The British health care system

Both advocates and critics of a government-run “single payer” system look to the example of Great Britain’s nationalized health care. Here British journalist Mike McNally offers a revealingly balanced view:

The British system is not nearly as bad as has been suggested by opponents of ObamaCare. But it’s fair to say that if Britain were setting up a health care system from scratch today, it wouldn’t bear much resemblance to the NHS. The service was established more than 60 years ago in a country battered by war and when the ability of the government to run such enterprises was unquestioned. Back then it did its job of providing basic health care for all admirably. But with people living longer, medical advances producing new and more expensive treatments, and the bureaucracy growing increasingly byzantine, the NHS has become a black hole sucking in ever-more public money. Labour has more than doubled spending on the NHS since coming to power in 1997 with little to show for it, and the service is projected to face massive funding shortfalls in the next few years.

Yet to talk of reforming the service is political suicide. The NHS employs around 1.3 million people — it’s thought to be the world’s third-largest employer after the Chinese military and India’s railway service — and remains broadly popular with the public despite a steady flow of horror stories (it’s just been revealed, for example, that more than 30,000 people have died in the past five years from infections picked up in NHS hospitals). Assuming the Conservatives win the next election, it’s unlikely Cameron will have the courage to propose significant reforms in a first term.

The simple fact is that while neither system is as terrible as their detractors claim, both have undeniable flaws. And while we can trade facts, figures, and anecdotes all day, a couple of things are clear. The first is that the poor enjoy a generally better standard of care in the UK than in the U.S. The second is that Americans with decent insurance enjoy a better standard of care than most Brits — survival rates for all the major cancers are considerably better than in the UK, and screening and treatment for heart disease and other chronic conditions is more widely available.

About Gene Veith

Professor of Literature at Patrick Henry College, the Director of the Cranach Institute at Concordia Theological Seminary, a columnist for World Magazine and TableTalk, and the author of 18 books on different facets of Christianity & Culture.

  • Carl Vehse

    A woman had a baby on the street outside of a British hospital after the hospital refused to send an ambulance after she had gone into labor. She had been told to walk to the hospital.

  • Carl Vehse

    A woman had a baby on the street outside of a British hospital after the hospital refused to send an ambulance after she had gone into labor. She had been told to walk to the hospital.

  • http://www.blogger.com/profile/01763924682909630509 Orianna Laun

    Just curious, how would population size compare in this debate? What is the population of the UK and the ratio of healthcare providers to populace? Would this make a difference in one country’s nationalized healthcare vs. another? Do the Brits shuffle coverage funding as much as some say (wrongly or otherwise) an American plan would?

  • http://www.blogger.com/profile/01763924682909630509 Orianna Laun

    Just curious, how would population size compare in this debate? What is the population of the UK and the ratio of healthcare providers to populace? Would this make a difference in one country’s nationalized healthcare vs. another? Do the Brits shuffle coverage funding as much as some say (wrongly or otherwise) an American plan would?

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  • http://www.toddstadler.com/ tODD

    We do all realize that those promoting “ObamaCare” are not necessarily at all “advocates … of a government-run ‘single payer’ system,” right? At best, there’s a lack of parallelism in this discussion. The current proposals would not give the US anything like the NHS, so it’s not clear why the NHS is relevant to the current US health care debate. With the possible exception that conservatives often conflate all other countries’ health care plans.

    But that aside, this article is rather poorly written (which, you know … Pajamas Media … enough said). The NHS is “thought to be the world’s third-largest employer after the Chinese military and India’s railway service”. Thought to be? Can’t he actually verify this fact himself? Or maybe he didn’t want to, since it’s not true. Ever heard of Wal-Mart? I have, and they have around 2 million employees. I found that fact pretty quickly. I have no idea what other large employers there might be in the world, and nor do I imagine the author does.

    But let’s look at his interesting anecdote that “more than 30,000 people have died in the past five years from infections picked up in NHS hospitals”. Okay, so that’s 6,000 deaths per year caused by hospital infections. Sounds bad, as that’s nearly 10 people out of every 100,000 in the UK that die needlessly every year.

    So how does the US compare? Did the author bother to investigate? I did. And while I can’t pin down an exact number, I found that, in 2000 in the US, “about 103,000 deaths were linked to hospital infections,” and in 2009, “Hospital-acquired infections cause nearly 100,000 deaths a year in the United States.” So let’s go with that last number. 100,000 deaths per year from hospital infections. That’s nearly 33 people out of every 100,000 in the US that die needlessly every year — a rate that is over 3 times worse than that in the UK.

    But the author didn’t mention that. He just made the NHS look like it was horrible. Perhaps it is, but by the metric he uses, our system is much worse.

    One can only wonder what other facts are wrong or missing in this article.

  • http://www.toddstadler.com/ tODD

    We do all realize that those promoting “ObamaCare” are not necessarily at all “advocates … of a government-run ‘single payer’ system,” right? At best, there’s a lack of parallelism in this discussion. The current proposals would not give the US anything like the NHS, so it’s not clear why the NHS is relevant to the current US health care debate. With the possible exception that conservatives often conflate all other countries’ health care plans.

    But that aside, this article is rather poorly written (which, you know … Pajamas Media … enough said). The NHS is “thought to be the world’s third-largest employer after the Chinese military and India’s railway service”. Thought to be? Can’t he actually verify this fact himself? Or maybe he didn’t want to, since it’s not true. Ever heard of Wal-Mart? I have, and they have around 2 million employees. I found that fact pretty quickly. I have no idea what other large employers there might be in the world, and nor do I imagine the author does.

    But let’s look at his interesting anecdote that “more than 30,000 people have died in the past five years from infections picked up in NHS hospitals”. Okay, so that’s 6,000 deaths per year caused by hospital infections. Sounds bad, as that’s nearly 10 people out of every 100,000 in the UK that die needlessly every year.

    So how does the US compare? Did the author bother to investigate? I did. And while I can’t pin down an exact number, I found that, in 2000 in the US, “about 103,000 deaths were linked to hospital infections,” and in 2009, “Hospital-acquired infections cause nearly 100,000 deaths a year in the United States.” So let’s go with that last number. 100,000 deaths per year from hospital infections. That’s nearly 33 people out of every 100,000 in the US that die needlessly every year — a rate that is over 3 times worse than that in the UK.

    But the author didn’t mention that. He just made the NHS look like it was horrible. Perhaps it is, but by the metric he uses, our system is much worse.

    One can only wonder what other facts are wrong or missing in this article.

  • http://www.toddstadler.com/ tODD

    Also, according to the Bureau of Labor Statistics, there are 16,499,250 people employed in the Health Care and Social Assistance sector in the United States.

    So while the UK’s 1.3 million in the NHS may sound like a lot, consider that the US has 2.5 times more health care employees per capita! It’s just that they’re spread out over a number of corporate and government entities.

  • http://www.toddstadler.com/ tODD

    Also, according to the Bureau of Labor Statistics, there are 16,499,250 people employed in the Health Care and Social Assistance sector in the United States.

    So while the UK’s 1.3 million in the NHS may sound like a lot, consider that the US has 2.5 times more health care employees per capita! It’s just that they’re spread out over a number of corporate and government entities.

  • http://www.bikebubba.blogspot.com Bike Bubba

    Let’s ask ourselves why the United States has twice the health care workers per capita. Is it perhaps because we don’t have a nationalized healthcare system, and people are free to pay for the care they desire?

    Might have something to do with it, I dare say.

  • http://www.bikebubba.blogspot.com Bike Bubba

    Let’s ask ourselves why the United States has twice the health care workers per capita. Is it perhaps because we don’t have a nationalized healthcare system, and people are free to pay for the care they desire?

    Might have something to do with it, I dare say.

  • Bob

    Here are some comments about why it’s pretty useless to compare the British health care system with what will
    happen here.

    This article was written by Zack Cooper, a health care economist at the London School of Economics:

    “The English National Health Service (NHS) has become part of the US healthcare debate. This is bad for both countries…”

    “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.’”

    http://www.huffingtonpost.com/zack-cooper/english-healthcare-in-the_b_259966.html

  • Bob

    Here are some comments about why it’s pretty useless to compare the British health care system with what will
    happen here.

    This article was written by Zack Cooper, a health care economist at the London School of Economics:

    “The English National Health Service (NHS) has become part of the US healthcare debate. This is bad for both countries…”

    “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.’”

    http://www.huffingtonpost.com/zack-cooper/english-healthcare-in-the_b_259966.html

  • http://www.toddstadler.com/ tODD

    Interesting. The article cited by Veith holds up the 1.3 million employees of the NHs as evidence of its inefficiency, of something that needs significant reform, so bloated has it grown.

    And yet when I point out that the US has more than twice the number of health care workers per capita than the UK, Bubba (@6) sees it as a good thing — not as bloated inefficiency, but rather of abundance and freedom of choice.

    Clearly, there is not a consensus among conservatives on how to measure the NHS. Is it woefully understaffed, or bloated and inefficient?

    Also interesting is if you take the two key sentences from the article: “the poor enjoy a generally better standard of care in the UK than in the U.S.” and “Americans with decent insurance enjoy a better standard of care than most Brits”.

    What if, say, we came up with a system that, rather than being a single-payer NHS-like system, allowed “Americans with decent insurance” to keep their insurance and their quality of care, while also improving the standard of care for the poor? I wonder what that would look like …

  • http://www.toddstadler.com/ tODD

    Interesting. The article cited by Veith holds up the 1.3 million employees of the NHs as evidence of its inefficiency, of something that needs significant reform, so bloated has it grown.

    And yet when I point out that the US has more than twice the number of health care workers per capita than the UK, Bubba (@6) sees it as a good thing — not as bloated inefficiency, but rather of abundance and freedom of choice.

    Clearly, there is not a consensus among conservatives on how to measure the NHS. Is it woefully understaffed, or bloated and inefficient?

    Also interesting is if you take the two key sentences from the article: “the poor enjoy a generally better standard of care in the UK than in the U.S.” and “Americans with decent insurance enjoy a better standard of care than most Brits”.

    What if, say, we came up with a system that, rather than being a single-payer NHS-like system, allowed “Americans with decent insurance” to keep their insurance and their quality of care, while also improving the standard of care for the poor? I wonder what that would look like …

  • Cincinnatus

    I think, tODD, the dilemma with the NHS is that it is both understaffed and bloated and inefficient.

    Something that I would like to see discussed, however, is the politicization of our health. Many British conservatives (and others who detest the growth of the Welfare State–yes, they do refer to it in capital letters there) have spoken or written at length about how the health of the British people and their access to adequate healthcare has become a political bargaining chip which can be threatened, withheld, expanded, or otherwise gambled at will of the party in power or running for office; not to mention the manner in which that trivializes the basic fact of human health in the first place. I have been quite disturbed by the Democratic Party’s (particularly Obama) recent politicization of our health, even employing his grandmother as a tool; fortunately, the American government cannot literally handicap/diminish/withhold/whatever our entire health system to influence the electoral process yet, but it certainly is a sign of things to come, whether the new instrument be a “public option” or a single-payer structure.

  • Cincinnatus

    I think, tODD, the dilemma with the NHS is that it is both understaffed and bloated and inefficient.

    Something that I would like to see discussed, however, is the politicization of our health. Many British conservatives (and others who detest the growth of the Welfare State–yes, they do refer to it in capital letters there) have spoken or written at length about how the health of the British people and their access to adequate healthcare has become a political bargaining chip which can be threatened, withheld, expanded, or otherwise gambled at will of the party in power or running for office; not to mention the manner in which that trivializes the basic fact of human health in the first place. I have been quite disturbed by the Democratic Party’s (particularly Obama) recent politicization of our health, even employing his grandmother as a tool; fortunately, the American government cannot literally handicap/diminish/withhold/whatever our entire health system to influence the electoral process yet, but it certainly is a sign of things to come, whether the new instrument be a “public option” or a single-payer structure.

  • Cincinnatus

    In other words, the NHS has become the greatest medium for political exploitation in recent history.

    For instance:

    http://www.ncbi.nlm.nih.gov/pubmed/18840851

  • Cincinnatus

    In other words, the NHS has become the greatest medium for political exploitation in recent history.

    For instance:

    http://www.ncbi.nlm.nih.gov/pubmed/18840851


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