Sunday, August 23, 2009

Explaining the US healthcare system

and not defending it, is Lawrence Lindsay in the Sunday Times.

He was a former advisor to George W. Bush, so many on the left will shut their eyes anyway. However, he makes many valuable points about the US system. Does it ration by price? No...

"Medicare is an entitlement. This means it isn’t subject to an appropriation by Congress — the spending is automatic and unconstrained. Whatever bills Medicare’s beneficiaries run up, the government will pay without so much as a by-your-leave by Congress."

"So the real issue in America is not that we ration by price — by and large we do not. Our bigger long-term problem is that we effectively do not ration at all"

what do you get?

"First, there is much less queueing. Any insured American can get an appointment with his or her physician at a mutually agreed time with almost no waiting.
Americans have much better cancer survival rates. A study of cancer survival rates in 31 countries published last year in The Lancet bears this out. America was consistently in the top three for both men and women in the four different kinds of cancer studied. Britain tended to rank about 20th. First, Americans are more likely to get tested, thanks to the lack of rationing, and therefore the cancers are likely to be diagnosed sooner. This naturally makes them more curable. Second, unrationed American healthcare throws a ton of money at cancer, relative to Britain.
The third main service obtained from the higher cost of the American system is “extra spending at the end of life
”.

He doesn't say this is all necessarily good, but it is what Americans might lose from an NHS based system, which rations more by regulation.

Have a read, it is one of the most balanced articles I have seen yet about the two systems. It should destroy the myth that the US system is about the free market, but also explains some of the reasons why it is more expensive as a proportion of GDP compared to the NHS.

Sadly, the debate on health care in both countries has been driven by largescale support of systems that are both fundamentally flawed.

1 comment:

Lindsay said...

I think the article also appeared in the DomPost last week.

As well as Medicare (for the elderly) there is also Medicaid which is mean-tested healthcare for low income people.

One of the reasons the US spends so much is that they are the innovators and the rest of the world bludges off them.