As part of the ongoing debate on the NHS and US healthcare systems, earlier today I debated the merits of different systems with UNISON on Good Morning Wales. As part of this show we were asked to write letters to America on what lessons they should draw from the NHS. My letter drew on earlier Reform research and follows.
"I am Dr Patrick Nolan, Chief Economist at Reform, and a person who has been watching your health reforms with interest. Getting health right is fundamentally important – with health systems not only costing huge amounts but also playing a key role in shaping quality of life.
Countries are competing in the race to deliver high quality healthcare. This race is being won by the Swiss and Japanese health systems. These are followed by France, Germany, Australia and the Netherlands. The UK and the US lag behind.
The universal cover provided by the NHS is a valuable strength. In contrast the USA is the only major developed country that relies on voluntary private insurance. This voluntary coverage is ineffective and unfair and, although you have Medicaid and Medicare programmes, many of your population have no coverage at all.
But the NHS has weaknesses too. It lacks the elements of insurance that are common elsewhere. This means that it places too great an emphasis on treating people once problems arise, rather than preventing problems from developing in the first place. This also means that relatively little effort is given to ensuring that resources are used in the most cost effective ways possible.
The NHS provides both good and bad lessons for health reform. In drawing lessons from overseas I would, however, encourage you to look further afield. Many countries have found ways to combine the best of all worlds – universal coverage and strong elements of insurance. We can both learn from them."
As I noted on the radio this morning, debate on the NHS is increasingly looking like the story of the Emperor with no clothes. Attacking suggestions that the NHS is in need of further reform, or that it could learn from health systems overseas, as being “unpatriotic” or “talking down the NHS” misses the point.
There needs to be an honest debate on whether the NHS is performing as well as it should and whether it will be able to cope with the challenges that it will face in the future. As Professor Karol Sikora, cancer expert and member of Doctors for Reform steering committee, has argued “blind religious faith does not provide a solution to the real problem.”
This problem is, as noted by David Cameron, that the gap between what we will have to do and what we can afford to do presents an urgent need for reform. But advancing reform will require honest debate and difficult decisions – and the time to have this debate and start making these decisions is now.