Healthy Choices

David Smith of The Guardian recently described the President of the United States’ use of Twitter as an ‘unrivalled glimpse into [his] id’ – and I have yet to find a more apt descriptor. Despite my own usual disdain for his problematic rhetoric, I have become fascinated by Trump’s almost constant churning out of 140-character tirades of vitriol and propaganda. Almost any thought that occurs to him seems to be sent directly into cyberspace, from apparently random statistics without sources to bizarre late-night accusations-turned-typos. He rarely edits or corrects himself, and never admits to being wrong. What is most astonishing is how often the man simply lies, as if he is so unafraid of retribution that he does not feel the need to use a quick Google search to remedy an error, let alone hire a fact-checker. The left-wing media seem to have grown almost ambivalent to this, ubiquitous as it has become, realising perhaps that pointing out his untruths does nothing except give the President what he wants: attention.

Yet, sometimes Trump’s claims need greater dissection. Sometimes, whether through chance or moment of competency, the President manages to make potentially relevant analyses of world event. In these cases, the division between truth and lies is less clear, whether by chance or deliberately. Here is a tweet from 5 February which has provoked a great deal of reaction in the UK and elsewhere:

The Democrats are pushing for Universal HealthCare while thousands of people are marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!

The president’s claim is indubitably guilty of over-simplifying things. The march at the start of February in London actually was about budget cuts proposed by Health Minister Jeremy Hunt. This policy is one that many on the left say could be countered with higher taxes and greater investment in healthcare, so to say that the NHS is ‘going broke’ is, at the very least, taking the issue out of context.

Image courtesy of NHS, 2007.

And yet – it is true that many NHS services, especially in England and Wales, are in dire straits. An aging population and impossible-to-fulfil A&E targets have brought the NHS ‘to its knees’, in the words of one NHS bigwig. Perhaps, therefore, this is a good time to look at the UK’s pride and joy, its National Health Service, and compare it with health services from around the world – including the US Democrats’ proposed Universal Healthcare – and see if the President could be to some extent correct in calling the NHS ‘broken’.

The history of the NHS has entered into British national folklore: set up by Clement Attlee and a Labour government in 1948, the radically socialist proposal for everyone in the UK to receive free healthcare was met with initial scepticism by many, but quickly became a huge success even in post-war austerity Britain. Since then, succeeding Conservative governments have cut funding every time they were in power, right up until the Cameron era, which saw the lowest percentage of funding for the NHS ever (though this has slowly increased each year since 2010). Hunt is proposing more cuts at the moment and this month’s march is only the latest response to choices that many seem to think spell the end of the NHS as we know it.

Hunt’s response to Trump’s tweet, however, would portray him as a voracious defender of the NHS and its socialist values: he tweeted the president that no-one in the UK would trade their lot to live in a country where 28 million live without health cover. Are things so bad in the USA though? The BBC reported in 2010, near the start of Obama’s tenure and therefore a far greater funding for Medicare and Medicaid and the Affordable Care Act (Obamacare) firmly in place, that healthcare was still the number 1 reason for bankruptcy amongst US citizens. With funding cuts, the discrepancy between those who can afford healthcare or whose jobs pay for their insurance and those who go bankrupt or untreated is only on the rise. However, for those US citizens with insurance, standard of healthcare is largely similar or better to that in the UK, according to some reports. The difference is indeed, as Trump puts it, that the care is largely more ‘non-personal’ in the UK – after all US hospitals are making money from how well they treat their clients, while UK hospitals simply need to process as many patients as possible. Whether this is a catastrophically bad thing is up to personal preference. The Democrats’ Universal Healthcare Bill – technically the Medicare for All Act – as introduced by Bernie Sanders in November 2017 has no chance of being passed in a Republican-held Congress. In Sanders’ own words, this would seek to emulate the NHS, which would indeed mean a less person-oriented and more budget version of healthcare than many in the USA enjoy today. Whether this idea could ever come to practical fruition waits to be seen. However, if it does Trump may be correct in assessing that it would be up against many of the same pitfalls which have caught out the NHS. There seems to be no obvious solution.

In the English-speaking West, it is easy to take these as the only possible models for how a healthcare system should look: under-funded pseudo-socialism or horribly unequal capitalism. The booming Middle Eastern economy Qatar rolled out a universal healthcare system a few years ago which largely excluded expatriates and relies on an extremely rich government to keep it going. Japan, meanwhile, famed for a high life expectancy and living standard, requires each member of the population to take out health insurance, with payment based on how much they earn. This system is the model for many of the world’s best healthcare systems, from Sweden to Switzerland, but even in these wealthy countries, aging populations and high numbers of refugees are beginning to test the breaking points of these systems. Nevertheless, the mandatory public insurance scheme seems to be largely more successful than the UK’s universal healthcare paid for by taxation or the USA’s non-mandatory insurance scheme bulked up by government aid programmes.

The USA and the UK both spend vast amounts of money on healthcare each year, and yet neither seem to have found a viable solution to the issues going on in their countries. Trump’s criticism of the UK and US systems is certainly poorly-phrased – however it is not entirely inaccurate. Countries which are already rich through their technology or resources seem – universally – to succeed in healthcare plans, but those of us in billions-worth of debt or under poor leadership will need a more nuanced solution.

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