BLAME it on the weather or the silly-season absence of more serious news, but arguments about America’s health care have become a touch delirious over the past couple of weeks. People have accused each other of being evil-mongers, dealers in death or even un-American; a sad substitute for a thoughtful debate about a complicated subject that intimately affects every citizen and ties up some $2 trillion a year, a seventh of the world’s largest economy.

Now the distemper has spread across the Atlantic. The enemies of Barack Obama’s health-reform plans have no more potent weapon, it seems, than to accuse him of seeking to replicate Britain’s dreaded National Health Service on American soil. Even David Cameron has been dragged into the affair. An unhelpful Conservative MEP has been caught joining in the NHS-bashing in America, leading to the predictable and unfair charge that Mr Cameron’s henchmen are secretly bent on unravelling the system.


This focus on the NHS is unfortunate in a couple of serious ways. First, by painting an inaccurate picture of the British system, it helps blind Americans to weaknesses in their own one that need to be corrected if it is not to collapse under the weight of its costly inefficiencies. Americans have been fed, during the summer slanging, a diet of ludicrous untruths: that the astrophysicist Stephen Hawking, for instance, would have been abandoned to die of his motor neurone disease had he been unfortunate enough to live in Britain. (He does.) More dangerous was the remark of Charles Grassley that his fellow senator, 77-year-old Edward Kennedy, would not be treated for his brain cancer if he lived in Britain on account of his age. Mr Grassley, through his position on the most important of the Senate committees considering health reform, holds its fate in his hands.

It’s not so bad in Britain
The reality which these calumnies obscure is that the NHS costs half as much per person as the American system costs. Yet it delivers results which are on some plausible measures (see article) actually superior, for instance in terms of health in middle-age or life expectancy at birth (America’s record at treating cancers is much better, though). And it does this while avoiding the disgrace that so shames America, of leaving around 46m people, some 15% of its population, without any form of health insurance and therefore reliant on emergency-room care, which is costly and inefficient. Many millions more are covered by only bare-bones policies, which can leave them destitute in the event of prolonged illness. But if American politicians peddle falsehoods about what goes on in other countries, Americans are correspondingly less likely to appreciate the extent to which they are being let down.

The second thing to lament about the current apology for a debate is that it is giving the idea of controlling health-care costs a bad name. Mr Obama promised that his reform package would bring down costs, as well as extend coverage. But so spooked has the administration become by accusations of “rationing” health care, as is done in “socialist” systems like the NHS, that very little cost control is now to be expected from whatever bill eventually emerges (see article).

The reality is that America, like Britain, already makes extensive use of rationing. Around half of all Americans are covered by one government programme or another, including those providing health-insurance for the elderly, the poor and government employees. These schemes lay down in great detail, in the form of national and local “coverage determinations”, which treatments and procedures can be claimed for, and at what rates. And all but the most expensive private insurance policies impose limitations of their own. A more honest discussion would accept that cutting costs, as the administration has promised to do, must involve reining in a system that encourages patients to demand tests and procedures that they don’t really need and doctors to recommend them.