Tuesday 3 February 2009

Universal Healthcare: A Domestic Issue?

Despite the current kerfuffle over Tom Daschle’s tax problems, I have every hope and expectation that in the coming years, perhaps months, we will start to see a real effort by the administration to solve one of the most pressing crises currently facing the USA - rising health care costs and the rapid increase in the uninsured.

Equally inevitable is that as part of this process we will start to see Conservatives and obstructionists of all sorts piping up to demonise OTHER health care systems that currently have universal coverage. Ranting and raving about the supposed failures of European and Canadian systems seems to be the first club at hand when the opposition reaches tries to beat back any effort at reform. And this view is widely believed by the American public - in fact, my mom told recently that she is very concerned about the quality of health care if America adopts universal cover.

This is an area where I, and Americans Abroad generally, have a useful point of view. After all, many of us have lived under the US healthcare system AND under those supposedly disastrous European systems that folks back home seem to find so worrying. So, from a patient perspective what is better; European style of American style health cover?

Well, the first thing to say is that there is no such thing as “European style” health coverage - countries across the continent all have different delivery models for their universal health care programs. In Britain, somewhat unusually, we have a single institution - the National Health Service (NHS) - that delivers all public sector health care. Other countries, Germany for instance, have an insurance model whereby third party providers offer the health services, but ultimately they are all paid for out of a single pool of taxation.

In fact, virtually the only things the different health systems in Europe have in common with each other are:

1) They are much cheaper than the US system.

2) They cover everyone, or almost everyone.

3) They deliver a better quality of care.

Here in Britain, for instance, we spend about 8% of the country’s annual GDP on health care, compared to 15% in the US, and yet the overall health of the population is similar, with perhaps even a slight advantage for the UK. For that 8%, we cover every single person living in the UK (including immigrants, like me).

You will frequently hear people point out that in Britain there are often waiting times for many medical procedures - this is absolutely true and is indeed a serious problem relating to the limited resources of the NHS. They are required to make some difficult decisions about how to spend their limited funding, and this does mean that sometimes people don’t get care as quickly as they should. The system can definitely be improved.

However, remember that this is based on a spending only a little more than HALF what the US is spending on healthcare as a percent of GDP. If we were willing to spend an equivalent amount - 15%! - to what they are spending in the States, we could virtually eliminate waiting times and many other inherent imperfections in the current system.

That is not to say that an NHS style system is right for the USA - I don’t think it is. But having lived under both systems I can tell you that if given the choice of living under the NHS or under the US insurance system, I would have no hesitation in choosing the NHS, even if only for career reasons. What do I mean by career reasons? Well, I recently parted company with my former employer and am working as an independent consultant. This career move would have been impossible for me in America - I would have had to either cling desperately to my previous employer at all costs, or to take a 9 to 5 job (ANY job) just to ensure I am covered. Living under universal health care has allowed me the freedom to pursue my own happiness. That’s surely something that Americans everywhere support.

If you are an American living in Europe, now might be a good time to pick up the phone to your relatives back home and give them the real story about your experiences with health care overseas. I bet they’d love to hear from you.

(Cross posted to www.eurobamablog.com)

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