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GRAY MATTERS: Government-Run Health Care

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

I would not live anywhere but the United States (except maybe in an Italian villa). But we could take some lessons from what we patronizingly call the “old world.” Old, after all, usually means they know how to survive and learn. And we’ve yet to learn how an adult nation should act.

For example, we don’t need the barbarous death penalty, especially if we stop the insane easy access to guns. We stop mothers from boarding airplanes with too much baby shampoo, but our Congress refuses to bar people on the no-fly watch list from buying assault rifles.

And if the right-wingers truly believe in limited government, should not our government stay out of a woman’s right to choose abortion and my right to die?

Along those lines, virtually every nation in the old world provides for its citizens access to free or inexpensive health care. But only one reporter covering the hotly fought British parliamentary elections for CNN-World (which is seen by too few Americans) told us, in a fine story, that all three major party leader candidates – with ideologies ranging from left to right - agreed on one thing: The British National Health Service is so popular that in the campaign, it was an untouchable. Indeed it got high praise and support from all the prime minister candidates. Paul Armstrong reported,

“To many Republican politicians [and some Democrats] in the United States, a publicly funded national health system like the NHS is the embodiment of austere, Soviet-era medical care but in the UK, it is viewed as sacrosanct.

“Launched in 1948 by a left-wing Labor government [which replaced the conservative Tories under Winston Churchill], the NHS was created out of a long held ideal that everyone should have access to good health care regardless of wealth.

“More than a half-century on, millions of Britons still enjoy free medical care, from routine consultations on coughs and colds to open heart surgery. Over the years it can boast pioneering breakthroughs from Britain’s first heart transplant in the 1988 breast screening program, providing free mammograms to reduce breast cancer in women over 50.”

There are four parts of the National Health Service, for England, Northern Ireland, Scotland and Wales. The scale of the NHS is vast, with thousands of doctors, technicians, nurses and administrative personnel working for the service.

There has been criticism of waiting lists for treatment or elective surgery. But those critics ignore the chaos and the waiting in America’s packed emergency rooms on a weekend or Monday morning. In Britain, as I discovered years ago when I was struck with flu symptoms while covering a story, I could choose from dozens of neighborhood doctors who worked for the NHS. I was treated at no charge. (It was the same for me in Israel and South Africa).

Despite the criticism, the NHS spends $2,300 per capita on health care costs in the U.K., which is far less than the $6,700 in the U.S. And U.S. spending is way more than any of the comprehensive and universal health care systems in the old world. Still, there are 40 million people in the U.S. without health insurance, which is unheard of and would be scandalous in the old world.

Armstrong writes, the Conservative Party leader, David Cameron, now prime minister, was effusive in his praise of the NHS, noting on his web site, ”Millions of people are grateful for the care they have received from the NHS – including my own family.” (British conservatives have no ideological relation to American right-wingers. We should remember that the conservative icon Margaret Thatcher, who would not be considered conservative enough in the U.S. today, declined to mess with the NHS).

Perhaps if President Obama had used and learned from his own family’s access to government-run, socialized medicine, we might not have given our health care reforms over to the drug and insurance companies. But it turns out that Obama, unfortunately, is neither a liberal or a socialist and was not as willing as his British counterparts to even consider single-payer health care reforms. A little socialism is okay for the banks, GM and the president’s family but not for us.

In Britain, the Labor Party and the middle-of-the-road Liberal Democrats, who will be part of Cameron’s government, joined in defending and praising the NHS. In the U.S., said Ruth Thornby, a British researcher who studied the American health care system, Republicans are

“worried about rationing by government or an official bureaucrat making decisions about who gets what. (But) bureaucrats within private health insurance companies are making those decisions all the time...”

Indeed, in the U.S., only original Medicare, untainted by private schemes like Medicare Advantage, provides beneficiaries with free choices of doctors, labs and hospital, anywhere in the country. For those of you who consider any socialist system as austere, I’d urge you to browse the colorful and informative website of the NHS.

While the old world has placed its trust and health care systems in the hands of their governments, the reforms just passed by the Congress have been entrusted to private insurance and drug companies, with the hope they will voluntarily comply with the reforms. This despite the fact that the companies are bound by their fiduciary responsibility to their stockholders to return as much as possible on their investments.

On May 9, Senator Jay Rockefeller (D, W.V.), scolded the nation’s leading health insurance companies for “gaming” the new law to dodge and weaken it in subtle but important ways. In a letter to Health and Human Services Secretary, Katherine Sebelius, Rockefeller noted that the law provides that insurance companies are supposed to spend 85 percent of premiums on health care. Rockefeller charged the companies are redefining administrative costs as medical costs and thus not spending more on patient care, as the law intended.

On May 6, CNN reported that large companies, such as Verizon, AT&T, Caterpillar and Deere, were secretly considering dropping health care coverage their employees have had for years. This would mean undermining a crucial Obama promise of the health reform, that beneficiaries could keep the coverage they’ve had. In addition, the companies are balking, as too expensive, that part of the law which provides insurance for employees’ children up to age 26.

If employer-sponsored plans were dropped, it would help the bottom lines of the companies but raise considerably the projected costs of the health care reforms. Representative Henry Waxman (D, CA), chairman of the House Energy and Commerce Committee, reacted angrily and demanded internal documents of the companies on their intentions. So far, possible change is on hold.

Similarly, Sebelius’ public pressure forced Anthem Blue Cross and Wellpoint in California to back away from an announced 39 percent increase in premiums. And she criticized Wellpoint for cancelling coverage on women diagnosed with breast cancer, to be prohibited under the new law. Wellpoint denies this.

Surely the companies will keep trying to nibble away at the reforms. If they do, government has little recourse except moral suasion. But the only punishment, tucked into the deep innards of the law, is a paltry $100 fine for each day of a violation. A multi-billion dollar insurance giant will find it more profitable to pay the fine than abide by the law.

Thus, this question for Americans: Who would you trust more with your health care? Government (as in Medicare or the NHS) or your insurance carrier?

Write to


As someone from Scotland I just want to praise our NHS. In the last few years I have had health problems and the care I have received could not be bettered. The thought of trusting private insurers and pharmaceutical companies fills me with horror. Of course there are problems - too many managers for one, and not enough attention to basic nursing in some places, but on the whole we are very fortunate. Thank you for your thoughtful article.

Thanks again Saul for your insightful reporting. If only the "right" people would read this blog, perhaps something would be done about this serious problem. Dee

It's a trick of the right to take a few horror stories and extrapolate them to a general conclusion.

In their book The Heart of Power: Health and Politics in the Oval Office, David Blumenthal and James Morone argue convincingly that while universal health care access is a liberal idea first raised and developed during the New Deal, the policy discussion shifted to Republican terrain over the years. The Eisenhower Administration originally conceived of a public-private partnership between government and insurance companies, and Nixon and Bush I added the policy refinements. The Nixon Administration was influential in redefining the terms of a debate that Reagan cemented in place.

For a number of reasons, I believe that President Obama had little choice other than to act as he did if he wanted to accomplish anything at all. Essentially -- and often for reasons beyond their control -- progressives have not succeeded in building a constituency for single-payer outside of themselves.

Anyway, I highly recommend the book, which covers the history of health policy across each administration beginning with FDR. It includes biographical background on each president about their own exposure to the health care system, which often drove their attitudes in office. FDR's bout with polio is well known, but his patrician upbringing made him uncomfortable with using it as a weapon. Truman and Johnson, on the other hand, saw the end results of inadequate health care every day as children and up-and-coming politicians. Nixon's loss of two brothers to TB made health care one of the few domestic issue he cared about. And so on.

Mr. Friedman, you are preaching to the choir on this blog, except me.
Regards, John

All of this points up the importance of who occupies the leadership of the regulatory apparatus. The right pols in those jobs can made our lives somewhat better. I think a case can be made that the current administration does that quite well; see this New York Times article.

But for people who did an amazing job of winning the 2008 election campaign, they've done a poor job of rallying and utilizing public enthusiasm for their projects. So we get half-baked, profit-friendly health insurance.

I am an Iowan now living in Scotland. I fear moving back to the US for this very reason. I don't think I could afford health care.

The length of time it is taking to implement these minimal benefits is another reason my blood pressure rises every time I think about the health care reform bill. If only sensible people had been at the helm, medicare for all could have been implemented quickly. With healthy young people paying a monthly fee, cost containment would have bean a benefit to all.

Eliminating the greedy insurance companies would have lowered our per capita cost dramatically.

The saddest words are these: "What might have been."

I count my health care blessings daily in The Great White North, though our theocorporocratic prime minister would nibble away at it if he could.
What is it about Extreme Christians and their hatred of healthcare for the great unwashed?

This so-called health care reform is a joke, and in the long run will certainly almost entirely benefit the health insurance industry. My 58 year old husband's premium for Blue Shield GROUP insurance, up for on renewal on June 1st, will jump a whopping 58% -- from $434 to $687 a month. This is similar to what happened when Medicare Part D was started. In the lag between passage and enactment, big pharma doubled and tripled the cost of their drugs so that the new law would not really hurt their bottom line -- only the Medicare recipients would suffer.

All that rhetoric and time and energy was wasted when all we get is watered-down, ineffectual health care reform. This is not reform; it is more hand outs to those who need it the least.

I am very disillusioned with our legislators and our legislative system.

Thanks, Saul for the link to the NHS site. It is quite impressive with the way it offers support in a wide range of health areas.

Single-payer, IMHO, has suffered from very smart progressives each of whom believes he/she has a better idea than the other. Result? We get too many groups and too many small bore differences that create too many organizations around the same issue.

We have much to learn from the NHS and its way of directing people to appropriate services--care-givers, exercise. There once were "Citizen Advice Bureaus" in the UK. Places one visited not for social services but simply to find out where to go. Would that be so hard here?

I wonder how long it will take before people realize that the insurance companies have no function except to make profits.

Well, I had great hopes for getting something truly meaningful about health care reform done via Obama. However, in all honesty, I can't see much improvement and at 58, a widow living on my husband's pension, I finally had to make the awful choice of getting by financially, or dropping ridiculous medical insurance premiums which actually prevented me seeing a doctor for routine care.

Once I actually dropped the insurance, I felt a HUGE sense of relief, and no longer do I fret so much about what is NOT getting done about the issue. Unfortunately, the whole thing had made me miserable for so long, I found peace in just letting it go.

I tried for the past four years to mkae a difference in more ways than I can describe, but it all came to nothing.

It's unfortunate that we live in a country that thinks profit is more important than an individual's health.

Very interesting post, Saul. I am so thankful for having Medicare for us, Without it and just living on Soc. Sec. we would be out of the loop. Appreciate your sharing this information - wish it would adopted.

Again, Saul, your words have touched my soul. As a 3-time cancer survivor, now aged into Medicare, I am eternally grateful for this coverage. I can only hope that few people ever know the internal panic that swirls around our cells when we are ill and relying on our insurance (or lack thereof).

During the last diagnosis and treatment (for five years) my insurance company changed twice; it is impossible to describe the terror that shot through me each time, but I was one of the fortunate; at times, I wished I had stayed in one of the Eurpopean countries I had traveled to, or the UK.

The last illness took every cent of retirement investments that I had saved after raising my children, and planned on for "later," so now I'm existing on my SS only for which I am profoundly grateful.

Someone mentioned that health reform is not new to this administration - that is correct; in fact President Obama spoke of that several times during the campaign. It almost went into effect under President Carter, but we can be grateful that it is in effect now.

Reform like this one, the largest bill in the history of the nation, takes a lot of time, but what it has done for thousands already is truly amazing. In time, everyone will be more relaxed, and grateful.

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