A National Health system in USA?

Home of Fred the Snake (and Dr. Peter)

A National Health system in USA?

The current bizarre health care “discussions” in Washington prompt me to comment. I grew up with, and served in, the National Health Service in Britain. When initiated in 1947 it was relatively inexpensive, since medical care was much less complex and most people died soon after retirement, if not before. The funding did not keep up with the enormous subsequent changes, and It was grossly underfunded in the 1980s when I was struggling to run an academic program in London. I was the only effective gastroenterologist in a 500 bed University hospital, responsible for all clinical activities, teaching and research, and also on call for acute general medicine. After 13 years I was glad to take up the offer of a position at Duke University in USA, where excellence, innovation and productivity were welcomed, and rewarded. And I have been very happy subsequently at the Medical University of South Carolina in Charleston. The best of US medicine is truly great, but I continue to be concerned, indeed embarrassed, that so many people do not have access to it. This lack of universal coverage is unique amongst advanced nations of the world. Despite spending a much higher proportion of GDP on health care than other countries, the overall health statistics are no better, and, in many areas, worse.

I am convinced that a single payer system is essential, and indeed inevitable eventually. You may say that I was  glad to escape such a system in Britain. Yes, but it has improved enormously since I left. Most Britains love it, as most Canadians love their similar system, despite what some allege. You may ask “who wants government in their health care”? It is deep in there already, with Medicare and Medicaid covering at least half of it (unless and until the Republican party decimates those programs). It is not perfect, but many people now bless the day they reach 65 to gain access to Medicare. The Democratic platform suggested a move in that direction with an option to allow folks to sign up for Medicare at 55.

The people making decisions in Washington are going to remove the insurance mandate, a key part of President’s Obama’s bill that obligated everyone to buy insurance, or pay a fine. This was to provide universal coverage, and bring healthy people (and more funds) into the insurance pool. Will our representatives also release us from having to have car, home and flood insurance? That would certainly save us money……until something bad happened.

Our representatives in Washington continue to ignore the input from all of the major medical organizations. What do doctors know about health care? One group that is pushing for universal coverage is “Physicians for a National Health Service” (worth a look at http://www.pnhp.org). Of course the devil is in the details, but there are plenty of smart people who can address them. Let’s at least try.

Gentle comments welcome.

July 6 2017. Many thanks for helpful comments. For those wishing to explore “single payer” further, there is a good review at  https://www.amsa.org/wp-content/uploads/2015/03/SinglePayer101.pdf     Note that it does not have to be government run.

We have an unusual President who likes to say and do outrageous things. Check out his repeated support for a single payer system    https://www.washingtonpost.com/…/trumps-forbidden-love-singe-payer-health-care/

Can we dream? It would scandalize his Republican “colleagues”, but maybe save his presidency.

One final comment about the National Health Service in England. It is not perfect, still underfunded and bedeviled by repeated political restructuring. It has also been disrupted by having to observe some European Union regulations. Everyone is covered by the NHS, which is “free”, of course paid by taxes, but there is an option to take out private insurance, as daughter Nicola mentioned. It is not expensive, but important to realize that it covers only elective issues, like specialist consultations, hip replacements and screening colonoscopy. There are no full-service private hospitals. If you get sick you go to an NHS hospital, and, usually, get well treated.

Surely a multi-talented US commission to look at all the systems in other countries would be worthwhile.

11 Responses

  1. Elaine Rawls says:

    I couldn’t agree with you more Peter.

  2. Nicky Richardson says:

    Very interesting Dad. We are indeed very grateful for the NHS in the UK and despite many negative headlines, my encounters using it have generally been very good, especially where the kids are concerned. We are fortunate that we are also covered by private health insurance which is cheap here compared to America, so we have options. I agree the US system needs to change. I know Obamacare was not popular with everyone but surely there must be a way – as you say there are plenty of smart people – to come up with a system that works for all.

  3. Dale Boozer says:

    I agree with everything you put in this post. I have Medicare and the Blue Cross supplements F and D. and of course “B” and “A”. It has been a sincere blessing since I am not employed and thus have no access to a corporate medical program (like I had when I owned a large company). I had to buy insurance for my employees (200 of them) and thus know a little about insurance. A single payer system basically covers 50% of Americans now, as you say. And the Fed. Gov. is not going to run out of money, they spend trillions on places like Afghanastan and no one complains. But spend dollars on making citizens healthy and some folks are up in arms. Possibly because of special interests promoting certain interests with large propaganda campaigns. But, as you say “God is in the details”. Get the details wrong, and single payer would be terrible.

    • Ann Procter says:

      Hi Pete,
      Be wary about what you say about the N.H.S. being a shining example. Lots of people find it unsatisfactory, some say VERY unsatisfactory – unacceptable waiting lists for ops, difficulties in getting an appt. with G.P. , long queues in A & E, wasteful bureaucratic fumbles, masses of expensive litigation for errors. We rarely visit our G.P. – unusual for people in their eighties ! – and seek help outside the N.H.S. to keep us as healthy as possible, just to avoid the inevitable hassles and delays.
      We are also aware that the pharmaceutical companies are making HUGE profits by selling their wares on the basis of dubious and biassed research so that many people, particularly the elderly, are on multiple medications which in themselves cause difficulties.
      We do hope that you over the other side of The Pond can find something which works better, and perhaps our own government could take note of your successes !
      Lots of love (sister) Ann

  4. Jan Mashman says:

    Agree completely

  5. janice Crean says:

    Good to read what’s on your mind Peter. Gerry loved working in the NHS and like him I feel that they are there for us, with sometime waiting lists but in an emergency they take us in and do their best to make us better. I like the sound of the Dutch system – the super rich pay the most for National Health Insurance, middle incomes pay less, poorer people pay the least and those at the bottom of society without any money get it free. It is simple and fairer and it works, and to me has almost a Biblical feel about it. Would that Mr Trump had a genuine wish to solve the US health care system, other than doing Obama one in the eye…!
    Love from Janice

  6. Dick Kozarek says:

    It is unconscionable to deny individuals health care or to expect hospitals and individual medical practices to pick up the costs of the uninsured. I support some form of universal health care. I support some form of government control of drug pricing. It seems absurd that we our pharmaceutical costs are several-fold higher than prices paid in Canada. I am a US physician.

  7. Miles Allison says:

    One strange thing is that we have four different health services in the UK. Here is Wales (and Scotland and NI) we have the Nai Bevan model without the Lansley commissioning processes. In fact commissioning is almost a dirty word in Wales. Waits for diagnostics such as endoscopy are embarrassingly long, but the model works better for the acutely unwell. Yet our hospital looks embarrassingly shabby from the outside, and infrastructure spending just isn’t there. Health service inflation outstrips general inflation by miles due to innovations and ageing population, so what we need is a cross-party commission on how we can fund healthcare in the long term. Am I alone in believing there is logic to tax breaks for private medical subscriptions?

  8. Dr Mike Anderson says:


    In spite of all the problems, like you, I am a strong believer in our NHS. I cannot claim it as the best in the world at present, but the idea of looking after everyone’s health “free at the time of need” is the sign of a civilised society in the 21st Century. The NHS can perform as well as anywhere and with few exceptions the vast majority of my patients were very grateful and spoke highly of their care when returning from hospital. However, demand is ever increasing, interference, constant change, lack of support and neglect by successive governments has destroyed the NHS. Too much is expected for too little and needless to say it is grossly underfunded with less %GDP spent on it than in any other civilised society.

    It is a Nationalised Industry and as such is not alone. All Nationalised public services are in the same boat. There has been a 1% cap on sector wages since the 2008 Banking Crisis. Banks were bailed out at enormous cost to the tax payer but essential services such as Fire, Police, Transport, Prisons, Education, Armed Forces have been forgotten and are under enormous pressure.

    I am sure that the best medicine in USA is extremely good but is only available to 50% of the population who pay enormous sums to their insurers. I know through family experience that care is patchy in USA even when paid for handsomely and is dependent on to which hospital one is admitted in an emergency. I know which system I would prefer!

    Leading countries of the world need a sound economy on which to function effectively. However, we seem to have “introduced and encouraged a greedy, self-serving species who has substituted social conscience with blinkered materialism” as one of my more learned friends remarked recently. It is time that those who can should show more responsibility for ensuring the welfare of those less fortunate as happened under the Whigs in the 19th C. Neither our Labour or Conservative parties show any sign of responsible leadership. What we need is a cross party coalition and a Churchill who has the guts to get us out of this mess; perhaps the same applies to USA.

    Unfortunately President Trump is dangerous, not up to his job and a child could probably do better. Both UK and USA need a new and inspiring Leader, rather like President Macron in France – although it is early days!

    I would encourage all physicians to stand up, be heard, take a lead as you are doing and not be brow beaten by politicians.

    Kind regards

    Mike (Anderson)

  9. John Cunningham says:

    Totally agree, we need a system that will cover basic healthcare for all. And the current thought to go ahead and drop the ACA, and we’ll submit s new plan in the future will leave millions in the lurch. US physician like Dick.

  10. Barry Slowey says:

    Great thoughts peter. There are many variations on the NHS in multiple different countries around the world. All of them with various pro’s and con’s. Why can’t we have an intelligent, informed debate in the US that looks at the various systems around the world and adapts some of their better points to develop a customized solution for the US. It is unconscionable to me to have a large part of our population live from day to day without access to healthcare. It should be a basic human right in a country as wealthy and successful as the US.


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