I think that some people in the US are very afraid of change. Also I think that health insurance companies and others who have vested interests in preventing health care reform have spent a lot of money to stir up these people. Perhaps these people who are afraid of change have good health insurance now and they have never been in the situation my family has been in.
We had good insurance, a HMO through my husband's employer, when our daughter was born and it was a very good thing we did, because her medical care cost over $250,000 before she was six weeks old. Shortly after all this happened, my husband lost his job. I think that it was largely because the company's health insurance contract was coming up for renewal and it would be cheaper if they eliminated the employees who had made heavy use of their health insurance. About the same time, they also got rid of an employee who had a heart attack. I think that he may have been still in the hospital.
When my husband lost the job that had supplied us with health insurance, we were able to pay the COBRA for 18 months, which means that we were able to keep the health insurance policy by paying the company's share of insurance costs in addition to our share plus a small added administrative fee. Then we had to figure out how to insure our daughter with her pre-existing health conditions and we found it almost impossible. My husband quickly got another job, but its insurance didn't cover us at the time. In the end, we were able to pay an exorbitant price for something called 'continuation coverage' which was the most expensive and worst insurance we had ever had in our lives, but at least they had to cover our daughter's pre-existing conditions. Finally, my husband's company changed their insurance carrier to one that covered us, so we have regular insurance now.
IMO, here's the bad thing about the NHS: If they want to contain costs, then they have to ration care. So I think there is a little germ of truth to what they say about adding a year to Stephen Hawking's life possibly being considered less worthwhile to the NHS than adding a year to a healthy person's life. To take this quality of life into account, the NHS uses something called a
QALY or Quality-Adjusted Life Year. Everyone's quality of life is rated, with a perfectly healthy person getting a 1.0 and a dead person getting a 0.0. For example, I read that if you have "some problems with performing usual activities, some pain or discomfort," you get a rating of 0.76. Right now, I have some pain from a sprained right ankle and this has been limiting my mobility a bit, so I think I would probably get a QALY of 0.76, which means that to the NHS, adding a year to my life would be worth about three-fourths as much as adding a year to the life of a perfectly healthy person. I have no idea what Stephen Hawking's QALY is, but it is arguably less than 1.0.
Medical treatments are assessed by their cost per QALY, so if chemotherapy that cost $100,000 would extend the life of a hypothetical cancer patient by five years, and if the NHS thinks those five years would be crappy ones and gives that patient a QALY of 0.20, then that treatment doesn't cost $20,000 per year, it costs $100,000 per QALY. Right now, the British health care system generally doesn't cover treatments that cost more than about $50,000 per QALY, so that particular cancer patient would not get his $100,000 chemotherapy.
I think that what a lot of Americans aren't taking into account is that we also ration care in the US, but we use a different metric. If a person is uninsured and can't afford to pay for an expensive treatment themselves and they aren't destitute enough to be covered by Medicaid, then they don't get the treatment. Also, quite often, some insurance company refuses to pay for a particular drug or procedure because of something in the fine print in their policy. Maybe people could see this issue as one over which they have more control because for one thing they often have some lmited amount of control over which insurance company they select. Also, if it's just an insurance company who refuses to cover a certain treatment, then the issue could be fought in a court if necessary, and the resulting bad press may cause the insurance company to relent and pay for the treatment. However, if we have just the government as a single payer, then there is much less room for appeal if they refuses to cover a treatment.
