(part one of two about the healthcare debate)
Opponents of government participation in healthcare love to point out horror stories from the British NHS, and why not- it's an easy target; the stories are easy to find. In just this morning's Telegraph there were two such: Almost 4,000 women 'forced to give birth outside maternity wards' , and Man's appendix ruptures a month after it was 'removed' in hospital . But those who do so do not understand the situation, according to Lawrence Lindsey, writing in the TimesOnline. His article, America’s lesson for the NHS We in Britain think US healthcare favours those who can pay for it, but that’s a serious misdiagnosis of a smart system , is a must-read for everyone on any side of the healthcare debate.
"The political class in the United Kingdom has taken a good deal of umbrage at the unkind comments about the National Health Service made in the context of the American healthcare debate. Please accept my apologies on behalf of my countrymen, who are looking at the NHS through the prism of the American experience and without the historical context of British health before the NHS.
That said, there is also a tremendous amount of misinformation in Britain about the American healthcare system. The fact is, both America and Britain are going to have to change the way they provide healthcare but through evolution, not sudden or drastic reform."
Some of the myths about American healthcare he explains to his British readers needs to be read on this side of the pond, too; I've heard and read them here. "Moreover, being uninsured does not close the door to receiving healthcare... Some of the uninsured simply pay out of pocket. But, if you are uninsured and indigent, you show up at the emergency room. It is illegal to refuse treatment in all 50 states. This creates an enormous crosssubsidy issue as hospitals and other medical service providers must push this unreimbursed cost onto their insured customers."
He also speaks of something at the core of the issue that I've tried to raise discussion about without success: it doesn't matter who's paying if you don't control the ever increasing costs. "Healthcare spending in America is growing between two and four percentage points faster than GDP. Washington views this as a long-term political challenge. As an economist, I view it as a long-term mathematical impossibility. One cannot have a component of GDP growing faster than GDP indefinitely."
I can't even begin to get into the even more important things he says without quoting the entire article; like many big issues, every facet is interlocked with every other. Just do yourself a favor and go read it right now.
6 comments:
It's illegal to refuse treatment at the ER, but that doesn't mean the hospital won't try to pursue you for years to pay the bill if you do show up there. I briefly interned at Legal Aid's Health Law Unit, and a substantial part of what we did was not so much law as negotiation: talking health care providers into forgiving medical debt. God help you if they've repackaged the debt and sold it for pennies on the dollar to a professional collection agency.
This actually leads to the more responsible people -- those who have jobs where wages can be garnished, or for whom credit scores matter, or who even have a phone number for the bill collectors to harass them at -- avoiding the ER except when it really is the direst emergency.
Also, about the births outside the maternity ward -- half of them were "unplanned" home deliveries, which makes it sound like Brits are not very good at hauling off to the hospital as soon as the water breaks. And there doesn't seem to be any connection between having your baby at home or even in the ambulance and having the birth be unsuccessful (in the sense of its resulting in a dead baby or mother).
Infant mortality in the UK = 4.85/1000 live births (according to the CIA World Book). Infant mortality in the U.S. = 6.25/1000 live births. Stats from WHO: both the US and UK have 99% of births attended by skilled health personnel. Births by C-section: 23% in US, 17% in UK. Maternal mortality: 14/100k in US; 11/100k in UK. As someone who might actually be giving birth in the UK someday (my husband would like to move back), I have to say it's mostly looking better for the folks who have 3500 women a year giving birth outside the correct part of the maternity ward.
Concerning C-Section rates, doesn't the higher rate in the US argue that some of them are done just for CYA, to avoid possible lawsuits? The other argument might be that British doctors take more risks, because of the cost factor, in which case you might be safer having the child here. Although strictly from a biology standpoint, one might argue that both rates are higher than strictly necessary- after all, any animal that reproduces as slowly as we do, and has a 23% bad outcome, would be extinct by now.
As to being hounded for payment, I know that well. Both of my elder brother's children were born with cleft palates, and he had to declare bankruptcy both times. But both children received the operations and therapy they needed, despite his inability to pay, which was the author's point.
As to the mortality rates, I can't comment without knowing more about the studies. I remember back in the 80's, when I worked for the Health Dept., I learned a lesson about stats like that. A big issue in the Mayor's race at the time was a terribly high infant mortality rate in certain neighborhoods, with the accusation being made of discrimination in medical care. I asked a coworker in the statistics dept. about it, and he said that he didn't know about any possible discrimination, but that he knew the lack of prenatal medical care was not the cause, because that infant mortality rate was actually higher than it was in 1819 when we became a state- and nobody back then had prenatal care, or even the guarantee of clean water, for that matter. When I asked him what the explanation was, then, he said, "Not being a doctor, I'm not competent to speculate that a 13 year old drug addict who lives on junk food isn't going to have a healthy baby."
Concerning C-Section rates, doesn't the higher rate in the US argue that some of them are done just for CYA, to avoid possible lawsuits?
Not necessarily. When people have the mindset that health care is a consumer good, they expect doctors to give them what they want, regardless of medical need. C-sections aren't inherently safer for women who haven't had them before; there's the risks created by anesthesia and surgery. The CYA pretty much only comes in when a woman who already had a C-section comes in with her next delivery. There's a slight chance that a natural delivery could cause the prior cut to re-open, so some ob-gyns will insist on C-sectioning the next kid too.
that infant mortality rate was actually higher than it was in 1819 when we became a state
Other possible causes: Miscarriages were more common back then, so fetuses that would have difficulties as newborns were more likely to die in the womb.
The overwhelming majority of births were at home (1819 was pre-Lister; you were pretty much asking for an infection courtesy of the last patient if you let a doctor attend you), so I'd be skeptical that the state could document newborn deaths very well. Who was keeping track back then? Maybe churches, but they'd almost certainly capture only the babies that lived long enough for baptism.
Also, I find your anecdote inapposite. I am talking about statistics for entire countries, not particular neighborhoods that stand out in a particular city. Unless you think the U.S. has significantly higher levels of irresponsible drug-addicted births than the UK (and looking at the UK today, I just find that unlikely -- they aren't like what you see on Masterpiece Theater), the difference in access to care is likely to have an impact on those mortality rates.
I didn't mean that anecdote to be *the* cause of the difference in statistics; I only used it to show how i learnd raw numbers may not mean what they appear to mean. Some other factors that may be involved are things like defintion of "infant"- some countries call it successful if the baby leaves the hospital; some extend it out for two or more years. You see the same kind of thing in average lifespan numbers- the US having a shorter lifespan than many G20 nations is frequently used to show how horrible our healthcare is... but nobody ever mentions that those countries have only a fraction of our murder, automobile accident, and overdose rates. And while those things are in fact horrible, I don't think any of the healthcare reform bills address the epidemic of 9mm lead poisoning.
As to who was keeping the statistics, the city was- they predate statehood. Back then, statistics was almost the only thing health departments did; the link between cholera and sewage was discovered by statisticians, not doctors. (remembering a lecture from the proud statisticians in the health dept)
Some other factors that may be involved are things like defintion of "infant"- some countries call it successful if the baby leaves the hospital; some extend it out for two or more years.
WHO seems pretty clearly to distinguish based on age: they break out Neonatal (0-27 days); two Post-Neonatal categories (28 days-5 months, 6-11 months); and two small Child categories (12-23 months, 24-59 months). They aren't going by each country's definition of an term like "infant."
"the US having a shorter lifespan than many G20 nations is frequently used to show how horrible our healthcare is... but nobody ever mentions that those countries have only a fraction of our murder, automobile accident, and overdose rates."
Are our greater rates of death by murder and automobile accident (keeping in mind, of course, that prompt access to health care has kept many people alive who otherwise would have died of intentional assault or auto accident) enough to account for the difference in lifespan? Using overdose/ suicide rates as an excuse doesn't seem very positive for our health care system, given that substance abuse and mental illness are supposed to be things that a medical system can ameliorate. Untreated clinical depression that leads someone to self-medicate with drugs or alcohol, and/or to commit suicide, doesn't reflect well on a health care system.
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