Saturday 15 August 2009

US health debate: motes and beams, apples and oranges

Why beholdest thou the mote that is in thy brother's eye, but considerest not the beam that is in thine own eye?

I couldn't recognise the picture of our National Health Service as painted in some of the TV commercials quoted on BBC News recently. Certainly, there are faults (many introduced by the cack-handed attempts to privatise parts of the system, in my opinion), but one can practically guarantee being treated, whether one "is a prince or a pauper" as RMT's Bob Crow put it on "Any Questions?" yesterday. This is clearly not the case for large numbers of US citizens, as today's front page story in the Independent shows.

I can quite believe that, if one had ample means or continuing health insurance, care would be more timely and more pleasant in the US than it is in some parts of the UK. (Again, the anti-socialized medicine lobbyists always choose the extremes, like overstretched inner city surgeries, to illustrate their point.) But most British people are happy with the care they receive from the NHS, especially in an emergency. Indeed, the NHS is probably at its best dealing with emergencies; it is the routine which is open to criticism.

And there are no death squads, terminating people who are too expensive to treat, as Prof. Hawking attested on his recent visit to the States.

Comparing Apples and Oranges

Not only are the "anti" commercials traducing the NHS, but they also attack the wrong target.
The solution which Obama favours, and which is, as I understand, implicit in the two (!) Bills going through Congress at present, is one not of "nationalised" health care, but of social health insurance. This is the method preferred by France and Germany. One can understand the anti-Obama lobbyists avoiding discussion of these countries, because they provide a Rolls-Royce service. Indeed, the major complaint is that more money is spent on them than is absolutely necessary, that there is over-provision.

Most glaring of all is the absence in the debate (at least, as it has reached us over here) of Canada. This seems to me, as an outside observer, to be the best model for the USA. There is there a strong presumption from the centre of health provision for all residents, but the detail is left to the individual provinces. It struck me at the time of Hillary Clinton's abortive attempt to reform health care that the scale - the whole nation - was too large for the scheme proposed. Devolution to States (a good Liberal proposal!) could well be the way to go.

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