Healthcare for profit and for good

OK, if you are bored with my occasional forays into politics or religion, I apologize for this post on a subject about which I know even less. I was preparing a long post on my expatriate view of the US healthcare system versus the UK NHS (and I’ve even had a few years under the Canadian single-payer system — as Nate Silver reminds us, not all “socialist” [sic] countries are alike). But apparently I’m not the only blogger interested in comparing and defending the NHS against the US insurance system. So just a few bullet points:

  • For those interested in the details of the UK system of controlling costs (AKA “rationing”) I highly recommend this podcast interview with Sir Michael Rawlins, head of the UK National Institute for Health and Clinical Excellence (NICE) So yes, there is rationing: some treatments, in some cases, are deemed too expensive. But it is not a simple calculation based on the cost of treatment. (And there is nothing to stop anyone from buying “top-up” insurance in the UK.)
  • The most entertaining exchange has been the Investors Business Daily’s contention that [UK resident and citizen] Stephen Hawking would be denied health care if he, er, lived in the UK, which he, um, does. Alas, they’ve taken that particular part of the editorial down, but not bothered to actually change the rest of their specious argument. Hawking himself has responded in a Guardian interview: “I wouldn’t be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived.”
  • The US system probably is better than the NHS if you’re upper-middle class in a high-paying white-collar job with good benefits (the infamous example being members of Congress). In that case, you’re likely in a very good insurance plan, mostly paid for by your employer, which lets you have any procedure that you want (or, somewhat more precisely, that you can get a doctor to recommend). But the vast majority of American either have a significantly less generous plan (if any), or pay significantly more of their own money towards it.
  • The UK system is not perfect: rather than being denied access to expensive procedures, the much more common complaint is that of waiting times. This applies to long waits in emergency rooms, as well as to occasional many-month delays between diagnosis and required surgery or tests (in 2002, the US had four times as many MRI scanners per person as the UK).
  • The UK was number 18 in the World Health Organization’s year 2000 list, while the US was 27.

Finally, it’s important to remember that a UK-style NHS isn’t actually on the table in the US; rather, even the “public option” is more similar to the Canadian single-payer system, albeit as one of many “payers”. On balance, in any case, I think I prefer the UK system, in which a safety net is deemed more important than encouraging competition. The rationing seems to me at least no worse than what is done by insurance companies in the US. Sure, some very expensive health plans essentially write you a blank check for any procedure recommended by any doctor. But many do not: there is a complicated system of gatekeepers, bureaucracy, and lists of covered procedures created specifically to cut down on the cost (to the insurance company!). Some of this is more or less explicitly rationing, while others are usually much more arbitrary and capricious (such as the recision of coverage even in the absence of fraud) — for its faults and occasional failures, at least the NICE rules are out in the open.