In Defense of the NHS
Norfolk and Norwich University Hospital (wikimedia)
Alex Massie writes:
There are, I think, two essential truths in international health policy. No-one sees fit to copy the National Health Service and no-one sees fit to copy the American system…. The relevance of the NHS to American health care plans seems pretty limited anyway since, as best I can tell (though I try not to pay too much attention to these things) Obama doesn’t actually plan on copying the NHS.
And Kevin Drum adds:
But with the exception of a few outliers, the liberal community really, truly doesn’t want a fully government owned and operated healthcare system like the NHS. We want a government-funded healthcare system like Medicare or most of the world outside of Britain. And unless I’m mistaken, this isn’t a ruse in any way. That’s really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.
I can assure everyone that Kevin is right, because I’m actually one of the rare outliers who thinks the NHS is a pretty great model and the British are on to something. And try as I might, I can never find anyone who agrees with me. That said, the case for the NHS is quite strong. As Ezra Klein says, the UK method saves a ton of money:
But the British system is extremely cheap. Uncommonly cheap. Weirdly cheap. About 41 cents for every dollar we spend per capita cheap.
Now it’s definitely true that to an extent the Brits are getting what they pay for here. If you look it up, the research shows that British health care is not especially effective by international standards. That said, the difference is subtle enough that you actually do need to look up the research. It’s not as if people in the UK are just dropping dead of the plague all the time. To the casual observer, it all looks about fine, and the 59 cents on the dollar they’re saving is quite a lot. The fact of the matter is that health care is not an especially important determinant of health outcomes. Genetic predisposition is hugely important, and we can’t do anything about it. The biggest issue is “behavioral patterns” which are hard to change. But even “social circumstances” and “environmental exposure” (which is really a kind of social circumstance) swamp health care as a factor.
Which is to say that if you were actually able to get British levels of care for British price levels you could redirect that other 59 cents to trying to improve the social circumstances of the poor, trying to reduce exposure to health hazards, and building infrastructure (trains, sidewalks, bike paths, even the dread parks) suited to less sedentary lifestyles. We’d be much better off that way. The collective social determination of the industrialized west to dedicate large and increasing volumes of resources to trying to be healthier makes a lot of sense, but dedicating vast sums of money toward health care services just isn’t a particularly smart way of accomplishing that.
69 Responses to “In Defense of the NHS”
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August 12th, 2009 at 8:37 am
“The fact of the matter is that health care is not an especially important determinant of health outcomes.”
If that’s the case, then why should we get all excited about people who aren’t covered, or under-covered? Maybe the best policy would be to not have a health care system at all. Certainly refactoring 1/6th of economy over something that is not especially important seems like a waste of time and energy.
Is your point really that a crappy system like the NHS is better because it’s cheap and we can spend that tax money on some other social programs without “especially important” impact on public health?
Yikes.
August 12th, 2009 at 8:38 am
This is really an interesting question. My quantitative, straightedge, hardcore utilitarian soul wants to agree with MY. But then I realize that people don’t *actually* define their own welfare the way he wants them to define it. They might be healthier if they biked to work through extremely clean city streets, and then had to deal with long waits for liposuction and other special services.
But in practice, they seem to want to roll out of bed, drive to work while eating a hasty donut, and pay someone else to solve their health problems for them later.
What a dilemma for a utilitarian. Which kind of happiness are we supposed to be maximizing?
August 12th, 2009 at 8:43 am
British healthcare is good and we want private top ups? God thanks i live in Germany where the idear that rich people get better healthcare still produces some morale outcry even so apperently we are also going down that path
August 12th, 2009 at 8:55 am
Rich people get better lots of stuff. BFD.
August 12th, 2009 at 8:55 am
Always worth remembering that it’s not just about premature death – healthcare tackles morbidity as well as mortality, and the former is arguably more important in overall human welfare terms and medical intervention has more impact.
But a bigger point is how important is health and is it worth much money spent on it? Every country seems to fetishise health care as a top priority, but if we live less long in a much more pleasant world, that sounds better to me.
August 12th, 2009 at 9:01 am
#1 – Although I largely agree with MY, I think he’s mistaken in implying that premature death rates are a key indicator of results from health services. I mean, of course the patient’s survival is the obvious goal of health care practices, but the social benefits of public health care are so much deeper and wider. Matt’s brought this up enough before that I think he can be let off the hook for making such a sloppy case. But DaveL, I’m not so sure that you can.
I’m a citizen of both the US and the UK, so I’ve had enough experience with the NHS to say that, although it’s inferior to some of the continental public/private hybrid systems, it’s definitely not crappy. As a patient, I find the NHS to be more competent, better organized, and more practical than any of the American insurers I’d previously been stuck with (and all of whom I had to fight at some point over fishy billing practices and misdiagnoses). On the whole, the NHS manages to get similar health results as the US but at a fraction of the price, while leaving no UK resident without access to care.
And contrary to some of the strange arguments I’ve been hearing, the formidable presence of the NHS hasn’t choked private competitors out of the UK market. It’s just that the vast majority of the time, the public system actually does the job. If anything else in the UK worked half as well, it might actually be a nice place to live…
August 12th, 2009 at 9:08 am
This post seems to me to be exactly on the mark: if we could get British healthcare outcomes for British spending, that would be a deal I’d make in a New York minute.
The problem here is that people who might be interested in a British style system don’t seem to have any interest in British style spending. They seem to want a British style system with American style spending.
If Matthew is interested in a British style system, he ought to present a plan for a system in which we spend less than we currently spend on Medicare and cover everybody in the entire country, not just those over 65.
August 12th, 2009 at 9:14 am
I agree with MY, the NHS is clearly the most efficient model around since the British grossly “underfund” it by OECD standards yet it produces only very mildly below average outcomes. If the Brits wanted to they could easily improve it significantly with additional funding at a level that would still leave them well south of Swiss or French levels of expenditures (let alone the US).
I would guess that it’s mostly the political power of the medical profession that prevented the NHS model from being adopted by other countries.
August 12th, 2009 at 9:15 am
The point of reform is so that it won’t be 1/6 of the economy. It is ludicrous to jump to the conclusion that because something is not worth 1/6 of our GDP that it should be eliminated.
August 12th, 2009 at 9:29 am
That’s really what most of us want: basic care funded by taxes
Well, there’s your problem right there, that last bit.
August 12th, 2009 at 9:34 am
Which is to say that if you were actually able to get British levels of care for British price levels you could redirect that other 59 cents to trying to improve the social circumstances of the poor, trying to reduce exposure to health hazards, and building infrastructure (trains, sidewalks, bike paths, even the dread parks) suited to less sedentary lifestyles. We’d be much better off that way.
This sounds like a good deal, particularly if modified as per Steve LaBonne to increase funding just a bit to see if we could close the small gap in outcomes between the British and other developed countries (call it saving 50 cents, rather than 59 cents).
But I am also entirely sure that if we squeezed that much in savings from health care, we would not in fact turn around and spend those savings in the way that Matt describes. In practice, that would appear as a huge tax increase for those purposes, and that isn’t going to happen. So, regrettably, this deal isn’t on the table.
By the way, did I detect a little retreat on the parks issue? This is one of the many points we raised in response to Matt’s anti-park crusade (that they provide a convenient place for pleasant exercise), and Matt seems to have acknowledged that he overlooked that benefit in his analysis.
August 12th, 2009 at 9:37 am
I find the evidence presented for this . . . unconvincing. Americans are by any of a number of measures arguably more healthy than other, longer-lived populations which utilize a different health care system. So how do we know which measure is the ‘correct’ one? Other than it’s obviously the one which gives the correct answer, that it demonstrates that Americans enjoy the best health care ever.
It strikes me that, given the timeline of the Great Health Care Debate, those who have asserted repeatedly that the American Plan is A-Number-One!!! have the burden of proof in showing that the longevity stats reflect some underlying superior state of health, be it in the genetics or the behaviour of the foreign population, not on others who use them to point out that perhaps the American First! sentiment is misplaced.
August 12th, 2009 at 9:39 am
If that’s the case, then why should we get all excited about people who aren’t covered, or under-covered? Maybe the best policy would be to not have a health care system at all. Certainly refactoring 1/6th of economy over something that is not especially important seems like a waste of time and energy.
Because it is still worth 10%, and an even greater percentage of the things we can actually affect, and probably an even greater percentage if you aren’t just looking at death, and finally there are likely diminishing marginal returns to spending in all these categories such that it will make sense to spread your funding around.
August 12th, 2009 at 9:46 am
I wouldn’t stand a CHANCE with the NHS!!!
August 12th, 2009 at 9:54 am
I think it is worth noting, however, that the low price has very little to do with the fundamental national-ness of the NHS. The UK govt could structure the NHS to pay doctors by treatment rather than by patient. They could allocate four times as much money per capita and end up with a more expensive system with the best possible care. In fact, one of Blair’s campaign promises was to spend more on the NHS and reduce wait lists, a promise he kept (with some qualifications).
Similarly, insurance companies in the US could be regulated to put a very low price cap on premiums and require coverage for all Americans, which would sure result in a much cheaper system with incredibly poor care.
The point is, spending a lot of money for high quality care under national system is far more economically efficient than they same path under a private system.
August 12th, 2009 at 9:57 am
@Gregory
What most of us want is perfect care funded by lower taxes.
Any poll of Americans across the political spectrum will tell you that fundamentally, what they want from their government is to increase spending, reduce revenue and eliminate the deficit.
Americans aren’t very realistic.
August 12th, 2009 at 9:58 am
Don’t forget about national temperament: the French are (nearly all) hypochondriac pill poppers who have their doctors on speed dial – meaning the french system accommodates that and does a great job of early diagnosis and long term maintenance care (like physical therapy, prenatal care, etc). The Brits are very stoic (stiff upper lips, what what) and avoid the doctor unless mortally ill because (this is a frequently heard direct quote) they “don’t want to bother them”. NHS trainee doctors* of my acquaintance have been known to toss around the phrase ‘the worried well’ to discuss anyone who goes to see the doctor when they haven’t already lost a limb or lapsed into a fever-induced coma.
That being said, both are head and shoulders above the american system (I’m from the states, live in the UK and lived in France) and I would never trade my NHS care for a US insurance company.
*it doesn’t get discussed at all, but the NHS also pays for medical school/residencies/training for all med students provided they spend a certain number of years working only or primarily for NHS practices/hospitals. I don’t know any med student who pays tuition – most have access to housing and food money too.
August 12th, 2009 at 10:05 am
A deal like that (plus doing something about our crazy malpractice system) would enable doctors to save us all a lot of money by making substantially smaller incomes while not having to give up much in living standards. More precisely, overpaid specialists (of whom we have far too many) would certainly have to buy smaller BMWs or, gasp, step down to a Lexus, but primary care doctors could actually end up better off.
August 12th, 2009 at 10:11 am
Americans are by any of a number of measures arguably more healthy than other, longer-lived populations which utilize a different health care system.
What measures? Americans are fatter, smaller, and yes live shorter lives.
Genetic predisposition is hugely important, and we can’t do anything about it.
Steve Sailer bait?
August 12th, 2009 at 10:22 am
Let me just say that picture of a hospital in the English countryside illustrates another wonderful truth about the UK: they understand planning. Instead of sprawl and subdivisions, you have a tightly constructed public amenity and leave the surrounding farmland intact. It even looks like the landscaping in the hospital leaves green space and human-sized buildings.
That’s why the UK is such a great country. Maybe after the fall of our empire the US will realize the brilliance of their example.
August 12th, 2009 at 10:24 am
I wouldn’t want to imitate England too much. Whatever they’re saving from spending so much less on health isn’t showing up in the general (for want of a better word) feel of the rest of the country. They feel even shoddier than we do. (Compared to Germany, France, the Benelux countries, and most of the Baltics.)
August 12th, 2009 at 10:27 am
Adding some numbers . . . and In every health care post, we SHOULD highlight strong estimates of how much money, per American, we could save by repairing our massively inefficient health insurance system.
If, for example, we decided to implement a British style health plan, we could save about 59 cents out of every dollar we spend, according to Matt. So, how much money is that?
Well, according to the Centers for Medicare and Medicaid Services . . .
“U.S. health care spending growth decelerated in 2007, increasing 6.1 percent compared to 6.7 percent in 2006. Total health expenditures reached $2.2 trillion, which translates to $7,421 per person or 16.2 percent of the nation’s Gross Domestic Product (GDP).”
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/highlights.pdf
That means, multiplying $7,421 by .59, that a British style health plan could put an approximate extra $4,378 into each American’s pocket, EVERY YEAR. A family of four could receive good health care, plus be ahead by approximately $17,513, every year. A nationwide savings, in our pockets, of approximately $1.3 trillion every year.
Imagine the strength of the American economy if we decide to grasp this level of savings. The workers currently making a living off the wasted money won’t be happy if we go for the savings, but we’ll cushion the blow for them in the short run, and find some other way for them to make a living in the long run. And those who have already gotten rich off the wasted money will be just fine without us pumping more of our cash into their wallets.
August 12th, 2009 at 10:33 am
The simple act of saving X dollars isn’t the only benefit. We also wouldn’t have the scimitar of bankruptcy due to a health catastrophe looming over us, and we wouldn’t be bound serf-like to our employers over health care.
August 12th, 2009 at 10:49 am
Matt has this just about exactly right.
Of course, expecting you can improve your own health by a process of committees in Congress is a mug’s game. The thing to do is take the parts of the idea that are portable and use them yourself.
Get a good half hour of physical exercise daily and don’t skimp on the exercise of pushing yourself away from the table. If you can do this in a pleasant outdoor environment, and avoid other problems associated with gluttony, you have an excellent chance or reaching age 60 with no major problems and enjoying the journey thither.
Genetic problems or cancer are actually quite rare in youth or middle age. Automobiles are the main menace to our health, but your chances of dying on a road trip are only half the chances of your dying from a health care mistake on a trip to the doctor.
There are lots of good reasons to work for health care reform, and even better reasons to take your own fate in your own hands and make the 80-20 rule work for you. Living well is not only a wonderful revenge, it’s also quite pleasant in it’s own respect.
August 12th, 2009 at 10:50 am
That’s really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.
Actually, Canada’s system is far closer to France and Holland (and to American Medicare) than to Britain’s. Canada has a single-payer system not a single-provider system.
August 12th, 2009 at 10:54 am
You aren’t alone in supporting an NHS model. Britain is one of the few places that have actual “socialized medicine”. The government not only pays for care (”Medicare for all”) but owns the hospitals and employs the doctors and nurses. Most other countries just have “socialized insurance”, which is what Medicare is (and what single payer/public option would be). The British system is so efficient precisely because the government does more than provide insurance. The most efficient healthcare system in this country is the VA system, which is the only instance of “socialized medicine” we have and thus is most like the British system. Compare the VA system, which has almost no price inflation, to Medicare and private insurance, which has runaway price inflation.
August 12th, 2009 at 10:57 am
Any poll of Americans across the political spectrum will tell you that fundamentally, what they want from their government is to increase spending, reduce revenue and eliminate the deficit. Americans aren’t very realistic.
Actually, what Americans want is to decrease spending while increasing services, to increase revenue while reducing taxes and all the while also eliminating the deficit. And they want a pony. And they want it now.
August 12th, 2009 at 10:59 am
Americans are by any of a number of measures arguably more healthy than other, longer-lived populations which utilize a different health care system.
Which measures are those? I can’t think of too many measures where Americans come out ahead of similarly-placed populations such as the Canadians, Australians, Germans or British, for example.
August 12th, 2009 at 11:01 am
See under: California.
August 12th, 2009 at 12:08 pm
Matt, you say “That’s really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.” Stefan at #25 has it right. He clarifies “Canada has a single-payer system not a single-provider system.”
After all the discussion, I am puzzled by your persistent distortion about the Canadian system Matt. It suggests that despite your efforts to represent yourself as a discerning, knowledgeable student of this issue of health-care, you continue to be a dupe for Insurance Company and Republican lies. Canada’s system is nothing like the British system aside from it being single-payer. The Canadian government does not own or run hospitals, employ doctors or provide any services at all (aside from very small operations for military and Native Indian situations). Canada is not even the payer. Canada contributes to Provinces, about 17%. Provinces pay full costs to self employed doctors according to negotiated fee schedules. Provinces pay community run hospitals according to fee schedules with some variations for governance. In fact, there are private hospitals but in some Provinces, there are also Provincially operated hospitals. Each Province has autonomy although they abide by National standards in order to tap into Canadian funding. People buy insurance for upgraded services, private rooms, enhanced home nursing, etc.
The continued representation of Canada as the same as Britain indicates that you are not being as insightful as you suggest and that you are being a tool (unwittingly I believe) for the lies of the Insurance and Republican death merchants.
August 12th, 2009 at 12:12 pm
MY: That’s really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.
Stefan @25: Actually, Canada’s system is far closer to France and Holland (and to American Medicare) than to Britain’s. Canada has a single-payer system not a single-provider system.
Matt knows this. That’s why he wrote “with additional care available to anyone who wants to pay for more”, which is not generally the case in Canada. Canada has a single-, and only single-, payer system, rather than what most American progressives want, which would be a single-or-more-if-you-want-to-pay-for-it-yourself-payer system.
August 12th, 2009 at 12:35 pm
Alcohol consumption, for one. Smoking for another. These aren’t hard to find; for example here is a typical breakdown of daily smoking by country. Note that both Germany(24.3%) and the U.K.(26%) have smoking rates greater than the U.S.(17.5%), yet both countries have a greater life expectancy than what is found in the States.
Yes, by other measures, citizens of the U.S. are less healthy. But let’s be honest; if the stats on bad habits were reversed so that, say, Germany had a greater incidence of obesity but a smaller incidence of smoking, does anyone doubt that the same boosters would be blaming the shortfall on smoking instead of eating habits?
Again – and I can’t stress this strongly enough – it is those who maintain that Americans have the best health care in the world who have to defend that statement in the face of these statistics. They can’t demand that those who produce these stats then go on to control for any of a number of factors. That’s their job. Another dab of honesty – does anyone seriously think that controlling for these factors would lead to any sort of concessions being made about American health care? Or is it more likely that those demanding proof will just go on to ask for more stringent controls and more intensive studies? That is, are these people really just making a God of the Gaps style of argument, and that no study, no matter how many variables are controlled for, will ever satisfy them?
August 12th, 2009 at 12:55 pm
Of course they’d concede- just like the birthers immediately conceded their error when a scan of Obama’s HI birth certificate was posted during the campaign. Oh, wait…
August 12th, 2009 at 5:21 pm
Matt, you keep yelling at us to forget about single-payer; to get tough and understand current political realities. To quit being ivory tower utopians!
And then you post this. It is like dangling a juicy newborn lamb just out of reach of a caged and starving lion. You suck, man.
It’s all too fucking funny, though. I find this blog makes me laugh, all the time, in that weird but good way when you are by yourself. Only DeLillo and Heller before you own that distinction.
August 12th, 2009 at 6:27 pm
I can only hope you come to the UK and fall deathly ill whilst here then, Matthew. Some first hand experience of our ‘wonderful’ medical system should slap the socialism out of you more effectively than anything I could say.
August 12th, 2009 at 6:28 pm
I am British and work in the NHS. Just to add one point:
concerning ‘behavioural patterns’: since 2004, every patient who suffers from one or more chronic diseases (heart disease, asthma, diabetes, hypertension, and so on) has the opportunity to be seen once a year for each disease and receive a major check up, medication review, etc.The hope is, say, that those suffering currently from hypertension, will receive enough advice and support that they are able to make behavioural changes, not go on to develop strokes, and therefore this treatment will be even more cost effective in the long run.If they need support from other outside agencies or referrals to exercise classes (again, all provided on the NHS) then they get them. It will take a few years for the effect of this preventative programme to be seen, but initial results look promising.
Also, it is not widely understood that we do have a private health sector here. We do have private hospitals. However, be referred to one and you will see the same consultant you would see in the NHS hospital; you will be attended by NHS trained nurses. If complications arise, the private hospital will send you off to the NHS hospital to be repaired for free, but will still request payment for breaking you in the first place. The main advantage is that they do serve meals on china plates.
August 12th, 2009 at 6:37 pm
[...] far more accurate than looking at specific cases. Britain’s system has its problems, although it is freakishly cheaper than the American system. If we allow anecdote to take the place of systemic analysis, we will find ourselves with patchwork [...]
August 12th, 2009 at 7:34 pm
The NHS delivers the care people need. Some complain because they don’t get the service they would like (as in pampering), but the fact is it doesn’t matter who you are, you get the treatment you need. This is why people who have had a serious problem often come away full of praise for the standard care.
Mistakes are occasionally made and there are problems, but these happen in every healthcare system because the care is delivered by human beings, who are fallible. British medical training and experience is second to none.
Clinicians can focus on care, and don’t need to waste time worrying out who’s going to pick up the tab, or tracking everything they can bill for.
August 12th, 2009 at 7:38 pm
Thank you Anne, for that post.
For what it’s worth, I live in Nottingham, England. A very small town compared to US standards (roughly 250,000 residents). We have a hospital called the Queen’s Medical Centre (link.
It’s the biggest hospital in the UK, filled with the best equipment, employing 6,000 NHS staff. Prince Charles, when he needed an operation on his knee (after playing polo), was operated on here.
The standards of care are world class. British doctors (and nurses) have to pass the most stringent exams, at least 3 grade As at A-Level, not to mention the brilliant foreign students who come here to study medicine (all of whom get their tuition fees paid by the NHS).
When I was 12, I fell off a high wall messing around with my friends. I broke my jaw, lost a few teeth, and was quite badly hurt. Within 12 hours of being admitted to hospital, i’d been operated on by world class doctors to fuse my jaw back together with titanium plates, and over the next couple of months had absolutely world class care to get me patched up.
Guess how much it cost my parents?
£0 (that’s exactly $0 at current exchange rates)
August 12th, 2009 at 7:43 pm
[...] Matthew Yglesias, blogger for the liberal Centre for American Progress,lamented the fact that Mr Obama was not planning to follow the British example. [...]
August 12th, 2009 at 8:27 pm
As a Brit, what you have to realise is that the NHS means I don’t worry about my healthcare, or that of my family. The birth of my children, the vists to the emergency room, the care of my elderly parents, all of it looked after by the NHS. I can pay privately if I want to be pampered or seen more quickly, or have exotic drugs, but I don’t need it.
I can highlight plenty of issues with the NHS, but the key point is the 60 million people who live here don’t ever have to worry about who will pay, or how to pay if we get ill or have an accident.
This peace of mind is priceless.
August 12th, 2009 at 8:52 pm
[...] Conservative attacks regarding an alleged increase in healthcare costs are also manipulative. As Matthew Yglesias recently pointed out, it costs the NHS only 41 cents for every dollar currently exhausted under the [...]
August 12th, 2009 at 8:55 pm
[...] Matthew Yglesias, blogger for the liberal Centre for American Progress,lamented the fact that Mr Obama was not planning to follow the British example. [...]
August 12th, 2009 at 9:03 pm
Crispin HT is spot on.
Yes the NHS is imperfect, but us Brits rarely question the ideological justification for it, nor do we begrudge paying tax for it. In this sense Daniel Hannan MEP (currently dancing to the tune of Fox News, Rush Limbaugh et al on his American tour – the man is apparently a member of the European Parliament so quite what he thinks he’s playing at is beyond me) sits on the fringes of the British political spectrum. He is grossly out of step with his own party, the supposed “progressive conservative” Conservatives – whose national policy platform is in direct contradiction to Hannan’s.
Those Americans who blindly denouncing it as “socialised medicine” fails to recognise why the NHS remains the sacred cow of the welfare state founded by Atlee, Bevan, Beveridge et al in the wake of the 2nd World War. It’s free at the point of use for all – and as has already been outlined in greater depth and with greater clarity than I can manage, represents real value for money. Long shall it continue.
August 12th, 2009 at 9:09 pm
I agree with Crispin. The NHS is wonderful, I don’t have any worries about paying for health care. My parents are in their 70s and I don’t have to worry about them paying for or getting quality healthy care. Whenever I have used the NHS the service has been excellent. Of course there are some problems but overall I would not like to have the US system. It seems to me most normal Americans are being ripped off by the hospitals and insurance companies because the system is run for their benefit not the American people. Dont believe these people who tell you otherwise.
August 12th, 2009 at 9:22 pm
[...] Matthew Yglesias, blogger for the liberal Centre for American Progress,lamented the fact that Mr Obama was not planning to follow the British example. [...]
August 12th, 2009 at 10:10 pm
[...] Matthew Yglesias, blogger for the liberal Centre for American Progress,lamented the fact that Mr Obama was not planning … [...]
August 12th, 2009 at 10:47 pm
“Yes the NHS is imperfect, but us Brits rarely question the ideological justification for it, nor do we begrudge paying tax for it.”
Speak for yourself, mate.
August 12th, 2009 at 10:53 pm
I’m going to join in the chorus of Brits above defending the NHS. In fact, it’s probably the most unanimous political opinion on anything you will find in the UK. The NHS isn’t perfect – what is? Life’s not perfect. But the NHS is pretty damn good, and brings immense security and peace of mind.
August 13th, 2009 at 12:33 am
As a british medical student studying in Scotland I would like to add my thoughts to the debate on the British system of healthcare. To my mind the underlying principle of healthcare for all, regardless of your circumstances, provided without judgement and free at the point of use is one of the most flawless principles of our nation. The system is there for anyone who needs it, when they need it. It is there to provide the preventative care (the most effective health-wise and cost-wise healthcare), long-term care for those with chronic conditions, palliative care for those who need comfort after a cure is unattainable and acute care. The task of the NHS is enormous, it is providing the healthcare to 60 million Brits. It is always striving to improve the quality of care it provides, the effectiveness of its out-patient services and it is making gains all the time on its better funded European counterparts to negate the small gap in outcome averages. Yes, the NHS makes mistakes but these are due to professional mistakes, because the thing is run by humans and humans make mistakes. There is no reason to scrap the principle to make things work better, the principle is fine, it is the tuning of the machine that is achieving the better outcomes. This is done by the NHS operating on the evidence for best practice, something that we’re getting better at all the time by reviewing and improving how things are done.
There is talk from the States that drug rationing is some huge national problem in the UK. Yes, occasionally there are special drugs which are denied to a minute percentage of patients but this is because they lack the evidence to support their benefit for how much they cost. They still receive the care which works but perhaps with a small difference in outcome for a few. Insurance companies sure as hell won’t pay for a lot more things that the NHS won’t.
As for patients not getting the services they need, you should visit the GP practices and hospitals of the UK, they provide countless services to those who need special attention to try to keep them healthy for as long as possible. And as a normally healthy citizen I know, and have experience of, that when something goes wrong, all I need do is turn up at hospital or go to my GP and I will get the care I need from first-rate professionals who are working for my health, not for the profit of companies. I am not against capitalism at all, but where peoples lives are concerned what matters is doing the best you can for the most you can with what you have.
I study medicine for free, something I am very grateful for and another pay-off of the NHS. I will train under the NHS and will work for them for many years and I wish to have the peace of mind that my patients will have the peace of mind that their care is their continued right in the United Kingdom and that the principles of the NHS will remain constant.
August 13th, 2009 at 2:05 am
Some first hand experience of our ‘wonderful’ medical system should slap the socialism out of you more effectively than anything I could say.
Oh, do fuck off, Perrier. When you end up in Charing Cross with the case of gout you’ve been cultivating all your life, you’ll be glad that you aren’t kept standing at the billing desk for an hour, even if you’re too much of a prick to admit it.
The people who talk about peace of mind are exactly right. You can extend that out: it’s not healthy to live with the fear of medical bills over your head. It’s not healthy to distrust your doctors, and the US system is one where the profit motive, both implicitly and explicitly, fucks over trust.
For all the rhetoric about “government getting between you and your doctor”, what comes between you and your doctor in the US every fucking day is $$$, whether it’s the impulse to order unnecessary tests, the regular passive-aggressive bullshit of insurers refusing to say whether something’s covered until you actually have it done, or just the suspicion that the blonde drug rep recruited straight from the cheerleading squad might have contributed more to your prescription than your symptoms.
Speak for yourself, mate.
Oh, that’s your job. By the way, how is your British libertarian movement coming along these days? Last I heard, you had to cancel your meetings because BT took away the phone box you were using as a venue.
August 13th, 2009 at 3:57 am
What makes us in the UK laugh, is that you have the lowest life expectancy and highest infant mortality rates in the western world!!!!!
I know that Hollywood portrays glamour, but I lived there in Florida and Texas for 5 years and in some areas the poverty in the US was horrendous in your cities and towns! The poeple are dying from no basic health or nutritional care. Massive obesity pandemic, poor basic diet and health. They cannot afford food let alone medical insurance. My wife is American and she says the NHS is amazing, and that Americans are nuts for not endorsing it. It is not a liberal society that cares for the health of its citizens, it is a moral one. We have private care also and the vast majority if ground breaking research and treatments come from this country. Glaxo is probably providing most of your paid for pills we get for free! The fact is the US is the laughing stock of the western world on this subject and the sooner Obama deals with this the better. Criticise all you like, I have never had any problems, my mother was treated and survived bowel cancer, the average American would have probably either died or had to sell their family home just to get in the door! I love America, but the hatred some of you show for other countries and their “proven” ways is the reason the Great America of the past is no longer respected.
August 13th, 2009 at 5:21 am
I work in the NHS as a physician.
If you look at the time when NHS was founded, there were similar arguments here in the UK, half a century ago. The private practitioners did not want state to intervene, the poor died of treatable diseases due to lack of ability to pay, infant and maternal mortality was high amongst the dispossessed and the list goes on.
Half a century later, NHS is part of everyday life. You have chest pain? No money? No worries, we will get you fixed. Lung cancer? Still smoking? That will not stop us giving you chemotherapy. You are 80 something and fell in your home unable to get up.. we will keep you in hospital till the social services have provided you carers. You do not pay a penny upfront, do not fill a single form , no need to sell your possessions.
As a junior doctor I once had to look after an American policeman, he was run over chasing someone, had exitensive injuries, required protracted medical care and exhausted his insurance. His daughter then booked him on a one way flight to Heathrow. The British could not send him back, he did not want to go back and the NHS in the East of England has looked after him since……without asking for a penny. They have now put in procedures to reduce the chance of such things happening again but to me it says it all about the healthcare system Americans have in place and some of you still want to keep.
August 13th, 2009 at 5:29 am
for stephen hawking:
errrr… but you are British and on the NHS??? Isn’t that what you said?
http://atlanticwire.theatlantic.com/read-more.php?id=679
“We say his life is far from worthless, as they do at Addenbrooke’s hospital, Cambridge, where Professor Hawking, who has motor neurone disease, was treated for chest problems in April.”
http://www.guardian.co.uk/politics/2009/aug/12/birthers-stephen-hawking-paul-rowen
August 13th, 2009 at 5:35 am
I remember when I moved to England as a child and went to public school there (a really nice one that I didn’t have to pay for) and the school sent me and my class on visits to the dentist every 6 months… for free… my mother freaked out (we weren’t British) But apparently it was alright… Cause the NHS doesn’t care who you are or where you’re from… If you’re on British soil and need help it’s there for you.
Although, I must say I feel guilty about spending tax payers money, but apparently the NHS has more than enough to go around…
August 13th, 2009 at 6:39 am
Just adding another voice in support of the NHS!! I’m an American living in Scotland (came for a degree and have stayed on as I just love it – festival time in Edinburgh almost makes up for the days it’s dark by 4pm!) and the NHS is absolutely terrific. I watch in horror the clips of the ‘town hall’ meetings taking place in the US – it’s fairly ridiculous for people who’ve never stepped foot off American soil to be decrying socialised medicine as the biggest threat since Godzilla! I need care, I go to the GP, I leave. It’s brilliant and it’s so great to see so many Brits standing up in support of the NHS.
I’m sure I’ll return to the US in a few years, but the thought of having to deal with the stress that privatised medicine brings is certainly something that will weigh heavy on my mind!
August 13th, 2009 at 7:11 am
That’s really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.
Umm… there are private doctors and hospitals in Britain, you know? For example, drugs which are not available on the NHS can be prescribed privately if a doctor believes they will be effective. And private health insurance is available for anyone who wants to pay for it. Some do – enough, in fact, for it to be a thriving industry.
August 13th, 2009 at 7:24 am
The point here, is that NO system is perfect. No one has mentioned the 45 million Americans who have NO health cover, any other system would work for them.
Yes the NHS has problems but no one is refused treatment as in the US and no one is arguing over bills. The NHS would be greatly improved if the British people demanded more of their politicans and valued the cost of their health more. The Americans do need a new system, a fairer one that covers everyone, it’s their choice but why don’t they get on with sorting it instead of critising the rest of us. And yes Stephen Hawking is British and is cared for by the NHS.
August 13th, 2009 at 8:09 am
Matt, you are so right. The NHS works pretty well–one hell of a lot better than the US system, Brits really like the NHS idea and resources should be targeted at preventative measures (better education, etc.), just as you say.
I seem to spend my whole time signalling agreement on this blog as I can’t find ways of adding or pushing back on what you say. Its not that I don’t have ideas or opinions or anything and I wish I could offer more…
August 13th, 2009 at 9:49 am
I’m an Englishman living in Australia and the healthcare debate has been fascinating to watch from this distance. Here in Australia we have a Medicare system which is available to every resident. All Australians are covered by Medicare, which imposes minimal costs on users for visits to GPs (about $54 per visit, of which about $30 is reclaimable from Medicare), hospital care and for medication. Pharmaceutical costs are capped per year under the Pharmaceutical Benefits Scheme(at about $1,200 per annum), so that people who need multiple medications only pay the capped per year amount before the rest is picked up by the state. There is a sizeable private healthcare system, run by not-for-profit companies, which many people are members of. Healthcare insurers are not permitted to decline coverage for pre-existing conditions or on the grounds of age (or for any reason, actually), and cannot cancel coverage unilaterally for any reason. Premiums are fixed according to age and cover chosen. Higher earners are encouraged to take out insurance by a (small) tax levy on those who don’t take up insurance, a policy designed to help reduce dependence on the taxpayer funded system.
I have the highest level of cover – full hospital and extras which my insurer offers (hospital, emergency, dentist, optical, physio, etc), for me and my partner, at a cost of about $4,000 per annum all up for both of us. Early last year I was diagnosed with stage 3 colon cancer and was operated on within 10 days of diagnosis, after all the available (free) tests (CT Scan, colonoscopy, endoscopy), by one of the best colorectal surgeons in Sydney, and stayed in a private hospital for 8 days. Total out-of-pocket cost to me for the stay – less than $50. Total out-of-pocket expense of two (private) consultant surgeons, one consultant anesthesiologist and theatre staff – about $5,000 (tax-deductible). The cost of seven months of chemo treatment and consultant oncologists’ care (under Medicare) – about $54 a fortnight for the drugs and no consultant or outpatient costs. Costs for CT scans every six months – nil under the Medicare system. The care has been outstanding, no waiting, I’m not broke, and my cover is unchanged, as are my premiums. if it’s possible here…
August 14th, 2009 at 1:30 am
I live in the UK, and I think the NHS is brilliant. Free at the point of need and thereafter, whatever the problem, from a splinter in the pinky to a triple heart bypass.
No bills, no insurance premiums just the treatment needed at the best possible place, whether that’s the nurse’s treatment room at my local health centre, or a bed in a world renowned university hospital, all funded from general taxation. Always caring and non-judgemental from birth until death, it doesn’t matter if you haven’t got a penny and you’re sleeping on the street, you still have access to the same standard of care as a multi-millionaire.
You people in the States may hear scare stories about the NHS, but you don’t hear about the millions who are treated successfully every year. When I hear of people over there having to sell their homes and go deeply into debt to provide care for their loved ones, I weep for them. How can you let that happen in the richest country in the world?
It’s a no-brainer really, but you have too many people making too much money for it to change, and a large proportion of your population will still be denied health care even coming close to the standards we Brits take for granted.
August 14th, 2009 at 2:10 am
Nearly forgot, have a look here The National Institute for Clinical Excellence this is what you people are touting as a “Death Panel”.
August 14th, 2009 at 2:12 am
I am a physician in the UK. A lot of the arguments being made by the US right are entirely false, and in any case, irrelevant. Most show a fundamental misunderstanding, possibly deliberate, of how the UK NHS works, what it covers and what the US can learn from it. The US would never adopt a Gov’t run system, although if they did, their economy would last longer without falling over due to the crippling, and rising, cost of healthcare.
I must have missed the part where members of Congress bemoaned the socialist infiltration caused by their own Gov’t funded healthcare scheme.
August 14th, 2009 at 2:20 am
Truth
Day 1
Tripped and Fell
Ambulance called and prioritized to our remote rural home in evening
Ambulatory staff competently checked patent in home
Ambulatory staff competently checked patent in Ambulance on way to our preferred hospital
Hospital Staff immediately received patient and competently checked patent including a vast number of blood checks
Pain killers administered to appropriate levels
X-Rays undertaken
Diagnosis made
Patent given bed in ward
Day 2
Anaesthetist checks patent
Anesthetic given
Surgery undertaken
….morning over
So in the space of 12-18 hours the patent was collected from rural home and underwent Hip Replacement
Her age 85
Did her age affect the West Suffolk Hospitals decision making
Yes
The effect was to prioritize her attention from the medical staff
The NHS – far from perfect
did she have to undergo wealth checks? No
was payment needed?
no – it’s the National Health Service
I think that the slogan was “Cradle to Grave” when introduced
well she’s to old for the Cradle part – I got that part as her son – but she is getting the “to Grave “ bit
an 85 year old injured woman got all the required attention from the NHS – doesn’t make a good headline but it happens every day ….
The NHS – far from perfect but way above most
August 14th, 2009 at 5:45 am
Just one more person crying out loud in support of the NHS in Britain.
I was three years old when it was introduced in 1948.
At age 5 I had an eye operation in our local specialised hospital.Cost? Nothing! Since then I’ve worn glasses and all tests and prescriptions have been provided as needed.
In my early twenties I required hospitalisation for depression. Thanks to all involved I recovered. Cost? Nothing!
The rest of my life has been healthy. Now in my sixties, I was diagnosed with a heart condition that required a cardiac pacemaker to be fitted and it was done within 3 days of diagnosis. Cost? Nothing!
I’m being regularly monitored for prostate enlargement. Eighteen months ago I was fitted with a hearing aid. All free.
Even the the batteries that power the hearing aid, I pick-up at our local heath centre when I need them again this costs nothing.
I hate to think what my life, not to mention my finances would have been like under the American system.
NHS BRILLIANT!
August 14th, 2009 at 5:53 am
Further to my comments. I forgot to mention that in my early thirties after my wife and I (yes Daisy is a man, it was my school nickname) had had two children I had a vascectomy op.
This and the pre and post natal care for my wife was of course all free on the gool old NHS.
August 14th, 2009 at 8:37 am
My family owe our lives to the NHS. I would have died aged five, from blood poisening. My neice has had extensive treatment for thirty seven years for displaced hips and a foot problem. I survived an emergency caesarian and my premature son grew into a healthy twenty-seven year old. We have asthma and this requires extensive on-going care. I have just been treated for a potentially pre-cancerous problem, with rapid and effective care.
It’s not perfect, but the NHS runs well because of the dedication and committment of staff who work in a caring service dedicated to free treatment at the point of need.I was on placement in a community mental health team who reflected the NHS’s tradition of unselfish d3edication to their patients. It is this sense of committment that can’t be bought.
America can only develop this over time, but if it doesn’t start under now President Obama then when can it ever hope to develop? if not now, then when?
Rosemary Rimmer-Clay
August 14th, 2009 at 8:42 am
Apologies, spotted my typos(laptop on knee-originated).
I do know how to spell ‘poisoning’, ‘dedication’ et cetera, honest!
August 14th, 2009 at 1:39 pm
[...] the point. This whole conversation about Britain’s National Health Service is a distraction. Very few Democrats or liberals or progressives want anything resembling the British system. What is at issue is a plan to improve upon the system we currently have – modest steps. [...]