Ticking healthcare time bomb

Popular wisdom states that prevention is better than cure. A modern health system should be about keeping people fit, healthy and out of hospital. Where inevitable, treatment should be effective, efficient and timely.

Data from the UNDP's Human Development Report 2007-8 shows that OECD countries spend 9-11per cent of their GDP on healthcare.

The US is the biggest spender, with 15.5 per cent of GDP. In real terms, an American person spends at least twice as much on healthcare compared to other rich societies.

Michael Moore, in his documentary Sicko (2007) exposed the abuses of the mercantilist American healthcare system. Privatisation is not always the right solution.

To have access to medical treatment, most US citizens have to buy expensive insurance. In return, they get tax credits (costing the government an estimated $250 billion in forgone revenue). The cost of providing healthcare for public service employees, the poor (Medicaid) and the elderly (Medicare) absorbs almost 20 per cent of the government's budget. Still, one in every six Americans does not have access to healthcare; either because they cannot afford the insurance or hope to get a free ride.

The most expensive health system in the world is not the best. The US leads in such areas as breast cancer survival and prevention of cervical cancers but it trails other affluent societies in most health indicators, including life expectancy and infant mortality.

The political class in America is aware about all this and has been attempting to reform the system for decades. In 1993, Bill Clinton appointed a task force headed by his wife Hillary to come up with a plan to provide for all Americans. The plan never made it through Congress. Mrs Clinton, sponsored by the healthcare industry, made it to the Senate.

Now it is Barack Obama's turn to take up the challenge. Success will bring him glory in his own country. Addressing the American Medical Association, Mr Obama warned that failure to reform the system could lead America to go the "GM (General Motors)' way".

The ball is presently in Congress' court. Should it fail to come up with an agreed solution by mid-October of this year, then the way will be paved for the US President to push his own reform programme.

Mr Obama says that the basic recipe should be to build on what has worked and to fix that which has not. The objectives are to cut costs and to ensure healthcare for every citizen. Sounds simple but it will be hard to overcome the resistance of the industry's powerful vested interests.

Health insurance will become compulsory for every person, with the government subsidising those who cannot afford it. This is estimated to cost government about $1.2 trillion over the next decade. Lowering the cost of healthcare is a more daunting task. Many Americans who can afford adequate insurance are happy with the system as it gives them uncontrolled access to all the treatment they desire. Little does it bother them that this pushes up the cost of insurance. Hospitals, at a local level, work as price-fixing cartels.

Doctors make more money the more tests and medication they prescribe. Doctors blame the high cost of the insurance, which they themselves have to procure to protect themselves from mal-practice lawsuits.

Many in Mr Obama's Democratic Party favour "bigger government" in the health system. Some would like direct public sector involvement so as to capitalise on economies of scale and lower marketing, administrative and lobbying expenses. Mr Obama seems to favour the introduction of a health insurance scheme run by the federal government while tightening regulation of the health insurance market. He claims that this is necessary so as "to give people choices and to keep the private sector honest" (The Guardian, May 5). In Malta, both major political parties assert they are committed to free public healthcare for all citizens. Perfect. This should be the starting point of a serious reform of our healthcare system.

Realistically, free healthcare can only be sustainable within the framework of a master-plan that set priorities, promotes best practice, cuts waste and controls costs. We can no longer make believe that in our country the health system is working and that it is free.

Cutting corners, including the non-availability (or poor quality) of medication and unduly long waiting lists, are not the solution. Almost a quarter of total healthcare spend in our country is paid for by the private sector. It is high time to stop our ostrich behaviour, unless we too want to end up the "GM way".

A modern health system is not just about having state-of-the-art hospitals. Nor is it just about costs. There are significant opportunities in medical tourism that are within our reach, provided we have the right attitude, commitment and incentives.

The over-riding objective re-mains the promotion of a healthy society, creating a culture that truly relishes physical exercise and the right nutrition. We are not talking clearly about the cure and are silent about prevention. For Malta too, healthcare is a ticking time bomb.