Healthy, wealthy & unwise

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Healthy, wealthy & unwise

On the 70th anniversary of the world’s first public healthcare system, Britain’s National Healthcare Service (NHS), it’s useful to look at parallels

Nothing is perfect and that definitely includes healthcare. On the 70th anniversary of the first full-coverage national health care system that is ‘free at the point of delivery’, Britain’s National Health Service (NHS), English people have been marching in the streets demanding better funding for the NHS, and Donald Trump naturally got the wrong end of the stick again.

Back in February, as part of his war against Barack Obama’s attempt to improve the coverage of the rudimentary US health care system (Obamacare), Trump claimed that the marchers were protesting because the British system is “going broke and not working”. It’s tough trying to defend the existing US system when every other developed country provides universal health coverage for its citizens but Trump battled bravely onwards, later tweeting that the Democrats in the US “want to greatly raise taxes for really bad and non-personal medical care.” Like the British allegedly suffer under the NHS.

In fact, the English National Health Service (Scotland and Northern Ireland have separate but similar systems) is, in former Conservative Cabinet member Nigel Lawson’s words, “the closest thing the English have to a religion.” It is almost universally loved and the protests were about Government under-funding of the NHS.

Even the Conservative Government that has strictly limited funding increases  for the NHS over the past seven years, despite rising demand due to an ageing population, has now been forced to yield to popular demands. Prime Minister Theresa May announced last week that the NHS would get a funding increase of 3.4 per cent per year over the next four years, giving it an extra $27 billion annually by 2023. But are the English right to love their healthcare system — and are the French, Germans, Russians and Japanese and the people of almost every other developed country right to revere their own similar systems? The US may be the odd country out, but it does spend far more on healthcare than anybody else. The country spends 16 per cent of its entire GDP on healthcare, almost twice as much as the average (8.2 per cent for Japan, 8.4 per cent  for the UK, 8.5 per cent  for Australia, 10.4 per cent  for Germany). In theory, that ought to mean that Americans are healthier than everybody else and live longer. In practice, it’s just the opposite.

The US is the only developed country where the average lifespan is less than 80. In fact, it’s barely 78 years in the US, whereas everywhere else it’s in 80-82 range. The US also has the highest ‘preventable death rate’ of any developed country and the highest infant mortality rate by a very wide margin. Americans spend more on health and get less back, than anybody else. They also spend far more of their time worrying about healthcare. The principal cause of personal bankruptcies in the US is ‘catastrophic’ health emergencies, and all but the very rich have to devote much time to find an affordable medical insurance. Elsewhere in the developed world, nobody really thinks about that. The care will be there when you need it and nobody goes bankrupt.

The model that was pioneered by Britain’s NHS on July 5, 1948 has been so successful that it is now spreading into many developing countries as well. India is still a poor country but its National Health Policy 2017 goals include a commitment to “progressively achieve Universal Health Coverage.” China is working to provide affordable basic healthcare to all residents by 2020. And so on. Attitudes change over time. In the 1930s, nobody thought that there was some sort of basic human right to health care. The well-off paid for themselves and the rest depended on charity (which wasn’t very dependable).

What changed that attitude was the World War II, a time of great national solidarity and sacrifice in every country. It was the worst war in history but it produced a generation who believed that the people who had shared in the sacrifice (in both the countries that won and those that lost) must not be left behind in the peace that followed. The will was there to do new and great things and they did them.

It is no coincidence that the same year of 1948 saw the signing of the Universal Declaration of Human Rights, which said (among other things): “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” The world had turned and what had been a privilege became a right. One that is still widely abused or neglected, of course, but it has nevertheless spread across the entire planet in the past 70 years. Why did the US miss out? The answer is probably a free-market ideology so strong that it enabled the insurance companies and the medical profession (which opposed the idea of a national health system in every country, at least initially) to win the political battle in the US and strangle the idea in its cradle. It keeps coming back even there but for the moment Americans must go on paying the costs of their ideology.

(The writer is an independent journalist)

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