Watching all the debates raging in the U.S. currently about “health” care, I figured now is probably about as good a time as any to offer a few observations that might be of some help for those who have not experienced Britain’s state system first-hand. It is important we are absolutely clear about the issue and any worries, and not succumb to politically-biased innuendo and fear-mongering. The subject is simply too important for that. [Warning: ***Long post follows***]

First, recently, as Jeff McWaters of Amerigroup said:

…Healthcare ranks second behind the Iraqi war. It is the most important issue for the upcoming 2008 election. Now, we don’t know if that will continue. Who knows what will happen between now and those elections, but I think it’s becoming clear and apparent for us to compete on a national and international scale. We’ve got to get control of healthcare costs. I think it’s becoming vogue for politicians, even Republicans, to be willing to talk about healthcare and access to healthcare, and healthcare insurance for all Americans. We saw Obama’s recent comments. He seems to be the most focused on healthcare in terms of the Democratic candidates, and certainly Governor Romney in terms of the Republicans….

But not everyone thinks it is quite that important. Certainly, not on the right. Consider the following snippet in the WSJ online:

‘Universal” government health care has once again returned as a political cause, with many Democrats believing it’s the key to White House victory in 2008. They might want to study last week’s news from Illinois, where Democratic Governor Rod Blagojevich’s tax increase to finance health care became the political rout of the year…

Voters will also, for example, unhesitatingly vote down school budgets when voters believe those budgets demand an unjustifiable tax increase; but that doesn’t mean voters are opposed to public schools. So the WSJ might want to be more cautious about dismissively knotting two issues like taxes and health care together in the same way, for back in March a CBS and the NYT poll had told us:

…Two-thirds [of Americans] say the federal government should guarantee that all Americans have health insurance…

And that:

…the public gives the Democrats a big edge over the Republicans on handling health care issues. Asked which party they believe will best improve the health care system, 62 percent said the Democrats, while just 19 percent said the Republicans…

That is just unacceptable for Republicans. One does not make political gains by trashing the views of some 2/3rds of the electorate. Indeed, Republicans certainly don’t seem to be willing to do that on, say, Iraq.

However, despite all their endless chatter about “health care”, Democrats are incapable of hardheadedly implementing “universal health cover” and shouldn’t be allowed anywhere near it. They are far too associated with the notion of making its creation appear to be some sort of leftist “sea change”, rather than what it should be viewed as being: a very sensible and conservative measure that would dramatically aid individuals and families and, indeed, also business. The latter would benefit greatly by being released from the bureaucratic, logistical and cost nightmare of having to deal with providing health care coverage for employees; health care provision should not be part of any business’s expected remit. One would think Republicans, and the likes of the WSJ, would appreciate that.

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“Whoa there! What are you some sort of closet socialist?!” some of you are thinking? Definitely not. Before you jump all over me, let me explain further.

Although a conservative paper like the WSJ would claim it is impossible, one can indeed be a conservative and favor “universal health cover”. In fact, a hero of Ronald Reagan (and many American conservatives) has and still does . . . because such a service can and does work, and its existence is not by definition the top of a slippery slope that leads down inevitably to a “North Korea” or a “Cuba”.

I haven’t yet seen his film, and probably won’t. But it seems a certain high-profile windbag moviemaker manages almost to discredit the entire notion by venturing to Cuba to try to make his point. For given the nature of Cuba’s government, which like all dictatorships imprisons its population — some use walls; or in Cuba’s case, a naturally provided moat — that reality of course means the outsider never can truly appreciate when he is being fed “the party line” in the proverbial “Potemkin village“. Better the windbag filmmaker had concentrated far more on democratic Britain and had spoken to prominent British conservative politicians, not just, as singled out in the Telegraph, an extreme left winger like Tony Benn.

Here, life is decidedly more like that in the U.S. than in any dictatorial socialist paradise. The British National Health Service (NHS) provides “universal coverage” regardless of income. As the BBC describes it:

The National Health Service (NHS) was set up in 1948 to provide free healthcare for all the residents of the UK.

For its founders, the most important feature was that it was free at the point of need. This means that every time you go to the doctor or receive treatment at hospital, it is provided free of charge. The NHS is funded through general taxation and is run by the Department of Health.

There are also private healthcare providers in the UK. People pay for private healthcare either through insurance or when they use their services…

Socialism in a leveling sense the NHS is therefore definitely not. What’s called “socialized medicine” — meaning “socialized” for the masses; the “fearless leadership” also gets help wherever it can — exists only where no other options are permitted, as in Cuba.

But from the NHS base, as the BBC accurately states those who then also desire it and can afford “more” can also opt to buy additional private health insurance. In fact, the Conservatives since Thatcher and Labour under Blair injected private-sector driven reforms into the state run NHS itself (Mr Brown is likely to do more of the same), and generally the organization has been improved by them.

Interestingly, the public and private accidentally work together well in tandem. The wealthier often opt to “go private” to get “better care”, which usually means elective procedures are done quicker and one has easier access to more experimental care. That in turn means that those not as well off without private insurance are seen quicker by the NHS than would be the case if everyone had instead chosen to go through the NHS.

On a standard criticism, Jane Galt (via Viking Pundit):

…The difference is, in a free market system, you can go see a different doctor. In Canada or Britain, you just have to wait it out…

I don’t know about Canada, but if one is talking about “waiting” for weeks to have your “cold” treated by your GP at the “surgery” (meaning, here, your “local doctors’ office”), my experience is you probably don’t have to wait any longer than you would to see your “family doctor” for an appointment in the U.S. Once, when I wanted to get in to see my GP, yes, he was booked pretty solid for day or two ahead; but one of the practice’s other partners saw me straight away. No wait at all.

Essentially, the biggest “wait” fears appear to revolve around specialist care. On the NHS, yes, such may require a varied wait for non-emergency cases; but a woman suddenly diagnosed, for example, with breast cancer generally gets pushed right to the front of any “line”. But if one is able to “go private” to see a specialist, that requires a wait not unlike that in the U.S. The real issue seems to be, if one lacks insurance in the U.S., how does one pay for an expensive specialist consultation? In comparison, in Britain, on the NHS one doesn’t pay, but one may have to wait a bit if it is not for a life-threatening ailment.

In private terms, overall, the situation in both countries is thus actually much the same. Private insurance is available for those who can and want to pay for it. (Indeed, does this sound familiar?  The mother-in-law just had private surgery in a private hospital, thanks to the retired father’s-in-law’s former job’s benefits package, which includes BUPA coverage.  The hospital and surgery were all that could have been reasonably asked for, but as she never ceased to remind us all, the food was — in her opinion — terrible.) However, a major difference is that in the U.S. there is not even an end of a state “waiting line”. So unless you are dirt poor or elderly, if you lack private coverage your only real “choice” is to max out your credit cards or take out a second mortgage, or you have almost no chance to get treatment at all. That is the core issue Democrats are relentlessly pounding on. Republicans and conservatives must not dismiss it lightly, because it seems to be finding traction with a great many voters.

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As I said, I have no experience of Canada’s system, so I can’t speak to that one. But, as I noted above, I have been treated for minor stuff by the NHS and seen how numerous others have been treated.

Before my first doctor visit here a decade ago, I had heard all the scare stories about “socialized medicine”. Naturally, I approached health care here at first with a healthy degree of American skepticism. Simply, I prepared myself for “the horrors”.

But I couldn’t have been more wrong. The “scare stories” back then were pretty much the same as they are now. Yes, many were narrowly true then, as now. However, individual horror cases and criticisms just don’t best convey “the truth” overall for the overwhelmingly majority: tens of thousands are treated every day, day in, day out — babies are born, kids get their shots, people get broken bones mended, women get cancer screenings, etc., and so on. (As with plane crashes, you tend to hear only the horror stories about the 1 that crashed, and nothing about the 4,999 other planes that landed safely that day. Put another way, because jihadists attack, there are delays regularly, and sometimes there are terrible crashes, doesn’t mean that flying has not proven itself to be of incalculable benefits to most human beings. Accepting the perennial problems, instead we work to try to improve security, turnaround and safety as a neverending process.)

If you have never known how wonderful it feels when sick (isn’t that an odd way to put things?) to walk into your doctor’s waiting room and not have to fill out insurance forms, and then walk out of your doctor’s examining room past the check-in desk and not have to stop to fill out yet more forms, you need to someday.

It was under the NHS that I witnessed my very first house call (and in London, not out in “the sticks”), when my wife had had an allergic reaction to some painkiller; it was so bad, she couldn’t even get out of bed. I was on the verge of calling an ambulance . . . but our doctor came to the house and saw her personally! Up to then, I had thought it was only in “TV Land” that people answered their front doors to doctors holding medical bags.

I’ve seen six nieces and nephews enter this world via NHS hospitals; one niece had a particularly troubled birth, which was handled in a first-class manner.  I’ve witnessed a colleague’s mother (aged in her young 70s) go through successful cancer treatment on the NHS; her treatments were prompt and the staff hardworking. Also, I saw an uncle-in-law get a hip replacement in an NHS hospital that was undergoing extensive refurbishment.

As I’ve thought on my experiences with the NHS in writing this post, I recall what happened when I first registered initially for the NHS at that doctor’s in Cambridgeshire. I remember vaguely our family debriefing at home afterwards:

…Wife: “So, how’d it go?”

Me: “Fine. I saw the nurse. Funny, she asked me first if I was living here and in the [U.S.] Forces, and said I couldn’t register if I was. I told her, no, I’m not.”

Wife: “The nurse? Which one?”

Me: “I didn’t get her name. She came in and said since I was just registering, the doctor didn’t need to see me. She asked me some health questions, took my blood pressure. You know. She also gave me a Tetanus shot.”

Wife: “What’d she look like?”

Me: “Uh … youngish. She sorta looked like…”

Wife: [Laughing] “Blond? I know the one you saw. You just forget it. You aren’t getting sick anytime soon.”

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That last bit of humor aside, I could go on about how dealing with “health care” here is, by definition, not essentially about trying to cope inside a chamber of horrors. But that’s not to try to convey the impression either that it is some “la-la land”, when it is certainly not. There are always serious challenges, and there have been — to put it mildly — some appalling scandals. (And, as we know, there have been some recent, umm, issues . . . with certain hires.) But we need to maintain some perspective: doctors and hospitals have their troubles in the U.S. also, of course. (”…Depending on which statistics you believe, the number of Americans killed by medical screw-ups is somewhere between 44,000 and 98,000 every year…”)

Phoenix raises the worrisome issue of, say, smokers being told by government to stop or move to the end of the line for state treatment. (That seems to be getting lots of play.) Refusing treatment to smokers, and to the obese, was implemented briefly in Lincolnshire by the local primary care trust in a bid to save money on treatments unlikely to work owing to the complications those habits/problems created. The trust has since backed off, but it (not unreasonably) still wants people to lose weight and stop smoking.

Some bureaucrats capriciously denying treatment (on what basis?) is not an unreasonable concern; but decisions always have to be made and private insurance companies both here and in the States regularly make them, too. For example, women can also get IVF on the NHS until age 40 . . . with certain conditions. But rather than stamp one’s feet about the perceived “injustice” of such conditions, it is worth bearing in mind that for a woman without private insurance approaching 40, what’s the treatment alternative? At least there is an NHS available to her. And looked at another way, should taxes be paying for IVF for a woman of, say, 45? Most would say no, of course not.

Interestingly, some doctors choose to view personal responsibility from this (seemingly perfectly reasonable) perspective. As one told the BBC in 2003:

…Dr Richard Nicholson, the editor of the Bulletin of Medical Ethics, says that something needs to be done to change the attitudes of a hard-core of people who expect the NHS to bail them out regardless of their own behaviour.

He told BBC News Online: “There has been the belief among some that they don’t need to take any responsibility for their own health, that they can just rely on the NHS to sort them out if it all goes wrong.

“That is, quite frankly, a stupid idea - not least because medicine doesn’t have all the solutions.”

Thus another danger: the few who may not do much to care for themselves, but expect the NHS to bail them out. Yet people here are no different than in the States: most naturally don’t want to go anywhere near their doctor or a hospital, period . . . even though they aren’t directly responsible for the payment at the point of delivery. Why? Well, being honest, who really likes going to the doctor when they don’t have to? How many people actually like being sick?

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Everyone knows the NHS is far from perfect. It is a hugely complicated organization, and funding it is a perpetual headache. However, unlike so many non-defense governmental agencies . . . it actually does something obviously worthwhile. The NHS is so popular with voters that no politician in Britain who hopes to get elected would ever dare let it slip out about how dismantling the NHS was in the back of his mind for even a second.

The U.S. could surely do one better. “Strong on defense/ strong on health” is where most American voters are; they yearn to be able to vote for ONE party that stands clearly for both. The single biggest benefit to Republicans of their promising to look for a solid health solution upon the election of a Republican president and Congress in 2008 is that it would put the Republican party squarely into the “middle of the road” driver’s seat as that strong defense/strong on health party.

But with Democrats at best lukewarm on defense, and Republicans at best limp on health, currently Americans lack a party committed fully to both. However, if Republicans really want to win thumpingly in 2008 and simultaneously make themselves the majority party for the next generation, rather than constantly finding themselves on the back foot on this major issue, Republicans should be taking the offensive on health. British conservatives (who are hardly communists — well, not most of the time anyway) do not see “universal coverage” as some nefarious “socialist plot”. American Republicans could also similarly choose to see it as investing in “internal improvements” in the Lincolnesque sense:

…in February 1860, he delivered an address at Cooper Union in New York City which garnered positive press coverage and made him a sought-after speaker at Republican rallies throughout New England. Lincoln’s advocacy of internal improvements and tariffs made him popular in states like Pennsylvania and New Jersey, and he had managed to be anti-nativist and anti-slavery without alienating moderates…

If only they could bring themselves to do so, Republicans would leave Democrats gasping for a response on an issue Democrats mistakenly believe, based on poll figures like the above, that they “own”. For if they do “own” it, it is only because Republicans have mistakenly conceded it; but it is time for that “concession” to stop. If Republicans really wanted to, they could cause Democrats to be the party in need of urgent resuscitation.

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Again, as with any political issue, it is necessary to keep one’s feet firmly planted in reality. In critiquing the British system, please put down the craftily paranoid (”They” are out to get us) Daily Mail. Whatever its many faults (and what organization doesn’t have them?), Americans — Republicans and conservatives especially — need to know that the NHS is most certainly not about unattended sick people gasping their last in filthy hospital corridors just hoping some indifferent staffer will leave them a dirty cup of water; nor is it about a “second coming” of the Soviet Union, or a Cuba or a North Korea.

The reality is the NHS is about trying to provide adequate health care to everyone in the U.K., regardless of personal ability to pay. Does that mean an American “NHS” is a solution for the U.S.? Probably not. The U.S. is too large and too diverse for a “one size fits all” national solution; but that doesn’t necessarily mean that some national solution should not be sought. Republicans, especially, must take heed of the reality that voters appear to want one. Failing to pay attention to such, or simply trying to dismiss that desire or downplay it, or hope it will vanish, might cause Republicans to end up paying a serious price at the polls in years to come.

And when arguing about the issue in general, let’s get our definitions clear; we have to make sure we are debating fairly “from the same place”. “Socialized medicine” is absurd; but “universal health cover” is, in and of itself, nothing to be afraid of. Really, it’s not.

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UPDATE:  Unsurprisingly, Reuters just today badly mischaracterizes Cuba’s system — a fundamental mischaracterization of the type that is badly hurting reasonable U.S. discussion of the matter:

…”Sicko” has received mostly good reviews from film critics, but some viewers have criticized it for a lack of a substantive comparison of the U.S. health-care system with countries like Cuba that offer universal health care…

As I’ve just explained, Cuba does NOT “offer universal health care”.  Instead, Cuba’s citizens must take what they are given by the state only, with no other options open to them.  (And, incidentally, they have no chance routinely to travel to the U.S. or to Europe for specialist care they may not be able to get inside Cuba’s “universal” offering.)  That’s called “socialized medicine”.

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UPDATE 2: A little while ago, someone very, very close and infinitely dear to me, who had just read this post, managed to come away from all that having zeroed in on this:

Wife: “Hmmmm. Well, Mr Health Care, I see you haven’t forgotten that nurse?”

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UPDATE 3, August 2:  Stefania has a different take based primarily on the windbag’s moviemaker’s having stupidly oversold Cuba, and I understand it fully, and agree. 

In no sense do I favor socialized medicine, as I have just explained in agonizing detail.  However, as I have also explained, I believe that Republicans must not discount the wider health insurance issue; instead, they must go at it, be creative, suggest solutions, win voters’ confidence, and take possession of it from Democrats. For if they don’t? . . . how does fewer than 40 Republicans in the Senate, less than 200 in the House, and a Democratic president sound?