HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, December 6, 2008

British Health Care v. American Health Care

Ezra Klein takes on Andrew Sullivan on health care and which system, the British or American, provides better results.  It is quite a fun read.  Here is Andrew Sullivan's view on why the British are more satisfied with their health care services,

Satisfaction is a subjective function of subjective expectations. If you have the kind of expectations that many Brits have for their healthcare system, it is not hard to feel satisfied. The Brits are very happy with their dentists as well. And there is a cultural aspect here - Brits simply believe suffering is an important part of life, especially through ill health. Going to the doctor is often viewed as a moral failure, a sign of weakness. This is a cultural function of decades of conditioning that success is morally problematic and that translating that success into better health is morally inexcusable. But if most Americans with insurance had to live under the NHS for a day, there would be a revolution. It was one of my first epiphanies about most Americans: they believe in demanding and expecting the best from healthcare, not enduring and surviving the worst, because it is their collective obligation. Ah, I thought. This is how free people think and act. Which, for much of the left, is, of course, the problem.

Ezra Klein responds,

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. . . . 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.

He further adds,

. . . the correct question is not whether Americans would want the National Health Service. The question is whether they'd want the National Health Service and a $4,000 check every year. 10 years under the British health system, and Americans would have an extra $40,000 per person (more if you account for inflation and spending growth). That's the choice. The British choose a more restrictive health care system -- and yes, the word is choose, they could vote to dismantle it, or fund it differently -- because that gives them a cheaper health care system. And I'm much less certain than Andrew that my countrymen have made some sort of explicit decision to demand the right to pay $4,000 more than the British for care that is not measurably better. responds,

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