A healthy debate? The US and English health systems

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On this side of the Atlantic we seem to be shocked that our esteemed NHS has been used so readily as a political football in the debate about health care reform in the United States. There has also been consternation that commentators have got so many facts wrong.

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.


Joanne Watson

Comment date
09 September 2009
Ruth is so right here with her final comment regarding our different histories. Whilst what unites us is more than what divides us, Americans in general have such a Libertarian Philosophy compared to the our Utilitarian/ Liberal one. State 'interference' to them is something that is more alien than we comprehend which is the root of our differences.

Yes, the NHS like all health systems can, should and will improve as we focus on putting patients at the centre of everything we do but we are in a much better position particularly in terms of equity and efficiency than America. We've got it more right and should build on this.

Craig Wakeham

Comment date
08 September 2009
Interesting to hear that the Commonwealth Fund's report being described as characterizing the UK as middling to good, when it topped the 'balanced score card' in the 2007 report.

The other great 'strength' of healthcare in the UK is primary care services. We need to not simply play 'lip-service' to this fact but really believe and act accordingly. Primary care is in great danger of being seen as a cheaper version of secondary/hospital based care and this will be its ruination. Primary care needs to embrace (and be embraced for) its pivotal role between public health and individual biomedical healthcare.

john kapp

Comment date
08 September 2009
Publicly funded medicine has a dreadful record of patient safety because it is drug based. The statistics show that the more that is publicly spent on health, the sicker the population. The healthiest year for UK was shown to be 1944 because all medical attention went to war-wounded, and no civilians got any healthcare. Dr Gary Null has shown (see Death by Medicine, garynull.com) that conventional medicine is now the biggest killer in the USA (mainly adverse drug reaction) The only remedy is to follow the Prince of Wales, and integrate complementary medicine into healthcare system.

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