Comparative Analysis: the National Health Service in England and Publically Funded Healthcare Provision in the United States

Comparative Analysis: the National Health Service in England and Publically Funded Healthcare Provision in the United States

Submitted to Dr. Lisa Parker, Tutor
Human Disease
Oxford University
Department for Continuing Education
Andrew Becker
Roger M. Jones Fellow Abroad, The University of Michigan
Michaelmas 2008

Comparative Analysis: the National Health Service in England and Public/Private Healthcare Provision in the United States

The British love to talk with Americans about their health care system, the American lack of a publically funded comprehensive healthcare system, and the comparative moral, functional, and other standards by which such systems should be measured. It is one of the greatest differences between the two countries, otherwise so very similar in culture and governance. The National Health Service in England and government healthcare services in the United States may be compared in terms of their scale, scope, and composition, their perceived efficacy, and their perceived moral righteousness.

“The founding fathers never intended for the poor to live into their forties”
–Jack Donaghy (Alec Baldwin) on 30 Rock (US sitcom, 10-1-2008)

Scale, Scope, and Composition of the Systems

National Health Service, United Kingdom

The National Health Service stated goal is “to provide a universal service for all based on clinical need, not ability to pay”. Private healthcare is used by only 8% of the British population. Staffing for the NHS as of 2005 amounted to 1.3 million people, the 5th largest workforce in the world. Doctors and nurses in hospitals are generally NHS staff, while General Practitioners (GPs) and other local healthcare providers are generally not and provide NHS services on contract.

The total budget of NHS England in 2008 amounted to 92.5 billion GBP. Funding is primarily via taxation, with most services free, however there is a charge of 7.10 GBP for prescription medicines that must be paid except by the young, elderly, and poor.
The NHS is controlled by the Department of Health, which oversees ten regional-geographic “Strategic Health Authorities”. Each Strategic Health Authority is responsible for a number of “trusts” providing the various component services for that region, such as hospital trusts, ambulance services trusts, and primary care trusts. This provides for complete control of healthcare services, if not always homogeneity between regions.

Medicare and Medicaid in the United States

Medicare is a national social insurance program in the United States that provides health insurance coverage to people 65 and over, some disabled persons receiving social security payments, and persons with certain medical conditions such as end-stage renal disease and Lou-Gehrig’s disease. In 2002 Medicare expenditures were $256.8 billion. Medicaid is another program that provides health insurance to certain qualifying low-income persons such as parents, children, seniors, and the disabled. Medicaid covers approximately 40% of the poor in the United States. In 2004, Medicaid covered 42.9 million Americans at a cost of $295 billion. Since 1997 another program, the State Children’s Health Insurance Program (SCHIP), has existed to try to fill the gaps by providing health insurance for children in relatively low-income families who do not otherwise qualify for Medicare or Medicaid. In 2006 SCHIP covered 6.6 million children and 670,000 adults at a cost of around $5 billion.

None of the major American programs directly employ medical staff or own facilities; they provide health-insurance type programs that reimburse care providers. In general they are run in cooperation between state and federal governments. Since 2006 all Medicare recipients have received prescription coverage, but some Medicaid patients may be asked to co-pay for some or all medical procedures, depending on a litany of state regulations.

Perceived Efficacy of the Systems:

The World Health Organization no longer publishes a ranking of the world’s healthcare systems, due to the complexity of that task, and the last such ranking was created in the year 2000. In that ranking, the United Kingdom placed 18th and the United States 37th out of 190 total ranked countries. In the current World Health Report 2008, a given statistic relating perceived efficacy of the systems by their users is the percentage of the population citing health as their main concern before other issues.


It would appear that the relative percentages for this statistic are approximately 18% for the United Kingdom and 24% for the United States.

Both are doing quite well in comparison to Bangladesh and Uganda, where greater than 50% of the population list health as their main concern.

Perceived Moral Righteousness of the Systems:

In the United States, publically funded healthcare of the type provided by the state in the United Kingdom is commonly referred to as “socialized medicine”, a term which, although demonizing, is generally used without that specific intent. This term provokes a knee-jerk negative reaction by invoking imagery of red North Koreans, Viet cong, the Gulag, and hiding under desks during nuclear apocalypse drills. There is a common fear that government providing healthcare, or really anything to an individual for no cost creates a disincentive for people to work and a has a general negative influence on the economy. At the same time, most people are sympathetic to the need to provide healthcare for children, the elderly, and the disadvantaged. The question is, who is out there without healthcare that isn’t disadvantaged?

The Barack Obama healthcare plan calls for the establishment of a Medicare-like institution to provide health insurance options for people under 65 who are not covered by private health insurance. The stated goal is quality affordable coverage for all. The mechanism of provision is government subsidy. However, by calling it “affordable” and not providing direct care, it is clear that this will not be the “socialized medicine” so upsetting to the stomachs of politically conservative Americans.
The main argument for UK-style provision of extensive publically funded healthcare is that such care is a human right, that all people by birthright are collective owners of national wealth and that in a first world country that can afford to provide such a service there is a mora

l imperative to do so. Detractors argue that government funding and control of such a service leads to civil liberties issues such as the issues surrounding the provision of tax-funded healthcare to smokers and alcoholics.

On the US sit-com 30 Rock, Alec Baldwin plays a General Electric executive who says, “the founding fathers never intended for the poor to live into their forties”. The US Medicare / Medicaid / SCHIP system effectively is designed to provide for care for poor children and their parents long enough to give those children half a chance to raise themselves out of poverty, similar to public schooling and other resources for children from low-income families. If those low-income children, by luck or by initiative, manage to survive into old age, they will again be provided for by the state. Even with the healthcare plan proposed by US President-elect Barack Obama, considered by many to be radically progressive, this is a far cry from the extensive National Health System of the United Kingdom. In many ways the United States is sitting back and watching, allowing the smaller United Kingdom to experiment with providing publically funded healthcare to an Anglo-democratic society so much like their own. Only time will tell which is the most sustainable, effective, and righteous solution.

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