Monday, 17 August 2009

The price of health

I see US President Obama is running into trouble over his proposed national healthcare reforms. It seems many Americans are very opposed to a government-run insurance scheme, or seemingly anything that involves more public money going into healthcare. This is all very interesting from a British perspective, as our public-funded system was founded in 1948 on the principle of free, universal healthcare for all, and has stayed remarkably true to that ideal over the years.

The NHS has come to be regarded as something of a national treasure, and for many people the idea of a system that relies on private health insurance, such as in the US, is almost beyond comprehension. We take it for granted that the NHS will always be there for us if we were to need it, whereas having to pay for our medical treatment in such a situation is, for us, almost as unthinkable as having to go without treatment if we could not afford it. Whilst some people do pay for private healthcare in the UK, I suspect that even they view it as something of a luxury, and are reassured to think that should their fortunes change, they could still get a thoroughly decent standard of service for free on the NHS.

Americans, it seems, would probably not be satisfied with thoroughly decent. Their system allows for more choice, at least for those able to afford healthcare at all, and they are very reluctant to give that up. There is something in the American mindset that demands the very best service, the very latest technology, the newest drugs; good enough, for them, is simply not good enough. In fairness, they are generally prepared to pay for it, as evidenced by how the US actually spends 16% of it's GDP on healthcare, compared with 8.4% in Britain. Surprising figures, which show not only that Americans are willing to pay top dollar for top class service, but perhaps also that the NHS is not as inefficient as you might think.

Of course, the majority of the money going into the US healthcare system comes from the private sector (insurance companies, employee healthcare plans, private individuals), but even so 47.2% comes out of public spending, mainly on the government-run Medicare and Medicaid insurance schemes that cover the elderly, veterans, some disabled people and certain qualifying low-income groups. So, as a proportion of GDP, the US and UK governments spend roughly the same amount of taxpayers' money on healthcare. For that, the US get a system that allows 46 million people to go without health insurance, while a further 25 million are considered under-insured for their needs. That's around 23% of the population who could potentially be faced with the choice between going untreated, or paying for treatment which they can't afford. Meanwhile, for around the same money, Britain gets a universal healthcare system which is guaranteed free at the point of use. And that's without the massive extra spending that Americans put in privately.

The two systems on either side of the Atlantic could hardly be more different, ideologically and practically, so direct comparisons are often difficult. But, when looked at in terms of sheer value for money, it does seem that we get a pretty good deal. And that is something that I would have thought the American taxpayer would appreciate more than almost anyone.

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