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re:act is caused by social problems related to drugs, alcohol, smoking, violence, et cetera. Poverty remains a major cause of illness and only government policy can change that. The NHS can only have limited impact.” The NHS is a point of national pride for many in Britain, but it faced much the same criticism as Obama’s bill faces now when it was established in 1948. The British Medical Association was initially opposed to the idea of a national health system, but it is now an adamant supporter of the NHS and regularly campaigns against the commercialisation of the NHS and its doctors, who it complains are treated like a “collection of profit-driven competing enterprises.” But in the US, persecution of left-leaning thinkers in the 1950s scarred society, and the continuing fear of socialism is scaring people away from anything resembling universal healthcare. The idea of socialism still retains its fear factor in the US, and this fear can easily be used as a club with which to batter any proposed Democratic reforms. Socialism is used as a powerful method of intimidation, but it hides the facts about American healthcare. Healthcare in the US accounts for 15.3 per cent of public spending, compared to only 8.2 percent in the UK, and a significant amount of breakthrough medical research takes place in the US. But comparisons with other European countries’ healthcare systems reveals that the NHS is rather efficient. Germany, for example, has the same life expectancy as the UK but spends more – 10.6 per cent of public money – on healthcare. Systems with multiple operators providing healthcare might be at the root of this cost efficiency. Some American NGOs argue that the reason the UK manages to spend less while being able to cover all of its citizens is that paperwork is involved in running only one organisation, rather than operating several private health insurance companies.

“The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers,” argues Physicians for a National Health Programme, a US organisation advocating a universal, comprehensive single-payer health programme. “Private insurers necessarily waste health dollars on things that have nothing to do with care: overheads, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy.” The efficiency of the private sector in the UK has also been questioned. Independent Sector Treatment Centres (ISTCs) are owned and run by private companies, but contracted to provide large volumes of NHS treatments such as hip replacements. A report by Parliament’s Health Committee showed that work carried out by the first wave of ISTCs was 12 per cent more expensive than the same work carried out by the NHS. France is often complimented on its healthcare system. They spend 11 per cent of public money on healthcare, and reap the reward of a high life expectancy of 81 years. France operates a national insurance program where doctors mainly operate in private clinics but draw their income from publicly-funded insurance funds. The government determines all financial matters and the clinics are left to treat patients, who get a refund of 70 per cent on their bills (100 per cent in cases of longterm illness). The real challenge for President Obama is to convince his citizens that universal healthcare does not equate to communism, that it is merely a way of improving quality of life. The future of American healthcare remains unclear. Whether the proposed healthcare bill passes or not, the current system benefits only a few. Avoiding illness at all cost is no way to live, so clearly something has to change.

Opposite photo: jamesomalley @ Flickr. This photo: hitthatswitch @ Flickr

Something is rotten in the state of Massachusetts. A secure Democratic seat in the Senate, long held by the late Ted Kennedy, has been lost to a little-known Republican, Scott Brown. For the Democratic Party, Brown’s victory represents far more than simply the loss of a safe seat in Congress. President Obama’s healthcare bill is now in grave danger. Having lost their Senate supermajority, the Democrats – and the 30 million Americans without health insurance who would be covered by the bill – are in for a long political slog before the bill has any hope of passing. Despite living in the only Western country without universal healthcare, millions of Americans are keen to keep things as they are. The current system may not be perfect, but the alternative, or so they believe, is unthinkable. To them, the idea of paying for others is a socialist one, going against their definitions of rights and freedom. Collective responsibility is an alien concept that means spending your hard-earned money on someone else. To these Americans, Obama’s ‘socialism’ is only a short step away from communism, the great fear of the 1950s. Lobbying groups, such as Freedom and Individuals Rights in Medicine (FIRM), argue that universal healthcare infringes on individual rights. “There is no such thing as a right to healthcare any more than there is a right to a car or a house,” argues FIRM’s Dr Paul Hirsch. “President Obama’s healthcare plan – or any other form of universal health care – is wrong, because attempting to guarantee an alleged right to healthcare must necessarily violate the actual rights of those forced to provide such care and those forced to pay for it.” The British National Health Service has often been dragged into the American debate, and Dr Hirsch believes that governmental provision of healthcare like that in Britain results in unnecessary bureaucracy. “Whenever the government attempts to guarantee health care, it must necessarily also control it,” he says. “Hence, crucial medical decisions are inevitably made by government bureaucrats, rather than physicians and patients. Healthcare becomes just another privilege to be dispensed at the discretion of bureaucrats.” However, an NHS midwife, who did not want to be named, says that she believes the NHS does serve its purpose – even if there is some room for improvement. “The NHS is the fairest and most efficient way of treating patients with acute illnesses,” she says. “Where it seems less effective is in the treatment of more chronic conditions, relating to old age in particular. In these cases, there needs to be good liaising between health and social services and this isn’t always the case. It can also be frustrating that the NHS is left to pick up the pieces where illness or trauma

US healthcare reform has dogged Democratic presidents for decades

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US healthcare reform has dogged Democratic presidents for decades Opposite photo: jamesomalley @ Flickr. This photo: hitthatswitch @ Flickr

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