The NHS versus American insurance-based healthcare

Six-month delay by NHS cost woman a cancer lifeline | Mail Online

This got flagged up on Facebook today, and the person who posted it also linked an article about boys getting inappropriately medicated for what some say is normal boyish behaviour but is treated as hyperactivity by (mostly female) primary school staff. Americans seem to be fascinated by the whole subject of British (and other European) healthcare, and the comparisons are sometimes favourable (because everyone is covered, unlike in the USA) and sometimes it’s these hard-luck cases in which someone’s denied an unusual or expensive drug, usually sourced from a right-wing British paper.

What distinguishes British healthcare from what appears both in the USA and elsewhere in Europe is that it’s overwhelmingly tax funded, and private healthcare deals mostly in specific types of surgery. Other countries use an insurance model, often making health insurance compulsory, but you can choose your provider. Not in the UK. There are private health insurance providers (BUPA being the best known) and joining one may mean you get access to the brand new drugs that might wait for NHS approval (or not get licensed at all, on cost or cost-effectiveness grounds), or wait a much shorter time for elective surgery, but there are some things you can only get on the NHS. Primary care is free (though dental care isn’t), but for most people, you pay a fixed amount for prescription drugs (the exceptions being those with specified conditions that require regular medication).

The point is, everyone gets cared for. People are entitled to get care and will not be turned down on the grounds that they are a bad risk to insure because of a pre-existing medical condition (i.e. because they actually need care). Women don’t pay more tax than men because they are likely to get pregnant and need the services of a midwife or gynaecologist (as is usual in the US insurance system). If sometimes people do not get the latest available treatment that a wealthy, or well-insured, American patient could get, the upside is that a person with a treatable illness is probably getting treated. It is possible that money is being wasted on managers and consultancies (and I mean management consultancies, not medical ones), but that has been an issue throughout the UK’s public services since the 1990s. It is not unique to the NHS and has not been present throughout the existence of the NHS.

This hasn’t stopped politicians trying to stoke Americans’ fears of “socialised medicine”, notably Daniel Hannan who I wrote about last August, leading to ridiculous claims being made that introducing this kind of medicine to the USA would result in “death panels” deciding who would leave and who would die. Some ignoramus suggested that if Prof Stephen Hawking lived in the UK, he would have been left to die — oblivious to the fact that Hawking has, in fact, lived in the UK all his life and, by his own admission, has done very well out of the NHS. The fact is that a lot less of this happens in the UK now, much as in the USA, because of changed attitudes. There would have been a time when doctors would encourage a mother of a baby with, say, Down’s syndrome would have encouraged her to leave her with them and go home and try for another. This happens a whole lot less now, as does the institutionalisation of disabled people generally.

Some things aren’t changed by the model of funding healthcare, and people will sometimes complain about “the NHS” when they mean the attitude of individual doctors, or groups of them, or their treatment at a particular clinic. There are people (notably those with certain chronic illnesses) who have had a hideous experience of British healthcare, but doctors with a “God complex” and a dismissive attitude to their patients can be found in both NHS-type and insurance-funded health facilities. Ultimately, it’s about whether we want most people to have most forms of care available to them, or whether we will allow the wealthiest to call the shots through the media, gaining the best care for themselves and leaving everyone else to flounder.

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