By JOHN M. BRYSON
Minneapolis Star-Tribune, September 15, 2010
The emotional debates over health care reform in the United States last fall and again this election season are puzzling to my wife and me. We are professors who were on sabbatical leave in London from August 2009 through August 2010, so we missed last year’s debates. While in the United Kingdom we were automatically covered by the National Health Service.
For us, the NHS worked quite well. One example: The week we arrived in London we went to the NHS Choices website (www.nhs.uk), punched in our postal code and immediately got a listing of local clinics. We chose the closest one, stopped by and filled out two short forms, let the reception staff make copies of our passports and visas, and that was it: We were covered. None of this business about needing coverage by an employer’s plan, no concerns about preexisting conditions (we both have them), no rationing by what we could afford, and no excessive paperwork. All that mattered was that we were in the UK. We had a right to be taken care of by the NHS.
Another example: I badly sprained my back one evening. The next morning I was in severe pain and couldn’t get out of bed. I called the clinic, and within two minutes a doctor was on the phone. He asked if I could come in immediately, but I was in too much pain. He offered to make a house call if I could wait for a few hours. I wondered if he might do something over the phone, so he ran me through a series of questions and little exercises to make sure he understood what was wrong. He then wrote prescriptions for painkillers and a muscle relaxant. My wife picked them up, filled them at a local pharmacy (at no cost because I am over 60) and was home within the hour. I was up and walking a few hours later and was fully better in a few weeks. How many times has anyone in the United States spoken to a doctor within two minutes of calling and had the same doctor offer to make a house call?
The British have a mostly socialized health care system, meaning they handle both finance and production through the government. In the United States, we mostly socialize risk through health care insurance paid for by employer, employee, consumer and government contributions, but we also socialize much health care financing; some estimate that government pays for about 50 percent of all health care costs. We leave production mostly to businesses and nonprofits, but there is also a lot of government provision through public hospitals and clinics. The Veterans Affairs health care system is as close as we get to the NHS.
What do the British get for their money? Using 2009 figures, they spend 9 percent of GDP on health care; we spend more than 17 percent. They spend $3,150 per capita on health care each year ($2,600 of which is public money); we spend $7,500 per capita ($3,500 of which is public money). They cover everyone (even visitors from abroad); we have a long way to go. They have an average life expectancy at birth of 79.4 years; here, the average is 78.2. Their infant mortality rate is 4.8 per 1,000 live births; here, it is 6.4. Is their system perfect? No, clearly not. For example, there are issues about timely access to specialized elective care, but they also do not ration that care based on ability to pay, which we do.
Having experienced the NHS and U.S. health care systems, I think it is safe to say that no one would design our system if they could start from scratch. Ours is 50 percent more expensive than almost any other nation’s, has left way too many people out and produces many population level outcomes far worse than they should be. In addition, our system places a huge burden on company balance sheets, making it far harder for companies to compete in world markets where other nations pay for health care through taxes. I am not a health care policy analyst, but it doesn’t take one to see that we are clearly not getting what we should for what we pay. Just consider what is politically unimaginable: If we had the British system, we would have at least 8 percent of our GDP of $14.5 trillion left over — or about $1.15 trillion each year — that we could use to fix every problem with the system and still have money left to give back to employers, employees and taxpayers — and we also would have better population-level outcomes. The switch to the NHS is not going to happen, but the thought experiment does help one see the merits of moving to a system that a least guarantees health care insurance to all, that moves away from reliance on employer contributions, and that produces better overall outcomes at less cost.
John M. Bryson is a professor at the University of Minnesota.
