The health reform debate is back, big time – and elements of it are startlingly familiar. There’s the issue of how to handle the needs of the “gray,” the infirm and the vulnerable; how to make health care services more “effective and accountable”; and how to determine who should make critical health care decisions, “local professionals” or “remote administrators.”
But here’s the catch: The fresh debate just described is occurring on the other side of the Atlantic, about nothing less than the future of the U.K.’s National Health Service (NHS), which has been around since 1948 and on which Medicare and many of our other plans are based. This week, The Daily Telegraph published an open letter from 42 British doctors urging the British government to support the Health and Social Care Bill. “The reforms [of the NHS] are not revolutionary but an evolution… They are the first significant attempt to coordinate all aspects of care into a coherent and seamless whole,” the doctors wrote.
As our own debate continues here this week, just after we learned about the deterioration of the financial positions of Medicare and Social Security, the lessons are clear: First, at a time when longevity and aging populations are challenging the health insurance models that were invented under an earlier demographic construction, we’re not alone. People are living longer and society is facing an explosion of age-related non-communicable diseases. Second, the U.K. debates teach us about the limits of national public programs. And third, the British uncertainty forces us to look at the four structural issues that are at the center of our health care systems’ challenges: aging populations; failing primary care; rising demands and expectations based on biomedical and technological advances; and fiscal sustainability in light of these developments.
If it’s common to say that the British ruled the 19th century and the Americans the 20th century, who might “own” the 21st – China, or the new BRIC coalition? (Both were frequently discussed at the recent Milken Global Conference in LA.) Will the European Union prevail, or can the U.S. hold on? One thing’s for sure: The leader, whoever that may be, will need to create fiscally sustainable approaches to health care systems that serve the rapidly expanding aging populations.
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