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T.R. Reid
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January 20 - January 24, 2021
most doctors in Britain—about 60 percent—are general practitioners. In the specialist-heavy United States, about 35 percent of doctors are general practitioners,
the GPs in Britain generally make more money than the specialists—on average, about twice as much. In a generally socialized medical system, Britain’s general practitioners tend to be thoroughly capitalist.
In British law, any doctor who can show that he was following the guidelines approved by NICE for a particular treatment or procedure is immune from a malpractice claim.The
Britain’s NHS has forcefully embraced the old nostrum “An ounce of prevention is worth a pound of cure.”
by 1961 everyone in Canada was covered by a taxpayer-funded hospital insurance program. Today the public health insurance system covers all medical and psychiatric care, in or out of the hospital.
“Economic growth is not the sole aim of our society,” the Hall Report said. “The value of a human life must be decided without regard to . . . economic considerations. We must take into account the human and spiritual aspects involved.”
The World Health Organization says that 67 percent of the world’s population has no “regular” access to drugs.
more than twenty thousand Americans die each year from treatable diseases, because they don’t have health insurance and can’t afford to pay for treatment out of pocket.
you make a graph that compares personal income to life expectancy in all the nations of the world, the two lines on the chart go up together almost in lockstep; the higher the GDP per capita, the longer people live. The biggest exception to this rule—the obvious outlier on that chart—is Cuba.
all the other rich countries provide high-quality, universal care, and yet they spend far less than the United States does. Which means that we need only borrow a few good ideas, from this country or that one, to arrive at reasonably priced universal coverage for the USA. It sounds so simple.
other industrialized, free-market democracies have managed to change their health care systems, despite the high stakes and the vested interests.
“A society cannot have complete equality,” M. Couchepin said. “It is not possible. You can earn more money than your neighbor; that is not society’s business. But a good railway system, a good school system, a good health system—the basic needs of the people—must be handled with a high degree of equality. To have a great sense of solidarity among the people, all must have an equal right—and particularly, a right to medical care. Because it is a profound need for people to be sure, if they are struck by the stroke of destiny, they can have a good health system. Our society must meet that need.”
Both countries decided that society has an ethical obligation—as a matter of justice, of fairness, of solidarity—to assure everybody access to medical care when it’s needed. The
Universal coverage saves lives, saves money, reduces the rate of abortion. And it promotes preventive medicine. If the health care system covers everybody, then the system has a powerful incentive to keep people healthy.
An ounce of prevention is worth a pound of cure.” But modern epidemiological studies make it clear that preventive medicine—the discipline sometimes called public health—trumps individual treatment as a means for keeping large numbers of people healthy, wealthy, and wise.
1953 paper, “The Place of Tobacco in Lung-Cancer Etiology,”3 Wynder
“The prestige of any given specialty within the house of medicine is inversely proportional to the size of the object it addresses,”
key role of any public health regime is to enhance each individual’s commitment to personal responsibility.
the major causes of premature death today are chronic diseases caused at least in part by diet, lifestyle, and tobacco use.
The British payment structure for general practitioners—the “capitation” system, which means a doctor gets paid by the number of patients on his list, and the pay-for-performance system, which gives the doctor extra income for keeping his patients healthy—drives the doctors to practice preventive care every day.
NHS Direct, a free phone line that anybody in the United Kingdom can call any day, anytime, to talk to a nurse about a medical problem.
In a land where all are created equal, which inequalities are we willing to accept?
we have built a health care system that discriminates on the basis of wealth, the American health care system lets one woman live and the other die. Are we willing, as a society, to tolerate that inequality? The world’s other developed countries have all considered that question, and all have answered: “No.” As we’ve seen throughout this book, no other industrialized democratic country allows people to die from treatable diseases because they can’t afford the doctor’s bill.
18,314 Americans die each year because they don’t have health insurance and thus can’t get the treatment that would save their lives.
The first question is: Do people in your country have a right to health care? If the people believe that medical care is a basic right, you design a system that means anybody who is sick can see a doctor. If a society considers medical care to be an economic commodity, then you set up a system that distributes health care based on the ability to pay. And then the poor, pretty much, are left out.”
granting every European the right to a paid vacation, the right to strike, the right to paid parental leave when a baby is born, the right to a clean environment, the right to “a high level of consumer protection,” and even “the right of access to a free placement service” when looking for a job. Given that laundry list, it’s hardly surprising that the European Charter also includes a right to health care:
judges have ordered prisons to provide medical treatment for an ailing inmate. The prisoners appreciate it. A twenty-year-old inmate named Melissa Matthews in Tacoma, Washington, declined parole and chose to stay in jail because she had cervical cancer. “If I’m in here, then I can get treated,” Matthews told KING-TV. “If I’m out, I’m going to die from this cancer.”
One much-discussed idea that did not get into the final version of the bill was a so-called public option—that is, a nonprofit health insurance plan offered by the federal government, a sort of Medicare-at-any-age program. Fearful of competition from the government, the health insurance industry lobbied strenuously, and successfully, to kill the public option plan. But the mere threat of a government-run competitor had a profound effect: to ward off the public option, the insurers reluctantly agreed to a broad range of new restrictions and regulations that they had never accepted before.
Every nation’s health care system reflects that nation’s basic moral values,” he taught us. “Once a nation decides that it has a moral obligation to provide health care for everybody, then it can build a system to meet that obligation.” Uwe Reinhardt’s
