US Healthcare ‘debate’

Having used both the US and the UK healthcare systems, and getting increasingly fed up by the misrepresentations by some in the US about the NHS, I write in favour of universal healthcare.

Apologies as this is quite off topic for this blog: I’m going to justify it under the “travel” tagline as I was unlucky enough to break my wrist while in the USA, and to require surgery.

The US healthcare debate appears to be descending more into farce by the day, the latest and well covered point is the laughable assertion that “Stephen Hawking would not be treated under the UK system as the cost-benefit analysis doesn’t stack up”. Aside from the obvious fact that he was, is and will continue to be treated by the NHS (and has since made a statement about his NHS care), this comparison is especially bizarre given that the Obama plan is not modelled on the NHS. The other mistake is laughable misrepresentation of the role of the National Institute for Health & Clinical Excellence (NICE).

Sarah Palin has been citing “death committees” who will somehow sanction treatment, and NICE was described as one of those. The role of NICE is to assess treatments, new and old, to recommend if they are offered on the NHS. It doesn’t assess things per patient, but it does assess the cost-benefit analysis of introducing a drug. Put simply drugs that cost 5% more than existing treatments, but provided a terminal patient with 30% additional quality-adjusted life tend to be approved, a new treatment that costs 500% more but provides limited improvement tend to be rejected.

NICE is often in the headlines for refusing new treatments, but rarely when it recommends that older, cheaper drugs shouldn’t be used as newer, more expensive, drugs are better. The concept of Quality-Adjusted life years is not that controversial, as much of the new treatments focus on terminal conditions.

It’s always an emotive topic, but the cost of providing someone 1 extra month of life, with a drug that costs 3 times the existing needs to be evaluated again providing 50 other patients palliative care. They make tough choices, and in the face of public outcry are overruled more than I would like. However, this is not a death committee.

The USA system already has something much closer to “death committees”, the teams of Doctors who scours medical records looking for unreported medical conditions that can be used to rescind insurance – removing coverage from patients with lethal conditions, because they omitted to mention a minor, unconnected illness some years ago.

There will always be some form of rationing: in the absence of an infinite supply of money there will always have to be choices. The US healthcare system already has rationing in place, by insurance providers. The opponents of reform claim that “a layer of bureaucracy would be placed between you and your doctor” which seems to be ignoring the fact that your insurance company is already playing this role quite successfully.

Would you rather those be made by a medical committee of experts looking at the true value of a given medicine, or by a fixed cap on your insurance policy, meaning that if you get cancer and you’re at 190k of your 200k cap, that you can have 10k of treatment? Oh, and finding a new policy will be problematic as it’s a pre-existing condition.

Rolling policies are prone to falling foul of the pre-existing problem – if you’re on a 3 month rolling policy, unless you fall ill at the beginning, and are healed by the end of the window you’re going to be in problems come the next renewal. It’s a new policy and your chronic condition is pre-existing… these policies are typically taken out by those unemployed or without workplace health cover. Even people attempting to do the right thing can still lose out if they are diagnosed with cancer at 2.9 months.

I am not going to say the NHS is perfect, we’ve a lot of bureaucratic problems that have crept in during the last decade. Our MRSA and C.Dif rates are nothing to be proud at all. We have deaths due to mistakes and mal-practice.

But so does the USA. However, unlike the USA we don’t have people dying because their cancer treatment is withdrawn part way through because of cost caps. Or because someone can’t afford co-pays.

While in america the staff at the hospital where I had surgery treated me fabulously, I was scheduled for day surgery, and received good care (and many opioid painkillers). I have no complaints, however a good friend received awful care at the same institution where they were dismissed due to superficial assessment. The best care in America is amazing, however this care is not universal.

The administration burden also appears amazing: In the fallout from my broken arm I attempted to get a bill out of one of the hospitals that I was treated by. As I had a foreign address they couldn’t send this, but they could send me a questionnaire to rate “how well they dealt with my billing enquiry?”. Badly, but thanks for asking.

This week I’ve had some of the best primary care that I’ve ever had from the NHS, I popped in for 1 item, and while there discussed 2 other things, both of which require some degree of specialist services, and both of which will be undertaken at my local, clean, modern GP complex.

And those services are also available to the people less comfortable and middle class who live down the road from me, and who don’t have an option to go private.

In the UK I live in a country where everyone has acceptable care, and where those who choose to can pay for better care in the private sector. In some cases that gets you better treatment, but mostly it allows you to jump a waiting list and while being seen by a doctor who still does some work for the NHS.

In America you can get exceptional care. I will not deny that, the specialist hospitals and surgeons available are among the best in the world. But not everyone gets that, the masses of un-insured or under-insured people go without healthcare, or have to make very tough choices to get basic care available elsewhere in the world free at the point of use.

Our system is not perfect, but it’s more equitable, and you don’t have to use it if you don’t want to. Go private, go abroad, you’re not stopped.

From what I’ve read of the reforms in the US, you won’t be stopped either.

One thought on “US Healthcare ‘debate’”

  1. Worth noting, also, that there’s an appeal process for many non NICE-approved drugs. So that if your doctor thinks it’s worth making an exception because of particular circumstances of your case, they can ask the local panel for it, and they grant it in a fairly large minority of cases.

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