According to physician turned social critic Theodore Dalrymple, a sick dog is better off than a sick human in the UK:
As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no delay in such investigations as you may need, and treatment is immediate. There are no waiting lists for dogs, no operations postponed because something more important has come up, no appalling stories of dogs being made to wait for years because other dogs—or hamsters—come first.
And for the dogs who can’t afford the treatment?
Are not British streets littered with canines expiring from preventable and treatable diseases, as American streets are said by Europeans to be littered with the corpses of the uninsured? Strangely, no. This is not because there are no poor dogs; there are many. The fact is, however, that there is a charitable system of veterinary services, free at the point of delivery, for poor dogs, run by the People’s Dispensary for Sick Animals, the PDSA. This is the dog’s safety net.
Obviously, Dalrymple’s comparison must be taken with a grain of salt for a multitude of reasons, foremost of which is the fact that dogs have not taken a liking (yet) to television and fast food. But the point remains that vets are able to consistently deliver quality healthcare to our canine friends without long waits and at a competitive price. For humans, on the other hand, it is a different story. the NHS, or National Health Service, covers the vast majority of Brits for everything from primary care checkups to cosmetic surgery. A private market does exist, but ironically enough its clients tend to be sick NHS employees who need to get back to work and can’t afford to endure the waiting times, which, for non-essential procedures, can be up to 18 months. Further, a recent influx of insecure women requesting cosmetic procedures like breast implantation, nose jobs, and face lifts (on the grounds that less than perfect looks are psychologically damning) have clogged the NHS ration system. According to the daily mail:
Today surgeons claim the soaring demand for cosmetic surgery on the NHS is putting a huge strain on resources. They say many patients are placing doctors in an impossible position by refusing to accept they cannot have free surgery.
So, before any meaningful discussion about healthcare it is worth mentioning that other countries have their problems too and looking at ANY policy as a panacea is not going to end well for anyone. That being said, no reasonable individual would argue that reform is not needed. Despite the plethora of mind-boggling statistics being thrown about by experts from all corners, it is clear that we spend more on healthcare than any other country with only mediocre results- not a winning combination to say the least. The current proposal whose skeletal version was released by the House democrats on June 19th promises to extend coverage to 95% of Americans, cut waste, and put insurance companies in check. Unfortunately, despite the estimated $1 trillion bill, the details of how they are going to go about actually doing these things are a bit fuzzy.
But assuming the details are worked out and congress does find a way to pay for this plan, does that make it the best option? And, to approach the question from a more philosophical perspective, is ensuring the health of the citizenry the responsibility of the government at all? If the government does take responsibility for our health, how long will it be before they start taking responsibility for our eating habits and our lifestyles? After all, if current trends continue and our waistlines continue to expand, our health issues will simultaneously increase as well. The latter question, which is surely the more interesting one, will be dealt with in a later post!
Any discussion of the solutions obviously requires a summary of the problems, which are manifold. Skyrocketing costs push individuals on the lower end of the socio-economic ladder from the market; well-meaning medical students are deterred from entering primary practice because of looming debts and oppressive overhead costs; the absolutely non-sensical “fee-for-service” (as opposed to fee for results) payment system encourages the few private practice doctors left to rush patients through as quickly as possible, subjecting them to a myriad of tests which are absolutely irrelevant to the issue at hand (it is only a matter of time before a diagnosis of the common cold requires a MRI), which consequently adds fuel to the fire of gross over-specialization in the American healthcare system.
Despite the fact that we are still waiting for additional information regarding the President’s plan I am skeptical that it would be able to address all of these issues. Yes, access to healthcare is an issue, but there is a more fundamental issue of quality at hand. Good healthcare has to be a based on a strong, personal relationship between the primary care doctor and the patient. Instead of punishing doctors who want to spend 30 minutes discussing lifestyle habits and medical history with a patient, we need a system where doctors are rewarded for results based on thoroughness and honesty, not their ability to throw pills around like confetti on July 4th. And I will be the first to acknowledge that the idea that every individual would be able to afford such care is just as unrealistic as the President’s dream that the government can ensure that every American could gain access to quality healthcare. However, is the solution to pauperize everyone like the NHS has done in the UK?
The idea of patient-driven, private healthcare is a path India has chosen to take and it is one that is quickly making the country a leader in healthcare. In a country where 75% of the population are skeptical that such a thing as the central government even exists, a public plan is not exactly a feasible option. Instead, India is home to a two-tier private market of its own. Rival chains of hospitals unfettered by excessive litigation and averse to buying the latest and greatest medical equipment have been forced to innovate new approaches to medicine. The Economist recently shared the story of a particularly ground-breaking individual in a Bangalore hospital:
Vivek Jawali and his team had nearly completed his complex heart bypass. Because such “beating heart” surgery causes little pain and does not require general anaesthesia or blood thinners, patients are back on their feet much faster than usual. This approach, pioneered by Wockhardt, an Indian hospital chain, has proved so safe and successful that medical tourists come to Bangalore from all over the world.
This is just one example of the kind of innovation that is being stifled in the status quo. Additionally, whereas some hospitals might cater to the wealthier class and medical tourists, other hospital chains are choosing to cater to the other market.
For years India’s private-health providers, such as Apollo Hospitals, focused on the affluent upper classes, but they are now racing down the pyramid. Vishal Bali, Wockhardt’s boss, plans to take advantage of tax breaks to build hospitals in small and medium-sized cities (which, in India, means those with up to 3m inhabitants). Prathap Reddy, Apollo’s founder, plans to do the same. He thinks he can cut costs in half for patients: a quarter saved through lower overheads, and another quarter by eliminating travel to bigger cities.
So, though far from perfect, this private, two-tier healthcare system is a helluva start, and it would serve the higher-ups well to take a look. The biggest mistake, after all, would be to engage in blind obedience to ideology and forget just how much is at stake.