Lessons from the New World.

[MSH]

Some right wing politicians have claimed that the money for healthcare has been protected in the recent austerity measures. It is true that the budget has been ring-fenced, but effectively has seen major cuts because of advances in medical technology and treatment and because of the ageing population. I read recently that the NHS needs in excess of £8 billion,

http://www.thetimes.co.uk/tto/health/news/article4443469.ece

Which predictably led to commentators suggesting root and branch reform generally in favour of a market based system. Some would claim that we are already moving in that direction. The problem is that our current system is one of the most efficient in the world.

http://www.commonwealthfund.org/interactives-and-data/us-compare-interactive#?ind=1

The problem with introducing a market mechanism is that the people who most need healthcare, the elderly, the mentally ill and those with long term conditions are the least attractive to service providers, and oftentimes the least able to pay.

There may be merit in the idea, but it won't be easy, and contrary to popular belief there isn't a great deal of wasteful demand in the NHS, (or if there is it is curtailed). A bigger problem in a market system is over investigation and over treatment as evidenced in the USA.

All healthcare sysems face major challenges because of the factors noted above, and unfortunately rationing is a reality. In the NHS this is the work of NICE and I have been impressed with how carefully they considered the case for Abraxane before ultimately rejecting the drug. Nonetheless advances are being made and I am convinced I have had at least two years of good quality life because of the introduction of Folfirinox over Gemcitabine.

I was recently able to take advantage of my well-being to enjoy a five week holiday in North America. During this time I spent three days each visiting the cities of Vancouver and San Francisco. These are both vibrant attractive places with much to offer. They are also home to a large population of the homeless and the mentally ill. I was appalled to see a few nights ago in SF three people check in bins for food all within the space of less than an hour. The irony is that in this land of plenty so many people suffer from obesity.

Those advocating a more market based system here should first stroll down Carrall Street in Vancouver, but not after dark, or anywhere in large parts of downtown San Francisco. Those of us on this board have more personal lessons of market based healthcare. I was unable to find travel insurance anywhere.