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Under normal circumstances, the spectacle of Gordon Brown using Twitter would offer the enticing prospect of more YouTube-style pratfalls.
But I'm glad the PM has twittered in defence of the NHS, following attacks on it from US conservatives trying to discredit President Obama's health reform plans. And to those British Right-wingers chiming in, such as the Tory MEP Daniel Hannan, I'd just ask this: have they actually tried American healthcare?
Because I have, and for me that makes the choice between a US-style, largely private system and a socialised one such as the NHS very simple.
When I think of American healthcare, I think of my friend Andrew, gravely ill with a brain tumour, in a Houston hospital. He was in pre-op with his head shaved when the medics got a call from the accounts department: his insurance money was about to run out. So they got him up and dressed again.
He did get his operation a few days later-accounts had screwed up — but the money ran low soon afterwards. They gave him his X-rays and told him to get on a bus across town to a cheaper hospital. He died the following year, age 31. I had a similar, bare-bones student-health package to Andrew: his ordeal didn't make me feel any safer.
Then I think of my uncle John in Cheltenham, who succumbed to oesophageal cancer early this year. At his age, 79, and with the disease far advanced and spreading into his lungs by the time he realised there was a problem, there wasn't much the doctors could do. Still, he got pain relief, and soon after getting the diagnosis he had a stent put into his throat to help him eat. He died peacefully a month later in a hospice.
That for me is an eloquent refutation of the rubbish about the NHS now being peddled by US industry lobbyists and their Republican allies through TV attack ads and the like. They claim that our doctors let old people who could be treated die, that those over 59 are ineligible for heart treatment, that the NHS is “evil” and “Orwellian”.
They need treatment. At present in the US, 45 million people, nearly 15 per cent of the population, have no healthcare insurance at all. Some get basic care under the means-tested Medicaid scheme, while since 1986, everyone has in theory been eligible for emergency treatment, although if you try it, you're liable to be harassed for payment. Meanwhile, the elderly are paid for by Medicare and there is better treatment for military veterans.
Yet what most foreigners to the US don't realise is that even for those with health insurance, the US medical industry delivers a poor deal. Getting and keeping employer health insurance is a constant concern, especially for anyone changing jobs, or worried about their job security in the recession. Even then it's often not free, and insurance premiums have been rising rapidly in recent years. At least one couple I know tied the knot in a “blue card marriage”, so that one who was jobless got on their employed partner's health plan.
Everyday healthcare for most middle-class professionals is usually provided by a health maintenance organisation (HMO). HMOs effectively run private GP surgeries. I suffer from asthma: while I was working as a journalist in Detroit, my HMO would give me a brief appointment in a bare office with a clock-watching physician's assistant (a kind of glorified nurse — you rarely get to see an MD). It was similar even at my US university, Duke, home of a leading American teaching and research hospital: GP care consisted of a long wait to see a physician's assistant.
By contrast, my London GP is a real doctor, as are the rest of the GPs in the practice (indeed, she is a senior university lecturer in general practice). I can see her within a few days, or if it's for one of my children, the same day. She has come to our home to do the post-natal checks on all three of them.
It's the kind of personal care that most Americans can only dream of. It's not surprising that when, for example, I recount the excellent midwife care that my wife had for her three births, all at home, American friends' reaction is invariably: “And you didn't have to pay?”
The campaign against Obama's health reforms is straightforward and entirely self-interested. It is powered by private health industry dollars: the industry stands to lose a lot of money if it is forced to loosen its stranglehold on the nation's health. The US spent $2.2 trillion on healthcare in 2007, more than $7,400 per head of population, almost double the average for developed nations.
Somebody's getting fat off that wasteful spending and it's not ordinary Americans or the companies that employ them, for whom the cost of their health insurance contributions is often second only to their wage bill.
The same scare tactics worked last time — in 1993-94, when a multi-million-dollar lobbying and advertising campaign sank Hillary Clinton's modest health reform proposals. This time, the private health industry has already spent $1.2 million on TV ads alone, while its lobbyists pack out town-hall meetings.
Of course, the NHS is far from perfect. It took my uncle several worrying weeks to see a specialist. And the first hospital ward he ended up in was pretty grim, sharing with four other men.
At the same time, Tony Blair's obsessive urge to give more business to the private sector has created distortions, as has the culture of targets. Yet most waiting times have plummeted. It has cost more than it should have but the NHS, at least up until the spending crunch, had got steadily better.
Having experienced private US healthcare first-hand, I'm always a bit puzzled that people here aren't more worried about the chipping away of free NHS care by the whackier Blairites or Tories. I think it's because most Brits can't remember the pre-NHS era, now more than 60 years ago, and simply wouldn't believe just how crass fully privatised healthcare can be.
The poison now being spread in the US should be a reminder of the cynicism of much of the American health industry, poised to become one of the biggest private-sector players here. However bad the mags in the GP's waiting room, I'll take my chances with our brilliant NHS.
Reader views (33)
Trusting US health cover to insurance companies who only protect you if you are not likely to get sick, is like leaving crime control to organized crime who would only protect you if you have nothing to steal.
- Andy Bush, Haugesund, Norway
Andrew your article is spot on!!America's health care system benefits only the"very rich" leaving the majority to rot or use their lives savings to survive.
I was diagnosed with advanced bowel cancer November 2008, my care to date from the NHS has been exemplary. The NHS does need some reform, its existing budget restrictions cannot meet todays modern advances regarding medication and technology.Health insurance allowance has a ceiling and from my experience when you have a critical illness you are left with a shortfall.
Interestingly I initially became ill whilst working for an American pharmaceutical company in UK, the occupational health doctors only advice was that returning to work would improve my health and whilst being "off sick" I phoned BUPA to arrange a routine annual health check only to find my name had been excluded from the list.Hence I lost my job and after 30 years in the work force when I needed insurance it failed me.The american philosophy is about survival of the fittest and to hell with the rest.Give me the NHS it is prolonging my time with my daughter, partner and family despite a dismal prognosis in November 2008.
- Patricia,, London,UK
Yes, we all have stories, either Pro NHS or Anti.
Political affinity does not seem to come into it either. All I can say is that my Labour voting 80 year old father has only ever been treated excellently by the NHS and supports it wholeheartedly. My politics have moved drastically to the right and in my mid fifties, having had my fair share of dealings with the NHS, I can only say I agree wholeheartedly with my father.
As a matter of interest, I went to a hospital appointment yesterday and took my friend, a US doctor along with me. He was interested to see how things were done. He was very impressed. "This is how our private clinics are" was his statement. I did not make it up.
- Dep, London
An American friend of mine, who has top end medical insurance, said that she has to have regular medicals and follow any recommendations by the doctor else she either voids her policy or gets her premiums massively increased. While our own free market medicine people might be intensely relaxed about letting nature take its course with the poor or incurably sick, I suspect they'd baulk at their insurance company ordering them to stop drinking and lose weight.
- Dave, London
NHS is great but it should stop providing free treatment for smoking and alcohol abuse triggered illnesses. People just abuse their bodies and expect NHS to treat them for free while those who need care have to wait for weeks / months. Instead, money should be used to add more capacity to existing infrastructure to make eessential healthcare better and faster.People should be encouraged to be responsible enough to take care of their health and adopt healthy lifestyle.
- Dhanesh, London
Kerry Early: I don't know where you heard that "you can change jobs even with a pre existing condition and still get insurance that covers everything including the pre existing condition as long as you don't let your insurance lapse for more than a month", but I can tell you that it's simply untrue. This is something that varies from state to state, and in some states you can be denied insurance altogether based on having a pre-existing condition even if you have had continuous insurance. In Texas, for example, insurers are not required to offer coverage to individuals, and if they do offer coverage, they are not obliged to cover any pre-existing conditions, EVER.
- Tasha, Arlington, VA, USA
john of cornwall - you say the French and German systems are very poor compared to the NHS. Based on what?
In France there are 3 doctors per 1,000 head of population, in UK 1.7 (OECD Health Data).
Intensive care beds: In France 38 beds per 100,000 people. In the NHS just 5. (OECD and WHO).
CT scanners? France has 9.7 per million population, the UK has 6.1 - fewer even than Turkey.
Premature deaths from coronary heart disease? In France just 85 per 100,000 population, in the UK 265. (WHO).
In France, if you are diagnosed with active lung cancer, your chances of being alive a year later are 40%, in the UK 22% (Eurocare).
And then personal experience. My wife had a suspected melanoma on her arm. Here, in France, it was surgically removed in less than a week, analysed, found to be malignant, and the more radical surgery conducted in less than 2 weeks. My French GP noticed I had a serious heart arythmia on a Saturday. I had more stringent tests the next week and a catheter ablation operation at a top cardiac clinic the following Thursday, 12 days after my GP's orginal diagnosis!
Sorry john, it is the NHS that is sick. The French system is excellent, and, interesting, not free at the point of delivery. You pay, or you insure, or you can do a mix and match.
- Ernest Hammond, Ste Sabine, France
I'm grateful to be working for an organization that offers a health care package that is affordable. However my younger sister has been without a job for months-looking every day, temping, doing whatever she can. It doesn't matter she has a masters degree- it's apparently making her "over qualified" according to the people not hiring her. She has diabetes-type 1. Her supplies are over $700 a month-insulin, needles, test strips, etc. Her credit cards are maxed-out-it's the only way she can get the supplies she needs so she doesn't die. And that's great that the guy from Florida has a good insurance plan that covered the sickeningly high cost of his daughter's care. Millions don't. And the guy who takes care of himself and his family with private insurance because "shouldn't adults look after themselves?" My sister is doing her best-she doesn't have type 2 overweight diabetes-she didn't create her disease. She's otherwise very healthy. In this country she could die from not being able to afford the diabetic supplies that are the only thing that keep her alive. But dammit "keep your government hands out of my free-to-be, loaded-gun-totin', town hall hate-speech yellin' American life! Oh wait-I just turned 60-I'll take that medicare thing now..."
- Rebecca, Portland, ME USA
I have had a HMO insurance before and always received better care then you described and every appointment I had was with a real doctor. And you can change jobs even with a pre existing condition and still get insurance that covers everything including the pre existing condition as long as you don't let your insurance lapse for more than a month. I am not saying there are not any flaws with our system - one of the biggest is the free care we give to people from other countries which raises our costs to make up for the free care.
- Kerry Early, cochise az
What most Brits don't realise is the extent to which health insurance--and its lack-- rules people's lives in America. In my own family, my parents separated years ago but have never divorced because my mother would lose access to my father's health insurance and she couldn't afford her own. My niece was born with an incurable disease: she is now 20 and uninsurable. This means she will never be able to set up her own business, and can only be employed by a large company. Her father said he would never have been able to change jobs during her childhood as he would have lost insurance cover for her. He is lucky he has not become unemployed--lose your job, lose your insurance.
My cousin fell pregnant 4 months before her wedding and had to get married secretly to access her bridegroom's health insurance.
Many doctors now decline to treat elderly patients supposedly covered by Medicare. When my 78 year old father needed treatment he had to "barter" with his doctor and paid cash, to make up the shortfall between his insurer and Medicare.
I'm an American fortunate to be resident here and blessed with the NHS.
- Evan Cassidy, London UK
Excellent article.
What a lot of people don't realise though is the cost of private/company health insurance in the USA. I'm a manager in a company and consequently qualify for a "free" family medical policy, sounds good doesn't it? Well my family deductable(excess) is $2400 per year and then I still have to pay 20% of all bills after that. Now can you see why so many families even those with insurance have to go into bankrupty to escape their medical bills.
I would willingly pay an extra 5% tax per year to get the NHS.
- Richard Tucker, Cotter, USA
Scotty, Cambridge UK - sorry about your son, but don't knock the oldies; they've paid their whack (most of `em for almost fifty years) and deserve the payback.
- Ted, London
The calculation of money input to NHs versus the amount used does not stand up to scrutiny.
The largest sum that the NHS tends to pay out per individual is in the three months before their death.
You have to make a 'lifetime' assessment of your so-called investment.
- Gerry, Glasgow
Anyone know of a decent NHS dentist?
- Ted, London
Some aspects of the NHS are wonderful, others not so. Spending 12 hours per day in a NHS hospital entertaining my son who is a paraplegic with learning difficulties was an eye opener. It became horribly obvious that the biggest problem is the number of elderly patients who believed the hospital to be their care home and who had the nurses running in all directions.
Clinics are not too bad although waiting an hour and a half over my appointment time made me cross, particularly when I discovered that the consultant was trying to treat patients on a 5 minute schedule, not enough time to allow him to read the notes let alone treat the problem.
Para medics andambulance drivers are stars in my eyes, but the real backbone of the NHS must be the district nurses who work alone and carry a huge weight of responsibility on their shoulders. Nothing is ever too much trouble for these ladies and without them the NHS would suffer greatly.
Petty bureaucracy abounds in most areas of the NHS. ie. My son requires special shoes that are made in our local hospital, but recent problems have changed the shape of one foot and I thought it would be a simple matter to call the department directly. Fat chance! As he had not been to the dept for 5 years it requires me to request my GP to write to the orthopedic surgeon who must then write to the dept requesting that they give my son an appointment. Pointing out that paraplegics really seldom wear their shoes out didn't make any difference.
- Scotty, Cambridge UK
I am proud of our NHS, and 'free' healthcare system.
We (as in my family) are happy to pay our taxes and do not calculate what we put in to what we then take out. We are happy to pay into a system that supports and provides healthcare for everyone.
My brother was introduced to Great Ormond Street at the age of 10, & since then has been in and out of the NHS system. We have had dealings with specialists, consultants and a whole range of medical practioners at the top of their fields. It has not been an easy journey, but we have been impressed along the way.
I am having my first child at the end of October and so far I have been impressed with my midwifery teams support. They are friendly knowledgeable and professional - and most importantly I feel safe.
My husband is not British & thinks our NHS & social support systems are great - he compares them with his country where everything has to be paid for. (Ultimately, if you cannot afford the care and drugs in his country you have a shorter life).
- Augustine, Haywards Heath, UK
Tobin of Newbury... you miss the point. The American health care refomrs are to provide those Americans who cannot afford any healthcare a safety net that will ideally, match the very good care provided by the NHS. Of course, those of us privileged enough to be able to afford private medical insurance, can opt out of the NHS system by going private where the medical treatment is invariably better (as would be expected). However, please don't deny health care to those that cannot afford it but are more often the ones that are most likely to need it. The NHS isn't perfect and there is much room for improvement but, for something more or less free, it is a fantastic system.
- Damien Miner, London, UK
Anyone for a NHS dentist?
- Ted, London
My daughter was diagnosed at age 2 1/2 yrs with leukemia. With my insurance I paid a single co-pay. She had blood work done twice a day every day for the first week. Because of complications she had numerous scans both ct and MRI's along with x-rays throughout her treatments. For all of this I paid nothing but my initial co-pay. I happened to get the EOB for the first week alone at over $30,000. Yes, I have insurance through my employer for which I pay part of the premium. Eight years later, my contributions to my insurance premium have not totaled $30,000 yet my family and I have received care well over that cost. Someone please tell me how a NHS would have benefited me more.
- Michaelk, Tampa FL USA
There may be 45 million uninsured Americans, but what about the other goodness knows how many millions who are insured on cheaper, lower quality programs that only cover the basics? I have visited many NHS hospitals, doctors and dentists during my lifetime and am always amazed at the level of quality and service. The Americans can keep their system. It may not be perfect, but I know which one I prefer.
- Matthew, London, UK
The NHS is great - keep it and let corporate America (that is the wealthy that perpetuate their grip on the real power and the Israel support) continue to deny their fellows any compassion. However, do charge fat people, alcoholics, drug adicts and the like. If they cannot pay, put them to the end of the wait list. It is fair in a civilised society to look after the health care of each other, but each individual has to keep themselves in decent condition. The food inductry is another corporate folly and needs drastic reform to cut out nonsense food. Eat to live, not live to eat.
- Andy M-P, Bangkok, Thailand
This is a complex topic and a few comments here will not be able to explore it fully. The point I would make is that we do have an almost total private system of medical care in the UK. Our dental system. Given the state this is in and the laughing stock that is the UK's oral hygiene around the world, I hope that the NHS never gets to this state!
In response to Ernest Hammond in France sometimes something is there to the benefit of society and not to the benefit of each individual. This is the case with the NHS. I too hope that I'm lucky enough not to use the value of NHS compared to what I put in. However if I do get a serious disorder I know that in most cases the NHS will be there for me and will provide me with services far beyond what I have put in. Also maybe a fact that you don't know that on average 90% of person's NHS services are used in the final few years of life which actually means you have done remarkedly well upto now.
- John, London
@Ernest - Think yourself lucky that you haven't had to use the NHS service so much. Your life is a long way from over so how much do you think your NHS bill will be before you and your wife die? And how much did you contribute to the NHS between ages 0 - 18? Nothing. But if you got sick you would be treated.
Like all taxes you pay the most when your earning the most but after you retire and when your young and don't have a job you still get the benefit of healthcare, roads, schools, etc
Also as the article stated the US pays twice as much per head for health care so your arguement that his friend with the brain tumour could have paid for the best insurance around doesn't stack up.
- Joel, London, UK
Personally I think you should provide for your own health care. I have private medical insurance for myself and my family simply because the care available on the NHS is unreliable.
Perhaps the state should consider providing care up to the age of 18 and then expect individuals to look after themselves. Obviously there are exceptions, the disabled, those with chronic conditions ongoing from childhood, but as a general rule shouldn't adults look after themselves.
- Tobin, Newbury
I note with interest the following comment added by a reader, "Over 20 years, my wife and I and our two children forked out £180,000 to the NHS and got back services worth about £30,000. A 6:1 ratio is not good value for money."
My comment is that if the cost of the care for services required had exceeded £30,000, funds exceeding £180,000 would NOT have been required.
- Jane, England
Ernest Hammond;
"Over 20 years, my wife and I and our two children forked out £180,000 to the NHS and got back services worth about £30,000. A 6:1 ratio is not good value for money."
I'm sorry, but this is a very silly remark - would you have preferred to have been chronically ill, so that you got better "value"?
- Davie, Poole, UK
Whine,Whine,Whine the US is off again, leave the NHS to the UK. Its our system it Works very well and will continue to do so. America's health service is a disgrace I fell ill there, before they would treat me they wanted my credit card details....Rule Britania.
- A. Flitcroft, Woodbridge. England
Nonsense. The French and German systems are very poor compared with the British NHS. WHO are nobody to quote, since they have enough skeletons in their cupboards to last a lifetime. The USA system is a survival of the economically fittest method. If you are rich you are okay. In fact it is better to have treatment in Cuba than in the States. At least its free. I personally would always opt for the British NHS above all others, and I've lived in lots of countries.
- John, Cornwall England
From what I can see, the only people who want the NHS to fail are the ones who will profit from it, if it does. I pray to God the Drug companies don't get their hands on it. And I certainly don't trust it in the consevatives hands, who didn't want it started up 60 years ago,can't see where their attitudes or policies have changed much 60 years on.
- Katherine, sheffield
American friends' reaction is invariably: “And you didn't have to pay?”
But you did. Last year you and your wife contributed at least £3,600 to the NHS.
Over 20 years, my wife and I and our two children forked out £180,000 to the NHS and got back services worth about £30,000. A 6:1 ratio is not good value for money.
As for your friend with the tumour, yes, a sad story. But can you explain just who was to go without paying? The surgeons? The anetheatist? The nurses? Admin staff? Ambulance drivers? Don't pay the rates? Don't pay for the maintenance of the hospital? The food? It's sad, but it's not heartless. For what your friend would have paid into the NHS each year, he could have afforded the best medical insurance going and had change in his pocket.
- Ernest Hammond, Ste Sabine, France
As a 1967 UK medical graduate, I lived for 35 years in the USA (in resarch, not clinical practice), and have been back in the UK for the past 3 years. I am hypertensive and have Type 2 diabetes. I must agree with the supporters of the NHS; the treatment I receive from my GP here is much better than I received in the USA. I sincerely hope that the 'Obama" health plan succeeds, otherwise more and more people will lose health insurance, and the overall health of the US will deteriorate to an even worse position than it is in today.
- James, London, United Kingdom
Couldn't agree more, my Mum who was diagnosed with Cancer at the beginning of this year had amazing care and treatment, unfortunately Mum passed away a few months later, after an op to remove some of the Cancer, at least we did not have to worry about the Bills for her treatment or fight to get Medicare. Long live the NHS
- Justin, London, England
The NHS is very far from brilliant. It may seem very good compared to the even more extreme US system, but it comes a long way down in the WHO evaluations, way below the superior continental systems, especially the French. People need to be reminded that it's not a matter of fully private versus fully tax funded. Both are very inefficient with poor patient outcomes. As usual the Europeans know better.
- Colin, Toronto, Canada
