What is it really like to get health care from the British National Health Service

During the health care reform "debate" that has been going on for the last few months, we have often heard mention of how horrible it is to obtain "government-run" health care from the National Health Service in England. An editorial in the newspaper, Investor’s Business Daily, even went as far as to state that renowned physicist Stephen Hawking, a professor at the University of Cambridge would not have survived if he lived in England and had to rely on the National Health Service because the National Health Service would have “pulled the plug” on him because of his disability. Dr. Hawking quickly replied that he has lived in England for all of his life and receives all of the health care from the National Health Service, who has not pulled any plugs. Embarrassingly Investor’s Business Daily quickly replaced that editorial with a revised editorial which removed the unfounded accusation about Dr. Hawking’s chances of survival in the National Health Service, but still argued that government-run health care “pulls plugs” on people. I guess facts don’t matter.

Well here is a letter signed by prominent British doctors and scholars talking about their experience as patients in England’s National Health Service.

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Dear Senator Kerry,
Your reported call for "lies" about health care reform to be refuted is essential and requires an urgent response. To that end, may we -- British health professionals and patients - respectfully expose those "lies" which are about our National Health Service, a service which our experience shows to work successfully for the benefit of all in this country.

PATIENT CHOICE: There is NO "death panel" in the UK NHS or anywhere else in the UK health care sector.

-Termination of a pregnancy is a personal decision if approved by two doctors. NO board or organization of any kind makes any decision about termination for fetal abnormality. Such decisions are personally made by those seeking such procedures after counselling by medical and other health professionals.

-Elderly people can get counselling and advice to help them determine /their/ requirements for/ their/ future care, but only if they wish it.
It is a service that provides information about issues such as living wills. This is similar to the US proposed Section 1233, which provides counselling and assistance to those wishing /voluntarily/ to make their own arrangements for their future, medically and physically.

-Patients are normally registered with a family doctor practice of their choice. A patient is able to see a doctor immediately for urgent care in general practice although seeing his or her own family doctor for non-urgent care may require waiting a few days. If the patient requires referral for specialist opinion or treatment, they can choose whichever hospital they prefer.

CARE FOR THOSE WITH PRE-EXISTING CONDITIONS: In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers. The NHS is literally a life saver for those with pre-existing health problems - they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.

CARE FOR THE ELDERLY: There is NO cut-off age for health care in the NHS. Senator Kennedy, /like anyone else of that age,/ or older, and with health problems such as his, would have been treated by the NHS with the same high levels of care as someone younger. Care for the elderly includes free flu vaccinations, free medication, free operations as needed, nursing care visits, and help and adaptions for the home. Many hospitals now offer "hospital to home" programs for palliative and end of life care to enable very ill people to remain at home.


CARE FOR THE DISABLED: Professor Stephen Hawking of Cambridge University, recently awarded the Presidential Medal of Freedom by President Obama, is disabled and has always been under the care of the NHS. Professor Hawking is an outspoken admirer of NHS care. Like thousands of others who are disabled, he is entitled to free medical care and medicine, and he can get adaptions, equipment and home care to allow him to live at home.


FREE MEDICATION: NO ONE is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don't pay for their medication from the NHS. 88% of medicines are dispensed without charge. For the minority who pay there is a standard charge of $11 dollars per prescription, regardless of the real cost of the drug. Some parts of the UK have abolished prescription charges altogether.


INSURANCE: Like the Healthy San Francisco medical plan, those in the UK can also take out private insurance, if they can afford it, although less than 1 in 8 currently do so. The co-existence of public and private coverage ensures complete freedom of choice.

THE COST: The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million underinsured.


BACKGROUND: The NHS was created in 1948. Its goal was to provide comprehensive medical care through taxation, universal coverage for the population which is free of charge at the point of care. It still does that despite the huge, and increasing, demands on its financial and practical resources.

The NHS is available free of charge to all regardless of ability to pay, and does not discriminate against those with pre-existing conditions.
Importantly it gives freedom from fear of the financial consequences of illness.

Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS. On average, British users of the NHS live longer and have a lower infant mortality rate than the US.

The NHS has shown itself to be open to -- and often the source of - innovation. How the US manages its own health care reform will doubtless provide us with new ideas about how to improve some aspects of our own NHS service. In the same spirit, we respectfully draw to your attention what evidently works well here



Yours sincerely,

Professor Alan Maryon-Davis FFPH FRCP
President, UK Faculty of Public Health

Professor Anthony Costello FRCP FRCPCH
rofessor of International Child Health
Director of Institute of Child Health, UCL

Professor Andrew JM Boulton, MD, FRCP
Professor of Medicine, University of Manchester, UK Consultant Physician, Manchester Royal Infirmary

Professor Mark B Gabbay MD FRCGP
Professor of General Practice
Head of Division of Primary Care
University of Liverpool

Professor Rodney Grahame CBE MD FRCP FACP Consultant Rheumatologist, UCH Honorary Professor at UCL, Department of Medicine

Professor Ian Banks
President of the Men's Health Forum and member BMA Council

Professor Eileen O'Keefe
Professor of Public Health
London Metropolitan University

Professor Gill Walt
Professor of International Health Policy Health Policy Unit, Dept Public Health & Policy, LSHTM, Keppel Street,

Professor Rosalind Raine
Professor of Health Care Evaluation
UCL Dept of Epidemiology & Public Health
1-19 Torrington Place, London WC1E 6BT

Dr Alex Scott-Samuel
Director, International Health Impact Assessment Consortium Division of Public Health University of Liverpool

Sir Alexander Macara
President , National Heart Forum
Trustee, Patients' Association

Dr Jean Taylor
Scottish Patients Association

Dot Gibson
Secretary, National Pensioners' Convention

The Creator of the Obama Death Panel Myth Speaks

Last week the “Daily Show” aired an interview with Betsy McCaughey, widely considered the creator of the Obama death panel myth. Dr. McCaughey is the former Lieutenant Governor of New York State and has a PhD in history from Columbia University. Dr. McCaughey never actually used the words "death panel." In fact it was failed Vice Presidential candidate and failed Alaska Governor Sara Palin who, inspired by McCaughey’s comments, coined the term death panels. Nationally prominent Republications soon joined in. Here is Senator John McCain supporting Palin’s comment (click here). And here is a video of Republican Party Chairman, Michael Steele agreeing with Palin (click here).

The interview between Betsy McCaughey and Jon Stewart is available on the Daily Show’s website (click here to view it). It’s an amazing spectacle. I urge you to view it and draw your own conclusions. If you would like to read the relevant section of the health care bill follow this link. (See pages 432-434). It is amazing that an educated person could read this bill and conclude that the bill is in any way creating anything that could be considered a death panel. It’s more amazing that so many serious national politicians believe it does.

Should Obese People Pay Higher Health Insurance Premiums?

I was at dinner the other night with several friends and naturally healthcare reform came up in conversation. One person suggested that people who are obese should be charged higher health insurance premiums than people who are not obese. This proposal has been gaining support. While it is currently not in any of the health reform bills I have looked at, I have been hearing more and more people making this suggestion.
Before I comment, I would love to know what you think.

My new favorite Member of Congress

This morning, while drinking my “morning Joe” and watching the MSNBC TV show by the same name, I saw my new favorite member of Congress. He is Anthony Weiner, a Democrat from Brooklyn, New York. I assure you my admiration for Congressman Weiner has nothing to do with the fact that I am also a native Brooklynite. My admiration for Mr. Weiner comes from his cogent defense of the “Medicare for All” proposal. Medicare for all would work like this. Currently the government-financed Medicare program pays for healthcare for Americans age 65 and above. “Medicare for all” would lower the eligibility age to birth. Even people without jobs would have access to health care. Your employer would be relieved of the responsibility of providing health insurance, and if you changed your job you would no longer have to change your doctors.

Medicare for all currently lacks the 218 votes needed to pass the House of Representatives. I talked with Congressman John Conyers of Michigan about the proposal back in the spring of this year. As of that time there were 86 co-sponsors (including Conyers and Weiner). It’s an even bigger long-shot in the Senate. The politics are too complicated. But, the policy is sound. Several months ago at the beginning of the healthcare reform process a fellow patron at my barbershop (knowing I am a health policy professor and believing my job title meant that I knew something about health policy) asked me how I thought healthcare reform would turn out. My answer then as now is: We will probably pass something this year that will be a slight improvement (for example disallowing health insurance companies from declining people for coverage because of preexisting health conditions), but the 2009 “reforms” will not address the major healthcare problems (rapidly raising costs, too many Americans without access, inadequate quality, and inequality in access and quality), then we will muddle along for 20 more years before we are finally left to conclude what Congressmen Conyers, Weiner and at least 84 others have already figured out. Medicare for all, while imperfect, is the best option.

As with Medicare in the 1960s, Dems should do it alone

Like most health policy professors I have been thinking about healthcare reform for years, so when the issue finally took front stage I was elated. I strongly supported President Obama’s objective of working with Republications to find a bipartisan solution, so although I favor Senators Edward Kenney and John Dingell’s “Medicare for all” approach, I understood that would never secure Republican support. So I got behind the President’s strategy of taking single payer off the table. But now, I must conclude I was wrong. There is no hope for biparti sanship. Republications have no interest in solving the healthcare problem. They merely want to see the President defeated. Republican Senator Jim DeMint made the strategy clear when he fashioned healthcare reform as President Obama’s Waterloo.

In last Tuesday’s New Hampshire town hall meeting, President Obama gave a “shout out” to Republication Senators who he felt were working in a spirit of bipartisanship to find solutions. Said the President, “now, I think that there are some of my Republican friends on Capitol Hill who are sincerely trying to figure out if they can find a health care bill that works -- Chuck Grassley of Iowa, Mike Enzi of Wyoming, Olympia Snowe from Maine have been.” (Click here for the text of the President’s remarks).

Less than 24 hours after the President’s “shout out” Senator Chuck Grassley was caught on tape spreading the "Obama death panel" lie. At an appearance at a town hall meeting in Iowa Senator Grassley told the crowd they were correct to fear that the government would "pull the plug on grandma."

Where did the death panel lie originate? Republication Senator Johnny Isakson of Georgia proposed that doctors be reimbursed by Medicare for time spent counseling patients and their families on end-of-life decisions, such as making a living will, or informing doctors about the patent's desire whether or not to remain on life support. This inherently reasonable Republican proposal somehow morphed into Obama's “death panels.”

Senator Grassley is not alone. Other national Republication leaders are also distorting Republican Senator Isakson’s proposal and acting as if the proposal was made by the President. Perhaps the most egregious case came from failed Vice Presidential candidate and failed Alaska Governor Sara Palin who went as far as to state that “Obama's death panel," might kill her infant son, Trig. “The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama's ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”

So here are three facts that seem to be getting lost in all the noise:

(1) President Obama has not presented ANY healthcare plan. He has left it to Congress to work out a bill.
(2) There are proposals making their way through the House of Representatives, but there still is no final House bill.
(3) The Senate has not even written a Bill yet.

The President's Town Hall Meeting

The president appears to be taking a new tack in his effort to make the case for healthcare reform. I watched his town hall meeting from New Hampshire today. He made all the right arguments. He focused on the personal stories of individual Americans who had suffered in the present system. He defused the lies and rumors… death panels, and such. I always get a chuckle when I hear people rant against “government healthcare” while insisting that the government not “mess with their Medicare.” But, most importantly he responded to the reasonable concerns that people have about healthcare reform. For example, one man suggested that a public option would inevitably kill private insurance companies, since “no company could compete with the government.” President Obama’s deft reply was that Federal Express and UPS are able to compete effectively against the US Postal Service, and in fact it is the USPS that has the constant financial problems. Another man asked about tax increases. The President pointed out that the previous administration (self-defined as fiscally conservative) added a new pharmaceutical benefit to the Medicare program without figuring out how to pay for it. Many of the same members of congress who now express concern about costs of healthcare reform voted to create this new benefit even in the face of massive income tax cuts, two wars, and a mounting budget deficit. My only quibble with the President’s message is on the cost issue. If you provide care to 47-50 million people who currently don’t have access to care, you are going to have to pay for it, and there are only three possibilities. (1) Increase revenue by raising taxes, fees or some other device; (2) cut services somewhere else in the budget; (3) add the costs to the deficit. None of these are pleasant options. However, in the end one of these things will have to be done.

Mental Contortionism Reigns

Healthcare reform is very complicated to explain, but very easy to distort. And, opponents are doing a great job of distortion. Their mantra - do you trust the government to run healthcare? - dredges up images of your last visit to the Department of Motor Vehicles. Now, that is scary! The fact that Medicare is a government run program somehow seems not to matter. I watched Keith Olbermann tonight with absolute awe and wonder as Medicare recipients shouted down Congressmen Ross and Snyder at a town hall meeting in Little Rock. Their demand? They didn’t want government to take over their health insurance - Medicare. Wow!

But, it is a particularly impressive act of mental contortionism to hear an actual sitting member of Congress warning Americans about the risks of “government run medicine” when government run medicine is precisely what Congress has voted to provide to the military, veterans and (most interestingly) themselves.