'Evil and Orwellian' – America's right turns its fire on NHS

[luke]

'Evil and Orwellian' – America's right turns its fire on NHS

The National Health Service has become the butt of increasingly outlandish political attacks in the US as Republicans and conservative campaigners rail against Britain's "socialist" system as part of a tussle to defeat Barack Obama's proposals for broader government involvement in healthcare.

Top-ranking Republicans have joined bloggers and well-funded free market organisations in scorning the NHS for its waiting lists and for "rationing" the availability of expensive treatments.

As myths and half-truths circulate, British diplomats in the US are treading a delicate line in correcting falsehoods while trying to stay out of a vicious domestic dogfight over the future of American health policy.

Slickly produced television advertisements trumpet the alleged failures of the NHS's 61-year tradition of tax-funded healthcare. To the dismay of British healthcare professionals, US critics have accused the service of putting an "Orwellian" financial cap on the value on human life, of allowing elderly people to die untreated and, in one case, for driving a despairing dental patient to mend his teeth with superglue.

Having seen his approval ratings drop, Obama is seeking to counter this conservative onslaught by taking his message to the public, with a "town hall" meeting today at a school in New Hampshire.

Last week, the most senior Republican on the Senate finance committee, Chuck Grassley, took NHS-baiting to a newly emotive level by claiming that his ailing Democratic colleague, Edward Kennedy, would be left to die untreated from a brain tumour in Britain on the grounds that he would be considered too old to deserve treatment.

"I don't know for sure," said Grassley. "But I've heard several senators say that Ted Kennedy with a brain tumour, being 77 years old as opposed to being 37 years old, if he were in England, would not be treated for his disease, because end of life – when you get to be 77, your life is considered less valuable under those systems."

The degree of misinformation is causing dismay in NHS circles. Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence (Nice), pointed out that it was utterly false that Kennedy would be left untreated in Britain: "It is neither true nor is it anything you could extrapolate from anything we've ever recommended to the NHS."

Others in the US have accused Obama of trying to set up "death panels" to decide who should live and who should die, along the lines of Nice, which determines the cost-effectiveness of NHS drugs.

One right-leaning group, Conservatives for Patients' Rights, lists horror stories about British care on its website. An email widely circulated among US voters, of uncertain origin, claims that anyone over 59 in Britain is ineligible for treatment for heart disease.

The British embassy in Washington is quietly trying to counter inaccuracies. A spokesman said: "We're keeping a close eye on things and where there's a factually wrong statement, we will take the opportunity to correct people in private. That said, we don't want to get involved in a domestic debate."

A $1.2m television advertising campaign bankrolled by the conservative Club for Growth displays images of the union flag and Big Ben while intoning a figure of $22,750. A voiceover says: "In England, government health officials have decided that's how much six months of life is worth. If a medical treatment costs more, you're out of luck."

The number is based on a ratio of £30,000 a year used by Nice in its assessment of whether drugs provide value for money. Dillon said this was one of many variables in determining cost-effectiveness of medicines. He said of his body's portrayal in the US: "It's very disappointing and it's not, obviously, the way in which Nice describes itself or the way in which we're perceived in the UK even among those who are disappointed or upset by our decisions."

On Rupert Murdoch's Fox News channel, the conservative commentator Sean Hannity recently alighted upon the case of Gordon Cook, a security manager from Merseyside, who used superglue to stick a loose crown into his gum because he was unable to find an NHS dentist. The cautionary tale, which was based on a Daily Mail report from 2006, prompted Hannity to warn his viewers: "If the Democrats have their way, get your superglue ready."

The broader tone of the US healthcare debate has become increasingly bitter. The former vice-presidential candidate Sarah Palin last week described president Obama's proposals as "evil", while the radio presenter Rush Limbaugh has compared a logo used for the White House's reform plans to a Nazi swastika. Hecklers have disrupted town hall meetings called to discuss the health reform plans.

David Levinthal, a spokesman for the nonpartisan Centre for Responsive Politics, said the sheer scale of the issue, which will affect the entire trajectory of US medical care, was arousing passions: "It's no surprise you have factions from every political stripe attempting to influence the debate and some of those groups are certainly playing to the deepest fears of Americans. There's been a great deal of documented disinformation propagated throughout the country." Defenders of Britain's system point out that the UK spends less per head on healthcare but has a higher life expectancy than the US. The World Health Organisation ranks Britain's healthcare as 18th in the world, while the US is in 37th place. The British Medical Association said a majority of Britain's doctors have consistently supported public provision of healthcare. A spokeswoman said the association's 140,000 members were sceptical about the US approach to medicine: "Doctors and the public here are appalled that there are so many people on the US who don't have proper access to healthcare. It's something we would find very, very shocking."

from http://www.guardian.co.uk/world/2009/aug/11/nhs-united-states-republican-health

Is public healthcare in the UK as sick as rightwing America claims?

The NHS has become the unexpected target of those opposed to Barack Obama's healthcare reform proposals. Republicans and rightwing commentators in the US have made strong allegations about the failings of Britain's health system. Denis Campbell and Girish Gupta put those claims to professionals in the health sector

The claim

Ted Kennedy, 77, would not be treated for his brain tumour if he was in Britain because he is too old – Charles Grassley, Republican senator from Iowa.

The response

Untrue, says the Department of Health. "There is no ban on anyone of any age receiving any treatment, " said a spokesman. "Whether to prescribe drugs or recommend surgery is rightly a clinical decision taken on a case by case basis."

The claim

Government health officials in England have decided that $22,750 (£14,000) is what six months' life is worth. Under their socialised system, if a medical treatment costs more, you're out of luck - Club for Growth

The response

The National Institute of Health and Clinical Excellence (Nice) decides whether new drugs represent value for money for the NHS in England and Wales. It replied: "This is a gross misrepresentation of how Nice applies health economics to try and address the central issue: how to allocate healthcare rationally within the context of limited healthcare resources. Nice assesses the cost of a treatment in terms of a cost-utility analysis which takes account of the quality adjusted life year – the amount and quality of extended life it is hoped the patient will gain. The current ceiling is £30,000 but exceptions are made."

The claim

In England, anyone over 59 years of age cannot receive heart repairs, stents or bypass because it is not covered as being too expensive and not needed – an anonymously authored, but widely circulated, email, largely sent to older voters

The response

Totally untrue. Growing numbers of patients over 65 with heart conditions are having surgery, including valve repairs and heart bypass surgery, says Professor Peter Weissberg, the British Heart Foundation's (BHF) medical director. For example, the average age at which people have a bypass operation has risen from 58 in 1991 to 66 in 2008.

The claim

Breast cancer kills 46% of its targets in Britain, compared with 25% in the US; prostate cancer kills 57% of the Britons it strikes, compared with 25% of American victims; Britain's heart attack fatality rate was 19.5% higher than America's in 2005 – Pacific Research Institute, a San Francisco-based thinktank

The response

Breast cancer does claim more lives, proportionally, here than in the US. According to the 2002 Globocan database run by the World Health Organisation's cancer advisers, 19.2 of every 100,000 Americans die of the disease, but 24.3 per 100,000 here die. On prostate cancer, a Lancet Oncology global study last year found that 91.9% of Americans with the disease were still alive after five years compared to just 51.1% in the UK. With heart attacks, 40% of Britons who suffer one die from it compared to 38% in the States – nowhere near the difference claimed.

The claim

In Britain, 40% of cancer patients are never able to see an oncologist; there is explicit rationing for services such as kidney dialysis, open heart surgery and care for the terminally ill – Conservatives for Patients' Rights

The response

"The claim that 40% of cancer patients are never able to see an oncologist comes from a 15-year-old study which is completely out of date. Since then we have had the Nice Improving Outcomes Guidance series and the NHS Cancer Plan for England, which has increased the number of cancer consultants and established specialist multidisciplinary teams," said Duleep Allirajah of Macmillan Cancer Support. However, "some people with serious kidney failure are unable to obtain dialysis on the NHS and die", said Tim Statham, chief executive of the National Kidney Federation. "Some parts of the NHS can't cope, because patient numbers are increasing by 6% a year, which is a huge burden. Of about 100 renal units in the UK, probably 20% are working at 100% capacity or above," he added. The claim about open heart surgery is not true, said the BHF's Weissberg. "There's no explicit rationing. Some people don't get treatment, but those decisions are made solely on the basis of clinical criteria and their risk of dying. We only operate on people who are likely to benefit and not die." The three main political parties agree that Britain provides good quality end-of-life care but that access to it can be patchy, depending on location and the patient's condition. The government is working to improve the situation.

The claim

In the UK, breast cancer survival rates are 11% lower than they are here in the United States – Sue Myrick, a Republican congresswoman from North Carolina

The response

If anything the gap is wider than Myrick says. Breakthrough Breast Cancer cite two recent studies from Lancet Oncology. One says that 83.9% of women in the US diagnosed with breast cancer between 1990-94 lived for at least five years compared to 69.7% in the UK – a 14.2% difference. The second showed that, among women diagnosed with the disease in 2000-02, 90.1% in the States survived for at least five years whereas in England it was 77.8% – a 12.3% gap.

The claim

The British healthcare system is infamous for denying state-of-the-art drugs to cancer patients – National Center for Policy Analysis

The response

Nice has recently reformed its procedures after a series of controversies over the unavailability of certain cancer treatments. "The vast majority of new cancer drugs are made available to patients with notable exceptions, such as the likely rejection of several new kidney cancer drugs," said Allirajah of Macmillan Cancer Support. "However, the Nice process does need reforming to ensure decisions are made more quickly and patients' quality of life is taken more into account."

The claim

The British NHS "does not allow" women under 25 to receive screening for cervical cancer – Jim DeMint, Republican senator from South Carolina

The response

The NHS invites women in Wales, Scotland and Northern Ireland to attend for cervical cancer screening from 20 upwards. But in England screening for the disease starts at 25. That policy was recently reviewed and remains unchanged.

from http://www.guardian.co.uk/society/2009/aug/11/nhs-sick-healthcare-reform

more at Fox News and Conservatives for Patients Rights use NHS as ammunition against Barack Obama's healthcare plan

[luke]

Republicans, religion and the triumph of unreason
How do they train themselves to be so impervious to reality?


Sarah Palin really has claimed with a straight face that Barack Obama wants to kill her baby

Something strange has happened in America in the nine months since Barack Obama was elected. It has best been summarised by the comedian Bill Maher: "The Democrats have moved to the right, and the Republicans have moved to a mental hospital."

The election of Obama – a black man with an anti-conservative message – as a successor to George W. Bush has scrambled the core American right's view of their country. In their gut, they saw the US as a white-skinned, right-wing nation forever shaped like Sarah Palin.

When this image was repudiated by a majority of Americans in a massive landslide, it simply didn't compute. How could this have happened? How could the cry of "Drill, baby, drill" have been beaten by a supposedly big government black guy? So a streak that has always been there in the American right's world-view – to deny reality, and argue against a demonic phantasm of their own creation – has swollen. Now it is all they can see.

Since Obama's rise, the US right has been skipping frantically from one fantasy to another, like a person in the throes of a mental breakdown. It started when they claimed he was a secret Muslim, and – at the same time – that he was a member of a black nationalist church that hated white people. Then, once these arguments were rejected and Obama won, they began to argue that he was born in Kenya and secretly smuggled into the United States as a baby, and the Hawaiian authorities conspired to fake his US birth certificate. So he is ineligible to rule and the office of President should pass to... the Republican runner-up, John McCain.

These aren't fringe phenomena: a Research 200 poll found that a majority of Republicans and Southerners say Obama wasn't born in the US, or aren't sure. A steady steam of Republican congressmen have been jabbering that Obama has "questions to answer". No amount of hard evidence – here's his birth certificate, here's a picture of his mother heavily pregnant in Hawaii, here's the announcement of his birth in the local Hawaiian paper – can pierce this conviction.

This trend has reached its apotheosis this summer with the Republican Party now claiming en masse that Obama wants to set up "death panels" to euthanise the old and disabled. Yes: Sarah Palin really has claimed – with a straight face – that Barack Obama wants to kill her baby.

You have to admire the audacity of the right. Here's what's actually happening. The US is the only major industrialised country that does not provide regular healthcare to all its citizens. Instead, they are required to provide for themselves – and 50 million people can't afford the insurance. As a result, 18,000 US citizens die every year needlessly, because they can't access the care they require. That's equivalent to six 9/11s, every year, year on year. Yet the Republicans have accused the Democrats who are trying to stop all this death by extending healthcare of being "killers" – and they have successfully managed to put them on the defensive.

The Republicans want to defend the existing system, not least because they are given massive sums of money by the private medical firms who benefit from the deadly status quo. But they can't do so honestly: some 70 per cent of Americans say it is "immoral" to retain a medical system that doesn't cover all citizens. So they have to invent lies to make any life-saving extension of healthcare sound depraved.

A few months ago, a recent board member for several private health corporations called Betsy McCaughey reportedly noticed a clause in the proposed healthcare legislation that would pay for old people to see a doctor and write a living will. They could stipulate when (if at all) they would like care to be withdrawn. It's totally voluntary. Many people want it: I know I wouldn't want to be kept alive for a few extra months if I was only going to be in agony and unable to speak. But McCaughey started the rumour that this was a form of euthanasia, where old people would be forced to agree to death. This was then stretched to include the disabled, like Palin's youngest child, who she claimed would have to "justify" his existence. It was flatly untrue – but the right had their talking-point, Palin declared the non-existent proposals "downright evil", and they were off.

It's been amazingly successful. Now, every conversation about healthcare has to begin with a Democrat explaining at great length that, no, they are not in favour of killing the elderly – while Republicans get away with defending a status quo that kills 18,000 people a year. The hypocrisy was startling: when Sarah Palin was Governor of Alaska, she encouraged citizens there to take out living wills. Almost all the Republicans leading the charge against "death panels" have voted for living wills in the past. But the lie has done its work: a confetti of distractions has been thrown up, and support is leaking away from the plan that would save lives.

These increasingly frenzied claims have become so detached from reality that they often seem like black comedy. The right-wing magazine US Investors' Daily claimed that if Stephen Hawking had been British, he would have been allowed to die at birth by its "socialist" healthcare system. Hawking responded with a polite cough that he is British, and "I wouldn't be here without the NHS".

This tendency to simply deny inconvenient facts and invent a fantasy world isn't new; it's only becoming more heightened. It ran through the Bush years like a dash of bourbon in water. When it became clear that Saddam Hussein had no weapons of mass destruction, the US right simply claimed they had been shipped to Syria. When the scientific evidence for man-made global warming became unanswerable, they claimed – as one Republican congressman put it – that it was "the greatest hoax in human history", and that all the world's climatologists were "liars". The American media then presents itself as an umpire between "the rival sides", as if they both had evidence behind them.

It's a shame, because there are some areas in which a conservative philosophy – reminding us of the limits of grand human schemes, and advising caution – could be a useful corrective. But that's not what these so-called "conservatives" are providing: instead, they are pumping up a hysterical fantasy that serves as a thin skin covering some raw economic interests and base prejudices.

For many of the people at the top of the party, this is merely cynical manipulation. One of Bush's former advisers, David Kuo, has said the President and Karl Rove would mock evangelicals as "nuts" as soon as they left the Oval Office. But the ordinary Republican base believe this stuff. They are being tricked into opposing their own interests through false fears and invented demons. Last week, one of the Republicans sent to disrupt a healthcare town hall started a fight and was injured – and then complained he had no health insurance. I didn't laugh; I wanted to weep.

How do they train themselves to be so impervious to reality? It begins, I suspect, with religion. They are taught from a young age that it is good to have "faith" – which is, by definition, a belief without any evidence to back it up. You don't have "faith" that Australia exists, or that fire burns: you have evidence. You only need "faith" to believe the untrue or unprovable. Indeed, they are taught that faith is the highest aspiration and most noble cause. Is it any surprise this then percolates into their political views? Faith-based thinking spreads and contaminates the rational.

Up to now, Obama has not responded well to this onslaught of unreason. He has had a two-pronged strategy: conciliate the elite economic interests, and joke about the fanatical fringe they are stirring up. He has (shamefully) assured the pharmaceutical companies that an expanded healthcare system will not use the power of government as a purchaser to bargain down drug prices, while wryly saying in public that he "doesn't want to kill Grandma". Rather than challenging these hard interests and bizarre fantasies aggressively, he has tried to flatter and soothe them.

This kind of mania can't be co-opted: it can only be overruled. Sometimes in politics you will have enemies, and they must be democratically defeated. The political system cannot be gummed up by a need to reach out to the maddest people or the greediest constituencies. There is no way to expand healthcare without angering Big Pharma and the Republicaloons. So be it. As Arianna Huffington put it, "It is as though, at the height of the civil rights movement, you thought you had to bring together Martin Luther King and George Wallace and make them agree. It's not how change happens."

However strange it seems, the Republican Party really is spinning off into a bizarre cult who believe Barack Obama is a baby-killer plotting to build death panels for the grannies of America. Their new slogan could be – shrill, baby, shrill.

http://www.independent.co.uk/opinion/commentators/johann-hari/johann-hari-republicans-religion-and-the-triumph-of-unreason-1773994.html

'Last week, one of the Republicans sent to disrupt a healthcare town hall started a fight and was injured – and then complained he had no health insurance. I didn't laugh; I wanted to weep.'

[luke]

NHS fares best on free access to healthcare
Britain is the only country in the industrialised world where wealth does not determine access to healthcare, study finds

The NHS is the only health system in the industrialised world where wealth does not determine access to care – providing the most widely accessible treatments at low cost among rich nations, a key study has found.

The survey, by US health thinktank the Commonwealth Fund, showed that while one-third of American adults "went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs", this figure was only 6% in the UK and 5% in Holland.

In all countries except Britain, wealth largely determined access to health, with patients with incomes below the national average more likely to report trouble with medical bills and problems with getting care because of cost.

The survey, of 19,700 patients in 11 nations, found "substantial differences" among countries on access to care when sick, access after hours, and waiting times for specialised care.

About 70% of British patients reported same- or next-day access to doctors when sick, less than the 93% of Swiss adults reporting rapid access. In contrast, however, only 57% of adults in Sweden and the US, and less than half in Canada and Norway, were seen this quickly.

The NHS was also extremely cost-effective, with spending on health per person almost the lowest in the survey. A person in the UK paid $1,500 less than a person in Switzerland, $600 less than a German and less than half the $7,538 paid by every American for healthcare.

Only New Zealand, where one in seven people said they skipped hospital visits because of cost, spent less per capita than the NHS.

The report was particularly damning about the healthcare system in the US, where it found patients "are far more likely than those in 10 other industrialised nations to go without healthcare because of costs, have trouble paying medical bills, encounter high medical bills even when insured".

Nigel Edwards, acting chief executive of the NHS Confederation, said the report was a "good result for the UK. The issue in many other nations is that you buy insurance to cover for the price of expensive drugs. Or that you need co-payments on hospital treatments, dental care, spectacles, which in a country like France amount to 11% of health spending."

Edwards said that there were issues with NHS care. "I think if you look at why we are not able to treat patients out of hospital well for, say, diabetes, or why we have high rates of coronary heart disease, or look at cancer survival rates, it would be a different story. But the question is whether the government's plans for the NHS help this."

Labour echoed this point, saying the report vindicated its reforms. "We need to keep a focus on the patients. The last thing the NHS needs is a big internal, high-cost and high-risk reorganisation," said Emily Thornberry, Labour's health spokeswoman.

A government spokesperson said: "The UK lags behind many international healthcare systems on survival rates – for example, for diseases such as cancer or stroke – and the NHS must reform in order to achieve better outcomes."

The health minister, Simon Burns, said: "Reform isn't an option, it's a necessity. With ever-increasing demands on our NHS, we must deliver efficiency and quality improvements if we want to sustain and improve services for patients."

http://www.guardian.co.uk/society/2010/nov/18/nhs-best-free-access-healthcare