Kuttner on TAP: A Visit to Hallowed Ground

LONDON – This was going to be a post about the Labour Party’s program and chances in the next British general election. That will have to wait a few days.

Yesterday, I had some odd health symptoms that suggested a visit to a doctor. This being Britain, off I went to the walk-in clinic of the nearest hospital of the National Health Service. What happened next is enough to make an American progressive weep.

I arrived at St Thomas’ Hospital, one of London’s busiest, at 10 a.m. By 10:20, I had been through a courteous triage process, filled out a basic form, and was scheduled with a GP. The doctor saw me at 11:00, took a history, examined me, performed a couple of tests right in his office, assured me that this was not serious, and shook my hand.

“Do I need to check out?” I asked.

“No, you are free to go,” he said. Less than 90 minutes after arriving, I was on my way.

Bill: zero.

At home, I would have waited hours; the ER charge alone would have been at least $1,000, plus separate line items for the doctor’s fee, the tests, and more. Insurance would have paid, but the inflated bills add costs to the system. (Had I needed treatment in London, I would have been billed, but at rates reflecting true costs.)

The NHS, founded right after World War II by the great postwar Labour government of Clement Attlee, remains a model for the world. The Tories, who have been in power since 2010, are doing their best to starve it. The waiting list for elective services has about doubled since 2012; doctors and nurses are overworked and underpaid.

But the system still gives priority to prevention and basic acute care. Even a besieged NHS is far better, fairer, and more cost-effective than our system. Britain is a poorer country than the U.S. but has an average life expectancy almost four years longer (80.9 years to America’s 77.3).

Because the NHS is true social medicine with salaried doctors and nurses, the money and time wasted in the U.S. on parasite middlemen, coding and billing, rapacious insurance companies, hospital profit-maximization strategies, and excess lucrative procedures, is simply not a problem or a drain in Britain. All the money goes to patient care.

Sitting in the pleasant St Thomas’ waiting room, I noticed that the people there were from all social classes. Nearly everyone in Britain uses the NHS. You can’t get better care by paying privately. You can jump the queue for elective procedures—but that’s due to Tory underfunding of the NHS, not because private services are superior.

In this fiscal year, the entire NHS costs 152 billion pounds, or about $180 billion. That’s close to two-thirds of all of Britain’s spending on health care. By contrast, the U.S. spends a staggering $4.4 trillion.

Relative to GDP, Britain spends about 12 percent and covers everyone. We spend just under 20 percent, and tens of millions of Americans have no coverage while tens of millions more are woefully underinsured and must pay exorbitant sums or do without.

Alert readers may recall a similar piece about a medical experience I had in France last year. (My wife accuses me of feigning illnesses in order to write columns comparing health systems, in policy travelogues.)

It took an electoral revolution in 1945 for Britain to get its cherished NHS. All the marginal tweaks being debated to fix the broken American health care system will change nothing fundamental. The cure is not technical but political. Only a comparable electoral revolution, with far more courageous Democratic Party leaders, will get us what ordinary Brits have had for three quarters of a century.