It began, as so many things do these days, with a Donald Trump tweet. Frustrated by his inability to kill the ‘Obamacare’ expansion of public healthcare provision in the United States, Trump seized on a protest about the under-funding of Britain’s National Health Service (NHS) in London last Saturday to trash the entire concept of universal healthcare paid out of taxes and free at the point of delivery.
World View with Gwynne Dyer
“The Democrats are pushing for universal healthcare (in the US) while thousands of people are marching in the UK because their system is going broke and not working,” he tweeted. It was an awkward moment for Britain’s Conservative prime minister, Theresa May, who tries to avoid criticising Trump whenever possible, so she let her health secretary, Jeremy Hunt, respond instead.
Hunt tweeted back that while he disagreed with some of the protesters’ opinions, “not ONE of them wants to live in a system (like the US) where 28 million people have no cover….I’m proud to be from the country that invented universal coverage – where all get care no matter the size of their bank balance.”
It is true. The British population is growing older and needs more health services, but Conservative governments over the past seven years have not raised spending on the NHS to match. As a result, many people are dissatisfied with the growing delays in treatment, but the NHS is the most beloved institution in the United Kingdom. Not one person in a hundred would want to replace it with a privatised, insurance-based system.
A huge controversy rages permanently in the United States over public vs. private spending on healthcare, with the Republican always trying to cut the share paid out of taxes by federal and state governments (currently about half). But there is no equivalent controversy elsewhere.
Every other developed country has a universal healthcare system – and in an eleven-country study published by the US-based think-tank The Commonwealth Fund last summer, the United States came dead last in terms of safety, affordability and efficiency. The contrast is particularly stark in the differences between the United States and the United Kingdom.
Americans spend twice as much per capita as Britons on healthcare. Health services account for an astonishing 17,2% of American GDP (the highest in the world), compared to 9,7% in the UK. Yet the British system delivers better results: life expectancy at birth is almost three years higher in UK (81,4 years, compared to 78,8 years for Americans).
To be fair, it is not only the NHS that enables British people to live longer. They are less obese than Americans (23% of English adults have a body mass index of more than 30, compared to 32% of Americans). The murder rate in the US is five times higher than it is in the UK. But even if average life-spans were identical in the two countries, Americans would be paying twice as much for the same result.
There really is no controversy: universal healthcare is better. Since half of that enormous American spending on health goes to profit-making enterprises like insurance companies, there is an immensely rich and powerful lobby fighting to keep the public-private controversy alive in the United States, but elsewhere, even in much poorer countries, it is a no-brainer. Like in India, for example.
India, which recently overtook China to become the world’s most populous country, is still relatively poor (although its economy is now growing at over 7% annually). Last week in the Indian parliament, Finance minister Arun Jaitley announced a new government initiative that will provide the poorest 100 million families (half a billion people) with up to US$7 800 annually to cover hospitalisation costs in case of severe illness.
“This will be the world’s largest government-funded healthcare programme,” he told parliament. “The government is steadily but surely progressing towards a goal of universal health coverage.” People are already calling it ‘Modicare’ (after Prime Minister Narendra Modi), and it does bear more than a passing resemblance to Obamacare.
India currently spends only 1% of its GDP on healthcare, so there is still a very long way to go – and as always in India, the tricky bit is actually implementing the programme, especially in the rural areas. (Free government hospitals are mostly in the cities.)
Diagnostic tests, doctor follow-ups, basic medicines (like statins for heart disease or diabetes control) and post-operative home care are not covered by the US$1,7 billion scheme. Private hospitals and clinics are still not properly regulated, and frequently overcharge. Poor families dealing with a major illness often end up in the hands of money-lenders, and even in government-run hospitals bribes are sometimes necessary to get good treatment.
All that said, the direction of travel is clear, and maybe in a couple of decades India will have a universal health service like the NHS. Beloved, in other words.
Dyer is a London-based independent journalist.