25 August 2009

Healthcare: The Truth

The United States of America has massive advantages over other countries - abundance of land and raw materials which brings cheap food and rent, a massive single internal market which brings economies of scale efficiencies and increased opportunities of monopoly dominance of industries.

The US is the number one military and financial power which protects its corporations' economic interests abroad through economic sanctions, intelligence interventions in other countries political institutions, interference in foreign elections and finally the US uses military action if deemed necessary.

Through these advantages, the US has the dominant global corporations, a reserve currency and raw materials priced in dollars which allow it to borrow money cheaply and run up huge deficits.

In short, the average US citizen should enjoy unprecedented public services, quality of life and wealth in comparison with other countries, but they do not. They earn less and pay more tax.

Yes the US has the largest GDP, yes GDP per head is fairly high in comparison with other developed countries, but the median wage earner ($32,390) in the US pays higher taxes than nearly all Western European countries. The median wage in the UK is $41,098.

They also get poorer quality public services for their money! Whats more, the less you earn in the US, the more tax you have to pay as a percentage of your income. And in the US you can earn very little indeed and receive little or no government help. Inequality is off the scale by European standards.

Healthcare is a prime example of this. Tax funded healthcare in the US is inefficient and complicated and only around half the population are effectively covered by Medicare, Medicaid and other government run schemes despite more tax money being spent per head than our NHS which covers everyone. So around 120m Americans (50% of the adult population) pay taxes toward a system that provides them with no effective healthcare cover, except running to expensive Emergency Rooms when in dire need of treatment - a highly inefficient way to provide care. It is particularly scandalous that in some states children are left without healthcare.

What about rationing for those who do have cover? As the Economist puts it:-

These [tax funded] schemes lay down in great detail, in the form of national and local "coverage determinations", which treatments and procedures can be claimed for, and at what rates. And all but the most expensive private insurance policies impose limitations of their own.

So, 'death panels' as the Republicans like to call them, exist in the US already and ration just as much, if not more so, than the National Institute for Clinical Excellence (NICE) does for the NHS. And this is before we consider the millions of Americans who pay their premiums only to find insurance companies weedling out of providing coverage by citing 'pre-existing conditions' from long ago that have no bearing on the current treatment and are so obscure that the patient would never have thought to mention them on an application form.

Comparing healthcare outcomes between the US system and elsewhere is fraught with difficulty, but EVERY single report that has attemped a comparison rates the US system worse than our NHS. On an admittedly crude measure like life expectancy the UK outscores the US, 79.3 to 77.8. I know this also depends on lifestyle, and obesity is higher in the US, but even when we compare death rates for under 75s for treatable conditions, the US scores lower than our NHS despite the US spending 16% of GDP on health compared to our 8.4% of GDP. The London School of Hygiene and Tropical medicine carried out such a study. As this week's Economist puts it:-

Their study placed Britain 16th among 19 advanced nations (France came first). But America came last!

And in 2006 a study compared the health of middle aged people in the UK and the US - the US was sicker.

I am not pretending that the NHS is the best system in the world - it quite clearly is not and careful reform is welcomed. The NHS has many faults, as do all systems, but what I am saying is that it is cheaper, less bureaucratic and more efficient than the US system which is based around the interests of big pharmaceutical and insurance companies. Their lobbying and funding of both Republicans and Democrats is preventing Americans from having a better healthcare system.

One much publicised area where the US does do better than the UK is five year survival rates for cancer. Expensive new drugs become available sooner in the US and diagnostic equipment is more available 25.9 MRI scanners per million people to 8.2 in Britain, but these figures hide once again the massive inequalities in the system where the richest few get the best care in the world while the poorest get some of the worst care. Also sometimes the side effects of these drugs, although extending life, make the quality of life so unbearable for the patient they probably would be better off taking their chances with the cancer.

For example, my dad is currently receiving a drug called SUTENT for his advanced kidney cancer at a cost to the NHS of £3,500 a month (at these prices and the limited value to the patient it is easy to understand why NICE thinks the money might be better spent elsewhere). My dad has been on the drug 3 weeks now and has gone from being able to walk to the library, mow the lawn etc to being virtually bed bound with sores all over his body IN THE SPACE OF 3 WEEKS - i.e he now has no quality of life at all. The drug 'might' stop the growth of the tumours and prolong my dad's life a few months, but at what cost to his quality of life? I am not sure it is worth it. If I was my dad I would take my chances with the cancer. Until the final stages of life and with symptoms treated, you can have some quality of life - go on holiday etc. It is a horrible choice to make and I understand my dad choosing the option that promises some hope, but personally I would rather have a shorter life that enabled me to have some time to enjoy what life I have left.

In the past few decades my dad has received many thousands of pounds of treatment - 2 hip replacements, a removal of a kidney, keyhole surgery on his lung, pins in his leg and now expensive cancer treatments. All of which he would have struggled to afford.

So, the overall verdict has to be that we are very fortunate to have establised an NHS in this country. Ask any ex-pat stung by health insurance or health costs in Australia, South Africa or the USA.


  1. Dear Neil,

    Please let me know if we can help your Father overcome the side effects he is suffering from - a lot of these can be mitigated by local treatments.

    Rose Woodward
    Email - contact@kidneycancersupportnetwork.co.uk

  2. Rose, thanks for your concern, but my dad has a macmillan nurse visit every week and they discuss the symptoms he is suffering in detail. So far, in consultation with the consultant they have decided to continue with the drug. He has been given some medication to deal with some of the side effects.