Thursday 25 October 2012

Swing States

Three Hafal staff are presently guests of the National Alliance on Mental Illness in Pennsylvania where we are exchanging ideas on a range of issues including criminal justice and Wales' Mental Health Measure: see more about this here.

This reminds me of a visit I made to Georgia and Tennessee a few years ago where I took a look at the care and treatment of people with schizophrenia. You might have expected health-care for poor and uninsured citizens, especially in those conservative southern states, to bear invidious comparison with our system but actually the picture was mixed.

A surprise was to find that people on Medicaid (government-funded health-care for the very poor) got the best possible anti-psychotic medications - much less grudgingly than the NHS - but it turned out that this wasn't because of state or federal generosity (both fund Medicaid) but rather because the health-care providers contracted to support these patients had worked out that it was cheaper to give them the best drugs because they recovered quicker and so cost less!

Lessons here for the NHS and others about a smarter approach which can be both better for patients and yet cost less - something which requires a system of individual budgets but does not mean that the principle of universal health-care need be in any way compromised.

On which subject it was chilling to find that uninsured poorer citizens who were not eligible for Medicaid (because not quite poor enough) had no means of getting support except through acts of charity which could not be wholly depended on. In practice the patients I met were getting the treatments because providers struck deals with the pharmaceutical companies to get extra supplies of drugs thrown in with the funded prescriptions, a precarious system indeed.

To his great credit President Obama has gone a long way towards plugging this shameful gap in US health-care with his recent reforms which so far seem to be surviving the furious backlash of his political opponents and a heavyweight legal challenge. I suppose I should maintain a position of political neutrality even concerning elections in other countries (though I note that Boris Johnson is backing Obama so there's no neat cross-over) so I will balance this apparently pro-Obama point by pointing out that Mitt Romney actually introduced near-universal health-care in Massachusetts when he was Governor - although now he's doing his best to play that down! He's also got a Welsh wife but I don't think that will tip the balance for him - whereas if she had been Irish...

Romney seems to have the edge today in the polls but I'm tipping Obama to win by a whisker and possibly with less votes than his opponent under their curious system. He still seems to be clinging on for dear life to Florida, Ohio and Virginia - and if he holds them he's safe. Pennsylvania is also close - if Romney takes it he will probably take Ohio too and there will be everything to play for - so Hafal's delegates are going to have to speak loudly to get heard!