Healthcare reform in the US is turning ugly. Democratic legislators are getting shouted down at town hall meetings, the president's approval rating is slipping and the prospects for reforming the US health system are murky.
Historically, the "special relationship" has produced some impressive results, but these days, gazing across the Atlantic is making healthcare worse in both countries. Rather than focusing on what we can learn from each other, the US and the UK are so fervently focusing on each other's weaknesses that it is paralysing progress in both countries.
Ask Americans why they're sceptical about healthcare reform and they'll say that don't want to end up like Britain: they don't want long waits or rationing. Americans' fears about the NHS were stoked by a series of television ads highlighting heart-wrenching accounts of sub-standard care in the NHS. While some of the content in the ads touch on cancer care, which is arguably the achilles heel of the NHS, there is nothing in what President Obama is proposing that would lead to these types of challenges in the US and the ads mask the positive aspects of the NHS.
Likewise, ask the British why they're sceptical about efforts to increase patient choice and competition and rely more heavily on private healthcare providers and they'll say that they don't want to end up like the US: they don't want people denied care because they can't pay, and they've heard the US doesn't perform well relative to what it spends. Indeed, an entire issue of the British Medical Association's BMA News was spent raging against market forces in healthcare and pleading not to turn the NHS into an American-style system.
Looking at our respective fears in more detail, it turns out that rationing in Britain is neither worse nor better than rationing in the US, it's just different. In reality, the US system rations care at a lower price than Britain. When patients forgo prescriptions because they lack insurance coverage or cannot afford co-payments, that is rationing at a lower threshold than the £30,000 limit set by Nice. The crucial difference between the countries is that rationing decisions in Britain are made by a government agency and driven by evidence, whereas in the US, they're often made by individuals and can be based on tradeoffs between healthcare and other expenses.
Waiting times in Britain, long used as a rallying cry against the NHS, have plummeted over the last decade. Today patients can see their general practitioner within two days. The wait to see a specialist is typically under six weeks, and the time from the original referral to surgery, if it's necessary, is within 18 weeks for non-urgent cases.
For British observers, the often-cited statistic that 46 million Americans are uninsured is misleading. While lack of insurance is a real problem, that figure actually includes individuals who are without insurance for very short periods of time. Furthermore, a significant portion of those counted as uninsured are under 30 years of age, more than 15 million have incomes above $50,000 and, most importantly, about a third are eligible for federal coverage.
As for quality, while the US lags behind other developed countries on some quality measures, those stats are influenced by Americans' lifestyle choices, like unhealthy eating, and are not directly related to the healthcare system. For complex conditions like strokes, heart attacks and cancer care, there is no place I'd rather be than in the US.
Faultfinding in the British NHS or American health system is easy. But faultfinding has left both countries' health systems at loggerheads and given critics of reform an excuse for ideological entrenchment and inactivity. This is ironic since there are so many lessons that each can learn from the other.
Britain needs to learn from the US that competition isn't a vice but an engine to drive quality and innovation, and improve the patient experience. Conversely, the US needs to learn the merits of investing in primary care as well as how to say no to paying for care that has no clinical benefit, rather than forcing individuals to choose between necessary care and other household expenses.
Every country is under pressure to slow the growth of healthcare spending, while still meeting rising patient expectations. That's a daunting challenge. Rather than fighting with one hand tied behind our back and ignoring international experience, the US and the UK need to forget about each other's respective faults and start focusing on what we can and must learn from each other.
