etnobofin

In talking about American healthcare reform, I’m tilting at a rather irrelevant windmill – I’m not American and I don’t live in the United States. But I have friends there, and I’m disgusted by the way certain opposition groups have been representing Obama’s proposed reform package, however ill-conceived it might be.

I’ve also spent seven and a half years working as a supplier to the healthcare industry in countries around the world – including the US, the UK, France, Germany, Spain and Canada. This doesn’t make me an expert, but I’d like to think I know some of the basics about healthcare delivery models. So…  I’m going to dive in anyway.

First of all – Campaigns currently running in the US describing the failings of the British NHS are misleading and not helpful to informed debate. Obama is not currently proposing an NHS-style single-payer plan, even though Obama has voiced personal preference for it in the past.

The overly complex bill before Congress is introducing the concept of a publicly-funded option available to all, alongside existing provision. While some are saying that this is a slippery slope to universal single-payer, I can’t see this happening given the immense vested interests who’ll ensure any such future law would be defeated.

Secondly – no health care plan is perfect. Yes, there are waiting lists in Beveridge-style health systems (eg. in the NHS and New Zealand). And yes there is “rationing” too – in the UK, decisions on treatment guidelines occur through NICE, generally considered one of the most rigorous branches of government, which makes decisions based on clinical evidence.

But in the current American system rationing occurs through a different, crueler mechanism – by denying care to those who can’t pay, while over-treating those who can. In the richest country on Earth, 18% of the adult population are uninsured. Scenes of people queuing overnight for charity-provided healthcare should’ve brought policy makers to their senses a lot earlier.

Thirdly – complaints that government-provided care is bureaucratic and inefficient are ill-founded. On average, Medicare (which is, by the way, a socialised healthcare system), costs substantially less (2-16%) to administer than private insurance (up to 25% according to some studies). With healthcare consuming upwards of 15% of US GDP, this means that around 4% of US GDP is accounted for simply in administering private insurance programmes.

Fourthly – socialised medicine doesn’t necessarily restrict patient choice.  The people most concerned about choice are those who are rich enough to go outside the public system anyway. In NZ and the UK, people can choose to pay for private insurance and “go private” for elective surgery if they wish.

In France, often cited as the best healthcare system in the world, healthcare is largely paid for by your national insurance contributions, with a small co-payment by the patient at the point of care. Most French people buy additional insurance to cover this co-payment. For me, this additional cover costs 24EUR (34USD) a month – not an excessive burden for peace of mind.

So some kind of reform in America is necessary. I wish it would be either single-payer (like in the UK or Spain) or a non-profit multi-payer system (like in Germany).  But it’s most likely to come in the form of a public insurance option available to all (take a deep breath guys, it’s not creeping socialism. Insurers, HMOs and pharmaceutical companies will still make enormous profits).

I hope Obama’s bill, with all its weaknesses, passes in a workable format. But mostly I wish that the healthcare debate in America was centred around rational facts rather than cynical scare-mongering.

Hey, we’re just actors. Don’t ask us about healthcare reform.