I’m currently finishing this piece the day before I leave the UK for the foreseeable future. It seems bizarre to me that only a week ago my priorities, concerns, and just general thoughts were in a completely different realm. I originally set out to write a post about the National Healthcare System in the UK in light of the upcoming US presidential elections and the debate surrounding the current US healthcare system. The necessity to discuss a universal healthcare system, however, has now jumped to a place very few of us predicted. Amidst the COVID-19 pandemic, it is more important now than ever to take a deeper look into what a universal healthcare system would provide, and what horrible outcomes it can prevent.
It is well known that the US spends a disproportionate amount of money on healthcare compared to other high-income countries. The current healthcare system in the US leaves an obscene amount of US residents in debt or hesitant to seek healthcare in fear of potential debt. These shortcomings, along with many others, have flagged the system as needing substantial improvements and possibly complete reformation.
As the COVID-19 pandemic is demonstrating for us, a universal health coverage system serves the interest of every single person. Nobody should choose between receiving treatment or paying their rent. And nobody should catch the virus because somebody they were next to on the bus could not afford a deductible or co-pay, or is one of the 37 million uninsured individuals in the US. As Senator Bernie Sanders recently said, “we are only as safe as the least insured person in America.”
One of the highest profile discussion points during the upcoming US presidential election has surrounded the US healthcare system. Sanders has proposed a universal health coverage system, Medicare-for-all, that many voters are uncertain about — how will we pay for it? What will it look like? Is the current healthcare system bad enough to risk an unknown one?
The proposed Medicare-for-all, however, is not as unknown or impossible to achieve as some might make it out to seem. Many countries offer universal health coverage including Canada, Norway, Israel, Sweden, and the United Kingdom. As a US student studying in the UK, I wanted to share some important and relevant information about the UK’s healthcare system, and examine if it really is as scary or unachievable as some think.
To learn more, I sat down with Ashok Handa, the Associate Director of Clinical Studies for Oxford Medical School, an Associate Professor of Surgery In Oxford University, and a Vascular Surgeon. For 32 years, Handa has been working in the National Health Service, or the NHS, which is the healthcare system in the UK. He has visited Singapore, Hong Kong, Kenya, South Africa, Germany, Italy, and the US in a professional capacity. His extensive work within the NHS and observations of other countries’ healthcare systems has given him unique insights into the advantages and disadvantages of various healthcare systems, but particularly the one employed by the UK.
Before the NHS was put into place, the UK hospital system was similar to the current one in the US: a two-tiered system with private hospitals for those who could afford it, and public hospitals for the rest of the country. Most medical specialists made their money from the private practice and would do charity work in public hospitals. The public hospitals then effectively ended up with a second-class citizen type of care, with poor facilities and an overcrowded system. This division in the quality of basic human rights is primarily what the inception of the NHS sought to heal.
The NHS came about in 1947 and was the brainchild of Nye Bevan, the Minister of Health at the time. The story, according to Handa, goes as follows: Bevan at the time worked in London. On his way to and from work, he would transfer trains in a town called Swindon. At the time, most people who worked on the railway were a part of “railway colonies,” as they all lived in social housing owned by the railway company. During his stopovers in Swindon, Bevan observed that the railway families all paid a penny a week to a central communal pot, which paid to employ the local family practitioner. This then meant anyone in the railway colony would receive free healthcare whenever they needed to visit the practitioner because they were part of that community. “[Bevan] said if they can do it in this whole colony, then that’s what we need to do. And out of that came the concept of the National Health Service,” said Handa.
The NHS was set up on three basic principles. The primary overarching principle was that taxpayers and national residents of the UK would have care, free at the point of use, from cradle to grave, making the NHS one of the first universal health coverage systems in the world. The second ensured that the system was funded by having everyone pay a special tax called national insurance. This tax was, and is, graded, so the more one earns, the more national insurance they pay. “It was meant to be a democratic way of looking after the welfare of the whole nation,” said Handa. The third principle is to pay the NHS doctors well enough so that they do not need or want to participate in any private practice. Because of this, it didn’t matter if a healthcare provider worked in London, or York, or a part of rural Scotland, the same grade of nurse, doctor, or pharmacist, would get paid the same.
In the UK today, there is huge public support for the NHS. “Even the most right winged politicians in the UK know that to publicly disagree or to get rid of NHS would be impossible and political suicide in the UK,” said Handa. Most of the research, innovation, and quality standards are all developed by the NHS and the public hospitals. Handa commented that, “there is a nagging suspicion and recent evidence that the quality of the care delivered in the private hospitals in the UK is worse, on the basis that you don’t have any peer review. In most of the public hospitals, there are very well developed systems of governance, patient safety, accountability, and multi disparate team working, whereas virtually none of those exist in the private hospitals in the UK.”
The prominent criticisms of the NHS revolve around the wait times an individual might face when seeking care, though the NHS is tackling this from both a monetary and strategic angle. For example, the NHS has set a goal that 90% of patients in emergency departments be seen within at least 4 hours of arrival. For emergency care in general, though, UK hospitals have a culture of treat first and pay later. When I asked Handa about how a non-resident would be treated within the NHS system, he said, “If you turned up to the emergency department here the chances are that you will never get a bill.”
The disadvantages of longer wait times, however, certainly do not outweigh the benefits. As Handa said, “it may be that you don’t have the same convenience of ‘I want to have [my appointment] tomorrow because I’m off work.’ You have to fit around it so that’s the downside, but the huge positive is that sheer worry that so many working families have about whether they can afford to have healthcare for their families just goes away.”
When I asked Handa about the NHS’s preparation for COVID-19, he said, “because we have universal healthcare, it is very likely that people will turn up and have the test and isolate themselves, whereas I can see if you’re worried that you might be carrying or having symptoms, and that if you’re going to get a bill for $1,000 or whatever, you may not turn up.”
Recently, the Trump administration has claimed to work with private insurance companies towards policies that reflect a universal health coverage system, such as waiving fees for COVID-19 treatment. It was later revealed, however, that these insurance companies only agreed to waive the fee for some policy holders for the COVID-19 testing, rather than the actual treatment for everyone. Still, the more progressive measures being adopted by the Trump administration point to the possibility of universal health coverage policies taking hold in the fabric of the American healthcare system, and the priorities of US citizens.
The path to enacting universal health coverage in the US, however, is twisted and foggy because our beliefs and actions can often differ in significant ways. Our belief might be that we want to pay more taxes because, when asked what is important to us, we will likely say good health, housing, food security, and other basic human needs. But when we take action, we often, especially in the US, vote for more autonomy and financial freedom. It seems to be a gamble: pay less taxes now at the risk that you might have to pay more in healthcare later. The reality, though, is that every one of us will come in contact with our healthcare systems at some point throughout our lives, and the COVID-19 pandemic might force that sooner than we would want. As Nye Bevan and the success of the NHS have shown, we can always provide more equitable access to healthcare, and we shouldn’t wait until a global pandemic to act.
As I head back across the pond prematurely and reflect on our current situation, I can’t help but feel a bit scared returning home. Many people have jokingly commented that I should, for my own safety, stay in the UK rather than return to the pitiful healthcare system in the US. It’s a funny thought at first, but as the reality of what we are facing settles in, the truth to that sentiment stands out. I am hopeful, though, that this pandemic will bring out the best in us and prompt us to truly vote according to our beliefs, and for the basic human care and respect that we all value.
