There are moments when politics and healthcare collide and all that is generated is heat. Absolutely no light.
As opponents turn their fire on President Barack Obama's health plan, a gross mis-characterisation 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 the 140 characters available on Twitter to defend it. They imply that all is beautiful in the British NHS, while the US system, with its 47m uninsured, its monumental costs and its capacity to bankrupt individuals, is the one that is "evil" - the word Sarah Palin used to describe the NHS.
This is a debate being driven by blind prejudice on both sides. For a start, what Mr Obama proposes for the US is not an 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 GDP that the US spends on healthcare - roughly double the level of 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 healthcare 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 59 do not get coronary artery bypasses.
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 that 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 now much shorter than they were. And - in contrast to the impression of "socialised medicine" held by some in the US - people can bypass those queues by going private.
About 10 per cent of the UK population has some sort of private insurance, paid for individually or by their employers. The proportion has barely shifted over a decade, implying at least some sort of satisfaction among Britons at what they get.
In response to the worst of the UK performance, Britons 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 avoiding 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 high-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 had it 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 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.
By Nicholas Timmins, Public Policy Editor Published: August 15 2009 03:00 | Last updated: August 15 2009 03:00
(Source: http://www.ft.com/cms/s/0/451af8fa-8934-11de-b50f-00144feabdc0.html)
As opponents turn their fire on President Barack Obama's health plan, a gross mis-characterisation 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 the 140 characters available on Twitter to defend it. They imply that all is beautiful in the British NHS, while the US system, with its 47m uninsured, its monumental costs and its capacity to bankrupt individuals, is the one that is "evil" - the word Sarah Palin used to describe the NHS.
This is a debate being driven by blind prejudice on both sides. For a start, what Mr Obama proposes for the US is not an 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 GDP that the US spends on healthcare - roughly double the level of 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 healthcare 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 59 do not get coronary artery bypasses.
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 that 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 now much shorter than they were. And - in contrast to the impression of "socialised medicine" held by some in the US - people can bypass those queues by going private.
About 10 per cent of the UK population has some sort of private insurance, paid for individually or by their employers. The proportion has barely shifted over a decade, implying at least some sort of satisfaction among Britons at what they get.
In response to the worst of the UK performance, Britons 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 avoiding 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 high-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 had it 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 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.
By Nicholas Timmins, Public Policy Editor Published: August 15 2009 03:00 | Last updated: August 15 2009 03:00
(Source: http://www.ft.com/cms/s/0/451af8fa-8934-11de-b50f-00144feabdc0.html)
