Great Britain In Denial About How Lousy Their Healthcare Actually Is
via “Universal Mediocrity” by Theodore Dalrymple – City Journal.
In April, the British Medical Journal published “How the NHS Measures Up to Other Health Systems,” a report about two studies conducted by the New York–based Commonwealth Fund that compared the health-care systems of 14 advanced countries. On the 20 measures of comparison, Britain’s famous or infamous centralized system, the National Health Service, performed well in 13, indifferently in two, and badly in five. Was this a cause for national rejoicing?
If popular satisfaction is the aim of a health-care system, the answer must be yes. According to the report, the British were the most satisfied with their health care of all the populations surveyed; they were the most confident that in the event of illness, they would receive the best and most up-to-date treatment; and they were the least anxious that their personal finances would prevent them from receiving proper treatment. One could doubtless raise objections to these measures of comparison, but let us for the sake of argument take the results at face value. Subjective satisfaction and relief of anxiety are not minor achievements. Indeed, though the free market’s ability to satisfy more needs and desires than any other system is usually cited as one of its principal advantages, here was an apparent instance of the contrary: a nonmarket health-care system that yielded the most satisfaction.
Still, the studies contained a paradox that the authors of the BMJ article failed to notice or, at any rate, to remark upon. On several measures of actual achievement, rather than subjective assessment, the NHS came out the worst of all the systems examined. For example, it ranked worst for five-year survival rates in cervical, breast, and colon cancer. It was also worst for 30-day mortality rates after admission to a hospital for either hemorrhagic or ischemic stroke. On only one clinical measure was it best: the avoidance of amputation of the foot in diabetic gangrene. More than one reason for this outcome is possible, but the most likely is that foot care for diabetics—a matter of no small importance—is well arranged in Britain; the amputation rate is four times higher in the United States.
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Gb is not the model liberals look up to.
You should look at sweden, germany and, of course, israel.
Do you remember thatcher? She made a pigs breakfast out of the nhs.
I’m interested to know in what what way Thatcher messed up the NHS. I lived in the UK from birth in the early 60′s until about 10 years ago and the health service was far worse in the 70′s than it is today, and it’s not good now.
It’s not important to liberals how well the NHS – or any “entitlement” – actually works. What’s important is that it exists. They’ve put it in place as they promised to do. They’ve made the right gesture, done the right thing. They’ve proven that they and the country are civilized and progressive. Anything beyond that is not their problem.
According to the above blurb the positive survey was conducted in the abstract rather than in reality. The survey asks the hypothetical “in the event of illness” rather than “how would you rate the cancer treatment that you received”. One measures what you expect to get, the other what you actually received. Based on actual achievement, which isn’t abstract or hypothetical, the NHS performs as well as one would expect… which is to say poorly.
In other words, it’s just another phony push-poll designed to generate the desired answer.
I’m reminded of Albania (I think it was) back in early 90′s. All the Albanians thought they had about the best standard of living of any country in the world. Then communism collapsed and the people were disappointed to find out they had about the worst living standard of any country.
I read somewhere many years ago that American students only led the world, at the time, in 2 categories. We spent more on them than anywhere else in the world, and their own opinion of their intellectual achievements, compared with children in other countries, was much higher. They were actually close to the dumbest students on the planet, but they were taught that they were smarter than everyone else, and they believed it.
So the British public thinks their health program is “satisfactory.” Does this mean it’s actually good, or have they just been told this ad infinitum, until they believed it?
Oh, and from what I understand, Britain’s system isn’t Canada’s. In Britain if you get sick, and you’re wealthy, you can hire a local physician; in Canada you have to actually leave the country.
You’re correct about the differences between Canada and Great Britain. The US acts as a safety valve for the pressure on the Canadian system as the most populated areas are southern, and those with the means can skip the lines, things like knee and hip replacements as they are one-shot deals that don’t require constant followup yet make a big difference in quality of life.
I’ve been to the UK and visited behind the scenes at various NHS facilities. My colleagues joked about pining a note to the inside of their clothing that says “take me to France”. But honestly, when I went back last year with the whole family I was careful to note the location of the London Clinic, which is almost as nice as your basic community hospital in the US, and completely outside of the NHS.
London Trader
Its is always re-assuring to see that a 10 yr old (born in the 60´s, and in the 70′s was worse) is capable of political analysis.
Ok, it was bad in the 60′s, worse in the 70′s, and horrible in the 90′s. What does that tell you?? That a public/national health service is intrinsically bad or that the Brits were not able to do what the Swedes, Canadians, Germans and Israelis did???????
Prior to the establishment of the NHS in 1946 (i believe), Brits had to pay for their health care. Please look at health care data relating to the decades preceding the establishment of NHS. GB, prior to the NHS, was a THIRD world country in terms of public health. The NHS solved that problem. It does not work properly??? Quite possibly. The alternative was better??? No, it was not. Compare the data. Before and after NHS. Quite simple.
The above comments apply to David W Nicholas. A simple exercise demonstrates it. ALL of the countries in Europe that established public health care systems dramatically improved the situation of the majority.
Note: Public Health Systems must be run like private companies. Waste and corruption should be harshly punished. Thats what Canada has done, I believe. Swedes and Canadians have not eliminated their public systems. They have made them more accountable, transparent and efficient.
So when Canadian Uncle Serge’s family had to change his sheets while he was hospitalized, was that punishing “waste”, or was that punishing “corruption”? I’m guessing that when he was sent home with boxes of medical supplies (aka “to die” from his manageable condition), that was punishing “waste”.
I had the opportunity to visit the NHS behind the scenes about six years ago, as part of a large conference of health care providers from around the world. Also was able to familiarize myself with other European systems, though not visit them.
While Great Britain as a whole might be in denial about the NHS, the people who run it aren’t- support for the system seems to come from the chattering classes (including the editors of the BMJ) who like the idealized socialist politics of it. People involved know it’s a mess, and ironically are looking to privatize as much as possible- that is, become more like the US. The problem with the NHS isn’t necessarily that it’s government-funded, but that it’s actually run by the government. Other European countries have voucher-type systems, or pay providers directly in some way through state sponsored insurance (though none are as restrictive as Canada). But only the UK actually employs the doctors and runs the hospitals, and that is the key problem.
Basically, it’s the VA applied to the entire country. Though, I hesitate to besmirch the VA in such a fashion.
No American patient, doctor or nurse would put up with what goes on over there- we were at the “best” facilities of course, and I still saw open wards, lack of handwashing stations, appalling lack of staff, lack of proper anesthesia, the list goes on and on. The entire city of London has about four MRIs- fewer than my town of 90,000 people. The two things I liked, however, were the terrific automated pharmacy at Chelsea-Westminister Hospital (the necessity of short staffing being the obvious mother of invention there) and the wonderful electronic medical records system, the likes of which we probably will never have because our system is too fragmented.
Dr. Dalyrmple is spot-on regarding the poor outcomes- he’s barely scratching the surface of the frightening statistics coming out of there. Another one that I recall is a NINE times higher rate of postop death. That’s right- you are nine times more likely to de after surgery in the UK than here. As I mentioned in a comment above, if you travel to London and need to see a doctor, your best bet is the London Clinic, which is similar to your average community hospital in the US.
Thanks for your well-informed comment Dana. Fascinating.
Fair point, Jeannette. Public funded and run systems are very problematic: waiting lists are long and sometimes, not to say very often, patients I inhumanely sent home to…
I am very aware of these probs, unfortunately.
But lets be honest.
For every story that you tell about the inadequacies of public funded and run health systems, I can mention an equal number about people that did not even get access to care for lack of funds. So, what is best? No money, no care OR Public money, poor care.
Both systems are less than satisfactory. As far as I can see, and I am no expert on these matters, the solution will have to be found somewhere in the middle. Thats what they have been doing in many European countries. The UK, I should tell you, is NOT an example to be followed. Had you visited Germany, France, Sweden you would have seen first hand top rate systems that compare favourably with the quality of (private) health care in America.
By WASTE, I meant this: Hospital Admins hiring too many people, often cronies etc. I meant supply contracts that are not offer the best value. I meant administrative waste. I certainly do not regard people/persons as waste. Do not put words in my mouth, please.
CORRUPTION: i meant contracts with civil construction firms that overspend state money purposefully, for ex.
Truth is: public health care systems all over do not work very well (hence recent privatisation efforts, albeit limited in Sweden, Germany etc) and private systems leave millions unprotected.
It doesnt take a genius to realise this.
Dana, let me be honest with you. NO UK politician would even DARE mention the destruction of the NHS System.
This is the case not because of the “chattering classes.”
The British people, especially the working class and the Labour Party, will not do away with the NHS anytime soon.
They believe that human beings are entitled to certain elementary goods: security, health etc. I agree with them.
Let me tell you something. Once, while in the US, i accidentally got hit in the face with a racquet. I ended up going to the nearest private clinic. A few stitches, a bit of cream and an hours waiting cost me a small fortune. I never felt so robbed in my life. While I was there, a lady was at reception. She had given birth there, prematurely. I learned later that in case of an emergency, ambulances are obliged to take the injured person to the closest hospital. This lady was taken to this private clinic. She could not pay. The clinic was initiating legal proceedings against her. That is ABSURD.
LIberal
I don’t recall recommending that the NHS be destroyed. But it’s broken.
The only thing anyone I’ve ever talked to has to say in support of it- including you- is “Well, at least everyone is covered.” Sorry, but lowest-common-denominator medicine is not the ideal.
As for the cost of American health care, surely you are not so naive as to believe the care in the UK is free. It’s sucked out of British citizen’s paychecks their entire working lives. At this point it is fair to say that they’re not getting their money’s worth. And at least the poor women in your anecdote got state-of-the art care to presumably save her child’s life- could she have received that care at any price in the UK? What’s that worth to you? Those are the questions we will need to grapple with in the future, but I assure you, the NHS is not providing the answers.
Dana,
I was not arguing nor suggesting that the NHS is providing good care and that it is free even though it is universal. I know that it is not providing the answers from personal experience.
The lowest common denominator is not good in any activity. Very true. Especially in health care.
he would not have been able to get that level of care in the Uk. True again. But she would have been able to have her baby without incurring an absurd debt.
It is worth a great deal to me. More than you imagine, I assure you. This is somewhat bizarre: your tone, suggests a moral indictment…What’s that worth to you?, as if I was defending some indefensible moral stance….As if it is somehow entirely reasonable to defend the best for a few and nothing for the rest!?!?!? IS that acceptable???
I could say that defending the Highest Denominator for a FEW is not only morally repulsive but outright unethical.
Yet, you can not ignore the equally disturbing fact: it is not RIGHT that state of the art be provided to those that have cashula whilst those with little or nothing are left to die without any care at all. Is that ethical?? Sweden, Canada, Israel, Finland, Denmark, Germany and France provide FIRST RATE health care to all of their citizens. It is not impossible to achieve this. And, YES, it is a mark of civilisational standing. I dont want to be walking in streets with sick elderly people dying around me because they have no care at all.
To be honest with you the lowest common denominator medicine worries me at least as much as Law-of-the-Jungle health care.
Both have its problems. The solution lies somewhere in the middle, I suppose.
thanks for your reply.
very informative
Lib
I can only hope that the UK will fix the NHS.
PS: I intended to erase the second part of the previous comment. I thought I had. Well, I did not.
Said the same thing. SOrry
American figures are hopelessly wrong because much of the mortality is unrecorded within the so-called health system. People die, in other words, without benefit of medical aid. It happens throughout the third world.