Monday, August 17, 2009

The Other National Universal Systems of Care Are Not Our Problem

You can't have an American health care debate without plenty of trashing of single payer systems elsewhere.

I am not a single-payer advocate. I believe it is simplistic to think that if we just had one and eliminated the duplicate expenses multiple payers bring with them everything would be OK.

I think a single-payer solution is simplistic because it misses the different histories that have gone on. When advocates compare what we have to Canada and industrialized Europe they miss a critical point--these single payer systems are 40 to 50 years old. Over these decades, our free market system has evolved to a point very different than the Canadian and European systems. Their systems had much less money poured into them than ours did over this period. The biggest difference is that we now have this huge medical industrial complex that devours great sums of money. Does it often provide excellent, even better care? Yes. But it needs to be fed vast quantities of dollars every day to keep it humming.

Layer a single-payer system over this money monster and I fail to see how politicians are going to stand in its way any more than they are this summer. This, by the way, is not intended to be an endorsement of the free market that has pretty much stood by the side of the road and watched--and profited from it.

Just what place we will ultimately come to that will fix our system is still very much a work in progress--and it will have to be both political and market-based.

My point here is that trashing systems in Canada and Europe is a handy political exercise but it really isnn't helpful. In fact, it just diverts us from the discussion WE need to have about OUR system.

I have lived in Canada and carried an Ontario Health Insurance Plan (OHIP) card (as a documented alien no less.) I had Canadian insurance company executives defend their system over the mess they thought we had.

I have worked with many of the people who lead our European systems. Their challenges look a lot like ours. We had far more in common than was different.

There is an op-ed in today's Washington Post, "In defense of Britain's Health System," penned by a former British Health Minister.

A few points:

Every Briton is registered with his or her own family doctor, whom they can see when they need -- without paying a fee. These doctors are independent contractors to the health service and are recognized and rewarded for quality in their compensation -- so they can focus on what works, not just what pays. Expanding on the facilities that are already in place, by next year every community in England will have a physician's office open from 8 a.m. to 8 p.m. every day of the year, and you can simply walk in and see a doctor, for free, regardless of whether you are registered.

In the unfortunate instance that a patient is diagnosed with a dire disease, such as cancer, it often takes only a week or two for a patient to be seen by all the right specialists, complete all the required diagnostic tests and be ready for surgery or other interventions. This rivals the best care in the United States or anywhere else in the world.

Under our NHS constitution, patients have a legal right to choice of provider. That means any provider -- public, private or not-for-profit. By April 2010 our NHS will be the first health system in the world to systematically measure and openly publish the quality of care achieved by every clinical department in every hospital. It means patients will be able to make meaningful, informed choices on what is best for them and their family. Some of this data is already published.

Many of the mischief-making rumors have focused on our National Institute for Health and Clinical Excellence, the clinically led body, independent of government, that gives advice on the effectiveness of drugs and treatments. Call it fiscal conservatism or old-fashioned common sense, but we think you should pay only for what works. At the same time, it should be remembered that Britain's pharmaceutical industry is second only to the United States in its innovation and the significance of its discoveries. The NHS invents and delivers pioneering treatments, from the first clinical use of MRI in the 1960s to leading developments in robotically enabled scar-free surgery today.

You can read the full op-ed here.

Should we have the British system in the U.S?

No. They have plenty of their own problems not the least of which is the millions of their citizens that have bailed in favor of a private plan. But the vast majority of Brits, Canadians, and all the rest are proud enough of their systems not to want ours.

Let's stop trashing some pretty good systems that work for their people and focus on something that will finally make our people proud.


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