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The NHS is envied for its principle of caring for all


I like America. I like its sweeping landscapes and sense of purpose. I know it has its problems. In some places, you are considered cosmopolitan if you marry outside your own family. And it gave the world George W Bush and didn’t listen when the world took him back with the receipt and tried to exchange him for some pyjamas and a soap on a rope.

We also know the US produces some of the most remarkable cities, nicest ice cream and biggest bridges in the world.
However, it is rubbish at organising healthcare and, judging by the recent debate around Barack Obama’s health bill, it is quite proud of that fact.

In America you get a health insurance package with “most” jobs and, while the packages vary, the chances are you can get to see someone if you are ill. However, at least 47 million people don’t have health insurance, largely because many employers offer limited or sometimes no health insurance packages. Hardly becoming of the richest country in the world, is it?

It’s strange that a country that can produce the Golden Gate Bridge, The Fabulous Baker Boys and stuffed crust pizza can so completely misunderstand the point of a healthcare industry and it is no surprise that they look at our NHS with a bemused incomprehension. But I can’t help thinking that perhaps we can learn something from their confusion, and maybe even help them as we do so.

‘It’s strange that a country that can produce the Golden Gate Bridge and stuffed crust pizza can so misunderstand the point of a healthcare industry’

The US thinks of healthcare as an opportunity for profit. Mr Obama’s health bill proposes healthcare for all without too many money-making opportunities and this appears to have made the rabid right wing of the US fall over with dizziness.
The health bill proposes a national health insurance that will fund health collectives designed to provide access and services for all. It is wholly reasonable and about 50 years overdue, but the reaction against it has been so rabid, so hysterical and so astonishingly dishonest that one would think the man was suggesting they all just give the country back to the Indians and go and live in Mexico.

Amid the hysteria, the NHS has come in for some astonishing attacks in America. Some remarkable questions have been asked. Is it true that we kill the physically handicapped? Do we eat babies? Are we all communists?

Touchingly, most people have moved to support the NHS - which hasn’t happened for a while, has it? And they have supported not the modern machinations of the internal market but the simple underpinning principle, so lost in language and organisational challenges, that is providing first-class healthcare for everyone, regardless of ability to pay. A principle that more than any other establishes our country as progressive and compassionate.

It is often useful to see yourself through the eyes of others. The NHS is not and never will be envied because of the way it has been modernised in the marketplace. It is admired because of its purpose and, if we could but construct a way of realigning ourselves to that ideal the way Mr Obama is trying to, we might just become the envy of the world again.


Readers' comments (4)

  • I, as a citizen of the United States and as a Family Nurse Practitioner, share your concerns about the way health care reform is rolling out here in the United States. What are we afraid of? It embarrasses me that the wealthiest country in the world is so unbearably greedy. My patients are the uninsured and I have witnessed firsthand the awful consequences of the profit-making health care industry. It amazes me that the "haves" are so inured to misery of the "have-nots" in a place where everyone could have enough. The National Health Service should be proud that it is not a marketplace phenomenon but an organization that simply provides enough for all. As a nurse practitioner, it is exhausting to constantly be investigating ways to sneak people into systems that can help them when health care should be available to them, defending diagnostic judgments to profit-driven insurance companies so they can save a buck, and watching the tragic--not to mention very costly-- outcomes that occur when one cannot afford daily medicines or other treatments for chronic illnesses. Opponents of health care reform decry the rationing that will start to occur if there is reform; rationing of health care services has been going on for decades in this country but the insured have not been confronted by it so they believe it is a myth created by the liberals who consider health care a right.

    While I do not doubt that the NHS has its difficulties, it is its purpose and the way it responds to the needs of the entire nation that we in the US need to emulate. Perhaps it will take more mentally ill people on the streets or people losing their homes through bankruptcy resulting from exorbitant medical bills to get the opponents of health reform to finally see the need for health care for all. One would hope that the American people will not allow that to happen and that, with rational thinking and knowledge of the facts, we can finally achieve social "justice for all".

    Dr. Norma Hannigan

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  • Both Mark Radcliffe and Dr. Hannigan express their viewpoints very eloquently. However, the devil is in the details. I am a retired thoracic surgeon. I trained in England and I practiced in the United States for over 30 years. I have seen the NHS from the inside and the outside, and I have "lived" and "breathed" the American health care system for decades. There is no comparison. They are two totally different systems, and anybody who is trying to emulate one or the other is making a big mistake. There are pluses and minuses in both systems. I agree that the NHS was created with the aim to provide health care to all. However, it has been proven totally inefficient in accomplishing this goal. The long delays in obtaining care are only one indicator of the failure of the system. The proliferation of private clinics and hospitals in England is another. Rationing is well known to occur, particularly when the patient happens to be elderly or infirm. Women give birth on the sidewalk because it is costly to send an ambulance to pick them up. We have our problems in this country, also. But the 47 million people, widely reported as uninsured and considered to be "victims" of the system, are not. About 12 million of them are illegal immigrants and they receive their care in the public hospitals' emergency rooms. Another 10 million or so choose not to have insurance because they are young and healthy, and they can afford to go to the emergency room if they break a leg. Others don't have coverage, or they have incomplete coverage, because they work for themselves and they don't want the expense of the insurance premiums to eat away into their profit. The real number of truly uninsured people is closer to 10 million, and they are always being taken care of in an emergency. What needs to be fixed, is the bureaucracy that stifles our system, and the malpractice threat that drives costs up. Some control is also needed in some doctors' exorbitant fees, particularly in some specialties such as spine surgery, obesity surgery, plastic surgery. The marketplace can take of the rest.
    Phoebus Koutras, M.D., F.A.C.S.

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  • Dear Phoebus Koutras,

    What planet are you on sir?

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  • Dr Phoebus Koutras response echos the comments of both of the other writers here, that some have health insurance and some do not. What he fails to recognise is the inequality that exists in the USA. That is the point Dr Koutras - not that people CHOOSE not to pay insurance but that many people do not have the resources to pay for health care. The NHS may have its faults - but at the end of the day everyone in the UK has access to equal care within the service. It is not dependent on either choice or ability to pay.

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