Commentology: Healthcare in the UK


Rod Unger writes:

I am, if you like, Joe the Plumber living here in the UK just to the North of London. I have no particular political mandate in terms of the NHS (more of this later). I don’t work for the NHS or have any other such vested interest. Nor do I have any knowledge or contact etc with any of the Pharmaceutical companies. Hence I am Joe the plumber. I am just an ordinary man in the street. Before going any further there is one other thing I would like to state as a prequalification. You have to understand the British mentality (as a generalisation). Many, many years ago we thought it proper and decent to be modest. This then slightly altered to us becoming a nation of moaners and pessimists! Unlike Americans who have (as a generalisation) a wonderful “can do” mentality and optimism.

The NHS is one of the most wonderful things about an excellent lifestyle we have here in the UK. Our weather is better than often reported. (Check out the stats if you don’t believe me) We are full of invention, fun and excel at many world wide industries and sports. But the NHS is one of the best things about the U.K. It is not run by the Pharmaceutical companies who only want to maximise profits. It is not run by lobbyists for their own benefit. It is run for the nation. It is not perfect and you will here the moaners going on about the small percentage of problems (big in number small in percentage). No government ever since the NHS as introduced has ever even considered doing away with the NHS. This is not a political issue in the UK. The NHS is supported by all parties and by everyone. Quite a few people do have private insurance as they can afford to pay for non essential matters or to jump queues. But even they in an emergency will be taken straight to an NHS hospital and receive an excellent service. There will be no queues and no questions asked!

I personally know many people who live in Spain, Portugal etc etc and they all come back to the UK for the NHS. Indeed my own parents lived in Portugal for 12 years when the retired and moved back to the UK at the age of 76!! just for the NHS. Since being back they have used the NHS on a regular basis (they are now 88) and we all have nothing but praise for all parts of this massive organisation. All their care, medications etc etc is free.

About 4 years ago my son was diagnosed with a serious ling term mental disorder. We use the NHS every day. He takes medication every day and will have to for the rest of his life. All this is free and the staff are fantastic

We do live in different societies. It is not for us to advise you as to what is best for your country but do not denigrate or criticise the NHS it is fabulous on a world wide scale. Yes there are problems not least of all trying to move this huge organisation in to the modern technological age plus coping with a huge influx of people from foreign countries many of whom cannot speak English. This has put a massive strain on the resources available, but still the staff provide a fabulous service.

Don’t believe the propaganda from those wishing to feather their own nests. It is too important

Best Wishes

Rod Unger

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14 replies »

  1. I wana translate this blog but my google translator is not working at this time. Is their any substitute tool for it? If anyone knows than please share. It ‘ll be highly appreciated.

  2. I wana translate this blog but my google translator is not working at this time. Is their any substitute tool for it? If anyone knows than please share. It ‘ll be highly appreciated.

  3. J Bean your study is 9 years old quoting one study by a firm who I have never heard of and have no idea who funded or what their political ideology is. Since we are living in today lets use today’s facts.
    “A Las Vegas hospital providing emergency dialysis services to 80 illegal immigrants says that accounts for much of its operating deficit.
    “The University Medical Center says the treatment will cost it about $24 million this fiscal year, aggravating a budget deficit that is expected to approach $70 million.”
    That’s just the dialysis, care for illegal immigrants is expected to be responsible for their entire deficit. Not to mention this 24 million figure pretty much invalidates your other study all by its self.
    Dialysis work related?

  4. Average GP salary in UK: 118,000 pounds/year (January, 2007, Daily Mail).
    Significantly higher than average primary care pay in US.

  5. It is nice to hear about personal stories but of course that does not reflect the true situation of the system. When I was a med student I spent three months in clinical training at a tertiary system in London and the public hospital I rotated through in the US had better equipment (e.g. MRI) with much better access for people without insurance for exanmple. I saw older people not get the care that uninsured people in the US get (e.g. a plasmaphoresis which is used to clean the blood of antibodies that cause auto-immunune diseases. For the same condidtion a 30-ish man got it and a 50’s woman did not).
    The cancer survival rate in the US far exceeds Europe (including the UK which is worse than France and Germany):
    From a recent epidemiological study. Since most do not have access to the journal, stats cited from blog and again in less detail in medscape:
    5-year survival:
    All malignancies (men) US: 66.3 Europe: 47.3
    All malignancies (women) US: 62.9 Europe: 55.8
    1/5 men in the US are more likely to survive cancer in the US than in Europe. 7/100 women. Prostate cancer is one of the most common among men (esp. ruling out those cancers caused mostly by lifestyle such as lung cancer) and slow growing thus time to treat yet in Europe 1/5 dies of it when in US it is rare to die of prostatic cancer.
    1/10 more women who get breast cancer in the US survive than in Europe.
    Thus it is a fallacy that the Europeans deliver better health care than in the US. It appears that they do and that they would but the reality is they do not. Millions die needlessly of cancer in Europe.
    The reason why there is such a difference in many outcomes in the US vs. Europe is that our population in many ways is less healthy (e.g. far more obese) and this impacts the overall figures.
    Never mentioned on this site is Ken Thorpe’s website, fightchronicdisease.com . Also never mentioned is Institute of Medicine determinants of health. 50% of health, 1/2, is determined by lifestyle (smoking, obesity and lack of exercise, firearms, alcohol and resulting automobile accidents, ….). 20%, 1/5 of heathcare is determined by environment. Air pollution kills anywhere from 20,000 to 50,000 per year (cited). Air pollution causes much increased asthma. 20% (1/5) of health is determined by genetics and only 10% (1/10) is determined by access to health care.
    The politcal debate and this web site focuses far more on lack of access than it does on altering lifestyle even though lifestyle has 5 times the impact as a determinant of health than does access to health care (according to the Institute of Medicine).
    Here are the stats mentioned above:
    Table 1. Five-Year Relative Survival Rates for Cancer of Different Sites, US and European Cancer Registries*
    5-year survival rate (%)
    Site The first number is US. The second is Europe.
    Prostate 99.3 77.5
    Skin melanoma 92.3 86.7
    Breast 90.1 79.0
    Corpus uturi 82.3 78.0
    Colorectum 65.5 56.2
    Non-Hodgkin lymphoma 62.0 54.6
    Stomach 25.0 24.9
    Lung 15.7 10.9
    All malignancies (men) 66.3 47.3
    All malignancies (women) 62.9 55.8
    Survival Rates Significantly Higher in United States Than in Europe
    One of the reports compares the statistics from Europe with those from the United States and shows that for most solid tumors, survival rates were significantly higher in US patients than in European patients. This analysis, headed by Arduino Verdecchia, PhD, from the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, Italy, was based on the most recent data available. It involved about 6.7 million patients from 21 countries, who were diagnosed with cancer between 2000 and 2002.
    The age-adjusted 5-year survival rates for all cancers combined was 47.3% for men and 55.8% for women, which is significantly lower than the estimates of 66.3% for men and 62.9% for women from the US Surveillance, Epidemiology, and End Results (SEER) program ( P < .001).
    Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons.
    National Cancer Intelligence Centre, Office for National Statistics, London, UK.
    “There were wide differences in survival across Europe, with rates in the UK well below the average, but all European rates were far below those in the USA.”
    In this last study it clearly demonstrates that on key metrics the US does as well as Europe and the differences in health outcomes are because of lifestyle issues, etc.
    Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion.
    We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role.
    We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
    There is much that can be done to improve health in the US and it should be done, but the next time someone tries to say that the US should adopt a European style system and that the Europeans deliver better health imagine the following:
    A room full of 5 men with prostatic cancer and with 10 women with breast cancer. Using European health care 1 of those 5 men would die and 1 of those 10 women. Pretend these are people that you know. Think about real human beings.

  6. And they don’t have a huge and unhealthy illegal alien population.
    Nor, fortunately, does the U.S. Of course, what you define as “huge” may be different than what I define as “huge” (in fact, I’m quite sure they will be different). However, expressed in percentage of total costs, the undocumented workers are mostly not elderly or unhealthy with emergency care (they do a lot of dangerous jobs that are not closely monitored by OSHA) being the bulk of the cost.

  7. >What is fair to say is that NHS works for the British who are nationally portrayed often as orderly and accepting of queues.
    Which goes to show that DKBerry has never run into a bunch of English soccer fans “visiting” foreign parts (Or for that matter the British army visiting the rest of the world in the last 300 years)

  8. To a degree…
    NHS is administered regionally. Each region is funded by Parliament based on per capita. It is up to each region to determine what number of procedures or which drugs which are nationally approved are supported by the regional management.
    Organisation for Economic Co-operation and Development (OECD)provides the best source for comparing performance rather than political posturing.
    What is fair to say is that NHS works for the British who are nationally portrayed often as orderly and accepting of queues.
    The major difference between UK and US is that unlike the US the UK has a very robust primary care sector of private practice physicians who are contracted by NHS per capita. There is no shortage of primary care capacity in the UK unlike in the US. In the UK specialists are employees of the NHS hospitals.
    The cause for primary care shortage in the US is without question the Medicare originated fee for service reimbursement system which routinely cuts remibursements (calling them new contract amounts) and slow payment. As many as 30% of med school grads 25 years ago went to primary care … now only 5% will match to primary care residencies in internal medicine, family medicine, ob/gyn, pediatrics, and general practice. Low reimbursement for their labor in primary care driven by Medicare means its harder to pay back $200k in college loans when you go into primary care.
    Per capita reimbursement based on real negotiation and real contracts keeps Brits from not having to show up at an ED to obtain primary care services.
    Unless the US reform changes how reimbursement to providers is made there will be no substantiative change in the quality or access to medical services.
    A la carte reimbursement = a la carte treatment.
    Having all Americans possessing health insurance coverage is great… gives them a card to pull out when they show up at the ED to get primary care services. Reform will do nothing to substantially increase the capacity of the US primary care sector sufficient to provide the DEMS promised Access.

  9. And they don’t have a huge and unhealthy illegal alien population. They are better drivers, less violent, and in better health. All sure fire signs that public plans are better tben private plans.

  10. Yes, Kurt. The NHS is paid for in taxes. But it’s worth remembering that the UK taxpayer still pays less in taxes for the NHS than the US taxpayer does for US publicly funded healthcare.
    The difference is that because the NHS is a reasonably well-run system (with some glitches as the original post acknowledges) it delivers a high standard of universal health care at low cost.

  11. Dave,
    NHS is a state-managed, single-payer agency. The government effectively acts as an insurance group serving all physician practices and citizens. It’s free only in the sense that it is paid for in taxes–like roads or public schooling.

  12. I am very sorry to hear about your son’s ailment. However, I am unfamiliar with the British system and was wondering if you can you explain how his care is “free”?