Public and private healthcare, US experience and other models - fiction, facts and the amazing potency of financial interest and political bigotry
To: joe and ann weiss
Sent: Saturday, August 15, 2009 5:56 PM
Subject: Socialism, the end of the world and the NHS
Dear Anne and Joe
It takes a lot to get us Brits roused, but the torrent of bigotry, ignorance and sheer malice that is issuing from certain orifices of the US right wing about the UK National Health Service is getting many of us very riled. The NHS is a treasured institution that not even Margaret Thatcher dared to lay a hand on. More than 90% of the population value it very highly and some 93% of people in receipt of its services describe their quality as very good. The detractors are a small fringe of right wingers and of course, those who have been "recruited" by the private healthcare industry. Trouble is, these freaks are getting all the airtime on the US media - people like virtually unknown right-winger Daniel Hannan, who has been disowned by his party leader.)
The idea that bureaucrats, "The Government" or some kind of faceless committee sits in judgment of who shall receive what is the first piece of misleading rubbish. Clinical judgments in the NHS are made by doctors, not bureaucrats or finance people. There are some sensible overall policy bodies like the National Institute for Clinical Excellence, an independent non-government institution, that researches the efficacy and cost-effectiveness of drugs and makes policy recommendations to the NHS management. This is an obviously sensible approach, as resources are not infinite. They have recommended that some drugs are not sensible to be on general release because the relationships between efficacy and cost make them less useful than others. But this is not some socialist politburo, it is an organisation run by medical people.
Overall, the situation in Britain is as follows:
- The NHS is funded by taxation. It provides a national health service, free at the point of delivery to all. Health includes campaiging for healthier lifestyles and preventative medicine - for example, everybody over 60 who wishes can have a free 'flu jab annually. Also, all medicines are free for over-60's. The NHS has run an enormously effective anti-smoking campaign consisting of a large and informative publicity campaign and clinics and medication for those who opted to stop smoking and is campaigning to do something about increasing alcoholism. The estimated impact runs into hundreds of millions of £s savings over the next twenty years or so.
- The pattern of health provision is common across the UK - local GP surgeries which provides comprehensive cover in daytime hours. There is also an emergency local doctor service out of normal hours and a telephone service called NHS Direct manned by qualified staff which can be accessed 24/7. Our local health centre in the next village 2 miles away has 6 doctors, 3 nurses and a pharmacist on permanant staff + visiting specialist nurses. We live in a rural area, so the number of people per doctor is quite small. This means that we can see a doctor on the same day we call, and nurses within two days or less notice. For emergencies, you just go in or they will call.at your house. The local hospital, some 20 minutes away, provides A&E services, plus the full range of medical and surgical disciplines. When I had a heart attack at home in 1999, the GP was there in 5 minutes and the ambulance in half an hour, so within less than an hour of starting the attack I was in the cardiac ward connected to a large array of machines and injected with clotbuster, anti-sick drug, diamorphine, the lot. I am needless to say more than a little grateful and the cardiac nurses were attractive and intelligent. Almost worth having a heart attack for!
- A feature of the UK system is that medical consultants can spend up to one third of their time in private practice. This means that people with private insurance ( often provided by companies) or who are able to pay can opt to have certain procedures done by the same doctor privately. NB, this also means that the best doctors work in the NHS and also do private practice, thus keeping up to date with the best knowledge. Senior medical people we know all believe that doctors who do not practice in the NHS are not up to standard and tend to be charlatans.
- There are private hospitals, which are fine for more minor elective surgery, especially as most of the surgeons are NHS doing their private stuff. But nobody in their right mind would choose a private hospital for major surgery, they are not well-equipped with intensive care facilities. So I had an angio-plasty done, because I would have had to wait 4 weeks for the NHS but wanted it done in 2 weeks for personal, not survival reasons. The procedure was carried out by an NHS doctor doing his private stint - had anything gone seriously wrong, I would have been transferred immediately into an NHS heart theatre in the same hospital. Only the seriously eccentric use all-private doctors in Harley Street, many of them are better at bedside manner than medicine and some are quacks. But you can see that the wealthy can purchase certain priveleges in Britain, but it is to do with choosing when to be treated and nothing to do with quality of treatment (apart from the supply of expensive wine in the private wards and a sherry with your doctor after the consultation is over!).
Now, this generally positive picture is marred by the fact that being a large organisation, the NHS demonstrates some of the features of any large enterprise (like General Motors, for example). This means that standards are not uniform across the whole UK, that some doctors are better than others, that some hospitals leave a lot to be desired. But there are independent league tables published that enable those who are mindful to choose the hospital they will attend and nationally published information puts great pressure on the recalcitrants to improve. Patients also have the right to ask for and get a change of doctor. I can say from personal knowledge that the standards of medical training in the UK are top-class. I have several doctor friends, a cousin who is a senior consultant and a son who has taken 12 years of bloody hard work doing his medical degree + professional follow-up training (5 exams so far) + 5 years of working in various medical disciplines in hospitals + 3 years GP training + working in India and Ireland in order to become a GP. His training has been rigorous and really hard work.
So the idea that the UK system is some kind of communist 3'rd world service is sheer bigoted crap perpetrated by people with some kind of political mania or possible financial interest! (there! I'm annoyed!) It is a hugely beneficial system that has helped the UK to a position where its public health record is far better than the US. Now, this is not to say that the rich and insured cannot get world class treatment in the US, but I think I would characterise your system as a private sickness system providing the best of treatment for the relatively wealthy, not a public health service. And it is this difference in basic philosophy that maybe is the root of many misunderstandings. In all European countries, public health is accepted as a national and public priority, not a private privelege.
It is true that the NHS is under great threat at the moment. Obviously a healthier population living longer is creating huge financial pressures (but this is actually a price of success). The greatest threat comes from the political right wing and the remorseless pressures coming from the private healthcare and pharma industries, which are using the media and some politicians to insidiously worm their way into the public health system.
Now, for some statistics and facts. Most of these come from the World Health Organisation (not the NHS!!) Sweden has the most elaborate public health system, US the least developed:
COMPARATIVE STATISTICS FOR 4 COUNTRIES
|Average life expectancy||75||80||77||81||78||82||79||83|
|Healthy life expectancy at birth (2003)||67||71||69||72||69||72||72||75|
|Probability of dying under 5 years per 1000 live births||9||6||6||4|
|Probability of dying between 15 and 60 years per 1000||137||80||98||61||91||59||78||49|
|Total expenditure per head 2006 in dollars||$6714||$2784||$2447||$3119|
|% health spend of GDP||15.3%||8.4%||9.4%||8.9%|
|Acute care hospital beds per 1000 population||2.8||3.6|
|Average length of stay acute care||5.6 days||3.6 days|
You can make your own mind up about the meaning of these stats, but value for money and overall public health record come to mind! I think it was in 2006 that the American Medical Association caused a degree of controversy by revealing that the UK public health record was comparatively pretty good. I wonder where all the good 'ol neo-cons and others of that ilk get their information from?
Still in Scotland. Raining.