What can the NHS learn from Obamacare?

Dr Karin Purshouse gives her perspective, as a doctor currently working in the NHS, on Obamacare, the private sector, and what the NHS can learn from both. Read her blog here

Shout out if you understand the ins and outs of Obamacare?

If you’re hearing the deafening silence too, then you’re not alone.  The Patient Protection and Affordable Care Act, or Obamacare as the cool kids like to call it, is America’s attempt to make healthcare accessible to the masses.  Tim Hoff, Professor of Management, Healthcare Systems and Health Policy, Northeastern University, Boston, recently gave an energising seminar in his capacity as Visiting Associate Fellow at Green Templeton College, Oxford, to try and demystify what Obamacare is and whether it’s actually working.  One of the big questions is – what impact could private healthcare have on research, and how important is the private/public healthcare divide on research?

The first thing to say is – America is not the UK with a different accent.  In the UK, publicly funded healthcare is almost part of our DNA.  Having just spent a year living in the USA, I was regularly at the receiving end of jokes about my ‘Communist’ country, or whether I’d seen an iPad used in a hospital before (answer: yes) or questions such as ‘do you have these drugs in the UK?’. My American friends and I would often talk about the deep-rooted differences between our two countries, borne out of completely different histories and therefore mentalities around the role of government in things like health and social care. 

That Obamacare made it through the American legislative process at all is therefore pretty amazing.  Obamacare broadly seeks to ensure the 15% of Americans without health insurance can get covered and therefore access healthcare.  There are other twists and nuances – it sets benchmark standards for insurance providers, mandates that employers of a certain size provide insurance for their employees, expands eligibility for Medicaid (which provides basic healthcare for those who have no insurance) and bans insurers from refusing to insure those with pre-existing health conditions. 

The successes and limitations of Obamacare would be an essay in itself but my question is – what about the relationship between private/public healthcare and research?  As one member of the audience said, are we just sitting on a pedestal in the UK, because, in pure number terms, the USA is the research powerhouse of the world and therefore we’ve benefited, innovation-wise, from private, insurance-based healthcare for the last few decades?  It is true that in the UK that the public and private sectors have a rather troubled relationship where healthcare is concerned. 

As a doctor, I have a great deal of concern about the encroachment of the private sector on publicly funded healthcare, and, having spent time in the USA, I feel I’ve seen first hand what happens to a society that doesn’t put its population’s healthcare provision as a nationally coordinated interest.  A study of 11 industrialised countries identified the UK healthcare system as the most efficient.  But that doesn’t mean the private sector represents ‘the bad guys’. Perhaps before leaping across the pond we’d be better off looking at our European neighbours –France and Germany have highly rated healthcare systems which, via a variety of methods, generally integrate health insurance into the social security system, and both invest a greater proportion of GDP towards research than the UK.

Fundamentally, we need to get a bit more comfortable with the private/public sector divide in the UK but to do so there needs to be a serious upgrade in trust and respect between the two.  The medical profession in the UK remains highly suspicious of the private sector because of our commitment to free-at-the-point-of-access healthcare, but innovation relies on ideas springing between NHS hospitals and biotechnology enterprise.  A bit more hand-holding between the two is likely to be mutually beneficial. Perhaps I’ve got my rose tinted glasses on, but I don’t think publicly funded, widely accessible healthcare needs to be a casualty of that.

Despite its critics, I hope and believe history will remember Obamacare as the beginning of centralised, nationally available healthcare in the USA.  The research and innovation sectors should be right alongside this evolution if integration between healthcare and research is to be optimised.