“We have nothing as bad as America’s worst, and nothing as good as America’s best,” wise words said to me by someone many years ago, and this principle has stood the test of time. There are certainly many dreadful things in American healthcare, but there are also wonderful services and excellent innovation with a rigorous evaluation for each of them. In my collection of ten classic articles on better value healthcare, eight come from the United States. This is a paradox. Although they have no finite budget and do not have full population coverage, the thinking and the innovation within healthcare organisations such as Kaiser, or universities such as Harvard or Dartmouth, is streets ahead of the debate in the United Kingdom. But let’s not feel too bad as we have nothing as bad as the worst, for example, the Republican views on healthcare, and the millions who are uninsured.
They also have very good writers. One of the most highly respected writers is Arnold Relman, formerly the editor of the New England Journal of Medicine. Writing in the wonderful New York Review of Books, he published an article called “How doctors could rescue healthcare” in October. Much of the article is about the impenetrable debate about Medicare and the Affordable Care Act, but his bottom line is powerful.
His analysis describes how there is an evolution from accountable care organisations called medical groups, which are “multispecialty physician-owned groups.” They are owned by physicians and are not for profit. Dr Relman’s hope is that they could rescue American healthcare whatever happens in Congress and the Senate.
If in any system those who spend the money are divorced from those that set budgets, the consequence is always that it ends in tears as Alan Enthoven pointed out in his great book, “How Much is Enough,” available free from the RAND website. A population based system of care in which the physicians feel responsible for the resources being used could rescue American healthcare, and could make an invaluable contribution to every other country, including England.
Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.