Super Tuesday came and went and the Democratic
presidential race is narrowing to two very
different candidates, far left Bernie Sanders
and the more moderate Joe Biden.
Biden and Sanders have clashed on the best
approach to reforming U.S. health care.
Sanders wants to get rid of private insurance
altogether.
While Biden proposes building on the framework
left over from Barack Obama's Affordable Care Act.
Bernie says that you have to bring people
together and we have to have Medicare for all.
But Bernie says and he says he wrote the damn
thing, but he's unwilling to sell with the
damn thing's gonna cost.
The idea middle class taxes aren't going to
go up is just crazy.
What Medicare, after all, will do is save
the average American substantial sums of money.
The U.S. already spends more money on health
care than any other developed country.
There's one country that spends less than
half what the U.S. does on health care.
And people generally don't pay anything out
of pocket when they go to the doctor.
The United Kingdom and out of all the health
care systems we've looked at, the U.K. appears
the most socialist.
The government effectively runs the whole
thing.
Right now, the U.K. is having its own debate
over how to reform the National Health Service.
So how does the U.K. system compare to the
U.S. and what reforms may be coming?
In 2018, the United States spent around ten
thousand five hundred U.S. dollars on health
care for each of its residents.
The United Kingdom spent around 4000 U.S.
dollars.
That means the United Kingdom spends 9.8 percent
of its GDP on health care, while the U.S.
spends 16.9 percent.
Despite spending less, the United Kingdom
manages to have healthier citizens who live
longer and are less likely to die in childbirth.
In 2017, life expectancy in the U.K. was 2.7
years higher than in the U.S., and the U.K.
has roughly 1.5 times fewer deaths that could
have been avoided by access to better health care.
The infant mortality rate is lower in the
United Kingdom, with 3.9 deaths
per 1000 live births as opposed to 5.8 in the United States.
And the maternal mortality rate in the U.S.
is nearly 1.5 times higher than in the United
Kingdom.
So how is the U.K. system structured so that
it gets these results while spending significantly
less than the United States system?
The National Health Service is a case where
the British decided right after World War
2 that health care should be government's
job, like paving the streets, putting out
fires, running a library, running the parks.
That's T.R. Reid, author of the book The Healing of America.
He traveled the world exploring different
countries' health care systems.
It's a service you get when you need it and
you never get a bill.
It's like going to the library.
They don't charge you to check out a book.
He's saying that the NHS is it's a risk sharing
system, so everyone pays into it through their tax.
If you need to use it, you don't have to pay
anything else.
So in a sense, it's not free because is paid
as of taxation.
Dr. John Puntis is a pediatrician who recently
retired from the NHS.
He is also co-chair of an organization called
Keep Our NHS Public.
All of his comments are reflective of the
organization and not his personal views.
It's a fair system in that the more money
you earn, the more tax you pay, the more you
contribute.
But there has been discussion about whether
tax should be increased to pay for sorting
the NHS out in terms of the current deficiencies
and problems, and that that is controversial.
I think a lot of people favor some tax increase,
but then there are other people who say, well,
maybe the focus should be on companies that
don't pay tax and people who don't pay tax
as the first step.
I would call that socialized medicine.
Government provides that care.
Government pays for the care it's paid for
through taxes.
Everybody's covered the same.
To me that sounds like socialized medicine.
The term socialized medicine has become a
political football, especially in the United
States.
The NHS is socialized medicine.
It's great.
And we hear this term mainly coming from the
US where it's used as a as scaremongering.
I would say if the NHS is socialized medicine,
we like it and most people are still very,
very supportive of the concept of of of a
national health service.
Each of the u.k.'s four constituent countries
have their own branch of the NHS, so rules
differ slightly between them.
But all of the branches operate under the
purview of the U.K. parliament.
There are some services that require patients
to pay something out of pocket, such as dental,
eye care and certain prescription drugs.
But those fees are low compared to the U.S.
and vary by NHS branch.
By one estimate from a data analytics firm,
prescription drugs cost 57 percent less in
the U.K. than they do in the U.S. Unlike with
other universal health care systems that are
only publicly funded, the government also
runs the NHS.
That means doctors that work in public NHS
facilities are employees of the government.
Most Britons receive their primary care through
general practitioners who are frequently referred
to as GPs.
They typically act as gatekeepers for secondary
care.
The problem is that people are experiencing
the moment as is taking longer to see your
general practitioner.
If you want to see them.
Most GPs are private contractors with the
NHS.
They don't charge patients for care.
Instead, they earn money directly from the
National Health Service.
Many GPs negotiate contracts with the NHS
to determine how much they can charge the
government for their services.
GPs may fund their own general practice facilities
or they can rent them from the NHS or private
companies.
One paper from the Journal of the Royal Society
of Medicine found that GPs faced many issues
because of how general practices are funded
in the U.K.
Some GPs, I think increasingly don't want
to take on the running of business aspects
of general practice, and so there are lots
of GPs who are salaried partners, so they
are paid by the practice to come in and work
as a GP, but they don't do any of the business
side of this stuff.
There's also a private sector in the u.k.'s
health care system.
It's funded from a combination of out-of-pocket
payments, private health insurance and the
NHS itself.
The private sector is growing because is being
consciously promoted by government and the
boundaries being blurred.
But I think the private health care has been
growing at a very rapid, steady pace in the
United Kingdom for the course of several decades.
That's going to continue.
That's Nile Gardiner.
He's the director of the Thatcher Center for
Freedom at the Heritage Foundation.
With regard to the National Health Service,
I mean, there's no there's no sign at this
stage that the U.K. will be moving to a different
system to the National Health Service.
All British parties all committed to the National
Health Service.
I think that's more or more Britons will be
opting for private healthcare in the coming
years and decades, not least because there
are long waiting lists with regard to the
National Health Service.
And analysis from the London School of Economics
found that in the 2018 to 2019 fiscal year,
NHS England spent around 18 percent of its
total expenditure on the independent sector.
There's been a blurring of the boundaries,
if you like.
For example, cataract surgery is the most
common operation done under the NHS.
Increasingly, it's being provided in the independent
sector and the NHS, as has contracts with
the independent sector to do that work.
There are implications in terms of staffing.
Private sector doesn't train its own staff,
it takes it from the NHS.
It cherry picks, takes the low risk patients,
not the high risk patients.
It has an impact on training NHS staff and
this is one of the problems with cataract surgery.
If they're all going to the private sector,
hospitals and the NHS staff don't become
experienced in doing cataract surgery.
And then along the line you find it's more
difficult to staff your NHS unit.
So it's not without negative consequence.
And we are paying private companies increasingly
to do work for the NHS, including American companies.
And they're very well established now, particularly
in the back office functions and providing
advice on commissioning support, this kind
of thing.
They're very involved and unfortunately that's
likely to increase and something which campaigners
are extremely worried about.
I don't think anyone really believed that
U.K. voters would decide to Brexit.
The news that the United Kingdom voted to
leave the European Union shocked the world.
The NHS was a big part of the Brexit media
discourse, with the Leave campaign famously
claiming that the U.K. would take back 350
million pounds a week that could then be funneled
into the NHS.
The U.K. Statistics Authority has since said
that the claim is a quote, clear misuse of
official statistics.
My name is Holly Jarman.
I'm an assistant professor in the Department
of Health Management and Policy at the University
of Michigan.
Those promises really did hit home for a lot
of people.
The idea that money would come back from Europe
to the U.K. was a very powerful symbol.
It's not actually true.
That wasn't really how EU financing works,
but we still saw that that was a big part
of the media discourse and most likely part
of people's judgment when they were casting
their vote.
The U.K. officially left the EU three years
after the original Brexit vote.
Entering a transitory period through the end
of 2020, while the U.K. government negotiates
international trade deals, the concerns about
private American corporations engaging more
with the NHS came up during the discussion
of the post-Brexit trade talks with the United States.
When you're dealing in trade, everything's
on the table, so NHS or anything else are
a lot a lot more than that.
Backlash to President Trump's comments on
the NHS led to many British politicians assuring
their constituents that the NHS was not going
to be a part of the trade talks.
The NHS is in no way on the table.
President Trump and backtracked on his comments,
saying he wouldn't consider the NHS as part
of the trade deal.
A lot of trade negotiations are actually quite
secretive by nature.
The two sides don't really want to reveal
a lot about what they're looking for in a
deal.
Our concern really as health researchers is
that the NHS really won't be accounted for
in that deal, that the U.K. government's preferences
have been shown to be largely economic and
not so much on the focusing on the health
of people in Britain.
The problem is that the NHS is is already
on the table.
It has been for a while.
The politicians who are now going to be negotiating
the trade deals, you know, it's going to be
across many fronts.
Campaigners were saying, okay, put your money
where your mouth is.
If if you're saying the NHS won't be in a
trade deal, then let's see legislation that
sets that out says cast in stone.
And they haven't rushed to do that.
Trade negotiations, cover everything at once.
And it's difficult to tell how they are going
to be pushing for the liberalisation of drug
regulations and to what extent the Johnson
cabinet would actually agree with any changes
that would be proposed to the way the U.K.
regulates pharmaceuticals.
It's really a central government led process.
That's not that democratic and does represent
big business.
And I think that's why a lot of people get
very concerned and anxious around trade agreements.
There are some who say the NHS won't be harmed
by Brexit, even in the event a trade deal
with the EU isn't reached by the end of the
year.
I don't expect that we're going to see huge
changes actually in the Brexit era with regard
to the to the National Health Service.
And so I think with with regard to the NHS,
we're not likely to see a significant impact
as a result of of Brexit.
I think the free trade deal will be largely
focused upon the service industry, which of
course is now the largest part of both the
US and British economies.
Whatever effect the trade deals end up having
on the U.K., reforming the NHS will continue
to be a big part of the country's political
conversation.
People's support for the NHS in the U.K. is
very strong.
There's no other country that when we hosted
the Olympics in London, we had nurses jumping
on beds and the NHS was actually a part of
that ceremony and a part of that national
celebration.
The U.K.'s NHS is very important in British
politics.
It's an important symbol of Britishness in
that context.
