When American campaigners against President Obama’s health-care reforms attacked his plans by throwing wild accusations against the NHS, it was inevitable that the row would spread to Britain. In the media and the blogosphere, the supporters and opponents of both systems have lined up to have a go at each other. Many of these commentators are adopting entrenched positions and there is a disappointing lack of data in their discussions. They tend to be anecdotal. ’The NHS left my mum to die’ or ‘But for the NHS I wouldn’t be here’ is the flavour of much of the debate.
This is not really surprising. For some, belief in a type of health-care system has become an article of faith. Supporters of the religious right in the US are turning up in large numbers to protest about Obama’s plans to make the US more like Commie Britain with its free health service. There is little point in trying to refute their views about Britain’s health system with facts. Many of these people believe that the Earth was created in 4004 BC. If they can cling to that belief despite overwhelming evidence to the contrary any fact-based arguments about the relative merits of health-care systems are futile. That said, many on the British left show an almost equally dogmatic opposition to the introduction of any private provision into the UK’s health service, despite evidence that it might have had some positive effects.
And as for Daniel Hannan; this is the man who said that the UK’s economy should be more like Iceland’s. If he’d had his way the country probably would be bankrupt by now. Few people have taken him seriously in the past and there is no reason why we should start doing so now.
The lack of evidence-based discussion about the relative performance of health-care systems around the world is even more disappointing when you consider that, just over a month ago, the OECD released its Health Data 2009 report. Try doing a news or blog search. Hardly anyone has referred to it even though this row has been rumbling on for the past few days.
The bad news is that you have to pay for the report and I’m far too tight- fisted to do that. The good news is that some bloggers have nicked bits from it and posted them. There is also a spreadsheet available for those geeky enough to want to manipulate the data themselves.
These two graphs make interesting reading. The first shows total expenditure on health as a share of GDP. Despite recent government spending increases, the UK still spends below the OECD average and much less than Germany and France. The USA, by contrast, spends by far and away the most of any country.
But it is this second graph where things start to get really interesting.
This shows health-care spending per head of population. Once again, the UK is around the OECD average and the USA is way out in front. But look at the graph closely. It splits the spending between publicly funded and private provision. The USA spends more public money per person on health-care than the UK does.
Just in case you missed that, I’ll say it again. The ‘free-market’ US health-care system spends more public money per head than the ‘socialist’ British one. Work that out then.
The OECD report makes this comment:
For this amount of expenditure in the United States, government provides insurance coverage only for the elderly and disabled (through Medicare, which primarily insures persons aged 65 and over and people with disabilities) and some of the poor (through Medicaid and the State Children’s Health Insurance Program, SCHIP), whereas in most other OECD countries this is enough for government to provide universal primary health insurance.
Expenditure is about the only area in which the USA tops the table. Its number of nurses per head of population is around the OECD average and its number of doctors significantly below the average. In both cases, the numbers are similar to those in the UK, despite the huge difference in spending. Its life expectancy rate is below that of the UK and the OECD average. Its infant mortality rate is worse than the UK’s, slightly worse than Poland’s and on a par with that of Slovakia. The USA scores better on flashy machines like MRI and CT scanners but that’s about it. It’s as if the British have bought a VW Golf and the Americans have bought an Audi A3 but paid the price of a Mercedes S-Class.
I have no idea why any of this should be. I don’t know enough about the American health system to offer an explanation and, unlike the morons sounding off about our National Health Service on TV and in public meetings in the USA, I’m not arrogant or rude enough to attack another country’s health system without having some knowledge of how it works and what it is up against.
The data don’t look good though. Whatever else you might conclude, the Americans pay a hell of a lot of money for health-care, both from taxes and from private insurance. We, on the other hand, pay a lot less and get a health service that, according to the data, works at least as well as that in the USA and, in some cases, delivers better outcomes.
That said, there is still a lot of room for improvement in the NHS. The recent increase in spending has not always translated into improved performance. But the OECD data suggest that looking to the USA for ideas on how to improve the NHS, as our politicians all too often do, would probably not get us very far. I’m more interested in a country much nearer home. Finland has a similar life expectancy, a much lower infant mortality rate and more doctors and nurses per head than the UK, yet it spends even less proportionally than we do. Perhaps that is where the next government’s health ministers should be looking for inspiration as they work out how to get the NHS to do even more with even less.
Update: My comments about bloggers not picking this up were, perhaps, a little unfair. Liberal Conspiracy’s Nosemonkey is on the case too.
Update 2: Chris Dillow has posted about the OECD figures too – but then, you’d expect that, wouldn’t you?