Page last updated at 12:29 GMT, Wednesday, 2 July 2008 13:29 UK

Project aims to change US healthcare

The US is one of the richest countries in the world - but on basic measures of health, like life expectancy, it lags behind many poorer countries.

As the state of Massachusetts pioneers a new scheme to increase state involvement and get everyone insured, the BBC's Jill McGivering asks whether it could be a model for the rest of the country.

Massachusetts General Hospital in Boston is private, making most of its money from patients' fees.

US hospital. File photo
The US spends more on healthcare than any other country

A tour of the facilities is certainly impressive. It bristles with multimillion-dollar technology.

But it could be more efficient. Dr David Torchiana, a hospital chief executive, told me paperwork eats up a vast amount.

"We send bills to probably about 25 different payers," he said.

"Every one of them has a different set of rules. If you printed out our regulations around billing for radiology studies, it would be a pile of paper seven inches thick."

'Crazy' system

That sort of waste disturbs those who see chronic imbalance in the US system.

All the rewards come from more procedures. The more talking you do, the more time you waste and the less money you make
John McDonough
Healthcare for All

Americans spend more than twice as much per person on health as the British. Yet more than 40 million Americans - about 10% of the population - are completely uninsured.

John McDonough, who heads consumer lobby group Healthcare for All, describes the system as "crazy".

"All of the incentives right now in our system reward healthcare providers for the volume of services they provide," Mr McDonough said.

"So, all the rewards come from more procedures. The more talking you do, the more time you waste and the less money you make."

The effect is that people with money have treatments they may not need and see specialists when a more junior doctor would do.

At the other end of the scale, the poor can't afford even the basics.

'Brave attempt'

Now Massachusetts is introducing pioneering new reforms which give the poor a much needed safety net.

Crowd in New York. File photo
More than 40 million of Americans are completely uninsured

It makes health insurance mandatory for all. Anyone who fails to buy it faces a tax penalty. It helps those who can't afford insurance by providing subsidised or even free cover.

"We have taken the exiting system, and we have said we're going to try to fill in all the holes," says Jon Kinsdale, the programme's executive director.

"Altogether we've enrolled about 340,000 newly insured in the last 18 months."

It doesn't create a totally level playing field. Private insurance companies still play a central role.

Mr Kingsdale admits that the rich will still end up with better quality health care than the poor.

But it is a brave attempt to address gaps in US healthcare without trampling on a core US value: freedom of choice.

'Shared responsibility'

The scheme has some enthusiastic supporters.

We're all mandated to get health insurance
Reverend Hurmon Hamilton

I went to one of Boston's poorer neighbourhoods to attend a church service.

Several worshippers here now have health insurance for the first time, and they say it has made a huge difference in solving chronic health problems and catching early potentially life-threatening conditions.

The preacher, Reverend Hurmon Hamilton, sees the Massachusetts reforms as a model for the rest of the country.

"We're all mandated to get health insurance," he said.

"There's a role for the government to play, in terms of subsidising those who are poor. There's a role for employers to play. And then there's a role for insurers to play. So, it's shared responsibility. That's how this country is going to have to figure it out," Hurmon Hamilton said.

There is one problem: paying for the programme has only been possible because of extra cash from the federal government.

So, its survival is very dependent on political will. All eyes, then, on the presidential elections in November.

Bernanke warns of healthcare bill
17 Jun 08 |  Business
Vote USA 2008 issues: Healthcare
20 May 08 |  Americas
Bush seeks health care shake-up
04 Mar 03 |  Americas

The BBC is not responsible for the content of external internet sites

Has China's housing bubble burst?
How the world's oldest clove tree defied an empire
Why Royal Ballet principal Sergei Polunin quit


Sign in

BBC navigation

Copyright © 2017 BBC. The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.

Americas Africa Europe Middle East South Asia Asia Pacific