I made a couple of media appearances yesterday to discuss the National Health Service. One of the points I stressed in both was how dismayed I have been by the level of political debate that this row – kicked off by American criticism of the NHS – has engendered.
The fact is that while there have been some improvements in the last decade, the NHS is by no means "the envy of the world". Indeed, on a whole range of indicators – whether it's patient satisfaction, waiting times, preventable deaths, stroke and cancer survival rates, hospital acquired infections, or the uptake of new drugs and technologies – the UK lags behind other European and developed countries.
The health service is hardly cheap either. We already spend £100bn a year on the NHS in England alone, and that figure looks set to continue rising regardless of who wins the next election. To put it another way, someone earning £30,000 a year will pay £2,300 in taxes to support the NHS. We may spend less than the US, but we also spend similar amounts to our European neighbours and get much less for it.
Britain deserves a proper, grown-up debate about its healthcare. But what do we get? Politicians 'tweeting' about how they love the NHS, and accusing anyone who dares disagree of being traitorous and unpatriotic. This is not just cowardly and infantile; it is also dishonest, shallow, and quite frankly pathetic.
Rather than burying our heads in the sand, we need to realize that there is a lot to learn from other countries – like Switzerland, the Netherlands and Singapore, among others – that provide better healthcare than we do. The key is to take the best elements of various systems come up with a reform model that will work in Britain.
A successful reform would likely embrace two key principles. The first is that healthcare is far too big and complex to be run from the top down. The second is that whether you are relying on tax or insurance to fund your healthcare, you can't completely isolate people from the cost of care, otherwise prices spiral out of control. I'll return to both these principles in future blog posts.
As my colleagues Steve Bettison and Tom Papworth have pointed out in previous blogs, the frequently quoted figure of 46 million uninsured Americans is something of a myth. To restate some salient facts:
9.7 million of these uninsured are not US citizens.
14 million of them are eligible for the government programmes Medicaid or SCHIP, but not registered. If they ever presented at an 'emergency room' they would be signed up.
17.6 million of those without insurance earn more than $50,000 per year. 10 million of them earn more than $75,000. That means that around 38 percent of the uninsured probably make enough to afford health insurance, but for some reason choose not to buy it.
18.3 million of the uninsured are under 34. Many of those may simply think, mistakenly or otherwise, that they do not need health insurance.
It is also worth pointed out once again that the 46 million figure does not mean that 46 million people are permanently without insurance. Indeed, it is estimated that 10-20 million are only temporarily without coverage. In many instances, that could be because the US tax system creates huge distortions in favour of employment-based health insurance – something which causes problems when people switch jobs.
Clearly, some people will fall into more than one of the categories I've outlined, so you can't you can't just subtract all of those numbers from 46 million to give you a fair figure. However, most people seem to think that 10 million or thereabouts would be an accurate reflection of reality. Back in 2003, a Blue Cross survey found the 8.2 million Americans were actually without health coverage in the long run because they are too poor to afford private insurance but earn too much to get government assistance.
Quite plainly, that is still a problem, but it is not a problem that suggests huge government intervention is needed (which is probably why President Obama prefers the 46 million figure). Interestingly, research from the University of Minnesota has suggested that if the US government simply permitted its citizens to purchase health insurance across state lines, 12 million more people would be able to afford insurance.
People in the operating room pay attention to a rich patient's wishes because they know a rich person can make their lives miserable. He can complain to the hospital president, or call the mayor. But the side effect is that their high quality care becomes habitual, and all patients receive it. When a poor person complains in most environments, no one listens. But in health care, through a common private insurance system, poor people go to the same hospitals and doctors as rich people and thus enjoy the benefit of rich people's power.
The public option severs this link. Dissatisfied with government-run health care, the rich will exit the system. The poor and middle-class will be left to flounder alone inside the public system. Government-run health care will become like the public schools.
Second only to zombies, the topic du jour it seems is lambasting the NHS. A new study brings some suitably shocking statistics for those who’ve already sorted their contingency plan for an invasion of the undead and aren’t overly concerned with Kerry Katona’s mental health. Apparently not only do NHS workers take more sick days than the average public sector worker and smoke just as much, but more than a quarter have absences due to ‘stress, depression and anxiety’.
Yes, the figures aren’t promising and are worth some consideration, but in reality they’re far from shocking, and most are in fact related to the job. Work in a hospital? Congratulations, your chances of getting an infection have significantly increased. While the Telegraph says picking up infections from patients wouldn’t explain all the absences, the runny noses and common colds the rest of us can work through will worsen the condition of the already sick. Far better to take a sickie and not risk it.
Saying the smoking figures should be lower because those working in hospitals have seen the effects first hand is failing to acknowledge that we all know someone who’s had cancer, we’ve all seen the effects and it hasn’t stopped one in five of us. Why should they be any different?
And the high stress and anxiety levels also come with the job. Every sympathy with that bad day in the office, but you don’t have people putting their life in your hands, you’re not handing out life-changing diagnoses, and you’re not dealing with people who are upset through sickness and bereavement – all valid reasons for a calming cigarette.
In the end, perhaps not so shocking. If these statistics extracted those in front line services from bureaucrats there might be a story. As it is, it is another missed opportunity to tackle the many necessary debates that need to be had on the future of healthcare in this country.
We often here the phrase, "the third biggest employer behind the People's Liberation Army and the Indian Railways" with regard to the NHS. And even if you go to the jobs section of the NHS website they seem proud of the fact that they employ over 1.3 million people, 'the biggest in Europe'. They are indeed one of the biggest employers in the world, but who are ahead of them?
Much of the debate relating to the American healthcare system revolves around the 'uninsured'. Even President Obama seems to be struggling, unable to get his figures straight: claiming 47 million, or is it 46 million are uninsured. Perhaps the best annual report is the US Census Bureau's Income, Poverty and Health Insurance (the 2008 survey will be out later this month). They give a headline figure of 45.657m uninsured Americans, or 15.3%.
We'll forgive the President's discrepancy of 343,000 but we'll examine who exactly constitutes this uninsured mass. For example 9.737m, 21.3% are not US citizens. But what of the remaining 35.920m. Overall 32.118 million people are in households that earn more than $25,000 per year (including 9.115m uninsured people in households that earn $75,000 or more). Insurance plans to individuals are costly but would not take much from an annual income of over $25,000. Obviously there is some overlap and we can't remove 32.118m from the overall figure based on their average annual earnings, but it does beg the question as to why they feel they can't afford insurance? Even if we lean to the extreme and exclude those earning over $50,000 it removes some 17.503 million dragging the total excluding non-citizens to 18.417m.
But what of the age breakdown? There are only 686,000 over the age of 65 who aren't covered. This compares to the 18.320 million between 18-34. who are the least likely to fall ill, which could explain why many choose not to take coverage. The picture of uninsured in America is a clouded affair. It has to be said that the real number 'in need' of health insurance falls some way off the 45.657m that is misquoted by those seeking to overhaul healthcare.
Liverpool Council would like to consult with organisations and members of the public upon a proposal to revise its licensing policy that would mean an "18" classification would be given to new release films exhibited in Liverpool if they depict images of tobacco smoking and do not already carry an "18" classification.
The lunacy of this proposal is beyond argument, but is further evidenced in the details. Apparently smoking will be permitted if it shows “a real historical figure (not an historical era) who actually smoked" and/or shows “clearly and unambiguously, the dangers of smoking, tobacco use or second-hand smoke." Imagine the jobsworths who will judge this; they would have had to make Saving Private Ryan an “18" . Under such circumstances this of course could have been avoided: Steven Spielberg could had also pointed out the dangers of smoking while telling the story of the Omaha beachhead assault of June 6, 1944.
If Liverpool Council really wants to stop people smoking I have found the solution and it also makes use of an underused recourse, namely civil servants. Sitting as I do, opposite the colossal Department for Children Families and Schools, nothing ruins the unequalled pleasure of the early cigarette more than the sight of four score civil servants sucking away on rotation throughout the day.
As such, I suggest the government moves civil servants to smoking hotspots around the country, located squarely opposite schools. If the glamour of watching the stars of Hollywood smoke encourages the habit, the solution is not to hide it behind the mystique of prohibition, but to replace it with the future that a depressingly high number of these state educated children have to look forward to.
Click here to let Liverpool Council know what you think.
At first blush you might think this is an easy question to answer: which is the best health care system? The American? Our own dearly beloved NHS? The French, Swedish, German, Canadian systems?
Then the real problem kicks in: best according to what criteria? Do we want a system which provides startlingly good care, like the US one, but patchily? One like ours that is a bureaucratic monstrosity but provides not all that terribly bad care to all? Do we go further with equality like the Canadians and near ban anyone at all from getting more than the government is willing to provide? Do we get the counties to run it, like the Swedes and the Danes?
We might even go further: part of the huge cost of the American system is that for those insured they've squeezed almost all of the waiting out of the system. The Rational Planner might not think that this cost is worth it but the Americans themselves seem very attatched to that part of their system. Is not having to wait a sufficiently desirable part of a health care system that huge amounts should be spent upon achieving that goal?
Your guess is as good as mine quite frankly: the criteria by which you judge these systems will depend upon your extant prejudices, little else.
But how are those international comparisons of health systems done then? What criteria do they use? The WHO for example, telling us that France is top, the UK 18 and the US 37? Glenn Whitman has done the work here. Only 37.5% of the index comes from actually measuring health care itself. The rest is one or another measure of how that care is distributed (ie, equally or unequally) and how it is financed.
When 62.5% of the weighting is given to the things we know that the US system is specifically bad at it's a surprise to see it quite as high as 37 th actually. The level of treatment must be pretty good to get it that high.
But much more than that, when 62.5% of the weightings are given to the things that the NHS is supposed to be good at, was specifically designed to offer: financial fairness and equal care for all and still it only comes 18th? Well, it must actually be pretty bad at providing the actual health care, the health level and responsiveness, mustn't it?
This might be a clue as to why no one has ever bothered to copy the British health care system for all we've been told for decades that it is the wonder of the world.
No system is perfect. But the furthest you can get from perfection is a government controlled monopoly, such as education or healthcare. So it's no wonder to find the people who are culpable for what passes for healthcare provision defending it to the hilt, as if it was flawless, and claiming that those who criticize it are, "un-patriotic". (To see an un-patriotic Dan Hannan truthfully answer questions on the NHS, click here).
A healthcare system where users don't have to wait, drugs aren't rationed, care is not substandard and you're not more likely to leave with disease rather than a cure is all people request. What we get is the opposite: and to deny that fact (as Cameronet al. have) is to deny us a proper discussion about how our system needs overhauling. The remote political class are trampling over our desire to discuss the problems we face on a daily basis, a fact made even more galling because undoubtedly the majority of them will hold private health insurance.
Having experienced health care on both sides of the Atlantic, and paid for both (please understand that the NHS isn't free!), the NHS is second in a two horse race. That is not to deny the fact that there is a minority within the NHS who do provide excellent health care. But these people are few and far between, and very difficult to find! Politicians live in a land of ignorant bliss, where unprincipled sound bites dispatch them into a fantasyland detached from the pain that we as a whole suffer on daily basis at the hands of the NHS. We need a system that is driven by people and not politicians and their meaningless targets. To get to that stage though we must first hold a debate.
It is about time politicians and the public wake up out of their coma. Dan Hannan tells some home truths about the NHS and suddenly politicians across the country are required to swear allegiance to that great behemoth.
The NHS has always caused much controversy. Clearly all sides of the debate are guilty of taking individual cases and extrapolating general truths from them, yet the reality is that in both theory and practice the NHS is an awful system for providing healthcare.
Let us not forget that because we have the NHS:
- it is only the very wealthy who get a truly world-class healthcare as it is only they who can afford to pay twice.
- politicians are interferes in the way we choose to live ours lives – and increasingly so.
- 250,000 people are still waiting more than 18 weeks for treatment.
Of course, the US healthcare system also needs reform, but instead of looking across the Atlantic, Obama could learn a thing or two from the Cato Institute. And as a matter fact, so could most of our politicians.
I made a couple of media appearances yesterday to discuss the National Health Service. One of the points I stressed in both was how dismayed I have been by the level of political debate that this row – kicked off by American criticism of the NHS – has engendered. 
Second only to zombies, the topic du jour it seems is lambasting the NHS. A new study brings some suitably shocking statistics for those who’ve already sorted their contingency plan for an invasion of the undead and aren’t overly concerned with Kerry Katona’s mental health. Apparently not only do NHS workers take more sick days than the average public sector worker and smoke just as much, but more than a quarter have absences due to ‘stress, depression and anxiety’.
Much of the debate relating to the American healthcare system revolves around the 'uninsured'. Even President Obama seems to be struggling, unable to get his figures straight: claiming 
Liverpool Council would like to consult with organisations and members of the public upon a proposal to revise its licensing policy that would mean an "18" classification would be given to new release films exhibited in Liverpool if they depict images of tobacco smoking and do not already carry an "18" classification.
No system is perfect. But the furthest you can get from perfection is a government controlled monopoly, such as education or healthcare. So it's no wonder to find the people who are culpable for what passes for healthcare provision defending it to the hilt, as if it was flawless, and claiming that those who criticize it are, "un-patriotic". (To see an un-patriotic Dan Hannan truthfully answer questions on the NHS, click 
It is about time politicians and the public wake up out of their coma. Dan Hannan tells some