Greetings friends,
Thanks for tuning in once again to my blog (devotees - you know who you are!). OK, so for some reason I have decided to write yet another serious post. God knows, perhaps I am coming down with a bout of swine-flu; better get on the NHS swine-flu hotline and get my order of Tamiflu in! No, actually it's primarily because I am trying to keep my mind active and focussed towards the impending start of my new Masters course. And because whilst I was in the US for three weeks in June this year, I couldn't help but notice that Obama's proposals for US Health Care reform had completely divided the nation, and certainly captured my latent interest. So for anyone reading this you will have to excuse me for crystallising my own thoughts and understanding on this very topical of issues for Americans.
I have recently read some interesting and informative articles on the current US health care debate, notably in Time magazine, and an article written by Philippa Thomas for the BBC. In addition my eldest sister and brother-in-law, whom I recently visited in the States, work in regulatory and pricing & reimbursement at a senior level for a large biotech company in California, respectively. Having had several conversations with them also, I now feel that I am starting to understand the American psyche, and correspondingly, why so many Americans are opposed to the new bill that Obama is proposing at the moment.
So it appears that right now Obama is lobbying America's doctors, including what was apparently a rather blunt message at the annual conference of the American Medical Association (AMA). During this speech he made it clear that the AMA will bear much of the responsibility for reining in the huge cost of American health care. Currently, the system operates on a "fee-for-service" basis meaning that doctors receive a fee for each service they provide such as an office visit, test, procedure, or other health care service. Ultimately this means that the system is based on quantity, not quality, and it is my understanding that many Americans perceive more contact time with doctors and hospitals with a "better" standard of health care. However, as much as I have canonised doctors in the past (my father was a successful GP), it does appear that the model in the US "has taken the pursuit of medicine from a profession - a calling - to a business", as Obama put it. Essentially, like everything else in America, what should perhaps be a sacrosanct profession in one sense has been commoditised as a consequence of free-market economics. And surely this just ain't right. Right?
There are now apparently 47 million Americans with absolutely no health care insurance and a further 25 million with sub-standard insurance. That's roughy a quarter of the entire population of the United States. Quite simply, this statistic shocks me and (NHS) jibes aside, I am rather proud to be a citizen of a country with a "socialised" form of health care, as the Americans put it. Surely that is a mark of a truly civilised country, which takes responsibility for ALL of its citizens, and does not deny a significant proportion of its people access to vital health care! Do not get me wrong, I am not fundamentally opposed to free-market liberalism but am willing to pay higher taxes if it means that the old lady next door can get her hip replaced courtesy of the NHS.
I have also been rather interested to read articles on "Comparative Effectiveness" (CE) in the States. Essentially there is talk of developing some sort of regulatory body like the National Institute of Health & Clinical Excellence (NICE) like we have over here. Indeed, I read a rather informative Time article which went into some great depth highlighting the differentials in costs at the most prestigious teaching hospitals in the United States. The salient point was made with regards to the "Mayo Clinic" in Minnesota, which appeared to have siginicantly lower costs per patient (cannot remember any precise numbers) but essentially the same outcomes. Clearly this sort of data shows that quality health care CAN be provided for less. Indeed perhaps we should all look at the Mayo Clinic as an exemplary model.
I think perhaps America's fear of socialised medicine is incredibly deep rooted; in 1948 Truman's plans for health care reform faltered in the face of cynicism about "Russian-style communism". More recently, in 1994, the health care initiative sponsored by the then First Lady Hillary Clinton was by all accounts, an abject disaster. "The American Dream" seems to be a double-edged sword: on the one hand, it is possible to achieve anything if you put your back into it, but on the other, you better hope that life doesn't deal you a bad hand, because as sure as hell no one else is going to pick you up. That, in a nutshell, is the philosophy behind capitalism. I think (I have been listening to Professor Michael Sandel's Reith Lectures recently...).
America spends roughly 16% of its GDP on health care (double the average spending of OECD nations), roughly one sixth of GDP. This is big business. The American libertarian thinker, Michael Cannon, who heads health policy analysis ay Washington's Cato Institute thinks that big reform is needed - but reform that puts financial power into the hands of the individual consumers, not another vast government bureaucracy. He estimates that it will cost around $2tn to cover all of America's uninsured over the next 10 years. A staggering figure. This will clearly create a burden on various stakeholders: doctors and hospitals will probably be tasked with providing more with less funding, thereby bringing the debate of comparative effectiveness right to the fore. The burden might also fall on workers, if salaries fall as employers are required to provide broader health insurance. The burden might also fall on taxpayers, facing more or higher taxes. Ultimately, to make universal health care work, everyone is going to have to sacrifice. As Michael Cannon puts it, what the government is really doing now is "trying to find the path of least resistance".
To me, America seems to be an incredibly greedy, selfish and divided country. On the one hand you have the wealthy who can afford full, private health insurance and college fees, thus ensuring that they propagate good health, education and ultimately wealth. On the other hand, clearly an underclass who are barely literate, uninsured and with no hope of ever breaking their cycle of poverty. Now I am not saying that the situation here in the UK (and Europe) is perfect, but right now I would rather live in a country where it is perhaps more difficult to achieve affluence, but at least people can live in the comforting knowledge that there is at least a socialised health care safety blanket called the NHS. God bless it, and all its failings. Perhaps we should stop grumbling and be thankful for what we have. Now I've just gotta get my hand on some of that Tamiflu...
Thank you for reading.
Currently listening to a rather lovely deep and chilled live mix entitled "Lipse" by my old friend, Max Cooper.
Peace,
F.
4 comments:
Hey Faisal, interesting observations. You should check out Peter Singer in the New York Times for the moral case behind NICE style cost-benefit (or as Republicans call it "Socialist Bureaucrats Rationing Your Health Care!!!") and also a really good article in the New Yorker (by a doctor, I forget his name) examining why insurance costs can be three times higher in some areas than others, with no discernable improvement in outcomes.
The big political problem here is that the majority of Americans (and a large majority of voters) get health care through their employers, which is financed by a massive government tax break. They have no idea how much their health insurance costs, or what their doctors charge, because it is all handled by their employers. They tend to like the result, without having any idea of the costs (unless they lose insurance). This is why the standard GOP/insurance industry scare tactic is to talk about "rationing", "socialised medicine" and run fear campaigns about Obama taking away YOUR insurance. I don't know if he has the strength to get this through (last couple of weeks have been disappointing with resistance growing in both Houses of Congress), but for America's sake I hope he does.
Hey Pinky,
Just this morning I was listening to Radio 4 (could have been my dream actually!) - how the majority of Americans are insured through their employers (who are in turn financed by government tax breaks). Indeed it is unfortunate that many of these people do not have a grasp of what their health insurance costs are, meaning that of course they will be very susceptible to scare mongering. Plus I am not sure how well American workers will respond to the idea of lower salaries in order to cover the uninsured/unemployed. One thing I now understand about Americans is that they do NOT like things being taken away from them. Especially money, choice and opportunities. But then again, who does?
Plus I really don't think that the AMA will give Obama full backing. At the end of the day, this bill will provide less money and more work for doctors. And who would want that? It looks like in America, doctors have things particularly cushty, especially compared to those over here. Perhaps it's time for the profession to undergo a little "rationing" too. That said, my nephew is just starting a pre-Med course, and to my understanding, the full course usually takes 8 years at university - a HELL of a lot of tuition fees at a good American university. And of course, young doctors are not only in huge debt, but obviously want to get a handsome return on their investment....
On so many levels I think Obama has the proverbial mountain to climb if he is going to successfully lobby the AMA, Congress and the American public. Will be really interesting to see how America responds if this bill is passed though. And what effect it will have on health outcomes; will they simply become more efficient (and follow cost-benefit analyses) or will the quantity AND quality drop? From my perspective, I am certainly excited at the prospect of studying cost-effective analysis in healthcare, and looking at the comparative differences between different health care systems around the globe. Indeed, I am thinking about working for a body like NICE on completion of my Masters. Though not sure I am enough of a jobsworth!
Anyway, I ramble on. Thanks very much for reading, and your comments. They actually mean a lot to me, and give me the impetus I need to continue writing. It's nice to know you have an audience out there, even if it is the sum total of 1!
F.
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How exciting, and rather cryptic. And who might you be...?
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