Will Obamacare be a good thing for most people? President Barack Obama should learn the lessons about governments controlling health care from the recent failures in the NHS
By Janet Daley
After the sordid mud-wrestling session in the Commons last week (official title: statement on the Keogh report by the Health Secretary), could anyone still believe that politicians are the right people to be in charge of healthcare? As Jeremy Hunt and Andy Burnham traded accusations and self-serving denials of blame for the thousands of unnecessary (remember that word) deaths in 14 NHS hospitals, they almost clean forgot to offer expressions of remorse, regret or sympathy to the victims and their families.
For what it’s worth, Mr Burnham was rather worse than Mr Hunt, but that is by-the-by. This was about as low as party politics gets. Egged on by their screaming supporters behind them, the front bench spokesmen presented us with a very nearly perfect case for removing the care of the sick from government manipulation altogether.
An edited video of that squalid parliamentary occasion should be made available to every member of the Obama administration and every Democratic congressman who is desperate for the US federal government to take charge of healthcare. Lesson: this is what happens when political parties are directly responsible for the dispensation of medical treatment. If you have power over a system, then you are held responsible when it fails. If medical and administrative personnel know that they are accountable to government, they are liable to put the demands of politicians over the concerns of patients – even if they know those demands to be mistaken or absurd. Not that the White House plan (inevitably known – in spite of the President’s people insisting that it is the Affordable Care Act – as Obamacare) is as remotely monolithic as our own government-owned, government-run, government-funded system. That would be anathema to the political culture of the United States.
In fact, our two countries have precisely opposite phobias: in Britain, anything that is private (or worse, privatised) must be assumed to exist solely to produce Profit, which is axiomatically regarded as wicked. In the US, anything that is run by central government is seen as inherently threatening to personal liberty. So Obamacare had to square an impossible circle, and ended up with something like the worst of all worlds. In order to guarantee medical care for everyone in the country while avoiding universal government provision – which would be socialist in the true sense of the word – the plan makes it a legal requirement for everyone to buy private health insurance.
The original rule was that all companies with more than 50 employees would be required by law to provide them with health cover but that has gone out the window (sorry, been delayed) because the business community objected.
Unfortunately, the poor individual, not having quite the same clout in Washington as big companies, is still stuck. He will have to pay for a health insurance policy – whether he wants it, or thinks he needs it, or not – or be fined.
Now that would be a very strange sort of law in any free society, let alone one that is positively paranoid about personal liberty. Should a democratic government be able to make it legally necessary for you to buy a product you do not want to cover the cost of your potential needs? It is true that in most countries you are legally obliged to have certain kinds of third party cover – on car insurance, for example – but that is to provide for the protection of other members of society, not yourself. What the Obamacare law is designed to do is pull the young and fit compulsorily into the health insurance net so that, in actuarial terms, risks are spread more widely and the cost of premiums comes down. It is a matter of hot debate at the moment in Washington as to whether this will actually be the result. In the meantime, there is huge popular resistance to the compulsion involved and to the overweening political interference in what most Americans see as the highly personal relationship between doctor and patient.
But America’s stumbling healthcare programme is not alone in creating bizarre anomalies. The absolute terror in which politicians of all parties in Britain confront the impossible dilemma of funding the NHS has led us into a positive Wonderland of self-contradiction and absurdity. The Nuffield Trust estimates that there will be roughly a £50 billion deficit between funding and demand for healthcare by the end of the next parliament.
Every sane politician knows that the present arrangements are unsustainable: even if we managed to reform the standards of hospital care to prevent patients dying of starvation and thirst, there is no way that a fit-for-the-21st-century comprehensive medical system can be afforded solely out of taxation. But say this to a Tory minister (or one of his team) and he will start shrieking about electoral doom. As one very sensible Conservative said to me recently: “You can’t start charging for things that people now get for free. We’d lose the next election.”
Well no, that is not the way to introduce a mixed economy in healthcare: you don’t “start charging for things” willy-nilly. You just start allowing people to pay for things above and beyond their NHS care without penalising them. Which, of course, is what they do already every time they go to the chemist and buy aspirin for a headache – on which grounds nobody threatens to take away their right to NHS treatment for the headache.
But try that with a cancer drug that the NHS doesn’t believe is cost-effective and will not administer, and you will be accused of illicitly “topping up” your NHS care and possibly (as has actually happened) be denied further treatment for your illness. Our healthcare system is so monopolistic that it will not permit you to spend your own money (for fear of creating “two-tier” healthcare), while the proposed US system is determined to force you to spend your money on a product you don’t want. This is crazy.
Lessons: no country can afford modern health care without a mixed funding system of some kind. The more power politicians have over the running of that system, the more likely it is to get bogged down in partisan point-scoring. The more choice and responsibility reside with the patient and the clinician respectively (rather than with the bureaucrat and the government), the greater the chance that people will receive proper care. The more government tends to function as an exacting purchaser and regulator of services, rather than as a provider of them, the less likely it is to cover up or ignore the fact that thousands of people are dying unnecessarily on its watch.
Couldn’t we start treating voters like grown-ups, and talk sense about this?