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Entries in Britain (2)

Sunday
Sep092012

Americans don't get healthcare

Britain's "socialised healthcare" system, the NHS, as celebrated recently during the opening ceremony of the Olympic Games

I guess all US elections are life-and-death elections - as there is usually a trigger-happy candidate on the ticket quite ready to bomb an oil-rich middle-eastern country - but, this time, whatever about the luckless citizens of Iran, the lives and deaths of millions of Americans depend on the outcome of the forthcoming US vote. This is simply because one guy (Obama), if he wins the election, has promised to try to extend access to healthcare to the 50 million Americans without it, and the other guy (Romney) has promised to restrict it. 

For most people in most developed countries healthcare works like this: you pay your taxes, the state provides quality healthcare. Methods of delivery vary, but if you get sick you will get treatment, usually for free and if not, for a fee that will not bankrupt you. (Even conservative administrations that oversee such healthcare systems are generally comfortable with this). In America, in most cases you only get access to healthcare if you can afford insurance (which means having a job) and even then, your insurance policy may not cover a plethora of illnesses or 'pre-existing conditions'; this means you can bet your bottom dollar that, should you have the misfortune of actually having to make a claim, a department at your insurance company will comprehensively scour your policy for even the slightest loophole that will get them out of having to cough up any cash for your treatment.

Needless to say, this has led to a crazy situation in the US, where a few people make an awful lot of money selling insurance, while an awful lot of people can't afford its cost and remain needlessly ill or, worse, die. (All the personal bankruptcies caused by medical debt, not to mention the problem of under-insurance add to this craziness too). As countless in-depth studies by the likes of the OECD, WHO or Commonwealth Fund regularly point out, the good folk of the USA spend more per capita on on healthcare than any other nation, whilst having less access to care than any other first world country. The facts are unambigious: America spends billions on healthcare in a way that guarantees that millions of Americans just won't get any.

But there is another sense in which many Americans don't 'get' healthcare: they are convinced that there is something profoundly weird with the government having any involvement with the delivery of it. There's almost a feeling, when you talk to a lot of Americans, that there is something 'unclean' about state provision of care; they invariably trot out a warning about the perils of a 'socialised medicine' that they have never actually experienced. Many of these same Americans are perfectly comfortable with their 'socialised' military, schools, postal service, judicial system, police service and firemen, yet find the notion of a state-funded healthcare system deeply perverted. (Oddly, some Americans seem more content with the state putting people to death than it helping to save lives, something I find perverse, but let's leave that thorny issue for another day).

No doubt a well-funded and sustained campaign by health insurance companies, designed to instill fear of government delivery of healthcare, is probably to blame for state provision of healthcare becoming a dirty phrase in the US - but for whatever reason, this mindset is a massive roadblock to the creation of a healthcare system that delivers care to all Americans. It needs to be confronted vigorously if the US is ever going to arrive at a situation where, as is the case with the vast majority of all the other industrialised nations, healthcare is guaranteed to all, regardless of citizens' ability to pay.

At this point my American cousins are no doubt thinking that I'm just a patronising cheese-eating-surrender-monkey telling them how to run their healthcare show (although really chums, I'm just a singer pointing out what a lot of respected global health research organisations have been saying for years anyway). But, unlike many Americans, I know first-hand what quality, state-provided healthcare has done for me and my family: my son is alive because of it (as are other relatives, including some cancer-sufferers) and my hearing has been saved by it. I know that I do not have to spend thousands of pounds a year on an insurance policy which may not even cover me if I need to make a claim, and I know that if I am sick in future I will receive free treatment from a healthcare organisation which is routinely described by international studies not just as being one of the absolute best in the world, but one of the best value in the world. That being, of course, the evil purveyor of 'socialised medicine' that is Britain's National Health Service (loved so much by the British that it even ended up getting a huge shout-out in the opening ceremony for the London Olympic Games; in the bar I was watching the ceremony in, the biggest cheer of the night was reserved not for Team GB but for an aerial shot of three letters that momentarily dominated the stadium: NHS).

I'm quite convinced that if American citizens actually get to experience the kind of healthcare that we Europeans receive, they will very much like it - and will in future vote against its removal, rather, than may currently be the case, its introduction. Obama's controversial 'Affordable Care Act', whilst by no means perfect, will widen the health safety net considerably for Americans, is a step in the direction of universal coverage, and crucially, is something that can be built upon or improved should he get re-elected. If Romney gets in, any hope of a decent healthcare system being introduced any time soon will die - and, as a consequence, so will many Americans. That's why, arguably more than other recent US elections, this one is a life or death affair for Americans themselves, and, for the sake of my Yankee cousins and friends across the water, I sincerely hope they take my patronising posts about healthcare on the chin and, er, choose life.

More Chris Singleton content

Wednesday
Mar112009

Britain for sale

Living in Britain as something of an outsider (sort of: I'm Irish but of a lot of English descent), I perhaps get more wound up than most by the anti-Johnny-Foreigner attitude that is expressed by the British media.

Now don't get me wrong - there is plenty of antipathy towards foreigners in Ireland - but the levels of hysteria expressed by the British press about immigration and the hatred directed towards all things to do with the European Union are in another league. And you see this hatred expressed by individuals too, with people I know joining Facebook groups such as "I was born in the UK so why the fuck do I have less rights than immigrants" or "This is our country and if you don't like it fuck off". No doubt the constant barrage of foreigner-bashing headlines in the media inspires the negative attitudes and the Facebook group names (and incidentally, I find it interesting that the more right-wing the group, the more the work 'fuck' appears in it).

The impression that the press gives is one of Britain being a perfect country with a perfect identity that is somehow sullied by these bad people from abroad interfering with it. But the problem with this (aside from the obvious) is that the British press also seem to hate their own state, and the idea of their own government 'interfering' either.

As such, most British newspapers have campaigned for decades for the Government to keep out of owning or running British public services - and successfully too. Railways, electricity, gas, airports, airlines, ferries, telecommunications and even water have been taken out public ownership and placed in the hands of wealthy private owners.

The irony of all this, is that the new private owners in question often tend to be...yes, you guessed it, foreigners. The French provide a hell of a lot of UK electricity. A Spanish company runs most of the big airports. American healthcare companies are cherry-picking bits of the NHS. If Mandelson gets his way, we might have a Dutch company delivering mail. God knows who's running the railways (the train operating companies certainly don't).

Remember British Rail? Sealink? British Gas? British Telecom? You, the Brits, used to own and run them. You don't any more. They are all in the hands of various rich people, many of them from abroad. The nationality of these private owners doesn't bother me; what frustrates me is the fact that public services have been placed in the "care" of private owners at all.

When a public service is privatised what typically happens is this: a middle man gets put into the mix (interestingly, something that successful companies always try to avoid). The service often remains bankrolled or underwritten by you and me, the taxpayer, but the middle man (Johnny Foreigner or Paddy Englishman, I don't care) has to make a profit. In order to facilitate this profit, invariably one (or all) of the following things needs to happen:

  • more tax has to be spent on giving our middle man his profit
  • the Government has to reduce the level of access to the public service because it now costs more
  • the middle man has to reduce the cost of the service by cutting corners or staff pay (both detrimental to the quality of the service)
  • the taxpayer, in addition to paying for the service through tax, has to provide a top-up payment to facilitate the profit (that's why UK rail fares are extortionate!)
The counter-argument to the above is that the private sector adds 'rigour' and competition. It's apparently meant to be more efficient than the public sector. Well, private sector 'rigour' and 'efficiency' don't seem all that appealing in the light of the credit crunch - if the private sector can't even get private finance right, how on earth is it meant to cope with public services?

As for competition, it doesn't (and can't) exist for many of the public services that have been privatised. Privatisation hasn't provided me with a range of choices when it comes to things like water, buses or trains. I'm stuck with what's provided - the middle man for my area. (I'm currently using Russian gas and French electricity and I have to get a bus owned by a company that operates transport in Germany and Denmark. Again, not that I mind the nationalities - it's the nature of the ownership that worries me).

Whatever the debate about efficiency, there is still the issue of accountability to think about. "Public service" means just that: serving the public, not making some guy rich. Should a health service be run to make somebody a profit, or should it serve the interests of everybody? Should an environmentally-friendly train journey cost two to three times as much as travelling by car, just so First Great Western can stay in business? Should something as fundamental to life as water be controlled by a company, or should it belong to all of us?

As for rich foreigners, it's hardly surprising that the press has no problem with them owning British public services. After all, they've got a little thing for owning British newspapers too. Isn't that right, Mr Murdoch? Mr Black? Mr Lebedev?

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