I don’t know if you have been following the US healthcare debate with interest but in case you haven’t this is a very brief summary of Preisdent Obama’s speech to Congress in September.
His aim was to:
Provide coverage to those without insurance and improve coverage for those already covered;
Address the rising costs of healthcare with emphasis on the government-funded burden of Medicare and Medicaid;
Amend in-state laws that protect individuals from losing coverage due to pre-existing conditions, suffering annual and lifetime caps on claims, and going without preventative care;
Introduce a Health Insurance Exchange to boost competition in the market;
Provide immediate need-based tax credits for those that have been denied coverage due to pre-existing conditions;
and make basic coverage a requirement.
One might regard this as a historical document since the stunning Republican victory in Massachusetts, which many attribute to concerns over Obama’s healthcare proposals, but what I want to focus on is the thinking in the two countries about healthcare.
In Britain we have lived for 60 years in a welfare state. While at the periphery many of the features have been eroded, the NHS still functions pretty well and is a huge brake on the development of private medical insurance (PMI) in the UK.
I was listening to a fascinating programme on Radio 4 while driving the other day. The reporter had lived in the US and marvelled at the insulin pump his diabetic son had been given over there. He would not have been able to obtain this specific technology yet in the UK.
He interviewed many commentators and architects of the American system. One pointed out that Americans had no problems about drug companies making large profits because it was all ploughed back into research and development for the ultimate benefit of patients. In UK it was suggested we suffered because of our attitudes.
Yet when he looked at the percentage of revenue ploughed back into research and development on both sides of the Atlantic he discovered that in America it was 17% and in the UK 23%. This illustrates the difficulty of jumping to hasty conclusions about national mindsets.
It also illustrates the huge emotional overlay that any in-depth study of healthcare produces. The National Institute of Health and Clinical Excellence (NICE) exists to oversee drug production and usage in the UK and we regularly see heart-rending debates about NHS patients being denied life-saving drugs. This is the reason many PMI insurers provide unlimited oncology treatment.
But ultimately in a welfare state rationing will always have to be applied somewhere and PMI sales will always have some sort of glass ceiling on them. But would we really trade our situation for the one across the pond? It’s a very complex debate.