Saturday, August 14, 2010

A Chance to See Both Sides

One of the statements I’ve heard about the Affordable Health Act (our new health care law) is that it is “an experiment.”  For supporters, that’s because it’s how we begin to discover how to meet the goal, in this case, access for all to affordable health care.  For critics, it’s that’s because we can’t know ahead of time how well it will work, with the implication that in fact it won’t.

And both are right, at least to some extent.  This is an experiment, at least to the extent that we haven’t really pursued a goal we’ve been talking about for generations.  It’s also an experiment in that we can’t know all the consequences, including that we can’t know how close this will get us to our goal.  One the other hand, many of us think it can work, and once again doing nothing certainly can’t.

Well, now we’re not the only ones experimenting.  Several weeks ago it was announced that the new administration in the United Kingdom had decided to make some changes to the National Health Service in England (services in other parts of the UK are separate and will not be affected).  They published a white paper describing the goals of the changes.  These included allowing more control over health care decisions to patients and to general practice physicians, with less control by bureaucrats.  Goals also included focusing on procedures that work, and no longer supporting those that don’t – much like our new health care law’s efforts at measuring effectiveness.

Over all, these goals seem quite ambitious.  At the same time, while goals are interesting, so are the measures taken to meet them.  Now we know a bit more about that.  The first step appears to be to privatize in whole or in part NHS Professionals Ltd, a subsidiary of the National Health System that provides employees for NHS hospitals and practices.  It functions largely as a temp agency within the National Health Service.  While what steps can be taken isn’t clear, the point will be to begin a decentralization of NHS structures and creation of opportunities for for-profit companies to provide services to NHS institutions.

Now, just as President Obama has insisted that, while our Government is more involved in overseeing health care, it remains primarily a private-practice, market oriented industry, so the British Government says that, even with decentralization and some private participation, it remains committed to the National Health Service as a service of the government.  That makes this all the more interesting.  As we experiment with more government involvement in our health care, they are experimenting with more market involvement in their health service.

While a great deal of attention is being paid to the fall’s Congressional elections, the new health care law is safe at least until our next presidential election (and longer if President Obama is reelected).  At the same time, there won’t be a new Parliamentary election in the UK for a while.  That gives us some time to see how this unfolds.  While we’re discovering what it means for us to have more government involvement in health care, they’ll be discovering what it means for them to have less.  I think there will be something to learn in both processes.  If we’re wise, I think we’ll pay attention to both.

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