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Dr Alistair Brown | Associate lecturer in English Literature; researching video games and literature

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Demolishing American Myths About the National Health Service

Wednesday, August 12, 2009

Sometimes, from my seat in the United Kingdom, it is hard not to laugh at politics in the United States. Take the fierce war about healthcare reform currently being fought in town halls throughout the country. Waking up bleary-eared to the radio news this morning, my ears pricked alert when I heard one woman berating a Democratic senator: "this is about the systematic dismantling of this country...I don't want this country turning into Russia. I don't want this country turning into a socialised country." What Cold War time warp is she stuck in?

But my laughter died and my blood got hot when I turned to this morning's Guardian. This reports that America's right wing is using the National Health Service to exemplify the terrible consequence of state controlled health care.

In television commercials and press releases from the American right wing, misinformation abounds. They report that the NHS puts "an Orwellian financial cap" on the value of human life. An email widely circulated among US voters claims that anyone over 59 in Britain is ineligible for treatment for heart disease. Republican Chuck Grassley says that:
I don't know for sure, but I've heard several senators say that Ted Kennedy with a brain tumour, being 77 years old as opposed to being 37 years old, if he were in England, would not be treated for his disease, because end of life – when you get to be 77, your life is considered less valuable under those systems.
A television advert from the conservative Club for Growth intones a figure of $22,750 whilst, with the backdrop of a Union Jack, a voiceover says: "In England, government health officials have decided that's how much six months of life is worth. If a medical treatment costs more, you're out of luck."

The group Conservatives for Patients' Rights has pages explaining healthcare systems in other, mainly European, countries. In its entry for Great Britain, it claims that in the NHS:
Waiting lists are a huge problem...Some examples: 750,000 are on waiting lists for hospital admission; 40% of cancer patients are never able to see an oncologist; there is explicit rationing for services such as kidney dialysis, open heart surgery and care for the terminally ill.
All of the above claims are at best misinformed, and at worst utter drivel.

There may be large waiting lists in NHS, but the simple number is irrelevant. What matters is waiting times, and as of 2009, no patient has to wait more than 18 weeks between being referred by their doctor and starting their hospital treatment. Most patients will actually start their treatments within 8 weeks. It is also utterly false that patients above a certain age, such as Senator Kennedy, would be denied any treatment.

The statement that 40% of cancer patients never get to see an oncologist is based on a study 15 years old (ironically, when the NHS was chronically underfunded by a conservative, right-wing government), and is no longer accurate. Naturally, though, some cancer patients may never get to see an oncologist, because advanced-stage but recently diagnosed cancers may kill before treatment.

The idea bandied both in the Club for Growth television advertisement, and also by Steven Pollard on the Conservatives for Patients' Rights site, that there is an "Orwellian financial cap on the value of human life" needs qualifying. The claims stem from the fact that when deciding whether to spend NHS money on new drugs, the National Institute for Clinical Excellence applies a cost-utility analysis. If a drug costs more than £30 000 to potentially extend the quality life of a patient by a year, NICE may deny funding for that drug. This is, of course, entirely sensible. Given a limited pot of money - and, yes, even US private health insurance schemes work with these - it would be unethical for one patient to receive an expensive drug to extend their life by one year, thereby meaning that other, cheaper drugs which might extend the lives for more patients for longer are restricted. NICE also offers a barrier against the salesmanship so prevalent in US healthcare, whereby doctors are pressed by the pharmaceuticals to prescribe the latest expensive drug. In the UK, with the health service working with more or less the same suite of drugs under NICE's recommendations, what amounts to bribery of individual doctors can have less of an impact.

One could go on all day exposing the lies behind the US claims, but The Guardian has already done a good job of collating decisive rebuttals on this page.

The bottom line, though, is this. In the UK, according to the World Health Organisation, healthcare spending per capita is around $2000. In the US, it is around $6000 per head. Yet in the UK (again using WHO figures), life expectancy is 79, whereas in the US it is 78. It is not surprising that the WHO ranks Britain's healthcare as 18th in the world, while the US is in 37th place.

But forget the figures for a moment, for healthcare is about humans. Healthcare is perhaps the most complex system any government administers. There can never be a perfect system which satisfies the needs of every patient every time; neither private health insurance nor a national health service are necessarily bad ways of paying for the service. Things do go wrong with the NHS. People get left waiting to see a nurse in a cold hospital corridor. Waiting lists always have room to come down. A patient is lucky if they can find an NHS dentist. Some cancer patients do get denied the most expensive drugs that might prolong their lives - if not cure the cancer - for a few months. Healthcare professionals are invariably overworked.

But the National Health Service has looked after numerous members of my family, providing cancer care, and long term care of chronically ill or disabled relatives, who would not have been able to afford to pay in the American model. If I want to see a doctor because I am worried about a tiny lump on my throat, I could see one this afternoon, and not put off the appointment until next year when I have saved enough. If I am in a car crash, I will receive trauma care that is second to none, and not be turned away at the doors of the nearest casualty department, or of the best department to treat my particular injuries, because my insurance is inadequate. If I have a child who suffers from learning difficulties, he or she will be seen and treated by an occupational therapist (someone like my mother, a paediatric OT), so that they can be integrated into mainstream education where possible. If my grandmother needs things such as grab rails installing in her home, she will be means-tested to see if on her income she qualifies for a grant to help her make the required changes, which allow her to live at home for longer. If I need a prescription, I pay just £7.20 per item, no matter how great the cost to the government. Or if I need a repeat prescription, I can take a prepayment certificate for £104.00 per year. And, for all these benefits, I pay less as a taxpayer than my US counterpart.

The National Health Service is a source of national pride, and I have to say I felt patriotically offended when I read the Guardian this morning. If the Labour government have done one thing well since 1997, it has been to fund the NHS sufficiently such that no future government could ever dream of removing it. It is our institution, and it is here to stay, robust against any abuse and slanders levelled at it from across the Atlantic.

Update Following the post above from this morning, I am delighted to see that I am not the only one who feels positively about the NHS. With thousands of people posting their personal, positive accounts of healthcare in the UK, Twitter posts using #welovetheNHS made it to the top of its trending topics this afternoon. Even the Prime Minister got in on the act.

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Posted by Alistair at 7:43 am


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Blogger rose said...

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