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On the ropes?

Is the US throwing wild punches at the NHS or is its attack indicative of a weak defence?

An illustration of two boxers named 'NHS' and 'USA' fightingI'm not quite sure what I feel about America. On visits to the US I am always struck by the stark contrast; huge wealth (still) and dirt-poor (still). Take Washington, for example. In this city the urbane elegance 'on-the-hill' is very different from 'down-town'. Then if you travel south you get the feeling you are in another country completely, what with its subsistence living.

So, it was with some optimism that I watched President Obama elected and make his first moves towards providing universal healthcare for all Americans. A great man (and I can't remember which one) once said: "Good health provision is a mark of a civilised society."

Judged by healthcare provision, the US is far from civilised.

The treatment model assessed
Fox TV recently invited me to defend the NHS in a news segment on Obama's proposed reforms. In my recorded contribution to their programme, I confessed that the NHS was a nationalised industry and, as such, was likely to be less efficient than a privately run company. I said that we swap a level of efficiency for universality and that rich or poor, old or young, by and large, you get the care you need. No one asks for your visa card or your birth certificate.

Well, Fox is a right-wing broadcaster and they editorialise their content accordingly. Fair enough. I didn't see the programme, but I was gleefully told by American friends that I was roundly denounced as a communist!

There were also reports in the US about a dental patient in Liverpool, who supposedly had to superglue a loose crown because of the appallingly low standard of dentistry in Britain. And apparently, anyone over the age of 59 in Britain is ineligible for treatment for heart disease. One lunatic, leading Republican even told the nation that the 77-year-old Senator Edward Kennedy would have been refused treatment for his brain tumour in the UK on account of his relatively advanced age.

It seems that presidential hopeful Sarah Palin (for whom, I confess, I once had high hopes) denounced the NHS as evil.

I would quite like to introduce the American public – which seems to be collectively saying, 'don't confuse me with the facts' – to my 89-year-old mother and 95-year-old uncle, both of whom have had health problems and have been swamped with care, kindness, expertise and medicines.

US citizens might also like to collectively read Journal of Health Care for the Poor and Underserved - Dancing with Broken Bones: Portraits of Death and Dying among Inner-city Poor (Project MUSE Journals Journal of Health Care for the Poor and Underserved Volume 20, Number 2, May 2009) by David Wendell Moller, director of human values in medicine at Saint Luke's Hospital, Kansas City. This publication gives a shocking evaluation of healthcare for people with terminal conditions living in poverty in the United States and the existing disease treatment model that dominates end of life care. Wendell received his MA for this seminal work.

Unenviable system
I admit that I am more than a little angry with the US' drift into selfishness and ignorance. The fact is Obama's plans fall well short of the sort of state-run NHS we enjoy here. All he is trying to do is ensure that the 40 or 50 million Americans – many of them black or Latino – who do not have health insurance are able to receive the same standard of care as the majority who do. If soppy Mrs Palin really thinks that is 'evil', she is not fit for public office.

Writing about this topic in the Daily Mail (August 13), Steven Glover recited a personal anecdote in support of superior US healthcare for the middle-classes. I quote directly from his article:

"Once, in America and suffering from bad earache, I visited a local doctor. In this country I would probably have been greeted with a weary smile and, if lucky, offered an aspirin.

"In the United States I was cosseted by a pretty nurse and subjected to several exhaustive tests by an accommodating doctor, one of which involved me sitting in a sound-proof booth to have my hearing tested. At the end of it all I was presented with a bill for several hundred dollars and the verdict that I had nothing to worry about."

Unwittingly Glover has exposed the deficiencies of US healthcare and the reason why the American medical establishment does not want the state involved in their lucrative business.

Having travelled to the US, presumably on a plane, Glover might have had a touch of earache, which is not uncommon for travellers after a transatlantic flight. He, most likely, did only need an aspirin. However, the US lug-hole doctor has a business to run, a boat to buy supplies for, a four-by-four to buy fuel for and a mistress who wants a fur coat. Of course he would charge a fortune and yes, the National Institute of Health and Clinical Excellence (NICE) would, probably, moderate his excesses if he were here.

Having said all that, there is something we should know. By a small margin, the data seems to suggest that the US system delivers better outcomes than the NHS when dealing with serious illnesses. These numbers come with their own health warning as numbers are not always compiled in the same way, country-to-country.

Last year Lancet Oncology reported that 91.9 per cent of American men with prostate cancer were still alive after five years, compared with only 51.1 per cent in Britain. They also seem to suggest that 90.1 per cent of women in the US diagnosed with breast cancer between 2000 and 2002 survived for at least five years, against 77.8 per cent in Britain. There are some data that suggest survival from heart attack might be better in the US.

It is probably right for us to stop pretending that the NHS is the envy of the world. No American with health insurance would wait four hours in A&E, neither would they wait 18 weeks for treatment. The important part of the sentence, however, is 'with insurance'.

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster.
To comment on this article, email pm@pmlive.com

21st September 2009

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