Just in case anyone hasn't noticed, there is a major row raging. Opposing President Obama's plans to widen public provision of health care, certain right wing Republicans in the USA choose to tell lies and fling insults at the UK NHS.
In retaliation, many people in the UK have been stating how and why they love the NHS (others, politically aligned with the right wing Republicans) have been telling tales about the NHS is a disgrace because they failed to get attention for a non-urgent condition at 4am, or tales of incompetence, which may or may not be true, but can be matched by similar anecdotes from the private sector, in the UK or elsewhere.
Someone said that the NHS is like a husband, you can moan about it as much as you wish, but as soon as someone else does, you are honour bound to defend it. That argument has its attractions, but it has its flaws. I do feel, however, that one is perfectly entitled to favour something in principle, and, generally in practice, but be able to see the flaws in the details and wish to improve them.
The debate is getting somewhat bogged down in arguments about the relative technical competency. I don't think anybody has ever suggested that the very best of US medical expertise can be bettered elsewhere (but the same statement could be applied to most developed countries).
The argument is, plain and simply, about whether or not it is desirable to have a system of healthcare provision that is available, free at the point of use, to all people irrespective of financial means. And I strongly believe that it is.
I don't believe that there are any plans in the USA to introduce a system analogous to the UK NHS, and, to be honest, I'm not sure it would be the system we would adopt if we were constructing it from scratch.
My major criticism of the US-style system is how healthcare is rationed on the basis of ability to pay. Anecdotes abound about people not being able to afford an insurance policy because they are in low-paid jobs, or because they are self-employed, or because they work for a small company that can't afford a health system.
Indeed, I have a cousin, who is a born again evangelical Christian and right wing Republican - was a county legislator, openly supported George W Bush during the 2000 primaries, home-schooled his children, didn't allow his daughters to socialise with their male cousins of similar ages in order to prevent inappropriate behaviour.
He wished to make a living as a preacher but knowing the cost of birth, and wanting many children (he has four children, and has adopted the orphaned daughter of his wife's sister), he instead became a carpet salesman.
I don't agree with his religion, but I always used to think it was a pity that he couldn't pursue that dream because of the terrible system of American healthcare; it has only just dawned on me that he is complicit, and in some ways entirely responsible for his lack of freedom to pursue his dream. Surely there must be many more who are 'trapped' into jobs or long hours, because it would be too much of a risk to become an entrepreneur or to work for one, or to stay at home to bring up their children (maybe even to home school them) - and they count among the insured, not the millions of the uninsured.
Our mutual aunt was a community nurse in Long Island; she has told me tales of how, basically, she would visit patients until their insurance ran out ie not based on their clinical need.
I read blogs and have done for several years, and what strikes me again and again how many people in the US write about how they, or their relatives, are not getting the treatment their doctor has recommended, because the insurance company has vetoed it. I know that people are denied treatment in the NHS because of 'postcode lottery'; personally I would prefer a transparent and accountable system.
One of the statistics I have read is that cancer survival rates are longer in the USA than in the UK. This may be the case and it may be that this is a result of the US health system having developed superior treatment (and refused to share the secrets with the rest of the world). Alternatively, it may be to do with one or more of the following factors:
- perhaps there is a culture in the UK of later self-referral for embarrassing but lethal cancers such as bowel cancers
- perhaps there is a greater incidence in the USA of non-lethal cancers, such as skin cancers, as a result of climate differences
- perhaps there is a greater culture in the UK of offering palliative care to maintain a quality of life rather than chemotherapy and radiotherapy to prolong life in pain and discomfort
- perhaps more people in the US - without insurance - die with cancer undiagnosed
Of course, I have no evidence to prove (or disprove) these statements, but it's just the auditor in me applying a bit of professional scepticism to bare statistics.
Quite a lot of people have argued in favour of the National Health Service on the grounds of compassion, humanity and society, and I certainly wouldn't argue against that, but sadly, I don't think that that would wash with these rapid right-wingers. I would reiterate my argument above that access to a health service free at the point of use increases freedom to pursue quality of life rather than merely working as a wage slave.
I find it shocking to know that in the USA working people on modest incomes are denied medical treatment. I find it even more shocking that people are denied coverage because they have an existing condition.
Jimmy had a heart attack at 29.This has never been a barrier to him receiving treatment; indeed, although he is perfectly healthy, because the attack shows up on the EEG it is always of interest to doctors. I believe that certain insurance schemes in the USA would withhold coverage on that basis.
I have several friends and acquaintances whose children have chronic incurable or congenital conditions such as cystic fibrosis, cerebral palsy, spina bifida or have received organ transplants. I understand that, under certain insurance schemes, their entire families would be excluded from insurance.
Some of these friends and acquaintances are on fairly high salaries, but by no means wealthy. I can't imagine how they could possibly afford to pay up front all the treatment their children have. I am perfectly happy to know that my tax/NI is being spent on their children.
It is not the place of a UK blogger to tell the citizens of the USA how to organise their domestic politics. However, when their politicians spread lies and insults about our system, I do think I am entitled to fight back.
