Liberal Vision

NHS: Postcode “lottery” strikes again

Britain’s state-run National Health Service (NHS) doesn’t fare too well in comparisons of cancer survival rates.  Every year studies show far more deaths under the NHS’s watch than in countries of comparable wealth.  “20% higher than Europe” reported a recent headline, while new cancer drugs continue to be rationed, often considered “not cost effective“.

Now it’s the turn of survival rates within the UK to throw up some shocking results, and destroy a few fallacies in the process.  The Guardian reports that your likelihood of beating cancer differs hugely depending on where in Britain you live.  People in plush Kensington & Chelsea, lo and behold, are three times more likely to survive a year than folk out in Herefordshire.

So back to those fallacies – firstly, there is no such thing as “healthcare” as a set, unvariable service. Just like food, cars, shoes et cetera, healthcare standards are completely variable – and new innovations constantly provide standards that people could not have dreamed of in the past. Like the aforementioned products, higher standards will come with higher costs, and therefore higher prices.

Secondly, these variations are not ironed out by government-provided services. We simply end up with varying services and less choice between them. Typically it’s the poor who lose out, just as children in deprived inner-city areas are obliged to attend worse state schools than children in leafy home counties with a comfortable local comp in the village. The “postcode lottery”, often not a lottery at all, continues to affect both these state monoliths.

Americans without health insurance: young, rich and foreign

Everybody is shocked by the fact that over 15% of Americans do not have health insurance.  In a system that supposedly relies on private insurance as the only door to healthcare, that more than one in seven is uninsured is a disgrace.  Right?

But who are these uninsured? The poor? The old? American citizens? Don’t you believe it.

Hat-tip to Steve Bettison over at the Adam Smith Institute blog for analysing the US Census Bureau’s Income, Poverty and Health Insurance statistics.

Of the 45,667,000 people in the United States of America that do not have private health insurance:

• 9,737,000 are not US citizens. In addition,
• 32,118,000 live in households with an annual income of over $25,000, of whom
• 17,503,000 live in households with an annual income of over $50,000, of whom
• 9,115,000 live in households with an annual income of over $75,000.
• Only 686,000 are over the age of 65.
• 18,320,000 are aged between 18 and 35.

It is important to note that those six groups are not exclusive, of course.  It is possible to fall into five of the six categories.  But that still means that the number of poor old Americans who lack healthcare is significantly less than is often suggested.

Now I am not suggesting that foreigners do not deserve healthcare, but it does slightly cloud the picture of poor Americans being denied healthcare.  Neither am I suggesting that it is easy to find the money for health insurance from a household income of $25,000 a year, though it is not easy for taxpayers on low incomes in the UK to afford healthcare either.  It is the case that young people are notoriously bad at choosing to insure themselves and prepare for their futures.

The point is that the oft-cited raw figures about the uninsured in America mask a very heterogeneous group, many of whom are well able to afford insurance, and many more of whom are making rational choices not to.  Whatever the arguments for and against various healthcare systems in the US, it is worth bearing these facts in mind.