US Healthcare: a master class in black propaganda

It’s been fascinating to watch the great US healthcare debate from this side of the Atlantic. The exciting bit for us in England is when the opponents of reform decide to attack Barack Obama's proposed reforms by trashing the NHS. They point to refusal of treatment to NHS patients, on the grounds of their age or their general health status. That kind of thing has certainly happened, and there’s been plenty of noise about it in England too. The loudest scandals have tended to be about the so-called ‘postcode lotteries’ which lead to people in some areas being refused treatments that are available in others. Sometimes however the cases have been hard to criticise: there are far too few livers available for transplant, far too many people waiting for one; does it really make sense to put one into a patient who seems incapable of breaking with his alcoholism?

But justified or not, there have certainly been many instances of refused treatment in the NHS. What makes the whole debate ironic, however, is that US critics of such incidents seem to ignore the status of US healthcare as the past master of treatment refusal, whether because you have no insurance or, even worse, because your insurance company finds some devious way to claim that your policy doesn’t cover the particular treatment you need.

This is a perfect illustration of the fact that a propaganda campaign doesn’t have to be true to be effective. This campaign has already achieved a first success: Obama has dropped his intention to give the Federal government responsibility for the reformed healthcare system. However remote its connection with the truth, the campaign has won popular support sufficiently widespread to become difficult to resist.

In England, ministers and health professionals have been queuing up to defend the NHS against the attacks from the States. They’ve been pointing out that the English healthcare system costs little over half as much as the American, but life expectancy in England is 78 years against 77 in the US, and the under 5 mortality rate in England is 6 per 1000 while in the US it’s 9 per 1000. But I'm far from convinced that they're making the right points strongly enough. As someone who’s spent 25 years around (though never in) healthcare, mostly with the NHS, I feel strongly about this subject. So here’s my view, for what it’s worth.

Incidentally, I love the expression ‘for what it’s worth’ applied to an opinion. ‘In my humble opinion’ is much too obviously false humility. ‘For what it’s worth’ sounds self-deprecating, though fundamentally it’s just as arrogant: after all, if you don’t think your opinion’s worth mentioning, you don’t mention it.

But let's get back to the main subject.

It’s true that English expenditure on healthcare is about 8.3% of Gross Domestic Product compared to 16% in the US. So US healthcare is certainly a great deal more expensive. Wouldn’t it be interesting to find a measure of what they’re getting for their money?

Comparing life expectancy strikes me as perfectly useless as a way of measuring healthcare effectiveness. The figures for the two countries are pretty much the same but, in any case, many other factors than healthcare influence life expectancy. A major factor has to be diet, which is more to do with health ing eneral than with healthcare.

The infant and child mortality rate doesn’t feel any more useful to me. It’s true that infant mortality (neonates and up to one year of age) has been falling much more slowly in the US than in other advanced economies and the problem needs to be addressed. However, I again feel it’s influenced by many more factors than just the effectiveness of the healthcare system.

So is there no measure of what the Americans are getting for all those extra bucks they’re spending?

Well, I came across a recent study which I think makes some pretty effective points. In Measuring the health of nations: updating an earlier analysis, Ellen Nolte and Martin McKee compare preventable deaths in nineteen nations in 2002-2003 with the figures from a previous study of 1997-1998. Preventable deaths are those that could have been avoided by providing suitable treatment. In the five years between the two studies, the US fell from sixteenth out of nineteenth to – nineteenth. Last. As with infant mortality, the US is improving its performance, but much more slowly than other advanced nations. For example, the UK with its maligned NHS went from 130 avoidable deaths per 100,000 to 103, whereas the US went from 115 to 110.

Now that really is a telling measure. Look at it another way: if the US could perform as well as the average of the nineteen countries, it could save 75,000 lives a year; if it could get up to the level of the three best, it could save over 100,000 lives a year.

9/11 cost just over 3000 lives and it reverberates with us today. But failure to treat the sick is causing 30 times more deaths than 9/11. Again and again. Year after year.

The US delivers what is often the best healthcare in the world. But it has the most expensive healthcare system. And that system is in effect killing the equivalent of a medium-sized town each year.

It may seem suprising that its defenders prefer to concentrate on the problems of the NHS. Though when you think of how propaganda works, it's not really that surprising.


For a summary of the study, see:

http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2008/Jan/Measuring%20the%20Health%20of%20Nations%20%20Updating%20an%20Earlier%20Analysis/1090_Nolte_measuring_hlt_of_nations_HA_01%202008_ITL%20web%20%20pdf.pdf