Curious Capitalist

Foroohar: What Obamacare Can Learn From Britain’s National Health Service

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My opinions about health care in the U.S. — including the current fiasco over the technical glitches in the launch of Obamacare — are forever shaped by my experience living and working in Europe for nearly a decade. From 1999 to 2007, I was a foreign correspondent based in London, where I gave birth to two children on the state-run National Health Service. It was a terrific experience and, to my mind, a model of cost efficiency. Basically, you deal with midwives unless you have a problem (at which time you are quickly and efficiently whisked off to see the more expensive MDs or specialists). A tremendous emphasis is placed on pre- and postnatal care, both of which have a very high return on investment. Every day for a week after I gave birth, a nurse came to the house to check on both the children, and me. From a U.S. perspective it seemed like an unbelievable luxury, but it’s actually a smart way to offset problems that could eventually result in a costly hospital visit.

Of course, guaranteeing a minimum level of care for an entire nation means that once you deliver a healthy baby, you recover in a room with 12 other moms and crying kids (not to mention dozens of assorted relatives stopping by for visits and assuring that nobody gets any sleep). But hey, if that’s the price to make sure that everyone gets to have a safe and free birth experience, I’m more than happy to pay it. I would also be happy to wait months for nonessential surgery — or opt out and pay privately, as I once did for a minor foot operation — so that the entire country could be guaranteed yearly physicals and free cancer treatment.

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Health care was more psychically seamless in the U.K. Nobody worried about going bankrupt if they got sick. In the U.S., medical emergencies are a chief reason people cycle in and out of poverty. And it was more technologically seamless too. Britain has certainly had its highly publicized website problems over the past few years; indeed, they eventually resulted in the country creating a national digital service of technologists in 2011, who help ease citizens’ transactions with the government.

But even when I was there, the U.K. already had a well-run national database of medical information on every citizen, which meant that if you happened to live in London, but got sick and had to go to the emergency room in Brighton, the doctors would automatically know that you were, say, allergic to penicillin. When my kids needed their next round of immunizations, I got a letter in the mail, sent automatically as part of the digitalized system. No need to remember and log it all yourself. And certainly no need to spend unpaid hours filling out paperwork that inevitably gets sent back once or twice by insurance firms for whom obfuscation is part of a business model. It has always amazed me that a country that created Silicon Valley had a health care system in which people still mainly scribble things on paper.

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Of course, that’s the great paradox of the U.S. Here, we invent the most cutting-edge medical technology known to man — and we also have the least digitally advanced national health care system of any rich nation. We pay more, as a nation, for worse health outcomes than most other advanced countries on earth. Yet we console ourselves with the idea that because we have the “right” to see the very best specialists on earth (assuming, of course, we have insurance) that it’s O.K.

That divide is in part what President Obama’s online federal health-insurance exchanges are trying to fix, which is why it’s a great pity that the rollout has been so fraught with problems. But I can’t help but think ultimately, when the dust has settled and the software glitches are gone, creating a seamless digital system in the U.S. will always be tougher because we simply haven’t yet bought into the idea that everyone deserves health care — and that if we give it to everyone, it will save us all money in the end. Until we do, we’ll all suffer — economically and socially.