Uni­ver­sal health care a no-brainer


It be­gan, as so many things do these days, with a Don­ald Trump tweet.

Frus­trated by his in­abil­ity to kill the ‘Oba­macare’ ex­pan­sion of pub­lic health­care pro­vi­sion in the United States, Trump seized on a protest about the un­der-fund­ing of Bri­tain’s Na­tional Health Ser­vice (NHS) in Lon­don last Satur­day to trash the en­tire con­cept of uni­ver­sal health­care paid out of taxes and free at the point of de­liv­ery.

‘‘The Democrats are push­ing for uni­ver­sal health­care [in the US] while thou­sands of peo­ple are march­ing in the UK be­cause their sys­tem is go­ing broke and not work­ing,’’ he tweeted.

It was an awk­ward mo­ment for Bri­tain’s Con­ser­va­tive Prime Min­is­ter, Theresa May, who tries to avoid crit­i­cis­ing Trump when­ever pos­si­ble, so she let her health sec­re­tary, Jeremy Hunt, re­spond in­stead.

Hunt tweeted back that while he dis­agreed with some of the pro­test­ers’ opin­ions, ‘‘not ONE of them wants to live in a sys­tem [like the US] where 28 mil­lion peo­ple have no cover ... I’m proud to be from the coun­try that in­vented uni­ver­sal cov­er­age – where all get care no mat­ter the size of their bank bal­ance.’’

It’s true. The Bri­tish pop­u­la­tion is grow­ing older and needs more health ser­vices, but Con­ser­va­tive govern­ments over the past seven years have not raised spend­ing on the NHS to match. As a re­sult, many peo­ple are dis­sat­is­fied with the grow­ing de­lays in treat­ment, but the NHS is the most beloved in­sti­tu­tion in the United King­dom. Not one per­son in a hun­dred would want to re­place it with a pri­va­tised, in­surance-based sys­tem.

A huge con­tro­versy rages per­ma­nently in the US over pub­lic vs. pri­vate spend­ing on health­care, with the Repub­li­can al­ways try­ing to cut the share paid out of taxes by fed­eral and state govern­ments (cur­rently about half). But there is no equiv­a­lent con­tro­versy else­where.

Ev­ery other de­vel­oped coun­try has a uni­ver­sal health­care sys­tem – and in an eleven-coun­try study pub­lished by the US-based think­tank The Com­mon­wealth Fund last sum­mer, the US came dead last in terms of safety, af­ford­abil­ity and ef­fi­ciency. The con­trast is par­tic­u­larly stark in the dif­fer­ences be­tween the US and the UK.

Amer­i­cans spend twice as much per capita as Bri­tons on health­care. Health ser­vices ac­count for an as­ton­ish­ing 17.2 per cent of Amer­i­can GDP (the high­est in the world), com­pared to 9.7 per cent in the UK. Yet the Bri­tish sys­tem delivers bet­ter re­sults: life ex­pectancy at birth is al­most three years higher in UK (81.4 years, com­pared to 78.8 years for Amer­i­cans).

To be fair, it’s not only the NHS that en­ables Bri­tish peo­ple to live longer. They are less obese than Amer­i­cans (23 per cent of English adults have a body mass in­dex of more than 30, com­pared to 32 per cent of Amer­i­cans). The mur­der rate in the US is five times higher than it is in the UK. But even if av­er­age life-spans were iden­ti­cal in the two coun­tries, Amer­i­cans would be pay­ing twice as much for the same re­sult.

There re­ally is no con­tro­versy: uni­ver­sal health­care is bet­ter. Since half of that enor­mous Amer­i­can spend­ing on health goes to profit-mak­ing en­ter­prises like in­surance com­pa­nies, there is an im­mensely rich and pow­er­ful lobby fight­ing to keep the pub­licpri­vate con­tro­versy alive in the United States, but else­where, even in much poorer coun­tries, it is a no-brainer. Like in In­dia, for ex­am­ple.

In­dia, which re­cently over­took China to be­come the world’s most pop­u­lous coun­try, is still rel­a­tively poor (al­though its econ­omy is now grow­ing at over 7 per­cent an­nu­ally). Last week in the In­dian par­lia­ment, Fi­nance Min­is­ter Arun Jait­ley an­nounced a new gov­ern­ment ini­tia­tive that will pro­vide the poor­est 100 mil­lion fam­i­lies (half a bil­lion peo­ple) with up to $7800 an­nu­ally to cover hos­pi­tal­i­sa­tion costs in case of se­vere ill­ness.

‘‘This will be the world’s largest gov­ern­ment-funded health­care pro­gramme,’’ he told par­lia­ment. ‘‘The gov­ern­ment is steadily but surely pro­gress­ing to­wards a goal of uni­ver­sal health cov­er­age.’’ Peo­ple are al­ready calling it ‘‘Modi­care’’ (af­ter Prime Min­is­ter Naren­dra Modi), and it does bear more than a pass­ing re­sem­blance to Oba­macare.

In­dia cur­rently spends only one per­cent of its GDP on health­care, so there’s still a very long way to go – and as al­ways in In­dia, the tricky bit is ac­tu­ally im­ple­ment­ing the pro­gramme, espe­cially in the ru­ral ar­eas. (Free gov­ern­ment hos­pi­tals are mostly in the cities.)

Di­ag­nos­tic tests, doc­tor fol­lowups, ba­sic medicines (like statins for heart dis­ease or di­a­betes con­trol) and post-op­er­a­tive home care are not cov­ered by the $1.7 bil­lion scheme. Pri­vate hos­pi­tals and clin­ics are still not prop­erly reg­u­lated, and fre­quently over­charge. Poor fam­i­lies deal­ing with a ma­jor ill­ness of­ten end up in the hands of money-lenders, and even in gov­ern­ment-run hos­pi­tals bribes are some­times nec­es­sary to get good treat­ment.

All that said, the di­rec­tion of travel is clear, and maybe in a cou­ple of decades In­dia will have a uni­ver­sal health ser­vice like the NHS. Beloved, in other words.

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