Thursday, November 20, 2008

US health debate that will impact on us all. 

It is looking more and more certain that the new US administration will make a big push on health reform in 2009. This will be a huge domestic debate in the USA that will have big international repercussions. Our own dear NHS will certainly figure in this debate as an inspiration or bogey as participants choose. So it might be well worth our while to keep in touch with what is going on.

Who know we might learn something – pick up ideas for change or perhaps even learn to appreciate more what we have got.

According to the Boston Globe

Senator Edward M. Kennedy, who made clear that universal healthcare is his top priority when he returned to work Monday in the Senate, announced today that three working groups of the committee he heads will explore key issues.
One group, led by Senator Tom Harkin of Iowa, will work on prevention and public health. Another led by Senator Barbara Mikulski of Maryland will work on improvements in the quality of care. And the third, led by Senator Hillary Clinton of New York, will work on insurance coverage.

The emphasis seems to be on a big push not only from the incoming White House but from Congress as well, in order to prepare the ground thoroughly for radical reform that will get enacted and survive.

An example of this is the Nov 13 2008 issue of the
New England Journal of Medicine which has a long section devoted to primary health care, including a comparative study of the situation in the USA and the UK.

One of the
cited studies makes the point that Britons tend to have superior health to US residents in an equivalent social and economic bracket. In other words the sector of the US population that has almost universal comprehensive health insurance still fares worse in terms of health outcomes than their UK economic counterparts. A possible implication is that the NHS primary care approach has direct health outcome advantages over and above simple access to available health resources.

The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. ….In many diseases, the top of the SES distribution is less healthy in the United States as well.
Banks et al
Journal of the American Medical Association vol 295 No. 17 May 3 2006

Something we are doing right to be protected and nurtured?

Direct international impacts? Well, one consequence of a shift from the employer-funded insurance model in the USA would be an increase in competitiveness for US industry which would no longer have to factor health costs into its prices in the direct way it does at this moment. So US industry would be better able to compete in our markets. Another would be to change the financial position of the pharmaceutical industry which might find the USA a less receptive market for price maximisation. Will they try to recoup elsewhere?

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