Neither of these was particularly surprising to me, having just returned from a year in the USA. I was regularly questioned by curious Americans about what it was like to live in a socialist country with socialised medicine. Even in policy circles, the NHS has an enduring reputation dating from its lowest ebb – mid-1980s? – of a service characterised by long waits and crumbling infrastructure. Reliable information about how other countries organise their health care systems and how those systems perform, is hard to come by. The Commonwealth Fund is one of the few organisations to publish comparative data, and not surprisingly the UK comes out middling to good, certainly when compared with the USA.
Part of the reason that it has been so easy for the American Right to land blows on the NHS in relation to waiting times, for example, is because the data are collected and published in the UK. Any large number of people waiting (even if only for a few weeks) might appear shocking when no such data exist about how long people wait for treatment in the USA. Rationing is explicit in the UK, at least when it comes to whether a new drug has been approved by the National Institute for Health and Clinical Excellence for use in the NHS or not. Rationing decisions are being made all the time in the US by private insurers, but the information is hidden and personal to each insurance contract. Denials of drugs surface only if patients or their families share their stories in the media.
In one sense, the use of the NHS in the debate is, of course, a red herring. A publicly funded, publicly provided single payer system has never been on the cards in the USA. What liberal supporters of President Barack Obama's administration had been hoping for was a government-run insurance plan that would still contract with the many private (profit and non-profit) providers. If Obama had wanted to quietly lift any examples from the NHS, he would have highlighted the transparency that government systems can bring, both in relation to prices paid for medical treatments (which are a murky area in the US health system) and effectiveness (Nice has many admirers in the USA as a tool to tackle the costly problem of over-treatment).
Opposition to a government insurance plan might now be insurmountable. However accurate the facts about the NHS or heartfelt the defence, it will have no effect on a strongly-held American view of government as essentially malign, a product of that country's very different history.
This blog also appears on the Public Finance website