Obamacare vs. the National Health Service

From Thinking Outside the Boxe’s London Correspondent

One of the most controversial bills to pass through Congress in recent years has been Obama’s healthcare reform bill. “Obamacare” has received extensive criticism, both from parties who resent the idea of government intervention in the health care (including the rumors of so-called “Death Panels” that would decide who gets life-saving treatment and who does not) and from those who believe that the bill does not go far enough.

Critics of socialized medicine often argue against “Obamacare” by pointing across the Atlantic to the United Kingdom, which has had a socialized healthcare system known as the NHS (or National Health Service) for over 70 years. Arguing that the NHS forces an entire nation to accept substandard health care, these critics fear that Obama’s new health bill will inflict a similar destructive situation on citizens of the U.S. if it is not repealed or overturned. However, these fears are based on two fundamental errors: a sensationalized misunderstanding of the nature of the NHS, and the mistaken belief that Obamacare bears even the slightest resemblance to the European concept of socialized health care.

The NHS in the U.K. is a system where all medical treatment that is considered “necessary” (including visits to the GP, hospital stays, operations [typically not including plastic surgery], ambulance rides and dental work for children) are ostensibly free, funded by taxes instead of by insurance companies or by those receiving care. This means that there is greater equity in the treatment of rich and poor. Those who wish to buy separate private health insurance, or pay for unnecessary procedures such as plastic surgery out-of-pocket, can also choose to do so, but no individual under the NHS has to worry about the financial cost of treatment while attempting to recover from an accident or illness. Obviously, the NHS is not a dream system. It does suffer from underfunding, and people often have to sit on long waiting lists to receive “non-urgent care,” such as hip replacements. Some expensive and unproven new treatments may not be available to patients on the NHS, and many critics of the system refer to the so-called “postcode lottery,” meaning that the quality of care you receive often depends on where in the country you happen to live. However, although many beneficiaries of the NHS criticize how it is run, it would be very difficult to find anyone in the U.K. who believes that the system should be scrapped in favor of privatized health care. Any politician making such a suggestion would be committing political suicide.

Obama’s new healthcare bill is nothing like this system. First and foremost, Obama’s bill is mainly concerned with health insurance, and not with the provision of health care itself. 46.3 million people in the U.S. were uninsured in 2008, and millions more were considered to have inadequate health insurance or “under-insured.” “Obamacare” attempts to remedy this and other problems with the insurance system, such as insurance providers refusing to support those with preexisting conditions, by introducing the individual mandate, which insists that every citizen must have health insurance in some form.

Although people have rejected this unnecessary government interference, the insistence that everyone receives health insurance protects more vulnerable members of society by lowering premiums and ensuring that companies cannot reject customers for being in a situation where insurance payouts are necessary, while benefiting anybody who may find themselves suffering from an unexpected illness. Those who compare this to “socialist” Europe should note that the NHS does not require anyone to buy health insurance, as health care is provided for free to everyone; perhaps Obamacare would therefore benefit from being more and not less similar to the European system. Obama’s healthcare bill also makes it illegal for insurance companies to deny coverage to uninsured individuals with pre-existing conditions, prevents insurers from dropping individuals once they do fall sick, and bans yearly and lifetime limits on care. It also aims to improve the Medicare system by providing free preventive care. Can these changes really be considered detrimental to citizens of the United States? And if the bill’s problems are that it fails to achieve these goals, it is criticizable not because it is too similar to the NHS, but because it falls far short of this standard.

Many critics argue that Obamacare and socialized medicine are too expensive. Considering the U.S.’s current budget deficit, it cannot afford to invest more money in healthcare when private companies can fund these gaps instead. However, before the introduction of Obama’s healthcare bill, the U.S. spent far more on healthcare than any Western European nation. In 2006, for example, the U.S. spent $2.2 trillion on healthcare, while the NHS only cost the U.K. £105.6 billion or approximately $161.5 billion dollars. Although the population of the U.K. is approximately 25% of the population of the U.S., the U.K. government spent only 7% of the amount of the U.S. government on health insurance. According to the OECD, the U.K’s per capita spending on healthcare is $2,992, while the U.S.’s per capita spending is $7,920. The U.S. could therefore implement a comparable system to the NHS and still decrease its annual spending on healthcare. If it dedicated the full current spend to a socialized system, it could also improve upon many of the flaws in the British example, and while some people balk at giving the government control over spending on such an important individual issue, others point out that the big businesses that currently control U.S. healthcare, including hospitals wishing to turn a profit and health insurance companies that rarely have their customers best interests at heart, are unlikely to provide a better alternative.

Perhaps the U.S. could benefit from taking an approach more like the NHS. But the current reforms bear very little resemblance to such a change. In many European nations, including the U.K., free health care is considered a basic right. If the U.S. is not ready for a similar perspective, Obama’s new health bill at least serves as a stopgap measure to protect those who would otherwise be left paying impossibly high medical costs due to the private healthcare system. The problem with “Obamacare” is therefore not that it comes too close to the European example of socialized healthcare; it does not come close enough.

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