Dr Richard Young of Fort Worth, Texas traveled to the UK to observe firsthand the workings of their healthcare system. He wrote an in-depth article that looks at the British National Health Service, or NHS, through the eyes of an American family physician. This is particularly important to us in the U.S. because it offers a glimpse of a far more efficient and effective way to run a nation’s health care system. We should learn a lesson from his observations. Unless we recognize the sheer folly of our own system before it is too late, the most efficient front line of medicine we will ever know in this country will disappear into the morass of the costliest, most overspecialized, profit-obsessed and monumentally wasteful healthcare in the world.
The NHS, which is anchored by their corps of general practitioner primary care physicians (GPs), is a stunningly effective and efficient national healthcare system. They provide care to citizens of the UK at about 50% of the cost of the U.S. For 2011, the Organization for Economic Cooperation and Development reported that British healthcare costs consumed 9.4% of their overall economy (GDP) while the U.S. spent 17.7% of the GDP. That equates to $3,405 per person per year in Britain against $8,508 in the U.S.
As a doctor and a teacher, Dr Young is committed to the preservation and propogation of quality, cost-effective family medicine. I can only surmise, as he saw how healthcare is managed over there, that maybe he was envious to see the British system in full scale action doing the things he practices and teaches back here at home. When an elderly British patient told him that she didn’t see the need for a diagnostic test at her advanced age and that it was a waste of time and money, I wonder if he felt a “high-five” was in order?
If we hearken back to the beginnings of the ObamaCare saga, which early on included discussions about a government health plan offering to citizens, we might remember the horror stories that were told. Powerful and entrenched healthcare special interests scared us silly with stories about all manner of Canadian and British health system miseries, and how we would be rationing care away from our grannies (aka, death squads). Dr Young was mindful of those scary tales of long waiting times for surgeries and cancer treatments, so he set out to learn on a more personal level how the British system really works. He talked to people both in and out of the healthcare system and observed doctors working in a hospital and a clinic. He also talked to British patients both inside and outside of NHS facilities. He even went on house calls.
Note During that pre-ObamaCare period of scary stories, I gained some of my own perspectives by talking with Canadian healthcare experts at the University of Manitoba Centre for Health Policy. What I learned from them closely follows what Dr Young has reported about the NHS. While all health care systems face challenges everywhere, the British and Canadian health care systems produce far better results at far less cost. Translation: higher quality with money left over for other needs of a nation.
Dr Young wrote that one of the elements of the NHS that held his fascination for years is how given instances demonstrate that, for the most part, British health policy decisions are not paralyzed by dramatic anecdotes and rhetoric the way they are in the U.S. The ability of UK politicians to mostly behave when debating challenging health care issues shows how different our two nations are culturally. From the WW II Blitz days, the English rally themselves on all manner of paraphernalia with the motto “Keep Calm and Carry On”. When the subject is healthcare, the modern American slogan always seems to be, “I want it my way and I want it all and I want it now.” While behavioralists tell us that stories are more powerful motivators of change than numbers, the English don’t let stories of some young people dying of cervical cancer, or anecdotes about expensive chemotherapy treatments not being covered, or decisions to not provide the most expensive Alzheimer’s drugs force the NHS to change its policies merely to quiet the clamorings of special interest groups.
Dr. Young’s British medical travelogue is not a highly clinical work. Rather, it is an up close and personal observation of care deliverers, care consumers and how a nation’s mindset works reflecting a shared sensibility about financial resources available for citizens health care needs and how to spend them to produce the greatest good. Notions like a preference for the quality of life one has remaining over the mere prolongation of life at all costs and beyond quality time.
They just don’t overdo healthcare in Britain (and Canada) like we do. They don’t go overboard on MRIs, CAT scans and questionable treatments, procedures and drugs that are marginally efficacious. When it comes to decisions about appropriate care, physicians in the UK decide and patient abide – imagine that! There is near zero tolerance for whining, demanding patients and families, and so patients and families don’t whine and demand much. And their numbers show the results – better outcomes there (and in Canada) in many categories of quality and cost. 70% of the citizens in the UK think their NHS is very good or excellent – the highest national opinion number ever recorded.
Here is a striking example that, to me, shows just how differently health care is provided over there and over here. A Dallas television commercial yesterday jogged my thinking about this.
In his travelogue, Dr Young wrote about his visit to a new, modern UK hospital and his time accompanying an internal medicine hospitalist. He went with the physician on his daily rounds in a modern hospital ward consisting of 22 curtained off beds. All new, all modern.
The glitzy local television commercial I watched was for Forest Park Medical Center, a fancy new hospital in an upscale north Dallas suburb. I had to watch closely to discern if this was truly a hospital or the Ritz Carlton I stayed at on my last trip to Washington, DC. There was a very upscale cafeteria (I looked to see if there was a sommelier standing somewhere), staircases like a cruise ship and private fashionably decorated rooms ensuite with guest quarters and hardly a single medical device showing. The only tipoff to this being a hospital was a sick person in a hospital type bed.
The commercial ended with “our patients like it here so much, many don’t want to leave”.
That’s them, that’s us. We are spoiled, extravagant and demanding – they are frugal, prudent and accepting. We spend, they conserve. We build opulent, luxury patient suites, they build efficient places to treat sick people.
They do health care better at around half our cost, and 70 % of the British people think their system is very good or excellent.