ONCE upon a time, when foreigners remarked that there was much to
learn from the British National Health Service their meaning was
perfectly plain: they meant the system as introduced by Nye Bevan in the
post-war period. Nowadays the same remark could mean one of a number of
things -- envy of the original concept of the NHS, a desire to emulate
the Government's pseudo-market reforms, or determination to learn from
Britain's mistakes. Dr Fitzhugh Mullan, a member of Mrs Hillary
Clinton's health task force, was evidently referring to the basic ideals
of the NHS and the principle of universal health provision when he spoke
in Edinburgh yesterday at the World Medical Education Summit and
expressed misgivings about what happens when the market enters the
system. Markets do not serve certain populations well at all, he pointed
out: they do not take care of the poor, or rural populations, or people
in institutions.
Dr Mullan's speech could hardly have been more timely. Now that
Congress has passed President Clinton's budget the plan for overhauling
health care is rising to the top of the agenda -- though residual
bitterness after the budget struggle will not smooth its already
problematic progress. Despite Dr Mullen's praise for the NHS it is
inconceivable that anything similar will be adopted in the US. The plan
is expected to centre on community insurance-purchasing co-operatives,
and at a time of sharply rising health inflation the task force's job is
to cut costs as well as make the system more equitable (aims that are by
no means incompatible, since the costs of the inferior American system
are higher than those of the NHS).
Dr Mullen himself, despite his caveats about the market, sees
''managed competition'' as the key -- with free markets coming under
closer control and state systems bringing in the market philosophy. The
latter aim might seem to echo the UK Government's introduction of an
internal market to the NHS, but the US would be approaching this point
from the opposite direction. The American rhetoric, too, is different:
Mrs Clinton speaks of injecting ''compassion and caring'' into the
system, which is not Mrs Bottomley's kind of language, and the stated
aim of the draft plan is ''making sure that Americans will never again
lose their health coverage''. Its progress in the months and years ahead
will be interesting to watch, and may even provide lessons to be learned
on this side of the Atlantic.
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