Friday, January 15, 2010

Guest Commentary: US Health Care Reform from a UK Perspective

Louisa Baxter, MD, MSc, MRCP
Harkness Fellow
Jefferson School of Population Health

When I landed at Philadelphia Airport in September after my 6-hour flight from Heathrow in London, I had half expected to be grilled by US Customs about my involvement in death panels and then turned back and sent home in disgrace. After 7 years spent in clinical practice in the UK, the home of “socialized” medicine, I had jumped at the opportunity to come to Jefferson School of Population Health to do some research and watch the tremendous theatre that is the US health care reform debate unfold across the country.

It has been an incredible 3 months; I have met clinicians from (nearly) every state, patients, hospital and health plan executives, researchers and policy makers. I have read commentaries in the New York Times, watched CNN and CSPAN, listened to Glenn Beck and Senator “You lie!” Joe Wilson and marveled at the heterogeneity of opinions around health care and its reform. As with all countries, it is clear that in the US the health care system faces significant challenges; the growing number of un- or underinsured, rising prices, the medical arms race, unwarranted variation in care and the lack of evidence base for many interventions, to name just a few.

From afar, it is easy to mock the debates as simply a circus fuelled by the special interests of big business and I fear that this is what many countries watching the US at the present time may do. But as an outsider to your system who has been given privileged access to the discussion, what has impressed me is the remarkable depth of feeling around the debate. It is clear, that hidden beneath very complicated policy wonkish jargon and the arguments at town hall meetings, that this is a discussion about what values and priorities should be at the very heart of your health system. It is something to be proud of, that so many voices can come together (relatively peacefully) to enter into the dialogue.

I have also been impressed by the kindness and openness of so many people both in Philadelphia and across the whole US. From everyone in the School at Jefferson, who have helped me through the maze of paperwork necessary to come over here, shown me the best delis to buy lunch and opened their homes to me, to passersby who have shown me how to post mail, how to ride the SEPTA and patiently given me directions, I am often surprised by the care that people take that of me as a guest in your country. If the death panels didn’t need me, it would be an incentive to stay.