Hot Air and the daily caller are excited to pronounce socialized medicine dead as the British NHS plans to contract with private hospitals and providers on top of socialized care. From The Caller:

Joseph A. Morris, a former Reagan White House lawyer who now serves on the board of the American Conservative Union, told TheDC that socialized medicine has turned out to be a threat to Britons’ health, and to their economy as well.

“Europe’s message to the world is no longer that the socialist dream of the cradle-to-grave welfare state is an easy achievement,” Morris said. “Rather, it is the shouted warning that it is a fool’s paradise. The bills are coming due and the only real alternatives — serious financial reform of government or national bankruptcy — are not pleasant.”

Morris added that the British government, “unlike the Obama administration, is hearing the warnings, identifying its greatest vulnerabilities, and trying to race ahead of the deluge.”

Well, yes and no. The British government is interested in passing a bill that would allow private providers to be contracted by NHS and ostensibly compete with NHS where NHS is lagging. It’s hard to tell from coverage exactly what provisions will ultimately be in this bill, although the overriding goal seems to be to introduce “competition” into the NHS. Although, it’s hard to imagine the NHS being more efficient with introduction of competition as the Brits spend roughly half as much per capita and a much smaller fraction of their total GDP on health care compared to the US.

But are our right wingers correct that this is the death of socialized medicine and should be a warning about Obama care?

Um no. This is a combination of egregious apples-to-oranges comparison and gross simplification. Their argument depends on a mis-characterization of virtually every other medical system in the world. By saying Britain allowing privatization into their single-payer system is “Europe” rejecting socialized medicine assumes that Britain’s health care system resembles any other system in Europe. It does not.

In fact, most universal systems are unlike Britain’s. Only Canada and New Zealand have similar, government-run single payer systems. Other socialist European paradises like France, Germany, the Netherlands etc., actually have very different systems. They rely on either insurers (with heavy subsidization for the poor), or other health collectives to pay for patient’s medical costs to private hospitals.

Further, the healthcare system envisioned by the health care reform act in this country is very, very far from being single payer, and that’s not necessarily a bad thing. In fact, when you look at it, it’s going to be much more like the Netherlands system than any other, and guess what, the Netherlands system has the best patient satisfaction rate in a comparison of metrics between their system, the US, Canada, Britain, New Zealand, Japan, Australia, Germany and France. They tend to have shorter wait times, and are more confident in their system providing the best available care.

We don’t need a single-payer health system in order to provide excellent care to our citizens in a universal fashion. Even a public option like Australia’s isn’t necessary to provide excellent care to all.

Well regulated insurance companies with risk sharing and provisions to require good coverage for the chronically ill, combined with subsidized insurance for the poor is the the Netherlands’ system in a nutshell. Unlike the single payer systems, there are not the same wait times for procedures and their speed of care is comparable to ours. Only 5% of their citizens complained of access problems to their system because of cost, in the US it’s 37%. Finally, the Netherlands system costs less than 1/2 as much as the US system does, per capita, while covering all of its citizens.

The conservative rags are conflating this enormous diversity of systems, many of which rely solely on private insurers, with the single-payer British system. Then, after they’ve erected this straw man of a consolidated European nanny-state, they declare the privatization move by the British NHS a sign socialized medicine has failed. Even though this will actually just move Britain slightly more towards the mainstream of universal health care systems within Europe. Even if Britain’s system is in need of reform, it’s still providing care to all of its citizens at a fraction of the cost of our system. To declare universal health care is causing financial collapse of Europe is absurd. Every one of their systems costs far less than ours does. Socialized medicine is cost efficient, and it’s our system that is failing both in scope and cost.

If anything the opposite effect is true. The privatization of our main socialized medical provider, Medicare, has driven huge increases in costs of its administration. Medicare used to be administered in a highly-efficient fashion. Within three years of Bush outsourcing medicare billing costs increased by 30% per enrollee at the same time physician frustration with fighting for reimbursement with a myriad of new businesses administering the system made everyone completely nuts. There are things government does cheaper. The money side of administration of medical care is one of them. The single-payer systems have shown that there are problems with a fully government-administered systems in which government administers hospitals, employs the docs, as well as cover costs. The wait times, ignoring the hyperbolic anecdotes, are longer for elective procedures in two of the three single-payer systems. This makes them easy targets for comments like this from Hot Air:

And the Times of London knows if that happens, the NHS would be available to treat Lansley’s gunshot wound in as little as six weeks, so no worries.

Trauma is not affected by wait times, of course. This is a cheap shot. Like pretty much 99% of the content of these articles. In smearing the NHS for trying to introduce a small amount of privatization, all they show is their complete ignorance of healthcare systems in Europe. They show their willingness to lie about the reforms enacted to our system when they compare our future changes to Britain’s NHS. Finally, they show their astounding arrogance for dismissing all of these systems as “socialist”, when all of them provide excellent care, to all of their citizens, for half the price of ours.

Comments

  1. #1 Alex
    February 20, 2012

    Also, the proposed NHS bill would leave the NHS as a single-payer system administered in the public sector, funded by general taxation, just one that contracted for some of its services from the private sector.

    It has always been possible to buy private health insurance in the UK, should you so desire.

  2. #2 David O.
    February 20, 2012

    As Alex commented, it has always been possible for the private individual to purchase private health care insurance to ‘top up’ the NHS scheme. And many do so, while many companaies also offer it as a ‘perk’ to their employees, or provide it at a reduced ‘corporate’ rate. Thus both systems thrive in the UK.

  3. #3 G.Shelley
    February 20, 2012

    Not only has it been possible to buy private health insurance, there are fully private hospitals and the idea that there could be some mixing of the two is not new.
    The idea that if the wait times on an NHS visit are too long, then the government should be able to subsidize the use of a private hospital is relatively uncontroversial. The more recent idea, that the private sector can compete with the NHS to offer services was much more so, which is what this bill originated as. And even in it’s modified state, it might be enough to cost the government.
    No party that wanted to get elected in the UK could ever suggest a US style of health service. Even suggesting a European style would be highly dangerous

  4. #4 MarkH
    February 20, 2012

    Corrected. They really are making a lot out of nothing here.

  5. #5 Kagehi
    February 20, 2012

    The only thing I can say about the whole “single payer” system is that either we need that, or we need something where its not the doctor, or their staff, jumping through hoops, trying to figure out who the hell, out of who knows how many companies, will actually be paying X part of the bill. Most doctors where I live are not even open any more on fridays, precisely because the paperwork has gotten so damned stupid that they are shuffling through it, trying to work out how to actually get paid, instead of seeing patients. Part of this is overburdened doctors, and the idiot idea some people have gotten that Obamacare makes getting into the industry a bad idea. How? Who knows, but entry into the field has, supposedly, dropped, and more than before, once his bill went through.

    Lot of idiocy in the US system. And… to fix it requires either making it less complicated to work out who the hell is paying, or making sure someone does pay (and not the person buying the supposed insurance, then not getting anything for his/her investment). The rest of the mess all hinges around this, and other things, like the bloody “drug shortages”, none of which help the problem.

  6. #6 derek
    February 20, 2012

    It’s Conservatives who are altering the NHS! For conservatives to argue that other conservatives messing with universal health care is an argument against the health service is absurd; all it proves is that the conservatives always hated universal health care. They voted against it when it was created and have worked to bring it down ever since. Their success doesn’t mean the service is flawed, it just means rich people don’t like paying tax.

  7. #7 Art
    February 20, 2012

    The same sort of smear was leveled at ‘socialized medicine’ when it was revealed that Canadians were coming to the US for MRIs. Argument was that those poor deprived Canadians were coming to the US where everyone has access to MRIS.

    My take on this was that the US free market system in medical care, which is supposed to by way of the “invisible hand” balance supply and demand, price and availability, doesn’t seem to work. MRIs sitting idle and US imaging groups willing to give MRIs to Canadians for what their health service is willing to pay suggests the free-market isn’t working very well in the US healthcare industry.

    The willingness of the Canadian health service to seek out services outside their own nation also seems to reflect that the good of the patients is being held higher than their nationalism or ideology. This is as it should be.

    The British NHS willingness to explore options to improve service shows that they are not blind ideologues pushing a political agenda. They are genuinely interested in constantly adapting and improving the system. If competition is the medicine that works in some sectors or situations; they are not adverse to using it. This is as it should be.

    Problem here is that the US system is conflicted as to what priorities the healthcare system is supposed to have. A lot of what the US system does wrong comes about because it is optimized as a profit making business. With patient care and medical efficacy coming in third or forth place behind corporate profits, shareholder value, remuneration of the head people running the hospitals. It only gets less efficient when insurance companies, with their own prime directive of showing a profit and compensating shareholders, insert themselves as gatekeeper between the medical care and the patient.

    In the US system the corporation, shareholders, insurance companies, administrators, and department heads all get their cut off the top. Which leaves the patient whatever is left over. Is there any wonder why we pay twice, sometime three times, what other nations pay for the same amount and quality of patient care.

  8. #8 mfhawkes
    February 21, 2012

    Just to note, the planned privatisation of the NHS is being implemented by a conservative government that was unable to obtain a majority at the election (and they explicitly pledged no “top-down reorganisations” of the NHS before the election). The bill is facing massive opposition from both the public and the majority of professional medical bodies. So not only is a move towards privatisation not representative of the wishes of Europe, it’s not even representative of the wishes of the UK. As a previous commenter said, it’s only representative of conservative ideology the world over.

  9. #9 Vince Whirlwind
    February 21, 2012

    I read the Guardian yesterday and it was reporting that
    a) 31% of Conservative voters oppose this Conservative NHS policy
    b) polled Conservative support overall has plummeted.
    c) those most likely to not oppose this Conservative polcy were 18-24 year-olds who don’t use the healthcare system much and also are the least likely to bother voting.
    d) those most likely to oppose this Conservative policy were the oldest age groups – most likely to use healthcare AND usually most likely to vote Conservative

    I’d say any crowing from US conservatives is a fairly hollow exercise….it’s pretty obvious to anybody who has ever used the NHS that it delivers excellent results, and not many people in the UK would swap it from the dysfunctional US system.

  10. #10 Holford Watch
    February 22, 2012

    Great post! It’s a serious financial reform of government or national bankruptcy!!

  11. #11 Robert
    February 22, 2012

    The single biggest advantage of universal health care is it de-stresses the system, takes one of the biggest worries in family life and makes it far more manageable.
    When you or a family members gets sick, it’s not can I afford it or will insurance pay for it, it’s all about how soon will they get better.
    When you have an very ill family member, the stress is enormous not having to worry where the money is coming from marks the difference between a humane society and a greed based society.

  12. #12 guthrie
    February 28, 2012

    The funny thing is that I (and I think many others) expect the condems ‘reforms’ to make the NHS more expensive, or to enable the removal of healthcare from people who then have to purchase it privately, ending up with more spending on healthcare. That an NHS type setup enables a low cost approach to healthcare whilst still covering the entire population is not in doubt, but fiddling with it for the benefit of private companies suggests that some people think healthcare costs don’t matter as much as getting public money into private hands.

  13. #13 MacTurk
    March 6, 2012

    The various statements about “Europe’s message to the world…” by so-called ‘conservative commentators’ in the USA merely point out the fact that the aforementioned ‘conservative commentators’ are utterly ignorant about the world outside the USA(“Yes Virginia, there is civilization outside the the borders of the continental USA”).

    A good guideline, with regard to ‘conservative commentators’ making any point about anywhere outside the USA, is treat their point(s) with extreme scepticism.

    The health care systems across Europe differ. In Belgium, you pay up front, and you get back about 90% of the money from the various insurance schemes, but it takes about a month. The French system will load you with prescription medicines. And so on, and so on….

    However, the main point is that all European countries offer universal health care, and as Robert(no 11) mentioned, it is a great reliever of stress. I lived in the USA for nearly five years, and the health care system is far too costly, far too complicated, and effectively, as far as I could make out, works for the interests of the insurance companies. Living in Europe means that that source of stress does not exist.

    The second point is that there is, to a greater or lesser extent, both private and public health care available in European countries. For language reasons – my Czech is still poor – I have supplementary private cover, with a clinic which has mostly English-speaking doctors. Mind you, sometimes it is easier to use French! At one time, nearly half of the Irish population had private health cover. Doctors can, and do, work in both sectors. The attempt to characterise the entire European spectrum of health care as being exactly the same as Britain’s single payer system is an attempt at gross deception, or more ignorance.

    Lastly, within the European Union, your health coverage is transferable. My Czech cover is accepted in all EU countries. The same situation applies, generally, to social welfare payments.

  14. #14 Wow
    March 6, 2012

    “as being exactly the same as Britain’s single payer system is an attempt at gross deception, or more ignorance.”

    And Britain has BUPA along with many other private healthcare systems. To relieve waiting lists, the NHS will buy from private hospitals and this also helps the private hospital, since the rooms and theatres would otherwise still need upkeep but be under-utilised, and they can more comfortably over-specify to ensure short private waiting lists without redundancy kicking in.

    And doctors will work in both public and private roles in their careers.

    Britain’s single-payer system is no different in elements than the other european systems. It’s run by accountants and the suspicion that since it’s government=run, it’s inefficiently run by the government (who have all bought in to the free market mantra of the USA). So it’s among the worse European systems, but mostly because it tries to ape the USA one.

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