TL: It’s hard to know that. Unless someone reads a lot of studies and examines Pub Med and the stuff from NIH, how are you really going to know if something is necessary or unnecessary? The hope of both liberal and conservative policy makers is that people will be able to use marketplace approaches, that people will look at ratings and read up and do the things you do when you buy a car. But it may not work with healthcare. My view is that it won’t, because healthcare is fundamentally different from cereals and toothpaste.

Equity here, equity there

TL: Your system is more equitable than ours. Our system is not equitable, and it won’t be even when the Affordable Care Act is fully implemented. It may be equitable in the sense that, yeah, if you’re sick you can get insurance. But that doesn’t mean everyone will have the same insurance that will pay for all the care a person needs.

A bronze policy is probably going to be the most popular policy—it certainly is in Massachusetts, where some 52 percent of the people chose it, because the others are pretty darn expensive. That policy covers only 60 percent of your healthcare costs. The silver, gold, and platinum policies will cost more and cover more. Better coverage may give you better outcomes or better care. So in that sense, the system is far from equitable.

CS: How much do they cost?

TL: You can look at the website of the Massachusetts Connector and that will give you some ideas of the price variation between the bronze and the gold policies, for example. For example, a 56-year-old person in Cambridge, MA, could find a bronze policy for as cheap as $462 per month. That same person could buy the lowest-priced gold plan for $712. My guess is that the platinum policy, which will be available under the exchanges, will be very expensive relative to the bronze policy. A policy that gives you 90 percent coverage is close to good coverage. It’s my understanding that under the NHS you have 100 percent coverage for most things. People over age 60 get their drugs free. In our Medicare program, even with a drug benefit, seniors may pay very high co-payments and co-insurance for their medicines.

The rise of marketing in healthcare

TL: I was in Coventry a year ago and visited one of your privately financed hospitals, and saw how they compete in their area. Their marketing and PR people are beginning to develop the same methods for marketing as US hospitals. They compete for patients using all the tricks and techniques of advertising and marketing. It was a very large hospital, very modern, very much like some of ours. They use the press. Their communications folks brought out this whole book of press clippings. It was huge. They said they needed to get more patients who needed treatments with high reimbursements. That’s what American hospitals do.

CS: What sort of methods were they using? Were they marketing to consumers? I know a lot of special hospitals have teams to market to doctors.

TL: They were marketing to consumers and trying to use the press, the local health reporters in the area, just as hospitals do here. They bring reporters in so they’ll write stories about some new machine. And judging from the book of clippings, the press usually complies.

CS: That’s interesting because in England, that never used to exist. The idea was that you would be referred to your local hospital and that would be that. Now, with these elective procedures, people have a choice of any hospital, really. So the incentive does exist for the hospital to market. But it certainly hasn’t gone to the extent of having billboards by the side of the road and that kind of thing. If they did and I’m pretty sure—going back to that taxpayer thing—people would say ‘what on earth are you doing spending my tax dollars on a billboard like that?’

TL: We have a lot of billboards on the side of the road, and most Americans never question what they cost.

Related stories:

“Keeping an Eye on Patient Safety, Part III: What we can learn from the Brits”

“A Laurel to NPR: Strong coverage on health care issues”

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.