national health care – Sheila Kennedy

One More Time….

The American Prospect sends out a regular newsletter, titled Kuttner on Tap, in which the author, Robert Kuttner, addresses a variety of issues.

Kuttner is a longtime journalist– currently a professor of social policy at Brandeis University.. He co-founded and co-edits The Prospect, which (according to Wikipedia) was created in 1990 as an “authoritative magazine of liberal ideas.” He is also a co-founder of the Economic Policy Institute.

Given Kuttner’s background, his preference for national health care is unsurprising, but a recent issue of the newsletter really resonated with me, not just because of stories like the one I shared last Friday, but because it mirrored my own experience with England’s National Health Service (NHS).

Kuttner was in London when he felt ill.

Yesterday, I had some odd health symptoms that suggested a visit to a doctor. This being Britain, off I went to the walk-in clinic of the nearest hospital of the National Health Service. What happened next is enough to make an American progressive weep.

I arrived at St Thomas’ Hospital, one of London’s busiest, at 10 a.m. By 10:20, I had been through a courteous triage process, filled out a basic form, and was scheduled with a GP. The doctor saw me at 11:00, took a history, examined me, performed a couple of tests right in his office, assured me that this was not serious, and shook my hand.

“Do I need to check out?” I asked.

“No, you are free to go,” he said. Less than 90 minutes after arriving, I was on my way.

Bill: zero.

As I said, this account mirrored a personal experience. A few years ago, my husband and I were on a cruise to England when he developed upper respiratory symptoms. By the time we got to Nottingham, where our oldest granddaughter was living at the time, he was really unwell, and she insisted we go to the nearby walk-in-clinic.

After a very brief wait, we were called back to the nurse practitioner. She took a history, examined him, and called an ambulance to take him to Nottingham University’s hospital. (She said she might be “over-reacting a bit–I hope so” but “better safe than sorry.”) The ambulance was there almost immediately, and I rode with him. I can’t say enough about how efficient and caring the EMTs in the ambulance were.

We were taken to A and E (Accident and Emergency). Again, we were impressed with the efficiency of the process; first, an evaluation and a number of lab tests, then further tests based upon the initial results. Throughout the (very long) day, personnel kept us informed of where we were in the process, and why they were doing what they were doing.

The fear was a pulmonary embolism; fortunately, the scans ruled that out. However, what the ship’s doctor had shrugged off as a cold or allergy turned out to be a heart problem that hadn’t been detected by his cardiologist on his visit a week before our trip. The NHS doctor explained that his symptoms were the result of fluid accumulation–probably the result of unusual activity on the trip. He was admitted for a short stay so that they could eliminate the additional fluid.

Only when he was released were we asked whether we had insurance, since we weren’t British citizens. (The ultimate bill was $1900.–for all the tests, and a two day hospital stay. And Anthem–our insurer at the time–bitched about that and delayed payment.)

As Kuttner wrote,

NHS is far better, fairer, and more cost-effective than our system. Britain is a poorer country than the U.S. but has an average life expectancy almost four years longer (80.9 years to America’s 77.3).

Because the NHS is true social medicine with salaried doctors and nurses, the money and time wasted in the U.S. on parasite middlemen, coding and billing, rapacious insurance companies, hospital profit-maximization strategies, and excess lucrative procedures, is simply not a problem or a drain in Britain. All the money goes to patient care….

In this fiscal year, the entire NHS costs 152 billion pounds, or about $180 billion. That’s close to two-thirds of all of Britain’s spending on health care. By contrast, the U.S. spends a staggering $4.4 trillion.

Relative to GDP, Britain spends about 12 percent and covers everyone. We spend just under 20 percent, and tens of millions of Americans have no coverage while tens of millions more are woefully underinsured and must pay exorbitant sums or do without.

Other Western countries have other versions of national health care. All of them deliver better results for many more people for far fewer dollars.

It turns out that it’s very costly to refuse care to “undeserving” (i.e. under-resourced) people…..

Comments

We’re Number Eleven…

The problem with living at a time when there are so many problems–and so many truly major ones, at that–is that our focus gets splintered. Climate change. Vote suppression. White Supremicists. Rightwing domestic terrorism. Guns. Government gridlock. The pandemic. Continual wars and the growth of the military-industrial complex …The list is endless.

But a recent report in the Washington Post reminded me of one of our most long-term and shameful problems–America’s perverse refusal to follow the lead of other wealthy (and plenty of non-wealthy) countries and provide universal access to health care. The negative consequences of our refusal to allow anyone to opt in to Medicare (Medicare for those who want it), or just to broaden the scope of the Affordable Care Act, have receded from prominence.

We may be distracted by other policy failures, but the problem remains–and it is as acute as ever, if not more so.

Researchers at the Commonwealth Fund compared the health-care systems of 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

The United States has the worst health-care system overall among 11 high-income countries, even though it spends the highest proportion of its gross domestic product on health care, according to research by the Commonwealth Fund.

“We’ve set up a system where we spend quite a bit of money on health care but we have significant financial barriers, which tend to dissuade people from getting care,” said Eric Schneider, the lead author behind the findings and senior vice president for policy and research at the Commonwealth Fund, which conducts independent research on health-care issues.

The researchers identified five metrics of a well-functioning health care system: access to care, the care process itself, administrative efficiency, equity and overall health-care outcomes.Norway, the Netherlands and Australia were judged to be the top-performing countries overall.

The high performers stand apart from the United States in providing universal coverage and removing cost barriers, investing in primary care systems to reduce inequities, minimizing administrative burdens, and investing in social services among children and working-age adults, the Commonwealth Fund found.

The latter is particularly important for easing the burdens on health systems created by older populations, according to Schneider. “These sort of basic supports throughout younger age groups reduce, we think, the chronic disease burden that’s higher in the U.S.,” he said.

Since I have a son who lives in Amsterdam, I was particularly interested in the description of the Netherland’s high-performing system. The researchers found that it was a “well-organized system of locally placed primary care doctors and nurses who provide care on a 24/7 basis”–a system that keeps minor problems from turning into major ones.

The U.S. doesn’t come close. (As a former graduate student, a hospital administrator, told me years ago, we don’t have a healthcare system in the U.S.; we have a healthcare Industry.)

The United States was rated last overall, researchers found, ranking “well below” the average of the other countries overall and “far below” Switzerland and Canada, the two countries ranked above it. In particular, the United States fell at the end of the pack on access to care, administrative efficiency, equity and health-care outcomes.

The article noted that the inequities in America’s healthcare, together with our inadequate primary care, put the country in a much weaker position when it came to confronting the pandemic. That fact–together with the GOP’s advocacy of vaccine denial–may account for the fact that the U.S. has the second-highest COVID death rate among the eleven countries in the study.

America’s healthcare industry is costly in both lives and dollars.

Spending on health care as a share of GDP had grown in all of the countries the Commonwealth Fund surveyed, even before the pandemic. But the increase in the United States has “greatly exceeded” those of other nations. The United States spent 16.8 percent of its GDP on health care in 2019; the next highest country on the list was Switzerland, at 11.3 percent of GDP. The lowest was New Zealand, which spent roughly 9 percent of its GDP on health care in 2019.

Meanwhile, health care in the United States is the least affordable.

I hate sounding like a broken record, but this is what happens when racism drives decisions about the social safety net. Political scientists and sociologists confirm that–in addition to the profit motives/special interests of insurance companies and Big Pharma–the fact that White Americans don’t want “their” tax dollars spent on medical care or other social benefits for “those people” has prevented us from installing a less-costly and vastly more effective medical system.

We keep filling in that swimming pool…

Comments

“Those People”

If there is any lesson to be learned from the current pandemic, it is that the U.S. population has suffered unnecessarily because we have stubbornly refused to do what every other modern Western nation has long done: provide universal health care.

Not only have we resisted any version of a single-payer system, we’ve thrown five million plus people off health insurance during this pandemic. And the “very stable genius”–our idiot President–has weighed in on a Supreme Court case challenging the Affordable Care Act, asking the Supreme Court to strike down a measure that provides health insurance to some twenty-three million Americans.

During a global pandemic.

So what accounts for America’s outlier status? For decades, the accepted answer to that question was some form of our individualism or our devotion to a market economy. But that excuse never really held water, because–as most of the world’s market economies understand–some areas of the economy are simply not suited to market transactions, which require a willing buyer and a willing seller, both of whom are in possession of all information relevant to the proposed transaction.

That clearly does not describe medical services.

The real answer–the real reason American government has been so unwilling to provide universal health coverage–is the same reason the rest of our social safety net is both inadequate and deliberately punitive, constructed to “weed out” anyone who can’t adequately demonstrate both need and moral worth.

I receive Paul Krugman’s newsletter (no URL of which I am aware) and awhile back, he addressed the real reason for our disinclination to offer medical care and basic sustenance to all our citizens:

Non-American friends sometimes ask me why the world’s richest major nation doesn’t have universal health care. The answer is race: we almost got universal coverage in 1947, but segregationists blocked it out of fear that it would lead to integrated hospitals (which Medicare actually did do in the 1960s.) Most of the states that have refused to expand Medicaid coverage under the Affordable Care Act, even though the federal government would bear the great bulk of the cost, are former slave states.

The Italian-American economist Alberto Alesina suddenly died on March 23; among his best work was a joint paper that examined the reasons America doesn’t have a European-style welfare state. The answer, documented at length, was racial division: in America, too many of us think of the beneficiaries of support as Those People, not like us.

There’s a significant body of social science research that confirms Alesina’s thesis.

Americans are finally grappling with the institutional racism that has distorted our society. Unlike the civil unrest of the 60s, we’ve seen significant white participation in the Black Lives Matter protests. There is finally widespread–although certainly not universal– acknowledgment of America’s “Original Sin.”

It is also finally dawning on the “chattering classes” that America’s social problems are interrelated–that the reason Grandma doesn’t have health insurance might have something to do with the fact that Grandpa and his friends have always believed they are intrinsically superior to “those people”–people who definitely don’t deserve access to services funded by Grandpa’s tax dollars.

They’re willing to forego health insurance and other benefits of a social safety net if that’s what it takes to ensure that “those people” can’t take advantage of them.

America: where we cut off our noses to spite our faces–and call it “freedom.”

Comments