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Universal health care results from a government mandated program to provide all citizens, and sometimes permanent residents, of a governmental region access to most types of health care regardless of ability to pay. Patients may pay for some portion of their care directly, but most care is subsidized by taxpayers and/or by compulsory insurance.

In the 1880s, most Germans became covered under the mandatory health care system championed by Bismarck. The National Health Service (NHS), established in the United Kingdom in 1948, was the world's first universal health care system provided by government. Universal health care is provided in most developed countries and in many developing countries. The United States is the only industrialized nation that does not provide universal health care.

Universal health care programs vary widely in their structure, funding mechanisms, and the level and nature of the government's involvement. Some government health care systems allow private practitioners to provide services, and some do not. In the UK, doctors are allowed to provide services outside the government system; in Canada, some services can be offered and some cannot.

Death by the dollar: healthcare USA and UK

21stcentury socialism Nov 2007

It couldn't happen here. That is, the fate which befell an 18 month old girl called Michelle Keys, related in Michael Moore's latest film, Sicko, could not happen in Britain- or indeed in most countries in the developed world.  When she became seriously ill, she was taken by ambulance to a hospital which had the facilities to treat her. But the system did not allow her to be treated.

Instead, as a Znet article explains:

'...her health plan, Kaiser, insisted Michelle not be treated at the hospital to which an ambulance had taken her, but instead be transferred to a Kaiser hospital. Fifteen minutes after arriving at the next hospital, Michelle died...' Her family was not dirt-poor. They had insurance. But, because the first hospital did not have a contract with the insurance company, she was allowed to die, from an infection that could have been treated with antibiotics.

It couldn't happen in Britain- because the UK has a National Health Service (NHS) which is free at the point of use. Although the system has been increasingly privatised and fragmented by Conservative and New Labour governments since the mid-1980s, the principle that most NHS facilities are free to use has been maintained. So, as was illustrated by the sequence in Sicko which was filmed in Britain, when people in Britain need hospital treatment, whether in an emergency or on a planned basis, there is no quibbling about who will- or can- pay.

But Britain's health service does have its problems. One of its biggest difficulties is the rise of the 'super-bugs': methicillin resistant staphylococcus aureus (MRSA) and clostridium difficile (C diff), bacterial infections which people catch while in hospital and are very hard to treat. In 2005, C diff was implicated in 3,807 deaths, and MRSA in 2,083 deaths, in the United Kingdom.
Armed with the fact that Britain's socialised healthcare system is far from perfect, right wing opinion-formers in media outlets- from the intellectual BBC station Radio 4 to the mass-circulation Daily Mail newspaper- have poured scorn on Michael Moore's representation of the NHS. On 1st November, the famous commentator Richard Littlejohn complained that:'...the usual suspects are all getting terribly excited about the latest piece of anti-American propaganda being peddled round the world's film festivals by Michael Moore, of Fahrenheit 9/11 fame.' Littlejohn favourably compared the William Beaumont Hospital, Royal Oak, Michigan, in which his mother is being treated, to hospitals in Britain: The place was spotless, even the public toilets - unlike the Whittington, in Highgate [North London], the last NHS hospital in London I visited.

Richard Littlejohn did not mention that cleaning in UK hospitals, including of the toilets, is not carried out by the NHS. In the 1980s, Margaret Thatcher privatised cleaning and other 'ancillary' hospital services, and since then they have been contracted-out to capitalist firms.  Other aspects of the William Beaumont Hospital also got Richard Littlejohn terribly excited. One was the valet parking, carried out by well-dressed attendants: As I pulled under the canopy in front of the main reception, a pleasant young man in smart chinos and bomber jacket opened the door for me, welcomed me to "Beaumont" and whisked the car away... it came as a huge kindness, for which I was more than happy to hand over four dollars.

But even more impressive is the subsidised treatment which the hospital is able to provide to the poor, by using its income from "medical insurance, donations from generous benefactors and research grants and endowments". Thus:

The hospital boasts: "Beaumont treats all patients regardless of ability to pay." Check it out on the web if you don't believe me...

Patients with earnings of less than twice the official poverty line - currently defined as a family of four on under $41,300 a year (about £21,000 at the current exchange rate) - are treated free.

Above that level, there's a sliding scale of discounts.

So, this is the' boast' of what is, no doubt, an excellent and very philanthropic US hospital. If you are very rich, you need not worry about the price of a stay there. If you have an extremely low income and are lucky enough to live nearby, you will also be treated. And, if your 'family of four' earns more than the level of the US poverty line... well, as Richard Littlejohn advised: check it out on the web if you don't believe me.

According to the website of the William Beaumont Hospital, in a section entitled 'charity', this is the 'sliding scale': A 15 percent discount for patients without insurance whose incomes are higher than the qualifying levels. Beaumont also gives special consideration, on a case-by-case basis, for patients without insurance whose hospital accounts are greater than 30 percent of their income.

So, this charity amounts to a 15% discount. Then you are on your own until your bills rise to 30% of your income. After that, the generous benefactors may consider, on a case-by-case basis, whether you merit special consideration.  Of course, most people do have insurance- although as US companies reduce their costs by cutting back on the health insurance benefits for employees, the number of people without insurance is rising. But does having  insurance mean that patients do not have to worry about how to pay for their treatment?

The William Beaumont Hospital website, on a page which is entitled 'Pay Your Bill', is most educational.

The page is set out in the form of Q&A:

Why didn't my insurance carrier pay my bill in full?

The guidelines set forth by your insurance carrier may include a deductible or co-payment for the services you received.

Besides deductibles and copays, the procedures that remain unpaid may be due to your contract guidelines. (ie: not a benefit, not a benefit for diagnosis reported, patient not covered on date of service, etc.) A call should be made to your benefits representative at your place of employment or to your insurance carrier.

Why is this non-covered by my insurance carrier?

Charges may be non-covered due to policy limitations. Please call your insurance plan administrator to make an inquiry.

My insurance company stated you did not bill with a payable diagnosis, so my claim was rejected.

Our coding department bills insurance companies based on medical documentation from the medical staff and treating physician. If the diagnosis was coded correctly, we can submit again for reconsideration; however, your carrier may continue to reject the claim. Your recourse is to appeal the case with your carrier. We legally are unable to change your diagnosis.

But, even if you find these answers less than reassuring, Richard Littlejohn is quite certain of one thing. He affirms:

I'm pretty confident that no one has ever died of MRSA in the Beaumont hospital, Michigan.
Indeed, the search function of the Beaumont Hospital's website reveals no entries under 'MRSA'.

Perhaps this is because they have no MRSA in that hospital. But one should bear in mind that the website of any commercial organisation serves an advertising function. It pays to advertise, but it may not pay to advertise the rate of hospital-acquired infections.

According to a study published by the American Medical Association, nearly 19,000 people died as a result of MRSA in the United States in 2005, the latest year for which figures are available.

As the Washington Post reported in October this year:

By extrapolating data collected in nine locations, the researchers established the first true baseline for M.R.S.A. in the United States, projecting that 94,360 patients developed an invasive infection from the pathogen in 2005 and that nearly one of every five, or 18,650 of them, died.

Allowing for the difference in population size, this suggests that the USA's MRSA problem may be even worse than that in Britain.

And scores of thousands more succumb to other healthcare-acquired infections in the USA. Aproximately 99,000 people died in in 2002 from such infections, as estimated by the USA's Centers for Disease Control and Prevention.

Life and taxes

Of course, socialised medicine does not mean that medical treatment does not have to be paid for. The NHS is funded almost entirely by taxation. But the UK's system is very inexpensive. One reason is that socialised healthcare, provided by mainly publicly-owned facilities, is very efficient in terms of value-for-money. However, this efficiency has enabled British governments to underfund the NHS over many decades. Despite increases in funding since 1999, Britain spends rather less on health than other West European countries, most of which now report better mortality statistics than Britain's. The difference between health expenditure in the UK and the USA is staggering.

In 2005, the UK spent 8.3% of its GDP on health, while the US spent 15.3%. But this way of comparing costs underestimates the true difference in the amount which people pay for their health, because the United States has a higher per-capita GDP. In terms of actual money spent, calculated by purchasing power parity, in 2005 the UK spent $2,724 per person on health, while the USA spent  $6,401 per person.

What do people in the United States get from their mainly private system which costs two and one-third times the amount, per person, as the mainly public British system? Here are two statistics. Britain's death rate for childen under five years of age is 6.0 per thousand, as compared to 7.8 per thousand in the USA. Average life expectancy in Britain is also slightly better, at 81.6 years as against 80.8 years in the United States.

Overall health statistics in the USA, as in all countries, mask a disparity in the health of different groups within society. To be poor means, on average, that you are more likely to die at any stage of your life; in the United States, to be poor and black means that you are much more likely to die. Within this, children are particularly vulnerable. An article by Robert Adler in the New Scientist magazine on 3rd November 2007 revealed that, despite the advances in medical technology, the death rate for infants (children under 12 months of age) in some parts of the USA is rising:

In 2005, Mississippi's infant death rate rose by 17 per cent, from 9.7 to 11.4 per thousand. Five other southern states - Alabama, Louisiana, North Carolina, South Carolina, and Tennessee - also saw increases in their infant mortality rates, though by smaller amounts.

Not surprisingly in a region where poverty is particularly entrenched among African Americans, the infant death rate death rate for blacks in Mississippi rose even more steeply, from 14.2 per thousand in 2004 to 17 per thousand in 2005, a 20 per cent surge... [despite a slight improvement for blacks in 2006] overall infant death rates are still higher than they were a decade ago.

Among the probable causes for this, Robert Adler notes that:

Many mothers are in poor health and get inadequate prenatal care through lack of money, insurance, transportation and, for some, motivation.

Haley Barbour, elected governor [of Mississippi] on 2004, kept his campaign promise to cut welfare costs... he made it harder to qualify for social services, causing enrolment in key programmes, including those for mothers and children, to fall by more than 50,000.

In general, spending more money produces better health results. In general, more socialised systems, particularly those involving public ownership, produce better results. Imagine what Britain's NHS would be like if we increased our spending on it to US levels. Imagine what healthcare in the USA would be like if they maintained their spending level while reforming their health sector towards a socialised, mainly publicly owned, system.

Neither is politically possible at the moment. Therefore, many thousands of people who would otherwise live are dying. Whatever it says on their death certificates, the cause of their deaths is capitalism.

See also
Time to decide how to replace the NHS

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