President Obama should look to Europe, not the NHS

Civitas, 17 August 2009

Claims by both sides of the fiery debate on US health system reform are clouded in ideology and misrepresentation. Democrats are demanding free health care for all as quickly as possible, providing only vague solutions for addressing the inevitably enormous costs of such a system change, while republicans are crying that reform will spark transformation of the country into a bastion of socialism. This past week, republicans have jumped back to their earlier attack on the reforms, highlighting the failings of government-run systems like the NHS.

As an American who has been impressed with her (thankfully limited) NHS care experiences, I find this attack saddening, but also quite silly. There are plenty of people who have received world-class treatment from the NHS and its staff and, as this recent Twitter campaign shows, are very grateful for it. More importantly, the structures of the two health systems are simply not comparable. Even if the democrats’ currently proposed reforms were to pass today, US healthcare would look nothing like the NHS. The NHS is fully funded by taxation, which is collected centrally and then allocated to individual regions using population and need-based formulas. The US reforms, by contrast, intend to enable as many people as possible to be covered by health insurance. Some of this insurance would be tax-funded, as are current Medicare and Medicaid programmes (possibly including an additional government-provided insurance option), but much of it would be paid for by large organisations, who would be required to purchase group plans on behalf of their employees. Much of it would be paid for by individuals themselves; another reform aim is to simply lower the prices of insurance plans so that most families can afford them.

The ‘communism’ scare tactics are a cheap shot and take advantage of the fact that most people outside of the health policy field are not aware of the workings of other international health systems. If the democrats want to fight back on this issue, they would be wise to present examples of other public/private systems similar to what the US might aim to resemble after reform, such as those in Switzerland and the Netherlands.

There is increasing recognition that we need health systems that are competitive, responsive and consumer-driven, with clear metrics of value (costs and health outcomes). The challenge for the US is to embrace these objectives within a universal care framework. The NHS does not provide such a model.

James Gubb explains further in a Civitas press release and recent media coverage.