![\"David](\"http:\/\/www.bmj.com\/channels\/icons\/davidkerr.jpg\")
Writers of the open letter to America in defence of the NHS rebut clearly and concisely some of the more ludicrous charges leveled\u00a0against our system of healthcare. It’s a debate that on the whole\u00a0leaves me cold. The idea that wittingly a Government would allow a huge chunk of its population to go without proper healthcare is unfathomable to me.<\/p>\n
Underlying the discussion, however, is an assumption that for those\u00a0who can afford health insurance, the US system is better than ours\u00a0could ever be.<\/p>\n
That’s a false assumption. Simply spending more money on healthcare\u00a0does not mean you will get better healthcare.<\/p>\n
In America, as health care costs spiral out of reach of many ordinary\u00a0families, we have an extreme example. The more expensive provision\u00a0becomes, the fewer people benefit (46 million at last count). A 17%\u00a0spend of GDP on health has not delivered the promised land.<\/p>\n
In the UK we spend 8% of GDP. It’s universal and 80% of the people who\u00a0use the NHS are satisfied with it. There are financial lessons there\u00a0to be learnt, if America wants to learn them.<\/p>\n
In particular the US should look at the strength of our primary care\u00a0system. In America, primary care is an area of relative weakness. GPs\u00a0are paid far less than their specialist counterparts. Not surprisingly, there are\u00a0 far fewer of them and this has far\u00a0reaching consequences. Specialists rule the roost and they maintain\u00a0
\ntheir high incomes by deploying ever more expensive and complex\u00a0diagnostic tools, drugs, and surgical procedures, sometimes\u00a0unnecessarily.\u00a0 The effect? Higher health care costs for all.<\/p>\n
In the UK, on the other hand, GPs are the first port of call for most concerns. GPs deal with the whole person and only refer patients to a\u00a0specialist when they\u00a0really need to go. GPs in the UK effectively absorb\u00a0diagnostic risk and patients, trusting in their doctors, give them the\u00a0power to do so. It’s good for the patient and good for the NHS as it\u00a0keeps costs down without jeopardizing patient care.<\/p>\n
Healthcare rationing is a second area where the US could learn from\u00a0the UK. If the US is going to reform its\u00a0 system to include an element\u00a0of universal care America will have to shift radically its concept of\u00a0 health care rationing from ability to pay to value for money.<\/p>\n
The UK already rations care on that basis, difficult as it may be. Not\u00a0every single medical advance can be approved by NICE regardless of how\u00a0marginal the benefits. But the system is transparent, evidential, and\u00a0
\nrule based and certainly not based on the amount of insurance cover an\u00a0individual has. It may not be perfect but it is fit for purpose and\u00a0America will have to adapt some kind of similar model if reform is to\u00a0
\nsucceed.<\/p>\n
An enormous part of the American health care debate has focused on how\u00a0to fund expanded healthcare provision. The NHS has been the bogeyman\u00a0of the debate with individual and tragic examples of failure\u00a0 – which\u00a0occur in every system – being hauled in front of the world’s media to\u00a0make a case against a public option.<\/p>\n
America can learn from the NHS not just in terms of the ethical\u00a0principle of universality but also in terms of financial control. If\u00a0Senator Baucus’ new legislative proposals are anything to go by these\u00a0lessons need to be learnt fast before the public option slides\u00a0irrevocably towards the exit of the US healthcare debate. America\u00a0should introduce a cost curbing, high quality competitive public\u00a0option and watch premiums tumble. This is the surest route to nearer\u00a0universality.<\/p>\n