The recent overhaul of the American health care system, which has been inappropriately referred as “Obamacare” by the media, and the frantic efforts of the new American administration to dismantle it—so far unsuccessful but time will tell—has brought some forced comparison with other care systems; some policy pundits have insolently dubbed it as the “Anglicisation” of our highly fragmented health care delivery system.
Since the health care reforms of Premier John Major—who enacted the “internal market”—and Premier Tony Blair—who instituted the “patient choice”—the health policy experts in the United Kingdom have been talking non-stop about the ongoing “Americanisation” of their venerable National Health Service (NHS). In 1948, the UK authorities created a universal health care coverage for every Briton, who were mostly impoverished after the World War II and the loss of their colonies. Citizens and pundits alike have denounced those modernization drives as a “Trojan horse” to force the entry of the “private sector” in an extremely revered and popular British institution.
What the two health care systems have in common is the following: their citizens live longer and are consuming a higher percentage of public and private financial resources in a technologically-driven medicine. In the USA the Medicare and Medicaid systems have been slowly replacing the fee-for-service system for a more integrated and efficient system of “managed care” that must be accountable. In Britain, the timid introduction of some kind of accountable care has sparked a vivid rebuke of organized citizens groups and the media that have denounced it as illegal because voters had not approved it.
James Meeks wrote in the “London Review of Books” an excellent review of the present reform in the United Kingdom with the forthright description of two universe. “In universe one, the NHS will be upturned to give most of the healthcare people need at home or on their doorstep and admit to the big hospitals only patients with major trauma, or suffering diseases that demand intensive care, or complex surgical or biochemical expertise. Big hospitals are to become centers of research, high technology, rare skills and dramatic, life-saving interventions.” In contraposition to that ideal, clean environment the author describes the other universe. “In universe two a counter-reality prevails: the reality of winter, the reality of need, the reality of an ever increasing number of frail, elderly people converging on the help of last resort, the emergency hospital.”
In the United Kingdom the combination of a providential welfare state and a good universal health care system has led to the marked prolongation of life expectancy for men and women alike. However the entry into an ever older age has brought the emergence of “multiple co-morbidities” in their clinical condition. Nowadays a patient that has a peak of high blood pressure must be treated taking into consideration that he/she might be also diabetic, or suffering form renal diseases, or a neoplasia. As a result, efficient and comprehensive long-term care for the elderly and disabled is a high time and resources-consuming endeavor. Sadly, even though elderly people might elicit compassion and understanding at an individual or family level, they are mostly ignored by the younger generations that work and fill the purse with their salary deductions. That commiseration does not translate into the civic approval of more funding. Younger citizens are usually in a state of “self-denial” about their own future fragility in old age.
Meeks studied the reform in Leicestershire, a miniature expression of modern England: densely populated, a dynamic economy and a younger population, many of them immigrants and students. It’s on the south-eastern rim of the Industrial Revolution of the 19th century, it has three Labor elected representatives and it narrowly voted to stay (Remain) in the European Union. The counties surrounding Leicester are very different as they comprise extremely well-off areas where the country gentlemen live and run-down districts that could not recover from the modernization. It is a whiter, older world where the need for home health services and ancillary support is stronger. The Lansley reform—named after the Conservative health secretary Andrew Lansley—created seven local organizations as the point of delivery in Leicestershire. The “Clinical Commissioning Groups” (CCG) are aggregation of general practitioners located at the city of Leicester and the east-west ends of the area. The Royal Infirmary Hospital, which has the largest Emergency department in England, is run by the “University Hospitals of Leicester Trust.” The “Leicestershire Partnership Trust” runs all the community care services, including Mental Health and the Prisons.
Meeks found that the authorities of Leicestershire have implemented a virtual system 256 bed “hospital” called “Intensive Community Support” (ICS) where the convalescent patients are being treated by nursing and ancillary personnel in their own residence. There is an integral, holistic approach to the patients that are discharged from the hospital as the home health personnel, social workers and ancillary personnel are being scheduled and supervised by the same administration. The author found that the altruistic objectives—like being able to access a local doctor until 8 PM seven days a week—are not completely attained, with some district areas worse than others. The push for cuts in services that are prodded by the central authorities of the NHS could not prosper.
Considering that the population of Britain is growing in overall number and longevity, there is dire financial need for more staff, more material resources, more distributive planning. Besides the demographic inflation, there is the salaries’ inflation to account for as the health care system is run by persons with increasing needs in a modern economy. In order to compete in a tight labor market for talent and expertise, the health care organizations must offer better benefits and good pay. The “Baumol cost disease”—named after the economist William Baumol—describes the asymmetry between industries like manufacturing that can be automated and require less workers with the ones like health care that cannot be readily automated and still require large number of employees.
Many citizens of modern societies like the UK and the USA (certainly not all and not in the same degree) are enjoying one of the biggest prolongations of their average life spans with an ensuing ability to continue enjoying their activities, including postponing their retirement and working into their late 70s. But they certainly are afflicted by chronic diseases like high blood pressure, diabetes, arthrosis, which require regular medical check-ups and proper long-term treatment. Young people will eventually reach that stage too and if they now refuse to fund the existing long term care services for elderly people, they will be dismantled by myopic bureaucrats that only know how to count beans. Watch out, Millennials. Those services take years to design and put up; they will not be available for you in your golden years if you don’t protect them now with your voices and votes. But there is a positive economic variable at play. William Baumol considered that the efficiency savings in the manufacturing sector will eventually liberate more funds to invest in health care. Let’s hope that politicians don’t squander those funds.
What do you think? Please tell us.
Don’t leave me alone.