I recently wrote a piece for Arc Digital, in which I aimed to dispel some of the myths I’d seen and heard about Britain’s National Health Service in American media and politics. The piece was not necessarily intended to sell Britain’s model to US voters, or the rest of the world. Merely, I wanted to illustrate that, despite the boogeyman of “socialized medicine” often portrayed in the US, the Brits receive excellent care whose combined quality and access is among the best in the world. It is also a system which is incredibly popular.
Although I addressed the popularity of the NHS in my last piece, I do believe not enough is said about just how uncontroversial the basic tenets of the NHS are in the UK. Free-at-the-point-of-use healthcare paid for through general taxation — a radical idea in the States — is a foundational principle for almost every British politician — including on the Right. The aim of my article was to go some way in explaining why that is. In my opinion, a key omission from much of American healthcare coverage is just how popular these principles are abroad.
There were, however, a few things in my article that I should have included. One response highlighted how I hadn’t compared costs to consumers in both countries. There was a reason I didn’t include it: it’s complicated. As I’ve said, the UK pays for its healthcare via general taxation, so the taxes you can expect to pay as a UK resident for 2019–2020 are (courtesy of the Money Advice Service):
- 0% on earnings up to £12,500
- then you pay 20% on anything you earn between £12,501 and £50,000
- you’ll pay 40% Income Tax on earnings between £50,001 to £150,000
- if you earn £150,001 and over you pay 45% tax.
As an employee:
- you pay National Insurance contributions if you earn more than £166 a week
- you pay 12% of your earnings above this limit and up to £962 a week
- the rate drops to 2% of your earnings over £962 a week.
So, essentially, as I outlined in my last article, you only pay what you can afford, and this sum is subtracted from your pay before you receive it — it’s a tax, after all. Income taxes (incl. National Insurance contributions) are noticeably higher than what you pay in the US. This is similar to other developed countries, but you get pretty-much comprehensive coverage in return. It is also worth remembering that income tax and National Insurance contributions pay for more than the cost of healthcare. In the US, we haven’t yet counted a penny of the healthcare bill. All of that is yet to come.
To attempt to provide even a semi-comprehensive overview of healthcare costs for each individual in the US is foolish. Unlike the UK and other countries, the amount you will pay will vary wildly depending on your income level, health, age, lifestyle, employer, number of dependents, number of chronic conditions, and other things. I will leave it for individual Americans to compare it to how much they would pay under a UK system. One American response to my article said that they had spent approximately $100,000 (or £79,000) in healthcare costs since 2008, which amounts to approximately the average annual spend of around $10,000 a year. Only the very highest earners would spend that on NHS care via taxes.
As someone with a variety of chronic illnesses (many of them very serious and requiring long-term and expensive care) I can say, confidently, that in most cases spending money on private healthcare in the UK is far from necessary.
“A public system is fine for colds and flu…”
Many of the responses to my article from Americans assumed, by virtue of defending the British system, that I was a cheerleader for Obamacare, and expected me to defend some of the failures of the system and the costs they had paid. In reality, the British NHS and Obamacare are two very different beasts. One is a single-payer system funded via general taxation, the other is an expansion of private insurance with patchy implementation. Somebody who is a fan of one shouldn’t necessarily be expected to defend the other.
Some of the responses criticism questioned the quality of care a single-payer system provides. One response claimed that “a public system is fine for colds and flu; but what if you were really sick? Do you want the government telling you what choices you have?”
I often see this kind of sentiment when healthcare is discussed on the internet, and it is an unhelpful (and inaccurate) portrayal of what might be on offer to the American people in this upcoming election.
I want to address a few things here. Firstly, the notion that a public system is only suitable for “colds and flu,” which is an odd (and demonstrably incorrect) statement considering neither of those illnesses usually require medical attention.
I’d like to consult a 2018 survey of global health, conducted in 28 countries, by IPSOS Mori, which threw up some interesting stats (I’d encourage anyone interested in this sort of thing to give it a read.) Spain and the UK were the most confident (1st and 2nd, respectively) that the healthcare system in their country provided them with the “best treatment”. Both, notably, have similar “public” systems. The US, however, was 13th. When asked to rate the healthcare they had “access to”, the UK came first (the US came 5th).
When asked if “many people in my country cannot afford good healthcare” the UK was 4th from bottom, beating only Canada, South Korea and Sweden — all systems that are among the most “socialized” in the world, unsurprisingly. The US came 7th, above Russia, Malaysia, India and Saudi Arabia — all countries that are far poorer. On whether “the healthcare system [their] country provides the same standard of care to everyone” the UK came 2nd after Malaysia; the US was 17th.
As I pointed out in my previous article, there are a few areas where the UK falls behind, and dramatically so. For example, the UK was top when asked if the healthcare system in their country was “overstretched”. (A point I made in my last piece.) There were times when the US did very well too; according to the survey, the US was third when asked about the shortness of waiting times. The US also beat most countries (coming fifth) when asked how easy it was to get an appointment with a “doctor in my local area” — both measures that the UK performed worse on. Two stats that back up one of the noteworthy positives of American healthcare; it might cost a lot, but you can see a relevant healthcare professional incredibly quickly.
There are some reasons to be cautious about this survey. For one, when asked, the Japanese were near the bottom when they were asked whether they felt “safe in their community” (on 44%). Indians were forth (66%), despite the fact that you are objectively safer, by many different measures, living in Japan — a country which is more prosperous, with lower levels of crime, and in better health — than in India. As with all qualitative surveys, perception isn’t everything.
As I mentioned in my article for Arc Digital, the Brits are notoriously proud of their health service, and this pride may also affect the results and make comparisons with other countries slightly harder. But the overall message is clear: — not only from the UK but other more comprehensive healthcare systems too — publicly funded healthcare does not perform worse in opinion polls. In fact, by many measures, those kinds of systems perform far better, especially in terms of fairness.
Secondly, I would like to address the idea that comprehensive healthcare coverage restricts patient choice.
For starters, in the UK, there is no rule against booking multiple appointments with different General Practitioners (GPs) to talk about the same problem at your surgery — most people pick the nearest, but it’s your choice. However, nothing is stopping you from re-registering at another surgery, with a doctor who may be more sympathetic should you not find the medical attention you’re looking for. Should everything fail, a trip to your local hospital’s Accident & Emergency department will usually have you in front of a relevant doctor within a few hours — faster if it’s urgent*.
(*As I mentioned in the last article, this is one of the chokepoints of the service, and a lot of the time the waits can be quite unpleasant.)
Of course, if none of these options suits you, you can go the private route.
So what about private healthcare? In Britain, only 10.5% of people choose to supplement their NHS care with private medical insurance, and there are many more than that number who could afford it. In 2017, the top 20% of earners in the UK had an average disposable income of £66,000 ($83,000), the second highest earning 20% had £37,000 ($43,000) to spend. Most people in both of these income groups could conceivably afford to pay for at least a basic private insurance plan. (A typical family premium — two adults in their forties and two children under ten — can vary from £700 to £1,800 per year, according to the Money Advice Service.) The fact that the vast majority of them don’t can be taken as a positive appraisal of the taxpayer-funded care they are already entitled to.
I also talked very briefly about prescription medicine in the UK in my last piece but didn’t mention one very notable fallback of the British system: drugs not covered by the NHS are often difficult to obtain.
In the UK, drugs go through a gruelling process before they can become approved and used on patients. First, a new drug is evaluated for safety, before being assessed for how worthwhile the drug is when considering the price that is being asked. This is done on behalf of the whole country’s healthcare system, so any drug that is deemed safe but not worthwhile will not be covered under the NHS. A recent case that has hit the headlines has been the drug Orkambi which is used to treat cystic fibrosis. As of writing, the NHS has yet to come to an agreement with the drug’s manufacturer Vertex over the price of the drug and the original version is unavailable. A generic alternative from Argentina is being sold to “buyers clubs” of desperate patients and caregivers. In the US, there is the opposite problem. Drugs are much more freely available, even if their clinical efficacy isn’t well proven, but they come with a much higher price tag.
Perhaps the best way forward for patients worried about access to medicine would be the Australian model — a hybrid system that includes the best of both worlds — drugs approved by the Therapeutic Goods Administration are often heavily subsidised by the government, and those are not licensed can be accessed with relative ease.