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Theodore Dalrymple
Universal Mediocrity « Back to Story

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I know this is an old article. But a couple of things need clarification. For some reason second only to loving the NHS, the Brits love hating the US.

I can't speak for the NHS. But I can speak to the US system. First of all something on the order of 30% of the US is socialized medicine and is considered by most to be avoided except for simple procedures.

But having been in care myself and with my parents and others, generally it's outstanding care. Like anything, you need to pay attention and advocate for yourself in any bureaucratic institution.

Regarding insurance, when you eliminate the young who refuse to buy inexpensive insurance, the uninsured while we want to solve the problem, is not a lot of people relatively. And it's not the poor, it's the lower middle class (poor are insured by the government) that have troubles with it.

Yes, we need to make some changes, but not the disaster that Obamacare is.

Regarding costs, remember we have to absorb health care for the relatively unhealthy 12 million+ illegal immigrants. In addition, we are wealthier, and people will spend more money on healthcare if they have the money (you can argue whether it's worth it or not).

Regarding pharmaceutical companies someone said 2% of profits on research!!! It's more like 10-20%.

While I'm sure the NHS is not as bad as we hear, the US is not the absurdity that is portrayed by many Brits either. By world standards both provide great outcomes.
A few points regarding Mr. Dalrymple's article:

#1, it is highly likely that modern plumbing, sewage systems, and general improvements in sanitation account for all of the longevity improvement before the NHS. That's been true everywhere that modern water and sewage treatment has been introduced.

#2, if Mr. Dalrymple thinks nurses behaving badly doesn't occur in market driven health care, then either he's been very, very lucky or has not been observant at all. Anybody in the U.S. knows that that only way to insure good care in a hospital is for a family member or friend to be at the hospital around the clock. Otherwise, patients routinely get ignored, no matter where the hospital is located or what the insurance coverage is. Doctors and hospital administrators get rich by making sure the people that actually provide care, like nurses and orderlies, are in short supply, or else grossly underpaid.

A point Mr. Dalrymple tends to dimiss, "they were the most confident that in the event of illness, they would receive the best and most up-to-date treatment; and they were the least anxious that their personal finances would prevent them from receiving proper treatment." seems to tell me that they, meaning the British people, know something we don't. Our "market driven" health care currently provides none of the above!

Comparing differing systems datalogically is fraught with error, as you mention repeatedly in this fine article.
As an example, I often wonder if the reason people are using so many drugs in the US is that it has become so hard to procure many drugs (even ancient drugs like colchicine) that we preemptively get what we can, when we can, so we don't have to go to an emergency room just for a single prednisone tablet. This is due to government interference at so many levels that it seems they don't want you to ever get any medicine at all. I was astonished, in the West Indies, to find several of my prescription medicines on the shelf, next to the aspirin, one being colchicine, for the gout.
Right now, in America, I can't buy colchicine. I must buy Colchrys, the exact same chemical, but repatented under auspices of the Federal Government to the company that ran it through testing similar to that undergone by new drugs today. They didn't like that it was an ancient drug (I wonder what Dr. Humocles' descendants, 2 millenia later, think of the USA giving their scion's rights away?) and hadn't been thoroughly tested.
I guess two thousand years of use doesn't count as testing to the brain trust at the FDA.
Now, not only is it an expensive copay (A bottle of 100 used to cost $1.80. Now the copay for 15 pills is $30. But 15 pills doesn't cover 30 days, so one must get a special exemption from your insurance carrier (I used to just pay cash, they were so cheap)to obtain any useful amount, involving phone calls to insurance companies and doctors, then the pharmacy. In Antigua, take them off the shelf and pay the lady.
In a different example, I recently had a kidney transplant and in the course of an unrelated jaw inflammation, got a prescription for oxycodone. Try filling that anywhere they don't know you for years. They just tell you they don't have any. It took me three days to get it filled, by an old pharmacist I'd known for years. Now, there are no renewals. You must go through this every two weeks if you're in pain.
It becomes a full time job just to obtain your medications.
On the other hand, Mt Sinai sure knows the kidney business, and my brief stay there was a complete and utter delight, and the new kidney is cranking away.
Yes. Approach comparisons very carefully. "There Be Dragons Lie!"
The sad joke appears to be that the British health care system kills the ones most likely to complain.
Apart from the small private sector, the NHS is a monopoly provider of healthcare; it is also a monopsony purchaser of the services of healthcare professionals. Thus it is impossible for staff salaries to be set by the market: they are set by NHS, in other words by considerations of national politics.

The generosity of funding for the public sector in the UK, including the NHS, changes in a long cycle. At the trough of the present cycle, 25 years ago, staff were underpaid and overworked; the NHS provided a broadly comparable level of service to that in other European countries but at half the cost, measured as percentage of GDP. In this part of the cycle, employees' ethos of public service is tested to the limits, and they are expected to give their lives to the service - just so that the rest of us can pay less tax.

Of course this state of affairs is not sustainable, because even if doctors can make ends meet, it becomes impossible to recruit and retain nurses and auxiliaries, and staff shortages must be filled by agency employees at a much higher cost than for direct employees.

The use of agency staff increases until its cost reaches scandalous levels, and then the funding shortfall is corrected - or rather, overcorrected. This is what the 1997-2010 Labour government did, taking us to the peak of the present funding cycle.

So, of course, we will soon experience the down-swing to the trough of the next cycle. The Labour government's blunders included a large increase in salaries for family doctors: a few of them now earn £250,000 ($400,000) a year. While this may not be a remarkable amount by the standards of US professional salaries, in the UK it is stratospheric. It is also unsustainable, particularly when combined with pension liabilities. Doctors went on strike in the UK this year because the government now plans to increase both their pension contributions and their retirement age.

However, if two things are clear from the discussion below, the first is that it is hard to compare the performance of broadly well-functioning services in different developed countries, particularly when this is compounded with cultural differences between their populations. The second is that there is no ideal or simple way to provide a costly and complex service to the entire population, including those who cannot afford to pay. Every system has its flaws, and the main flaw of the US system seems to be that it is so expensive.
Most dispute is about values; most of the rest, about differing personal circumstances causing different results; little is enlightened by 'facts'. Perhaps public monopoly is bad enough that IT IS susceptible to an attack based on facts, but I doubt it.
Alistair,

Firstly thanks for taking the time to defend your position – I appreciate you making coherent arguments even if I don’t agree with the core of your position. I probably won’t post after this – too much else needing attention - but it’s been fun debating this with you.

“In other words the so called data are nothing more than the opinions of doctors and patients with some mortality data thrown in. So if British doctors are happy the score goes up and if American MD's are in a huff their score goes down. This is not exactly rigorous science is it?”

It may not be as definitive as anyone (including the authors) would like but it’s based on surveys of the opinion of patients (not doctors) so they haven’t cooked the findings. There’s the McKee study and others that broadly support these findings so I don’t find anything strange in them. The key point is that there is no data to support the thesis that US citizens are getting better healthcare than in the UK, quite a bit to support the thesis that they’re getting worse healthcare, and indisputable evidence that they spend 2.3 times as much per capita for what they get as in the UK. I consider that to be pretty damning for US healthcare.

“You say I have a bias against Government, and as a free market libertarian, I confess that this is the truth. The author also clearly has a bias against the NHS.”

Thank you for admitting it (its brave to do so) – unfortunately, though this bias is getting in the way of a fair assessment. I’m not the least against market-based solutions – in most cases they work well – and were the system in the US working better than in the UK I’d be the first to say we should be looking at emulating it – unfortunately that just isn’t the case. I’m a pragmatist not an ideologist so I really don’t care who owns the service provider as long as it provides value for money. The list of reasons I cited for why the US healthcare is so unbelievably expensive are my best guess for why it’s so costly compared to elsewhere but I’m curious to hear a better explanation. If the profit margins I mention are so low (from your data) then presumably it’s the salaries of the middlemen that are high. Who are these middlemen? The insurance companies, the lawyers, the admin people, the sales and marketing people – all the people who are making a living from healthcare in the US but would (mostly) not be necessary to deliver the healthcare part of the service were the system structured differently. One thing is sure – there are an awful lot of people feeding at the US healthcare trough and they have a strong vested interest to steer the policy debate away from international value for money comparisons.

“Do you think the Labour Government 1945-51 and Nye Bevan were not ideological when they imposed this creature on the nation (almost bankrupting the UK in the process)?”

If being idealistic is ideological (and it generally is) then yes they were, but that doesn’t mean they were necessarily on to a bad thing. This “creature” as you disparagingly call it, is actually a very cost effective universal healthcare system that has greatly helped improve the lives and productivity of UK citizens. It’s been a very good investment not a waste of resources. It may shock people in the US to know this – but that’s why people over here like it – not because of statist propaganda drumming it into our gullible heads against our better interests. If the NHS at 9.8% of UK GDP was a near miss on national bankruptcy we can be sure that the 17.4% of GDP needed under the US model would have been a bulls-eye.

Best!
With regards to the before and after NHS life expectancy increases, 47 to 66 and 66 to 77.5 years - these do not seem to be entirely comparable. Once the life expectancy was raised from 47 to 66 it would seem to be harder to raise it from 66 to 85 (19 years) because of the upper limit to life expectancy (105 or so?). Surely it must be easier to raise life expetancy from 50 to 51 than from 76 to 77.
Paul
I don't know if you read the report from The Commonwealth Fund, but let me quote

"Any attempt to assess the relative performance of countries has inherent limitations. These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients' and physicians' assessments might be affected by their experiences and expectations, which could differ by country and culture."
In other words the so called data are nothing more than the opinions of doctors and patients with some mortality data thrown in. So if British doctors are happy the score goes up and if American MD's are in a huff their score goes down. This is not exactly rigorous science is it?
You say I have a bias against Government, and as a free market libertarian, I confess that this is the truth. The author also clearly has a bias against the NHS.
However comments such as "pandering to lawyers fees" (less than 5% of US health care), "insurance company profits" (health insurance companies have among the lowest profit margins of any listed group in the S&P 500), and "middlemen rake-offs" (whatever that means) betray a pro-Government, collectivist sympathy of your own.
Why is it that to be against the Government and its various scams is "ideological", but the opposite is not true? Do you think the Labour Government 1945-51 and Nye Bevan were not ideological when they imposed this creature on the nation (almost bankrupting the UK in the process)?
There is no other country in Western Europe or the Anglosphere that has a health care system as centralised as the UK. In almost all other countries the primary care doctors are not employees of the central Government, so I stand by my statement that nobody has copied the NHS.
"There is a lot of evidence that the US healthcare system is responsible for iatrogenic disease, mostly due to over-medication"

Not just overmedication - variously estimated at well over 100,000 deaths a year caused by iatrogenic harm

"But that is true in Britain also--UK hospitals have a (deserved?) reputation for being filthy and MRSA-ridden."

I'm afraid you're about 7 years out of date on that MRSA rates have fallen massively since 2005 when specific, government directed, programmes for eradication were implemented. And this is an important point, left to themselves, as Dalrymple would like, doctors did little to deal with very high levels of MRSA, it required concerted multi-disciplinary effort.


"Without a proper price mechanism there is no way to efficiently allocate the resources to where they are needed. If, for example, they started charging 30 quid to go to an emergency room then all the drunks would go home and puke up in their own toilet, leaving the A&E free for real emergencies. You would hear no more about bed hogs if they charged a daily "B&B fee". "

This moral hazard hypothesis was disproven by the RAND corporation in the 1970s.

"The problem in Britain is that the very thing that everyone loves about the NHS-free at point of delivery-- is the very thing that causes the waiting lists that everyone hates. "

Waiting times have been massively reduced over the last 15 years and appear to be broadly holding even under tighter financial regimen (I will admit against my prejudice and contrary to what Dalrymple asserts).


As for tax I have explicitly included NICS in my calculations (as this is really a tax). Sure there are indirect taxes in the UK but you also have sales taxes in the US (often applied to things where it is not applied in the UK) plus state income taxes in the majority of states. Having lived in both, the proportion of nominal salary that was taxed in the US was much the same as in the UK (and I lived in a state without state income taxes). Unless you are extremely wealthy I'm unconvinced that your tax situation is easier in the US (and of course you (or someone) has to pay your medical insurance on top of that - for me 5 years ago it was $2000 a month for a worse service (and much much slower access to a family doctor) than I had in the UK
“The flaw in your argument is using only life expectancy as a measure of outcomes for health care systems.”

Er no. The report the article is supposedly critiquing (twisting out of all recognition would be a better description) lists 20 international healthcare comparison benchmarks under which the NHS does pretty well. It does best of all when judged in terms of productivity because it spends the least on healthcare yet gets very good outcomes for most benchmarks. All your micro criticisms of the NHS are basically a result of the UK not spending more than they do on healthcare, not because the system is inefficient in resource allocation. By contrast the US system is clearly a mess. While the NHS uses “socialized medicine” that targets service delivery at healthcare outcomes the US system seems to pander to lawyer’s fees, drug company profits, insurance company profits, unnecessary and cosmetic treatments, excessive and unhelpful drug prescriptions and innumerable middlemen rake-offs to deliver basically the same outcome that the UK achieves at well over twice the cost. I’ve never said the US should copy the NHS but I would have thought they should be aiming to set up a system that is as efficient in delivering healthcare per unit spent and shouldn’t be happy until they’ve done at least as well.

You assert that “The last thing they need to do, however, is copy the NHS--and indeed no other country has done so.”

That’s simply untrue – many countries were inspired by the NHS to introduce universal healthcare coverage even if they all implement it in different ways (they are all different btw so none of them have copied each other 100%).

“The British would benefit from a system than encourages competition, has some copayments, and is much less bureaucratic.”

And this seems to be your problem. If a system like the NHS is demonstrably shown to be more efficient than healthcare systems that follow the prescriptions you advocate you can’t accept it’s true because the NHS is state-managed and in your mind it has to be inefficient and bureaucratic. Never let reality get in the way of preconceptions.
Paul
The flaw in your argument is using only life expectancy as a measure of outcomes for health care systems. The US spends far more than the UK but Americans die earlier. However, only a small portion of health care is spent on prolonging life. Most of it involves trying to improve the quality of life for those who are suffering. Almost all psychiatric care, assisted living, pain management, diabetic monitoring, neurological treatment, cataract removal etc etc deal with quality of life issues. If you break your leg you probably would not die without surgery but you may be crippled for life if the bone is not set properly.
As for lifestyle being important look no further than Japan, which has the highest life expectancy in the world but is relatively frugal in healthcare spending. If you plotted a graph of spending/GDP vs longevity there is no significant correlation (assuming you include only OECD countries).
The US healthcare system is rife with waste and fraud, it needs to be radically overhauled, and you are right that they do not get value for money. The last thing they need to do, however, is copy the NHS--and indeed no other country has done so. The British would benefit from a system than encourages competition, has some copayments, and is much less bureaucratic.
Would you like to give up your choice of mobile phone providers and give telecom back to the post office? Are Government run quasi monopolies things that you would normally associate with customer service and an efficient allocation of resources?
Thanks for the reply Alistair and let me address some of your points (barring education which is somewhat off topic). You say:

“As for health spending in the UK, one could argue that it is being held down artificially by the Government--that in a free market system Britons would prefer to spend more (for questionable benefit?).”

Britons can, and do, spend as much as they want on healthcare; private healthcare is available in parallel with the NHS. It turns out they don’t want to spend as much as people in the US but get pretty much the same level of outcome.

You say “Most of an individual's health is in their own hands by the lifestyle that they choose.” And “There is little to no relationship between healthcare spending and life expectancy (beyond, obviously a certain minimum spending). For example the LE difference between the US and the UK almost disappears if LE at age 65 is considered”.

Were the first point true (and you surely know it isn’t) we could all save ourselves a heap of money, retire early and spend our days in the sun by scrapping our redundant healthcare services. But you then assert:
“It would seem that as people in other countries become wealthier the more they are willing to spend on staying healthy and/or alive”.

It appears as if you intended this as a justification for why the US spends 17.2% of GDP on healthcare and the UK only 9.8% but earlier you asserted that there’s no connection between healthcare expenditure and life expectancy. So are you saying that US healthcare expenditure is a complete waste of money and that it could cut it back to UK levels with no loss of outcome?

My basic point is that if the British system is so poor, as this article goes out of its way to claim, how come US citizens don’t get any better health outcomes despite spending 2.3 times more per capita? On a rough reckoning the US health care system is only 43% as productive as the UK system, which by any sane reckoning should be considered a scandal.
Expatr
First lets get one thing quite clear. The US healthcare system is not, as you put it a "free market". About 60% of health care is funded by Government at all levels, one way or another. Also there are thousands of laws and regulations at both the State and Federal level mandating what can and cannot be covered resulting in higher premiums and less choice at the consumer level.
When I worked at a hospital in Wisconsin, at any one time, about 10-20% of the beds were occupied by either patients who could not pay anything or by patients in which the reimbursement would not cover the cost of care. In other words being uninsured does not mean outright denial of care. As I stated previously catastrophic insurance is affordable for most people, and if many choose not to enroll, well that is their choice. The majority of the uninsured are under the age of 30--they probably think they can get away with it, being young and healthy.
You correctly stated before that US income tax rates are not that much lower than in the UK, but you neglected to mention a 20% VAT, petrol at $8/gal due to tax, NICS at 12% vs FICA at 7.65% ,much higher taxes on booze, cigarettes, capital gains and inheritance. The NHS is not free.
As for US life expectancy--it is lower than in the UK but mostly can be explained by higher rates of homicide, infant mortality, suicide and obesity. At age 65 UK residents can only expect to live an extra 3 months than their US counterparts. There is a lot of evidence that the US healthcare system is responsible for iatrogenic disease, mostly due to over-medication, but that is true in Britain also--UK hospitals have a (deserved?) reputation for being filthy and MRSA-ridden.
The problem in Britain is that the very thing that everyone loves about the NHS-free at point of delivery-- is the very thing that causes the waiting lists that everyone hates. Without a proper price mechanism there is no way to efficiently allocate the resources to where they are needed. If, for example, they started charging 30 quid to go to an emergency room then all the drunks would go home and puke up in their own toilet, leaving the A&E free for real emergencies. You would hear no more about bed hogs if they charged a daily "B&B fee". If people want to wait until they are 35 to have kids and find out they need IVF, then 500 pounds a pop sounds about right to me.
"There is little to no relationship between healthcare spending and life expectancy (beyond, obviously a certain minimum spending)."

Yes quite - the USA has terrible life expectancy for shed loads of cash. It's what we might call inefficiency.

There is however a strong correlation between quality of healthcare and mortality amenable to healthcare. The USA is bottom of the list for that too, and interestingly has the lowest level of improvement over the last 15 years - see McKee et al 2006
"All the socialists who commented here are all for bashing the author but non have so far disputed his stats about cancer and heart disease."

I have no idea whether he's a socialist. but re-read DaWolf August 20, 2012 at 1:14 PM where he does precisely this. Or indeed me at August 21, 2012 at 6:20 AM

" As for American health care, it is of high quality (and there is no waiting) but expensive, and virtually nobody dies because of lack of medical care unless they want to."

Yes that's right all 45 million Americans without health insurance choose not to have it out of sheer bloody mindedness and not because they are on minimum wage jobs without health insurance benefits.
Encore to Paul Encore
There is little to no relationship between healthcare spending and life expectancy (beyond, obviously a certain minimum spending). Most of an individual's health is in their own hands by the lifestyle that they choose. The reason the US spending on health is so high is that a lot of Americans are over-insured and therefore spend wastefully on care that isn't needed. As long as someone else is paying, they allow the Doctors and hospitals to rack up the bills. This would happen in Britain too but the Government has a global limit thus putting a lid on the total amount of care. As for statistics, they can be misleading. For example the LE difference between the US and the UK almost disappears if LE at age 65 is considered. There are problems in the US with suicides, homicides, obesity and infant mortality that skew the LE statistics. I would also be interested if the US spending figures include money for herbal medicine and various quack therapies that many Americans indulge in.
As for health spending in the UK, one could argue that it is being held down artificially by the Government--that in a free market system Britons would prefer to spend more (for questionable benefit?).It would seem that as people in other countries become wealthier the more they are willing to spend on staying healthy and/or alive.
As for education, I would be the last person on earth willing to defend the dumbed-down disaster that has befallen the schools in the US. The question I have is why did Britain go down the same path and wreck theirs too? At one time British secondary education was admired and copied all over the world (unlike the NHS) which makes it all the more puzzling.
I decided to download and read the report the author is basing his article on. Out of 20 indicators of health system performance that cover accessibility, safety, coordination of care, chronic care management, primary care, mortality, and prevention in 14 advanced countries the NHS was in the top 3 countries for 13 of them (top in 7) and the lowest ranking it got was 10th for measles immunisation (which was temporarily lowered due to a media-fanned scare about the safety of the vaccine). The report doesn’t hide the fact that the UK needs to do better in cancer care, treatment of cardiac infarctions and in deaths amenable to health care. In the latter case the UK scored second worse of the fourteen countries. The worst score, however, was for the USA (paying attention Ali G?). Why doesn’t Dalrymple mention that? Probably for the same reason that he doesn’t report the statement in the report that says “Cancer survival rates in the US are artefactually increased by the systematic exclusion of poor people and African Americans from the Surveillance Epidemiology and End Results register”. In any case it’s very clear that Dalyrimple is cherry picking his facts to suit his thesis (that the NHS is socialised healthcare and hence bad) rather than letting the evidence guide his judgement.

Munk: “The populace is on prescribed narcotics, they cannot see the reality.”

If you’re referring to the USA you’re bang on. According to the above report “Per capita expenditure on drugs is 2.5 times higher in the US (where the lobbying power of the pharmaceutical industry has blocked price controls) than in the UK”. You must be high as kites while you spend 2.3 times the amount per capita on healthcare to get a worse outcome than the inefficient socialised medicine doled out in the UK.

Ali G: “I notice all the defenders of the NHS don't seem to want to talk about the French, the Dutch or the Swiss health care systems--all of which are less centralised, superior and universal.”

I lived 10 years in France and the healthcare system there is excellent. I found it to be somewhat better than in the UK but it’s also more costly and everyone in France was aware they were going to have to cut healthcare funding even prior to the current economic crisis. The Dutch and Swiss systems may well be better but they are more costly again. All of these countries spend a higher percentage of their GDP on healthcare than the UK does but none comes near the US’s whopping 17.4%. As for education, the US scores worse than the UK on maths and sciences and better on reading according to the most recent OECD international league tables. Don’t, whatever you do, let any uncomfortable facts get in the way of your preconceptions though.
Munk August 21, 2012 at 3:41 PM
"The populace is on prescribed narcotics, they cannot see the reality."

Which population?
@Alistair G.

You may well be right about state education in the UK. When the two tier system of grammar schools and secondary moderns was abolished they were replaced with comprehensive schools which were modelled on the US high school system. So, thanks for that.
All the socialists who commented here are all for bashing the author but non have so far disputed his stats about cancer and heart disease. As for American health care, it is of high quality (and there is no waiting) but expensive, and virtually nobody dies because of lack of medical care unless they want to. Hospitals in the US are required to treat anyone in the ER regardless of ability to pay. What is definitely screwed up in the US is the insurance system whereby many are way over-insured while some have none. As for those that went bankrupt, well you can buy catastrophic insurance at a reasonable rate and if they chose not to do so--well that was their mistake.
I notice all the defenders of the NHS don't seem to want to talk about the French, the Dutch or the Swiss health care systems--all of which are less centralised, superior and universal. That is because the main point of the author is correct--the NHS is mediocre, as is state education in the UK. Almost anytime you are spending other peoples' money on a quasi-monopoly "service" waste, indifference, and mediocrity is what you are going to get.
The populace is on prescribed narcotics, they cannot see the reality.
Could any of the failures of the NHS be attributable to the growing segment of the population arriving from third world countries. It has been point out that the prevalence of of "Cousin Marriage" in Islamic countries, leads to a higher incidence of birth defects and life long disabilities. Also arrival from a place with little or no steady medical care, would also place new strains upon the system
Dalrymple is very good at critcising Britain. From his home in the south of France.
Marju, thanks for responding. I’m not surprised by your anecdote. The NHS seems to meet its performance targets by sparing on the frills so delays in seeing a doctor for non-urgent treatments and shabby waiting rooms (sometimes) are indeed part of the mix. If your condition is serious though, treatment is pretty swift, efficient and competent. Many people buck the waiting and improve the ambience by paying for private healthcare which grants rapid access in pleasant surroundings. The costs of this (NHS and private healthcare) are already included in the average per capita healthcare expenditure figures I quoted previously. As for there being many factors involved in mortality, I agree that there are. In the UK we have a healthcare system not just a medical care system and part of the budget is used to encourage healthier lifestyles. It has mixed results; however, as we drink more than American’s and smoke less. I haven’t managed to find comparable data on illegal drug use, sedentary lifestyles and food related factors; however, the key point is that US citizens are paying 2.3 times what UK citizens are paying and seem (at best) to be getting nothing extra for it.
I don't think life expectancy is necessarily a measure of a national healthcare service's effectiveness. At the same time there have been gains in quality and quantity of food. Even the availability of vaccines isn't exactly the healtcare services per se. The proper timing of administration of them might be.
Paul, is our lower life expectancy a factor of our medical care alone? No. The methodology needs to adjust for (c) drug and alcohol abuse; (b) smoking; and (c) a sedentary lifestyle. None of these have anything to do with the quality or availability of medical care.

I lived in the UK for 2 years, went to the doctor once and after a weeks-long wait, was treated like a number in an old, filthy surgery. I waited until I returned home for my next visit.
Marju: “Being satisfied with your health care doesn't mean your healthcare is necessarily good. Just means that Brits are satisfied with second best. The complaining Americans are not”.
So why are you satisfied with paying twice as much per capita for a health care system that delivers a lower life expectancy?

JP Knight: You talk about “death panels” but your country operates the biggest death panel in the western world – can’t afford insurance? – crawl under a rock and die.

You also talk about the British being victims of propaganda but I don’t see any of those here who are trashing the NHS willing to debate the basic statistics – the British pay less than half as much for their healthcare and live longer than Americans.

jz seems to think the NHS equates to jobs and Eileen Pollock seems to think the Darwinian struggle to pay for health insurance in the US stimulates people to get jobs, which the dreadful socialized medicine in Britain doesn’t. Well guess what, unemployment in the US is currently 8.2% and in the UK is 8.0%.

Floyd R Tubo (American – was it ever in doubt?) calmly asserts that “The British love the NHS because they no longer have a free press.” Goebbels would have been proud of your information sources Floyd. The unintended irony of your comment is delightful.

PoliticalPaige.net does even better. He/she/it compares the poor bewildered British to the plight of the Jews in the “Polish” ghettos. Unable to appreciate we have a chance to throw off our captors (the evil NHS camp commanders) and escape to freedom. Blinded by statist propaganda we are led like sheep into our NHS death panels while smiling at our luck. Yup, we sure are a bunch of saps here in the UK.

BTW guys it turns out this article is written by a staffer of a “conservative, market-orientated think tank” (according to Wikipedia) and it’s an election year where healthcare’s on the agenda. Coincidence? Draw your own conclusions.
"Never underestimate the ability of humans to fool themselves. Britons are dying at unconscionable rates from diseases and conditions that a free medical system treats routinely and with far greater success"

Evidence? there is none. Mortality amenable to healthcare is higher in the US than anywhere else in the developed work (McKee et al 2006).So your "free" (oh the irony) system does a much worse job.

As Peter Capusutto said eloquently below - you are entitled to your own opinions but not your own facts
Apparently the EU has ruled that the NHS can no longer require that nurses from other EU countries must speak English when working in the UK.

The British love the NHS because they no longer have a free press. The British press complains routinely about every other British institution except the NHS. This is because they want to support Obamacare (or complain about free-market healthcare) and they want to play up the virtues of socialized medicine. If Obama gets a second term it won't be long before the NHS is being negatively compared to the Cuban Healthcare system.

40% of Doctors and nurses in the NHS are ethinic minorities who have emigrated to the UK. Without the ability to pay these people low wages the NHS would be even more insolvent. But nobody has pointed out that it is morally reprehensible for a poor country like India to pay to educate a physician so that he can then go and provide care for people in Britain. India and other 3rd world countries need these people far more than the UK does. The UK should be educating UK nationals to meet this need.

I'm trying to think I've ever read anything more at odds with reality and reason than this comment.

Perhaps you might want to visit Britain before you comment about things you know nothing about.

Britain has a pretty free press and right wing newspapers in particular love nothing more than to damn the NHS (and even left of centre papers will jump when they smell a scandal).

The EU most certainly has not ruled as you suggest and has no practical way that they could. And as for minority ethnic groups you might want to consider that a very large proportion of them, are actually BORN in Britain and as such are rather more British than Prince Philip.
"Research on medical therapies is not similarly driven - new diseases appear only very slowly. Researchers in the US are motivated by: 1) the desire to improve the human condition, and by: 2) the activities of advocacy groups like the March Of Dimes (A group that wishes to minimize birth defects), and by: 3)the profit motive whcih is still strong in the US - although the FDA is making it increasinly difficult for companies to make a profit.

Bureacrats in socialized medical systems take a very short term view - they don't see the point of spending money on research that probably won't see a result for twenty years."

Whereas actually only 1.3% of Pharmaceutical company net profits are spent on basic research which largely comes -er- state funded universities.

Try again.
2. But most Americans pay less than 35% of their income in income taxes. Isn't the rate of income withholding in the UK over 45%?

NO!!!!

UK income tax is not levied on the first c. $13k (£8k) you then pay 20% on the next c$50k (£35k)

In addition you pay 12% national insurance from about £3k to about £38k and 2% thereafter

At the average male wage of c £25k ($40k) you have just under 25% of salary withheld
Wow disingenuity from start to finish.

1 - what is life expectancy in the free-market US - way lower than in Britain and anywhere else with a socialised system. When right-wingers are challenged on this they tend to point to social determinants of health. Strange that you don't do that for the UK where the disparities are - as Marmont and others have shown time and again linked to socio-economic disparities.

2 - As you grudgingly admit waiting times fell dramatically in the UK under the Labour administration. The seven years you mention would be impossible now, and since the early 1990s could only have happened due to administrative error (even the Tories set a two year limit for waiting).

3 - International comparisons, particularly of mortality, are notoriously tricky and depend more open national differences in coding and definition than actual variance.

"But the principal damage that the NHS inflicts is intangible. Like any centralized health-care system, it spreads the notion of entitlement, a powerful solvent of human solidarity. Moreover, the entitlement mentality has a tendency to spread over the whole of human life, creating a substantial number of disgruntled ingrates."

There we have your real gripe - those damned ungrateful working classes thinking that healthcare is a human right.

That and us doctors can't do what ever we like anymore. Read Awande and Berwick on why doctors doing whatever they like might not be such a good idea.
The irony is that all the state schemes ignore critical insurance concepts though calling it "insurance" whether implicitly or explicitly. Until it's approached from concepts of risk pooling, adverse selection, financial incentives, and competition all will fail eventually from an indvidual and public health prospect.
The comments towrds the end of the article are dead-on. I am a practicing physician and have made the comment multiple times to my colleagues that we are no longer professionals but implementers of policies and guidelines dictated by insurance companies and the governement.
I've lived in the UK for 27 years and the US for 28 and have direct experience of both systems. I found the UK's NHS to be superior by every meaningful measure (accessibility, clinical results and cost). With a few exceptions (e.g. the VA), the US does not really have a health care system. It has a medical procedure delivery industry that produces health care as a tangential side-product.
allan, you're misinformed. if somebody in the u.s. is sick, they seek and receive treatment (paid for by the rest of us). Even people with insurance sometimes die from their diseases.

Such a lot of distortions about the U.S. Being satisfied with your health care doesn't mean your healthcare is necessarily good. Just means that Brits are satisfied with second best. The complaining Americans are not.
Brilliant, but you may as well be whistling in a hurricane. All health care systems seem to be immune to any real efforts to improve them.
I have seen the same phenomenon in Canadians, whose system (a death panel) killed both my father in law and one of his daughters (another is my wife, who moved to the USA many years ago). They take great patriotic pride in a system that kills them, because they all suffer equally, so they reason. They are victims of propaganda, as the British appear to be.
Some questions for the author of this article.

Which is worst? Rationing (UK) or death (USA) because of a lack of health insurance?

Which is worst? Free health care for all (UK) or Bankruptcy from high medical bills? (USA)
Well having read some of the strange comments that followed mine I feel compelled to comment again. In short US citizens pay over twice as much per capita for healthcare (on average) than people in the UK and receive a worse service when averaged over the population(note the UK figures include expenditure on public and private healthcare, not just the NHS). There are many benchmarks you can use but mortality rates are the first point of comparison and US citizens, who used to have a longer life expectancy than those in the UK, now live on average 2.4 years less. You can attempt to spin this however you like, but I don't see how its possible to avoid the obvious conclusion that US citizens are being fleeced for their healthcare. Were I one of you, instead of cherry picking nuggets that suited my political preconceptions (as the author has clearly done), I would be looking around to see how others have achieved more with much less and seeing what can be learnt from them.
Brits like their NHS for one reason, as Joe Biden would say, a 3 letter word: J O B S
No one has pointed out that in the US, people are motivated to find jobs that pay health insurance so they will have coverage. So they gain education in fields that are promising, such as medical fields, become nurses and medical technicians, physicians assistants, etc., in the hope of improving their lot. If they didn't have to worry about health insurance, Americans would lose motivation to improve their professional lives. We would also have to import nurses from India.
I liked the part about spending 20 Billion to have thetotal population on computerized medical records as I move forward with our USA government demanded EMR that is a waste of money as well. Also note how the use of anecdotal stories ( but ooh so compassionate) is a statistical& scientific waste of time but matters little to empowered goverment buracracies. Obama,Daschle, Berwick all love the NHS. Good Luck to your generation
The costs of the NHS is greater than you suggest. I lived in the UK for 9 years and worked for a major corporation. I did not know any permanent resident of the UK who did not also have a private health insurance policy. When they were told that they had to wait 18 months for a procedure they would pull out their private policy and go private. Most good doctors rent premises on the famous Harley Street and see private patients one day a week to supplement their earnings. Basically "hot seating" and sharing the offices with 4 other doctors.
You need to verify what I am saying but many people are paying twice for their health care in their UK. This is rarely mentioned.
Floyd R Turbo (American) August 20, 2012 at 3:46 PM
@clawhammerjake. Your comparison is logically flawed. Research for weapons systems is driven by an outside factor - namely; new weapons systems that have been fielded by our enemies.

Research on medical therapies is not similarly driven - new diseases appear only very slowly. Researchers in the US are motivated by: 1) the desire to improve the human condition, and by: 2) the activities of advocacy groups like the March Of Dimes (A group that wishes to minimize birth defects), and by: 3)the profit motive whcih is still strong in the US - although the FDA is making it increasinly difficult for companies to make a profit.

Bureacrats in socialized medical systems take a very short term view - they don't see the point of spending money on research that probably won't see a result for twenty years.

The net result is that prior to 1948 the UK conducted far more medical research than the US, now the positions are reversed. I used to work for the number three pharmaceutical company in the world in terms of sales. This company was number one in the European market (it was headquartered in Paris), but number 9 in the US market. In spite of this disparity the company made 90% of its profits in the US market. If the US turns to socialized medicine medical research will stop dead.
It was the British Health Care system that said the Lockerbie bomber had only 3 months to live and so he was released. They assumed he would be cared for in their health care system. After the release of the bomber, he was treated by Libyan Health Care and survived more than a year. Doesn't this prove the quality, or lack thereof, of the British system?
Floyd R Turbo (American) August 20, 2012 at 3:19 PM
Apparently the EU has ruled that the NHS can no longer require that nurses from other EU countries must speak English when working in the UK.

The British love the NHS because they no longer have a free press. The British press complains routinely about every other British institution except the NHS. This is because they want to support Obamacare (or complain about free-market healthcare) and they want to play up the virtues of socialized medicine. If Obama gets a second term it won't be long before the NHS is being negatively compared to the Cuban Healthcare system.

40% of Doctors and nurses in the NHS are ethinic minorities who have emigrated to the UK. Without the ability to pay these people low wages the NHS would be even more insolvent. But nobody has pointed out that it is morally reprehensible for a poor country like India to pay to educate a physician so that he can then go and provide care for people in Britain. India and other 3rd world countries need these people far more than the UK does. The UK should be educating UK nationals to meet this need.
It is a misconception that the poor in the US have no access to healthcare. They use emergency rooms or clinic and those agencies absorbed the cost by elevating charges for those who do have insurance. That $5 box of tissues is paying for a few other poor people who used the services without paying. Obama's plan to cut payments to doctors and hospitals will result in reduced services, delayed procedures and less medical people going into the business. Plus taxes on medical device makers,are forcing them to cut staff, offshore jobs and build research facilities overseas. A mad deal.
great article- unfortunately few in the US will read it.
PoliticalPaige.net August 20, 2012 at 2:49 PM
Never underestimate the ability of humans to fool themselves. Britons are dying at unconscionable rates from diseases and conditions that a free medical system treats routinely and with far greater success. But recall that the Jews forced into the Polish ghettos outnumbered their captors by many thousands, yet stayed in place, convincing themselves day by day that their plight was not so bad. Britons are in their own little medical ghetto, placidly accepting that they will simply die earlier and more painfully than their cousins across the pond rather than object to the socialist meme that they imbibe with their mother's milk.

And why not? It works. The Chinese by and large subsist on a few dollars a day, convinced that they are living in a worker's paradise.
It's hard to know where to begin a critique of this damning article. Here's just one example of how to lie with statistics: "In the 48 years of the twentieth century that preceded the establishment of the NHS, British life expectancy rose from 47 to 66 (that is, by 19 years, or 40.4 percent); in the 48 years after the institution of the NHS, life expectancy rose from 66 to 77.5 (by 11.5 years, or 17.4 percent). Thus life expectancy rose more, both absolutely and relatively, before the NHS than after it." A moment's thought should tell us that increase in life expectancy can't be linear -- if it were, it would have been 108.8 in 1996, and about 120 today.
That said, the key take-away from the article is in the headline: Universal mediocrity. We have a choice, universal mediocrity for those who can't afford private insurance, or appallingly bad healthcare for them. The resources simply do not exist to provide universal excellence for a rapidly aging population.
As a Brit I can assure your readers that there are plenty of things that Britons would like to see improved in the NHS; however, if they are relatively satisfied with the NHS despite this perhaps it’s because of value for money. According to OECD figures the average Briton spends $3487/year (9.8% of GDP) on healthcare whereas the average American spends $7960/year (17.2% of GDP). The average Briton lives 80.4 years whereas the average American lives 78.2 years. All Britons have access to healthcare whereas only the insured do in the US. Now things may not always be great with the NHS, but whenever we feel like complaining we only need look across the pond to see how much worse they could be.
Some people seem to think medical research will end under national health care. Only if we decide to let it. Has research in the field of national defense suffered because the funds come from the government?
As an American living and working in England, I also wondered about the supposed quality NHS. I had used it and never had any problem, but the English love to complaion and the NHS is an easy target. I checked with some friends in Germany who are doctors, and they had absolutely nothing but praise for the NHS in comparison to the German system. So, it appears that among doctors it appears that the NHS has an excellent reputation.
The Americans get tested much more often, which means they survive 5 years past that test much more often. That doesn't mean they live longer: just if you catch something in year 1 and the average lifetime from there is 5 years, you are much more likely to survive 5 years than if exactly the same thing is caught in year 3.

However, the extra testing comes at additional cost, both in money and in worry (due to false positives).

Unfortunately missing this point means most of this article is worthless.
"Universal Mediocrity," you say. Well, I would say it may be a bit slow in places, BUT everyone gets healthcare. Overall,then, the British are likely in overall better health than are Americans, overall. I think children and their families are worth delivering health care to, even if one has to wait a bit longer.
I understand this is an ideologically-driven column, but Mr. Dalrymple is only entitled to his own opinions, not to his own facts.
The peer-reviewed paper, published in February 2012 (abstract available online, Google it), shows that the authors compared the UK with 14 high income countries, including the United States.
Of the 23 areas covered, the UK is #1 in 7, it is # 2 in 4 areas and #3 in 2. So they have a top-three finish in 11 of the 23 areas. In Mr. Dalrymple's that is mediocre... Compared to which system and where?
So while the National Health System in the UK spends way less per capita than the United States and provides a service that is similar (if not better, look at the data) to the United States, the dicussion is therefore reduced to pure ideology.
I personally want a health system that provides the same treatment to everyone at the lowest cost to businesses and governments. I do not care if it is public, private or a mix of both. Let's stop writing propaganda.
What is typically left out of the story is how much R&D is done by the semi free market healthcare system in the US. More patents relating to technological and pharmaceutical products are out of the US. Americans pay a higher price for these things to offset the price controls of other countries, so everytime we pay $400 a month for a drug, we are footing the bill for many others in countries like Briton and Canada. If we go they way of the UK, the world better hope that Asia picks up the ball or medical development will stop in its tracks.
This article is full of misleading use of statistics. For instance, the author cites relative life expectancy as evidence the NHS isn't egalitarian. But on his own evidence (life expectancy primarily not down to healthcare) this statistic isn't relavant to the NHS. Indeed, even if life expectancy were primarily down to healthcare you would need to take account of whether some of the wealthier people were using private healthcare. So the conclusion that the NHS isn't egalitarian is pure speculation, relative to the evidence produced in this article.

Similarly the author mixes and matches between survival rates for hospital admittees, which will exclude the uninsured for countries like the US because they never make it to hospital, and survival rates for the country generally, which fail to consider lifestyle differences (see smoking, obesity etc) and the rate of private healthcare use even in countries with socialised medicine like the UK. It all smacks of cherry-picking.

Finally, the author laughably descibre the increase in spending on the NHS over the last decade as responsible for the financial crisis. No evidence produced, of course - because there is none. How the author managed to get a job writing articles for a journal primarily concerned with the City despite apparently being unaware of the global financial crisis (hint: the NHS is not global) is a mystery.
Those statistics are meaningless. The population is woefully uninformed about what's going on and have had their expectations downsized over the decades.
That is the major problem with the studies that rank the 'health care' in the world - they include a large number of things that have nothing to do with the ACTUAL care provided.

The author here does a great job of showing that regardless of how the UK (or any country) may FEEL about their health care, they are getting mediocre or sub par results. Survival rates of various ailments such as cancer, heart attack, physical trauma, etc are the only TRUE metric of how well any health care system is working (infant mortality rates are trickier - infant deaths, especially in 3rd world countries, can be due to complications that NO health care can overcome). And yes, if somebody is denied care and dies, that should figure into the mortality rate.

But the Ritalin is always free.
As a Yank with several relations in the UK, let me make the following observations:
1. @ Burleton, while all are pleased with the wonderful treatment outcomes for you and your wife, the main question examined by the article is whether substantially similar results are pervasive enough to deem the entire system a success given the costs and treatment outcomes. My 80 year old uncle also went in and came out of NHS in Manchester with a good result, but it seems clear to me that my relations' description of his outcome as a "miracle" is justified by the fact that he was not being given any proactive treatment and had in fact been written off upon admission. But I will give you a worse example of bad outcome, which gives some comparison to the US system. Over a year ago, a Northern Irish girl named Natasha McShane was brutally assaulted in Chicago, sustaining near fatal head injuries. She was treated, without concern for upfront costs (and her family has never complained about cost and they received cost support) at a better Chicago hospital. Within months, she was progressing well, with speech, cognitive functions, and motor skills returning. Her hopeful parents brought her back to NI, and a year after the incident, after months of continuing care in NI, Natasha has profoundly regressed, being unable now to walk or talk. Google can provide you with this well publicized story.
2. @ Braden, I think you are an example of the cost-anxious Briton to which Mr. Dalrymple refers, by virtue of your opinion that Americans must "mortgage" their homes to acquire the best medical treatment in a crisis. But what the article does not touch upon is the actual cost for the kind of anxiety relief to which you refer. In the US, people must obtain health insurance in order to avoid economic disaster in the face of unexpected medical costs. But most Americans pay less than 35% of their income in income taxes. Isn't the rate of income withholding in the UK over 45%? Regardless, I know it is much higher than in the US. Thus the unexamined question is, what is generally more costly: the tax per person paid in the UK or the insurance premium and non-covered medical costs borne by Americans? If the NHS is a satisfactory system, the British taxpayer pays a heavy price for it, a price which remains ever increasing.
3. @ Marju, you raise an excellent question which was not covered in the article and which also skews the comparisons, and skewers the "egalitarian" pose of the British system. Yes, there is an ability to procure "private" care in the UK. See http://www.nhs.uk/chq/Pages/2572.aspx?CategoryID=96&SubCategoryID=226 My very liberal aunt, who staunchly defended the notion of nationalized health care, had cancer, but in discussing her treatment, rather glibly told me that "of course" she was obtaining private care, inferring that she wouldn't trust her care under NHS. So this raises the question as to how many Britons, after paying exhorbitant tax rates for heatlh care, are opting to pay even more for private care. My aunt wasn't wealthy, therefore I would guess it is a substantial number. And if so, I would argue that it radically undercuts the notion that the UK provides equal care to all regardless of income or cost.
4. Not the best source, I know, but the Daily Mail once published an article about the high rate of "self dentistry" in the UK due to the general lack of dentists. A good number of people apparently resort to doing their own extractions at home. The British Isles seem to have a less rigorous concern regarding dental hygiene than Americans (yes, a stereotype, I know, but plenty of anecdotal evidence), and that can be dangerous. Studies show that tooth decay, bacterial growth, and gum disease can result in adverse affects in blood circulation, resulting in turn in more heart disease and other adverse effects. Perhaps one result of rationing is poorer preventive care.
Doesn't the US military use the NHS as a healthcare provider for its British air bases?
If you have the insurance coverage or the money, sure, you can get better treatment in the US. But in Britain you don't have to worry about getting treated -- and for the most part relatively quickly, especially at primary care level -- and whether one can afford to have any health care whatsoever. That's the point Dr. Dalrymple ignores here. A major, nagging, crippling worry for many Americans is avoided by the British. No wonder they love the NHS. I am a US citizen who has been living in Britain for 20 years and can understand this very well.
Isn't the idea that there is no public health care provision in the US just an Americanophobic myth perpetuated by left leaning liberals such as Michael Moore in his truly appalling "documentary" "Sicko"?

In the realm of mental illness at least I don't get the impression that people are bring left to rot, despite what propagandists with sinister agendas all of their own have to say.

"Obamacare" seems to be all about fixing something that isn't actually broken.
Isn't the idea that there is no public health care provision in the US just an Americanophobic myth perpetuated by left leaning liberals such as Michael Moore in his truly appalling "documentary" "Sicko"?

In the realm of mental illness at least I don't get the impression that people are bring left to rot, despite what propagandists with sinister agendas all of their own.

"Obamacare" seems to be all about fixing something that isn't actually broken.
I cannot claim personal experience, but I do have friends who are British subjects. I think one factor you ignore here is the relative lack of aggrevation which seems to be a feature of the NHS, at least in dealing with relatively simple problems. I have relatively good health insurance in the US, and the volume of ridiculous and incomprehensible paperwork which accompanies every medical visit is daunting. Dealing with for- profit HMOs almost always involves copayments,appeals, questions, and so on. If my friends are right, that does not happen- one told me she was treated for a broken leg, and went home after a few days in the hospital with no charges and no paperwork. This may be secondary to the sophistication of care, but it is something to remember, from the patient's point of view.
unlike the american system which is universally despised as in efficient,too expense and ludicruis in design. need to move to Swiss or Taiwan system. to defend the current system is insane
It really doesn't matter what authors like this write. The bottom line is that the degree of satisfaction with the health system is higher in the Uk than in the USA. Try by all means to misinform people, but it really doesn't matter. The British are proud of their system, don't tear them down. Let them enjoy it, and support the American system objectively.
I hear that in "Socialist Yookay" the state kidnaps great doctors (like Dr Dalrymple) from their Harley Street surgeries and forces them to work for the NHS.  Somebody should DO something.  Or maybe the US should just offer them political asylum.
"funkg August 20, 2012 at 9:39 AM
Do you not ever have a good word to say about our country (UK)? Month in month out you delight in trashing almost every institution of this great nation of ours. Yes we have our issues in the UK, we are crowded, we are unsure about the massive increase in immigration and we worry about the economy, but we move on. but with you instead of showcasing our achievements and attributes you delight in your pseudo colonel Blimp role in front of a mainly American audience. "
A case of playing the man rather than the ball -
you have ignored everything he said.
Theodore,

Surely you know the reason. It is because it is not PC
to say these things. I have many friends who are immigrants and none of them share the mainstream UK
view about the NHS.
It is hard to believe that they are all wrong.
However I would never in public say that the NHS is not wonderful.
Only racism or holocaust denial is worse in the UK.
There are lots of things which need to be changed in the UK and can be e.g. immigration policy, benefits and law and order. Sadly changing the NHS to something very different is not possible.

David
I believe there is a side-by-side private system for those who can afford it in U.K. How do the results for those people compare with the NHS?
One could argue Britain had the luxury of spending on a huge entitlement because the U.S. shouldered it's defensive and security burden over the years (or at least was the senior partner.)

Even so, I wonder if the lackadaisical and middling economic environment since Thatcher can be blamed on such expenditures. Sure, it's got a NHS, but overall, what has Britain contributed to the world lately? Demographically, the nation is shifting, and it's culture is changing. From a bird's eye view, I don't think we've fully understood the myriad ways such a huge giveaway affects a population and a nation.
Our neighbor was a Brit - after a football accident he broke his arm and had it set in Britain. Whatever the British doctors did, they did it very poorly, and weren't going to fix it - so on coming to the States he had his arm taken care of by American doctors.

It's anecdotal but these people, who voted for Labour their whole lives, had no love for the NHS.

The health care system in the United States may desperately need modification, but why not learn from the mistakes of those who do have universal health care?
The NHS...like all socialism...is an example of redistributing wealth and resources in the quest for utopian "equality". The result is an equal distribution of povery....unlike market-oriented systems which have an unequal distribution of wealth.

Europeans are plagued by Class resentments. Socialism is the most effective method of dealing with this, but the downside is the creation of a host of disincentives for good performance. The NHS does deliver "equality"; it does not deliver quality healthcare.
Reading this analyis of the effectiveness of the NHS brings to mind the proverbable story of the Frog in the Frying Pan - throw the frog into the hot pan (NHS) and he will leap right out - put him in the pan (NHS) and slowly bring the water to a boil and he'll accept his fate quite nicely.
I was a Navy Hospital Corpsman in the '70's and got a good first-hand look at how government controlled health care fostered the entitlement attitude. It wasn't pretty, to say the least. People being treated for free usually showed very little appreciation for what they were getting, and indeed were usually very demanding.
Do you not ever have a good word to say about our country (UK)? Month in month out you delight in trashing almost every institution of this great nation of ours. Yes we have our issues in the UK, we are crowded, we are unsure about the massive increase in immigration and we worry about the economy, but we move on. but with you instead of showcasing our achievements and attributes you delight in your pseudo colonel Blimp role in front of a mainly American audience.
Universal mediocrity is better than mediocrity for 80 percent of the population at 50 percent more cost
At the age of 87 I have nothing but praise for the NHS which has kept me alive, having survived removal of cancer from the colon in 2006 at St.Mark's Hospital. My eyesight has improved 100% since cataracts were removed in 1997-98 at Moorfields Hospital, and a knee replacement at Stanmore orthopaedic in 2007 has been completely successful.
My wife had a successful operation at Harefield Hospital in 2010 on a large aneurism in the ascending aorta close to the heart replacing about 2" of the artery with a dacron tube.
In addition, we have had excellent service over the past 30 years, from the doctors in Ellis General Practice, Wembley.

Why do Britons like their NHS ? Simple, they don't have to mortgage their house to get comprehensive treatment. By comparison the cost of U.S. medical treatment is exceedingly more expensive.
For an Australian, the medical insurance cover for a visit to the U.S. is several times more costly than that for Europe. The insurer will fly you home at all costs rather than face the massive cost of U.S. care. Not so for Europe.
The question and its answer is already in front of you; Socialism thrives on mediocrity and the acquiescence of the masses.The Illusion of Egalitarianism,(Kekes)is a great departure point to read.
Informative. Shows no improvements over the years.
You lost me when you converted increases in life expectancy to percentages. This is classic innumeracy and abuse of statistics.

There is no ceiling on personal income, no difference in the nature of the millionth dollar and the billionth dollar. Percentage comparisons would be appropriate here.

But in life expectancy there is an absolute ceiling of around 110, and a practical ceiling in the 90s.

More importantly, there are substantial differences in vulnerability between, say, the fifth decade and the tenth.

So converting changes in mortality rates to percentages has no meaning.