James Gubb: Obama's plans fuel need for a dose of realism in healthcare debate

IF things weren't already heating up in the US healthcare debate, they have now well and truly erupted.

Right-wing Republican groups, such as the Conservatives for Patient Rights, have led the charge against President Obama's health reform plans by condemning the "socialised" path they will tread towards the NHS. It has been referred to as "evil" by Sarah Palin, who would have become Vice President to John McCain had he won the election.

Gordon and Sarah Brown have been twittering their support for the counter-campaign "welovethenhs". Now, in response to Conservative MEP Daniel Hannan's claims that he "wouldn't wish the NHS on anyone", David Cameron has weighed in and pledged his unquestioning support for the organisation.

There is a need for a bit of realism on both sides. First, let's start with the Right-wingers. The NHS is not "evil" and as for Daniel Hannan's comments, there are plenty of people who will have received world-class health care from the NHS and its staff and – as the Twitter campaign shows – are very grateful for it.

Yes, the NHS does ration treatment – recently, we saw the story that 1,000 cancer patients were denied cancer drugs – and while a more open policy towards top-ups would be welcome, since the National Institute for Clinical Excellence (NICE) started its work, there is at least now an acknowledgment that the NHS has a finite budget.

It should be remembered that in the US, many people are "rationed out" of treatments simply because they cannot afford them or their health plan does not cover them – some 48 million people are uninsured.

It is this risk that is the underlying reason health care is collectivised to some extent or another in pretty much all developed countries. We believe, out of compassion, that everyone should have access to a fairly comprehensive package of healthcare, and recognise that healthcare is necessary to give everyone an equal chance to participate fully in society.

Also – and this is not to say the NHS does not have very serious problems, too – the US health system is in big trouble. On measures of amenable mortality – deaths from conditions that should be preventable by good medical care – the US is the worst in the developed world. Yet it costs the most.

Over the last 35 years, health spending has risen by 9.8 per cent versus 7.2 per cent elsewhere in the US economy, which is what has made it unaffordable to many. Employers are often burdened with a large part of this, making them uncompetitive.

And, if governments were forced to include in their financial statements the liabilities they face from contractual commitments to provide healthcare for retired employees, then nearly every city and town in the US would be bankrupt. So something needs to be done.

But now to the NHS. "We love the NHS... more than words can say," says Sarah Brown. "Thanks for always being there," said Gordon. David Cameron says "we're proud of the NHS", and Shadow Health Secretary Andrew Lansley says it's a service where "quality is as good as anywhere in the world; where outcomes are as good as anywhere in the world".

Many may love the NHS, but not everyone shares the same benign attachment. In an ICM poll, in 2006, 65 per cent of respondents agreed that the NHS was the right idea when it was introduced in 1948, but that Britain has changed and we need a different system now.

Eighty per cent, for example, said it shouldn't matter whether hospitals or surgeries are run by public, private or voluntary organisations, so long as everyone has access.

Perhaps it is the ideals of solidarity and universality that attracts such support, rather than the NHS itself?

Because, to put it bluntly, Andrew Lansley's assertion that quality and outcomes are as good as anywhere in the world, is simply not true.

In an individual ward or hospital, it may be so, but across the board it isn't. Taking a snap-shot of several countries of similar

development to the UK – Denmark, France, Germany, Japan, the

Netherlands, Spain, Sweden, Switzerland, the UK and the US – and using figures collected by the World Health Organisation, the UK comes eighth on amenable mortality, cancer mortality and life expectancy. On cardiovascular mortality and infant mortality, it comes ninth (the US is typically worse). In a pan-European survey of patient satisfaction, the UK came 19th out of 30 nations.

And productivity in the NHS, according to the Office for National Statistics, has declined by four per cent over the last decade.

There is, then, an urgent need for a bit less propaganda and a bit more honesty on both sides when it comes to the debate on the NHS and healthcare in Britain and the US.

The NHS doesn't leave old or disabled people "to die" as the American magazine Investor's Business Daily would have it; but, equally, it isn't the omnipotent deity that many domestic politicians – Mr Hannan excluded – crank it up to be.

The fact is that if President Obama is serious about health reform and providing universal coverage, then he would do well to look across the Atlantic.

In countries like France, Germany, Switzerland and the Netherlands, there are health systems that are insurance-based (a good start for where the US is coming from) that are more competitive, responsive and patient-led than the NHS, and that provide universal coverage.

It is they who sit at the top of the tree – not the US, nor the NHS.

James Gubb is director of the health unit at Civitas, an independent social policy think-tank.

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