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Universal Health Care

Nothing is perfect, and that definitely includes health care. On the 70th anniversary of the first full-coverage national health care system that is ‘free at the point of delivery’, Britain’s National Health Service, English people have been marching in the streets demanding better funding for the NHS, and Donald Trump naturally got the wrong end of the stick again.

Back in February, as part of his war against Barack Obama’s attempt to improve the coverage of the rudimentary US health care system (‘Obamacare’), Trump claimed that the marchers were protesting because the British system is “going broke and not working.”

It’s tough trying to defend the existing US system when every other developed country provides universal health coverage for its citizens, but Trump battled bravely onwards, later tweeting that the Democrats in the United States “want to greatly raise taxes for really bad and non-personal medical care.” Like the British allegedly suffer under the NHS.

In fact, the English National Health Service (Scotland and Northern Ireland have separate but similar systems) is, in former Conservative cabinet member Nigel Lawson’s words, “the closest thing the English have to a religion.” It is almost universally loved, and the protests were about government under-funding of the NHS.

Even the Conservative government that has strictly limited funding increases for the NHS over the past seven years, despite rising demand due to an ageing population, has now been forced to yield to popular demands. Prime Minister Theresa May announced last week that the NHS would get a funding increase of 3.4% per year over the next four years, giving it an extra $27 billion annually by 2023.

But are the English right to love their health-care system – and are the French and Germans and Russians and Japanese and the people of almost every other developed country right to revere their own similar systems? The United States may be the odd country out, but it does spend far more on health care than anybody else.

The United States spends 16% of its entire Gross Domestic Product on health care, almost twice as much as the average (8.2% for Japan, 8.4% for the UK, 8.5% for Australia, 10.4% for Germany). In theory, that ought to mean that Americans are healthier than everybody else and live longer. In practice, it’s just the opposite.

The United States is the only developed country where the average life-span is less than 80. In fact, it’s barely 78 years in the US, whereas everywhere else it’s in 80-82 range. The US also has the highest ‘preventable death’ rate of any developed country, and the highest infant mortality rate by a very wide margin. Americans spend more on health, and get less back, than anybody else.

They also spend far more of their time worrying about health care. The principal cause of personal bankruptcies in the United States is ‘catastrophic’ health emergencies, and all but the very rich have to devote much time to finding affordable medical insurance. Elsewhere in the developed world, nobody really thinks about that. The care will be there when you need it, and nobody goes bankrupt.

The model that was pioneered by Britain’s NHS on July 5, 1948 has been so successful that it is now spreading into many developing countries as well. India is still a poor country, but its National Health Policy 2017 goals include a commitment to “progressively achieve Universal Health Coverage.” China is working to provide affordable basic healthcare to all residents by 2020. And so on.

Attitudes change over time. In the 1930s nobody thought that there was some sort of basic human right to health care. The well-off paid for their own, and the rest depended on charity (which wasn’t very dependable). What changed that attitude was the Second World War, a time of great national solidarity and sacrifice in every country.

It was the worst war in history, but it produced a generation who believed that the people who had shared in the sacrifice (in both the countries that won and those that lost) must not be left behind in the peace that followed. The will was there to do new and great things, and they did them.

It is no coincidence that the same year of 1948 saw the signing of the Universal Declaration of Human Rights, which said (among other things) that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”

The world had turned, and what had been a privilege became a right. One that is still widely abused or neglected, of course, but it has nevertheless spread across the entire planet in the past 70 years. Why did the United States miss out?

The answer is probably a free-market ideology so strong that it enabled the insurance companies and the medical profession (which opposed the idea of a national health system in every country, at least initially) to win the political battle in the US and strangle the idea in its cradle. It keeps coming back even there, but for the moment Americans must go on paying the costs of their ideology.
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To shorten to 725 words, omit paragraphs 5 and 9. (“Even…2023”; and “They…bankrupt”)

Universal Health Care – a No-Brainer

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.

“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’s 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 percent of American GDP (the highest in the world), compared to 9.7 percent 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’s not only the NHS that enables British people to live longer. They are less obese than Americans (23 percent of English adults have a body mass index of more than 30, compared to 32 percent 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 percent 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 $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 one percent of its GDP on healthcare, so there’s 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 $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.
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To shorten to 725 words, omit paragraph 8. (“To be…result”)

Struggle Against the “War on Drugs”

4 January 2007

The Struggle Against the “War on Drugs”

By Gwynne Dyer

Barry Cooper’s new DVD, Never Get Busted Again, which went on sale over the internet late last month, will probably not sell very well outside the United States, because in most other countries the possession of marijuana for personal use is treated as a misdemeanour or simply ignored by the police. But it will sell very well in the US, where many thousands of casual marijuana users are hit with savage jail terms every year in a nationwide game of Russian roulette in which most people indulge their habit unharmed while a few unfortunates have their lives ruined.

Barry Cooper is a former Texas policeman who made over 800 drug arrests as an anti-narcotics officer, but he has now repented: “When I was raiding homes and destroying families, my conscience was telling me it was wrong, but my need for power, fame and peer acceptance overshadowed my good conscience.” Of course, Cooper’s DVD, which teaches people how to avoid arrest for marijuana possession, will also bring him fame, plus a lot of money, but at least it won’t hurt people.

However, Cooper lacks the courage of his own convictions. He argues that the war on drugs is futile and counter-productive so far as marijuana is concerned, but nervously insists that he is offering no tips that would help dealers of cocaine or methamphetamines to escape “justice”. It’s as if reformers fighting against America’s alcohol prohibition laws in the 1920s had advocated re-legalising beer but wanted to continue locking up drinkers of wine or spirits. But there are bolder policemen around, who are willing to say flatly and publicly that all drug prohibition is wrong.

One is Jack Cole, 26 years with the New Jersey police, whose organisation, Law Enforcement Against Prohibition (Leap), is supported by growing numbers of serving policemen who have lost faith in the “War on Drugs” and want to make peace. “Leap wants to end drug prohibition just a we ended alcohol prohibition in 1933,” says Cole, who argues that neither kind of prohibition has ever had any success in curbing consumption of the banned substances, but that each has fuelled the growth of a vast criminal empire.

It is policemen who take the lead in these issues because they are the ones who must deal with the calamitous consequences of the “War on Drugs.” No doubt the use of “recreational” drugs does a lot of harm, as does the use of alcohol or tobacco, but that harm is dwarfed by the amount of crime and human devastation caused by forty years of “war” on drug-users.

Howard Roberts, the deputy chief constable of the Nottinghamshire police, was the latest senior policeman to make the case for ending the war, pointing out last November that heroin addicts in Britain each commit, on average, 432 robberies, assaults and burglaries a year to raise the money for their illegal habit. Each addict steals about $90,000 of property a year, whereas the cost of providing them with heroin on prescription from the National Health Service in closely supervised treatment programmes would be only $24,000 a year.

So the NHS should provide heroin to addicts on prescription, said Roberts, like it used to in the 1950s and 1960s, before Britain was pressured into adopting the “war on drugs” model by the US. (Since then, the number of heroin addicts in Britain has risen several hundredfold.) Days later, it emerged that the NHS is actually experimenting with a return to that policy at three places in Britain — and Switzerland has actually been prescribing heroin to addicts on a nationwide basis for some years now, with very encouraging results: crime rate down, addict death rate sharply down.

If every country adopted such a policy, legalising all drugs and making the so-called “hard” ones available to addicts free, but only on prescription, the result would not just be improved health for drug-users and a lower rate of petty crime, but the collapse of the criminal empires that have been built on the international trade in illegal drugs, which is now estimated to be worth $500 billion a year. That is exactly what happened to the criminal empires that were founded on bootlegging when alcohol prohibition was ended in the United States in 1933.

But what about the innocent children who will be exposed to these drugs if they become freely available throughout the society? The answer is: nothing that doesn’t happen to them now. There is no city and few rural areas in the developed world where you cannot buy any illegal drug known to man within half a hour, for an amount of money that can be raised by any enterprising fourteen-year-old.

Indeed, the supply of really nasty drugs would probably diminish if prohibition ended, because they are mainly a response to the level of risk the dealers must face. (Economist Milton Friedman called it the Iron Law of Prohibition: the harder the police crack down on a substance, the more concentrated that substance becomes — so cocaine gives way to crack cocaine, as beer gave way to moonshine under alcohol prohibition.)

This is probably yet another false dawn, for even the politicians who know what needs to be done are too afraid of the gutter media to act on their convictions. But sometime in the next fifty years, after only few more tens of millions of needless deaths, drug prohibition will end.

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To shorten to 725 words, omit paragraphs 5, 9 and 10. (“It is..drug-users”; and “But what…prohibition”)