US capitalist medicine in the UK? No thanks

As the Tories race to finish the privatisation and outsourcing of the NHS before the election, one critical aspect of this precipitate rush to turn Britain over to a US-type healthcare system has not been understood. What has brought it to notice is the recent report by a former head of the US Centres for Medicare and Medicaid Services (CMS) and a senior executive at the Rand Corporation which sets out the costs of fraud to American medicine. They are mind-blowing. They estimated that fraud, including the extra rules and inspections required to fight it, cost a staggering $98bn, about 10% of the Medicare and Medicaid budget, and up to $272bn across the entire health system. In this fully privatised healthcare, the scams are legion, as these examples show.

Some scams are simple and blatant. Patients claim benefits they’re not entitled to, and suppliers charge Medicaid for non-existent services. They form organisations of health workers and patients, perhaps going round nursing homes looking for old people who for a small bribe let pharmacists supply their medicines, but charge Medicare for much more expensive ones. Stealing patients’ identities is a money-spinner since medical records contain more information than credit card numbers and can be used to obtain prescriptions for controlled drugs. It also takes longer for victims to notice that their details have been stolen. Some pharmacies pay wholesalers to produce false invoices, while others bribe medical workers to hand over medicine left unused. Or a doctor’s clinic may be turned into a prescription-writing factory for painkillers which are then re-sold on the street at a handsome profit.

The scams are endless. Nor is scrutiny adequate, even though very costly. New York for example has 110 staff to scrutinise $55bn of annual payments and 137,000 providers. Medicare’s contractors have to process 4.5 million claims a day, and the Medicare system incredibly has no less than 140,000 billing codes. It all adds up to an exceedingly complicated and wasteful healthcare system. The US spends a colossal $2.7 trillion on health (or rather illness, or pretend illness, which is 17% of US GDP. That is twice as expensive per head of the population compared with the NHS. The British system, at least before the Lansley bill, is far simpler, much cheaper and difficult to defraud. Doctors are actually paid for making patients well, not for every extra thing they throw in, like recommending unnecessary tests and operations, or charging for no-existent ones.

So who wants capitalist medicine in the American style, which is what the UK’s going to get unless the Tories are stopped? Along with reversing austerity this should be no. 1 issue at the next election.

Image credit: detail from cover of Michael Moore’s film Sicko (thoroughly recommended to all readers)