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US Healthcare debate 2009. Should passion and anecdote ever outweigh evidence?

Ami Banerjee
Last edited 17th March 2010

Gobsmacked, bamboozled, annoyed: my emotions on following news stories about the ongoing US healthcare reform debate this week. Then came the onslaught on the UK’s National Health Service by various Americans and Tory MEP, Daniel Hannan. Hannan described the NHS as “a 60 year mistake" and that he "wouldn't wish it on anyone". The Republican former vice-presidential candidate Sarah Palin has called health rationing by NICE "downright evil" , referring to it as a “death panel”. Stephen Hawking has come to the defence of the NHS and even the PM has been Twittering his support.

Everybody is entitled to an opinion. Hannan’s last blog entry on 14th August had drawn over 450 comments from both supporters and fervent opposers of his standpoint. When a person in authority gives an opinion, it is naturally given more coverage than if a member of the public made a statement. Therefore, politicians have a responsibility to check their facts before opening their mouths and we, the public, whether in the UK or the US, have a responsibility to check the facts. In his blog, “The NHS row: my final word”, Hannan argues the sales pitch for his book, “The Plan: Twelve Months to Renew Britain”, which has “a lengthy chapter on healthcare which sets out how Britain compares with other countries in terms of survival rates, waiting times and so on”. Since when did whether or not a book is a bestseller equate to factual scientific evidence? And would you take financial advice from a doctor? Would you take plumbing advice from a banker? Then why are we listening to a politician/bookseller to tell us what is best for the US or the UK’s health?

As somebody who trained and works in the NHS, I know that it has many flaws and many changes are necessary. However, we have to get our facts right when comparing with other systems. I have previously blogged about how charges and private user fees make health systems less fair and less efficient. I am not going to repeat the evidence that is freely available in the public domain. In a nutshell, the UK spends half of the US on healthcare as a percentage of GDP and per capita, has lower infant mortality and higher survival rates as a population. Most importantly, the US comes bottom out of industrialised nations in terms of health equity and 15% of its population do not have health insurance, whereas every UK citizen, regardless of who they are, what colour they are, where they are, is entitled to NHS care.

Atul Gawande, a surgeon and public health advocate in Boston, wrote a great piece in the New Yorker in June about the financial incentives which have led to a country with spiralling health costs and inadequate health services for its population, and makes a strong case for universal health insurance in the US. This week’s NEJM includes a review of recent US nationwide opinion polls, showing that “most of the public wants a major change in the health care system. But majority support for a specific legislative proposal will depend on Americans’ believing that they and the country will be better off if such a change is enacted”. Obama has higher approval ratings than Bill Clinton, the last man to attempt US health reform on this scale and he likes evidence-based medicine, which shows that the US is failing its citizens at the moment. If he can’t make America focus on the health of its population, nobody can.

Call for better tracking of health data in US

This week's New England journal carries a great piece by Chris Murray (lead author of the Global Burden of Disease studies), arguing that America's low world ranking in terms of health indicators will drop even further if data collection and monitoring within the US (and internationally) are not improved.


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8 million people without access to decent healthcare. Surely the USA cant be proud of this statistic. The USA sells itself all around the world as a country of low taxes, high earnings, terrific life style etc. It doesnt mention what happens if things dont quite work out and you dont have a company healthcare plan, or pension you can count on. For these people, US citizens as well as immigrants, the reality is pretty awful. As the baby boomers are hitting older age, retiring or being laid off, they are finding they are becoming the new under class. They voted against paying taxes for a national healthcare for all system, they mostly voted against any national pension system that would provide income for all in their old age, they wanted the freedom to invest their money as they decided. Well, human nature being what it is, they spent their money on new cars, designer clothes etc. pretending they were all rich, now they realize it was just an illusion, and they are really quite poor and the socialist protections dont exist to help them. Many US pensioners are scrambling to find links in their families that will enable them to move to Europe to retire and be protected by European healthcare plans.

You get what you pay for

I do wonder what happened to all the Flower children of the 60s that were going to make the world a fairer, better place. Well they grew into the executives and well paid middle class that voted against taxation for healthcare and even agains compulsory pensions. When people are working for companies with pension plans and healthcare plans, they rebel against any suggestion that their taxes should be used for poorer people. The problem is, that as these baby boomers are getting laid off or retiring, so goes their pensions and healthcare. Now they want it but they didnt exercise their freedom to save for it. You cant have socialist benefits or protection without paying for them. I live in Europe, and we are already seeing Americans digging out their grandparents status to obtain passports to allow them to loot our healthcare systems. As someone once said, a country is judged by how it looks after its poorest, well the middle class will soon be the poorest. Unfortuneatly, the 30 and 40 year olds of today are crying that they dont want to pay taxes for healthcare and pensions, theyre all right. Well, I guess the lesson wont be learnt for an other couple of generations. You get what you pay for and if you elect to not pay for protection, then dont cry when you dont have any.

Don't be fooled by bogus statistics

Thanks for the comments.

  1. I think you are underestimating the statistical methods by which other industrialised nations collect infant mortality data-the US is definitely not the only country to do this. The reference you quote is from the early 1980s-30 years ago! If we corrected for various health issues in other countries, we would also get massaged mortality rates. For example, shall we correct for HIV/AIDS in subSaharan Africa? And regardless of whether the cause of ill-health is gun trauma or accidents, access to healthcare is still a major problem all the way across the US. Undoubtedly, at the top-end, the best health care in the world is available in the US to infants and adults alike. However, this care is simply not available to a lot of people because health insurance and health costs are way too expensive and there are no incentives to put patients before profits. That is why patients are not getting a fair deal in the US.
  2. Interesting that you should totally discount WHO and OECD statistics, which use standardised methods to collect data from many countries at regular time intervals to keep the data up-to-date, On the other hand, you choose to believe data from a single health insurer in the US. The article you quote uses much older data than the data which I quote, and it is not representative.


- Infant mortality and higher survival rates as a population are poor measures of actual health care. Very-low birth-weight infants have a much higher chance of being brought to term in the U.S. Obviously, many of these infants die shortly after birth, and these are not counted in many other countries' rates(1). Furthermore, when you correct for homicides and accidents, the U.S. has the highest life expectancy (2).

  • This awesome 15% number, or 45-50 million uninsured is a ridiculously abused and misleading statistic. When you account for immigrants who would not qualify for a public plan, people who qualify for government programs but are for some reason not enrolled, people who earn more than $50k a year, and people who are transiently without insurance for a few months between jobs, you are left with 8 million chronically uninsured U.S. citizens. That's 2.6% of the population(3), based on U.S. Census Bureau data.

(1): Miranda Mugford, “A Comparison of ReportedDifferences in Definitions of Vital Events andStatistics,” World Health Statistics Quarterly 36(1983)

(2) Robert L. Ohsfeldt and John E. Schneider, TheBusiness of Health: The Role of Competition, Markets,and Regulation (Washington: American EnterpriseInstitute Press, 2006)

(3) BlueCross BlueShield Association, “BCBSA Analysis Shows One-
third of Uninsured Americans Could Have Affordable, Quality
Healthcare Coverage Immediately,” May 9, 2003

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