| The government wants to follow the American example in health care, turning it into a private enterprise. But even in the US the model doesn't work... |
Wall Street ethics invade health care
WORKERS, NOV 2005 ISSUE
Choice and competition, market forces and the private sector, we are told, will improve patient care and make the NHS more efficient. We have been here before. The old discredited ideas of the internal market from the 1990s are being revived, only this time posing a greater threat to the NHS. Privatisation proceeds by stealth, without any public debate and with the rules rigged to give the private sector a greater foothold in public health care.
The evidence that markets don't work in health care is freely available from the United States. And it is totally ignored. Advocates of the market tell us they bring greater efficiency. In fact, the most wasteful and expensive health system in the world is found in the US, where profit and the market rule.
The US spends $1.7 trillion every year on health care. That represents 15% of its national wealth, or two to three times what we spend per person in Britain. Americans get little for that money, which goes hand in hand with low use of hospitals and other health services in comparison with other countries.
Premature death
The US is the only developed country in the world which does not provide universal health coverage for its citizens. Forty-five million Americans have no health insurance, mainly the working and unemployed poor. A shocking 18,000 people die prematurely each year having put off seeing a doctor because without insurance they could not afford medical care. The WHO ranks the US a lowly 29th in healthy life span. Its infant mortality rates are higher than in most developed countries. Higher, too, than Cuba's.
Those who can least afford to pay are charged the most. The uninsured and underinsured pay five to ten times as much for health care as the insured. Those who can't pay are sued, have their wages stopped and hold car boot sales to pay their medical costs. Families are left with debts that would take a lifetime to pay off. One hundred million Americans, those with loopholes and exclusions in their insurance coverage, are underinsured. Every thirty seconds someone in America files for bankruptcy following treatment for a serious health problem. Twenty-nine million Americans are in medical debt.
American hospitals: machines for transferring money to Wall Street
So if ordinary Americans are not benefiting, where is the massive healthcare spend going? On bureaucracy. Every year, administration of the market swallows up $300 billion on the paper chase of bills and claims.
Health inflation is out of control and the market has failed utterly to control costs. General Motors estimates that its employee health plan adds $1,500 to the cost of every car it makes.
If American citizens get a raw deal from their health system, at least Wall Street benefits. The profits of Pfizer, the pharmaceutical company, dwarf those of Wal-Mart. Meanwhile American seniors cross the border into Canada to buy drugs they can afford; the Bush administration forbids the sale of Canadian drugs in the US, although they are identical to those produced in the US.
The ethics of Wall Street pervade American health corporations. HealthSouth, the Enron of health, using the same accounting scams, lied about its earnings to the tune of $2.7 billion. Senate Majority leader Bill Frist's family business HCA Inc had to pay the government $1.7 billion for making false claims against its Medicare and Medicaid programmes.
The best kept secret in American health care is that if markets don't work, then government-funded and government-provided health care does. The Veterans Health Care Administration, known as the VA, provides health care for military veterans who are ill because of their military service, poor, or suffer from a catastrophic illness. Fifteen years ago, the VA was renowned for the poor quality of the care it provided. Since then it has been transformed.
Research published earlier this year shows that the VA outperforms the best of the private sector across a whole range of diseases and conditions. In part, the VA has succeeded by becoming more like the NHS. An old-fashioned hospital-based service has been replaced by an integrated health service with strong primary and community care.
Many years ahead of the NHS, the VA implemented an electronic records system which helps clinical decision-making and reduces errors. Devolution of decision-making has gone hand in hand with strong performance management and accountability. Research excellence and an easy transfer of research into practice has contributed, too. All of this is underpinned by a strong public service ethos, pride in and commitment to the VA.
Blocking
International surveys show that Americans are far less satisfied with their health system than people in other countries. Compared with them, more Americans think their health system needs a radical shake-up. But the drug and insurance lobbies that blocked the Clinton health care reforms are doing very well out of the market and will resist any change. Health care barely figured in the last presidential election.
The US health system is a failed market. Costs are out of control. Thousands of health plans and hospitals compete for business. Patients find it impossible to find their way through the health maze. Only the insurance and drug companies profit. Despite all this evidence to the contrary, the British government insists that competition will give patients more choice, drive down costs and improve quality. In reality, choice will be a myth for the vast majority of patients.
NHS staff will be forced into the private sector. More money will be spent on administration, less on patient care, and our public service values will be eroded.
It is no surprise that Blair's former policy adviser jumped ship to the American corporation United Health Europe in anticipation of the privatisation of the NHS. The market is not benign, and if the government's agenda is allowed to go ahead, the only people who will benefit are Wall Street and their friends in the City of London.
