Letters from Ireland #7

Coincidentally given the current US healthcare debate and #welovethenhs on Twitter, I caught an American programme on Irish TV. It was called ‘The Doctors’ and featured a very handsome young doctor (possibly a surgeon?) in blue scrubs and an older, not-quite-as-handsome-but-would-appeal-to-the-older-female-viewers, man in white. It was a Jeremy Kyle show style format, but thankfully nowhere near as trashy.

The show featured a couple with three children, the youngest of whom, Kayleigh, had been born two months premature. She’d had something like 42 procedures in her first few years of life, including 9, I think, operations. They’d run up a medical bill of $2 million, paid for by their insurers. (Their insurance policy had an upper limit of $5million which is higher than most – who knows what happens when that is reached? Do the insurers just, metaphorically speaking, pull the plug?)

The parents were in real estate, and had been making $200,000 a year. They had a nice home. (So a conveniently ‘deserving’ case, the cynic in me says, not a feckless – for which read, poor – couple who had never taken out insurance in the first place). But then the housing slump happened, and their income dropped dramatically. They were faced with a choice – pay the mortgage, or keep up their health insurance payments, so that they could continue with Kayleigh’s treatment. They chose the latter, as most parents would. Now the bank was due to foreclose on their house that Monday, leaving the family of five homeless. (OK, they were going to move in with one set of grandparents, but in far from ideal circumstances).

Of course it had a happy ending – one of the insurance reps said his company would cough up $20,000 so they could pay off their mortgage arrears and stop foreclosure. The other insurance rep said he’d match it. But only coming on a TV show had saved them. What I found chilling was how the focus of the show was on advising the audience how you can get the best out of your health insurance, not criticising the system which had forced a family to choose between a roof over their heads and their child’s life.

In the UK and USA people often talk of the welfare state as a disincentive to people to look after themselves, to be self-sufficient. (See Portillo’s recent comments, for example, and this excellent response). And of course it’s true to an extent – some people won’t stick it out in jobs they dislike because they know they can fall back on benefits. Some won’t look for work for the same reason. So right-wingers posit that tough welfare rules – e.g. the Wisconsin model, where you can only claim out-of-work benefits for a maximum two years in your lifetime – will force people to be more self-sufficient, to look out for themselves, to get their act together. Of course this is a grossly simplistic view, which ignores those who are reliant on welfare ‘through no fault of their own’ (a horrible phrase but convenient shorthand for the purposes of this blog post).

On this principle, shouldn’t the same apply to health care? If people don’t have a socialised healthcare system to fall back on, like the NHS, and know that it will cost them if they get ill (i.e. those of the 46 million Americans who don’t have health insurance and aren’t eligible for Medicaid or Medicare or children’s healthcare – check initials) shouldn’t the knowledge that they either won’t get medical treatment or they’ll have to find substantial sums of money to pay for it, be an incentive for them to look after their health more? But you can bet that the health freaks jogging along the beach in LA or attending Ashanti yoga classes in New York, with their macrobiotic diets and their wheatgrass shots, aren’t the ones without health insurance. It’s the ones in McDonalds and KFC and Taco Bell. (I have no evidence for that – feel free to prove me wrong, if you can!)

Has anyone here (Daniel Hannan?) suggested that if the NHS wasn’t there to ‘bail people out’ with treatment for illnesses that are obesity or smoking or alcohol related, people’s habits would change as a result? There has been a debate (for example, in George Best’s last years) about whether liver transplants should go to alcoholics or be reserved for ‘more deserving’ cases but that wasn’t really suggested as a possible incentive for heavy drinkers to give up the booze. For the avoidance of doubt I don’t think for a moment (the availability of) healthcare could be used as a carrot or stick to encourage people to lead healthier lifestyles. But for those with an evangelical belief in the power of the market, shouldn’t they be saying this? And how then does this square with their belief in individual liberty, in the right to live your life as you choose?

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