Posts Tagged ‘US healthcare’

President Obama tries to revive healthcare reform

BBC Health - 23rd February 2010 10:05 am

US President Barack Obama has unveiled new plans to reform US healthcare and revive stalled legislation on the issue, aiming for bipartisan support.

Mr Obama’s proposal “helps over 31 million Americans afford healthcare who do not get it today - and makes coverage more affordable for many more”, the White House said on its website.

It gives the federal Health and Human Services Department - in conjunction with state authorities - the power to deny substantial premium increases, limit them, or demand rebates for consumers.

This comes after one of the biggest companies, Anthem Blue Cross of California, announced it would raise premiums by as much as 39% from 1 March.

Mr Obama’s latest plan requires most Americans to take out health insurance coverage, with federal subsidies to help many afford the premiums.

It bars insurance companies from denying coverage to people with existing medical problems or charging them more.

A tax on high-cost health insurance plans objected to by House Democrats - and trade unions - is to be scaled back.

On Thursday he will hold bipartisan talks at the White House on the issue.

The Republican reaction to Mr Obama’s efforts has so far been critical, with House Republican leader John Boehner saying the proposals took the same approach as that of previous Democratic bills.

Read more at BBC Health.

Learning points from Obama’s bloody nose

By Tom Goodfellow - 22nd January 2010 11:01 am

Many of us in the UK, although admitting the manifold weaknesses of the NHS, are totally bemused by the violence of the opposition to President Obama’s healthcare reforms.

The good folk of Massachusetts have just delivered him a severe bloody nose by electing a largely unknown (other than for his nude pose in Cosmopolitan) Republican senator. This is sad, but if the majority of Americans chose to have a system which provides phenomenally good healthcare for those who can afford it while providing Third World medicine for those who cannot, then surely that is their issue! After all in the land of the free you should be free to chose, even though your choice effectively deprives millions of others of any choice at all.

Medical bills are the highest cause of bankruptcy in the US. But hey, if they cannot afford to support themselves or their family then they must be the undeserving poor for “The greatest of evils and the worst of crimes is poverty” (G B Shaw, Major Barbara). So why should this bother me?

But in some strange way it does! It is not the ludicrous comments made by the likes of Sarah Palin (pit-bull in lipstick) on the NHS “death panels” that upset me, or the assertion by the Republican right that Prof. Stephen Hawking would long since have died had his care been left to the NHS. We all know that Middle America, fed on a diet of Fox News (an oxymoron if ever there was one), is largely unaware of the world beyond its own back yard (it is said that many Americans only learn world geography through the countries they invade).

However it is too easy to ridicule Palin, and the views she represents. Many millions of Americans regard her as a cross between Princess Diana and Joan of Arc (although thinking about it most of them are unlikely to have heard of St. Joan - she never appeared on Oprah).

What really troubles me is the fact that to some extent I agree with them! The Republicans hate what they term “big government” and they profoundly resent the interference of politicians in healthcare matters. Does this ring a bell?

When Blair came to power, recognising that the NHS was chronically broke, he significantly increased funding (a good thing). But then he could not leave it alone and imposed his top-down, command and control, micro-management culture. Thatcher was almost as bad!

The results are MTAS, MMC, WTD, revalidation, endless standards and regulations, the Care Quality Commission (and its predecessors), process and outcome measures, a legally binding NHS constitution, Lord Darzi and, of course, targets.

Don’t get me wrong. I think the American healthcare system is vile and a disgrace to a supposedly fair and democratic society. But I do wish our politicians would back off the NHS for a bit and let us get on with the job.

Obama healthcare bill passes vital US Senate vote

The Guardian - 21st December 2009 5:42 pm

US healthcare reforms backed by Barack Obama passed a vital vote in the Senate , clearing the way for a bill to be passed before Christmas.

In the early hours a procedural measure to block Republican delaying tactics was passed in a 60-40 vote, with unanimous Democrat backing.

The vote all but assures the passage of healthcare reforms through the Senate, a feat that eluded generations of Democrats.

“We’ll get this passed before Christmas and it will be one of the best Christmas presents this Congress has ever given the American people,” Democratic senator Tom Harkin said.

The bill will provide 30 million uninsured Americans with health cover.

In 13 hours of dramatic talks on Friday, the Democratic leadership was forced to accept further whittling down of the bill at the hands of Bob Nelson, an outspoken anti-abortionist. Provoking a storm of protest from pro-abortion groups, Reid placated Nelson by introducing an amendment that would ensure no federal money was spent subsidising abortions.

Read more at The Guardian.

Health pressures mount globally for the big economies

By Mike Broad - 5th October 2009 3:50 pm

A report by the Economist Intelligence Unit examines the challenges facing different healthcare systems around the world.

For all the different permutations in healthcare systems around the world, the report - called Health reform: the debate goes public - suggests policymakers face several broadly similar challenges.

These are namely spiralling costs and increased demand. These factors are creating pressure just as the worst economic downturn in decades is stretching budgets. The need for healthcare reform is evident and in some countries, including the US and the UK, increasingly urgent.

As President Obama has suggested, unless major changes are implemented soon costs could severely cripple the world’s biggest economy. In the UK, the NHS Confederation recently warned that the NHS could face real-term funding reductions of up to £10bn from 2012.

For political leaders grappling with tight budgets in a financial downturn, health is simply too big an issue to ignore, the report says. Healthcare is forecast to account for a whopping 16.3% of GDP in the US in 2009, about 10.6% of GDP in Germany and 9.9% of GDP in the UK. Even in India, a country long criticised for under-investing in health and social services, the World Health Organisation forecasts that healthcare will account for about 5% of GDP in 2009.

Healthcare systems are complex, enormous and unwieldy, whether they are state-managed monoliths, such as the UK’s, or dominated by the private insurance sector, as in the US. The report says they are traditionally slow to adapt to change, but now those immovable objects are being forced to confront not just one, but several irresistible forces: demographic (ageing populations), epidemiological (increasing incidence of chronic diseases), technological (more expensive drugs and technologies) and economic (global recession, high public debt, smaller pensions).

These forces cannot be ignored. But try telling the end-users of healthcare about these pressures, and they will be nonplussed.

This report is based on a survey of four large economies - the US, UK, Germany and India - and what their public thing about their healthcare systems.

The findings show clearly the kinds of dilemmas faced by healthcare policymakers who seek to implement reforms.

The starkest example emerges when respondents were asked in basic terms about their expectations for choice and cost in healthcare. Globally, 83% of respondents say that they would prefer to shop between a range of options in order to get the best treatment. At the same time, however, more than half say that they are not prepared to pay more to get a better healthcare service, whether in the form of taxes, fees at point of provision or fees to insurers.

Consumers want choice - but are not prepared to pay for it.

The survey shows that citizens’ expectations for healthcare are high - not just in developed countries, which have been used to high standards of care, but also in developing countries such as India, where people are becoming accustomed to better standards.

Globally, the public want access to the latest treatments, timely, affordable care, and a range of choices. They are better informed than ever about their health and their treatment options. They are prepared to take some responsibility for their own health, but broadly they do not want to have to pay a lot more than they already are for their healthcare. If they are unhappy with aspects of their healthcare, they largely lay responsibility at the feet of their governments.

Key findings

The survey finds that:

1. Governments get a thumbs-down on their handling of healthcare. Not surprisingly, the economy and jobs are seen by respondents as the most important issues for their government, but healthcare takes second billing in the US, Germany and India - ahead of education, the environment, crime, defence and housing.

In the UK it comes third, after crime, but 29% of Britons are generally more inclined to think that their government has the right approach to healthcare. By contrast, just 8% of Germans think their country is on the right track, whereas 62% think their government has the wrong approach, as do nearly half of American respondents.

2. If patients are now customers, they are not happy ones. When it comes to healthcare, Americans, arguably, have more choices than citizens of most other countries. However, when asked to indicate their levels of satisfaction with a range of aspects of healthcare (such as waiting times, quality and availability of care and doctors, cost of treatment and medicine), almost one-quarter of Americans say they are not satisfied with any.

That was an even higher figure than in the UK (15%), where patients have far less choice. That does not mean Americans believe they receive poor quality care; compared with other countries, more US respondents are satisfied with the quality of their doctors, with waiting times and with general quality and availability of healthcare.

Strikingly, about one in five respondents across the global sample say they are not satisfied with any aspect of their country’s healthcare system.

3. Some patients are more empowered than others. Only one-quarter of UK respondents feel they have much control and influence over where and how they are treated, compared with 64% of Americans.

Nearly 60% of British respondents say that they are not encouraged to choose from a range of doctors or hospitals for their treatment. The UK government’s recent about-face, allowing patients to choose between public and private healthcare, without losing access to the NHS, appears to be a welcome one - three out of four respondents say that they would compare services to get the best possible treatment.

Meanwhile, US residents are more optimistic (74%) than those in the UK (61%) or Germany (38%) that they will get prompt, effective treatment if they become ill. Some 74% of Americans, however, say they are concerned about being able to afford that treatment - far more than Germans (55%) or Britons (50%).

4. Britons are not keen on fees, but are more relaxed about tax. UK citizens are less keen than people elsewhere on the idea of paying fees at the point of provision (co-payments), or to insurers, for an improved healthcare service. However, the survey found that more Britons (27%) would be willing to pay higher taxes for improved healthcare services than would Americans (15%) or Germans (9%).

Meanwhile, nearly 45% of Britons say that they would not be willing to pay anything extra, compared with 61% of Americans and 64% of Germans. The British are also wary of the notion that greater private-sector involvement would improve the country’s healthcare system, perhaps not surprising given that private healthcare takes up a relatively small amount of the country’s healthcare expenditure.

5. German gloom spells a warning to reformers. Germany began reforming its healthcare system a decade ago. Since then, according to Economist Intelligence Unit data, Germans are living longer and pay less for their healthcare than many of their neighbours. However, German citizens’ doubts about their healthcare system permeate the survey, just as German healthcare professionals revealed their pessimism in a separate survey earlier this year.

Far fewer German citizens (38%) than those elsewhere are optimistic that they will get prompt, effective treatment, more than half are worried about the costs of getting treatment, and far more (79%, compared with 57% in the UK and 36% in the US) feel their healthcare professionals are working too many hours to be effective.

The way forward

Against all this, the report claims policymakers are floundering to come up with solutions. They need to find a way to strike a grand bargain with patients, who are no longer simply passive recipients of care, but increasingly active consumers of health services.

The key issue is not necessarily one of knowing which reforms to implement. No matter how sensible reform plans may sound, there is generally one important stakeholder who remains unconvinced: citizens.

There is a big gap between policymakers and consumers when it comes to appetite for health reform. The first group sees it as an essential way to relieve financial and social pressures, while the second is afraid that they might lose what they currently have.

Consequently, selling healthcare reform is not a task for the faint-hearted. Even Mr Obama, who campaigned successfully on the issue in his presidential campaign, has struggled in his bid to implement a fairer system in the US.

The example of Germany, which implemented major reforms a decade ago, but whose citizens remain broadly pessimistic about their healthcare and distrustful of those who manage it, serves as a warning to would-be reformers.

If they are to be successful, policymakers must be prepared to be thick-skinned and patient, and to avoid quick fixes, the report concludes.

The results of broad-based reforms are unlikely to be seen overnight: South Korea’s plan to introduce universal healthcare coverage began in 1977, and is still being developed today. The UK, it says, has pumped millions of extra pounds into its NHS in the last decade, but it may be that the country’s more subtle reform strategies, such as patient-reported outcome measures, will be the ones that have most impact on cost containment and patient satisfaction in the long term.

Read the full report.

NHS consultants refute Republican lies in the US

By Mike Broad - 15th September 2009 10:06 am

Over 100 NHS consultants have signed a letter which has been sent to leading political figures in the US correcting misconceptions about the NHS propounded by republicans in their health care debate.  

The letter strives to set the record straight. It says: ‘No one is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don’t pay for their medication from the NHS.’

The letter has primarily been sent to democratic Senator John Kerry in the US, who called for the lies about healthcare to be refuted.

Republicans have accused the NHS of being Orwellian, Marxist, and presiding over ‘death panels’ that decide which patients should live. The debate was fuelled by Conservative MEP Daniel Hannan who, when interviewed on US television, described the NHS as “a 60-year mistake”.

It also suggests the NHS is good value for money. ’The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million underinsured.’ 

The letter criticises the US health care system, particularly about the standards of care for those with pre-existing conditions. ‘In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers.

‘The NHS is literally a life saver for those with pre-existing health problems - they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.’

It was signed by senior figures from the medical profession including Sir George Alberti, past president of the Royal College of Physicians and dean of Newcastle School of Medicine, Professor Andrew Boulton, professor of medicine at the University of Manchester and Sir Alexander Macara, chairman of the National Heart Forum.

Co-author of the letter Dr Jacky Davis, consultant radiologist and co-chair of the NHS Consultants Association, said: “The US healthcare system makes trillions of dollars in profits every year, some of which finds its way into the pockets of politicians and lobbyists. The new proposals threaten these profits and their recipients.

“In addition, the American right sees this issue as a way to bring President Obama down, so it is not surprising that this toxic mix of vested interests has organised a campaign of misinformation on the subject, including outright lies about the NHS. This letter is an effort to refute the lies.

Read a full account of the letter.

British consultants set the record straight in US health debate

By Mike Broad - 14th September 2009 9:43 am

Members of the public and politicians all twittered their support for the NHS when it was criticised by American Republicans this summer, but a group of consultants has taken a more direct approach.

An open letter - signed by over 100 doctors - has been sent to democratic Senator John Kerry in the US seeking to correct misconceptions about the NHS. It was sent to Senator Kerry because he had called for the lies about healthcare to be refuted.

As part of the current healthcare debate over ‘Obamacare’ in the US, Republicans have accused the NHS of being Orwellian, Marxist, and presiding over ‘death panels’ that decide which patients should live. The debate was fuelled by Conservative MEP Daniel Hannan who, when interviewed on US television, described the NHS as “a 60-year mistake”.  

The letter strives to set the record straight. It starts by emphasising that NHS patients are given choices about their care. It explains, for example, that termination of a pregnancy is a personal decision if approved by two doctors. ‘No board or organisation of any kind makes any decision about termination for fetal abnormality.’

On the treatment of older people the letter says: ‘Elderly people can get counselling and advice to help them determine their requirements for their future care, but only if they wish it.’

And describing primary care it states: ‘Patients are normally registered with a family doctor practice of their choice. A patient is able to see a doctor immediately for urgent care in general practice although seeing his or her own family doctor for non-urgent care may require waiting a few days. If the patient requires referral for specialist opinion or treatment, they can choose whichever hospital they prefer.’

Chuck Grassley, the most senior republican on the Senate finance committee, was the most provocative of the US critics. He said that then ailing democratic colleague, Edward Kennedy, would have been left to die untreated from a brain tumour in the UK on the grounds that he would be considered too old.

The letter tackles this claim head on: ‘There is no cut-off age for health care in the NHS. Senator Kennedy, like anyone else of that age, or older, and with health problems such as his, would have been treated by the NHS with the same high levels of care as someone younger…Many hospitals now offer “hospital to home” programs for palliative and end of life care to enable very ill people to remain at home.’

It also says: ‘There is no “death panel” in the UK NHS or anywhere else in the UK health care sector.’

American papers also claimed that Stephen Hawking wouldn’t survive if his care was managed by the NHS - an accusation he was quick to refute. 

The letter says: ‘Professor Stephen Hawking of Cambridge University, recently awarded the Presidential Medal of Freedom by President Obama, is disabled and has always been under the care of the NHS. Professor Hawking is an outspoken admirer of NHS care. Like thousands of others who are disabled, he is entitled to free medical care and medicine, and he can get adaptions, equipment and home care to allow him to live at home.’

And the issue of rationing was addressed. ‘No one is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don’t pay for their medication from the NHS.

‘88% of medicines are dispensed without charge. For the minority who pay there is a standard charge of $11 dollars per prescription, regardless of the real cost of the drug. Some parts of the UK have abolished prescription charges altogether.’

There is also criticism of the US health care system, particularly about the standards of care for those with pre-existing conditions. ‘In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers.

‘The NHS is literally a life saver for those with pre-existing health problems - they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.’

A brief description of the NHS and its origins is included and points are made about patient satisfaction and relative costs.  ‘The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million under insured.

‘Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS. On average, British users of the NHS live longer and have a lower infant mortality rate than the US,’ it says.  

The letter was signed by senior figures from the medical profession including Sir George Alberti, past president of the Royal College of Physicians and dean of Newcastle School of Medicine, Professor Andrew Boulton, professor of medicine at the University of Manchester, Professor Mark Gabbay, professor of general practice at the University of Liverpool, Professor Eileen O’Keefe, professor of public health at London Metropolitan University, and Sir Alexander Macara, chairman of the National Heart Forum.

Co-author of the letter Dr Jacky Davis, consultant radiologist and co-chair of the NHS Consultants Association, said: “The US healthcare system makes trillions of dollars in profits every year, some of which finds its way into the pockets of politicians and lobbyists. The new proposals threaten these profits and their recipients.

“In addition, the American right sees this issue as a way to bring President Obama down, so it is not surprising that this toxic mix of vested interests has organised a campaign of misinformation on the subject, including outright lies about the NHS. This letter is an effort to refute the lies. We cannot tell Americans how to reorganise their healthcare but we can at least help them have a debate based on facts rather than lies, distortions and selective use of statistics.”

The letter has also been sent to a number of American politicians, newspapers and the AARP.

Read another consultant’s blog on the issue.

Read the full letter as it has been presented in the US.

Oi, moose face, leave my NHS alone already

By Sarah Burnett-Moore - 25th August 2009 8:33 pm

Sarah Palin is closest proof that one can have that scientologists have been right all along. Having tried, almost single-handedly, to destroy the entire credibility of the American nation at the last election, now she’s got her moose-blood stained hands wrapped firmly around the throat of the NHS. 

You can call the NHS many things (and over the years I certainly have) such as: inconsistent, inadequate or 

downright incompetent in parts, but you cannot use a term like evil.

That such a spectacularly ignorant woman can be given any sort of international forum from which to spout her particular brand of Alaskan nonsense. Having said that, I quite like the sound of the NHS ‘death panels’ that she claims exists. I wonder what these might be? I know much NHS decor is woeful, but to call panels deathly is taking it too far.

It all sounds very Harry Potter…Little Andy Burnham and the Deathly Panels…Peter Mandelson would obviously be Lord Voldemort.

Mind you, the Yanks love Harry Potter, so maybe we could use that to sell them the concept of the NHS. Harry Potter and the Urologist’s Stone, Harry Potter and the Prisoner of Ara Darzi, Harry Potter and the Half Blood Transfusion…I’d go on but my husband is begging me to stop, and if you’re reading this out loud I expect your spouse is too. 

I assume she is thinking more along the Logan’s Run theme, panels to judge who is no longer useful to society.  Personally I would put Alan Rickman in charge, that should appeal to Americans as well, we know how Hollywood loves a British villain. Or we could have an NHS version of Running Man, then Arnold Schwarzenegger could compete for his life against other contestants chosen by the NHS staff. My guess is that every health secretary for at least the last decade would be suggested for the first episode.

The NHS is staffed by people who fundamentally have patient’s best interests at heart, and who do the best job that they possibly can with limited resources, both financial and human. So Moose Face, leave my NHS alone.

The NHS needs economy and business class

By Paul Thorpe - 24th August 2009 3:31 pm

So, the evil Tory party has been ‘exposed’ as not supporting the NHS.

Sixty per cent of Tory MPs have admitted in a survey that we should support giving tax relief to those who buy private health insurance, which has been extrapolated by those who commissioned the study as leaving their policy statement of supporting the NHS as being “in tatters”.

On the other hand, only 1% of New Labour MPs were allowed by Gordon and Peter to agree, the other 99% suggesting that it was fine to tax the rich to the hilt, so long as their own  healthcare insurance wasn’t affected. And a slightly fuzzy number of Lib Dems thought it might or might not be a good idea. Possibly.

Forget the argument in the US that the NHS is an evil government behemoth that has “death lists”, and must be resisted at all costs to allow the free market economy to flourish unchecked in healthcare. How have we let ourselves get to the polar situation that any support for the private sector is somehow an assault on the concept of universal healthcare, free at the point of access?

When you fly abroad, you can fly in economy. You, and your luggage, still usually get there, they show you a film, feed you and give you a seat. The fact that you can choose to fly in club, with a range of movies, a more comfy seat and nicer food - and pay more for the privilege - does not seem to be an assault on our right to go on holiday.

Interestingly, if you have a crap pilot, your chance of having a bad landing or crash is as likely in first class as in cattle class - a good analogy to the surgeons who maintain both a good NHS and private surgical practice.

So, if someone wants to pay extra to ensure that they see a consultant, have a nicer waiting room, a private room with a TV and a bowl of fruit, should they not be allowed to do so? Given that they actually take some of the pressure off the NHS system, by removing themselves from NHS clinics and waiting lists for investigation or treatment, should they not receive some recognition for that from the Inland Revenue to say: “Yes, we know that you are taking some financial responsibility for your own healthcare”?

In other countries, this is a no-brainer. In Australia, if you have a condition requiring emergency treatment, you generally get treated quickly and efficiently. If you have an elective condition, you wait…often years. If people complain about this, they get short shrift. “If you want quick elective treatment, get health insurance”. No-one seems to complain - they know the score.

Unfortunately, in the UK, the government has promised the public a universal healthcare system, with waiting times that challenge the private sector, and salubrious surroundings to boot. It costs a fortune and is undeliverable. Let’s stop pussy-footing around this and tell the truth.

No matter how socialist your ideals, let’s admit that a fully functional modern health care network cannot be delivered just through public funding, and let’s allow the two  systems to symbiotically develop, while educating the public of the need to take a bit more physical and financial interest in their own healthcare.

Labour not Tories to blame for privatising the NHS

By Dr Tom Goodfellow, consultant radiologist in the West Midlands - 18th August 2009 11:07 am

I got onto Any Answers? (again) after last Saturday’s Any Questions? on Radio 4. What got my goat this time were the comments of a panel member, Bob Crow, leader of the RMT union, who was described as a “communist/left wing socialist”.

In response to the fairly predictable question comparing the NHS and the US healthcare systems he managed to get in a diatribe against the Conservatives. David Cameron and his team, he insisted, hated the NHS and were going to sell it off the private sector. We could not trust them with the future of the NHS!

Excuse me but which planet has this guy been living on for the last 12 years? New Labour has taken the NHS further down the privatisation road than anyone could have imagined. They have paid between £5bn and £7bn to private companies, much of this very questionable value for money and with some very dubious clinical outcomes. Tony Blair seemed to fall in love with the private sector, as did a number of health secretaries who landed very lucrative personal contracts as advisers to private companies six months after giving up the job. So the idea of the NHS as “safe in our hands” is questionable to say the least.

Having said this, I doubt that an incoming Conservative government would change much.

The NHS is heading for a major financial meltdown for all the well-rehearsed reasons and changes in the way it is funded and managed. We have already accepted the principle that many of us will need to fund our own dental care from now on and I suspect that other aspects of healthcare will soon follow.

Perhaps the current debate with our US cousins over the differing types of provision will stimulate a healthy debate. As doctors we must be part of the solution, not part of the problem.

- Tom Goodfellow’s comments on Any Answers? are aired after 8 mins 45 secs of the programme if you want to listen.

Motherhood and apple pie and the NHS

By Katherine Teale - 10:31 am

Like others, I was a bit put out this week to learn that I’ve spent 20 years working in an “Orwellian”, hopelessly outdated organisation which we shouldn’t wish on anyone, otherwise known as the “the NHS”.

One of the features of the NHS, apparently, is that patients have to sit in front of a “death panel” which decides whether they deserve treatment. A straw poll amongst colleagues failed to identify anyone familiar with this process, although several did comment that they quite liked the idea.

Old people, Americans are told, are routinely denied treatment as their lives are not deemed to be worth preserving. Although really it’s amazing that anyone survives long enough to reach old age under such a system, which should obviously be abolished immediately.

Of course, dismantling the NHS isn’t a new concept: New Labour thought of it quite a while ago. I’m sure it seems a perfectly sensible idea if you 1. believe everything you hear on Fox News 2. stand to make a lot of money out of private health care, and 3. are sufficiently wealthy to afford health insurance and insufficiently imaginative to conceive of ever not being.

Criticism from a country whose life expectancy is shorter and child mortality higher than our own and all for twice as much per head, reminds me of the time my mother, who’s never really got to grips with the Highway Code, offered to buy me some Advanced Driving lessons (the difference being that in Mum’s case I had to pretend to be grateful).

We, on the other hand, are very fond of criticising the American health care system, but  do so from an informed position, as we’ve all watched ER and some of us have even seen Michael Moore’s “Sicko”.

Come to think of it, the American health care system features quite regularly in American films (serious Jack Nicholson fans like me will recall “As good as it gets” in which his waitress friend can’t pay her son’s medical bills). Strangely, British film makers aren’t queuing up to slag off the NHS, which may explain why American criticisms seem to be based on the fevered imaginations of right-wing republicans, someone from Fox News who once read 1984, and a few Tory MPs including one MEP living in Brussels, which is probably the nearest any of them have ever been to a British public institution. 

Of course there is one area where the American system is really far superior to the NHS, and that’s enabling lots of people to make very large amounts of money out of it. The NHS is really very bad at this, and that is the real reason why many people wish to make fundamental changes to it, and why many in America are so frightened of it.

The NHS isn’t perfect, but it’s one of the best things about living in this country. So next time the Americans want to play political football (sorry, soccer) with the NHS, just lay off one of our national treasures - otherwise we might just start picking on one of theirs, if we can think of any. Anyone got some lurid stories about Mickey Mouse?