An external journalists take on US Healthcare

[weemadando]

Lies, damned lies and health care


Faced with the debate over US President Barack Obama’s project to overhaul American health care, I’m finding it difficult to maintain the impartiality required of an ABC current affairs presenter.

I’ve had rather a lot of care from what the Americans call “socialised medicine”, here and in the UK – in fact without it, I’d be dead several times over – and some of the things that have been said against it strike me as plain ridiculous.

We’ll come to my own experience shortly, but first a taste of what I mean about the American debate

According to Sarah Palin, for example, the Obama plan will involve a system of sinister committees – “death panels” - which will decide whether the old or infirm have the right to live or die. No proof has been produced for this remarkable accusation, and even Palin’s defenders, like John McCain, have been luke-warm: the best he could offer was that reform “at least opens the door to a possibility of rationing and decisions ... such as are made in other countries”.

Yet the death panel notion has taken a firm hold in middle America, especially among the middle-aged and elderly, and anyone who supports healthcare reform finds it difficult to be heard. Here’s just one of the many rowdy “Town Hall” meetings where debate has consisted largely of shouting and abuse:



Most absurd of all was an editorial in Investor’s Business Daily which claimed that “people such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service (NHS) would say the life of this brilliant man, because of his physical handicaps, is essentially worthless”.

Now Stephen Hawking, as most people know, is not just the world’s best-known theoretical physicist, but also its most famous sufferer from motor neurone disease. Diagnosed with it in the early 1960s, he was given only a few years to live. He has defied those predictions for more than four decades with the help of Britain’s National Health Service, and he said so: "I wouldn't be here today if it were not for the NHS," he told The Guardian. "I have received a large amount of high-quality treatment without which I would not have survived."

Investor’s Business Daily did publish a correction, but an obscure one, merely acknowledging that Stephen Hawking lived in Britain.

A lie is halfway around the world before the truth has got its boots on, and the impression many Americans have of systems like the NHS, and Australia’s Medicare, is of a terrifying faceless bureaucracy mainly concerned with denying and rationing health care to a few. On the American left, by contrast, you might get the impression from such as Michael Moore in his film Sicko of the NHS as a system of utopian perfection, guaranteeing speedy and luxurious care for all.

Neither extreme is true: but the system I have encountered, while it has major flaws, does have one massive advantage for the seriously ill: you can be sure that you will not be faced with the choice of ‘bankruptcy or death’.



I became ill in Britain in 1994, not long after an assignment for the ABC in Rwanda and Zaire.

The disease I had contracted proved exceptionally difficult to diagnose – it’s rare, and presents a varying range of symptoms. After several visits, my National Health Service doctor had the sense and humility to confess himself beaten, and sent me to London’s Hospital for Tropical Diseases. There, also on the NHS, I was tested exhaustively for every known tropical disease.

If I’d been in America, I’d have already have spent thousands – in Britain I’d spent nothing.

But this was also where one of the failings of the NHS kicked in: waiting-lists. The Tropical Disease doctors discharged me with instructions to see another specialist, but when I rang him I discovered he couldn’t see me for six weeks. My condition was deteriorating fast, so when the ABC’s Dr Norman Swan got on the phone from Sydney to offer help, I jumped at it. He got to work and within a day had made an appointment for me with the doctor who would go on to save my life.

Insured by the ABC, I ended up spending almost six months in hospital. I was in a private ward, but treated in a National Health Hospital. The food was better in the private ward, and I had privacy, but I am certain that the treatment was the same. My doctors were sparing time for me out of their public rounds.

My illness is a long story, which has not yet found its ending, but back here in Australia I continue to get the best care. My specialist, a brilliant professor at Sydney’s Prince of Wales Hospital, takes no private patients, so for the last 12 years I have been treated on Medicare. The Pharmaceutical Benefits Scheme (PBS) has subsidised the many drugs I have had to take.

Without all of this public medicine, in the American system for instance, I believe I would be dead, or dead broke, or both. Is that an exaggeration, on a par with Sarah Palin’s “death panels”? I think not.

Why? In the American system, you’re all right in theory if you’ve got a steady job, because your employer sponsors your health insurance.

But what many Americans don’t know is the limitation of that insurance in case of long-term illness.

After 90 days off work, the employer ceases to have any obligation to pay for your insurance. Under an Act called COBRA, you can extend the insurance (at your own considerable expense), but only for 18 months. After that, as I understand it, you are no longer covered by health insurance at all. Nor can you take out a new policy, because insurance companies won’t cover those with ‘prior conditions’.

Small wonder, then, that 62 per cent of bankruptcies in the USA are linked to medical bills.

And small wonder, as Nick Kristof of the New York Times wrote this week, that the American system is wreaking heartbreak on families faced with the choice of health care or poverty.



The USA spends more than 15 per cent of its GDP on health care. Australia and Britain spend just over 8 per cent, When it comes to looking after the seriously and chronically ill, I think I know which nations get better value. Britain’s NHS and Australia’s Medicare are not perfect – far from it. But they’re not the Orwellian monsters of American myth either.

Hillary Clinton failed to overhaul the American system when she tried in the early nineties. Was she defeated by the big drug companies, the insurance industry, or just the deep historical suspicion many Americans have for big government in any form? Impossible to say for certain, but what is clear is that Barack Obama now faces the same forces, and the early indications are that he’s not going to find them any easier to deal with.

Posted by Mark Colvin on Sep 02, 2009 in Mark Colvin | Permalink