They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury. Some of these Americans had walked miles simply to have their blood pressure checked, some had slept in their cars in the hope of getting an eye-test or a mammogram, others had brought their children for immunisations that could end up saving their life.
In the week that Britain’s National Health Service was held aloft by Republicans as an “evil and Orwellian” example of everything that is wrong with free healthcare, these extraordinary scenes in Inglewood, California yesterday provided a sobering reminder of exactly why President Barack Obama is trying to reform the US system.
The LA Forum, the arena that once hosted sell-out Madonna concerts, has been transformed ”“ for eight days only ”“ into a vast field hospital. In America, the offer of free healthcare is so rare, that news of the magical medical kingdom spread rapidly and long lines of prospective patients snaked around the venue for the chance of getting everyday treatments that many British people take for granted.
This debate arouses such strong feelings in the US that I am a little scared to contribute here, let alone kick off. But I feel I have to. Along with a lot of people in the UK I have been surprised to see our health care system held up by US critics and trashed. Often the information is inaccurate. And lots of people over here have been dismayed, and indeed angered, to see Daniel Hannan MEP joining in the mauling. Traitor is among the words some have apparently been applying to him. By contrast here are some of my most recent experiences. I may have to wait two or even three days to see my physician (if I say it is urgent, he will see me that day). I have had blood tests and a CT scan. For both I just walked into the hospital and waited: 10 minutes for the blood test, one hour for the scan. I am on medication for hypertension and (typical of men my age) benign prostate hyperplasia. All of this costs me nothing, except what I pay through my taxes. All of it has been readily and easily available. A friend’s son lost a leg in a road accident: he had nothing but praise for the acute care his son received, including a high-tech artificial leg. All free. The really big things seem to be done well: organ transplants, intensive care, heart surgery, orthopaedics and paediatrics.
Often it is, paradoxically, the simpler things that seem to be problems in the NHS. It has too many administrators. Cleanliness and hygiene have sometimes been substandard. And yes, unless there is manifest urgency, sometimes you have to wait. Care of the terminally ill has not been brilliant, but we have developed and nurtured a growing hospice movement for this which is run independently usually by local charities. I think that oncology provision is spotty, good in some regions, not in others. Geriatrics is regarded us unromantic and a low priority, and therefore is chronically underfunded. People would prefer a private or shared room in place of the wards they are stuck in, with their lack of privacy and mixing at times of the sexes. Food is often ghastly. And yes, sadly, the state funds abortion.
So: the British NHS presents a mixed picture. But not, please note, the hideous caricature that is sometimes portrayed right now in the US as part of the fierce debate about health care reform.
Hi Terry
I would like to provide you some support. I cannot comment on the British NHS but we have a very similar system here in New Zealand, and the results speak for themselves. We spend a significantly smaller proportion of out national income on health (and still complain it is too much) but have much better health outcomes than the USA. I hope Americans realise that they spend an awful lot of money to have the worst health outcomes of the OECD.
Our system, like it seems the NHS, does ration both by queues and by saying no. That is inevitable – any free good is likely to be over consumed. But the rationing is done explicitly on health grounds — not on wealth grounds. If you need health services, then you will be put on the list — and your position on the list will be determined by the severity of your condition — not on when you turned up. We have never found the system to be irrational — if you need care, and it will help you then you will get it. If you need it urgently then you get it urgently. If you are not urgent, then you have to be prepared to be considerate to others, and let those who are urgent have their cases done first. It seems to me that these are priniciples that could easily (and probably originally were) have been dreamed up by Christians.
We have had many experiences with the system — and none of them have been anything less than quality. Our most serious was when our youngest son as a seven year old became seriously ill because of a congenital defect in the common bile duct. Then he was the one who went first — who was pushed to the operating room ahead of everyone else — and who got the full attention of the top specialists. Now when he goes for his check-ups sometimes we have to wait as others get rushed passed us — but would I really want someone to die just because our appointment time was first — would I have wanted my son to die because he didn’t have an appointment time when he was critical?
One final thought – in NZ there is a small private health system as well. Those who want to can take out the kind of insurance that the USA seems to work on, and get care in this system if they want immediate attention, private rooms and all the trimmings. My two observations about it are — its small size says volumes about the level of discontent that really exists with the public health system. Second, in my experience, people with health insurance are at a significant risk of killing themselves with health care. I have know two people who were denied operations in the public health system because the surgeons said that it was too dangerous and was not worth it for the health improvement they would get. Both of these people chose to go ahead using their health insurance. One died on the operating table — a very fit 64 year old who would, had he taken the advise of his public health doctor probably 10 years of quality life before his condition became an issue (it was a very slow growing cancer). The other one did not die, but he was a very, very ill man for months after the operation and when he came “right” he found his heart condition was just as bad as before. We are not on a star-ship with a Doctor who can wave his instruments above us and all comes right — there are times when aggressive treatment actually kills. It may be that is part of the reason why the health outcomes of Americans are so poor — they actually spend too much.
OK, Terry Tee – I’ll see your experience of the NHS, and raise you by whatever factor the ‘Australian echo’ of your NHS is. We call it Medicare but that’s not the whole picture. Our family pay a substantial – $3000/annum I think – extra amount for the supplementary private health cover that actually does pay for nearly everything such as the good local hospitals rather than the two gigantic urban ones in which for example golden staph runs rampant much of the time. In June my husband watched his 52-year-old colleague die in one of the large ones, and is convinced it was actually the golden staph he had just caught rather than the organ failures he was in theory on a transplant list for, that actually brought on the end.
Said husband, with benign prostate hyperplasia (if I understand correctly) and taking medication (Flomaxtra) for a YEAR now which has been working, was beside himself a week ago when told by his urologist/surgeon that actually the PSA had gone up (but still under the ‘limit’), and he should have a biopsy and perhaps surgery in case of cancer. Since the biopsy would require needle through the bowel wall, an infectious environment if ever there was one, husband is exceedingly anxious and now angry that the uro/surgeon did not tell him a YEAR ago that he should have a biopsy. He suspects this is a quick-draw surgeon who now sees in my fully insured husband an opportunity to make the extra money that surgery for prostate cancer would bring him – never mind that it’s well documented the PSA is the worst of all cancer diagnostic tests with roughly 48 out of 50 incorrect diagnoses.
Meanwhile, I can report that, now that we have arranged surgical (under GA) removal of our son’s wisdom teeth, which turned out to number more than 4, we have paid the full surgeon fee a week in advance on pain of losing the hospital booking, and now that I have called the surgeon’s office, the anaesthetist and the hospital admissions on my own initiative with still 4 days to go, I know for certain that none of these will be contacting him or me to offer any further information, advice or mere ‘we’re here for you’ kind of communication. Instead we just turn up and flash all the correct numbers and get ‘done’. Or rather, 18-year-old gets done, and it’s going to be a sort of wake-up call for him I suspect…..
When I had my gall bladder out last year, I can say the end result was excellent. But it only was so because we could pay the extra couple thousand such as excess for the private hospital room at top Catholic facility and so on, and because I did a tremendous amount of homework myself beforehand, went through 2 proposed surgeons before making the choice of the 3rd myself (steady hands, no ego trip) and I not only researched the ailment thoroughly on the web, I made substantial changes in my diet 6 week before the procedure, which it turned out shored me up physically for the surgical trauma and to throw off the anaesthetic effects more easily (harder at 55+). How many people who are really sick, perhaps old, and need medical attention can manage that ? (I was beyond sick, I was thoroughly desperate.)
What Americans are bemoaning and protesting is at least in part the degradation of the highest quality healthcare which many have had, with choice in things and [i]attentive, professional[/i] ministrations by doctors, nurses and other staff, in order to share much lower quality healthcare among a greater number of Americans. To the American way of thinking this is a major injustice as well.
All I can say is, the socialized version is ‘User, beware!’ from top to bottom, get ready to work hard at getting the healthcare you need, and by the way, never forget that you are the User – and the User Pays.
There is a great deal of misinformation being spread in the American health care debate, from both sides, and very little argumentation starts with the real problems with the American way of health care (I’m hesitant to call it a “system). For example, I’m on Flomax and haven’t had a PSA either, and am on private insurance. A realistic assessment of American health insurance would go a long way towards suggesting a good way forward.
Hint: insurance, privately run or governmental, is the problem, not the solution.
I guess I’m fortunate to be covered by two systems: The Veterans’ Administration Health Care System and Medicare Parts A and B, now that I’m over 65. I don’t expect to be seen immediately by either facility (my primary care provider is Medicare), and I suppose I can say this because I got used to it while I was on active duty with the USAF. All too often, people gum up the system by going to emergency rooms rather than clinics for nothing more than common colds, and therefore making it more difficult for those who are really sick to be seen. It’s an abuse of the system, and it needs to be stopped. This is something that the VA doesn’t permit, and non-government healthcare providers shouldn’t, either.
#5 – so you’re covered by the government?
Anyway, its interesting to hear the anecdotes but the evidence is the following:
US $7,290
UK $2,992
lifespan US 78, UK 80.
Those are numbers, not anecdotes.
#3 – this has little to do with who pays, but with bad health care. Someone with excellent insurance can have such stories happen to them.
[blockquote]Those are numbers, not anecdotes. [/blockquote]
Well, you’re right…they definitely numbers. I don’t think they’re the right numbers, the figures I’ve seen being much closer, around .5 years. But this isn’t a valid reflection of quality of healthcare. Heck, Bosnia has a longer life span than the US does…does that mean we need to start a bloody ethic civil war to get our numbers up?
Oh, dear, #7, you missed my point I think. Those were not meant to be examples or stories of [i]bad[/i] health care but of the [i]socialized[/i] i.e government-insurance-funded version, and in what ways the latter differs from what well insured Americans have been used to. W/r/t to the example of the PSA – in a decent private system there will be drs. who are honest with their patients about how lousy the PSA is, and won’t use it to try to get them on operating table. In the socialized system where one has to obtain a referral from the GP to any specialist to be seen at all, it is much trickier and can prove impossible to get even a second opinion; the patient bears the risk.
Having been in one system for most of 40 years, and in the other type for almost 20, raising a child and caring for a ‘family unit’ in it, I feel I have grounds to compare the two systems. Others may lack this. Mr Stan Black evidently also felt he had grounds to compare, and has concluded a different thing than I have. He is it strikes me benefiting enormously from the system he disparages, and no longer has to rely on the inadequate system he would impose on American citizens, having had much success in the (oh so reprehensible) American capitalist economy…..I think he is staging his inner Mother Teresa, but one thing he is doing that is excellent is eating his porridge and fruit diet, and if he did nothing else and got the millions who need to, to change their diet in a similar way he would do as much good as his whole medical giveaway.
I have to say, Margaret #2, that you don’t seem to have much idea about American healthcare aside from (value-less) statistics. Health is not some abstract good that can be distributed/re-distributed among some given number of economic human units, it is a condition that any particular individual experiences for their own good, or not as the case may be. In your country (which I basically adore) the population is far more homogeneous or at least bi-modal ethnically than the US is, and seems to have been accustomed for all its history to a cooperative relationship with the Mother Country, easing through (relatively speaking) a transition from colonialism. It also has I think a higher percentage of people eating a sensible diet and perhaps with a healthier lifestyle, given the wonderfully invigorating climate especially, and clearly the medical training is good because about 1 in 3 or 4 of the med techs and nurses I encounter her are Kiwis. The US economy, with which its medical professions and healthcare are intimately connected, didn’t evolve in a smooth or cooperative way at all, and for that reason imposition on society of a system like those in Commonwealth nations is not going down well. In the US advances in medicine often came out of the needs generated in war as well as from needs of the poorest people in society.
I have to wonder, furthermore, just how needy the people lining up for the LA care may be; how for example did the poor woman who some years ago had a gastric bypass which ‘went wrong’ and left her with stomach acid eating at her teeth, [i]afford a gastric bypass[/i]?? What is going on there? How can another woman repeatedly go to Mexico for cheap dental attention until the requirement of a passport, which she claims not have the money for, made her unable to? What if she had saved the money spent on most of those trips’ fares or gas and [i] spent it on a passport[/i]?? Didn’t see it coming? Why on earth would it be just/fair if American taxpayers (rather than the generous Stan Black here) had to pay for errors in judgement or medical advice like these two cases appear to me to suggest?
The description given in the article of the LA arena where this medical care is being dispensed actually reminds me a lot of any scene that might occur where the US Army with a medical detachment is present; free care is made accessible.
If you want statistics that are (a) reliable and (b) done on a compatible basis, then the best source is the OECD.
They have a short summary of expenditure here:
http://www.oecd.org/dataoecd/46/2/38980580.pdf
and life expectancy is here:
http://dx.doi.org/10.1787/538382241346 (its an excel spreadsheet)
Some key statistics
% of GDP spent on health then expenditure in $US and then life expectancy at birth (the expenditure figures are 2007
USA 16% $7,290 77.8 years
UK 8.4% $2,992 79.1 years
New Zealand 9.2% $2,510 80.2 years
Canada 10.1% $3,895 80.4 years
I think what the rest of the world is struggling to understand is why so many Americans are defending so vigorously a system that is costing them a fortune for the privilege of dying young. It just seems so irrational as to defy belief!
TACit
in reply to your
[blockquote] I have to say, Margaret #2, that you don’t seem to have much idea about American healthcare aside from (value-less) statistics. [/blockquote]
My valueless statistics are in no 10 above — and what they say is that on average I will live 2.4 years longer than you. You may not value that — after all didn’t St Paul say to die is to gain — but many people would.
I will also be on average $4,780 better off every single year of my life (ie that is the amount I pay for health on average through my taxes compared to what you pay on average through your health insurance). If I live the 80.2 years that adds up to $383,356. Again you may think that is not valuable — but many people would appreciate having that money.
and with respect to
[blockquote] In your country (which I basically adore) the population is far more homogeneous or at least bi-modal ethnically than the US is [/blockquote]
I doubt that America is any more ethnically diverse than New Zealand — we have one of the highest rates of foreign nationalities in the world, and the dominant number of these are people from the Pacific and Asian countries that would be poor even compared to Mexico. We do not have the ingrained “poor who have been born amongst us” category but then that is because we have chosen to not let those who are borne amongst have so little chance of social mobility. Given that is a choice and that it has meant that we put a lot of effort into our education system to ensure people have a chance — (another area where the USA statistics do not bear looking at ie another very expensive system that produces appallingly poor results) — I don’t think you can then validly say “you are more equal”. We have made ourselves more equal.
I am not coming from an Anti-American viewpoint here. I would like to see your country get both a health and an education system which works. There are far too many of your citizens being “passed by on the other side of the road” for a civilized, let alone a Christian, country.
It would appear that infant mortality can throw off the statistics:
[blockquote]This ought to be of particular concern to Americans. As is often pointed out, U.S. life expectancy (78.06 years) lags behind other developed nations with government health care (United Kingdom 78.7, Germany 78.95, Sweden 80.63). So proponents of Obamacare are all but offering an extra “full year†of Euro-Canadian geriatric leisure as a signing bonus.
“Life expectancy†is a very crude indicator. Afghanistan has a life expectancy of 43. Does this mean the geriatric wards of Kandahar are full of Pashtun Jennifer Lopezes and Julia Robertses? No. What it means is that, if you manage to survive the country’s appalling infant mortality rates, you have a sporting chance of eking out your three-score-and-ten. To say that people in Afghanistan can expect to live till 43 is a bit like saying the couple at No. 6 Elm Street are straight and the couple at No. 8 are gay so the entire street is bisexual.
*******
America is the Afghanistan of the western world: That’s to say, it has a slightly higher infant mortality rate than other developed nations (there are reasons for that which I’ll discuss in an upcoming column). That figure depresses our overall “life expectancy at birth.†But, if you can make it out of diapers, you’ll live longer than you would pretty much anywhere else. By age 40, Americans’ life expectancy has caught up with Britons’. By 60, it equals Germany’s. At the age of 80, Americans have greater life expectancy than Swedes.[/blockquote]
http://article.nationalreview.com/?q=OTAxYzFjODdiN2E3OWUyNzY1MDU1ODM1ZjZjYmY3YjM=
That’s interesting, Br. Michael, thanks for pointing out the article. I really don’t wish to argue the points about NZ compared with America, as I don’t have enough info at hand. I still think as I said above that it would be a very great help if more Kiwis and Aussies came along to teach more Americans about sensible diet, and the true importance of exercise no matter the climate (we thought South Island’s was ideal, Margaret G., and would return in an instant – not that we’d get the chance to stay). Climatic extremes in the US are one more reason the issues of diet and exercise are difficult and variable, especially as so much of the populace lives where there are freezing winters.
I wanted mainly to make the point that changes toward socializing the system there are going to cause a loss of qualities that Americans have had in their care, and now that I’ve experienced that change I don’t intend to stay silent about it. The necessity of standing in long lines waiting to be able to claim the rebates that patients receive in a socialized system is an added burden on the patient, or the parent of a patient, that has not been a feature of the US system, and would come as an unpleasant surprise to some I expect.
A lack of nutritional information to guide them, or maybe the will to act on it, is at the root of a very large proportion of Americans’ health problems; witness 750,000 gall bladder removal surgeries/year, most common procedure performed in the US, for example, or the chronic diabetic problems especially in poor urban populations where access to refined flour and sugar products is dominant. An area in which I think Michelle Obama is doing good is attempting to change this thinking with her White House organic veggie garden etc. A problem such efforts face is in areas where cultivating, for example, pork and corn, neither of which is good for anyone in quantities, has been a way of life for at least 300 years and suits the conditions. I’ve lived in the South and know well how beloved are grits, biscuits and gravy, green beans in bacon fat, fried pork rinds…..won’t go on. And I’ve seen my mother and brothers in well-off Northern suburbia all develop type 2 diabetes from too much refined flour and sugar and dairy, with not enough fresh produce or fish in their meals, and even my changed life isn’t making them do much different.
Like it or not, Americans have a national character that is more independent and stubborn than docile, and there is going to be a struggle over removing any options from our choices in health care. To those who haven’t had care of course that is not the issue but to at least 200,000,000 who have, it is likely to be.
Are we missing the point? To me the discussion should not be about comparing the details of one plan with another, but about who controls it. I, for one, have no interest in any health plan that is controlled by the government. And yes, I know Medicare is a government plan, but since Americans pay into it over a lifetime, certainly they are going to use it. Plus, why would any American want government controlled health care? Medicare is what a government controlled health care system will be like except far more intrusive and Medicare is such an ill conceived, poorly run and corrupt system that it simply is not sustainable – not surprising since history has shown that socialism/communism doesn’t work. To close, please don’t forget, freedom and freedom of choice are gifts from God and very precious things not to be lightly tossed aside.
#14 – “controlled by the government” is a slippery term. The British Government runs its health care. Doctors work for the government.
In Canada, the government pays the doctors. It’s the difference between a city paying for private contractors and the government hiring the army corps of engineers. In Holland, the government just sets the rules and forbids recissioning, and prohibits insurance companies from refusing to provide care.
In anycase, Private insurers benefit from the government paying for the elderly. It helps insurance companies be profitable.
TGS: where do you get your belief that its run inefficiently? the polls show that people are more satisfied with medicare care than those with private insurance. In fact, there was one fellow who was so angry about the prospect of Obama care he yelled to his representative “Get the government off my medicare!”
[blockquote]I think what the rest of the world is struggling to understand is why so many Americans are defending so vigorously a system that is costing them a fortune for the privilege of dying young. It just seems so irrational as to defy belief! [/blockquote]
Because we don’t want to become serfs, cattle tended by our Central State? Is that irrational?
[blockquote]In Canada, the government pays the doctors. It’s the difference between a city paying for private contractors and the government hiring the army corps of engineers. [/blockquote]
Oh, so in Canada, a doctor can run a fee-for-service business along side his government-compensated practice? (Hint: No, he can’t. Phony comparison, JW.)
John Wilkins, I think perhaps I should tell you about the medical care which I and so many other American veterans receive from the VA. The VA has a disability rating system which runs from 10 to 100%, and that includes a priority schedule. Veterans whose disabilities are determined to be service-connected and/or combat-related are moved “to the head of the line,” while others must wait their turn…..depending, of course, on their medical problems. I am rated at 90% physically disabled (I have one leg) due to a serious injury suffered while on active duty, and I am paid at 100% compensation for Individual Unemployability, as authorized by Federal law. It is not something that I would have chosen, but my doctors told me that the leg would have to go, or my wife would lose the only husband she ever wanted in three months.
I wish everyone could have the same high quality care that we veterans receive, and they could, if it were made available to them. Yes, Federal employees…..and by that I mean military personnel and their dependents…..are entitled to such service, and that’s why we have TriCare and Tricare For Life. I also seem to recall that we have the U.S. Public Health Service, and that this service at one time operated its own hospitals, which were mainly used by the Coast Guard and the maritime unions. It seems to me that the government should build new federal medical facilities under the aegis of the USPHS and make their services optional to all Americans. It wouldn’t be perfect, of course, but if were operated in the same manner as the VA system…..including its purchasing practices…..it might go a long way towards meeting our needs, it seems to me.
It took a while to find but an answer to the question above, about why Americans seem to prefer what appears to be a much more expensive and less rewarding health care system, may be: “Well, amazingly, millions of freeborn citizens’ exercising their own judgment as to which of the latest drugs, tests, and procedures suits their own best interests has given Americans a longer, better, more fulfilling old age to the point where there are entire states designed to cater to it. (There is no Belgian or Scottish Florida.)” That’s from the same article that Br. Michael quoted in which it is also showed that Americans at age 80 have better life expectancy than Swedes, e.g. The entire article conveys just why Americans do prefer their system, where ‘treatment’ rather than ‘care’ is the by-word. That comparison of terms reminded me that my husband, who grew up in CA’s Kaiser Health system, relates that his parents have always said that Kaiser was great on maintenance, but they did absolutely nothing toward prevention; that would be the individual’s responsibility.
There is now a really revealing article in the NYT by an ex-pat living in the UK about her family experience with NHS. Finally it occurred to me that in fact the cost comparison is beside the point, because Americans generally want the best care regardless what it costs and have been free to pursue that calibre of care. That is the American value; the actual cost of the treatment or care is not the point. Now that there is an at least 45,000,000 strong contingent of people not successful in this pursuit, identified by elected representatives, the whole matter has been turned political.