Intended for healthcare professionals

Editor's Choice

When necessity becomes opportunity

BMJ 2009; 339 doi: (Published 24 September 2009) Cite this as: BMJ 2009;339:b3915
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}

    President Obama’s healthcare reforms continue their slow passage through stormy waters. Will the open letter to Congress signed by 400 prominent doctors and academics give him sufficient boost to push them through (doi:10.1136/bmj.b3865)? Unlikely, I think, but we can always hope. Lack of health insurance is taking a huge toll on America’s health, according to researchers at Harvard University, who found an excess 45 000 deaths a year among uninsured adults even after adjusting for socioeconomic confounders (doi:10.1136/bmj.b3838).

    The letter calls for urgent reform to prevent America’s current healthcare crisis turning into a catastrophe. Its recommendations echo Obama’s plan. But there are people at both ends of the political spectrum who feel betrayed. One of the Harvard researchers calls Obama’s “public option,” which offers less expensive insurance to those who are currently uninsured, a “pitiful gesture at what ought to be done, which is a national healthcare plan.” Meanwhile, those with a vested interest in the status quo have been tapping into America’s horror of anything that sounds like socialism. The open letter to Congress, and another to Senator Kerry from prominent UK doctors (doi:10.1136/bmj.b3768), both try to put the record straight—no death panels, no age discrimination, no reduced access to the doctor of your choice— but the damage to the NHS’s reputation around the world may have been done.

    I’m not the first to have said it, but it’s surely time for both countries to stop peering at each other and to start looking elsewhere for models of health care. One place to start might be the European Observatory on Health Systems and Policies. It aims to help countries learn from each other’s experience of implementing healthcare reform. It also brings together ministers and health researchers in the hope of promoting evidence based policy making. As Tessa Richards discovered, the UK is not yet on its growing list of governmental partners (doi:10.1136/bmj.b3871).

    As an example of what can be learnt from looking to Europe, Harald Schmidt and colleagues describe Germany’s health incentives scheme (doi:10.1136/bmj.b3504). Since 1989, Germans have been offered reduced copayments for dental treatment if they attend regular checkups, and there’s now a range of incentives for participating in prevention schemes. The initial evidence suggests clear potential for cost saving, say the authors. But they warn that however effective they are, the schemes mustn’t compromise the social solidarity underlying Germany’s health system.

    The UK’s social solidarity will be severely tested in the coming years with the fallout from the economic crisis and a rapidly ageing population. Which makes it all the more important to debate proposals for a national social care service. This could smooth out variations in access and availability inherent in the current localised system, says Christina Victor (doi:10.1136/bmj.b3384). But how will we afford it, especially if the NHS escapes the worst of the cuts as is currently politically expedient? Des Spence warns that sparing the NHS will only fuel resentment from other public sectors (doi:10.1136/bmj.b3910). “The time has come to rationalise, consolidate, prioritise” he says. No doubt all countries think they are good at turning necessity into opportunity. Now’s our chance to prove it.


    Cite this as: BMJ 2009;339:b3915

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