The Other I

July 20, 2013

Health care: two alternatives

In his exploration of democratic alternatives to some of our American institutions which seem to have gone array, Gar Alperovitz discusses health care.  In the United States, we have mostly either paid for health insurance or  pay up front when we need treatment.  Up to a point, Medicare and Medicaid helps those who have paid social security, but hundreds of thousands of Americans are deprived of medical treatments they need because they cannot afford it.  Obama Care was meant to plug this gigantic hole, making it possible for all Americans who need medical care to get it, whatever their financial state.  It has run into fierce opposition, been rejected outright by some states, and even taken to the Supreme Court on the grounds that it is unconstitutional.

Alperovitz recommends setting up a health system run not by private insurance companies and hospitals but a system by and for the people.  The National Health Service (or NHS for short) here in Britain is closer to the kind of system he describes.  The NHS was set up after World War II in a country rejecting the injustices of a system which allowed thousands of working class people to die for their country, but which did not provide health care even for families of those who had died for democracy if they could not afford it – as many many could not.   Today, it is a system at which treatment is free at the point of need to anyone.  It is paid for out of general taxes.

I have seen the NHS, for better and worse, close up for more than 20 years.  I have received, I believe, some of the best treatment available in the world here, and I have seen dedicated medical treatment go far beyond their defined duties to care for the sick.  I have also seen first hand examples of prejudice, particularly against the elderly, that are terrifying.  I saw a 90-year-old man dying of cancer in a wheel chair left outside a hospital door in the middle of winter.  I have seen arrogance and indifference on the part of medical staff, and now a major report has  identified 14 hospitals in the UK where the death rate is far higher than average, and in part almost certainly due to medical errors, carelessness, and sheer lack of concern even for the dignity, let alone suffering, of patients.

These latter are the kind of stories that turn many Americans away from “socialized medicine.”

But should we be so ready to dismiss the British system or other similar systems in Europe?

I’m not so sure we should.  First of all, the British are immensely proud of the NHS.

I have seen enough in America to know that injustices and disregard for patients occur in our medical system that are as grave as anything that has been uncovered here.  The difference is that here in Britain, failure to protect  the health care system can bring governments down just as surely as a failure to protect the economy.  The outrage at the state of some of the UK hospitals is huge, and the government as well as opposition parties are putting unprecedented effort into improving the system.  There is little doubt in my mind that some of the gravest deficiencies here will be effectively addressed.

Cost, too, is a major factor.  Americans’ life expectancy is lower than it is here and throughout most of Europe, although our medical expenditures are about twice as high.  That is in large part because the US system is private and run as a business to make money.

It seems clear to me that no system, as a system, is going to eliminate prejudice or disregard supported by the culture at large.  But when they are exposed in a socialized system of health care, there is apt to be outrage.

In America, too often I fear the response is the one we are seeing to Obama Care — that it is people’s own fault if they do not have the insurance required to pay for the medical care they need, and that the rest of us should not have to pay our taxes to take care of them.  To the extent that is true, I suspect socialized medicine would not work in America.  When scandals are uncovered, too many of us may very well respond by saying that it’s not the system, but the fault of the patient who should have been paying for his or her own treatment in the first place instead of relying on the state.

So which system, given the choice, would I prefer to live with?  If money is no object, one can get some of the best care in the world in the United States.  As long as I can afford adequate health insurance, the American system can meet my needs.  But what if I can no longer afford to keep paying insurance?

And what about those who, often through no fault of their own, do not have adequate insurance, or who cannot get insurance at all because companies label them as not potentially cost-effective?  I don’t really feel comfortable reaching the conclusion that “I’m okay, jack.  I’m sorry I can’t  help you as well. But that’s life.  It’s tough, and we get what we pay for.  You’ll just have to take care of yourself.  “

For all its limitations, I think the British system is better.

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