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Entries in Commonwealth Fund (1)

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.

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