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Aug 142009
 

I am taking the unusual step of explicitly reserving the right to update this post – in case someone comments and I update the post to reflect their comments

According to the news, the health care debate in the US brought about by Obama’s attempt to reform the health care system is hot and furious. In particular the UK’s NHS is being targeted as an example of how horrendous socialist health care can be – including one ridiculous comment that Stephen Hawking would be dead if he had been British (he is British, and most of his health care is provided by the NHS).

The big concern about the NHS is the length of time it takes to wait for treatment because of health care “rationing”. It is implied that UK health care is rationed whereas US health care is not – nothing could be further from the truth! At a simplistic level, UK health care is rationed by need, and US health care is rationed by ability to pay.

Looking a little deeper, US rationing is mostly controlled by the insurance companies. Now sometimes (perhaps even the majority of times) this is done with the patient’s best interest in mind. But sometimes less scrupulous insurance companies will restrict access to more expensive treatments; particularly those who have pre-existing chronic conditions such as diabetes, or MS.

Looking around I can see there is particular concern with something called “co-pay” where the insurance company pays 80% of the cost of treatment, and the patient pays 20% (undoubtedly this varies between different providers). Sounds like a not unreasonable way from preventing people signing up for unnecessary treatments? Well perhaps, but 20% of many medical procedures is a lot of money and many people will find it difficult or impossible to fund a sudden large bill that might occur because of a medical emergency.

Apparently there are ways to get assistance with paying the 20%, but that involves scrabbling around looking for people to help. This is probably not the sort of thing that is helpful in a medical emergency!

The NHS provides treatment free at the point of delivery with the exception of Dentistry. Prescriptions are also subject to a flat £7 fee in England, although they are free in Scotland and Wales. In other words, you will not suddenly find yourself paying a huge bill.

The real truth is that most people who need it can get treated whether they are in the US or the UK. Although if you are poor and in the US, your access is likely to be not quite so easy. Are there millions of people in the US who have no access to medical care ? Probably not, but there are enough indications out there that a significant number of the US poor find access to medical care difficult. If you read this article it would seem that the uninsured get medical treatment in circumstances that look suspiciously like a field hospital in a third world country!

As for waiting times, it is easy to pick particularly bad examples of NHS waiting times and wave them around as examples of how bad socialist medicine is. Now the NHS did used to have a problem with waiting times and some people did die as a result of not getting the treatment that they needed. This was indeed a scandal, and was a direct result of a long period of chronic underfunding by the Conservative governments (1979-1997).  The situation now is much improved and people do not have to wait so long for treatments.

In fact the NHS this year reached their target of having no patients wait more than 18 weeks (or more explicitly 18 weeks from referral to when treatments start). This is a bit on the high side, but the average wait for ‘inpatients’ is 8.6 weeks and 4.6 weeks for ‘outpatients’. Still too long, but this is far cry from claims of 18 month waits. And these statistics conceal something – for urgent treatment a certain amount of queue jumping goes on including going to non-local hospitals for treatment. The full details can be found here. Reducing waiting times would be a simple matter of increasing the amount of money invested in the NHS – and we pay a lot less than people in the US do – more on that later.

As a little personal example, my grandmother recently had to wait several weeks to be moved from a hospital to a rehabilitation clinic (for physiotherapy), but my Aunt (with cancer) was seen the same week by a specialist after her initial diagnosis.

Another story going around is that the treatment in the UK is very much worse than that in the US. One of the areas that people target is the cancer survival rates. Indeed the UK’s record of treating cancer is not ideal, but this is just one area. And sometimes simple comparisons can be deceptive. A little story from the US media about prostate cancer – the US has a much better rate of long term survival rate than the UK, but prostate specialists point out that the US does more testing for prostate cancer than anyone else.

That would be good except that once prostate cancer is found in the US, it gets treated despite the fact that many prostate cancers are slow and unlikely to cause death in many patients. The US system inflicts painful and uncomfortable treatment on patients who do not need it, and as a result they boost their long-term survival rates (see here). This illustrates the dangers of doing a naive comparison of health care statistics … which is what I’m just about to do!

In fact if you look at a more widespread selection of conditions, the UK does not look quite as bad. Unfortunately the WHO statistics available are a little dated, but can be used to do a naive comparison.

Lets have a look at the mortality rates for all cancers – in 2002, the US had 134 deaths per 100,000 and the UK had 143. It is quite possible that the US rate has improved since then, but if so the UK is likely to have improved more – the NHS was asked to concentrate in this area because of the UK’s poor record here. Still even with the 2002 figures, the UK isn’t that much worse!

Now lets have a look at mortality rates for cardiovascular diseases – in 2002, the US had 188 deaths per 100,000, and the UK had 182. What’s this ? A country with a socialist health care system does better than the US? Obviously I am excluding lifestyle differences, but even so this does not look like the UK has a chronically bad health care system.

And now let’s have a look at mortality rates from injuries – in 2002, the US had 47 deaths per 100,000, and the UK had 26. That’s quite a big difference! The rates for deaths from non-communicable diseases were 460 (for the US) and 434 (for the UK). Again we have the UK apparently doing better.

If we look at more recent figures (2006) for rates of infant mortality, we see the US had 7 per 100,000 and the UK 5. Again the UK looks better!

I would rather like to include some more finely tuned statistics here such as more recent figures for how many people with a set of conditions are successfully treated, and will indeed update this post if I find some.

Because of the lack of recent figures I am not going to say the UK health care system is better at keeping people alive than the US system … or visa-versa. But it should be clear that the UK system is not dramatically worse (or better) than the US system at actually treating people.

What does become obvious when looking at health care statistics, is just how much more the US spends on health care than the UK. The UK spends about 8.4% of GDP on health care and the US spends 16%. That is dramatically more. For that much more, you wonder why the US health care system is not dramatically better than the UK health care system, because it should be! Let’s have a look at some more statistics (sorry, but facts are needed when comparing two systems) … a table from the UK newpaper The Guardian (specifically their “Datablog”) :-

Country

United States

$ per person

6719

Doctors

(per 10,000)

26

Nurses

and Midwives

94

Hospital

Beds

31

Life

Expectancy

78

United Kingdom 2815 23 128 39 80

With only one exception (the number of doctors), the US does worse than the UK in terms of number of health care personnel. Of course this by itself does not show anything about the quality of what is provided (although we covered that earlier). The question seems to be what does the US get for all that money they spend on health care ? Looking at the full table in the relevant Guardian article, we see that the US spend far and away the highest per capita cost on health care than any other country in the table.

For the amount that the US spends, it should have a health care system by far and away better than any other developed nation. It doesn’t. It certainly does better in some areas (cancer) than the UK, but it does not do better in all areas. Is the UK health care system as good as that in the US ? Well I don’t have accurate enough figures to say so, but I think I do have the figures to say that it is not immensely worse to the level that US right-wing politicians with an axe to grind are portraying. I have no wish to try and tell Americans what kind of health care they should have, but they should be aware of the facts when considering health care reform.

One thing to be wary of are anecdotal stories of how bad the UK health system is. Undoubtedly many (if not most) are true, but are frequently very dated. And don’t you think that we could come up with very many similar stories about the problems with the US health care system ? I’m sure there’s a number of stories from people who “fall between the cracks” in the US, and essentially get little or no health care.

On the subject of anecdotal stories, apparently there are short videos circulating in the US (adverts?) detailing NHS horror stories. Interestingly enough those same people have been interviewed recently in the British media to indicate that they are disgusted that their stories are being used in this way, and that they fully support the NHS – they just want more money for the NHS!

I very much doubt that Obama is planning on setting up anything that would come anywhere near the socialism of the NHS. The right-whingers (spelling mistake intentional) over there are spreading disinformation – not only in how bad the NHS is, but in what Obama is planning. Please just find out the facts for yourself and don’t count on so-called “facts” provided by people who have a vested interest in the status quo.

The lies about health care by the NHS are grossly offensive to people in the UK. However if I were a US citizen I would also be grossly offended by the spread of disinformation being spread in this campaign. For more information about the lies and how false they are, there are a number of links to further information :-

And as for the UK people, well we moan about the NHS amongst ourselves but as has been shown in the last week we certainly defend the NHS when it comes to outside attack. One way of judging the success of the NHS is that no sane political party would attempt to dismantle it – if they managed it, they would probably never be elected again. If you watch US media, you will probably be familiar with a certain Conservative politician (Daniel Hannan) who does attack the NHS. He belongs (at present – his future is quite possibly in doubt) to the lunatic fringe of the Conservative party and the party leaders have dismissed his views.

Whilst most people in the UK would greatly like to see the NHS improved by the investment of more money, there is no way that they would trade the system they have for the system in the US.

  • m meredith the elder

    Cost of treatment can be misleading as the mindset in private medicine is to pile on the costly investigations as there is no profit in common sense. JDM was investigated with a barium meal and radioactive xrays when he needed a simple antibiotic course for child’s urinary infection. Pragmatic UK GP would have tried the antibiotic first.

    Money doesn’t provide caring nursing either. Remember the treatment MSM received when having surgery in the US??

  • Pingback: More "Quality" Health Care by the NHS - Page 3 - U.S. Politics Online: A Political Discussion Forum()

  • chrissy

    Quality of care in the USA ??? It is apalling compared to the UK . I have experienced both . There is no evidence based practice here . You are just starting to take note of research that Britain took notice of 10 years ago .
    Waiting to see the family doctor ?? I waited almost 2 weeks to see a doctor here in the US – most I waited in UK was 4 days . Uk has out of hours GP centers so I don’t need to lose time from work to see a doctor .
    Waiting to see a specialist ?? I was referred to a neurologist 6 months ago here in thye USA . Waited 6 months for an appointment only to have it cancelled twice and I am still waiting !! I telephoned my normal neurosurgeon in the UK Friday and had an appointment Monday ! Yes I had to pay a small fee of $200 but many people do that .
    I have seen kids thrown off parents health care insurance plans because they developed a chronic disease ( not cost effective to treat these folks ) I have seen cancer patients refused a 3rd round of treatment on a cost basis and have to rely on charity to pay for vital treatment.Plus if you look at bankruptcy rates in the USA a huge proportion is due to health issues Even if you have insurance co pays are exhorbitant
    As for less doctors per capita that is because we have many more nurses / midwives who are the primary carers in many areas – espescially the midwifery care
    We have a much lower rate of infant death in the Uk a slightly higher age at death and very similar success rates for cancer survival at less than half the cost !

  • Just to correct an apparent misconception – I’m UK-based!

    And as an earlier comment implies, I’ve also experienced health-care in both the UK and the US, but I mistrust anecdotal evidence.

    As to cost – yes, either the UK should be a lot worse than it is, or the US should be a lot better given the variation in the money paid.

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