Wednesday, August 19, 2009


I'd really like to stay out of this one. No, I really would.

When I turn on the TV and see my countrymen at Town Hall meetings almost coming to blows over heath care reform; when the news is full of half-truths, misconceptions and misleading statements about health care; and when the pundits all line up to have a pop at anything that smacks (in their view) of socialism – then I know we're in trouble and I'd dearly love to duck the issues!

How about some facts?

These web pages sum up the Obama healthcare plan. Is it perfect? No. Is it better than what we have already? Yes. Is it a British National Health Service in disguise? Absolutely not.

So, what is the British NHS and how does it work?

First of all it is not exactly what it was designed to be. The origin of the NHS was steeped in ideological tea and poured from a socialistic pot onto the public purse. It has never been either all-inclusive or all-encompassing. Americans might be flummoxed to learn that despite its name the NHS is not really national at all. Scotland and Wales have quite a different NHS than England and Northern Ireland.

They might be puzzled by the fact that there is a substantial, thriving private healthcare system running alongside the NHS. The might be amazed that it isn't really free at all – even disregarding the National Insurance contributions workers and employers pay to fund the system, large parts of the NHS are not free. Except for children, old people and a few others, prescriptions are paid for by the consumer. NHS dental treatment is very patchy. Most people pay for their dental treatment. Visitors from countries who do not have agreements with GB pay for their treatment. Many people have private health insurance which they or their employers fund as part of their pay structure. Many doctors who work for the NHS also have private patients at the same time.

Second, the “national” part is misleading. Folks in England think of the NHS as a local service. We have our local GP's We have four hospitals, James Paget in Yarmouth, Queen Elizabeth in King's Lynn and the Norfolk and Norwich (which includes Cromer Hospital) in Norwich. Serious cases are transferred to specialist hospitals like Addenbrook's (heart) in Cambridge or Great Ormond Street (children) in London. Key point: thereby services are not duplicated! Must be cheaper! So, despite the name, the NHS is for most people a local service.

Thirdly, the NHS is one of the few universally unifying structures in the UK. For 60 years no government or opposition has ever questioned the need for or the underlying rationale behind the NHS. To many people in the UK the NHS is the government. To borrow freely from the Constitution it is the one thing in Britain designed “to promote the general welfare, and secure the blessings of liberty to ourselves and our posterity”. Therefore it enjoys almost universal support. And, even though it is a national service people think of it as local. So, they speak about their GP and their hospitals.

What about the present US health care?

The WHO rates US heath care as 37th in the world – UK comes in at 18. How can this be? Surely as the richest nation on earth the US should enjoy the best healthcare. Maybe it's the money?


Per capita spending: U.S. about £4000 per person UK about £1700
As % of GDP – U.S. about 16% - UK about 9%.

Number of nurses and doctors as a % of the populations?
Nope - Just about the same.

So, despite spending far more money both in real terms and as a percentage of national income, the US lags behind in providing healthcare for its citizens. How can this be?

This is the real question that the numpties who we see on TV screaming nonsense about healthcare are not dealing with. Any reasonable debate must focus on this issue. It is a national disgrace. Where does all the money go? I suspect it goes in the pockets of the doctors and the health insurance lobby – not to mention the drug companies.

The real tragedy is that we have been here before. With the Great Depression in full swing the incumbent President, Herbert Hoover, struggled manfully to attempt to get the economy moving again. Hoover made his name as a crusading humanitarian in WW I – providing relief for starving Belgians. Problem was he was ideologically opposed to the kind of government intervention that was needed and eventually was provided by Roosevelt's New Deal. He just could not come to terms with the kind of government intervention which eventually brought an end to the Great Depression.

In modern times when we see both the US and UK governments spending billions to kick start the economy and bail out the very crooks (sorry bankers) who got us into this mess, it is well to remember that the kind of government intervention/regulation which Roosevelt proposed in the New Deal was violently opposed as Un-American, Communistic and down right criminal by the forefathers of the present idiots who are so upset at the thought of decent health care for all citizens – not just those with money.

This argument will rumble on. Nothing affects people's lives so directly as health care. People who have legitimate concerns about the Obama plan need to have them answered and addressed. People who are just ideologically an philosophically opposed to any form of government health care need to listen the the arguments and stop shouting. You don't win any argument just because you can shout the loudest.
President Obama needs to make his plans clearer. Hesitation is just seen as weakness. This may be the only chance to reform US health care in a generation. It must not fail.

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