22 August 2009

An essay by an American who loved Britain's NHS

The British National Health Service has become part of the dialogue on American health care reform. TYWKIWDBI experienced the system indirectly in London in the 1980s, and recommends this essay found at Salon today:
It is a system that I found to be very different from the one currently being described as "evil" and "Orwellian" by politicians and commentators eager to use it as an example of the dark side of public medicine.

I was initially skeptical about the NHS. I’d grown up comfortably in suburban New Jersey; good private healthcare was always immediately available through my father’s insurance... After all, healthcare in the UK was free. How good could it be? Friends and relatives back in the States were spending thousands to have children. If you get what you pay for, I was about to get a whole lot of nothing.

My first glimpse of our prospective hospital was not promising. It seemed crowded, aging and apparently devoid of the gleaming, beeping equipment I associated with modern medicine...

Whoever needed help got it. When a terrified Afghani girl arrived, rumored to be only 14 and apparently abandoned by her family, several nurses dropped what they were doing to teach her the rudiments of child care. The rest of the mothers waited patiently until they were finished. Other wards were the same. There was no private wing with champagne service. Everybody was in this together. If you were a woman and you were in labor and you were in our part of London, this is where you came. If things went wrong, skilled doctors appeared with the latest technology. Nobody asked about insurance or co-pays...
Much more at the link. Recommended.


  1. There are so many lines in that piece that would make me laugh if it weren't so ridiculous.

    "After all, healthcare in the UK was free."

    No, it is not. It costs all kinds of money. You know, just once I'd love to hear someone walk into a grocery store and say, "I have a right to free food." Because if health care is a right, why not food?

    Hell, why not housing?

    Guess what? I don't work for free. Neither do the therapists, counselors, doctors, surgeons, housekeepers, mechanics, and millions of other people who work in the health care system.

    We, along with all of the technology we use to help take care of the public, COST MONEY. Now, you can pay for it one way or the other but YOU WILL PAY FOR IT.

    The second ridiculous statement in that piece: " . . .all of them were cared for in exactly the same manner . . . ".

    Wow. Clearly the writer of this piece nor anyone who buys this line of tripe has not spent much time in American hospitals. Again, I am a nurse and have worked in a major teaching hospital on the east coast, a small ER on the east coast, and a cardiology unit in the mid-west. Now listen up: UNLESS SOMEONE TELLS ME OR I LOOK IT UP IN THE PATIENT'S FILE, I CAN'T TELL ANY DIFFERENCE IN THE TREATMENTS RECEIVED BY PATIENTS WITH INSURANCE VERSUS PATIENTS WITHOUT INSURANCE.

    I'm not saying that there are not differences. I'm sure there are. But given that nurses are the ones who spend vastly more time with patients than any other health care personnel, don't you think we'd see the difference???

    Third hilarious falsehood: The assertion that in America, you don't get help if you need it but in Britain, " . . . Whoever needed help got it."

    Ummmm, go talk to an ER triage nurse. Go ahead. Pick any one you want. And ask them precisely how many patients they have turned away in the last 5 years. Go on - and get back to me on that. I'll give you a hint: it's somewhere south of one.

    But the one that really, really, got me was this one: "This, I learned, is what the NHS is about -- common decency."

    I don't doubt it. I believe him. I don't think that the British are horrible people at all - I think they're actually quite wonderful and dedicated to helping their fellow man.

    But it is incredible that someone could actually believe that that decency is due to their health system.

    To anyone who is reading this: Do you really, truly believe that this decency does not show up every single day in every single hospital in America?

    Do you think that somehow, this ability to be decent is achievable only in the U.K. because of their system?

    Look - I love the U.K. Absolutely love it and I love the people. But we have extraordinary decency here in America, and yes, even in our "horrible" hospitals. I keep thinking of all the times when hospital staff has worked overtime to provide extra care for patients, hugged a sobbing loved one, talked to a lonely patient even though they have so much work to do, literally hurt themselves trying to help patients get up and start walking again.

    I could go on and on but I realize that there are a lot of people who simply want to believe what they want to believe. No country has the perfect health care system. We don't right now (and yes, we DO need reform!) but neither do Canada, the U.K. and other countries.

    So go on and believe that we all can enjoy French wines, German cars, tickets to Cats, endless holidays, and "free" health care.

    And unicorns. Don't forget the unicorns.

  2. Deana, I admire your enthusiasm, but I think your love for the American health care system is slightly clouding your reading of the essay. It seems to me to have been written in defense of the NHS - but not as a criticism of the American system. I encourage you to read it again and see if you can find one place where the author says American health care is bad. He doesn't say that.

    The essay seems to have been written by an upper-middle class American who previously probably had little contact with indigent people and probably experienced some culture shock when his wife was in the same ward with poor immigrants; thus his seemingly surprised statements that "all of them were cared for in exactly the same manner."

    Your allegation: "Third hilarious falsehood: The assertion that in America, you don't get help if you need it but in Britain [you do]" That's not what he says. Nowhere in the essay does he say that in America you don't get help if you need it. That's a comment that came to your mind by some fantasy of your own. The author says that in the U.S. "good private healthcare was always available through my father's insurance." He never says (or even implies) that in America you "don't get help if you need it."

    Your statement that no ER triage nurse turns away any patient is true as it applies to nurses confronting walk-in patients, but if you think American emergency rooms in private hospitals don't turn away patients and tell the ambulances to take them to county hospitals, then you have some grim facts to become acquainted with.

    You say it is "incredible that someone could actually believe that that decency is due to their health system." Again, you're imagining that statement. The author never says that decency is due to the health system. What he is quite clearly saying is that decency and decent health care can be achieved in a system like the British one.

    There are many possible means for providing health care. The NHS is one such system. The fact that someone says it is o.k. is not an indictment of a competing system such as the American one.

    I think you're being way, way too defensive.

    But I do admire your enthusiasm.

  3. Any government provided, subsidized and/or regulated healthcare exists through the use of violence (taxation and regulation). If you do not think so, then refuse to pay taxes, follow their regulations or pay their fines. You will find yourself dragged off to prison at gunpoint. This alone is reason enough to reject it.

  4. A dear friend complains regularly about her husband and his best friend, who lives across the street. They are O'Riley, Hannity, Limbaugh true believers. Now they are having their first disagreement. It seems the neighbor is from Germany, and thinks that any developed country should have nationalized health care. Amazing. He's basing his opinion on experience and facts instead of lying hyperbole. Maybe there's hope for him...

  5. By your statement V, are we to privatise the entire infrastructure?

  6. I am baffled by the heated resistance to the idea of nationalised health care.
    I think a lot of things are clouding the debate and I can only hope in 50 years people will look back and wonder what they were all so resistant towards....

  7. Minnesotastan -

    I encourage YOU to go back and read what I wrote and spare me the whole "I admire your enthusiasm" shtick. I could care less about your admiration.

    I explicitly said that our health care system needs reform.

    Let me say it again in case you missed it:

    Our U.S. health care system needs reform.

    AND (brace yourself)I believe that the federal government has a role in that reform.

    But it should not be a nationalized system. It should not be a single payer system.

    The reason I get upset about these pieces is not because the writer thinks they have a great system - if they like it, great! It is the underlying assertion by the writer and, particularly, by people in this country who want a nationalized health care system that these other countries have discovered nirvana.

    Nationalized health care supporters in this country do NOT post these essays because they think people enjoy reading how citizens of other countries "just love" their system. They post these essays in an effort to sway the debate.

    And you know what? That's fine. They absolutely should be doing that if they believe that is the way we should go.

    But that does not mean the rest of us cannot respond.

    Do you think we are supposed to just read these pieces, sigh, and say "Oh, that sounds like heaven! Let's do it!

    As for your assertion that ERs in private hospitals turn away patients, M., YOU need to get familiar with what OUR reality is.

    There is a law referred to as EMTALA that REQUIRES hospitals to provide treatment to people regardless of citizenship or ability to pay. Hospitals are not necessarily reimbursed for these people. ALL HOSPITALS who participate in Medicare and Medicaid MUST comply with this law.

    I'm sorry if you are not aware of this but that is the way it is.

    You act as if you are some sort of expert in health care. I WORK in health care and am not an expert. But I can tell you that I have personally witnessed a man being admitted into the hospital because he was having trouble "getting an erection." M., that is NOT an emergency. But we couldn't turn him away. Talk to any ER nurse and they will tell you similar stories.

    I have to go but let me say one more thing: I do NOT believe that all health care in the U.K. and Canada is horrible. I actually think they do some amazing work and we should study what they are doing to see what parts we like and think might work here and what we don't like. But this "we've got to do this in 3 weeks or it's all going to go to hell!!!" approach by the president and certain members of Congress is ridiculous.

    Healthcare here in the U.S. is huge, huge business. Doesn't it deserve some time, consideration, and thought?

    Would you support an effort to change the entire U.S. financial system in a month? Probably not. I bet you would want people to slow down and think about it.

    Please give that some thought.

  8. @Deana - I do admire your enthusiasm, and I'm sorry you consider that comment to be "shtick." You write long comments in full, coherent sentences, presenting logical viewpoints, and sign with a name - rather than just writing expletives while hiding as "anonymous" as so many others do. You contribute to the dialogue here, and I admire that. I'm sorry you took offense at my comment.

  9. This piece is a defense against the recent bulls*** criticism levelled at the UK's NHS.

    The stats tell the story.

    UK ave. life expec. 79.2
    UK infant mortality rate 5

    US ave. life expec. 78
    US infant mortality rate 6.4

    Its time the world's biggest super power started helping out its people.

  10. Anonymous -

    No, the stats do NOT tell the whole story.

    Please take a look at this:


    If reading that is too much work for you, let me summarize:

    The U.S. and the various European countries do NOT count infant deaths in the same way.

    So what do you think that leads to?

    Different infant mortality rates.

    The U.S. and European countries are not comparing apples to apples. Even the European entity (the Organization for Economic Cooperation and Development) responsible for their infant mortality rates WARNS AGAINST using their numbers as a comparison against the infant mortality rates of other countries for PRECISELY THAT REASON!!


    "The United States counts ALL births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths."

    In certain European countries, " . . . fetal weight must be at least 500 grams (1 pound) to count as a live birth (and/or) . . . the fetus must be at least 30 centimeters (12 inches) long . . . (and/or the pregnancy must have lasted at least) 26 weeks . . .)"

    Anonymous - some European countries don't even bother to count full-term babies who sadly die within the first 24 hours?

    What the hell do you think that is going to do to their numbers????

    Also, in the U.S., we're busy helping 45 year old women get pregnant. Well, that's great - I'm all for it - but the biological reality is that that 45 year old woman is much more likely to lose that baby than she was at 25.

    And yes, we count those deaths too.

    So take a moment and look into this before you leap (like you obviously did) to some conclusion that is based on false data.

    Your health, and the health of people who care about, is going to depend on it.


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