England's National Health Service has always been a political punching bag, but usually, the jabs are aimed at British politicians, and they are most often thrown by the English electorate.
Iowa Republican Sen. Chuck Grassley's recent off-the-cuff remarks in which he mentioned that he had heard that Sen. Ted Kennedy might not get care for his brain tumor in England, have put the English health system into a very different kind of fight. Now, the English are facing off against the U.S. political right.
Usually, international learning is vital to crafting strong policies. However, in the current health care debate, looking across the pond is actually making American and English health policy worse. Instead of looking at what we can learn from each other, both countries are so paralyzed by each other's faults that neither country can move forward.
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The British are intuitively skeptical about the U.S. health care system. The English system was founded on two principles: that coverage was comprehensive and that care was free and not based on ability to pay. The English simply cannot understand the idea that an estimated 46 million Americans go without insurance coverage.
However, they do not realize that the 46 million uninsured Americans statistic is misleading. While un- and underinsurance are indeed huge problems in the United States, the 46 million tally includes individuals who are without insurance for very short periods of time. Further, many of the uninsured are under 30 years old, a surprising number are making more than $50,000 annually and almost a third are already eligible but choose not to enroll in federal coverage.
Separating Facts from Fiction in the Health Care Wars
This misread of the U.S. statistics in part reflects why England was slow to adopt competition and reluctant to embrace private sector health care providers.
This malaise historically didn't do England any favors. Competition can be the engine to drive quality and innovation and fundamentally it can improve the patient experience. Indeed, it's partly the result of competition that high intensity care for cancer and strokes in the United States is so much stronger than it is in England.
Of late, England has begun to more actively embrace competition, and as a result, patient satisfaction and patient outcomes are improving.
But the United States is equally guilty of letting anecdotes get in the way of policy. Americans cannot understand the concept of long waits for care, or the rumors of rationing care in England.
However, just as the 46 million uninsured statistic is misleading, so, too, are rumors about waiting times and rationing. Waiting times have plummeted in England over the last decade to the point where they are no longer a problem. Likewise, England has taken big strides to improve access to the latest cancer medications.
And yes, Kennedy would have received cancer care in England.
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.
Where to Get Better Health Care?
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.