World’s greatest healthcare (TM)

What does it mean when a US politician like Chris Christie tells the Republican National Convention the US has “the world’s greatest healthcare system”? Is it like when kids buy a “World’s Greatest Dad” mug for Father’s Day: An expression of affection for an ill-favoured thing, but mine own?

One of my formative political experiences was the summer during graduate school, when I listened on the radio to broadcasts of the US Senate debating the Clinton healthcare proposals. What struck me above all was how the senators universally (it seemed) invoked the unmatched excellence of American health care. “The envy of the world”, “best health care in the world”. The only difference of opinion was, of course, that opponents of the reform said that tinkering with this paragon of perfection would inevitably be disastrous, while supporters argued for making this blessing available to more people.*

So, the politicians certainly appear to believe it, and to believe that it should have policy implications; or to believe that a significant portion of the public believes it; or to believe that a significant portion of the public will respond favourably to the assertion, even if they suspect it is untrue. Is it cognitive dissonance? We’re America dammit, and being the sort of people we are, we certainly wouldn’t put up with a ramshackle healthcare system.

Continue reading “World’s greatest healthcare (TM)”

Will small hospitals kill you?

Disquisition on medical statistics in The Guardian

A recent front-page article in The Guardian claimed to show that small NHS hospitals are killing people. “Huge disparity in NHS death rates revealed” was one headline. “Patients less likely to die in bigger hospitals“. “Safety in numbers for hospital patients” is another headline. The article makes no secret of its political agenda: “The results strongly suggest that smaller units should close. This presents a major challenge to the health secretary, Andrew Lansley, who has stopped all hospital reorganisation.” Online, Polly Toynbee decries “Hospital populism”, saying “Local hospitals may be loved, but they can kill.” Wow. That’s pretty bad. Here’s the schematic of the story: Smart and selfless experts want to save lives. Dumb public clings to habit (in the form of community hospitals). Evil politicians pander to dumb public, clings to campaign promises. “The health secretary, Andrew Lansley, has now put the project on hold, in line with his election promise to halt hospital closures, to the dismay of experts who believe that lives will continue to be lost.”
Continue reading “Will small hospitals kill you?”

In praise of the National Health Scapegoat

All over the world babies are babies, and birth is birth, but having a baby in Oxford is certainly quite a different experience than having a baby in California. The comparison is mostly favourable to Oxford, in our experience. The prime directive of the NHS (which recently celebrated its 60th anniversary) is borrowed from Douglas Adams: Don’t Panic.

The NHS is a great success by any definition. When you factor in the constitutional niggardliness of the British taxpayers and Her Majesty’s government — leading the UK to spend per capita on healthcare substantially less than half what the US spends, and much less than any major industrialised country except Japan — it seems a veritable miracle of efficient socialism. Whereas health research in the US is dominated by the profit motive, producing marginally improved drugs at breathtakingly higher prices*, the NHS has a brilliant record of pioneering cost-effective healthcare solutions, which may be individually trivial, even slightly absurd, but which together add up to systematic and measurable improvements in public health. (For example, this scheme to prevent complications due to chronic lung disease by providing patients with automated telephone warnings of impending cold snaps. Or something as simple as reducing infections by requiring doctors and nurses to wear short sleeves.) Continue reading “In praise of the National Health Scapegoat”