We might like to moan about our health service, but now that the Americans have started criticising it, many Brits are rushing to its defence. President Obama’s plans to revise the US health-care system, are stoking fears that richer Americans will have to pay higher insurance premiums to subsidise those less well off. Some Americans, fearing that Obama is planning to introduce a health service similar to the UK’s National Health Service at great expense to taxpayers, are demonising the British system.

As well as campaign groups creating advertisements with horror stories from UK patients, there are fierce wars of words taking place on social media sites such as Twitter. On one side of the argument, there are the views such as those of Conservative MEP Daniel Hannan, who is campaigning against Obama’s healthcare reforms and is appearing on US media complaining about the NHS. On the other side, there are NHS supporters such as Professor Stephen Hawking, who while in Washington on 12 August to receive the Presidential Medal of Freedom from Obama, made it clear that he owed his life to the NHS.

National pride
Since its launch 60 years ago, the NHS has grown to become the world’s largest publicly funded health service. As well as treating on average around eight people a second, the service is now having to issue statements defending its constitution, as more stories are written describing the debate stoked up in the US. A Department of Health spokesperson discusses the benefits of our system saying: “The NHS sees one million people every 36 hours and 93 percent of patients rate their care as good or excellent. In recent years patients have benefited from record levels of investment and more lives have been saved through better prevention and treatment – waiting lists are at their lowest ever levels, there has been a 44 percent reduction in the mortality rate from cardiovascular disease, and 50,000 more lives have been saved through better cancer services."

Even Andy Burnham, Health Secretary, is issuing statements concerning the arguments on Twitter, saying how proud he is that Britain has a “world class National Health Service which treats people on the basis of clinical need – irrespective of their ability to pay.“ He adds: “The global groundswell we have seen on Twitter about this and the pride and strength of feeling in some of the posts is testament to its remarkable achievements.”

Geoffrey Rivett, NHS commentator and author of From Cradle to Grave: Fifty Years of the NHS, has also been following the debate. He says that one reason the Americans have reacted so strongly to suggestions that they should reform their health-care provisions is because, “It is an article of faith for most Americans that the USA is the greatest and virtually beyond criticism”. Rivett says that it is hardly surprising that during the hard-fought battle for health-care reform some Americans are quick to dismiss the NHS, and then rush to engage in a certain amount of boasting. He adds, “That is what superpowers and their citizens do,” but believes that such posturing should not be taken too seriously.

Sickness and wealth

Discussing the value of the NHS, Rivett says: “People may be scared of illness but not of the financial effect of it on themselves and their families.” Comparing our system to that in the US, Rivett points out that 60 percent of bankruptcies in the US have their roots in health-care bills. However, in defence of the US, he says, “At its best, US health care can be world-beating; new treatments are developed, hospitals are clean, waiting lists are rare and staff generally show how customers should be cared for. Even at its worst, people are not allowed to die in the streets after a road accident.” But there is a big downside, as Rivett explains: “If you are uninsured and cannot meet the bills, do not expect your cataract or your hip to be repaired. The only developed country without a comprehensive health-care system, the infant mortality rate is among the highest of the western world – because of the failure to provide basic health promotion and maternity care to all. Yet the US spends three times as much per head as we do, perhaps half of this already coming from federal and state funds.”

Although the NHS is defending itself against current arguments that compare it unfavourably with the US system, Rivett believes that unlike the Americans, we are less inclined to claim that we are the best. And discussing worldwide health-care systems, Rivett says that there are other comprehensive models that also work well, France among them, even though in France one often has to pay upfront and claim back later, which can be a disincentive. Summarising the British system today, Rivett says: “Improving health care is a never-ending process, and I speak as a governor of an East End hospital. Yet we are impelled by the motivations of religion and socialism. We are our brother’s keeper, and we do believe that it should be ‘to each according to his need, from each according to his ability.’ Comparing this with the US situation, Rivett points out that President Obama is beset by a population that does not want its tax dollars spent on other
people’s problems, and a health and insurance industry likely to lose from health reform. He adds, “The sufferers are not just minority groups and the indigent, but skilled tradesmen, those losing jobs during the recession, even academics whose income cannot meet the $12,000 or so annual family premium. Our sympathies should be with them. The NHS has no need to feel defensive.” (For information about the history of the NHS, go to www.nhshistory.net.)

Case Study: experience of both sides of the Atlantic
Melinda Butler is an American who now lives in the UK and has been joining in the debate about the US vs. British health systems on Facebook. She works part-time as marketing assistant and data coordinator for a small publishing firm.
“I feel that everyone deserves a basic level of health care and that a socialised health service does not mean that the Americans cannot still have private health coverage. I have lived in the UK for 13 years, have had two children and have no problems with the NHS at all. I feel very fortunate to have that because I have recently lost my job. As a single mum, I have had to take a lesser paying and part-time job to ensure my children have a good grounding. Not having to worry about health care has seriously been a huge advantage in that area. Four years ago I was in the States and had what they thought was appendicitis. It was not. US$6,000 later and numerous tests, they never figured it out. I was unimpressed to say the least. Now, every time I come to the US, I have to pay extra for the most basic of coverage just to ensure I don't go broke for any health issue.”