Universal Care vs Insurance The first thing that stands out is that quite a few people I know in the US don't have health insurance. I ask them what happens when they are ill; they kind of shrug their shoulders as if to say, well it's a bit inconvenient. They say some hospitals have a reputation for treating the uninsured and are not too officious on chasing up the bills afterwards. But, it hardly inspires confidence that health care is based on going to a hospital and running away before anyone notices.
At least one person I know indirectly, declared bankruptcy after a serious illness. In fact, health care costs are one of the biggest reasons for bankruptcy in the US. According to a study by Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass, health care costs accounted for 60% of bankruptcy cases in the US. (CNN, link) One note is that even those who are insured often have only limited insurance.
One thing I find undeniable is that for many Americans, health care is a real and continuous worry. My friends say that to get a serious illness can be financially damaging. In the UK we may worry about not getting the best treatment, but the idea of going bankrupt from a serious illness just isn't there. Nor is there the same level of bureaucracy in getting a private insurance company to pay.
The UK model is far from perfect, they point to the waiting lists on the NHS and also the fact in the UK, doctors make judgements about the cost-benefit of certain treatments. In the US, this weighing up of whether to offer expensive treatments for marginal improvements in life quality, would likely be referred to as the highly emotive 'death panels'. Health care is certainly an emotive issue.
|% of health care spending as % of GDP||Govt spending as % of total health care||Per Capita expenditure 2006 (PPP)||Doctors per 10,000 population||Nurses / midwives per 10,000||Hospital beds per 10,000||Life Expectancy||male obesity|
US health care costs were 7% of GDP in 1970. UK was 4% of GDP in 1970 (Runaway health care costs)
Relative costs of Health Care
The US spends 15% of GDP on health care. Yet, from these statistics, it is not clear the US gets value for money. In terms of numbers of doctors, nurses and hospital beds, the UK seems to come out slightly better.
Where does the Money in US go?
- Profit margin to Private Health insurance companies
- Profit margin to Drug companies
- US has a much greater willingness to pay for expensive treatments. In the UK, doctors facing a tight budget have to make decisions and choose most cost-effective. In the US, someone else pays (i.e the insurance company and indirectly insurance premiums). US doctors might get sued for not giving best possible treatment, they won't get sued for suggesting most expensive treatments. Therefore if in doubt, pay the money
- US doctors / nurses are paid better.
- US has higher level of obesity so may have more health care related issues. (though I'm sure UK is trying its best to catch up with US obesity levels?
- Advantages of Private Health Care
- You could argue US health care is better because private health care has that profit incentive to be more efficient and offer best possible treatment. If you have full insurance you don't have to worry about waiting lists and being given inferior treatment.
Americans hate tax. But, they pay for health care indirectly. What is health insurance if not a type of tax?
It is hard to make a case for the UK to adopt the US model of health care. It would be more expensive and leave people with uncertainty. It is said that the US has no chance of adopting a Western style free at the point of use system. Presumably vested interests have too much influence. (even in UK, the great Socialist Nye Bevan claimed he had to 'stuff the doctors pockets with gold' to make them accept the NHS)
Also, health care costs in America will be difficult to control in the future. It is rising health care which poses biggest long term danger to US budget.(free market and health care by Krugman)