Obama's health plan has nothing to do with the British National Health Service

Coming back to America after almost 20 years in England, I am appalled at the nonsense being spouted by Obama and his supporters, CNN, etc., saying that the Democrat proposal would be like the "good" National Health Service system in the UK, in which everyone is well looked after from cradle to grave by a compassionate state.

I don't recognise the NHS that Obama is describing. You would think that there is a doctor on every street corner waiting to help you blow your nose. Not so. Even the left-wing Guardian newspaper, champion of the NHS, is an avid chronicler of its flaws.

In the real world the NHS has its share of serious problems, the quality of care ranges from superb to diabolical, and health care reform is a top political issue in the UK. But no British politician would have any chance of election on a platform of replacing the NHS with an American-style system. That's not what the debate is about there.

The US right has seized on the idea of formal Death Panels as though this is part fo the NHS furniture. The suggestion that something even slightly like this could be going on makes headlines and arouses furious dissent in the UK. Check out what Britain's leading conservative paper, the Daily Telegraph, has to say about this. Angry, but arguing for reform not abolition.

While the NHS has some significant problems, most people in Britain receive very good health care almost all of the time. The ranters on Fox News and talk radio are equally as wrong about the NHS as Obama, with their obsessions about death panels and statism. You would think that pretty much every ill person in the UK is lying neglected and in agony by the side of the road.

In a world where very clever, slightly better, very expensive new treatments come along regularly, the NHS is in a difficult position. Should everyone have the latest, best treatments? Should the NHS invest in training their immense staff in how to deliver the latest, best treatments?

These difficult decisions are mired in the sort of bureaucratic sludge familiar to everyone who has dealt with Big Government anywhere. They are too slow, they may tend to worry more about job security than the public good, they miss the point, and so on. NHS management can sink into a tangle of red tape at times, thanks in recent times to the Labour Party's statist delusions of centralised micro management but sometimes thanks simply to huge scale.

Americans who can afford it get the benefit of expensive marginal treatments that are either unavailable in the UK due to cost (is it a Death Panel!?), or worse are only available if you are lucky enough live in the right NHS region (aka the "postcode lottery"). Is it fair? Is it right? The answer is very important if you live in the UK, but hardly relevant to the American debate.

The NHS is in fact very good at almost all of what it does, particularly in emergencies and in day to day health care delivery. A Brit comparing the NHS to the US system would quickly notice different attitudes toward service as evidenced by availability of CT scanners (anytime in the US, 9 to 5 in the UK). You are more warmly welcomed in an American doctor's office than in a UK equivalent, but that's also true of the corner shop.

Very few Brits would trade the anomalies of the NHS for the underlying risk of medically driven financial devastation that most Americans face.

For all the grousing about the flaws of the NHS (and the flaws are genuine), it has a very clear ethos - that medical care should be free at the point of delivery, to everyone.

Could an American politician on either side of this debate offer such a clear objective? Without a clear statement of what we are trying to do, can things really get better?

The Democrats enjoy holding up a fantasy NHS as a harbinger of paradise, and the Republicans engage them heartily with great fervor, giving the fantasy straw man a prolonged thrashing.

The whole discussion is a sham, the NHS used as a red herring to keep us from having a sensible discussion about issues that actually matter here.

Both sides in the US are dealing in slogans and made-up comparisons, with little connectivity to any of the possible outcomes in America. For the purposes of the American health care debate, it doesn't really matter what the NHS is, or isn't.

Why does the American left (which is, to be fair, not very far left by world standards) use the UK as an example of their ideal health care system, when nothing even slightly similar is being proposed?

To emulate the NHS, we would have to move much further to the left than any American politician would dare to do beyond a few enclaves like San Francisco (or perhaps Minnesota).

You would start by nationalising all the hospitals and doctors - telling them they are now all employees of the government (with suitable incentives to make them happy to comply). As a sort of casual side effect we would of course wipe out the US indemnity health care industry at a stroke. The Democrats don't propose anything of the kind.

The actual proposals that have a chance seem to be mainly about extending the employer-paid insurance model to those who don't have this now. This model is not even remotely similar to the NHS, which is a government agency for which American-style indemnity health insurance is simply an irrelevant concept.

If we did emulate the NHS, and made the ENTIRE health system a government agency, might we enjoy the left's promised reduction in the overall cost of US health care? Maybe, but that's not what they're suggesting. It could be we are headed for a level of red tape and political interference in health care that matches that in the UK, but at the same time NOT headed for a reduction in costs or an improvement in quality.

Can we really make progess while starting from the proposition that employers should fund health care? Are any of the noisy people in the news asking whether this makes sense, where it came from, and what the alternatives might be?

Read the excellent piece in the Atlantic Monthly by David Goldhill "How American Health Care Killed My Father," for an interesting and well documented view of how our system got to be the way it is and a very different idea about how to fix it.

Goldhill's own experience and investigation shine a harsh light on the flaws in our American system, and makes a compelling case that the Republicans and Democrats have both missed the point about what is wrong and how we might take steps toward fixing it. Is it that the politicians aren't smart enough to understand the problem? We seem to be about to spend an awful lot of money without having any sort of serious debate, or a clear vision of what a desirable future might look like.

I worry that we will just make things worse, that we are missing a chance (just as we missed it with the Clintons) to make a real change for the better.