What it could and could not do: Universal health care through the British National Health Service

Sarah Lyall's story:
As an American who lives in Britain, occasionally writes about the health service, and uses public and private medicine here (as well as back home, occasionally), I have seen firsthand the arguments from all sides.

For me, the Health Service was a godsend when my husband suffered a severe stroke in the 1990s. He got exemplary critical care; I did not get a bill.

It was only in the aftermath – when I learned that, unusually in Britain, my husband's job came with private insurance – that I came to realize what it could and could not do. A little over one in ten Britons have some sort of private supplemental insurance; others pick and choose when to use the National Health Service and when to pay out of pocket for the top specialists or speedier care.

Told my husband needed a sophisticated blood test from a particular doctor, I telephoned the office, only to be told there was a four-month wait. "But I'm a private patient," I said. "Then we can see you tomorrow," the secretary said.

We should create a system in the U.S. that covers everyone, and gives everyone a choice or public or private insurance. That would be a huge improvement for many millions, though still far from perfect, like in Britain.

Thanks to Sarah Lyall for the source article in the Sunday New York Times.

Beginner's Luck & the Darlin' Spector of Universal Health Care: Obama's First Hundred Days

Today was Barack Obama's 100th day as president, giving us wags an irresistible chance to bloviate.

Are you healthier than you were on January 19? Probably not. Will you be healthier in the future, based on the last 100 days? Probably so, though not for the reasons you think.

Pres. Obama chose a guy from Scranton, Pennsylvania as his vice president. Joe Biden had been commuting home from Washington DC on the train, sharing seats with passengers he came to know well – like Sen. Arlen Spector of Pennsylvania. Biden influenced Spector's decision to change his party affiliation, giving the Democrats a nearly filibuster-proof majority in the US Senate. And it significantly strengthens the chance of passage of legislation favored by Pres. Obama like the coming universal health care bill.

Today the Senate voted by 53-43 to accept the president's budget, which includes funding for universal insurance. Sen. Spector, along with all the other Republicans, voted No. Presumably the newly Democratic Sen. Spector will vote Yes in the future, adding a critically important vote to the slim majority for the very controversial universal health insurance bill, forthcoming by October.

The conservative Democrats who voted against the budget because of what they saw as its excessive funding will likely insist on cost controls in the future universal health insurance bill, according to today's NY Times. Electronic medical records are being touted for this purpose for their role in limiting costs. For example, an EMR might reveal to a doctor that an expensive test like an X-ray or CT scan has already been performed, saving costs and time in the hospital. Or the legibility of the EMR's typed doctors' orders and progress notes might prevent costly errors. Or the automatic reminders generated by the EMR might lead to the earlier detection and cheaper treatment of cancer. Of course, in addition to these financial benefits of the EMR are their savings of lives and suffering: fewer days in the hospital, invasive tests that need not be performed, less chemotherapy, etc.

Obama was lucky to have Sen. Spector become a Democrat. Arguably, he created his own luck by choosing the guy from Scranton as a vice president. Either way, the result is a higher chance of passage of universal health insurance, and of substantial financial support for the widespread use of electronic medical records.

The result, ultimately, in your life: you're more likely to get an automatic reminder from your doctor about your next appointment. When you call your doctor's medical practice at night and get a covering doctor on call, that doctor is more likely to have electronic access to your medical record, and to give you better advice. When you're in the hospital, the computer will be more likely to intercept would-be overdoses and wrong drugs.

And, if you’re one of the 50 million Americans who don't have health insurance now, you'll be more likely to get coverage, and health care, based on Obama's decisions, and luck, during the last 100 days.

These likely future improvements of broader health insurance and broadened use of EMRs add to those in Obama's first month.

All in all, not a bad start in improving public health.