Ross Hunter, Headmaster ESS School, Lefortovo
It is hardly a secret that health care systems around the world are under huge strain and challenge. Why? It seems as if there are two major problems, one medical, one political.
Since 1945, we have witnessed the most phenomenal increase in life expectancy and improvement in human health ever. We are living longer and longer, adding ~2 years per decade. Wow! When Bismark invented the state funded old age pension, it was set at 65; but Prussian life expectancy was then just 63. 65 has remained the benchmark, but now the average lifespan is some 83, and there are fewer of working age to fund it, (the UK is exceptional in already raising retirement to 66, soon 67+, to ease this). Further, we have conquered the ‘cheap’ premature killer diseases – polio, smallpox, measles, pneumonia, and many more. But many heart conditions, dementia, Alzheimer’s, strokes and more are often chronic and debilitating, but not fatal – the cost of long term care or treatment is huge. Penicillin and warfarin have been replaced by more sophisticated drugs, which are slightly more effective but MUCH more expensive. This is all against a backdrop of governmental fixation on pretending that taxes must be cut not raised.
Health services cannot cope with this quadruple strain: lower revenues, more elderly chronic patients, more expensive treatments and social care being foist upon the hospital budget. Governments – not exclusively in the UK, are being totally dishonest when they claim that health care spending is rising, as the slight cash increase is nowhere near sufficient to offset greater demand and inflation in technical and pharmaceutical costs. Further, threats of legal action, and the rabid frothings of the tabloid press push doctors into prescribing more medicine that is prudent.
The British NHS (National Health Service), was set up immediately after WW2, as part of the revolutionary campaign to make a better country, and the fight against ‘five giant evils’ of squalor, ignorance, want, idleness, and disease. Health care based on need not ability to pay, a safety net for every citizen. Affordable housing, better schools, social security, and an improved, affordable food supply came too. The NHS is widely held to be one of the UK’s most proud achievements. Arguably, it has been too successful, as noted above; and also gets abused by people who need to take more responsibility for their own well being. It is under threat from extreme zealots who want to switch to a market provision (and frequently, line their own pockets while so doing. ‘Over our dead bodies’ probably sums up the popular resistance. General practice (polyclinics), hospital care, accident and emergency services, ambulances and acute hospital treatment are all still largely free at the point of need. The inevitable queueing can be avoided in a small but growing ‘for-profit’ sector. As in Moscow, many specialists do some work for both sectors. Dentistry was in the main not integrated into the NHS, and this is largely run privately although it is just about possible to get NHS treatment if one can prove one is a student or destitute, and even then NHS dentistry provision is very local.
The result is either rationing by price (USA) where ever larger percentages of people miss out, or rationing by queueing (UK), or cutting services available; as well as unreasonable squeezes on nursing or doctor’s salaries.
On top of all this, there is a subtle and largely covert attack on the idea of collective responsibility. In the UK, the case for Brexit was based largely on two arguments – cutting immigration and more money for the NHS (see ‘that’ bus). The first has meant fewer low cost nurses and care workers. The latter is plainly dishonest. The hard core libertarians are intent not on financing the NHS but on starving it so as to make the case for privatisation/Americanisation: cutting state/collective responsibility, and handing ‘services’ to profit making private companies.
Consider these figures (for demographically ‘mature’ countries, all with ageing populations; figures for countries with young populations are not comparable).
Health Care – Share of National Income. Source: World Bank
Note that the cost has risen by a quarter in every country; and also that the USA is unique in denying care to a large slice of its own people, and is the only country with DECLINING life expectancy.
Something has to change. ‘We The People’ either have to accept higher taxes (a UK Liberal Democrat proposal, swamped by other issues last time we voted) or ration services: cutting care for the very old; charging for Accident & Emergency services for drunks on a Saturday night; denying knee operations to the obese, cancer care for smokers and more. So far, politicians have shirked their responsibilities to make these tough choices options clear to voters – and we have been complicit in voting for snake oil miracles rather than facing our own responsibilities. But beware anyone who has a cunning plan, especially if he is a stakeholder in the business that profits from that scheme.
The future is neither simple, not cheap, not guaranteed to succeed. We cannot say we have not been warned. What do you think? How do those recollections chime with your experiences – does this picture fit, or is it spectacularly wrong?
Ross Hunter 26.2.18 © RussiaKnowledge