a curious Yankee in Europe's court

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A User’s Opinion of UK’s Universal Health Care

Posted on the January 11th, 2010

Some American critics of the United Kingdom’s universal health care system (NHS), I’ve noticed, have pointed to it as a primary example of why it would be a mistake for the U.S. to move its reform efforts toward any such public plan. Curious as to the validity of these boos and hisses, I recently queried an English friend of mine on the subject.

Some context for the witness: 1) She and her family are financially comfortable and, therefore, are able to choose between public or private care; 2) They also lived in the USA for several years a couple of decades back, and so are familiar with the American private system; 3) My friend leans conservative in her political views, and rates Margaret Thatcher’s leadership highly.

Here is a slightly edited transcript of our email Q&A last month on health care:

Q: Notwithstanding legitimate concerns and criticisms of the UK’s national health plan, would you approve of it being repealed and the country returning to a fully private health care system, without government funding except for retired people and the very poor?

A: No – in short.

Q: May I ask you to describe you and your family’s use of the public system together with private health care in terms of the mix — i.e., what percentage of care you receive from the public plan versus your recourse to private care?

A: We have always used both, through job based private insurance and now by self-funding, if we need elective or immediate ‘serious’ investigations. However, when it comes to the actual treatment, we might well revert to NHS care. Emergency and life threatening situations result in the same care, whichever way you go, albeit maybe in greater comfort in a ‘private’ facility. But as with all things in life, what really counts is doing your homework and knowing your options. I would say it’s been about 50/50, given that none of us have had a chronic problem, which usually would be too expensive and eventually precluded from insured private care. In my parent’s generation, until late in life when they could afford it, all the care was NHS.

As a final comment, our system cannot be described as either ‘very bad’ or ‘highly rationed’. It is neither. What it is is HUGE, and difficult to manage fairly. Often it’s a bit of a zip code lottery. Some hospitals are wonderful, others are not. It also depends a great deal on HOW the individual interacts with the system. It is abused and overused because it has become the accepted route… people don’t think for themselves anymore. We have created the system we deserve. There is huge waste. But there is also life saving, life changing work being done.

There is no short sound-bite answer to this. We could talk about it for days!

It could be the most amazing system in the world, but it needs a complete overhaul in management terms. Like all other walks of life, you have management consultants meddling in it with no clinical or patient experience, and they are screwing with the training that they give to Doctors and Nurses also. It’s become a Big Business, with hugely wasteful contracts going out to private companies.

But I would never advocate going back to a wholly privately funded system. A more carefully worked out combination would seem to me to be the way to go… to allow the system to work better for those who need it most.

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