The Olympics, Doctors, NHS, Transformation, and Heroes: Why the Difference between USA and UK?

I was surprised when the Opening Ceremonies of the Olympics in London honored two of my favorite institutions:  the National Health Service and the World Wide Web.  I was not surprised when LA Times sports writer Diane Pucin posted the following tweet: “For the life of me, though, am still baffled by NHS tribute at opening ceremonies.  Like a tribute to United Health Care or something in US.” @swaldman responded to the sports writer with “Well, maybe, if United Health Care were government-run and a source of national pride.”

I was not surprised when Meredith Vieira and Matt Lauer of NBC admitted they had no idea why Tim Berners-Lee was being honored by sending out a tweet.  Ever since I read his book Weaving the Web:  The Original Design and Ultimate Destiny of the World Wide Web by Its Inventor (HarperSanFrancisco, 1999), Berners-Lee has been one of my heroes.  Finally locating my hard copy of the book in the guest bedroom where my son Colin used to sleep, I quickly located the marked passage I was looking for:

“People have sometimes asked me whether I am upset that I have not made a lot of money from the Web.  In fact, I made some quite conscious decisions about which way to take my life. These I would not change…. What does distress me, though, is how important a question it seems to be to some.

This happens mostly in America, not Europe. What is maddening is the terrible notion that a person’s value depends on how important and financially successful they are, and that that is measured in terms of money.  That suggests disrespect for the researchers across the globe developing ideas for the next leaps in science and technology.  Core in my upbringing was a value system that put monetary gain well in its place, behind things like doing what I really want to do.  To use net worth as a criterion by which to judge people is to set our children’s sights on cash rather than on things that will actually make them happy.”

I am certainly not alone in admiring Berners-Lee, as this passage from a blog by Daniel Nye Griffiths demonstrates:

“With less of a commitment to openness, Berners-Lee could have used the Web to become a very rich man. Instead, he has used every accolade – Fellow of the Royal Society, Knight Commander of the Order of the British Empire, one of only 22 holders of the Order of Merit and recipient of enough honorary doctorates to fill a skip – as a lever, opening doors for his mission to keep the channels of communication open, accessible and affordable.

Looking to the future, he has championed the idea of the Semantic Web – a system of data tagging to help search engines to understand questions as well as find words. Closer to home, he has advised data.gov.uk, and pushed governments past and present to make their data available for free. If you’ve looked at an OS map online recently, you have him to thank.” (http://www.high50.com/archives/life-times/berners-lee-come-on-tim)

The Olympic Opening Ceremonies got me thinking about heroes, health care, doctors, and the struggle to transform the American health care delivery system.  Why is our delivery system such a mess?  Why aren’t Americans proud of their hospitals and doctors and sending out tweets like @MaxwellLeslie’s “The NHS is one Britain’s greatest & most loved institutions, reinforcing the ignorant American stereotype very well with that tweet” by the Southern California sports writer.

Paul Levy, the former hospital CEO, discussed how Dr. Don Berwick’s praise for the NHS made it impossible for him to ever be confirmed by the United States Senate as the permanent head of CMS.  Levy quoted Berwick’s speech on the occasion of the NHS’ 60th birthday:

“The National Health Service is one of the truly astounding human endeavors of modern times.  Just look at what you are trying to be:  comprehensive, equitable, available to all, free at the point of care, and – more and more – aiming for excellence by world-class standards.  And, because you have chosen to use a nation as the scale and taxation as the funding, the NHS isn’t just technical – it’s political.” (http://runningahospital.blogspot.com/2012/07/will-nhs-medal.html)

And Levy closed his blog post by writing, “In the former colonies (the US), we take on the task in a different way, but we face the same issues.  Indeed, as I have noted, ‘After all, the countries are dealing with the same organisms, both biologically and politically.’” (http://runningahospital.blogspot.com/2012/07/will-nhs-medal.html)

Since the United States and the United Kingdom both have health systems that take care of humans and since both operate under similar democratic political systems, why are the results so different?

Kent Bottles, MD, is past-Vice President and Chief Medical Officer of Iowa Health System (a $2 billionhealth care organization with 23 hospitals). He was responsible for the day-to-day operations of a large education and research organization in Michigan prior to his work with in Iowa with IHS. Kent posts frequently at his blog, Kent Bottles Private Views.

6 replies »

  1. Terrific post ! it deserves to be widely disseminated.
    As I listen to the what passes for discussion in the ongoing debates about the Affordable Care Act, I perceive one particular irony in our approach to health care in this country. It centers around the notion of personal liberty.

    That is, those who oppose the act typically trumpet their desire to preserve their freedom to not buy health insurance, being that individual freedom is a core value of our society. On the other hand, I look at the citizens of Britain and wonder who is more free: the American who has the freedom to choose not to purchase health insurance, or the Brit who is free from the worry of going bankrupt from medical bills and who is free to think about employment that is not linked to the presence or absence of health insurance. Perhaps we need a broader definition of freedom.

  2. The NHS should always be tributed, it has done so much for the people of britain by not only treating everyone rich or poor, but also creating thousands of hospital jobs for people all over the country. It still baffles me to why America hasnt adopted a similar sollution to afordable health care for the population. It needs to be tested in the states.

    Sam Apex

  3. The British chose to include a tribute to the NHS in their opening ceremony because – despite the grumbling – the NHS is a national point of pride for the British people. Delivering affordable, quality healthcare to every citizen reflects the values of the British people.

    How much highlighting it in the ceremony was a shot across the bow of the US is impossible to know. That some feel compelled to be defensive about the shortcomings of our own non-system speaks volumes.


  4. I love this post Kent!

    Such a stark contrast between a mission centered v. ‘money, property and prestige’ centered life. Thanks for connecting Olympic dots, the NHS, and Berners-Lee contributions. I missed the opening, but will look for it on YouTube (aka for free).

    Thank you Tim for your mission centered life and choices. In the United States of Amnesia, the only thing we more often than not do NOT fail to remember is: how do I/we monetize ________ (you fill in the blank effort)?

    We all stand on the shoulders of those who came before us. Mr Romney’s sound byte disingenuous campaign notwithstanding, no one does it by themselves, we all have help (some considerably more than others).

    If everything reduces to a ‘monetization WIFM’ which it sure appears to be in some camps, we’d be blessed by considerably less treasure, wisdom and community under a pay to play set of rules.

    I doubt neither Meredith Vieira nor Matt Lauer would be similarly trumped by questions or metaphor tied to American Idol or mind numbingly hollow entertainment plays. We value, more often worship, essentially useless and valueless things and possessions, until something wakes us up to our ever present mortality. Yet, many die before they ever open their eyes to this great realty, not a fact un-recognized by Chris McCandless in the film ‘Into the Wild’ ie ‘Happiness only real when shared.’

    Some get it, many don’t.

  5. But how many onlookers (and perhaps more specifically, American onlookers) do you think really made the connection or tribute to universal access…be it Berners-Lee’s valiant strides toward universal access to the web or the NHSm committment to universal health care? Of course, we have awonderful after-thoughts (like this piece) that have us comparing systems and culture between two countries that seem so similar in structure. But I’m not so sure how well this message was conveyed, other than a bit of a surprise–with children dreaming of Voldemort and a huge house hiding Berners-Lee during a pretty terrible dance routine and cheesy love story.

    My point here is not to criticize the direction of the Opening Ceremony–because I do think the tributes were great ideas. I just wonder what the takeaway was for the general population here in the US. Do we even think that many people have turned the very point that this post brings up in their heads?

  6. Having worked with both the US and UK health systems (and also in the UK private sector), the NHS is a marvel. The NHS delivers better health outcomes than the US health system overall on about 60% of the share of GDP allocated to health care in America. The Health Service in the UK is a beloved institution which was inspired by Lord Beveridge’s report written after World War II, creating a social safety net for all people in Britain, regardless of income or social class. The US health system is fragmented based largely on class: looking to the future, with incomes slipping for the middle and lower ranks, Medicaid rolls will be challenged to absorb growing demand. At the same time, the nation is split 50/50 in terms of what a “social safety net” would, could, or should look like. The UK decided 70 years ago that health care was a civil right for all living in the UK. The US went in another direction. The organisms aren’t the same: culturally, the US and its health citizens have not decided that universal access to health care is a right. I’ve seen it, I’ve worked in it, I’ve lived it as a health citizen, and I’ve benefited from services delivered by the NHS. I believe Berwick was/is right.