Friday, 21 August 2009

Issues of health care

There has been a certain bemusement in the UK recently over the sudden American preoccupation with the British National Health Service. I followed the debate with some interest: these are important issues. I also have some familiarity with the private system: when we were in Lebanon the system was totally private. The result was that at the entrance of the American University Hospital casualty department two sombre signs were posted . The first read something on the lines of ‘No guns allowed beyond this point!’; the second, ‘Medical Insurance Essential’. Immediately beyond the signs was an armed guard and a cashier’s office to ensure that both these entry criteria were met.

Anyway, I have to say that most Brits I know were pretty indignant about the NHS being trashed on US television by those opposed to Obama’s health care reform package. Passing over the ridiculous assertion that Professor Stephen Hawking would not have been kept alive by the British system, when that is exactly what it has done, our indignation was aroused on a couple of counts.

The first is that on the whole the British system works very well, and when it comes to accidents and emergencies, extremely well. We get the odd horror story but in general the system is really very good at what we call A and E. One of its big plus points is that when you do get ill or injured the only thing that matters is the medical process. If you hear someone in the UK say ‘I can't afford to get ill’, 99 times out of 100 what they mean is ‘I can't afford to take time off work’, ‘I’ve a wedding to attend’ or ‘It’s the big match coming up’. It is also very good for long-term care. As some of you know, our first grandson (now a thriving one-year-old) has a major hormonal deficiency that will require him to be on replacement steroids and to have regular health checks for the rest of his life. The total financial cost to him and his parents of this condition is zero. Well given that all three of them have enough to deal with anyway, there seems a degree of justice in the state shouldering some of the burden. I don't mind my tax money going to that.

The second point of indignation centred on our perception of the existing US health system. Not having much experience of this, I do not wish to comment too much but it is a generally accepted truism that whenever you go to the States you make sure you have good health insurance. There is much that Americans may legitimately take pride in but I have never heard any American boast of their health system.

There is also much muttering in the UK over the perception (note, I choose my words carefully) that the protest against health care reform was being funded by the vested interests of the healthcare industries. Maybe I'm getting unusually cynical, but I too tend to take the old policeman's rule that when faced with a crime, you ask ‘who benefits?’.

However the venerable NHS is not perfect. There are two problems, which relate to the general Christian theme of these blogs, to which I have no easy answer. The first one is that the NHS was created after the Second World War for a population that was still largely speaking, Christian. They felt that life was inevitably tough (the war and rationing had reminded them of that) and they had little expectation of making it much beyond the biblical 70 years. They had, if you like, limited expectations of a Health Service: it was not expected to reverse the Fall. (It should also be said that in those days there was not a lot the health service could do anyway; I have read somewhere that in the first years of the National Health Service, there were only 27 drugs available to doctors.) The problem now is that people expect to live to 90 or more, with all their organs working perfectly, their looks preserved and preferably sexually active, all at the state's expense. (I hate to think of the number of drugs now available to the NHS, or their cost.)

My second concern, and I know it is shared by many people, is the extent to which we should bail out those who have effectively brought upon themselves self-inflicted injuries. I knew someone who courtesy of illegal steroid use during weight training destroyed his knees and put him and his family at the mercy of the state forever. A very large number of injuries received in our excellent accident and emergency wards over the weekend come about as a result of excessive alcohol abuse. And do I need to mention sexually transmitted diseases in unhealthy life styles? I do wonder if we had a private medical system, as we do with car insurance, such people would lose their ‘no claims bonus’ or its equivalent. But a totally free system is inevitably open to abuse.

Anyway I have no easy answers; the eternal Christian dilemma of balancing generosity and justice, fairness and forgiveness, persist. But I would cautiously suggest that, in both the UK and the US, we really need to do some careful and compassionate thinking about the way ahead.