The current bizarre health care “discussions” in Washington prompt me to comment. I grew up with, and served in, the National Health Service in Britain. When initiated in 1947 it was relatively inexpensive, since medical care was much less complex and most people died soon after retirement, if not before. The funding did not keep up with the enormous subsequent changes, and It was grossly underfunded in the 1980s when I was struggling to run an academic program in London. I was the only effective gastroenterologist in a 500 bed University hospital, responsible for all clinical activities, teaching and research, and also on call for acute general medicine. After 13 years I was glad to take up the offer of a position at Duke University in USA, where excellence, innovation and productivity were welcomed, and rewarded. And I have been very happy subsequently at the Medical University of South Carolina in Charleston. The best of US medicine is truly great, but I continue to be concerned, indeed embarrassed, that so many people do not have access to it. This lack of universal coverage is unique amongst advanced nations of the world. Despite spending a much higher proportion of GDP on health care than other countries, the overall health statistics are no better, and, in many areas, worse.
I am convinced that a single payer system is essential, and indeed inevitable eventually. You may say that I was glad to escape such a system in Britain. Yes, but it has improved enormously since I left. Most Britains love it, as most Canadians love their similar system, despite what some allege. You may ask “who wants government in their health care”? It is deep in there already, with Medicare and Medicaid covering at least half of it (unless and until the Republican party decimates those programs). It is not perfect, but many people now bless the day they reach 65 to gain access to Medicare. The Democratic platform suggested a move in that direction with an option to allow folks to sign up for Medicare at 55.
The people making decisions in Washington are going to remove the insurance mandate, a key part of President’s Obama’s bill that obligated everyone to buy insurance, or pay a fine. This was to provide universal coverage, and bring healthy people (and more funds) into the insurance pool. Will our representatives also release us from having to have car, home and flood insurance? That would certainly save us money……until something bad happened.
Our representatives in Washington continue to ignore the input from all of the major medical organizations. What do doctors know about health care? One group that is pushing for universal coverage is “Physicians for a National Health Service” (worth a look at http://www.pnhp.org). Of course the devil is in the details, but there are plenty of smart people who can address them. Let’s at least try.
Gentle comments welcome.
July 6 2017. Many thanks for helpful comments. For those wishing to explore “single payer” further, there is a good review at https://www.amsa.org/wp-content/uploads/2015/03/SinglePayer101.pdf Note that it does not have to be government run.
We have an unusual President who likes to say and do outrageous things. Check out his repeated support for a single payer system https://www.washingtonpost.com/…/trumps-forbidden-love-singe-payer-health-care/
Can we dream? It would scandalize his Republican “colleagues”, but maybe save his presidency.
One final comment about the National Health Service in England. It is not perfect, still underfunded and bedeviled by repeated political restructuring. It has also been disrupted by having to observe some European Union regulations. Everyone is covered by the NHS, which is “free”, of course paid by taxes, but there is an option to take out private insurance, as daughter Nicola mentioned. It is not expensive, but important to realize that it covers only elective issues, like specialist consultations, hip replacements and screening colonoscopy. There are no full-service private hospitals. If you get sick you go to an NHS hospital, and, usually, get well treated.
Surely a multi-talented US commission to look at all the systems in other countries would be worthwhile.