Dr Phil Hammond, broadcaster and GP returner in Bristol

Whatever happens, do not Americanise the NHS

Michael Moore’s film Sicko, which attacks the US healthcare system, has sparked a series of protests calling for a single-payer system to replace the US private insurance programme, which leaves about 46 million people (16% of the population) uninsured. Protesters have been campaigning outside cinemas with banners (‘Health care is a human right’) and chants (‘Hey, hey, ho, ho, insurance companies have got to go’ and ‘Pills cost pennies, greed costs lives’). I am not sure it will have UnitedHealth and Kaiser quaking in their boots, but it is a start.

Sicko is particularly critical of the US health insurance lobby, which it claims paid huge sums to the campaign funds of leading politicians—nearly $900,000 to President Bush alone—to support a bill requiring elderly Americans in the Medicare insurance plan to sign up to one of a confusing number of plans offering drug discounts. The bill, passed in the middle of the night nearly 4 years ago, prohibited Medicare from negotiating drug prices with manufacturers, leading to higher prices for Medicare users as well as for the Medicare administration. Never mind the manufacturing slump and the threat from the Chinese economy, this alone could bankrupt America.

The film itself gives us a rose-tinted view of the NHS but at least it reminds us of its beauty as a one-stop shop, free at the front door. If you are run over or stabbed, you do not need to check your wallet before you get into the ambulance. If you have a brain tumour removed, you are not kicked out the next day because your insurance policy does not cover continuing care. Equally, you do not have to choose which of your severed digits to have sewn back on.

Whatever happens to the NHS, we do not want to Americanise it. There is no need for large companies, who will cherry pick easy operations and leave those too sick to turn a profit to die in casualty, or preferably just outside. In all countries with insurance systems, the sickest patients are those without insurance. Let us not go there.

However, I am not sure that socialised healthcare could ever work in a country as rabidly consumerist as America or where drug companies are allowed to advertise direct to consumers. Every American is a potential consumer of pills for every possible complaint. No longer do you use a doctor to get them either, you request your drug of choice from your ‘prescriber’. One US television advertisement is for genital herpes:

Well-off middle class man in happy embrace with well-off middle class woman says: ‘I have genital herpes.’
Woman: ‘I don’t.’
Man: ‘Because I care.’

This is re-enacted by another couple, this one black, then another white couple, and then a Hispanic couple. Finally the name of the drug appears along with the list of possible side-effects.

There are many advertisements for erectile dysfunction, with helpful warnings like ‘Please check with your prescriber if your erection lasts for more than 4 hours or you develop vision problems.’ That sounds like a great sales pitch for teenage boys! And there is an advertisement for Viagra to the tune of ‘Viva Las Vegas’. Sing along now: ‘Viva Viagra’.

Another advertisement features nubile young girls dancing happily around because they are taking a birth control pill that only gives them four periods a year. Another announces an incontinence pill to ‘keep your bladder quieter’. There are numerous advertisements for different sleeping pills and antidepressants, with advice to ask for them by name.

The culture is pure consumerism. The consumer goes in to the prescriber to request the drug they have seen on the television, and the prescriber feels compelled to prescribe because otherwise the consumer takes his or her business next door to the next prescriber.

If America really does want a single-payer healthcare system, it is going to have to ban the advertising and import NICE too! G

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