The news that the White House may be retreating from its insistence that a “public option” be included in any health care reform bill appears to herald a victory for Republicans. But while conservatives in the U.S. may be celebrating, the row over the future of health care in the country is causing problems for David Cameron, the leader of Britain’s Conservative Party.
Britain has found itself dragged into the U.S. health care battle in recent weeks. Opponents of ObamaCare highlight failings in the National Health Service as part of their campaign against “socialized” health care, and proponents of ObamaCare hold up the British model as one that America should seek to emulate. The NHS-bashers seem to have got the better of the argument — at a recent town hall in Montana, President Obama felt compelled to reassure Americans that he didn’t want to adopt the British system.
In Britain, however, Cameron has been forced to defend the NHS after Daniel Hannan, a Conservative member of the European Parliament, attacked it on U.S. television in interviews with Glenn Beck and Sean Hannity.
For all its flaws, Britons have a soft spot for the NHS, and the Conservatives are traditionally seen as being hostile to the service. Gordon Brown’s governing Labour Party — divided, discredited, and facing meltdown in the general election that must be held in the next ten months — has seized on Hannan’s remarks as evidence that the NHS would not be safe under a Tory government.
And so Cameron and Brown have been competing over who loves the NHS the most; the prime minister — always with an eye for the latest gimmick — even lent his support to a “we love the NHS” campaign on Twitter. The British press has weighed in with attacks on the U.S. system — attacks which mostly feature sweeping generalizations or are based on an unhappy personal experience. Britain may be on the verge of electing a center-right government, but much of our media retains a condescending attitude to all things American — Obama excepted — which transcends the political divide.
There’s a great deal of misinformation on both sides of the Atlantic. Anyone watching the TV news in Britain would think that opposition to ObamaCare was limited to a few swastika-waving crazies, led by Sarah Palin and funded by sinister “special interests.” There is little mention of “Blue Dog” Democrats, tort reform, Obama’s deal with the drug companies, or the fact that most Americans are happy with their health care. And the figure of “47 million uninsured” is trotted out daily, when the actual number of U.S. citizens who are long-term uninsured and who are genuinely unable to get coverage is probably closer to eight million.
Come to think of it, there’s not that much difference between the reporting in Britain and that in the New York Times.
Likewise, the British system is not nearly as bad as has been suggested by opponents of ObamaCare. But it’s fair to say that if Britain were setting up a health care system from scratch today, it wouldn’t bear much resemblance to the NHS. The service was established more than 60 years ago in a country battered by war and when the ability of the government to run such enterprises was unquestioned. Back then it did its job of providing basic health care for all admirably. But with people living longer, medical advances producing new and more expensive treatments, and the bureaucracy growing increasingly byzantine, the NHS has become a black hole sucking in ever-more public money. Labour has more than doubled spending on the NHS since coming to power in 1997 with little to show for it, and the service is projected to face massive funding shortfalls in the next few years.
Yet to talk of reforming the service is political suicide. The NHS employs around 1.3 million people — it’s thought to be the world’s third-largest employer after the Chinese military and India’s railway service — and remains broadly popular with the public despite a steady flow of horror stories (it’s just been revealed, for example, that more than 30,000 people have died in the past five years from infections picked up in NHS hospitals). Assuming the Conservatives win the next election, it’s unlikely Cameron will have the courage to propose significant reforms in a first term.
The simple fact is that while neither system is as terrible as their detractors claim, both have undeniable flaws. And while we can trade facts, figures, and anecdotes all day, a couple of things are clear. The first is that the poor enjoy a generally better standard of care in the UK than in the U.S. The second is that Americans with decent insurance enjoy a better standard of care than most Brits — survival rates for all the major cancers are considerably better than in the UK, and screening and treatment for heart disease and other chronic conditions is more widely available.
The most emotive areas of the U.S.-UK debate — and the issues seized on in Republican attacks on the NHS — concern rationing of care and “end of life” provisions. There’s no disputing the fact that care is rationed in Britain — mostly for the chronically-ill elderly, but increasingly too for smokers, the obese, and others whose lifestyles are deemed “unhealthy.” It’s going too far to call the entire NHS “Orwellian,” as some U.S. critics have, but the acronym for the NHS body which decides whether particular treatments are cost-effective — and thus how long certain patients can live — certainly has an Orwellian ring to it: NICE.
As for whether bodies such as NICE constitute “death panels” … well, my dictionary defines a panel as “a small group of people brought together to discuss, investigate, or decide on a particular issue.” If that issue is whether or not to provide certain drugs or treatment to an individual and that person’s life depends on whether or not they get that treatment, then I’m with Sarah: “death panel” isn’t that much of a stretch.
It’s a testament to the ability of leftists to make that which is true sound ridiculous (“Come on! As if the Democratic candidate for president would ever have hung out with a terrorist!”) that the term has been offered up as evidence of right-wing paranoia. But here too, lawmakers appear to be backtracking, with the Senate Finance Committee saying it will drop “end of life” provisions from its proposed bill.
Just because there’s no “panel,” however, doesn’t mean the vulnerable will be protected under a government-run system. More insidious than any group of experts are the statist mindset and the institutional heartlessness that pervade any large publicly funded body. As I discovered over the last few years while dealing with the system on behalf of my dying mother, there’s no need for anyone to “pull the plug on granny” when the system as a whole takes a dim view of providing care for those deemed not to be sufficiently productive members of society.
Mum suffered from dementia and spent the last few years of her life in nursing homes. During her illness she had several stays in the hospital, and every so often some doctor would take my brother and I aside and whisper to us about “quality of life” and “letting her go.” We politely declined the invitation, on that grounds that as long as mum wasn’t in pain, and as long as her face lit up when we arrived to visit her, then by our quaint standards she had “quality of life.”
Mum didn’t require any expensive drugs or other treatment, but the “experts” had decided that she was a burden on the system. What she did need, in addition to basic medication for various ailments, was help to make sure she got enough to eat and drink, and time after time we had to ask doctors and nurses to please, if it wasn’t too much trouble, make sure she didn’t die from dehydration.
It’s important to add that on many occasions doctors and nurses showed great skill in taking care of mum. They also showed great kindness, both to her and to my brother and me. But even with the best of intentions, staff shortages and simple incompetence meant that if we hadn’t visited mum every day, and often twice a day, to make sure she was eating and drinking enough, she would certainly have died two or three years sooner that she did.
So yes, U.S. health care needs to be reformed to reduce costs, and there must be better provision for the poorest. I’m not qualified to say how it should be done, but I do know that Americans should keep the role of the government to an absolute minimum and rely instead on solutions based on the principles of freedom of choice and personal responsibility. There will be an element of rationing under any system — the free market is itself a form of rationing — but difficult decisions should be taken by patients and their families in consultation with health providers who are responsive to the demands of their customers, rather than by government bean-counters.
And the less the government takes from its citizens, the more they’ll have to spend as they see fit. One of the biggest objections to state-run health care is that if you want anything over and above what the state is prepared to provide, then you pay twice: once through your taxes and again for private treatment. For Obama, this means “those who can afford it” paying “a little bit extra.” “Spreading the wealth,” if you will.
The U.S. should not be looking to Britain for ideas about how to run health care in the 21st century. Americans, with their resources and resourcefulness, should be able to do much better.
But that’s a task for another day — right now the priority is to pull the plug on ObamaCare.