Great Britain’s National Health Service is (choose one):
- A shining example of the power of government to provide health care for everyone.
- A bloated and sclerotic bureaucracy which demonstrates the impossibility of effective socialized medicine.
As the debate over health care reaches new heights of absurdity—with the label “socialized medicine” continuing to be the ultimate insult—I figured its time I share my experience with Britain’s National Health Service. Given that the NHS has been characterized as anything from “evil and Orwellian” to one of civilization’s “greatest achievement,” I am cognizant that I am not able to add anything profound to the debate. And, to some extent, the fact that I can’t offer anything of substance is, at least obliquely, the point of this post (read on!)
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Although I very much want to be a believer in socialized medicine, I had heard stories about the NHS—byzantine bureaucracy and endless waits—before I came here. As a result, I was a bit tentative when the time came for my first encounter with the fabled system. This cross-cultural experience came when my I was down to just a few weeks left of my medication, I decided to walk over the surgery (British for doctor’s office) affiliated with Worcester College. I went to the desk asking for an appointment, expecting that, with luck, I might get an appointment for the next month. To my surprise, the medical assistant booked me for that afternoon. I was keenly attuned to notice any differences, anything with which I wasn’t familiar, but up through seeing the doctor, I couldn’t much tell that I wasn’t at home in the U.S.
After I saw the doctor, I returned to the front desk. After standing for a few seconds, awkwardly, the clerk turned to me and asked if she could help me. I said something to the tune of “I’d like to pay now.” She clearly didn’t understand what I was talking about, so I prompted, “Will you send the bill to my address?” While I knew that health care in the U.K. was publicly subsidized, I found it hard to imagine that I – not an English taxpayer and not a resident – could possibly get off so easily. Despite my best efforts, though, I left without spending a penny. Nonetheless, I figured that the charges would hit me when it came time to fill my prescription. I walked to the chemist, and handed over my script. I asked how much it would cost and—without even bothering to check what medicine I was ordering—the clerk told me £7.20, the price of nearly all medications in the U.K.
I can’t help but draw some comparisons to the United States, where I am, supposedly, one of the “winners” of the private health care system. I’ve been on my parents’ high quality insurance before I was born, and have never thought twice about medical care because of cost. For me, though, the contrast between health care in the U.S. and U.K. is both quantifiable and undeniable: what cost me £7.20 in the U.K. would have cost me $160 in co-pays in the U.S. (insurance covers a whopping $26—thank you Aetna!) While my insurance isn’t paying for my medication, they are busily sending me notices attempting to get me to help them sue the insurance company of the guy who I ran into during reunions at Princeton, which is idiotic. Moreover, I’m getting my wisdom teeth out over break—which is totally unnecessary at this point in time—because come my 23rd birthday, I will be off my parents’ insurance and have no coverage when I am in the U.S.
In short, my experience with the NHS was unambiguously positive, both absolutely and relatively. The only tell-tale sign of the NHS supposed sclerotic inefficiency was a brochure I picked up during my short stint in the waiting room. The cover advertised a bold new plan to reduce waiting times between doctor referrals and evaluations by a specialist. When I opened it up, it announced that most patients would now wait no more than eighteen weeks! Bear in mind, that’s the wait for an evaluation—not treatment. Still, this didn’t strike me as particularly significant, until I friend of mine got sick. She went to the doctor in extreme, debilitating pain. While she got to see a General Practitioner promptly, this was hardly any solace: she left with some pain relievers and an appointment to see a specialist—in February. For her, public health care clearly wasn’t working, so she traded what she described as a decrepit NHS hospital with overworked doctors for a private one, where she got prompt and state-of-the-art treatment, all paid for by her American health insurance. Even as a progressive advocate of a government role in health care, like myself, she had to admit that being treated by the NHS didn’t exactly leave her enthusiastic about socialized medicine.
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Our wildly different experiences are not easy to reconcile. In fact, it’s somewhat hard to believe that we were both served by the same system, and so it’s hard to look at the two and come up with any useful lessons for the health care debate. Basically, our two stories perfectly capture a fairly reasonable evaluation of the trade-offs endemic to socialized medicine. In one system, you have universal and quality primary care. In another, you get cutting edge technology and specialization. It’s good to live in one system over the long term; it’s better to get sick in another system. One rations health care based on minimizing costs and maximizing the good of society; the other rations it based on ability to pay and gives no-holds-barred treatment to those who can.
The social scientist in me, though, is left unsatisfied; I hate the idea that, in answer to my quiz above, the answer is inevitably option three, “both.” I find it hard to accept that all systems are simply “equal but different.” There are always trade-offs, but I like to believe that, occasionally, there are “facts” about societies which are indeed “knowable.” And so, in that spirit of inquiry, I poked around and found a few facts about health care in the U.K. and the U.S:
– For all the talk of avoiding “government-run healthcare” in the U.S., we already have it—it’s just terribly inefficient. The United States government pays for over half of all health care in the United States—but manages to cover only one-third of the population in doing so. The United Kingdom’s government spends less per capita, but covers essentially everyone.
– Overall, the United Kingdom pays around 40% as much per capita as the United States does. For that price, the get the same number of doctors, substantially more nurses, and a greater number of hospital beds.
Ultimately, of course, the inputs of health care (doctors, money, technology) are irrelevant—what matters is outcomes:
– There’s been some political hay made over the fact that the U.K. has higher death rates from cancer, as a result of failure to adopt high-tech treatments. Overall, though, the U.K. still does fine: they have a lower infant mortality rate and a slightly higher life expectancy.*
– My own personal experience, from talking to Europeans from all sorts of different countries, is that pretty much everyone thinks their health care system is flawed. But Britons are certainly more satisfied with their health care system than Americans are.
What occurs to me as I watch the debate over health care reform in the U.S., though, is how little these kinds of statistics and comparative analyses actually matter. No one really seems persuaded by the “fact” that the U.S. ranks near Cuba in health care or that France covers more people for less cost. What politicians, pundits, and the public do seem to find convincing our stories. We care about narratives: Barack Obama talks about the woman with terminal cancer being booted off of her insurance plan; lefty magazines relate the sad tale of a father of three joining the army to get healthcare for his wife; Republicans claim that the NHS would have let ultra-genius Stephan Hawking die. Somehow, these isolated anecdotes are more convincing than the statistics I cited above. And, while I like to think of myself as a rational person, I get it; I am far more convinced of the merits of nationalized health care by my thirty minutes in an NHS doctor’s office than I am by any article, however well researched, I could ever read.
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I promised at the outset that I would come to a disappointing conclusion, and I will not fail to disappoint. From a political perspective, I find the un-convincing nature of statistics and data to be somewhat terrifying: it worries me that more American’s believe in angels than anthropogenic climate change, or that people can seriously claim undocumented immigrants don’t learn English when by the 2nd generation 95% of them do. From my place in academia, though, there is something reassuring and validating about the strange and irrational way people come to decisions about the world around them. Ethnography often seems to be the stunted stepchild of social research, an inferior method that lacks the rigor of numbers and statistics. And yet, while qualitative research is often dismissed as mere storytelling, the fact is that personal experience have an incredible power to frame how we understand in the world, a power which graphs and tables lack. The stories we tell matter, however partial, disjointed, and unrepresented they are. And so, I beseech you, support universal health care, because if you do, all our medication will only cost £7.20 and the receptionists will be way nicer. It must be true, because it happened to me.
* As an interesting aside, the life expectancy at 65 in the U.S. is higher. That is to say, Americans overall don’t live longer, but they DO live longer if they make it to retirement. Probably not by coincidence, retirement is when Americans get universal, government-run health care, of the kind Joe Lieberman just decided the rest of us don’t deserve.
And at that, I reiterate, fuck you Joe Lieberman.