07.23.09 3:28 PM ET
In Defense of 'Socialized Medicine'
Far be it for a mere Brit to intrude into the U.S. health-care debate, but after a week in New York watching the arguments unfold on TV, it's clear the opponents of reform are dragging the British National Health Service into their side of the debate with the most outrageous distortions and "porkies" (as in pork pies, i.e. lies!).
When Rudy Giuliani on CNN dismissed our NHS with the claim that "nobody goes to Britain for health care, they all come here if they can," I found myself shouting at the screen: "Hold on, Rudy, it's not as bad as that." Indeed New York's ex-mayor is just plain wrong.
The better off in Britain can still enjoy the best health care that money can buy; but the poor and the middle class know that the cost of their health care is not something they will have to worry about.
London is a world-class medical center to which patients flock from all over the world for state-of-the-art medical procedures. I visited my Harley Street clinic only last week: It was full of foreigners in London for various operations. No doubt they were all pretty affluent. That's also true of the health tourists coming to America. Nor is London the only British center of medical excellence. The great medical university cities of Glasgow, Edinburgh, and Manchester—to name only three—have world-class teaching hospitals and research (Dolly the Sheep was not invented in the Big Apple, Rudy!). The fact is Britain is a world leader in many areas of medical research, including cancer.
The NHS is regularly dismissed by U.S. critics of American reform as "socialized medicine." This is strange to trans-Atlantic ears. Most Brits don't think there's anything "socialist" about the NHS—it enjoys all-party support, including all right-of-center parties. The British Conservatives, who gave the world privatization under Margaret Thatcher, are totally committed to a national health service, tax-funded and free at the point of use (and Mrs. T never challenged these principles either). The parties disagree about how to run it—the Conservatives and the Blairites want less central control, more patient choice, less bureaucratic distribution of resources—but all are agreed on the basic principle behind it.
And that's not just true of Britain. The fact is that all mainstream right-of-center parties across continental Europe regard some kind of national health service covering everybody and largely free at the point of use as not particularly "socialist." There is broad consensus on the left, right and center about this. Most people don't think of it as socialized medicine—just a key feature of a modern, rich, civilized society. When you try to explain this to those opposing a health-care overhaul in America, either they don't believe you or think you're making it up. It is striking just how far apart America's Republicans (and anti-reform Blue Dog Democrats) are from what should be their natural European allies, like the British Conservatives, the French Gaullists, and the German Christian Democrats on this issue.
But enough patriotic outrage. We Brits are under no illusions that our NHS is the last word in health care. We know about the queuing, the bureaucracy, the frustrations of dealing with a producer-led rather than patient-friendly system. But the way it is depicted by Obama's opponents—developing-world medical procedures, endless queuing, no choice of doctors or hospitals, antediluvian facilities, government dictation of health care—is a travesty of the truth. For those whose default position has been to criticize the NHS ourselves, we suddenly become quite defensive.
For a start, the NHS is now full of spanking new hospitals—there are several within a few miles of where I live and I recently visited an amazing new hospital complex in the Midlands. Yes, there are still waiting lists for some procedures, but they are much smaller than before and you don't wait for anything life-threatening. Yes, there are too many bugs to catch if you do end up in an NHS hospital—but that's a problem in the U.S., too.
Of course, nobody in mainstream American politics is proposing a British-style National Health Service or even the sort of compulsory comprehensive insurance systems that exist in Europe. But for America's right, anything that involves a bigger role for government seems to be regarded as "socialized"—and the slippery road to the supposedly clapped out NHS.
The fact is health care on both sides of the Atlantic is rationed: in Britain, it is rationed by queue (though with the billions of pounds thrown at the NHS in recent years the queues are diminishing) and in America by price (no health insurance, no right to health care). Americans might like to ponder that it is better to be in a queue for health care that not qualify for any at all—which is the plight of those 47 million Americans who have no health insurance.
Nor are the problems confined to them. Ordinary Americans with health insurance are finding that their insurance doesn't cover all the costs of their care—25 million are deemed "under-insured"—and are having to cough up some of the cost of their treatment. Even those who think they are fully insured are having to dip into their own pockets to meet costs (payments called "deductibles").
As somebody who has benefited from health care on both sides of the Atlantic, I'd have to say that U.S. health care, at its best, is probably the best in the world. But often that "best" is not available to ordinary families—and not at all to those under-insured or without insurance. For the Brits, there is something comforting and reassuring that, if you are struck down by catastrophic illness or in need of expensive operations, being able to afford your treatment will not be an issue. The better off in Britain can still enjoy the best health care that money can buy; but the poor and the middle class know that the cost of their health care is not something they will have to worry about.
Of course the British and American health systems are not as far apart as some make out. Britain has a flourishing private health-care system—something the U.S. critics never mention when they talk about the danger of a state monopoly of health care—which mainly works in harmony with the NHS and attracts all these health tourists. And America already has plenty of socialized medicine in the form of Medicare (for the old) and Medicaid (for the poor), taxpayer-funded schemes which cost 4 percent of America's GDP and, in absolute terms, means the U.S. already spends many, many billions of dollars more on "socialized" health care than the NHS.
Indeed the incredible cost of U.S. health care is breath-taking, whether you're a reformer or anti-reformist. The U.S. spent some $2.2 trillion on health care in 2007. It is a mind-boggling number which amounts to more than 16 percent of U.S. GDP. That is nearly twice the average spent by other rich nations with advanced health systems—yet you have to wonder if this is value for money when, by most measures, the U.S. is a less healthy nation than other rich countries, on everything from infant mortality to longevity.
The Brits know their NHS can be bureaucratic, wasteful, and costly; but it is still regarded as one of the country's most valued institutions by voters of all persuasions. Nobody who wanted to dismantle it (reforming it is another matter) could ever be elected. And compared with America's existing health-care system, you could be forgiven for concluding that the NHS is cheap, efficient, and comforting. Take that Rudy!
Andrew Neil is a publisher and broadcaster working out of London, New York, Dubai, and the south of France. He is chairman and editor in chief of Press Holdings Media Group, publishers of The Spectator, Spectator Business, and Apollo.