Healthcare: Look anywhere you like for answers, just not the US

America’s healthcare Clusterf**k offers no solutions

What do we really want from healthcare?

The Scandis are much more local in their government than we are, so Denmark bases healthcare on the communes, Sweden on the counties. France is more corporatist so theirs is a combination of Big Unions, Big Government and a bit of market.

Nobody really seems to have sat down and really thought through what it is that we all want from a healthcare system. So, let's do that ourselves. And what we do want is some mixture of efficacy, equity, and efficiency. Efficacy is simply how well a system actually treats the diseases and problems that are presented to it.

One way of measuring this is “mortality amenable to healthcare” and this is something the NHS is, for example, not all that good at. Equity is how fair this all is. We tend to think that all should have an equal chance of equal treatment if they're hit by a car. Or get some appalling cancer.

We'd like to get as much decent healthcare as we possibly can for whatever amount of money we're going to spend on it. Or ... spend as little as we need to to get the healthcare system that is good enough

Perhaps we shouldn't think that way but we do, so to hell with it, let's try to design our system to do that. This is something that the NHS is good at and something that the US (which is very good at that efficacy, if people actually get treatment at all) is appalling at.

Finally, we want efficiency. Subject to those other two constraints we'd like to get as much decent healthcare as we possibly can for whatever amount of money we're going to spend on it. Or, if we run it the other way around, spend as little as we need to to get the healthcare system that is good enough.

The NHS is pretty good here, for the government can indeed just tell us to eff off if a treatment is too expensive (that's what NICE is for). Except in unusual circumstances, if a treatment costs more than £30,000 (they may have changed this number) for a quality adjusted life year on average, then NICE's job is to tell you to you-know-what off and die. But nicely, of course, and the US is waaaay out there in a universe of its own.