Tuesday, 14 March 2017

The National Health Service:The Best Present Britain Ever Gave Itself

As an American citizen living in the UK, I am following anxiously the current Republican attempts to repeal and replace “Obamacare” with “Trumpcare.” Obamacare, or to give it is actual name, the Patient Protection and American Care Act (ACA), is a flawed system. but an improvement over what preceded it. Trumpcare, or whatever the Republicans will ultimately call it, is likely to be labeled "Who Cares?"

Anyone who has paid attention to the rest of the world since World War II should realize by now that some form of single payer system that covers everyone and is free or nearly free at the point of service, is both more humane and more efficient than anything that exists or is under consideration in the US. One such system, of which I have extensive personal experience, is the National Health Service of the United Kingdom. It is an unlikely model for the US, but it does bolster the case that a single payer system can be successful, and it is one of the oldest in the world.

The National Health Service was established in 1948. At the time, opponents argued that it would never work. Nearly eighty years have passed and it has earned a reputation as one of the best health-care systems in the world. 

The NHS is not an insurance scheme, such as exists in Canada and most European countries with virtually universal health care systems. The NHS is funded out of general taxation. Everyone is automatically covered, not only citizens but non-citizen residents, and even persons visiting the country. It is free at the point of service, except for some types of dental and eye care.

I was born in the UK shortly before the NHS was established, but my family emigrated to the USA in 1952 when I was six. Although I was covered by the system until then (I recall receiving penicillin shots for ear infections and care for a vision problem), I did not remember much about the NHS during my formative years in the US.

Growing up in the Cold War USA in the 1950's and early 60's, I was repeatedly told that socialized health care is communist; that it does not work; and that the American fee for service system was number one. 

None of these claims was true, but if you hear a lie often enough you may begin to believe it. I suppose I did for a time, although I’m not sure I was ever completely convinced. In any event, several things led me to a different view. One is that I studied British history as an undergraduate in the mid-1960's, and later earned a PhD in Modern British history. Among other things, I learned about the NHS, and the poor provision of health care for ordinary folk that preceded it.

Second, and more important, I discovered the reality of the NHS through personal experience. I used the service (free of charge) in 1971 while residing in the UK as a PhD student, and on other occasions while doing research as a history professor. 

Since 2009, I have been living in the UK most of the time, and my family and I have benefited numerous times from the NHS, for both minor and major ailments. My wife received what she refers to as “brilliant” care on two occasions when she was in hospital for life-threatening conditions, in one of which she required an emergency operation. Because we are over 60, our prescriptions are free. For under 60s, they cost a flat fee of @$10.00 at current exchange rates.

A great plus of the NHS is that I do not fear going bankrupt from medical bills, as do many people in the US. Less important, but still significant, I do not have to fill out insurance forms when I need service, or try to choose from a bewildering array of insurance options.

The NHS is expensive, as any health care system will be. But it is far more efficient in a fiscal sense than the chaotic mess that masquerades as a health care system in the US. As proportions of national income, the UK spends about half the amount that the US does. That is also true of countries with national insurance systems. The US public is being ripped-off bigtime.

The NHS is not perfect. Far from it. Americans are told that waiting times for service are long. That is sometimes true, but in my experience, that was sometimes true in the US as well. Americans are told that care in the NHS is "rationed" and that death panels decide who will live and die. Apart from the fact that no such panels exist, in the US it is insurance companies who often decide who will and who will not receive a particular treatment. Such decisions can be a death sentence.  

The NHS is currently under financial stress, partly because of the aging of the population, and partly because the current Conservative government has not provided needed resources. Some Tories -- though not all, by any means -- and a few other politicians, would like to privatize more of the system, make it more “American.” That, in my opinion, would be a disaster. 

The NHS is the best present the British ever gave themselves. I think most people in the UK understand that, and will resist attempts to undermine the NHS. The US Congress, which enjoys access to free, government-sponsored (AKA, socialized) health care, should understand that feeling as well.


  1. This is all true as I have learned about the NIH from many current Brits! The current Prime Minister needs to be sure that the funding for the NIH continues on an upward track!

  2. Excellent. My father was a small town surgeon with a general practice in the US in the 1950-60s before insurance. It was quite different then. Curious. How difficult is it for an American to move to the UK? What a depressing time for the United States.

    1. Hi Charlotte, It was very different then. I remember the doc coming to our house in Chicago in the 50s to see us. Wouldn't happen now. It's impossible for an American to come here right now. After covid, possible, but not easy.