent of GDP, the US's 16.2 per cent. Since wages and salaries represent 60 per cent of costs, big cuts are hard to find. Obama has talked about cutting out ineffective treatments but is unlikely to find huge savings that way. Hard as it is to stop costs rising, it is much easier than cutting them once they are high.
Q. What's the major obstacle to reforms working in the US?
A. The lack of a consensus around the idea that universal healthcare is an ideal worth striving for. European countries made it part of their "new start" after the Second World War: they cannot imagine a world without it. The US saw no reason to abandon individualism, and now it is much harder to do so. While the protests have been orchestrated, they would not have occurred at all unless they chimed with deep and strongly-felt sentiments.
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Comments
This is rather Enlightening. The cost of insurance is too expensive for millions in the US. Even if you are insured deductibles can be as high as $3000 to $4000 for many. When you think you are insured you may not be and Insurance companies rip off folks all to often or deny them treatment. Need treatment get a lawyer.
Health Insurance Abuses in US. Not much fun when this happens to a person or entire families who can loss everything including their lives.
http://hcfan.3cdn.net/40024020be3710c57
Health care in USA is a real disaster.
I say, "Stay hungry don't get sick"
The cost will kill you before you sigh through.
Doctors education costly.
Early years low paid, when they reach higher place
The courts can smash their sense.
Also endless exams to feel they are still students.
Some Sensless physicians are reading only articles
to put exams multipe choise questions
To smash the doctors who work hard
bleeding their brain every night under artificial lights---
People against people not far than animals.
If they do mistakes
Lawyers are waiting to call them to courts
and smash their homes, identities,
till prove their innocence, after high cost.
Some will pay million for clever lawyer
who wants to be rich on account of hard working doctors.
Their expensive unrealistic health system
will never give results.
till they end this unfair system,
Who is able to change deserves Nobel price.
At the end every one will die
If the hospital room was even from seven stars.
Why poor doctor will suffer, having every night a new nightmare
Why lawyers enjoy hurting poor surgeons who are real servants
Dedicated for the patients care, which leaves their family uncared.
Those stanzas I reached after having experience
Being a pediatrician my self having a husband who was a cardiac surgeon
Having a salary of a nurse, dedicated for poor in a very rich Gulf state.
Where the rich leave away from local care.
Having many qualifications and publications in the U.K
Now seeing my boys, who are both doctors working in USA.
Suffering endlessly, still they feel lucky that they depend on us
having better life than others, who are under loans paying their depts.
Up to 45 million(nearly 15% of the country's population) Americans cannot afford health insurance , hence cannot afford to be treated therefore refused treatment . This is not fiction but facts from the Americans themselves and does not include those who do have insurance which is enough to afford treatment . Compare that with the uK , where everyone is entitles to treatment , be it having to be on a waiting list due to lack of funding after the introduction of Thatcherism in the 1980's .
First, they are clearly not managed properly and are a cause of wasteful spending because it is very common to see drug addicts, women who are not working yet are having lots of children, and just in general very lazy people taking advantage of the system. Lots of these types of people, people who are fully capable of working but are either too lazy to do so or just want to take advantage of the governmental program, will be accepted by one of these programs and then just live off of the handouts from the government without even trying to get a job or attempting to support themselves. They just expect the government to keep on paying for them.
Second, medicare and medicaid are one of the reasons why private insurances are so expensive. In order to keep costs for these two programs low, the government agrees to pay hospitals a very low fair, which is actually lower than the hospital's expenses. In order to make up for the expenses that the government did not pay, the hospitals charge the private insurances extra, causing the cost of private insurances to increase.
So I'm not saying that universal healthcare for the united states is a bad idea, I just don't think the federal government is ready for it now. It cannot properly manage or fund the two healthcare programs that currently exist. Also, with such an enormous deficit, I think the federal government should work on a plan to rectify that before trying to take on the expensive burden of universal healthcare. If the federal government really wants to work toward universal healthcare for the US, I think they should run a reserach project that researches all of the successful healthcare systems around the world, so that we can adopt the beneficial practices and learn from the poor practices and implement a program that is well thought out. Do that instead of rushing through a plan that isn't thought through and that half of the citizen does not agree with.