Thursday, September 10, 2009

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.

12 comments:

Anonymous said...

Very interesting. Here in Australia we have healthcare, too. There is great dissatisfaction with it at the moment, but the intstitution itself is seen as a necessary thing.

I think you are probably right about the view of government being largely responsible for the different viewpoints on healthcare. My American husband has said many of the same things.

Pam

Debbie said...

Thanks for the post. It is always good to see another side of things. I would be one who distrusts the government's ability to run health care. And I think that there are other things that need to be done first before the government just sweeps in. But that is just me.

By the way, come and find me on Ravelry - 4bookworm would be me.

Jennifer said...

I was hoping you would chime in! It seems many people think that national healthcare is of poorer quality than what we have now. Hearing from British and Canadian bloggers, though, it doesn't seem as if these rumors are true. I have mixed feelings, but what we have now is badly broken. Healthcare issues are the biggest single threat to our financial security. Our options for treatment are already limited by what the individual can afford and what the private insurance company allows.

Lauri B said...

I think most Americans are truly isolated from opinions outside the US. Nearly everyone I've spoken with about the issue who is against an NHS says something along the lines of, "my neighbor's mother's sister lives in Canada..." or "a guy at work knows another guy from England..." and then proceed to tell some NHS horror story. Few seem to know anyone personally who lives with the NHS every day, and fewer still have asked their friend or relative what they think.

The second issue is exactly what you stated, Kathryn. Americans (even 1st or 2nd generation Americans) are absolutely anti-government. There is an ingrained Revolutionary spirit, which is constantly throwing off the shackles of whatever government happens to be in power at the time. There are "midterm" elections for Senate/Congress in the middle of Presidential terms. If a Democrat is in the White House, nearly always will the Republicans sweep the midterm elections. And vice versa! Americans hate the government no matter what. I used to be interested in Politics, but it's such a game that I no longer care even a little. (Though I do vote, and watched the Inauguration.) My uncle is a life-long senator (that happens a lot) and they all think it's a game - Left or Right, regardless. They'll argue viciously in session, then have lunch together and their families often vacation together! They create an atmosphere of animosity and a war of sides, but it's all a game and they quit and go home. In the mean time, average Joe American will refuse to speak to his neighbor because he's a democrat as a Direct Result of the tone of animosity those Senators set. It's not real. Sure, they're governing, but it isn't what we in the public think it is.

Theresa said...

Your way seems so much more...civilized.

sarah haliwell said...

Thank you for this excellent and dignified post, which I found linked at Facebook. I am an NZer and haven't been able to get my head around this issue until now. I realise finally the only way to understand it is to appreciate just how foreign America is to my own country. We usually think of it being like us because we have so many American things here. But the mindset is radically different.

rox said...

I tried to post yesterday but it didn't work
I being a Canadain also do not quite get the whole fuss in the states about this issue . Change does instill fear in many but if one wishes to move on try new things try it you may like it . if not if it dosen't work you'll figure it out pretty quick ;-)
I love love health care . I love our system here in Canada . There are flaws in all systems be they education , gov. or medical , justice etc.
being people who are a blue collar , in the middle family and yes have been on welfare and been poor I can say I absolutely love our system .I also have wealthy family who are doctors , nurses both here and in the states . Although we have greedy doctors here I can honestly say my family in the USA are far more greedy in regards to taking from others.
I am so happy we need not spend our income tax refund on medical bills or borrow money to do so .
We do have the option if we have money to go to other provinces or other countries to purchase faster procedures that are not high priority here and people want a quick quick fix .
Yes our sustem can be improved , people abuse it , people are over medicated etc. pharasuitacls & big business play a big role in our system here as they do any where in the world .
For those just getting by or stuck in the middle I can assure you this syetm works . also I saw a man in the states an immigrant who said he did not want hand outs that is why he didn't want this type of system .It is not a hand out he pays into it like anyone else via taxes . It is a choice as a country we decided to do for each other . It works it is good and there is nothing to fear .

Dorothy said...

"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."

I think this is the crucial bit. Can you imagine trying to introduce something like that today? We are all far to individualistic, less empathetic, less compassionate now. Britain's wartime experience pulled people together in a way we can't imagine now and made us want to embark on a great national adventure that would bring blessings to everyone.

Also, most European countries took an understandable slight (or huge) turn to the Left after Nazism was defeated. That and the fact that the churches supported the idea of the NHS, from what I've been told.

In short, unique circumstances produced the NHS in Britain. It's not advisable to try to overlay the concept of our NHS on top of another society. The US needs to find its own way to improve access to healthcare and not to worry about ours.{g}

I thank God every day for the NHS.

Carole in Wales said...

I have seen both systems at work. You may think what you want about Americans not trusting government, and I can honestly tell you that is an accurate statement for many individuals in the States (myself included).

But I have seen in the UK the government is involved in everything and at great cost to the country in your tax department. I have found that going to the clinic is not a problem, but getting to a specialized physician takes a bit of time and then getting the results even more time on top of that. It has been very frustrating for our family.

I was never faced with the long waits to see specialized doctors, nor the long waits for testing that I have encountered here. I still have not heard the results from a test that was conducted in May almost four months ago. I do not find NHS to be very accessible when it comes to something more than visiting the local clinic.

And I have heard many complaints from others who live here who will be purchasing private insurance because they are unhappy with NHS and its administration.

Carole in Wales said...

I just spoke with my dh and he pointed out that there has been a lot of discussion in government about whether top-ups should be allowed in this country. Many feel that no one should be allowed to buy better care than what the poorest person is provided by NHS.

While top-ups are still allowed for now, who knows when the tide might change. Imagine health care where the government tells you what healthcare you are allowed to receive, no more, no less.

Remember the Church's teaching on subsidiarity. Is the federal government the best place for health care? See Samaritan Ministries at http://www.samaritanministries.org/index.php?I=25b2822c2f5a3230abfadd476e8b04c9
for an alternative option.

One of the things that I have noticed is the shortage of specialized doctors in this country (hence the delay when trying to obtain medical care). Many do not treat doctors with the respect they deserve; consequently, doctors are being brought in from foreign countries at such a rate that their qualifications and credentials are not being checked before they begin practice.

I find this also to be true in the dental program as well. Long waits (18 months for our family), and then another 18 month wait for our son to see the orthodontist.

Dorothy said...

I think there is a little confusion about K's use of the words 'top up'.

She was referring to private health insurance which people think of as an extra insurance which gives somewhat more choice and flexibility for minor ailments. There has never been any question of that being disallowed. Why would it? It takes some of the pressure of the NHS.

It is in the USA that people have talked about private health insurance being banned, not here. I don't know if that is likely to happen there or not.

What some people might think of as 'top ups' (and where the confusion comes in) is the idea that people might be able to *combine* private and NHS treatment for, for eg, a serious condition like cancer. At the moment, the rules are that if you embark on, say, a new and unproven expensive drug treatment for cancer, then you must persist with all your treatment being privately funded, not just the drug treatment you are funding privately. There is talk in govt about possibly *relaxing* that rule so that those who want to go down the unproven route may still have the NHS do all the testing, hospital stay, chemo etc and even pick up the pieces for them if it all goes horribly wrong.

I too have experience of both systems (US and UK) and a third (Ontario) which was slightly in between. I much prefer the UK's system and was so thankful to God when we returned to this country.

Last week, I needed an ultrasound scan and was given a choice of hospitals, a choice of appointments, and was seen three days after the referral was made. My condition was not immediately life-threatening, so I thought that was excellent. I was given the results immediately.

Thankfully, the govt seems to be bringing in new rules about NHS trained dr's running off to the USA for huge salaries as soon as they are qualified. Then perhaps we won't need to go recruiting in India etc to make up that deficit any more.

There can also be confusion about the role of specialist drs in this country and the role of the GP as 'gatekeeper' to secondary services, which can be frustrating when you come from another system, but I won't explain all that now. I'll run into the character limit.

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