As the curtain fell on the first night of a Capital Fringe Festival play yesterday, something occurred that I found disturbing. The director took to the stage amid the clapping, hushed the audience, and made a plea: when we left the theater that night, would we please give money to the actors to pay for their healthcare (and that of other Washington D.C. actors). And thus did the performers turn essentially into beggars, shaking their money cans hopefully at the departing audience. I was the only one who looked disconcerted.
I have been following the Healthcare Bill debates in Washington, and as a Brit and a physician, I am finding it intriguing. Perhaps indoctrinated from birth in the joys of a National Health Service that is free at the point of use for the entire population, I was naturally going to find it difficult to reconcile the many things I love and admire about the United States with a society that accepts reducing its citizens to begging from strangers (or, presumably, to selling their homes, going without food, or the numerous dubious ways people who don't/can't have health insurance can mobilize quick money) to access essential healthcare. The actors shaking the money cans cast me back to university days, listening to Masters lectures on financing healthcare, and the graphs depicting low income countries where governments were struggling for solutions to prevent catastrophic healthcare costs, hurling its citizens into poverty. The director's speech last night, along with the Healthcare Bill debates, demonstrated that this struggle is alive and well in high income countries too.
There are no clear solutions to financing healthcare anywhere in the world. Every option has its pros and cons, and there are no easy answers. Indeed, when last week I was sent a consultation as an identified 'thought leader' on healthcare financing, I felt a fraud, as I couldn't really provide a great thought with which to 'lead' on this issue. Healthcare financing is hard. At the end of the day, it's a balance between economics and values.
No matter what country you're in, healthcare sucks up GDP at an increasing rate as tests and treatments get ever more sophisticated (and consumer expectations rise). This is true in the United States more than anywhere else in the world. And of course, everywhere in the world wants both values and value. Britain's values currently surround ensuring that every resident of Britain can access healthcare, and government-funded healthcare is assessed to ensure it provides sufficient value. Whereas from the debates, I'm hearing and reading, America's values on access to healthcare are split, with a much bigger emphasis on individual responsibility, and less emphasis on mechanisms to ensure that the healthcare delivered provides sufficient value. But values evolve. When the British National Health Service was set up, there was bitter opposition from many parts of the population, just as we're hearing currently in the United States. Now, despite British governments seeking solutions to manage rising costs, the population at large can't stomach a society without healthcare that's free at the point of use.
At the end of the day, there are no easy answers. But personally, I find it difficult to accept that a system that is simultaneously the most expensive in the world, and incorporates citizens begging strangers for their lives, to be the best system (in terms of both values and value) that one of the most developed countries in the world can think of and implement. Obama's Healthcare Bill seems to be working on it. But healthcare financing, anywhere in the world, is hard. I will be intrigued to follow what transpires.