Posted tagged ‘healthcare’

Obama has another go at health

February 23, 2010

Public health and the availability of healthcare in an affordable and efficient way are top priorities for people in most countries. Governments respond to that by ensuring that they, too, are seen to prioritise healthcare. And yet it is a political graveyard, whatever country you may want to consider. The only politician that I can remember in my lifetime, in any country of which I have knowledge, making some political capital out of the health brief was Charles Haughey, when he was Minister for Health in Ireland in the late 1970s. He somehow managed to side-step the hot issues and dodge the usual bullets, and was admired and lauded; and for what? He offered every member of the population a toothbrush. Smart move.

Every other politician who has tried health has regretted it. Brian Cowen and Mary Harney in Ireland; Frank Dobson and many others in the UK; Hillary Clinton and, now, Barack Obama in the US. The problem is that everyone wants to be protected and cared for, but without big bills when disease or ill health strikes. And nobody knows how to square that circle. The only way to do it securely is through insurance that has been properly assessed on an actuarial basis, but unless there is some ‘risk equalisation’ (meaning that the cost of insurance is not related to the likelihood of illness) it becomes prohibitive; and if there is risk equalisation it becomes unprofitable for insurers. There is no way of winning in this game.

And yet, as civilised countries, we must find a way of addressing this, as we cannot go back to making people live insecurely in fear of the consequences for them and their families of serious illness. So we must continue to try, and more politicians will have to be offered up on this altar.

Let us hope that Barack Obama – whom the world needs to be successful for all sorts of reasons – is not one of these. After a lot of political jousting over the past year on the back of proposals made by his Democratic Party, he has now come forward with his own proposals for health reform. In the United States this is vital not least because of the large numbers who are currently outside any system of healthcare. If I read his plan correctly, he is hoping to achieve progress through compulsory insurance for all in a setting of a regulated industry with capped premiums (so presumably some risk equalisation). Whether this can work remains to be seen. But much more important right now than whether the figures might add up is whether it can work politically. There would be damaging consequences if this plan fails. So I am not thinking too much about whether this is a viable way of managing healthcare, I am just hoping it is accepted and is implemented, so that Americans can get proper cover and so that Obama’s political capital rises again. These are tricky times, and what happens to US healthcare may affect us all in unexpected ways.

Future health

November 24, 2009

When the Taoiseach (Irish Prime Minister), Brian Cowen, was Minister for Health he memorably called this particular cabinet brief ‘Angola’, because of all the unexploded political landmines he felt it contained. In fact, very few politicians have found the stewardship of the country’s health system to have furthered their careers, with the possible exception of Charles Haughey, who was able to remain focused on policy initiatives and service improvements while there. Most politicians in charge of health appear to be quickly overwhelmed by the combination of intractable problems and vocal vested interests. And just in case anyone thought that this was a peculiarly Irish phenomenon, the same is pretty much true in the UK, and as we know even Barack Obama is struggling (though perhaps with some success now) to make health reform work for his administration in the United States.

But difficult though health policy and its implementation may be, it is right at the top of everyone’s list of priorities. Right now the global health system is having to deal with H1N1 influenza, as well as the various other diseases and pandemics rampaging through parts of the world. We also know that ageing-related health issues will need to be addressed for demographic as well as social reasons. We know that the relationship between health, diet and lifestyles needs to be explored further. In short, health is everyone’s burning concern. And in that setting, we have not really worked out yet how best to structure the healthcare systems in our countries, and how to pay for them; the demand-led system of universal benefits, when applied to healthcare, has not just become unaffordable but actually unmanageable – but we struggle to work out how we could do it better.

One aspect of all this that will need a lot of attention is health research. This is important for two reasons: first, we should be addressing in high value research the key issues that are having an impact on people’s health; and secondly, we should harness the economic benefits of healthcare research as a magnet for high value investment by companies in this field, including some of the biggest blue chip companies in the world. Although these are two different reasons, they actually point us in the same direction: that we should focus on certain programmes of research where as a country we have or can reach critical mass, and we should present these areas as ones that should attract international industrial investment in Ireland. Some of these areas are already clear, such as cancer research (where the National Cancer Institute has brought together the key players from the North and South, with US partners); others show potential, such as Diabetes; and others again support health research and treatment, such as medical diagnostics (with DCU’s Biomdedical Diagnostics Institute playing a particularly important role).

All this is likely to be helped by the new strategic plan of the Health Research Board, which has prioritised research in certain key areas and has also highlighted the importance of translational research, meaning research with a programme for its use in improving or solving health-related issues.

It is important for us to think of health as an opportunity as well as a problem. Ireland has some real excellence in health research across all the universities and other institutions (such as the Royal College of Surgeons in Ireland), and therefore can both make a contribution to addressing global health issues and gain an economic benefit from doing so. It is, as they say, a no-brainer.

Letter from America

November 6, 2009

This post is coming to you from Washington DC, where I am on a very short visit in order to attend two meetings. As ever, it is fascinating to be here, as you get to see at first hand the trends and events that are influencing opinion in the United States.

As I arrived in the city yesterday, I came upon the tail end of what was apparently a major demonstration, aimed at persuading Congress that the planned healthcare reforms were unacceptable. As you may have guessed, the demonstrators were overwhelmingly of a conservative Republican persuasion, and some of the posters they were carrying displayed a depth of opposition to the reforms that, to me at least, was baffling. One poster carried the message that the reforms were likely to ‘bury for all time the principles of the American constitution’. Really? Another still much more alarming poster suggested that the proposed reforms justified a call for ‘waterboarding Congress’, a rather chilling reference to the alleged torture applied against terror suspects during the years of the Bush administration.

I confess that I find it very hard to understand this depth of passion, bordering on fanaticism, about something that may be right or wrong (right in my view) but which really should not draw out this kind of response. Social reforms should always be discussed rationally, not hysterically. But healthcare has become the touchstone of the Obama administration, and the ability of Congress to adopt the measure (planned for Saturday) will tell us a great deal about the capacity of Barack Obama to chart a reforming course.

The other thing that struck me forcefully was an article about last year’s Republican Vice-Presidential candidate, Sarah Palin. She has never quite left the news since the election, though the coverage of her oscillates between support and ridicule. Conservative film critic Michael Medved, in commenting on Palin and her forthcoming book Going Rogue, suggested in an article in USA Today:

‘A nation that proudly offers fresh starts and open doors regardless of old world titles or family connections should reject snobbery based on either academic attainment or aristocratic ancestry.’

Leaving aside entirely the matter of Sarah Palin’s personality or achievements, it struck me as very significant that the writer was equating academic qualifications with feudal concepts of society. Is he right? Are academic institutions the purveyors of social elitism? Is knowledge divisive if celebrated? The aristocracy of intellectual performance is perhaps a feature of the academic world. Do we need to re-think this, and find a way of valuing knowledge while avoiding any suggestion that it elevates the holder? Are attempts to open up access to knowledge to everyone doomed, so that we will always be left with a privileged elite? These are genuine questions which, perhaps, we do need to answer. And our lack of skill to date in answering them may explain some of the reservations about academic institutions, in Ireland as much as in the United States.