One More Time….

The American Prospect sends out a regular newsletter, titled Kuttner on Tap, in which the author, Robert Kuttner, addresses a variety of issues.

Kuttner is a longtime journalist– currently a professor of social policy at Brandeis University.. He co-founded and co-edits The Prospect, which (according to Wikipedia) was created in 1990 as an “authoritative magazine of liberal ideas.” He is also a co-founder of the Economic Policy Institute.

Given Kuttner’s background, his preference for national health care is unsurprising, but a recent issue of the newsletter really resonated with me, not just because of stories like the one I shared last Friday, but because it mirrored my own experience with England’s National Health Service (NHS).

Kuttner was in London when he felt ill.

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.

As I said, this account mirrored a personal experience. A few years ago, my husband and I were on a cruise to England when he developed upper respiratory symptoms. By the time we got to Nottingham, where our oldest granddaughter was living at the time, he was really unwell, and she insisted we go to the nearby walk-in-clinic.

After a very brief wait, we were called back to the nurse practitioner. She took a history, examined him, and called an ambulance to take him to Nottingham University’s hospital. (She said she might be “over-reacting a bit–I hope so” but “better safe than sorry.”) The ambulance was there almost immediately, and I rode with him. I can’t say enough about how efficient and caring the EMTs in the ambulance were.

We were taken to A and E (Accident and Emergency). Again, we were impressed with the efficiency of the process; first, an evaluation and a number of lab tests, then further tests based upon the initial results. Throughout the (very long) day, personnel kept us informed of where we were in the process, and why they were doing what they were doing.

The fear was a pulmonary embolism; fortunately, the scans ruled that out. However, what the ship’s doctor had shrugged off as a cold or allergy turned out to be a heart problem that  hadn’t been detected by his cardiologist on his visit a week before our trip. The NHS doctor explained that his symptoms were the result of fluid accumulation–probably the result of unusual activity on the trip. He was admitted for a short stay so that they could eliminate the additional fluid.

Only when he was released were we asked whether we had insurance, since we weren’t British citizens. (The ultimate bill was $1900.–for all the tests, and a two day hospital stay. And Anthem–our insurer at the time–bitched about that and delayed payment.)

As Kuttner wrote,

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….

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.

Other Western countries have other versions of national health care. All of them deliver better results for many more people for far fewer dollars.

It turns out that it’s very costly to refuse care to “undeserving” (i.e. under-resourced) people…..


  1. As long as profit is the motive of what passes as our “health-care system” we will continue to be more expensive with worse results.
    Some years ago there was an investigative report on PBS that compared our system with the systems in the 5 top democracies in the world. the reporter interviewed the king of Sweden and asked him how many people in his country went bankrupt due to the medical cost. The king looked at him incredulously and said “None. That would be an outrage.”
    The commonalities of the five systems were that insurance companies were regulated and doctors, while making a good living, were not paid exorbitant wages. Socialized medicine is a sign of a civilized society.

  2. I lived in England for four years. My sister-in-law came to visit. She was four months pregnant but had been approved for the trip. The morning they were to leave she began bleeding. We took her to our doctor and he put her in the hospital on bed rest. I can’t remember how long she was there but it was under a week. It was the only child she was ever able to have. She miscarried three other times in the States.

  3. I have had health care in Germany, out-of-pocket costs minimal. I had a shoulder surgery in Japan with a 3 day hospital stay and PT twice a week, less than $5,000 (and the Japanese hospital personnel, as well as the surgeon, kept saying, “This is going to cost a lot of money.” I thought you have no idea the cost in the states.

    Every medical person I encountered in Germany or Japan, from the front office to the physicians and surgeons said the same thing: ‘You treat your poor people terribly in the U.S.’ We do. We don’t treat the working poor much better.

  4. Stand by for the “My friend has a friend whose 3rd cousin lives there and it’s terrible”. I point out to people unwilling to consider a smarter system our own insurance companies often deny needed care, before and after the fact, for various reasons, or place medicines on a list that needs approval. One of the reasons I retired early from Anthem was the clear placement of profit over patient care. “Urgent” medicine auth could take 72 hours, routine? Up to 3 weeks. As a CSR I could, in better times, tell claims to pay a claim that had been denied, then the company said the customer had to appeal, even if there was documentation Anthem had told them the service was covered. I don’t mind doctors and nurses & other medical professionals making a large paycheck, especially given the education required and often long days/togh schedules. But the CEO of the insurance company or the health care conglomerate? Not so much. Sadly our system services the CEO class & shareholders not the medical professionals at the expense of patients.

  5. You forgot to mention the ambulance was free!

    I had surgery in Switzerland in January. I had a tear in my right bicep tendon that needed a repair. Two surgeons, two nights in hospital, 6 weeks of rest (I don’t work), and pain meds. The total was 3,500 dollars. We had already paid my 500 deductible (from lab work before) so our cost was 10%, 300 francs. (Dollar to Franc = 1:1). It’s criminal what the states charge.

  6. I have no problem at all agreeing with this. But I know people who will respond with, “Yes, but there are 263+million more people in the US than in the UK, so of course it costs more here.” To counter that, I wish I had the per capita statistics. I’m betting they would present the same scenario.

  7. Underlying every national problem the United States faces is, IMO, one primary factor. That factor is so imbedded into our society that we are unable to solve any problem we face as a nation. Gun violence, inequality of wealth, homelessness, climate change, and a totally dysfunctional health care system; they all haunt us year after year after year. And that factor? Competition. Competition for the biggest… the best….the newest. Competition for the power. .. the money… the privileges. Winning has become everything. Surround yourself with other winners; shut out any sight of the losers you pushed down on your way up. Feed your ego whatever lies you need to sleep at night. But above all, do not entertain any idea of sharing… of co-operating.

  8. The American people have been told that foreign healthcare is in shambles because they don’t have the excellent healthcare system we do in the States—all propaganda. What we have is a luxurious healthcare system–expensive!

    Most CEOs in insurance and pharma companies make $20+ million in salaries. This luxury system allows for high-priced lobbyists stroking checks to politicians and regulators to keep the expensive system in place. Someone proposes a change to reduce the cost of healthcare and out come of the checkbooks.

    The American people are playing a game of roulette with their healthcare because they cannot afford so they postpone treatment and hope their illnesses just magically go away.

    Furthermore, have you noticed all the Knozone air quality days we’ve been having lately? Air pollution is staggering and will only get worse.

    We have one candidate for president in 2024 who will fix the healthcare system and the environmental pollution, but we have to have a serious discussion about it first. Robert Kennedy, Jr. is already under attack, but the attacks will get harsher as he becomes more of a threat. No Democrat or Republican has an answer–only lip service.

    p.s. I was being sarcastic yesterday. That’s all that remains on Trump because he will not be taken seriously. He’s a fraud who’s playing a con on people. He’s not the only one in Washington playing a con… 😉

  9. Health care is the wealthiest corporation in this country which cannot be shipped to other countries to provide cheaper services for patients. I keep asking myself how we think we can simply enact universal health care into the current government’s tax system; what is to be done with the current for-profit system which isn’t going to willingly give up their billion dollar corporations and profits to their many tentacled system now in place.

  10. It’s a pretty heavy lift to convince people that other countries have better healthcare – seeing as the message has been “we’re the best!” forever. It’s even true if you have gobs of cash.

    I feel like step one is to remind people that the government already pays for something like 60-70% of healthcare already between Medicare, Medicaid, VA, government employees, various other programs, ACA grants, etc.

    The dangerous part will be that once you start pointing out that government already pays, but we aren’t getting the benefits because the system is siloed – monstrous people will push to privatize everything rather than saving the money and improving services by combining all into a national healthcare system.

  11. Governments can provide health care more cheaply than private insurers because the emphasis is on keeping people healthy, whereas the emphasis here is on profits. It seems reasonable to say that when people are healthy, they don’t need medical attention very often.

  12. I, too, had an experience with NHS in England. What I learned showed me that a NHS will probably be impossible to install in the US. I fell onto a concrete curb with my head while on vacation in a small town in Southern England. The restaurant we had just left brought me a napkin which I pressed to the bleeding wound while we walked two blocks to our hotel. Luckily the husband of the owner/desk clerk of the small hotel was a nurse at a nearby hospital. The husband/nurse slowed the bleeding and ordered a taxi to take me to the A & E. Good service at the A & E, but I had a long wait as the room was jammed with patients on a Sunday night. Eventually saw a young doctor who cleaned the wound and told me he could not stitch it. For stitches I would have to return the next day and wait for a “surgeon” to stitch the wound. He agreed to a give me a bandage that would stop the bleeding, but I would have a scar. I opted for the scar. In our discussion I learned that he had little choice of where he would practice when he finished medical school. He was simply sent where the NHS assigned him. I suspect that he will have more opportunity to pick where he wants to work and live as he accumulates seniority, but doctors can’t always pick and choose where they want to live in England. Although he was a young man, he had several missing teeth. He was not planning to buy or build an expensive house either. There was no charge for the medical services, but we did have to pay for the taxi rides. I have a scar, but that it, to me, no big deal. If I hadn’t fallen outside of a pub, it might even be a badge of honor. A NHS restricts doctors options and doesn’t pay as well as in the US. For those reasons I think installing a NHS here will be a very difficult, if not impossible. When we leave the US we buy a travel insurance policy which covers medical bills and transportation to the states in emergency situations. I have never made a claim; but get great comfort by just having the policy. I heartily recommend such a policy.

  13. Having worked in financial management at two nonprofit hospital systems in Indiana, I can assure you that healthcare financial management is a complicated game. I was sickened by the fudging and moving around of numbers on Medicare and Medicaid Cost Reports after I had compiled the actual true numbers that should have been turned into the government.

    Jeffrey Swett mentioned working at Anthem. I was responsible for negotiating rates with insurance companies and NO other insurance company was more difficult to work with than Anthem was. Anthem was accustomed to telling hospitals and other healthcare providers what they would pay for services rendered – until I became involved. I calculated the weighted costs of every service my employer provided and knew exactly what reasonable price I needed to charge to keep us in business. If Anthem refused to agree to my very reasonable rate I told them to find another provider. I had that luxury because we were a home healthcare division of a hospital and home healthcare was not considered emergency care. After trying to find other providers to accept their rates that were less than half of actual costs they always called me back to agree to my rate. Does anyone else recall when Anthem became national news several years ago for illegally refusing to pay for breast cancer treatments? They would lie to claim someone had missed or was late with a premium payment. The most disgusting part of that story is the CEO during that time was a female that was in on it.

    How about Eli Lilly pharmaceuticals? I often wonder how many nonprofit organizations that rely on begging for donations from them would need to exist if Lilly’s profit margins weren’t so exorbitant. Lilly maintains goodwill news with their massive foundation pot of gold. I would be impressed by all their goodwill donations if they hadn’t accumulated billions by sentencing many people to death with their unaffordable high priced medications such as insulin.

  14. Great posts!

    To answer JoAnn’s question, the first reasonable step would be to transition all private insurers to Medicare+ accounts, allowing the federal government to become a single-payer.

    That’s a far cry from universal health care, but it makes it closer. As a country, we’d save billions, if not trillions, from moving folks to Medicare+ coverage.

  15. its called investor owned,managed and,well the death squad. and the republicans still vote for it. (the death squad) makes me sick to think about those who collect a quarterly share dividen from those who are charged by night stick for their insurance. but then again its been designed to be that way. the whole idea here is to bleed ya for anything and everything as wall street has paid to have it their way. control of every aspect of every cent. just how much is given away (thats earned right?)every quarter by dividen by every insurance co,would be a better argument. now lets see the figures…

  16. Todd is mostly correct today. The NHS was created in Britain just after WW II ended. The government thinking then was that since ALL Britains paid severe hardship prices during the war, ALL Britains’ health should be the reward for doing so. ALL Britains contributed to the NHS and ALL Britains – and their guests – still reap the benefits. They were, at that time, not slaves to capitalism run amok.

    The United States displays capitalism run amok in the form of Republican generated allowances to the greedy suits running our predatory insurance industry. THAT is where the $4+ trillion dollars goes. I think it was the Reagan administration – along with compliant Congressional Republicans (READ: Kickbacks from the industry)- that decided it was good for business and Americans to allow insurance companies to wag the dog of health care and allow them to make medical decisions based on profit motive rather than the health of the people.

    Once again, Republicans come to the rescue of sanity and good of the people. In this case, literally, EVERYTHING REPUBLICANS TOUCH DIES.

  17. I’ve been thinking about insurance a lot lately, since I paid for my new roof, post Ian out of pocket. I has occurred to me that the company representatives are just doing their jobs. It’s their job to say NO! That’s true regardless of the industry being insured.

    So is there an interim stage that can start us moving in the right direction? There is! My all time favorite Surgeon General, C Everett Koop, did a study years ago. He found that the good old US of A could save millions by simply requiring standardized forms for claim submissions. When that works, add lower ages to Medicare, while fixing Medicare to cover ALL health care issues and associated costs. Before long it will be easier to push through single payer health care.

    We have to start playing the long game!

  18. Todd, Medicare +? Are you referring to the new part C plans that are taxpayer funded, but operated by the Insurance companies? That’s just an HMO for old people. The insurers have the say over what gets covered. Not the doctor, not the patient.

  19. I have read that France has the best healthcare system in the world and have also read an account of an American tourist who became ill while there, sought and received excellent medical care, stopped at the clerk’s desk while leaving to pay the bill, and was informed that there was no charge. The lady tourist told the bilingual clerk: “But you don’t understand. I am not French, I’m an American tourist,” to which the clerk replied, “Yes, I understand. There is no charge.”

    We have sold our healthcare system to Wall Street from the day Nixon allowed his old friends at Kaiser back in California the right to start profiteering from the nation’s health. The profiteers and their corporate press apologists have poisoned the minds of hapless American consumers with the horrors of “socialized medicine.”

    Whatever the label, i.e., Nazi Healthcare, Communist Healthcare, or whatever, it is not the label that treats our collective ills, so it seems to me that the socialist healthcare of the UK and France is cheaper and better than ours and that we should ignore the propaganda of the status quo and adopt a system that mirrors theirs. We can throw the Kaisers and their ilk a bone. We can call our new system “Capitalist Healthcare.”

  20. We socialized countries (I’m Canadian) generally accept that there are areas that should not be treated as businesses, where the object is not to maximize profits. (Note that I think businesses _should_ be about longterm growth and stable income, but that is no longer tenable, as CEOs get paid for how well things are going in the moment.) These areas include health care and education, as examples. These are examples of areas where the goals _should_ be antithetical to the typical business model.

    Your system actually hurts our system, and those in Europe, too. Our doctors do very well; they are rich compared to most people. But they are not rich compared to your doctors. Every year, your system pulls a few of our more ambitious and greedy doctors and surgeons to the US where they can make more money.

    Now, maybe that’s “good riddance to bad rubbish” as my grandmother would have said, but it still puts a strain on the size of our pool of medical professionals. Fortunately, the doctors we keep largely got into medicine for (I’d argue) the right reasons, to help people.

    Our system is far from perfect, but I _never_ worry about health care. My sister and wife both survived cancer, with help from numerous doctors, nurses, technicians, specialists, chemo, radiation treatments, surgeries, etc. My daughter survived anorexia (which is an utterly terrifying illness, by the way) through similar help, but also nutritionists and psychologists, and others. We never saw a bill for any of it. When we’re ill or injured, we focus on getting better, and the health care system provides.

    Importantly, insurance companies have no say in the medical matters. If the medical people say something should be done, it’s done. The number of medical-related personal bankruptcies in Canada last year? Zero, same as every year.

  21. Medical care is a necessity for all. It’s infrastructure that serves all. The system we have serves the few at the expense of the many. The only informed reason to be for it is if you are one of the few it serves and simply don’t care about the many who you live at the expense of.

    When are we going to take the country back from the few? Why do we act like we didn’t win the Revolutionary, Civil and World wars?

  22. We are all forgetting the most important aspect of healthcare for all. Educating those doctors should be free like the UK, France, etc. We are asking for tax payer funded healthcare but you have to include education, training and research in that figure and that’s the end of the whole idea. That’s how these countries make a workable system for everyone.

  23. This is a really important point.One of the (legitimate) arguments for MD’s high incomes is the cost and time invested in medical education, which they have to recoup.

    That’s very different from arguments about drug prices; big Pharma talks about the costs of R&D, but an enormous amount of medical research is funded by government, not by the
    drug companies. Those companies actually spend more on advertising/marketing than on research.

  24. Bob DuComb. I think some U. S. doctors are getting fed up with our “health” system, too. As insurance companies continue to increase their control over medical decisions and numbers of patients doctors are required to see and make paperwork more and more onerous for their offices, doctors are expressing negative opinions about the system. While some physicians make a lot of money, being one is no longer a guarantee of becoming very wealthy. The insurance companies are scooping up money everywhere they can and some of it is at the expense of the doctors.

  25. Nurse here–Not alot to add because all your comments show how bad our system is–took health policy through SPEA and really I am happy to see you all agree our health system is a piece of shit and I LOATHE insurance companies for the bureaucratic nightmare. I have already worked two prior authorizations for Medicare HMO on meds that are cheaper using GoodRX coupons. Cheaper care and better outcomes and almost everyone is covered–that is not America.

    The hospital network I am currently working at is on a hiring freeze because we were the only group (we are a non-profit hospital) that didn’t cut hospital beds (some in the area cut beds by 40%) during the pandemic–but d/t the higher costs in those travel nurses, therapists, etc…the meager budget got blown to bits.

    Sheila brought out a good point and a reason why there are a lack of doctors and specialists in the rural counties. The cost of medical school is enormous–I know of many who are leaving with school loans near $400,000 and because they are not cardiac surgeons it will take a LONG time to pay those off. Other countries do not have this type of exorbitant costs for medical school–so those coming out of Fellowship are going to the big cities where they can see the volume of patients to help pay off their loans.

    Anthem–Yep, when I heard they were trying to negotiate a payment lower than Medicaid—lower than Medicaid–I asked our leadership why negotiate–we had a year wait list to get into our clinic, we didn’t need to negotiate for a patient supply (which was Anthem’s argument)– a year’s wait and once you got in, we were so busy most of the doctor’s couldn’t get you back for a return for 6 months and our population was Pediatrics

  26. An exhorbitant, inefficient health care system that produces at best mediocre outcomes.
    Minimal to no restrictions on individual ownership or freedom to carry everything from handguns to weapons of war, producing unheard of numbers of mass shootings and homicides.
    Backward slides on women’s rights and LGBTQ+ rights that seriously endanger health and well-being.
    A powerful political movement and party that denies climate change, is responsive to the oil and gas lobby, and rejects an active EPA, thereby endangering the health of all future generations.

    It would seem that American exceptionalism ought to be defined as ANTI-life. Somehow I still manage to love my country, but it gets harder by the day and I feel incredibly fortunate to live in Canada and have dual Canadian citizenship.

  27. Yes, and we are truly exceptionalllllyyyy dumb, did I say short-sighted and dumb?
    Did I say, short-sighted, dumb and greedy? Did I say that our culture is much too
    based on a zero-sum prospect, where the powerful rake it in and the rest can go fly
    the cheapest kite they can find?

  28. Todd, I was actually with you for most of your post. But then you suggested that RFK would fix the healthcare system which was beyond bizarre. He is an anti-vaxxer, conspiracy-theorist nutjob. The idea that a person who believes vaccines cause autism would fix healthcare is ridiculous.

    By the way, if _you_ are a person who worries about autism when you hear about vaccines, then you haven’t really looked into it. Andrew Wakefield is a complete fraud. He set up his sham study specifically in order to accomplish two things:
    (1) He worked with a lawyer (and a few vaccine-sceptical families) to come up with the scam to try to create proof for what they hoped would be class action suits which would make them a ton of money, and
    (2) Create doubt in the MMR (mumps, measles, rubella) vaccine in favour of individual vaccines, because he had previously applied for his own patent on a measles-only vaccine, which could make him a ton of money.

    So, his study of about a dozen hand-picked kids included changed and incorrect data, and multiple dangerous tests unethically (without due warnings) delivered, leading parents to report that autism was noticed around vaccination time, and much more. He is very similar to TFG in a lot of ways, actually: looking for get-rich-quick schemes and hurting people who might be in the way. After his measles-only vaccine didn’t work and was never used, and his fraud was uncovered (and his MD credentials revoked), he moved into the anti-vaxxer circles instead, and actually made a lot of money selling books and giving talks. He is a complete scumbag.

    Plus, it caused a lot of money to be spent on numerous real studies in the following years, where absolutely zero evidence for an autism connection was found.

    But you still have people forgoing vaccination because of these fears, and that puts their kids at risk, plus those kids who have some health issue that prevents them from taking the vaccine. He has definitely caused the deaths of children with his crap.

  29. John H–Hear. Hear. Wakefield did alot of damage w/ that fake study and the ramifications are still ongoing. Millions of $ wasted to disprove his ‘research’ and then finally the truth came about on how fraudulent it was—back ground in working in Autism and lived this.

  30. Per Sheila’s comment
    My PhD thesis advisor, who loved teaching medical students much more than he cared about graduate students, opined that with the rising cost of medical education (this was the ’80s), that the government would have to start paying for it in exchange the young doctors working in poorer communities. This, he believed, would lead to the US adopting a more European or Canadian styled healthcare system.
    This wasn’t the only time that he was wrong. He also thought he looked like John Cleese. He didn’t.

Comments are closed.