Andrew Sullivan has been on a multi-day tear about health care reform in the United States, as compared with Great Britain.
One reason I'm a conservative is the British National Health Service. Until you have lived under socialism, it sounds like a great idea. It isn't misery - although watching my parents go through the system lately has been nerve-wracking - but there is a basic assumption. The government collective decides everything. You, the individual patient, and you, the individual doctor, are the least of their concerns. I prefer freedom and the market to rationalism and the collective. That's why I live here.
As a British ex-pat, Sullivan of course has something that many Americans don't have -- direct experience of the British healthcare system (as well as grave health concerns). But his ire toward NHC in Great Britian seems to be based on his own personal experience, rather than any analysis of the issues (and, let's face it, his own conservative ideological pre-disposition against government programs just on general principle).
Fortunately, Sullivan has posted several replies to his posts by those with more knowledge and sense than he has, and also provides a link to Ezra Klein's blog, which provides some much needed objective data:
Then we could ask the question: Do the Brits seems to be in worse health? Do they have a health care system that delivers worse outcomes? The answer to both is no. In the case of ill health, they're actually in much better health than their American counterparts, though that's a function of lifestyle more than hospital choice. And in the case of health outcomes, it sort of depends. You're probably better off getting your breast cancer treated in America and getting your diabetes treated in Britain. In the aggregate, however, the evidence is fairly clear that the British are better off. Health researchers look at a measure called “amenable mortality,” which refers "to deaths from certain causes that should not occur in the presence of timely and effective health care." In other words, deaths that are prevented by contact with the health care system. If Andrew is right that those stoic Brits just grit their teeth and bear their illness, this measure should be much higher in Britain than in the US.
But it's not. In concert with Andrew's thesis, Britain does indeed have a high rate of amenable deaths. Just not higher than ours. in 2002-2003, Britain suffered 102.81 amenable deaths per 100,000 citizens. America suffered 109.65. This doesn't totally eviscerate Andrew's assertion of cultural difference. It may be that Brits believe they should endure that many preventable deaths while Americans don't believe that but have such a bad health care system that they nevertheless beat out the Brits. But either way, the difference between the American and British health care systems is not that we are enjoying timely and lifesaving interventions while they are forgoing them.
It's unclear how Sullivan would respond to this. On the one hand, his conservative ideology presumes that government programs produce worse outcomes than private programs in the aggregate -- a presumption at odds with the data of most national healthcare systems as compared with the U.S. But on the other hand, his ideological commitment to private versus government solutions could lead him to conclude that the American system is preferable regardless of outcomes.
As for me though, ideology is irrelevant. We want a healthcare system that produces better outcomes, and that could be provided by almost any existing national health care system but our own.