Healthcare Here and There

As I am dipping my toe into a hot potato subject here, I'm going to start with a disclaimer: I thought it might be of interest to my transatlantic mixed bag of readers to attempt an explanation of why there is a huge gulf in the perception of healthcare issues between the UK and the US. I'm not trying to make any sort of political point.

The US healthcare debate has been in the news again over here, and I was reminded of a forum thread I saw on Ravelry recently. Triggered by a question from a bemused British poster asking (politely) why plans to introduce a universal health care system in the US were reducing Barack Obama's popularity, it rapidly ran to over 1500 posts before being shut down by a moderator.

A year ago I could have been that bemused poster. Having grown up with a National Health Service (NHS) it had never occurred to me that people of good will could possibly consider nationalised healthcare a bad thing. In the run up to the presidential election I realised that a number of online friends - people whose integrity and opinions I respect - thought it a very bad thing indeed. Huh? What was I missing? After ten years hanging out on largely American message boards and egroups I had heard enough horror stories about health insurance and the lack of it for an American equivalent to the NHS to sound like a no-brainer to me.

By the time the presidential election was over I think I had more or less got my head round the deep seated suspicion many Americans have of government involvement in healthcare. The gist of it seems to be (1) distrust of "big government", and a belief that individuals should provide for themselves rather than rely on the state, (2) cynicism about the ability of government to do a good job in providing healthcare, (3) financial inequities and the likelihood of paying more for worse services, and (4) restriction of choice. And trying to put myself into American shoes, I can sort of understand this, though my ingrained assumption that national healthcare is best means it takes all sorts of mental gyrations for me to do so.

The mental effort is necessary because in the UK few people now remember a time before the NHS and we cannot imagine living without it. The idea of having to personally, directly finance our healthcare is literally foreign to us. Private top-up health insurance is an option, for those who want and can afford quicker, "better" (maybe?) and more luxurious treatment, but we assume that a reasonable level of care should be there automatically for everyone, regardless of financial circumstances. There is almost universal support for the NHS as an institution, and it is the sacred cow of British politics. While politicians and political parties may have different views on how the NHS should be run, and the extent to which private services can or should be integrated into the NHS, it would be political death to suggest that the NHS itself is a bad thing. Aspects of the service provided by the NHS are often criticised, but there is a general belief that the system can be improved from within. In other words, the NHS has flaws, but none that undermine the general perception that a universal healthcare system mainly free at the point of use is unquestionably the right option for this country.

So why are British and American perceptions so different? There is a big difference in the way government is perceived in the UK and the US. In the UK we tend to see government as irritating but necessary. The British grumble about and laugh at our government, but underneath the cynical veneer most of us are optimists who expect the government to at least be trying to work in our interests, whatever its political persuasion. We expect the government to bumble around and mess things up, but in a fairly well-meaning sort of way and without becoming so incompetent that things fall apart. From what I can see, many Americans are deeply suspicious and distrustful of government interference in a way that simply isn't the case in the UK. The British also seem less resentful of taxation as a way of redistributing resources for the benefit of the community as a whole. I'm not sure why this should be.

Then there is the matter of history. Put simply, the UK already has a national healthcare system; the US doesn't. Ours was set up in the aftermath of World War II. There was a widespread feeling that after the sacrifices and hardships of the war years steps should be taken to make post-war life better for all. The political will that made the introduction of the NHS possible in 1948 was a function of its time. The circumstances in which the NHS was introduced also helped to give it a high value in the national consciousness that has never been lost. Introducing government run healthcare in the UK in 2009 would likely be a very different prospect. For one thing, the financial implications are far larger. Back in the 1940s it was thought that once the whole population received good medical care, the health of the nation would improve and the cost of the NHS would decrease. Nobody then could have predicted the medical advances that would be made and the increased costs they would generate.

All in all, America and Britain have many similarities, but there are also some pretty big differences - attitudes to healthcare among them.