In Defense of the NHS

Norfolk and Norwich University Hospital (wikimedia)

Norfolk and Norwich University Hospital (wikimedia)

Alex Massie writes:

There are, I think, two essential truths in international health policy. No-one sees fit to copy the National Health Service and no-one sees fit to copy the American system…. The relevance of the NHS to American health care plans seems pretty limited anyway since, as best I can tell (though I try not to pay too much attention to these things) Obama doesn’t actually plan on copying the NHS.

And Kevin Drum adds:

But with the exception of a few outliers, the liberal community really, truly doesn’t want a fully government owned and operated healthcare system like the NHS. We want a government-funded healthcare system like Medicare or most of the world outside of Britain. And unless I’m mistaken, this isn’t a ruse in any way. That’s really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.

I can assure everyone that Kevin is right, because I’m actually one of the rare outliers who thinks the NHS is a pretty great model and the British are on to something. And try as I might, I can never find anyone who agrees with me. That said, the case for the NHS is quite strong. As Ezra Klein says, the UK method saves a ton of money:


But the British system is extremely cheap. Uncommonly cheap. Weirdly cheap. About 41 cents for every dollar we spend per capita cheap.

Now it’s definitely true that to an extent the Brits are getting what they pay for here. If you look it up, the research shows that British health care is not especially effective by international standards. That said, the difference is subtle enough that you actually do need to look up the research. It’s not as if people in the UK are just dropping dead of the plague all the time. To the casual observer, it all looks about fine, and the 59 cents on the dollar they’re saving is quite a lot. The fact of the matter is that health care is not an especially important determinant of health outcomes. Genetic predisposition is hugely important, and we can’t do anything about it. The biggest issue is “behavioral patterns” which are hard to change. But even “social circumstances” and “environmental exposure” (which is really a kind of social circumstance) swamp health care as a factor.

Which is to say that if you were actually able to get British levels of care for British price levels you could redirect that other 59 cents to trying to improve the social circumstances of the poor, trying to reduce exposure to health hazards, and building infrastructure (trains, sidewalks, bike paths, even the dread parks) suited to less sedentary lifestyles. We’d be much better off that way. The collective social determination of the industrialized west to dedicate large and increasing volumes of resources to trying to be healthier makes a lot of sense, but dedicating vast sums of money toward health care services just isn’t a particularly smart way of accomplishing that.