British health care system does work

Published 5:46 pm Thursday, August 20, 2009

To the editor:

In response to the myriad of letters to the editor and comments in the daily forum, I would like to offer some insight from one who has lived with the National Health Service in England since 1964 and then became a legal citizen of the U.S. in 1989.

First of all, it is only fair to the citizens of this country — including Dalton — that correct, researched information with substantiated comments are made public, allowing everybody to make an educated decision or in the very least receive worthwhile quality information regarding the topic of health care.

Reform is long overdue. Of course, opponents of change are able to quote examples of failings in the English system. However, one should not allow these to undermine the case for universal health care.

The British government formed the National Health Service (NHS) in 1948. It was based on the principle of direct provision of GP and hospital services by central government. It would be funded by national insurance contributions deducted from pay and by general taxation. Access to services is free at the point of use. Thus the costs of hospital operations were spread across the population and not borne by individuals. This principle seems generally accepted in England. People never requiring hospital care seem quite prepared to contribute to the costs of treating the unwell.

However, there are problems. Standards of care now seem to be lagging behind those in many European countries who are investing more in their health care services. Queuing for especially non-urgent operations — such as hip replacement — has been such a problem as to lead many people to take out private health insurance. They still have to pay for their national insurance.

The government has addressed this issue by setting targets for waiting times with some success. Also, it is possible for patients to be treated in different areas of the country. Where hospitals are concerned, there are many documented criticisms of standards of nursing care and lack of cleanliness. The government has sought to decentralize hospital administration with hospitals run by local trusts.

The way for America: The U.S. is unlikely to adopt the English system in its entirety. This would involve the federal government owning and running all hospitals and health centers, as well as setting the levels of compulsory contributions. Thus hospitals and health care centers are likely to remain privately owned and run for profit.

However, the main issue is access. All U.S. citizens should have the same rights of access to health care without regard to income. There will always be arguments over budgets. For example, one can anticipate issues over availability of the latest drugs and decisions on whether or not to carry out heart transplant operations. Such decisions are best taken by local managements who must keep within budgets.

The main defect in the American system is the unpredictable nature of the costs of health care, particularly hospital operations. In England, national insurance payments are fixed by government. The National Health Service meets the full costs of treatment so nobody is denied care due to lack of money. However, there are changes — drug prescriptions for example — and they are likely to increase in the future. What is important is not that the government should own the hospitals or health care centers but that a national insurance scheme should cover most costs so citizens are not faced with significant bills when they get ill.

Additional issues for reform are that more needs to be done with regard to leading to a healthier nation: better care for the less well off, a stronger focus on preventative care and on health education, especially young people. Dealing with the unhealthy lifestyles of so many Americans and Europeans is a priority for any health system.

Mavis Hackney