How The United Kingdom's Health-Care System Works

Summary

The script discusses the contrasting U.S. and U.K. healthcare systems, focusing on the U.K.'s National Health Service (NHS). It compares healthcare spending and outcomes, highlighting the NHS's efficiency despite lower costs. The script also touches on Brexit's impact on the NHS, the role of private healthcare, and political debates surrounding potential reforms and trade deals.

Takeaways

• 🇺🇸 The Democratic presidential race featured two candidates with contrasting health care reform proposals: Bernie Sanders advocated for Medicare for All, eliminating private insurance, while Joe Biden aimed to expand on Obama's Affordable Care Act.
• 🏥 Sanders' Medicare for All plan was criticized for its high cost and potential increase in middle-class taxes, despite claims of saving money for the average American.
• 💉 The U.S. spends more on health care per capita than any other developed country, yet has less favorable health outcomes compared to countries like the UK.
• 🌍 The UK's National Health Service (NHS) is a government-run system that provides universal coverage with minimal out-of-pocket expenses, spending significantly less than the U.S. while achieving better health outcomes.
• 💼 The NHS operates as a risk-sharing system funded through taxes, with services provided without additional billing to users.
• 🏛️ The NHS is considered socialized medicine, a term that has been politicized in the U.S. but is generally well-received in the UK.
• 💸 There is debate in the UK about increasing taxes to address the NHS's deficiencies, with some advocating for higher taxes on companies and individuals who currently evade them.
• 👨‍⚕️ General practitioners (GPs) in the UK are often private contractors with the NHS, receiving payment directly from the government without charging patients.
• 💼 The private health care sector in the UK is growing, funded through a mix of out-of-pocket payments, private insurance, and NHS contracts.
• 🏦 The involvement of private companies, including American ones, in the NHS has raised concerns among campaigners who worry about the impact on NHS staff training and the potential for increased privatization.
• 🇪🇺 Brexit discussions raised concerns about the potential for the NHS to be part of trade negotiations, with some fearing that it could lead to increased privatization or changes in drug regulations.

Q & A

What are the two contrasting candidates in the Democratic presidential race mentioned in the script?

The two contrasting candidates mentioned are Bernie Sanders, who is far left, and Joe Biden, who is more moderate.

What is the main difference between Bernie Sanders' and Joe Biden's approach to U.S. health care reform?

Bernie Sanders wants to eliminate private insurance in favor of a Medicare for All system, while Joe Biden proposes to build on the Affordable Care Act framework established by Barack Obama.

What does Bernie Sanders argue about the cost of Medicare for All?

Bernie Sanders argues that Medicare for All would save the average American substantial sums of money, despite the fact that it would require middle-class taxes to increase.

How does the United Kingdom's health care spending compare to that of the United States?

The United Kingdom spends significantly less on health care than the United States, with the U.S. spending around $10,500 per capita compared to the U.K.'s $4,000.

What is the percentage of GDP spent on health care in the U.K. and the U.S.?

The United Kingdom spends 9.8 percent of its GDP on health care, while the U.S. spends 16.9 percent.

How does the health outcome in terms of life expectancy compare between the U.K. and the U.S.?

In 2017, life expectancy in the U.K. was 2.7 years higher than in the U.S.

What is the National Health Service (NHS) in the U.K. and how is it funded?

The NHS is a government-run health care system in the U.K., funded through taxation, where citizens receive health care without additional charges.

What are the controversies surrounding the potential increase in taxes to support the NHS?

There is debate over whether taxes should be increased to address the NHS's deficiencies, with some favoring a tax hike and others suggesting focusing on companies and individuals who currently evade taxes.

How does the U.K.'s NHS differ from other universal health care systems?

Unlike other universal health care systems that are only publicly funded, the U.K. government also runs the NHS, employing the doctors and providing care.

What is the role of the private sector in the U.K.'s health care system?

The private sector in the U.K.'s health care system is growing and is funded through a combination of out-of-pocket payments, private health insurance, and the NHS itself. It provides services like dental care, eye care, and certain prescription drugs.

What was the impact of Brexit on the NHS and how was it discussed during the Brexit campaign?

The NHS was a significant part of the Brexit discourse, with the Leave campaign claiming that the U.K. would redirect £350 million a week from the EU to the NHS, a claim later criticized as a misuse of statistics.

What concerns do researchers and campaigners have regarding the NHS and post-Brexit trade deals?

Researchers and campaigners are concerned that the NHS might be compromised in trade deals, particularly with the U.S., and that the U.K. government might prioritize economic interests over public health.

Outlines

00:00

🌐 Health Care Debate and Comparison

The paragraph discusses the U.S. Democratic presidential candidates' contrasting views on health care reform. Bernie Sanders advocates for Medicare for All, eliminating private insurance, while Joe Biden supports expanding the Affordable Care Act. The U.S. spends more on health care than other developed countries, yet has worse health outcomes. The United Kingdom's National Health Service (NHS) is highlighted as a successful model of socialized medicine, spending less than half of what the U.S. does with better health outcomes. The NHS is funded through taxes, providing care without additional costs to citizens. Concerns about the NHS's future in the context of Brexit and potential trade deals with the U.S. are also mentioned.

05:04

🏥 Structure and Funding of the NHS

This section delves into the structure of the NHS, where doctors are government employees and general practitioners (GPs) act as gatekeepers for secondary care. GPs are often private contractors paid by the NHS, and there's a growing private sector in the UK's health care system, funded by out-of-pocket payments, private insurance, and the NHS. The private sector's growth is due to government promotion and blurring boundaries with the public NHS. There are concerns about the impact of private sector growth on NHS staffing and training, as well as the increasing involvement of private companies, including American ones, in NHS operations.

10:06

🤝 Brexit and the Future of the NHS

The final paragraph addresses the impact of Brexit on the NHS. It discusses the Leave campaign's promise to redirect funds from the EU to the NHS, which was later debunked. Post-Brexit, there are concerns about the involvement of American corporations in the NHS and the potential for trade deals to affect the service. Despite assurances that the NHS would not be part of trade negotiations, there is skepticism and a call for legislative protection. The paragraph concludes by noting the enduring importance of the NHS in British politics and culture.

Keywords

💡Super Tuesday

Super Tuesday is a term used in the United States to describe a day in the presidential primary season when multiple states hold their primary elections or caucuses. It's significant because it can dramatically influence the race for the party's nomination. In the script, Super Tuesday is mentioned to set the context of the narrowing Democratic presidential race between Bernie Sanders and Joe Biden.

💡Medicare for All

Medicare for All is a proposed single-payer health care system in the United States where the government would provide comprehensive health insurance coverage for all U.S. residents. The concept is central to the script as Bernie Sanders advocates for it, contrasting with Biden's approach. It is a key point of debate between the two candidates on how to reform U.S. health care.

💡Affordable Care Act (ACA)

The Affordable Care Act, also known as Obamacare, is a comprehensive health care reform law enacted in March 2010. The script mentions it in relation to Joe Biden's proposal to build upon the framework established by the ACA, suggesting a more moderate approach to health care reform compared to Medicare for All.

💡National Health Service (NHS)

The National Health Service is the publicly funded healthcare system of the United Kingdom. The NHS is highlighted in the script as a model of socialized medicine, where the government provides and pays for healthcare services through taxation. It is used to compare the U.S. health care system's high costs with the more efficient and less costly U.K. system.

💡GDP

Gross Domestic Product (GDP) is the total value of goods produced and services provided in a country during one year. The script uses the percentage of GDP spent on health care to compare the economic burden of health care between the U.S. and the U.K., showing that the U.S. spends a significantly higher portion of its GDP on health care.

💡Life Expectancy

Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of birth. The script uses life expectancy to demonstrate that despite spending less on health care, the U.K. has a higher life expectancy than the U.S., indicating a more effective health care system.

💡Maternal Mortality Rate

Maternal mortality rate refers to the number of women who die from pregnancy-related causes while pregnant or within 42 days of end of pregnancy. The script mentions the U.S. has a higher maternal mortality rate than the U.K., suggesting disparities in the quality of health care between the two countries.

💡Infant Mortality Rate

Infant mortality rate is the number of deaths of children under one year of age per 1,000 live births. The script compares the infant mortality rate between the U.S. and the U.K., with the U.K. having a lower rate, indicating better health outcomes for infants in the U.K.

💡Socialized Medicine

Socialized medicine is a system in which the government owns and operates health care facilities and provides services to the people. The term is used in the script to describe the NHS and is a point of contention in U.S. politics, often used as a scare tactic. The script explores the public's perception of socialized medicine in the context of the NHS.

💡Brexit

Brexit refers to the United Kingdom's decision to leave the European Union. The script discusses Brexit in the context of potential impacts on the NHS, including funding and the possibility of increased involvement of private American corporations in the NHS post-Brexit.

💡Private Sector

The private sector, as mentioned in the script, refers to the part of the U.K.'s health care system that is funded through out-of-pocket payments, private health insurance, and the NHS itself. The script discusses the growth of the private sector in health care and its implications for the NHS, such as the potential for longer waiting lists and staff shortages.

Highlights

Super Tuesday narrowed the Democratic presidential race to Bernie Sanders and Joe Biden, with contrasting views on healthcare reform.

Sanders advocates for Medicare for All, eliminating private insurance.

Biden supports building on Obama's Affordable Care Act.

Bernie Sanders criticizes the cost of his own Medicare for All proposal.

The U.S. spends more on healthcare than any other developed country.

The UK spends less than half of what the U.S. does on healthcare and has better health outcomes.

Life expectancy in the UK is 2.7 years higher than in the U.S.

The UK's infant mortality rate is lower than that of the U.S.

The UK's maternal mortality rate is nearly half that of the U.S.

The National Health Service (NHS) in the UK is government-run and provides care without direct cost to the patient.

The NHS is funded through taxation, which is considered a fair system based on income.

There is debate over whether taxes should be increased to address NHS deficiencies.

The term 'socialized medicine' is politically charged, especially in the U.S.

The NHS is popular among Britons and is seen as a symbol of Britishness.

The UK's four constituent countries have their own NHS branches with slightly different rules.

Some services in the UK require out-of-pocket payments, but fees are low compared to the U.S.

The UK's private healthcare sector is growing and is funded through a mix of payments and NHS contracts.

The Brexit vote and subsequent negotiations have implications for the NHS and its funding.

There are concerns that the NHS could be part of trade negotiations post-Brexit.

Reforming the NHS continues to be a significant part of UK political discourse.

Transcripts

Super Tuesday came and went and the Democratic presidential race is narrowing to two very

different candidates, far left Bernie Sanders and the more moderate Joe Biden.

Biden and Sanders have clashed on the best approach to reforming U.S. health care.

Sanders wants to get rid of private insurance altogether.

While Biden proposes building on the framework left over from Barack Obama's Affordable Care Act.

Bernie says that you have to bring people together and we have to have Medicare for all.

But Bernie says and he says he wrote the damn thing, but he's unwilling to sell with the

damn thing's gonna cost.

The idea middle class taxes aren't going to go up is just crazy.

What Medicare, after all, will do is save the average American substantial sums of money.

The U.S. already spends more money on health care than any other developed country.

There's one country that spends less than half what the U.S. does on health care.

And people generally don't pay anything out of pocket when they go to the doctor.

The United Kingdom and out of all the health care systems we've looked at, the U.K. appears

the most socialist.

The government effectively runs the whole thing.

Right now, the U.K. is having its own debate over how to reform the National Health Service.

So how does the U.K. system compare to the U.S. and what reforms may be coming?

In 2018, the United States spent around ten thousand five hundred U.S. dollars on health

care for each of its residents.

The United Kingdom spent around 4000 U.S. dollars.

That means the United Kingdom spends 9.8 percent of its GDP on health care, while the U.S.

spends 16.9 percent.

Despite spending less, the United Kingdom manages to have healthier citizens who live

longer and are less likely to die in childbirth.

In 2017, life expectancy in the U.K. was 2.7 years higher than in the U.S., and the U.K.

has roughly 1.5 times fewer deaths that could have been avoided by access to better health care.

The infant mortality rate is lower in the United Kingdom, with 3.9 deaths

per 1000 live births as opposed to 5.8 in the United States.

And the maternal mortality rate in the U.S. is nearly 1.5 times higher than in the United

Kingdom.

So how is the U.K. system structured so that it gets these results while spending significantly

less than the United States system?

The National Health Service is a case where the British decided right after World War

2 that health care should be government's job, like paving the streets, putting out

fires, running a library, running the parks.

That's T.R. Reid, author of the book The Healing of America.

He traveled the world exploring different countries' health care systems.

It's a service you get when you need it and you never get a bill.

It's like going to the library.

They don't charge you to check out a book.

He's saying that the NHS is it's a risk sharing system, so everyone pays into it through their tax.

If you need to use it, you don't have to pay anything else.

So in a sense, it's not free because is paid as of taxation.

Dr. John Puntis is a pediatrician who recently retired from the NHS.

He is also co-chair of an organization called Keep Our NHS Public.

All of his comments are reflective of the organization and not his personal views.

It's a fair system in that the more money you earn, the more tax you pay, the more you

contribute.

But there has been discussion about whether tax should be increased to pay for sorting

the NHS out in terms of the current deficiencies and problems, and that that is controversial.

I think a lot of people favor some tax increase, but then there are other people who say, well,

maybe the focus should be on companies that don't pay tax and people who don't pay tax

as the first step.

I would call that socialized medicine.

Government provides that care.

Government pays for the care it's paid for through taxes.

Everybody's covered the same.

To me that sounds like socialized medicine.

The term socialized medicine has become a political football, especially in the United

States.

The NHS is socialized medicine.

It's great.

And we hear this term mainly coming from the US where it's used as a as scaremongering.

I would say if the NHS is socialized medicine, we like it and most people are still very,

very supportive of the concept of of of a national health service.

Each of the u.k.'s four constituent countries have their own branch of the NHS, so rules

differ slightly between them.

But all of the branches operate under the purview of the U.K. parliament.

There are some services that require patients to pay something out of pocket, such as dental,

eye care and certain prescription drugs.

But those fees are low compared to the U.S. and vary by NHS branch.

By one estimate from a data analytics firm, prescription drugs cost 57 percent less in

the U.K. than they do in the U.S. Unlike with other universal health care systems that are

only publicly funded, the government also runs the NHS.

That means doctors that work in public NHS facilities are employees of the government.

Most Britons receive their primary care through general practitioners who are frequently referred

to as GPs.

They typically act as gatekeepers for secondary care.

The problem is that people are experiencing the moment as is taking longer to see your

general practitioner.

If you want to see them.

Most GPs are private contractors with the NHS.

They don't charge patients for care.

Instead, they earn money directly from the National Health Service.

Many GPs negotiate contracts with the NHS to determine how much they can charge the

government for their services.

GPs may fund their own general practice facilities or they can rent them from the NHS or private

companies.

One paper from the Journal of the Royal Society of Medicine found that GPs faced many issues

because of how general practices are funded in the U.K.

Some GPs, I think increasingly don't want to take on the running of business aspects

of general practice, and so there are lots of GPs who are salaried partners, so they

are paid by the practice to come in and work as a GP, but they don't do any of the business

side of this stuff.

There's also a private sector in the u.k.'s health care system.

It's funded from a combination of out-of-pocket payments, private health insurance and the

NHS itself.

The private sector is growing because is being consciously promoted by government and the

boundaries being blurred.

But I think the private health care has been growing at a very rapid, steady pace in the

United Kingdom for the course of several decades.

That's going to continue.

That's Nile Gardiner.

He's the director of the Thatcher Center for Freedom at the Heritage Foundation.

With regard to the National Health Service, I mean, there's no there's no sign at this

stage that the U.K. will be moving to a different system to the National Health Service.

All British parties all committed to the National Health Service.

I think that's more or more Britons will be opting for private healthcare in the coming

years and decades, not least because there are long waiting lists with regard to the

National Health Service.

And analysis from the London School of Economics found that in the 2018 to 2019 fiscal year,

NHS England spent around 18 percent of its total expenditure on the independent sector.

There's been a blurring of the boundaries, if you like.

For example, cataract surgery is the most common operation done under the NHS.

Increasingly, it's being provided in the independent sector and the NHS, as has contracts with

the independent sector to do that work.

There are implications in terms of staffing.

Private sector doesn't train its own staff, it takes it from the NHS.

It cherry picks, takes the low risk patients, not the high risk patients.

It has an impact on training NHS staff and this is one of the problems with cataract surgery.

If they're all going to the private sector, hospitals and the NHS staff don't become

experienced in doing cataract surgery.

And then along the line you find it's more difficult to staff your NHS unit.

So it's not without negative consequence.

And we are paying private companies increasingly to do work for the NHS, including American companies.

And they're very well established now, particularly in the back office functions and providing

advice on commissioning support, this kind of thing.

They're very involved and unfortunately that's likely to increase and something which campaigners

are extremely worried about.

I don't think anyone really believed that U.K. voters would decide to Brexit.

The news that the United Kingdom voted to leave the European Union shocked the world.

The NHS was a big part of the Brexit media discourse, with the Leave campaign famously

claiming that the U.K. would take back 350 million pounds a week that could then be funneled

into the NHS.

The U.K. Statistics Authority has since said that the claim is a quote, clear misuse of

official statistics.

My name is Holly Jarman.

I'm an assistant professor in the Department of Health Management and Policy at the University

of Michigan.

Those promises really did hit home for a lot of people.

The idea that money would come back from Europe to the U.K. was a very powerful symbol.

It's not actually true.

That wasn't really how EU financing works, but we still saw that that was a big part

of the media discourse and most likely part of people's judgment when they were casting

their vote.

The U.K. officially left the EU three years after the original Brexit vote.

Entering a transitory period through the end of 2020, while the U.K. government negotiates

international trade deals, the concerns about private American corporations engaging more

with the NHS came up during the discussion of the post-Brexit trade talks with the United States.

When you're dealing in trade, everything's on the table, so NHS or anything else are

a lot a lot more than that.

Backlash to President Trump's comments on the NHS led to many British politicians assuring

their constituents that the NHS was not going to be a part of the trade talks.

The NHS is in no way on the table.

President Trump and backtracked on his comments, saying he wouldn't consider the NHS as part

of the trade deal.

A lot of trade negotiations are actually quite secretive by nature.

The two sides don't really want to reveal a lot about what they're looking for in a

deal.

Our concern really as health researchers is that the NHS really won't be accounted for

in that deal, that the U.K. government's preferences have been shown to be largely economic and

not so much on the focusing on the health of people in Britain.

The problem is that the NHS is is already on the table.

It has been for a while.

The politicians who are now going to be negotiating the trade deals, you know, it's going to be

across many fronts.

Campaigners were saying, okay, put your money where your mouth is.

If if you're saying the NHS won't be in a trade deal, then let's see legislation that

sets that out says cast in stone.

And they haven't rushed to do that.

Trade negotiations, cover everything at once.

And it's difficult to tell how they are going to be pushing for the liberalisation of drug

regulations and to what extent the Johnson cabinet would actually agree with any changes

that would be proposed to the way the U.K. regulates pharmaceuticals.

It's really a central government led process.

That's not that democratic and does represent big business.

And I think that's why a lot of people get very concerned and anxious around trade agreements.

There are some who say the NHS won't be harmed by Brexit, even in the event a trade deal

with the EU isn't reached by the end of the year.

I don't expect that we're going to see huge changes actually in the Brexit era with regard

to the to the National Health Service.

And so I think with with regard to the NHS, we're not likely to see a significant impact

as a result of of Brexit.

I think the free trade deal will be largely focused upon the service industry, which of

course is now the largest part of both the US and British economies.

Whatever effect the trade deals end up having on the U.K., reforming the NHS will continue

to be a big part of the country's political conversation.

People's support for the NHS in the U.K. is very strong.

There's no other country that when we hosted the Olympics in London, we had nurses jumping

on beds and the NHS was actually a part of that ceremony and a part of that national

celebration.

The U.K.'s NHS is very important in British politics.

It's an important symbol of Britishness in that context.