It also turns out that rationing is not an exclusively English phenomenon. It is also done in the United States, just differently. In England, decisions about which drugs and treatments to pay for are influenced by a quasi-government agency that decides whether medications and therapies are clinically effective. Cost does come into the picture, but it is not the arbiter of whether or not a course of treatment is paid for. The agency makes nonbinding recommendations that local areas decide whether or not to follow.
In the United States, there is rationing too. It takes the form of individuals choosing not to purchase care or not to make a co-payment because they can't afford it. And those decisions tend not to be evidence-based. Similarly, private insurers make similar decisions about paying for treatment to the ones that are made in the NHS; they're just more subtle.
Grassley's comments show that he misses the point about why health care reform in the United States is important. Ted Kennedy would get amazing care, no matter where he lived. However, the real test of our health system isn't the quality of care we provide for Kennedy, it's the quality of care we provide for the rest of us.
To be sure, if I had full insurance and I got cancer, I'd want to be treated in the United States. However, if I had a long-term illness, had a small business and two kids and didn't have insurance, I would probably prefer to be in England. This is why President Obama is promoting universal coverage, and this is why there are lessons that we need to learn from England.
First, England invests heavily in family doctors, and that turns out to be a very efficient way to improve quality and save costs. Having better primary care in the United States would improve the way American doctors deal with patients with chronic disease, and it would keep more patients out of emergency rooms.
Second, the United States must learn from England about how to say no to paying for care that we know does not have clinical benefits. We need to assure that have access to care they need and to steer patients away from care that is fruitless. This type of "rationing" is more efficient and healthier than forcing individuals to choose between necessary care and other household expenses.
The U.S. and English health systems are fundamentally different, and we'll never see a situation where we're delivering care the same way in both countries. However, this doesn't mean that we need to misrepresent each other. Every country is facing rising health care costs and rising patient demands, and dealing with those challenges without looking at what other countries are doing is like getting into a fight with a hand tied behind our back.
Zack Cooper is a health economist for LSE Health at the London School of Economics and Political Science, and a native New Yorker.