English Healthcare in the US Reform Debate: Setting the Record Straight

The English National Health Service (NHS) has become part of the US healthcare debate. This is bad for both countries. In America, the English NHS is a straw man that distracts from the real discussions that need to happen about how to expand health insurance coverage, improve quality and reduce costs. In England, this negative coverage gets the British defensive and makes that government even more reluctant to press ahead with its recent market-driven reforms. Those market-based reforms to the NHS, championed by Tony Blair, have played a vital role in the improvements its health service has made over the last five years.

There have been a host of rumors about the English NHS, ranging from the benign to the outright asinine. There have been stories of long waits for care, patients being denied coverage because care is too expensive, claims that Sen. Ted Kennedy would have gone untreated in the NHS and even the idea that Stephen Hawking would have been left to die in England.

All these rumors are false. Waiting times have dropped tremendously in England to the point where it is no longer a problem. While there is explicit rationing in England, very little care is denied exclusively on the basis of cost. Sen. Kennedy would have received cancer treatment despite his age. And Stephen Hawking summed up his perspective on the health service saying that 'I owe my life to the NHS.'

But those aren't the rumors that are necessarily most damaging to the healthcare reform debate in America. In fact, one of the most harmful rumors out there right now is that which suggests that the only way to provide every American with health insurance coverage is to create an English-style single payer system. A single payer system isn't what is being proposed by President Obama, wouldn't work in America, and isn't on the American health policy radar. As a result, contrasting healthcare in the US and England is an apples to oranges comparison.

The English NHS is a byproduct of post World War II solidarity. It was founded on two principles: 1) that coverage was universal and 2) that care was not based on a person's ability to pay. Those are certainly laudable goals and ones that we would do well to adopt in the US, but England's health system -- its structure and its ethos -- have been shaped by 60 years of British history. That history, and the health system that has resulted from it, can't simply be shifted across the Atlantic.

There are many different types of healthcare systems that provide universal coverage ranging from those that are almost fully private to those that are fully public. France has achieved universal coverage, as has Germany; and the Dutch are getting pretty close. But none of these systems are right for the US. The key to US healthcare reform is looking at the best of what's out there in Europe and in the US and shaping it into policies that align with American values.

England has strong primary care and family medicine that the US would do well to adopt. The Netherlands has a very competitive private insurance industry that keeps prices down and rewards innovation. Germany is known for its strong pharmaceutical policies. Yet, many of the tools that we need to improve healthcare in the US can be found at home in mini-health systems, such as the Cleveland Clinic, the Mayo Clinic and in the Kaiser network.

It also turns out that some of the best performing areas of the country also have the lowest costs. That bodes well for the prospects of improving quality, slowing cost growth and expanding access. The real challenge is to create the right type of incentives, which reward the innovators and drive out those offering a bad service at a high price.

A final point on the England-US comparisons. There was something very telling about Sen. Chuck Grassley's concerns over whether or not Ted Kennedy would get treatment for his cancer in England. Senator Kennedy (and Senator Grassley for that matter) would both get great healthcare regardless of the country -- England, the US or elsewhere. The real challenge for the American health system is to make sure that the same type of remarkable medical care being delivered to Senator Kennedy is available to everyone else, as well.

Comment - 9/17 - There is an important distinction to be made between the 'British' NHS and the 'English' NHS. It turns out that there really isn't a British NHS because health policy in England, Scotland and Wales, for instance, are each very different. After devolution of the health services in the UK, each country took a very different path. Most of the rumors out there right now focus on aspects of the English NHS, not the British NHS.