This past year’s health discussion has been remarkable for the narrow range of ideas and opinions that have floated down to the man on the street. Journalists have sought out the same organizations and sources for their stories, offering up what has become the conventional wisdom for reform. To bring more voices into the conversation, our Excluded Voices series will intermittently feature health care experts who aren’t on the media’s A-list of sources. This is the seventh entry in the series, which is archived here. We want to offer journalists more options for their stories and encourage a deeper conversation. To that end, we’ve asked the experts featured in each post to respond to questions from Campaign Desk readers.
Since 1948, when President Harry Truman tried to bring national health insurance to the U.S., doctors and others with a vested interest in protecting their pocketbooks have railed against British-style “socialized medicine.” Over the decades they’ve managed to convince men (and women) on the street that people are dying in England because the government “rations” care. The “R” word became a staple in America’s health care vocabulary. Myths die hard, as my CJR colleague Greg Marx has pointed out. Even students who were born forty years after Truman’s presidency know about the “evils” of British medicine.
Earlier in this round of reform, it seemed that the socialized medicine bogeyman had been buried in the North Atlantic. Once it was established that Republican presidential candidate Rudy Guiliani got his stats all wrong when he tried to demonize British health care, not too much was said about socialized medicine. That is, until now.
Opponents ranging from members of Congress to conservative writers have again revived the bogeyman. Iowa Sen. Charles Grassley told the News Hour’s Judy Woodruff that a public plan was “one step towards a government takeover of our health care system, and I’m not going to go along with anything that rations health care.” When Woodruff said that U.S. insurers already determine which treatments people get, Grassley replied: “If you don’t like the insurance company you have, you can go get another insurance company. You’re not stuck like they are in England.” That would be news to thousands of workers whose employers offer only one option and truly are stuck, or to British citizens who can buy private insurance (a point Grassley later made).
The conservative Club for Growth, which stands for limited government, lower taxes, and less government spending, launched a $1.2 million ad campaign in early August attacking the British system. The ad, which the St. Petersburg Times’s Truth-O-Meter called “misleading,” features a man weeping over someone lying in a hospital bed. An announcer says: “$22,750. In England, government health officials decided that’s how much six months of life is worth.” Apparently the Club is so proud of the ad that its Web site boasts that it has put “Britain’s health service on the defensive.”
What conservative politicians and groups like the Club for Growth are really attacking is the possibility that health reform might create an outcomes research institute that would help doctors make informed decisions about treatments based on scientific evidence. Such an agency would also identify national priorities for comparative clinical effectiveness research—finding out what really works, and whether it’s worthwhile to pay for it. That’s exactly what drug companies, bio-tech firms, and technology sellers don’t want—-they might make less money and will have to work harder for the money they do get.
In late June, I conducted two extensive interviews with Andrew Dillon, who heads Britain’s National Institute for Health and Clinical Excellence (NICE), which seems to be the object of these conservative attacks. NICE, part of the British National Health Service (NHS), advises health professionals, the public, and public officials about the best way to approach medical treatments. Any U.S. outcomes research institute is likely to be patterned on NICE and similar organizations in other countries.
Trudy Lieberman: How did NICE come about?
Andrew Dillon: In the late 1990s, there was broad support among health professionals within the NHS for a national resource to help the NHS make consistent, evidence-based decisions on the best approach to using new and existing treatments. Although [British] doctors are as independently minded as others in the world, there has been a long tradition in British medicine to use evidence. So there was a recognition that an agency that would help professionals strive for a good standard in treating patients was a worthwhile idea. Most professionals here are trained in a system that works on a fixed budget that has expanded rapidly over the last six or seven years, but still everyone knows there are limits to what can be spent.
TL: What else did professionals want such an agency to do?