By Tony Fox

This Winter has highlighted the immediate and longer-term crisis of the NHS. This article is gleaned from many of these reports, apologies for lack of attribution of multiple sources.

There is a great myth that in Britain, despite recent very serious problems, the NHS is still amongst the best health care systems in the world, “free at the point of delivery” continuing to deliver relatively good value for money. Even at its inception, the NHS was still far from the best healthcare systems; those in the USSR, Eastern Europe, and China continued to improve their systems after WWII which were far better in terms of available resources. Over the years the system in the USA, despite some improvements like Medicare and Medicaid from Lyndon Johnson in 1965, forced on it in times of heightened class struggle, continued to be by far the worst in terms of resources spent. The collapse of the USSR and the restoration of capitalism East Europe and China, Vietnam and Laon saw a dramatic collapse of those healthcare systems, with a disastrous fall in life expectancy of up to 10 years in the USSR and Eastern Europe as a result of the mass privatisation of the economies on behalf of western imperialism by Yeltsin, Walesa/ Jaruzelski etc. But one healthcare system stands out in terms of delivering excellent healthcare with the very limited resources available to it which puts its neighbour the USA to shame, that of Cuba.

A few statistics will give us a better picture. Infant mortality rates in the UK is 3.7 per 1,000 live births, in the USA 5.4 and in Cuba 4.8. Life expectancy in the UK is 81.2, in the USA 79.3 and in Cuba 79.1. In both the USA and UK life expectancy is now falling due to the imposition of austerity and failing healthcare systems.  Gross Domestic Product per capita in thousands of US Dollars: USA $ 59.6, UK 37.8, Cuba 7.6. Of course, the US and UK figures hide gross and growing inequality. Of some interest also is the primary GDP figures in Billions of US dollars: USA 16,624, UK 2,649, Cuba 87.

Finally let us look at the percentage of GDP spent by the three countries on healthcare systems in 2014 according to the World Health Organisation; USA 17.1%, UK 9.1%, Cuba 11.1%. The USA’s 17.1% in 2014 is the highest proportion of GDP spent of healthcare of all the countries in the world listed by the WHO. And given that its GDP is some 300 times the size of the UKs and 2,000 times the size of Cuba’s we can see it produces perhaps the world’s worst results in terms of healthcare for that expenditure grossly and proportionally.

Britain’s NHS

NHS Providers, a trade association that represents acute, ambulance, community and mental health services, warned the number of people waiting more than four hours in A&E would increase by 40% in 2018 to 1.8 million, and the number waiting more than 18 weeks for routine operations would rise 150% to about 100,000. Dr. Adrian Harrop, an A&E doctor in North Yorkshire said in early January:

“The patients who are at the front of the queue waiting to be seen next have been waiting 10 hours to see a doctor because there’s no space to see them in. This year, with the current degree of winter pressure that we are feeling, this is the worst condition that I have ever seen the NHS in. A&E is not a destination in itself, it is like a sorting office. When I come onto the unit and I see the management disaster that the senior nurses in the department are responsible for sorting out, I feel desperately sorry for them because there is nothing they can do to help that situation. They are dealing with patients that have been there for an entire day in A&E. These are patients who are meant to be in and out of the department within the space of four hours… and we feel like we are failing… and we can’t do anything to stop the ship from sinking. Everyone is working as hard as they possibly can, bailing water out of the Titanic with a bucket, but ultimately everyone can see the ship is sinking.”

A total of 16,900 people were forced to wait for more than 30 minutes to be seen by staff at emergency departments over the 2017 Christmas week, up from 11,900 the previous week, including 4,700 delayed for more than an hour.

It warned the number of people waiting more than four hours in A&E would increase by 40% next year to 1.8 million, and the number waiting more than 18 weeks for routine operations would rise 150% to about 100,000.

The NHS is already under strain in the wake of the Brexit vote. The number of EU nationals registering as nurses in England has dropped by 92% since the referendum in June, and a record number are quitting the NHS.

Only 96 nurses joined the NHS from other European nations in December 2016 – a drop from 1,304 in July, the month after the referendum.

The service is also facing a long-term failure to hire enough people. Applications for nursing courses plummeted by almost a quarter in a year after the government axed bursaries for trainees in 2016. Numbers fell by 9,990 to 33,810 in 12 months, according to figures released in February by the university admissions service Ucas. Meanwhile, one in three nurses is due to retire in the next 10 years and there are 24,000 nurse jobs unfilled, Royal College of Nursing figures show.

The number of NHS hospital beds in England has more than halved over the last 30 years, from around 299,000 to 142,000. The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34-member countries in terms of the number of doctors they have relative to their populations.

A report by The Kings Fund, a think tank in England which examines the health system and is linked to GlaxoSmithKline, said this is partly because more patients with mental illness and learning disabilities are cared for in the community and patients generally need to spend less time in hospital than in the past.

The USA

Major problems with the NHS are the increasing inroads private healthcare providers are making into the NHS and the Private Finance Initiative, which was a device to suck money out of the NHS and into the profit balances of multinationals. The collapse of Carillon highlights the extent this has advanced, in both hospital building and maintenance and in service providing.  The frequently expressed fear is that the NHS is morphing into a US-style healthcare system.

The healthcare system in the USA is the most expensive and inefficient in the world. It is obscenely dedicated to enriching transnational health care providers, drugs manufacturers and equipment providers. And the very wealthy doctors and consultants who seem to have no social conscience at all. This is not surprising because the neoliberal basis of the system looks at a hospital patient as a source of profit, not a human needing assistance in a very difficult time in their lives.

The fear is well based. Take the following table which sets out what happens to you if you fall seriously ill in the USA:

Deductible and coinsurance

Part A – For each benefit period, a beneficiary pays an annually adjusted:

A Part A deductible of $1,288 in 2016 and $1,316 in 2017 for a hospital stay of 1–60 days.

A $322 per day co-pay in 2016 and $329 co-pay in 2017 for days 61–90 of a hospital stay.

A $644 per day co-pay in 2016 and $658 co-pay in 2017 for days 91–150 of a hospital stay., as part of their limited Lifetime Reserve Days.

All costs for each day beyond 150 days.

Coinsurance for a Skilled Nursing Facility is $161 per day in 2016 and $164.50 in 2017 for days 21 through 100 for each benefit period (no co-pay for the first 20 days).

A blood deductible of the first 3 pints of blood needed in a calendar year, unless replaced. There is a 3-pint blood deductible for both Part A and Part B, and these separate deductibles do not overlap. [1]

Note the obscenity here that your Medicare stops after 150 days and only three pints of blood PER YEAR.  But if you survive this illness you have the very attractive option of selling your own blood back to the people who gave it to you to pay off your medical bills. In the USA 643,000 are declared bankrupt over medical bills every year; this never happens in any other first world country, but is quite common in Africa and south-east Asia and Latin America, where it only happens to middle-class people. The poor get no medical facilities in the first place, due to the global domination of US and European parasitical finance capital.

Cuba

According to the UN’s World Health Organization, Cuba’s health care system is an example for all countries of the world.

The Cuban health system is recognized worldwide for its excellence and its efficiency. Despite extremely limited resources and the dramatic impact caused by the economic sanctions imposed by the United States for more than half a century, Cuba has managed to guarantee access to care for all segments of the population and obtain results similar to those of the most developed nations.

Margaret Chan, Director-General of the World Health Organization (WHO),  said in July of 2014 “Cuba is the only country that has a health care system closely linked to research and development. This is the way to go because human health can only improve through innovation,” She also praised “the efforts of the country’s leadership for having made health an essential pillar of development”

Cuba’s health care system is based on preventive medicine and the results achieved are outstanding. According to Margaret Chan, the world should follow the example of the island in this arena and replace the curative model, inefficient and more expensive, with a prevention-based system. “We sincerely hope that all of the world’s inhabitants will have access to quality medical services, as they do in Cuba,” she said.

Cuba has sent it doctors abroad and has trained third world doctors in Cuba to such an extent that even the adverse stories that are told about it are not believed. It is true that some Cuban doctors are corrupt and that its medical infrastructure is crumbling. But corruption is very much an exception and the infrastructure is a victim of US sanctions. Curiously the sanctions seemed to act as a spur to Castro, particularly after the collapse of the USSR in 1991. Since then the system has greatly improved and the global medical outreach is astounding.

Operation Miracle, a major vision restoration program launched in 2004 by Fidel Castro and Hugo Chávez. It is a free service treated cataracts and other eye diseases, restoring the sight of 3.5 million people in ten years. Currently, nearly 30,000 Cuban medical staff are working in over 60 countries around the world. Its vaccination campaign against malaria operated in  15 West African countries. Since its inception, 11,000 young people from over 120 nations follow a career in medicine at the Cuban institution. According to Ban Ki-moon, Secretary-General of the UN, ELAM is “the world’s most advanced medical school.” He also praised the Cuban doctors working around the world, including those in Haiti: “They are always the first to arrive and the last to leave. They remain in place after the crises. Cuba can be proud of its health care system, a model for many countries.”

In praising Cuba, the World Health Organization stresses that it is possible for Third-world countries with limited resources to implement an efficient health care system and provide all segments of the population with social protection worthy of the name. This is possible if the political will exists to put human beings at the centre of the project.

The success of Cuba’s healthcare system is down to its national plan and its operation on the basis of need and not profit. No capitalist system could operate like this. Its doctors and nurses are poorly paid by first world standards but the psychological difference dedication to human deed could not be greater than that which operated in its northern neighbour, whose economy is 2,000 times its size.

The tiers of the system illustrate its integration: 1) the community containing individuals and families, 2) family doctor-and-nurse teams, 3) basic work teams, 4) community polyclinics, 5) hospitals, and 6) medical institutes.

While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by the patient. Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental, and orthopaedic processes, wheelchairs, and crutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge. [3]

Conclusion

All the reports and inquiries into the running of the NHS will not come up with a version of Cuba’s healthcare system, capitalism cannot eliminate the profit motive from any aspect of life, although it can greatly suppress it temporarily in the face of the struggles of the working class. And here we would mention that the US working class is also a major factor in this equation; the struggle for a single-payer healthcare system in the USA had had many false starts and Governor vetoes in  states like California, Maryland  and Massachusetts but  the success of the Affordable Care Act (Obamacare) and the great difficulty Trump is having to reverse it has begun to open up the possibility of a single-payer nationwide centralised healthcare system. Despite the virulent opposition of many Republicans and Democrats. The Harvard Business Review reported in July 2017:

“By contrast, a single-payer model stands to be much more durable and provides a chance to build a health care system around the well-being of patients rather than the profits of providers and insurers. Thirty-three percent of the American public now support a single-payer system — a 5% increase since January.” [3]

It seems that the sight of very wealthy Republican politicians feathering their own nests whilst attempting to cut healthcare to some 20 million US working class poor has outraged even Trump supporters. As The Nation reported on 1 August:

“Recent polls and reporting by The New York Times indicate that a lot of voters—including Trump voters—who opposed Obama’s Affordable Care Act have changed their minds. They now not only like Obamacare but want to keep it and improve upon it. As one man in Pennsylvania told the Times, “I can’t even remember why I opposed it.” What’s more, a Pew survey reports that fully 60 percent of Americans now say that health care for all is the responsibility of the government.” [4]

Fears for the future of the NHS and Cuba itself may yet prove unfounded if the movement in the USA begins to develop on this vital question and the US working class begins to take its rightful place as the leaders of the world revolution against not only US imperialism but all of capitalism in the world.

Notes

[1] Medicare 2018 costs at a glance, https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

[2] Wikipedia, Healthcare in Cuba, https://en.wikipedia.org/wiki/Healthcare_in_Cuba#cite_note-37

Sandro Galea, JULY 18, 2017

[3] The Harvard Business Review,  https://hbr.org/2017/07/is-the-u-s-ready-for-a-single-payer-health-care-system

[4] Ann Jones, The Nation,  AUGUST 1, 2017, Is State-Level Single Payer Within Reach? Scandinavian-style health care is part of at least one candidate’s platform for 2018, https://www.thenation.com/article/is-state-level-single-payer-within-reach/