Health care in reverse

While the U.S. debates more government involvement in health care, the U.K. debates less


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One of the big opening ceremony numbers at the London Olympics baffled American audiences in the summer of 2012. Happy pajama-clad children bounced on hospital beds. Medical staff bopped and jived around them before nurses in crisp uniforms roller-skated along to tuck the little ones in.

How much more bewildering that scene must be in the wake of Obamacare’s chaotic debut. An exuberant celebration of a government-run health service? Are the British mad?

Well, not entirely. Since the founding of the National Health Service in 1948, everyone in Britain has been encouraged to register with a local doctor. When they see that doctor, the consultation is free. If they’re referred to a hospital or a specialist service, nobody mentions insurance or any other form of payment. When an elderly person falls in the street and breaks their hip (as my mother did recently), and then receives X-rays, an MRI, surgery, follow-up scans, drugs and physiotherapy, all of it is completely without charge.

There’s a fixed fee for medicines of $12.60 per prescription, whatever the drug. Children, seniors and the unemployed pay nothing at all.

Of course, we’re all paying for it all the time through our taxes.

And mostly, we like it that way.

The NHS, the world’s oldest and largest single-payer health care provider, is consistently ranked as one of the most popular institutions in the United Kingdom. When asked to say what’s good about their country, Britons point to the NHS, along with the monarchy, the military and the BBC.

As Margaret Thatcher’s chancellor of the exchequer, Nigel Lawson, once said, “The NHS is the closest thing the English have to a religion.”

But for how much longer?

While the Obama administration struggles with attempts to extend and deepen government involvement in health care, Britain is heading the other way.

Right now, the NHS is going through the biggest reorganization in its 65-year history. The Conservative-led government says it’s giving doctors and nurses more autonomy and giving patients “more power over how and where they are treated.” Critics say the service is being broken up and sold off to the private sector.

The reforms (never mentioned in the Conservatives’ election manifesto, nor in the coalition agreement with their Liberal Democrat colleagues) are highly complex. But at their heart are new rules that mean all NHS services must be put out to competitive tender.

Companies, including Sir Richard Branson’s Virgin (yes the one that owns an airline, operates trains and provides cable TV), are now running dozens of health facilities.

Many medical practitioners — and opposition politicians — say the private sector is cherry-picking the profitable services and leaving the poor old NHS to sweep up the complex and expensive ones. The result will be, according to a doctor and leading researcher on the reforms, Lucy Reynolds, “The public sector will shrink away.”

There are, of course, many arguments in favor of a free market. But outside the government and a tiny minority of doctors, nobody in Britain is convinced these arguments apply when it comes to health. Just look at the United States, they say.

So the government is trying to help them see the wisdom of the reforms — through relentless attacks on the NHS.

Some are warranted. It is not a perfect service, as a recent investigation into atrocious negligence at a hospital in the English Midlands revealed.

But government ministers manage to find fault almost every day. They criticize care and demand ever-higher levels of staffing on hospital wards. Why aren’t there more senior doctors in the emergency rooms, they ask, while tightening budgets so that any improvements are all but impossible to achieve.

If the attacks aim to soften up the public in preparation for the NHS’s final demise, they may be working. Polls indicate that public satisfaction with the care they get has fallen significantly — to just over 60 percent. That’s compared to nearly three-quarters who said they were happy with the NHS at the end of the Labor government in 2010.

Ah, those were the days. Prime Ministers Tony Blair and Gordon Brown spent a fortune on the NHS and the service improved hugely. Waiting times for treatment plummeted, shiny new facilities were built, health outcomes in some key areas got better.

But to fund this health bonanza, Labor borrowed heavily and increased our equivalent of Social Security taxes. It also did deals with the private sector that got hospitals built but saddled them with enormous debts that will hang over them for years.

We loved it at the time. But after the 2008 financial crash and with an aging population adding to the strain on resources, it was unsustainable — as the Tories are fond of pointing out.

They now have until the election in May 2015 to convince the British public that their free-market model is better. It will be a hard sell. Americans may be suspicious of more government involvement in their health care. Over here, we’re worried about less.


Claire Bolderson, a longtime correspondent and anchor for BBC News, is a freelance journalist based in London (claire.bolderson@gmail.com).

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