When I decided to write a blog on healthcare I had no idea that I would spend last Thursday evening travelling half way across the country to visit my father in hospital. He was 93 years old and despite trying desperately to fight off pneumonia sadly passed away on Sunday night. My impression of Milton Keynes Hospital where he is ended his life was that every single member of staff I met was kind, considerate and professional. Everybody I spoke to was determined to make his stay as comfortable as possible and answered my myriad of questions professionally and compassionately. I would like to thank each of them and every doctor, nurse, cleaner, Porter, etc across the UK and dedicate this blog to them.
Interestingly because we live in the UK nobody is pursuing my parents for payment for his treatment, but if it was dependent on insurance cover it would not normally be considered a critical illness. According to website Insure.com: “Critical illness insurance provides payment if you experience a serious illness, such as a heart attack, cancer or stroke. The policies vary in what they cover, but generally pneumonia would not be considered a critical illness.” This despite the fact that the chances of surviving are less than 30%. It does rather beg the question: what is a critical illness?
It is also worth noting that the growth in private health insurance in the UK has been parasitical upon the NHS paid for by your taxes. A 2014 Kings Fund report estimated that private healthcare in the UK was worth some £6.42 billion in 2011. Meanwhile The Guardian reported in 2017: “After falling steeply between 2008 and 2011 and then staying flat, demand for private medical insurance cover in Britain rose by 2.1% in 2015 with just over 4 million people insured.” The majority of professional staff in private practice were trained by the NHS and many continue to straddle both public and private practice.
In this General Election the very future of the NHS may well be up for grabs. We know that partial privatisation has been going on for a while now and many people fear that our healthcare system will end like Americas. Consider, for example, if you are unfortunate enough to need a hip replacement. In the UK the average waiting time is now about 8 months. The cost to you is zero. In the USA waiting times are likely to be less but unless you have health insurance the cost to you is approximately $39,000 (just over £30,000). This is just one example.
According to the most recent data available from the Centres for Medicare and Medicaid Services (CMS), “the average American spent $9,596 on healthcare” in 2012, which was “up significantly from $7,700 in 2007.” It has risen well above inflation in the intervening years.
In the UK employees pay 12% of their salary toward National Insurance. The bulk of NI income is pensions and benefits, but a proportion goes toward the NHS with the rest found from general taxation.
The NHS has as its principle that healthcare should be free at the point of use. If you were to contract cancer the NHS will care for you without giving you a large bill. Compare that to the IUSA, where the American Cancer Society offers the following advice:
“It is very important for adults and children with cancer to have a health insurance plan that covers needed cancer treatments.”
You can well imagine who does not have insurance. According to KFF around 28 million people in the US remain uninsured. In 2017, 45% of uninsured adults said that they remained uninsured because the cost of coverage was too high. Although things have certainly improved with Obamacare it is not a comprehensive health service such as that enjoyed by citizens of the UK. Most uninsured people in the USA are in low-income families and have at least one worker in the family.
You may recall that one of Trump’s campaign pledges was to totally dismantle the healthcare revolution which was the major achievement of his predecessor, but so far has not been able to secure enough senate votes to do so. He has tried to chip away at the provision through the law courts and if successful it could leave 20 million Americans with no cover at all.
You might wonder why anybody would oppose universal healthcare based on a principle of need? The answer is that where you and I see need, the rich and their hedge fund managers see opportunities for investors.
The largest 125 U.S. health insurers collected approximately $713 billion (approximately £550 billion) in premiums, with the top 25 accounting for nearly two-thirds of the total. It is big business. The largest is UnitedHealth Group with a revenue in 2018 of $226 billion (over £175 billion). In 2017 the New York Times reported that UnitedHealth was overbilling Medicare by hundreds of millions of dollars a year and was being investigated by the Justice Department. Of course, this could have been an admin error, but it is more likely that the company saw a state budget as easy pickings. No wonder they are looking at the NHS with avaricious eyes.
As my father was reaching the end of his life he was given a combination of painkillers and sedatives so that he was not visibly suffering. Drugs are an important part of healthcare but they are also a major source of profit for large pharmaceutical companies. Whilst they will claim that they plough their profits back into research and development, the truth is that they see R&D as mainly a means to acquire patents which keep the cost of drugs high. This serves their shareholders well, but it does not necessarily serve the interests of people who are sick.
One of the largest American pharmaceutical companies is Pfizer, worth over $225 billion. In the 1980’s the American Food and Drug Administration investigated reports of dozens of fatalities linked to heart valves made by Pfizer’s Shiley division. In 1986, as the death toll reached 125, Pfizer ended production of all models of the valves. Yet by that point they were implanted in tens of thousands of people, who worried that the devices could fracture and fail at any moment.
Large for-profit organisations have a history of placing profit before people. Also on Pfizer’s list of scandals are a 2012 bribery settlement; massive tax avoidance; and lawsuits alleging that during a meningitis epidemic in Nigeria in the 1990s the company tested a risky new drug on children without consent from their parents (Philip Matters, 2017).
Whilst Trump has thus far failed to prise open Obamacare, he has made it entirely clear that any post-Brexit trade deal with the UK will see everything, including the NHS, on the table. In June the BBC reported that Trump certainly saw the NHS as a pawn in any future trade deal. "When you're dealing in trade, everything is on the table," he said when questioned.
According to the Health Confederation whilst spending on the NHS has increased since 2010 on a range of metrics we can see a service in crisis:
· In 2016 health expenditure in the UK was 9.75 per cent of GDP, compared to 17.21 per cent in the USA, 11.27 per cent in Germany, 10.98 per cent in France, 10.50 per cent in the Netherlands, 10.37 per cent in Denmark, 10.34 per cent in Canada, 8.98 per cent in Spain and 8.94 per cent in Italy.
· The UK had 2.8 physicians per 1,000 people in 2016, compared to 4.1 in Germany (2015), 3.9 in Spain (2015), 3.8 in Italy (2015), 3.5 in Australia (2015, est), 3.4 in France, 3.0 in New Zealand (2015) and 2.7 in Canada (2015).
· The UK had 2.6 hospital beds per 1,000 people in 2015, compared to 8.1 in Germany, 6.1 in France, 3.2 in Italy (2015), 3.0 in Spain, 2.8 in the USA (2014), 2.7 in New Zealand (2016) and 2.6 in Denmark (2016).
· The UK had 0.4 psychiatric care beds per 1,000 people in 2015. This compares to 1.3 in Germany, 0.9 in France, 0.4 in Canada, 0.4 in Denmark (2016), 0.4 in Spain, 0.2 in the USA (2014) and 0.1 in Italy.
Ironically, when the unredacted document was presented last week it was Labour who were accused of lying. The document which was the notes of meetings between the UK and the US where at least one government minister was present should have been a political bombshell, and an election changer.
However, Laura Kuenssberg’s analysis began:
“Jeremy Corbyn doesn't provide evidence ministers have agreed the health service should be part of a trade deal with US.
But details of discussions about the demands of US pharmaceutical companies will still be motivating for Labour voters worried about the NHS.”
Read that carefully. Jeremy Corbyn provides no evidence. Apart from a 450 page document. But for Kuenssberg, who almost certainly has private health insurance as part of her remuneration package, it is only “Labour voters” who need to be worried. Forget for a moment the inherent bias in her statements, but should it not be a concern for every citizen of the UK that the NHS is available free at the point of use and not seen as a gateway for more profits from some of the biggest pharmaceutical companies in the World?
The Guardian’s summary of Labour’s revelations is in marked contrast to every mainstream title, with the exception of The Mirror. Their report which certainly reads as considered and impartial makes the point:
“The documents show that between July 2017 and July this year, trade talks between the UK and US have covered the NHS, drug pricing and patents, the pharmaceutical industry and medical devices, in the context of the future trade landscape between the two countries.”
Of the daily newspapers only The Guardian and The Mirror led with this incredible story on their front pages, every other mainstream British newspaper either buried this bombshell in the inside or used this evidence to attack the Labour Party. The Sun, for example, claimed that: “Mr Corbyn’s wild claims were rubbished” an assertion proved beyond reasonable doubt by citing Liz Truss, Matt Hancock and James Cleverly. There’s investigative journalism for you..
Now, let’s be clear, right wing newspaper attacking the Labour Party is hardly earth shattering news, but when experienced and supposedly respected journalists such as Laura Kuenssberg spend an entire afternoon tweeting how it could not possibly be true because it might be unpopular, then we can see clearly the morass into which the one-time writers of the first draft of history have fallen.
That the entire mainstream print and broadcast media took it upon themselves to undermine this story, without even reading the documents is important, but even more important is what the effect of this will be on ordinary people.
Since the inception of the NHS in 1948 people in the UK have been used to being able to access free healthcare when they need it. Of course, there have always been private patients, those wealthy enough to afford it can jump waiting lists and doctors made it a condition of supporting the NHS that they should be able to retain a private income. But, for most of us, a broken limb, a bout of flu, or a major illness are not affected unduly by finance, that care has been there when we need it.
It is difficult to imagine the huge cultural shift that losing the NHS would bring to Britain. Already, according to the United Nations, 14.6 million people are in poverty. That figure will double or treble as ordinary people are crippled by medical bills. Make no mistake if the American health insurance business gets its claws into the NHS their profit will be guaranteed on the backs of the payments of ordinary people. The better off will afford private insurance but even they may struggle if they have a major illness as their premiums rise, that is supposing that any insurer will cover them in the first place.
This is not just being alarmist we have seen what has happened to the insurance status of people whose homes are ruined by floods. If anybody has been in a car crash, even one where it was not your fault, you’ll know how your premiums rise. If the American experience is anything to go by health insurance, once they have a monopoly, will rise year on year and way faster than wages.
Some people continue to doubt whether the leaked document is real, though nobody has actually denied it, and think this is just politicking by Labour. Maybe it is. Though personally dodgy dossiers is not something normally associated with Jeremy Corbyn, and surely people couldn’t be confusing him with Tony Blair, so I am apt to believe that not only have the talks taken place but that the Americans are eying the NHS.
What those who are casting doubt on their veracity have to ask is whether they are really prepared to gamble with not only their own future, but the future well-being of their children and children’s children. It has been said before that this election is a once in a generation opportunity for real change, it would be a disaster for Britain if that real change turned out to be the end of the NHS.
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