The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

Lord William Beveridge and Nye Bevan, two British politicians from very disparate backgrounds, instituted the British National Health Service. Beveridge designed the system on which so many British citizens rely for health care, while Bevan “muscled [it] into existence” on the principle that no one should ever be required to pay a medical bill (104). It doesn’t matter if patients go to a general practitioner’s office for cold medication or to a cardiac surgeon for a quadruple bypass, the bill is also paid by the government. While private health insurance plans still exist in Britain, few people bother with them. About 90% of the British population uses the NHS, which is funded through tax revenue.

Reid recalls that he and his family were satisfied with the care that they received through the NHS, despite waiting for weeks to see specialists. For the problem of his bad shoulder, a doctor told Reid that the NHS would not provide coverage. The NHS is so popular with the public that, in the 1980s when Margaret Thatcher privatized other public services, she never dared touch the NHS. Thirty years later, Prime Minister David Cameron “promised severe cutbacks in government spending,” but offered to provide more funding to the NHS (106).

During World War II, most British medical services were managed by the Emergency Hospital Service—a centralized agency. This was the precursor of the single health care system that Beveridge invented. The doctors who belonged to the British Medical Association, however, protested the idea of becoming government employees. Moreover, the health insurance programs that existed, called “friendly societies,” were worried that a national health care system would render them unnecessary.

Bevan decided that all hospitals would become a part of the National Health Service and all specialists who worked in them would be government workers. However, the doctors could continue to see patients based on their own schedules and charge fees. Bevan also agreed that general practitioners could also operate privately and treat patients in their own practices. Finally, Bevan assured the insurance industry that it could still sell insurance to those who opted out of the NHS. On July 5, 1948, the National Health Service began.

Its first problem was dealing with too many people using too much health care. As a result, the service exceeded its budget within its first year. This remained a problem for many years thereafter. To offset the costs, treasury officials demanded that patients pay some fees. Bevan, in his role as health minister, agree to charges on prescriptions, as long as children and the elderly were exempt. Then, in 1951, the Labour government also agreed to charge fees “for spectacles and false teeth,” prompting Bevan to resign (111). He argued that this would eventually lead to charges for doctor’s visits and hospital treatment. His prediction turned out to be untrue.

Currently, more than 1 million people work full-time for the NHS, making it the largest employer in Europe. The NHS operates 2,000 hospitals and operates what many experts consider to be “one of the most cost-efficient health care plans ever devised” (113). To access the NHS, everyone must register with a general practitioner in their community. If a patient wants to see a specialist, he or she must be referred to one by a GP. This is a cost-control measure. Another cost-control measure is the waiting list. It can sometimes take weeks or months to get an appointment with a specialist. American politicians use this as proof that “socialized medicine” doesn’t work properly. However, both prime ministers Tony Blair and Gordon Brown increased funding to the NHS in the late-1990s and early-2000s, causing a reduction in queues. Now, lines are much shorter, but patients must still wait to receive treatment for procedures that the NHS deems elective. For serious problems, such as cancer screening, a patient will see a consultant within 14 days. For chest pains, a cardiac specialist will see the patient within an hour.

To control costs, the NHS strictly rations which medications, tests, and treatments it will pay for. The National Institute for Health and Clinical Excellence, referred to by its acronym, NICE, makes those decisions. Sometimes, the organization makes decisions that are unpopular with the public, but its harshness prioritizes longevity. For instance, NICE may decline to pay for a sick grandmother’s operation if it allows for more money to treat children who are ill.

Consultations with NHS doctors usually last for about 10 minutes, which is the same length of time in which an American doctor sits with a patient. The NHS is less likely to perform X-rays and tests than American doctors and the system refuses to pay for annual physicals. A patient reserves the right to pay for it out-of-pocket, however, at the cost of about $500. Reid was even refused a prostate test, though it’s common for men his age in the US. The NHS, however, has determined that it isn’t “a proper indicator of cancer” (120). On the other hand, his GP did advise him to get a colonoscopy, given the prevalence of colon cancer in his family.

In Great Britain, around 60% of all doctors are general practitioners. In the US, only around 35% are GPs. In Britain, GPs earn twice as much as specialists and they find other ways to make income, such as making house calls and writing off their cars as a business expense. Doctors who meet targets for best practices receive a bonus of up to $125,000 per year. British general practitioners pay about as much for malpractice insurance as an American GP would but would likely never face legal action as long as the doctor can prove that he or she was following NICE guidelines when providing treatment. Also, medical school tuition fees are so low—and, in many cases local governments pay medical students’ tuitions—that doctors graduate without debt.