English Healthcare in the US Reform Debate: Setting the Record Straight

The English National Health Service (NHS) has become part of the US healthcare debate. This is bad for both countries. In America, the English NHS is a straw man that distracts from the real discussions that need to happen about how to expand health insurance coverage, improve quality and reduce costs. In England, this negative coverage gets the British defensive and makes that government even more reluctant to press ahead with its recent market-driven reforms. Those market-based reforms to the NHS, championed by Tony Blair, have played a vital role in the improvements its health service has made over the last five years.

There have been a host of rumors about the English NHS, ranging from the benign to the outright asinine. There have been stories of long waits for care, patients being denied coverage because care is too expensive, claims that Sen. Ted Kennedy would have gone untreated in the NHS and even the idea that Stephen Hawking would have been left to die in England.

All these rumors are false. Waiting times have dropped tremendously in England to the point where it is no longer a problem. While there is explicit rationing in England, very little care is denied exclusively on the basis of cost. Sen. Kennedy would have received cancer treatment despite his age. And Stephen Hawking summed up his perspective on the health service saying that 'I owe my life to the NHS.'

But those aren't the rumors that are necessarily most damaging to the healthcare reform debate in America. In fact, one of the most harmful rumors out there right now is that which suggests that the only way to provide every American with health insurance coverage is to create an English-style single payer system. A single payer system isn't what is being proposed by President Obama, wouldn't work in America, and isn't on the American health policy radar. As a result, contrasting healthcare in the US and England is an apples to oranges comparison.

The English NHS is a byproduct of post World War II solidarity. It was founded on two principles: 1) that coverage was universal and 2) that care was not based on a person's ability to pay. Those are certainly laudable goals and ones that we would do well to adopt in the US, but England's health system -- its structure and its ethos -- have been shaped by 60 years of British history. That history, and the health system that has resulted from it, can't simply be shifted across the Atlantic.

There are many different types of healthcare systems that provide universal coverage ranging from those that are almost fully private to those that are fully public. France has achieved universal coverage, as has Germany; and the Dutch are getting pretty close. But none of these systems are right for the US. The key to US healthcare reform is looking at the best of what's out there in Europe and in the US and shaping it into policies that align with American values.

England has strong primary care and family medicine that the US would do well to adopt. The Netherlands has a very competitive private insurance industry that keeps prices down and rewards innovation. Germany is known for its strong pharmaceutical policies. Yet, many of the tools that we need to improve healthcare in the US can be found at home in mini-health systems, such as the Cleveland Clinic, the Mayo Clinic and in the Kaiser network.

It also turns out that some of the best performing areas of the country also have the lowest costs. That bodes well for the prospects of improving quality, slowing cost growth and expanding access. The real challenge is to create the right type of incentives, which reward the innovators and drive out those offering a bad service at a high price.

A final point on the England-US comparisons. There was something very telling about Sen. Chuck Grassley's concerns over whether or not Ted Kennedy would get treatment for his cancer in England. Senator Kennedy (and Senator Grassley for that matter) would both get great healthcare regardless of the country -- England, the US or elsewhere. The real challenge for the American health system is to make sure that the same type of remarkable medical care being delivered to Senator Kennedy is available to everyone else, as well.

Comment - 9/17 - There is an important distinction to be made between the 'British' NHS and the 'English' NHS. It turns out that there really isn't a British NHS because health policy in England, Scotland and Wales, for instance, are each very different. After devolution of the health services in the UK, each country took a very different path. Most of the rumors out there right now focus on aspects of the English NHS, not the British NHS.

Comments

[PregnantFemale]

As an American who lives in London and has had much experience with the NHS with my first, and now my second, pregnancy, I can attest to the fact that there are pros and cons to both systems. This assumes, of course, that you have health insurance in the US. In both countries, you find youself unsure of whether you are receiving the best quality care at all times, and have to educate yourself in order to ensure that the system works for you. At the end of the day, the NHS works as well as the US system, even for those who do have insurance. For those who don't, it isn't even a comparison! So, stats aside (and I'm a healthpoli­cymaker!), the fear tactics are nothing more than that. There is a whole new war on terror that has to happen internally in the US.

[FoxIslander]

"a single payer system wouldnt work in the US"...why? it seems to work in every other developed nation. This argument isnt about healthcare­...it's about the next election. One thing I will say about the NHS...Larr­y Hagman would have been denied a liver transplant.

[Finbarr Saunders]

Why wouldn't he?

[Finbarr Saunders]

Sorry, I meant: Why *would* he be denied it?

[MJinCanada]

How do you know?

I live in Canada, which also has universal health care. A few weeks ago, one of my friends was literally dancing with joy because her nephew, who has cystic fibrosis, got the double lung transplant he needed to survive. Another friend, who's pushing 80, is waiting for a call to come in for a new hip. He wrecked the first one playing professional sports and has actually worn out his first artificial hip with his active lifestyle.

It doesn't matter what you get or how you got it, in Canada you will get treated the same as everyone else, including a scolding from your doctor about looking after yourself better.

[John Gabner]

I have friends in Canada who talk about how happy they are with the Canadian healthcare system which is available to all residents, unlike the broken, top-heavy U.S. system which many defend out of nationalism rather than out of the facts that other countries have systems which are fair, available to all despite income levels and, even though flawed to a point as all are, and more cost-effective. We have slipped to number 37 according to the World Health Organization for fairness, availability and efficacy. Sad! Unbridled capitalism in my viewpoint is selfish and evil. Medicare works in the U.S.! Extend it to all!

[Finbarr Saunders]

I worked as a staff nurse on a liver unit in a large NHS teaching hospital in the early 90s.
People with alcoholic liver disease were routinely considered for transplant - with the proviso that they had been abstinent from alcohol for at least 6 months (not unreasonable given that someone had died to provide the liver).
And this was at a time when the NHS was chronically starved of cash by that close ideological cousin of the American Right; Maggie Thatcher. Things have improved dramatically in recent years.

So many colossal lies deployed to defend an extreme ideology and to protect privelege and power - now THAT'S what i call Stalinist.

[NHSdefender]

The attacks on Britain's NHS have dragged me into this debate and I must admit.....­I just don't get it. Why are so many Americans opposed to free healthcare for vulnerable and sick citizens? The hysteria and rage it generates is mindboggling. The downright lies being peddled Palin and Guiliani leave me open-mouthed.
I was interested to see the likes of Rush Limbaugh comparing health care reform to Nazi eugenics. After all it was Hitler who wrote in Mein Kampf that "the broad mass of the nation are more likely to fall victim to a big lie rather than a small one" backed up by his propaganda chief Joseph Goebbels who said that "making a noise is an effective means of opposition".
That broad mass in the US is being well and truly manipulated by big business and their political
mouthpieces making a big noise.
My family has benefited from the NHS in many ways...fro­m the operation my son had at six months, which would have cost 20,000 dollars in the US (as it is classed as cosmetic and not covered by insurance), to my granny's hip replacement, my dad's medication for diabetes and high blood pressure, my mother's operation to fix a detached retina....­all of it free.
I was amazed that so many Americans were vehemently opposed to all citizens being eligible for that same coverage.
But then my wife said: "More fool them." And she was right.

[fleaba]

Very interesting article. My brother-in-law is a Brit who lives with my sister here in the States. He still retains dual citizenship. I will never forget him seriously considering taking my pregnant sister back to the UK when he found out how much it costs to have a baby here. Even with insurance.
I don't blame him for thinking this way.

What I want to know is what the U.S. is going to do with people in their late 40s and 50s who are out of work, without medical insurance, losing their homes to foreclosure? What happens to these people who get hurt and can't work because they can't get the medical help they need?

Frankly, I'm so sick and tired of the politics regarding this issue. The conservatives are pathetic with their death to granny rhetoric which is just complete nonsense (see Rachel Maddow).
However, I am even more incensed at the Democrats who are buddying up to the insurance and pharmaceutical companies. If they keep it up, frankly, the revolution can't start soon enough.
I'm very unimpressed with Obama's record. I voted for him and love the man, but I feel that he is rapidly becoming ineffective. I understand that the health reform is a congressional issue, however, the White House's pandering to insurance companies makes me furious.

[UNCLEJOE]

Here are the reason Obama will fail in getting any Health Reform worth the title:

When Obama started this crusade for health Reform he started a piecemeal Reform that alienated several groups from his support. If the President had come right out with Nationalized Health care for all Americans based on the Healthcare our Congressmen get, he would have had a great majority of Americans supporting his program.

The way his original bill was presented he divided the Haves from the Have-nots, by teling them you can keep your insurance if that is what you want, but you will have to pay higher taxes to help pay the Healthcare insurance of the 20 million who don't have it and can't afford it. It was the Republicans who talked him into a 'Divide & Conquer' strategy that diminshed the ranks of his supporters.

And the more Obama cut the Reform benefits down the more divided his support became. Obama surrounded himself with Federal Reserve lackeys and they led him down the precipice of failure. The Fed owns the Pharm. conglomerates. Insurance companies are the Feds biggest customers, bigger that the banks, but no one knows this until they need to borrow a few billion to build a Mega shopping mall and the only place they can get that kind of loan is through an insurance company. I learned this when I was a practicing Real Estate Broker in the 1970-80s
The Fed Must Go !

[lastpost]

The NHS is not perfect. No human endeavor ever is. But many of its ill can be diagnosed as effects attributable to the unwarranted and intrusive interventions of political parties and politicians. Whose transitory visitations appear motivated by a need to justify their own existence.
The latest setbacks result from a massive injection of funds, without a preliminary examination to determine the system’s existing level of efficiency. An horrendous degree of waste then followed. Complications arising from this debacle include the current cutbacks and closures. Cynically, in areas where a loss of votes would hopefully have no significance at an election.
It has been demonstrated that an entrepreneurial approach to the operation would prove more efficacious. One individual showed that rather than introducing partisan dogma into the patient a more holistic attitude would work best. Engaging with and encouraging those who deal daily with the tasks being undertaken. Proliferating those devised procedures, which exhibit improvements in efficiency, across the system as a whole. Then repeating that process again and again. Thereby establishing an expert system that continuously evolves by virtue of its own inherent motivation.
But why do the job properly once, when you could do it and redo it, an infinite number of ways and times?

[t9chi]

They don't care about insuring the uninsured. They have too much pride to admit that universal health care is working in other countries. They just want to continue looking like a bunch of idiots trying to bring down a "Black President". That's their priority.

[sheilarks]

Perhaps someone has already mentioned this, but Mr. Cooper is mistaken in saying that the NHS is a "single payer" health care system. In a single-payer system, such as Canada has, physicians and hospitals are paid by the government for services rendered. In the U.K, most hospitals are part of the NHS and most doctors are employed by the NHS. In the U.S., Medicare is a single-payer system and the Veterans Administration hospitals and clinics are closer to the UK's nationalized system.

[peterg76]

The NHS as employer and the NHS as insurer is still a single payer.

[Daniel Wilkes]

The NHS isn't an insurer though. Whilst you can get private health insurance in the UK it is for access to the resources of private hospitals and physicians (who may also do some work for the NHS) not access to the NHS. The assets of the NHS are owned by the state, and the system is under the control of the UK government and the devolved administrations in Scotland, Wales and Northern Ireland. Access to the NHS is free for all residents of the UK, no insurance is required or exists to pay for NHS services.

Single-payer means a system where private health insurance is paid for by only one entity- the state. As we have private insurance which may be bought by private citizens in addition to the NHS, the UK system cannot be described as single payer. The NHS does what it says on the tin- it is a National Health Service, it is nationalised- an integral part of the state.

[gjackson1966]

Social Security and Medicare are good programs that have provided for millions of Americans. It is now time to close Medicare loopholes that permit wasteful spending and fraud. How many times have you seen the electric scooter ads promoting "no cost"? They do cost. They cost me and you everytime one is sold. But how many of these are approved by Medicare that are not medically necessary? How many are approved for people that want them -not need them? This is only one example of fraudulent waste. There are many more throughout the system that is run by the government.
Who wants our healthcare ran by the government? The drug companies, the hospital corporations, the medical supply companies, the lawyers who earn 33+% on malpractice healthcare claims,the lobbyist , the unions for healthcare workers, and many more who currently make money at our expense because of the loopholes in Medicare. With all the billions of dollars these parties provide to our elected senators, congressmen, and including the president ; do you really think there's going to be some BIG healthcare reform? Not unless it is structured the way that can be approved by the same people who are looking for a way to make a bigger profit.

[Rog49Thomas]

Well, if the NHS were so good, then Dennis Carey would still be alive today!

Oh, never mind, I see from Friday's Financial Times (that liberal broadsheet) that he still is.

[Popaluma]

In Australia we have universal health care. Currently, my granny is in hospital (age 91) after suffering breathing difficulties and she's been there for nearly 3 weeks. A few years ago she had a massive heart attack and was in intensive care for 3 weeks, an ordinary ward for 8 weeks, and rehab for 4 weeks. The next year she had an operation for bowel cancer. My grandad had two hernia operations and then was hospitalised for 3 months following a fractured pelvis. Cost to both - zero. Even our drugs are subsidised. We have an excellent system and excellent doctors and surgeons and I'm amazed at the misinformation about universal health being spread in the US. As an Australian, I'm also entitled to reciprocal free medical and hospital in the UK and from experience, I know that it's more than satisfactory.

[CJWebber]

Same thing in Canada. My father in law when he was 75, had 2 hip replacements done a couple of years apart; my mother in law when she was 83 was hospitalized for 2 months and wasn't allowed to go home until doctors were satisfied she would be OK; my neighbour when he was 50 developed a brain tumor, malignant, and had surgery, radiation, lengthy hospitalization and countless pharmaceuticals. Also the survival average for this is 5 years, he is still here after 9.5 years and has received an unbelievable amount of tests and drugs during that time. He no longer works and is not a 'productive member of society', but that is not the issue. His life is never thought of in those terms. The only things he has paid for in all that time are a few hotel rooms for his wife.

Canada hasn't turned into a communist country yet. When is it supposed to happen? ROFL

[FreidaPeeple]

i truly disagree with the amount of money the United States wastes on it's world empire...b­ut for the Queen Mother and her doting coterie to sit there wagging their feathers and clucking like old hens at the Rooster they come running to when the fox shows up...thank­s, but no thanks.

[Chip W]

This article is the closest I've seen to comparing coverage in different countries.
I'm sure many have researched this, but I don't know how much it's been part of the process in coming up with a plan for the US.
It only makes sense to look at what other countries are doing, many of whom have higher-rated health systems than we do, see what works/doesn't work for them, and what would apply over here.
I suspect our hubris gets in the way. We don't learn; we lead the way. Well, in health systems, we're not leaders.

[ADVOCATE4ZPG]

....stumbl­ing sentiently into the truth: The U.S. health care system is a MONOPOLizED source of great wealth for MANY, U.S. doctors and their apologists in the health insurance industry.

In what sociol. trend, by the way, has the U.S. "lead the way" recently? Isn't the U.S. COASTING on momentum garnered earlier in the 20th Century?

[max08]

“There have been a host of rumors about the English NHS, ranging from the benign to the outright asinine. . . .All these rumors are false.”

Ditto Canada. Every piece of bullshit you hear about Canadian health care is an outright lie. Americans would give their left tit to have Canadian health care.

The issue in this country is that Americans have to decide whether health care should have the same importance as the police and fire department in any given community. Imagine the mess if you had a fire and your house was left to fry because (1) you didn't pay your fire dept premium, or (2) the fire department, like the private health care insurance companies, decided your house wasn't worth saving.

[Daniel Wilkes]

I would also say that the author's assertions that the free market is what's best for the NHS and that waiting times are not a problem are incorrect. Deals with private companies have resulted in the costs of new hospitals spiralling out of control, people having to pay to park at some hospitals even in emergencies, the outsourcing of cleaning so that cleaners do a half-a**ed job and are obsessed with profits so don't go all out to ensure cleanliness. Waiting times are much less of a problem than they used to be, because of an increase in resources (and resourcefulness) in the NHS, but in some circumstances they are still undesirably long- but at least you're guaranteed treatment!

[Daniel Wilkes]

You talk about the "English NHS" but what about NHS Scotland, NHS Wales, and Health and Social Care Northern Ireland? Those universal systems are even betterin many respects. Walesoffers completely free prescriptions to everyone and the other two are going the same way. I point this out to remind the American audience that England is not the only part of the UK, and that the health services in the 4 parts of the UK are independent of each other.

I am a strong supporter of our National Health Service. I have found that the service has always been there for myself and my friends and relatives when we need it and on the whole provides an excellent standard of care. Of course there are failures sometimes- there are failures in every system. Isn't a common failure of the American system that it leaves people to die who would live given appropriate treatment? I dislike a system which seems to place profits above what is best for the patient- the fact for instance that American hospitals seem to do as many tests as they possibly can even if they aren't necessary. The NHS is accessible to anyone, regardless of their status, it provides appropriate care for each individual, and for those who don't want to use it there is a private option.

[Chip W]

It sounds like you're from England.
You site examples where free market pieces are working so well.
Are there free market pieces that are working well?

[Chip W]

Correction to comment below: "You site examples where free market pieces AREN'T working so well."

[Chip W]

Correction to comment above: "Correction to comment ABOVE:"

[Chip W]

Regarding the three comments above: Just ignore them. And don't read this one either.

[Daniel Wilkes]

Well that is rather difficult.­..

If I'm honest not a single "free market initiative" that has actually worked springs to mind.

The story that really sums up why I think private companies have no place anywhere near healthcare is that of a woman who had to rush to hospital because her husband had attempted suicide. On arrival, having parked up with no change on her, she was told by a parking attendant working for the private company which owned the hospital car park that if she didn't go and buy a ticket from the ticket machine, or go and park elsewhere, she'd have her car clamped and have to pay 100 pounds (about $165) to get the car released. She told the attendant what was going on, but he still insisted that she would get clamped and wouldn't give her any change for the machine, in her understandably fragile state she then ran around the hospital trying to get some money eventually shouting in front of a roomful of people that she needed money. A nurse finally gave her some change. But after the event (and her husband's eventual successful suicide) she's been left terrified of hospitals and suffering from post traumatic stress disorder. All because some vile human being put profit before patients.