Issues of health care

By , 21 August 2009 6:00 pm

There has been a certain bemusement in the UK recently over the sudden American preoccupation with the British National Health Service. I followed the debate with some interest: these are important issues. I also have some familiarity with the private system: when we were in Lebanon the system was totally private. The result was that at the entrance of the American University Hospital casualty department two sombre signs were posted . The first read something on the lines of ‘No guns allowed beyond this point!’; the second, ‘Medical Insurance Essential’. Immediately beyond the signs was an armed guard and a cashier’s office to ensure that both these entry criteria were met.

Anyway, I have to say that most Brits I know were pretty indignant about the NHS being trashed on US television by those opposed to Obama’s health care reform package. Passing over the ridiculous assertion that Professor Stephen Hawking would not have been kept alive by the British system, when that is exactly what it has done, our indignation was aroused on a couple of counts.

The first is that on the whole the British system works very well, and when it comes to accidents and emergencies, extremely well. We get the odd horror story but in general the system is really very good at what we call A and E. One of its big plus points is that when you do get ill or injured the only thing that matters is the medical process. If you hear someone in the UK say ‘I can’t afford to get ill’, 99 times out of 100 what they mean is ‘I can’t afford to take time off work’, ‘I’ve a wedding to attend’ or ‘It’s the big match coming up’. It is also very good for long-term care. As some of you know, our first grandson (now a thriving one-year-old) has a major hormonal deficiency that will require him to be on replacement steroids and to have regular health checks for the rest of his life. The total financial cost to him and his parents of this condition is zero. Well given that all three of them have enough to deal with anyway, there seems a degree of justice in the state shouldering some of the burden. I don’t mind my tax money going to that.

The second point of indignation centred on our perception of the existing US health system. Not having much experience of this, I do not wish to comment too much but it is a generally accepted truism that whenever you go to the States you make sure you have good health insurance. There is much that Americans may legitimately take pride in but I have never heard any American boast of their health system.

There is also much muttering in the UK over the perception (note, I choose my words carefully) that the protest against health care reform was being funded by the vested interests of the healthcare industries. Maybe I’m getting unusually cynical, but I too tend to take the old policeman’s rule that when faced with a crime, you ask ‘who benefits?’.

However the venerable NHS is not perfect. There are two problems, which relate to the general Christian theme of these blogs, to which I have no easy answer. The first one is that the NHS was created after the Second World War for a population that was still largely speaking, Christian. They felt that life was inevitably tough (the war and rationing had reminded them of that) and they had little expectation of making it much beyond the biblical 70 years. They had, if you like, limited expectations of a Health Service: it was not expected to reverse the Fall. (It should also be said that in those days there was not a lot the health service could do anyway; I have read somewhere that in the first years of the National Health Service, there were only 27 drugs available to doctors.) The problem now is that people expect to live to 90 or more, with all their organs working perfectly, their looks preserved and preferably sexually active, all at the state’s expense. (I hate to think of the number of drugs now available to the NHS, or their cost.)

My second concern, and I know it is shared by many people, is the extent to which we should bail out those who have effectively brought upon themselves self-inflicted injuries. I knew someone who courtesy of illegal steroid use during weight training destroyed his knees and put him and his family at the mercy of the state forever. A very large number of injuries received in our excellent accident and emergency wards over the weekend come about as a result of excessive alcohol abuse. And do I need to mention sexually transmitted diseases in unhealthy life styles? I do wonder if we had a private medical system, as we do with car insurance, such people would lose their ‘no claims bonus’ or its equivalent. But a totally free system is inevitably open to abuse.

Anyway I have no easy answers; the eternal Christian dilemma of balancing generosity and justice, fairness and forgiveness, persist. But I would cautiously suggest that, in both the UK and the US, we really need to do some careful and compassionate thinking about the way ahead.

4 Responses to “Issues of health care”

  1. Bill says:

    Hi Chris,

    It's been fascinating to see the oversimplified view of both the US and UK health care systems in the American press in recent months. Having lived with the NHS for four-plus years before returning to the States, our personal experience was not a bad one. Save for the small inconvenience of having to report back to the Doctor's office monthly to have prescriptions renewed, we were very thankful for the low cost and then free medications we received under the NHS in Wales. Similar meds are costing us about $140 monthly here in the States. And that's after insurance pays for part.

    I suppose what was a bit disturbing to us as observers were the instances of government-selective treatments that were trumpeted in the press – excessive waits for major treatment, availability of some critical-care meds on the basis of your residence post-code, and the seemingly endless number of super-bug stories in NHS hospitals.

    The historical context of both our systems is rarely talked about – how things got to the way they are. All the press and protesters seem to want is an apples-to-apples comparison, shouting horror stories at each other.

    There's no simple solution. What seems clear to me is that the current administration are coming across more and more as used car salesmen, pushing the customer hard to buy something with a good coat of wax and a leaky transmission.

    God help us all.

    Bill D.

  2. Catherine Brislee says:

    Very interesting to read Bill's comments, as someone who knows both sides!

    One thing I don't see mentioned in the media hype is the element of choice in the U.K. Private insurance with private health care is available and a minority of people choose it, not all of them rich. They don't get better doctors and nurses, but I hear there is less waiting and better accommodation in hospital. Personally I'm happy with my experience of the NHS, but I think the element of choice is important.

    I get the impression (correct me if I'm wrong) that Americans who get upset about the idea of "socialised medicine" are concerned about some kind of government takeover and losing their freedom of choice. I don't see why you can't have both systems running together.

  3. Bill says:

    There is already a government-run health care system in the USA. Our Medicare system is designed largely for pensioners. Depending on who you ask, it's either an inconvenience or a bureaucratic nightmare. But it exists to support those who are no longer earning enough to support payment to private insurance companies.

    I think the fear that many who choose private insurance have is that the government-run system being proposed will undercut their insurance companies and force them into the government's arms. It's hard to compete with someone who can print (or seize through taxes) their own money to pump into their own system. The impact through the insurance system would be significant. Many medical insurance providers provide other types of insurance. If their ability to do business is crippled because of changes to the medical part of their companies, how likely is it that life insurance, property insurance, auto insurance bills will increase just to keep them afloat? It's a delicate balance.

    Many companies in the USA offer health insurance coverage as part of an employee's compensation. At present, that part of income is not taxed. However, one of the proposals being put forward is that medical insurance coverage will be taxed. While some would merely tighten their belts and pay the tax and continue with their current medical insurance, many who live month to month already would drop out and be forced to go to the government system.

    On the most basic level, I think the objections exhibit a fear of increased government penetration into issues of personal choice and a huge expansion of government bureaucracy. [What's puzzling is that the government health system proposed won't actually come into place for several years, so through Obama's first term, the possibility of it will be hanging over our heads much like Damocles' sword.]

    Again, there's no easy solution, and the rhetoric in the news and at the town hall meetings is a severe over-simplfication. However, most people vote based on simple assumptions – right and wrong. I have a feeling that the Democrat party will suffer losses because of this in the mid-term elections. If government healthcare in its present proposal is passed before then, the losses will undoubtedly be large ones.

    Bill D.

  4. Kirsty says:

    Just wanted to say that I'm very grateful to know the NHS is there, should I need it.

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