Which Country Has the World’s Best Health Care? Ezekiel Emanuel Hatchet Book Group, New York £23
The title of this book is misleading. Really it’s a comparative study drawing on 10 healthcare systems around the world to reflect upon, and try to address, the train wreck that is US healthcare. The analysis offers us in Britain a stark warning of what might come to be. Here’s the situation regarding the erosion of Britain’s NHS and its sell-off to private health providers. In the past five years private firms have received about £15 billion in NHS contracts. By the end of 2019 US healthcare companies had become firmly entrenched. Acadia Healthcare, based in Tennessee, owns the Priory chain of hospitals in Britain. The company sees substantial revenue growth from its NHS operations. Steve Filton, vice-president of Pennsylvania firm Universal Health Services, has salivated over the company’s British ambitions. In 2014 the firm bought Cygnet Health Care in Britain and has continued buying to become one of the largest operators of privately run psychiatric hospitals in the NHS. Centene Corporation, a St Louis-based health insurance giant, noted the UK market provides a “very exciting example of a healthcare system where policymakers are signalling their interest in making transformational change”.
Centene bought the Practice Group in 2016, which provides primary care and outpatient services, and invested £37.5 million in British healthcare start-up Babylon Health. According to Tenet Healthcare, Britain is “an increasingly attractive market”, due to privatisation. Other US companies include insurance behemoth UnitedHealth, which now owns British health service management firm Optum. HCA Healthcare, the US hospital chain, now owns several hospitals in Britain. The NHS privatisation agenda was set out in 2011 by then Tory backbenchers Liz Truss, Priti Patel, Dominic Raab, Kwasi Kwarteng and Chris Skidmore, a year before the 2012 Health Care Act which signalled an acceleration of NHS sell-offs. Raab, Patel and their chums argued Britain needed at least two-thirds of hospitals to be run privately in order to capture the “extra efficiencies private companies can provide”.
That the NHS is less efficient than private competitors is a well-used myth that years of research has shown to be nonsense. Raab and Patel — now key members of Johnson’s cabinet — expressed the urgent need to place more healthcare costs on the individual, much like in the US. Which brings us back to Emanuel’s book. As the author makes clear, it’s not simply that US healthcare is obscenely expensive, tiered to disadvantage those most in need and complex beyond all understanding. It’s also the REVIEWS BOOK least efficient in the world at providing healthcare for the vast majority of the population. The US spends by far the most money on healthcare globally. In 2000 it was $1.86 trillion annually ($6,500 per person). By 2017 this had risen to $3.5 trillion ($10,700 per person). That’s very nearly a fifth of US GDP, way beyond what other countries spend.
The US accounts for just over 4 percent of the world’s population, yet is responsible for half of the world’s drugs spending! Navigating US health systems is nigh on impossible, with contracts, sub-contracts and payment exemptions built into every health cost and health exchange. Each medical intervention and procedure is individually costed via ‘diagnosis related groups’ that, unfortunately, are rated differently according to your insurer, your state and the government scheme that is covering your costs And that of course depends if you’re covered at all. In 2017 at least 28 million people were not, a figure that will have ballooned after job losses and illnesses resulting from Covid-19. Even if you think you’re covered, watch out. Your procedure may not be “networked”. When Mrs Wilkes’s newborn child needed to spend one night in intensive care she discovered that, because the service was sub-contracted and had refused to be included in insurance ‘networks’, the cost of saving her child would be an additional $50,000.
The casual and ruthless way in which US healthcare commodifies everything from the life of a newborn child to an in-growing nail on your big toe is staggering. Though he makes little of the point, Emanual tells us that ‘employer sponsored’ health insurance — which makes up the largest single portion of health coverage, providing for around 200 million US citizens — is actually a form of withheld and redirected wages. In other words, health insurance supposedly paid by employers simply comes out of workers’ pay packets. In this way, employer sponsored health insurance helps to suppress aggregate wages across US society as a whole, holding down wages for everyone, insured or not.
This inhumane, rapacious and utterly dysfunctional approach to healthcare is the future we face in Britain. The vampires are already greedily sucking, aided and abetted by the Tories and, to their eternal shame, the Labour Party. Despite itself, this hugely detailed book makes the truth very clear: US healthcare is our future, unless we come together and act now to stop it.