‘ObamaCare’ formally launches in the US – are there lessons for the UK?
Elliot Bidgood, 8 October 2013
Last week, even as the US federal government shut down and ‘non-essential’ personnel – including half the Department of Health and Human Services – were furloughed, crucial parts of the Patient Protection and Affordable Care Act 2010 (PPACA, or ‘ObamaCare’) reforms went into law. These were the bill’s public insurance exchanges – essentially a set of government-run comparison websites – which will at last enable some of the 15% of Americans unable to obtain health insurance in America’s haphazard open market to choose from a number of regulated private plans.
In order to ensure that the sick and the young and healthy alike sign up – known as ‘risk-pooling’ and vital for controlling costs – Americans without existing cover who fail to buy taxpayer-subsidised insurance from exchanges will be fined. This ‘individual mandate’ has in particular enraged right-wing Republicans and is a focus in the irresponsible shutdown, but this carrot-stick approach should increase coverage to around 94%, bringing America incrementally closer to the universal healthcare Britain and the industrialised world rightfully prize.
Incidentally, one of the firms new insurees may go to is UnitedHealth, whose current VP is Simon Stevens, a British former advisor to Tony Blair and Alan Milburn and co-author of the ambitious NHS Plan 2000. Last week, it was speculated that Stevens, whom Health Service Journal editor Alastair McLellan has described as “the cleverest health policy thinker I’ve ever met”, remains the top choice for NHS England Chief Executive should he ever return. Between the measurable improvements Stevens inspired in our NHS in the 2000s and his experience in the flawed but often-innovative US health sector, his name is certainly worth consideration.
As well as the insights Stevens could bring and the lessons we might learn from US hospitals I wrote about recently, America’s new regulated-competition mandatory insurance system will also be important to watch as implementation deepens, especially as it’s somewhat inspired by some models Civitas has profiled such as the Netherlands (acknowledged last week by HSJ as an example for the UK), Switzerland, perhaps Germany and America’s own Federal Employee Health Benefits Programme (FEHBP). Also interesting was the Democrats’ decision to earmark $2 billion worth of loans under PPACA for new non-profit health insurance cooperatives. There, it is hoped these cooperatives will challenge the monopolistic power of for-profit American insurance firms. However introducing cooperatives to the purchasing side of our own NHS could serve a different-yet-similar purpose here – cooperative-run commissioning non-profits could perhaps counterbalance the sometimes distant and centralised public administration of our own health service, as Anton Howes recently laid out in his paper for Civitas, ‘A National Health Service for Patients’.
Overall, while America’s health system is rightly maligned for its lack of coherency, equity, solidarity or cost-restraint, Obama’s reforms stand a decent chance of starting to change some of this. What’s more, they may well hold some lessons for us along the way.
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