To bring some diverse experience into the discussion on health care reform here in the USA, I’ve asked my friends in Europe to share how health care works in their lives. In this second of four entries, here are comments from my British friends:
From Martin in Wales:
The National Health Service (NHS) in Wales is essentially the same as the English NHS founded over 60 years ago. Today, the main difference between the services in England and Wales is that in Wales (as in Scotland) we pay nothing for medications. Our Welsh Assembly decided that no matter the cost of the drugs, the duration of the illness, or the wealth of the patient, no charge is made for prescription drugs.
This fulfils of the one of founding principles of the NHS — like justice, health care is “blind.” You are treated no matter who you are or what your financial means are. None would pretend that the NHS is perfect: New and expensive drugs are used to combat diseases in an increasingly aging population, which puts financial strains on our system. However, knowing that the NHS will try always to treat you to the best of its ability is something valued highly by most Welsh people.
Treatment under the NHS is free, but the cost is huge. We pay for it in our taxes. In the US, people pay insurance companies for their health care, whereas in Britain, we pay the government. You may think this makes the two systems the same, that it’s only a matter of who you pay. I don’t think so. Don’t forget that the NHS is “blind” and its blindness is its true virtue. Insurance companies insure the individual for a profit, while the NHS delivers care, free to all.
From Tom in England:
The United Kingdom National Health Service (NHS) was 60 years old last year and continues to provide “free” health care from cradle to grave. The NHS is state-funded. It is paid for by employers and employees making a contribution direct from earnings. Care and treatment is free to citizens. Drugs are about $10 per prescription. The NHS system enables completely free access and care for people who can’t pay taxes: the poor, unemployed, and elderly.
When things go wrong with the NHS, it’s given massive prominence by a media looking to sell newspapers and pump up TV ratings. However, for the majority of the English — those not made fools by hysterical media coverage — it is quite popular. We like the NHS because it takes away the worry about what would happen if your health fails, if there’s an accident, or if you just need help as you get older. It’s not perfect. No health care system is. But there are millions of people who would testify that they’d be dead without it.
The creation of our free service came after World War II, when there was a desire to spread health care to all citizens. The demographics have changed since then, however. A population that lives longer requires more costly care. Every society needs to deal honestly with this reality. Life-saving treatments have been developed that cost more. And so, in 2009, the NHS is one of the biggest topics of political debate — it’s called by some a “sacred cow.” The bottom line is that none of the major political parties will try to remove it — and certainly not when they are facing a general election in 2010. I think most of us would call our NHS a 60-year-old success story, regardless of today’s financial challenges.
I know this is Rick’s blog and he has his views on this. However, why don’t we so a more balanced view of this from Europe? Not everyone enjoys the system. One thing that is VERY VERY important to point out here is that European countries DO NOT have the debt America does. European countries, as part of the EU, are required to have a balanced budget and stick to it. Therefore, any system run by their govts can be assured of not overspending. In America, we know this will never be the case. We have seen it every step of the way from times of prosperity to times of struggle. And time and time again, govt spending is not the answer. We are working on two different playing fields here when it comes to govt sponsored health care. When are we going to see the other side of this argument which actually deals with the reality that we live in here in America as opposed to the feel good, idealistic system where “everyone” is happy and feels good about things in Europe. Sorry but that just isn’t reality.
Excellent posts by all. Wasn’t there a recent study done that came to the conclusion that if the Clinton tax and budget plan had been left in place the US Federal budget would be in surplus today, and the total federal debt would have been paid off? I am not sure if this study made the assumption our adventures in Iraq would not occuring. Interesting that my verifier is muntions; one can have muntions or health care, but not both?
I think these views do represent the vast majority of their respective nations. They certainly reflect what I’ve heard when traveling. Though many, maybe even most, would like to see relatively minor tweaks of one sort or another made in their healthcare system, very few wish to privatize healthcare, virtually none believe that universal healthcare isn’t a basic human right. I’ve yet to meet any who’d say they’d trade their system for ours.
It is always informative to read the replies to Rick Steves’ blogs. You don’t get universal insight to our country’s citizens because those who follow RS seem to represent just a select segment of our population. In our country we pride ourselves on having brought ourselves up by our bootstraps even if we were provided a good education, family help with finances, taxpayer subsidized mortgage interest rate reduction, taxpayer funded schools, veterans’ benefits etc. And what is more revealing about our circumstances than the fact that some of us have traveled and have friends in other countries? My own experiences in government, business and non-profits give me the impression that those that have comfortable circumstances do not want to give up much if any of it to help the less fortunate – partly because they think the less affluent could have earned it if they tried hard enough (or were born into the right family) and partly because they distrust our government(or Boeing and banks) and partly because they feel there will be nobody there to help them with their own problems in a society that values self-sufficiency over all else. Anytime group well-being surfaces as an issue, we want to know “what will it cost me?” Some other countries have better social safety nets because they value their citizens of all ages more than we do. Our own “I’ve got mine crowd” is very vocal, influential, and, often without justification, feels it has earned affluence because of our brilliance and diligence – when in fact parentage, race, luck, and economic conditions meant we were born with silver spoons in our mouths compared to others. The United States of America can afford health care for its citizens even if it’s not quite up to par with the health care the U.S. Congress has voted itself. Bill Kester
those that have comfortable circumstances do not want to give up much if any of it to help the less fortunate…….. The USA is the MOST charitable nation on earth! http://www.msnbc.msn.com/id/16638810/
Read the footnotes on that link. That percentage is boosted because our government provides mighty tax incentives for “charitable giving.” Plus a large proportion of that giving goes to our churches – including funding to build nicer churches and worldwide efforts to proselytize. Plus 1.67% isn’t anything much to brag about in the first place… which kind of proves bill’s point. Plus many in other nations “give” via their tax dollars, in providing “humanitarian and foreign aid,” where the U.S. ranks near the bottom: http://www.princeton.edu/~soapbox/vol2no4/24noveck.html Take it all together, and you might wish to add a bit more humility to your claim.
Thanks for posting this Rick. I’ve been asking my friends around Europe the same thing. They all seem to like what they have, but I would be very intrigued to know their main concerns or criticisms of their system. So far there is nothing but general praise in your contacts’ responses. Surely there must be other sides to the story?
The USA is the most charitable nation on earth! How does the USA rank in giving as a percent of GDP? In giving per capita? In governmental giving (foreign aid)when military aid is excluded?
Ok, I’m not seeing many (if any at all) claims that the American health care system is perfect as is and should not be improved. Nor am I seeing any testamonials about any private company (or collection of them) having all the answers. What I have said and will say again is that I am very afraid of the U.S. government being responsible for this. I’m sure someone will say that the public option is only one option and that the private insurers will still be there etc, etc. However, my question is how will that public (read government) option stay in business? No government business I can think of is ever competitive with the private sector (i.e. the post office, etc) unless they have a monopoly situation. It’s not because private sector business men and women are all geniuses and government officials are idiots. For the most part it is because government officials almost always make decisions about everything based on what they think the voting public may jive to on election day rather than making the tough decisions sometimes needed. Here is what Tom from England said: “…none of the major political parties will try to remove it—and certainly not when they are facing a general election in 2010.” In other words, they know they need to make a tough decision about the going costs (as they careen toward insolvency) but will not since that may cost them votes. To whomever was ranting about the private sector being short term focused (perhaps dprat), is this not the perfect example of being dangerously short term focused? I have a real life example where our senator’s office in Washington informed us they would not propose eliminating/reducing a tariff to help our business because that seemed like corporate welfare and could cost votes in the mid term election. Interestingly, the product being tariffed does not compete with any U.S. market.i.e. unbelievable since tariffs are intended to protect U.S. businesses. Govt run health care? Please no.
Bill has hit on the point I have made before and in the previous post. While health care may be a good idea, how are you going to make it happen when you are fighting the culture here in America? This isn’t just a nice idea here. You have to change culture and expect this plan to be carried out and administered by a govt trillions of dollars in debt and known to have run many programs into the ground. One reason this can succeed on some level in Europe is because countries are REQUIRED to balance their budget. There are so many obstacles to overcome here in America to pass this that it would be a good idea to address the realities of this rather than the idealism of it.
Ok, one more comment on this as another point has been made. The USA is a more giving country and it isn’t for churches. True giving, in my opinion, happens when it is from the heart. And many people are moved to give to katrina victims, or hungry people, or orphans, or the homeless, or whatever it might be out of their own pockets. If you look at giving in Europe, the number and percentage of people who give are way below the US because they expect the govt to do it. If you look at this from a Christian point of view, that is COMPLETELY and TOTALLY WRONG! We are called to give to, care for, and love one another. It’s great if your socialistic govt takes care of this for you but where is the sacrifice and love behind that? If you depend on someone else to do you charity for you, then you have missed the point. It’s not just to help but caring enough to be part of the solution while being touched by it at the same time.
Then, I assume, Jeremy B, that you will join me in proposing that all tax incentives for charitable giving, especially to churches, should be eliminated? Because we want to make sure we purify our motives, that “giving” involves as much “sacrifice” as possible? Of course, this is ludicrous. If Europeans pay higher taxes, in (some, perhaps small) part because their nations provide greater humanitarian and foreign aid, that’s not a “sacrifice?” Of course it is.
Jeremy says “One thing that is VERY VERY important to point out here is that European countries DO NOT have the debt America does. European countries, as part of the EU, are required to have a balanced budget and stick to it.” Not true. Lots of places to look it up. For a list try: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2186rank.html For a graphic, here’s: http://www.metlin.org/blog/wp-content/uploads/2009/07/national-debt-by-gdp.jpg Several of the European countries have debts larger than the USA’s as a portion of their GDP.
Quoting Jeremy B: One reason this can succeed on some level in Europe is because countries are REQUIRED to balance their budget. Quite simply not true. I lived in the UK for the first 40 years of my life, then moved to the USA twelve years ago (my wife is American). The amount of absolute nonsense I have read about the British NHS since moving this side of the pond is absolutely beyond belief. I only wish that the population of the USA would wake up and do a little research, you are being consistently *lied to* by the opponents of a universal health care system for all. I really don’t understand how so many people can be brainwashed into accepting the HMO propaganda. I have one friend who’s in sufficiently dire financial straits that she qualifies for Medicaid, yet she’s adamantly against “socialised medicine”. Huh?
Having worked in the UK for 7 years back in the late 90’s, it seemed that many of the people in middle management and above (the upper middle class) did not enjoy the health system that they had. sure it was great for the everyday items, but most of them found themselves buying health insurance on top of the NHS in order to get priority in certain instances and be able to visit “private” hospitals. They felt the care at these facilities was better and you did not have to wait, but it came with an added cost. And on top of this, Dentists were almost non-existant unless you lived in a larger city. Most in the UK found that dentists were not a necessity, mainly due to the fact that basically nothing was covered under the NHS. So I could give you several people that could write in here that would give you a different view than what you see here. Two people in a country of over 55 million is a little lite.
To Brian who said “I have one friend who’s in sufficiently dire financial straits that she qualifies for Medicaid, yet she’s adamantly against “socialised medicine”. Huh?” I think you are asking the wrong question. I’ll admit that I don’t know much about the UK health care system or any of the other ones on Europe. However, what is clear from all the posts for all the European countries so far is that taxes are higher than the US (in fact much higher in many cases) as result of entitlements such as universal/socialized/government/whatever you want to call it health care. If you ask me in absolute if I would want universal health care, of course I would say yes. However, a more relevant question would be do you want to give up 20% of your take home pay for universal health care? I’m ballparking something around 20% tax rate for mean incomes going to something more like 40% (52% if your in Denmark according to the posts). If you make $50,000 per year, that means your taxes go from $10,000 per year to $20,000 per year. Let’s assume folks are lucky enough to live 20 years (say age 20 to 40) relatively healthy with no major health issues (which most people do by the way). That means $10,000/yr times 20 years = $200,000 of take home pay gone presumably to pay for health care. Perhaps its going to the greater good and maybe that’s ok–likely a lot of it is going to waste and beauracracy. Point is, what most people against government run health care are saying is I’d rather keep my money. Of course the politicians and President are saying it will be cheaper and not raise taxes…I bet some politicians said that same thing in many European countries before the tax rates hit 50%–and by the way, European economies aren’t doing much better than the U.S. economy with many doing worse. Net, the Europeans may have free health care for now, but seems to me things are heading for a train wreck–read the Italy posts. Aging population=fewer taxes=insolvency=bad news.
Priorities-I trade currencies for a living and the dollar has gone up and down dramatically in the last year but has not crashed. Currency markets are controlled by financial fundamentals and by the large banks(the market makers because they make the large trades daily) that cause currencies to rise and fall. There is no SEC in the currency markets to enforce rules. There is 3 trillion dollars traded daily and the large traders will not let the dollar crash or it would ruin their markets and profits. The EU is 13 trillion in debt and will have its own set of problems if they dont control it. The GBP is in much bigger risk of crashing than the dollar. The only way the dollar will crash is if we continue to rack up trillions in debt. There are common sense ways of lowering the cost of healthcare,reducing the profits of insurance companies,covering the low income folks and maintaining quality care without a government option and raising the debt. Its just that the debate right now is about the government option and nobody is talking about any other options. Nobody is saying that George W was a financial wizard because he spent like every other administration and then some but the debate right now is with the current administration and I am still waiting to see an example of that great intelligence that many claimed Pres. Obama posessed. I agree we should have left Iraq long ago but when you raise taxes on those who create jobs and run businesses they tend to do something else with their money and un-employment will go above the current 10 percent. Neither side of the aisle has it right. History has shown that do the best when both sides propose ideas and then compromise.
dprat, your point is valid. However, let me pose this question to you in terms of giving. Which scenario do you think actually gives more – one in which the amount given is dictated by someone else in which you don’t have a choice or one in which you make a conscious choice to give on your own? You may be surprised to see that the latter may actually end up giving more than the former. Therefore, I argue that the amount of charitable giving is greater than the taxes that the govt could collect otherwise and give in place of it. As for matter of priorities, it is EASY to have a budget surplus. You can write down on a piece of paper that you will bring in 100k and only spend 95k. It’s another story altogether when you look at the amount actually spent. While there was a budget surplus on paper when Bush took over, the national debt actually increased under Clinton. This is not to argue that Bush didn’t increase it more. But it would help to know the difference between budget and actuals.
I find it interesting that no one brings up the cost of their own health insurance coverage. When I was working my company paid over $800 per month for my individual coverage (I paid for the family coverage but lets just stay with individual coverage) and if that figure ($9,600 per year) were added to my total yearly paid taxes, that total would be higher then the 30% to 50% level mentioned in these blogs. Individuals pay for coverage either through their employer or directly but the cost is paid by the employee becuse the company has a total cost of employment figure they place on each position within the company. Part of that cost figure is your salary but benfits and employer paid taxes are also a part of that figure. I feel removing the anti-trust exemption, allowing cross state insurance company competation (each state through there insurnce commission controls the sale of insurance by each carrier) and a government option (like opening up Medicare to all) is a safe answer. Also, a culture shift is necesary on law suits and aggressive medical practices is necesary. Americans like to sue to correct wrongs and seem to never be satisfied with a doctor saying take two asprins, rest and call me if your cold gets worse. We want to have the latest medicine to make us better instantly when there really isn’t a pill but rest and let the body cure its self is the answer to our illness.
The risk with a government option is that they (the government) don’t have to make a profit to stay in business. Therefore, it is easy for them to undercut the insurance market and put everyone out of business; which given the appetite for power in Washington, is highly likely! I say open up the market first; evaluate the results; then move forward as needed VERY SLOWLY. This problem does not need to be ‘fixed’ all at once, as that’s exactly when the unintended consequences occur, of which there will be many.