The envy of the world

A fascinating article in The Economist about the crisis in the American healthcare system. Since the US is notorious for its lack of full health coverage (46 million people are left uninsured) then it's not well-known that the US spends more on healthcare than any other country in the world.

I'm not au fait with the functioning of healthcare systems, perhaps because I live in a country with a centralised behemoth. The US system is predominantly employer-based and arose from historic accident. The US government gives tax subsidies to employers who pay for health insurance - exceptions are the poor/old for whom the government pays directly, people who buy their own health insurance and the unemployed, un-'poor' (e.g. students). Health care is supplied by a numerous providers. US healthcare provision is becoming increasingly expensive to government and companies - economic growth and employment is affected. The Economist recommends that the US adopts the system existing in many European countries - a "hypothecated" health tax raised by government and used to pay for care from a variety of healthcare providers. This should maintain choice and innovation whilst lessening the problems of the system.

European-style health care provision was also the approach favoured by David Laws infamous article in the Orange Book (Jo Otten summarises the chapter here). As with all policy, the devil is in the detail. The Economist states that healthcare is an area where market forces traditionally fall down - there is a distinction between the consumer (patients and doctors) and the person paying. The poorest are likely to be those with the highest insurance premiums (the elderly, etc.). An alternative vision of non-monolithic healthcare provision is presented by Steve Webb here. Steve Webb's approach seems to be the same as Chris Huhne's (this is the best I can do) which is to keep the NHS entirely government funded/provided, but to devolve management and control down to a local level to allow experimentation. As I say, I'm not hot on healthcare provision.

Neither of these systems is likely to be accepted in the US - the arguments/solutions are very different. But it got me thinking about what type of healthcare provision would be best for the UK. It would have to provide social justice, fairness and equality of opportunity whilst also being efficient, accountable, of high quality, and ideally giving choice. This is one issue I'm open to suggestions...