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God's Politics

Health Care in the UK: An Astonishing Example of Communitarian Justice

by Gareth Higgins 07-14-2009

Sometime in the spring of 1974, my world was somewhat disturbed by the event of my conception, in Belfast, Northern Ireland.   When this became obvious to my parents, they went to see a doctor, employed by the UK National Health Service.  They saw the doctor quite a few times.  They got ready.

The doctor’s fee to them?  Nothing.

My mum spent a few days in the hospital in January 1975, including a monumental and pretty heroic 24-hour labor.  She was attended to by the doctor she had come to know well and by excellent nursing staff; my dad was there for the duration.

The hospital’s fee to them?  Nothing.

When I was 7 years old, I had my tonsils removed due to the fact that my doctor thought it would help with a recurring sinus problem.  Two nights in the hospital.  Very dry throat. Large-scale Boba Fett ‘Star Wars’ toy arrived to make me feel better.  It worked.

What it cost my parents?  Nothing.

Throughout my childhood, prescriptions cost me the equivalent of around $10, the same as any prescription for any medicine did in Northern Ireland until recently.  In fairness, I have to acknowledge that the price has changed in the last year.

It’s been cut in half.  And starting January 2010, medical prescriptions in Northern Ireland will be entirely free.

Of course it isn’t strictly true to say that ‘my parents paid nothing’ for my health care.  They paid taxes — taxes that in the UK amount to nothing on the equivalent of the first $10,500 of income.  Above this level average earners pay 22 percent; in practice, this is favorably comparable to U.S. federal income tax rates.  (Frankly, the total amount I have paid in taxes in my adult life may amount to less than one typical, private industry, major medical intervention in the U.S.)

This is what funds the UK National Health Service.  This is what made it possible for my parents to have three children cared for through pregnancy, labor, birth, and throughout our lives.  This is what salaries my doctor.  This is what paid for the attempts to save my grandmother’s life from breast cancer, covering two mastectomies and long hospital stays.  This is what has paid for all of my sister’s diabetes medicine and hospital care for over 20 years.  This is what paid for another family member to have an electronic breathing apparatus at home when his asthma sometimes became so severe he needed extra support.

This is why no one in the UK ever has to go bankrupt due to medical bills.  This is why no one in the UK has to choose which part of their body to care for.  This is why no one in the UK has to stay in a job they hate because they’re afraid of getting sick.  This is why no one has to hide details from their doctors in case a pre-existing condition became the reason an insurance provider refused to provide insurance.  In my book, that would suggest the insurance provider probably should call its business something else.  No one in the UK ever worries about how they are going to provide for their own or their family’s health.  This, to me, is an astonishing example of communitarian justice, the highest ethic of humanity: when people care for their fellow people, with no concern for individual reward.  And this is why, if I require major medical intervention in the future, instead of receiving it in the United States where I now live, work, and hope to contribute as a grateful immigrant, I may have to go back home.

Gareth HigginsGareth Higgins is a writer and broadcaster from Belfast, Northern Ireland, who has worked as an academic and activist. He is the author of the insightful How Movies Helped Save My Soul: Finding Spiritual Fingerprints in Culturally Significant Films. He blogs at www.godisnotelsewhere.wordpress.com and co-presents “The Film Talk” podcast with Jett Loe at www.thefilmtalk.com.

To learn more about health-care reform, click here to visit Sojourners’ Health-Care Resources Web page.

Categories: Health
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  • Ngchen
    Excellent post. I have always believed that needed health care is a human right. The trick is figuring out how to fairly provide it. IIRC the US has the most expensive health care system in the world by far, but we do not have the healthiest people.

    Insurance reform can spread the pain (cost). After all, insurance is basically a cost spreading mechanism. But it cannot reduce the overall cost by itself. The high costs are probably due to a bunch of different factors. IMHO, real reform will have to have people making some hard choices. Here are the factors (by no means inclusive) that come to mind.

    1. An unrealistic demand for "perfect" medicine. I read at pathguy.com claims that the Pap smear could be had for a few dollars, until a very small number of false negatives lead to lawsuits, and a drive for a "perfect" pap smear. This new test, cost more than 10X more, and did not save any lives since people ended up not being able to afford it anymore. Doctors report practicing "defensive medicine" all the time in a bid to avoid rare mishaps, and end up saving no lives anyway. Perhaps there should be *real* tort reform in the sense of more carefully delineating what is and is not the standard of care and reasonable damages (rather than the fuzzy "pain and suffering," "what a 'competent' doctor would have done or not done," etc.) Supposedly one of the key benefits of the rule of law is the reduction in uncertainty; yet tort law is full of uncertainty.
    2. High-cost of prescription drugs. Drug research and development are expensive, and the money needs to come from somewhere. But the current patent system makes it so that companies can go from boom to bust in a few years (see Viagra for instance), and they have to charge exorbitant prices to survive the bust cycles. Would patent reform, say having price caps for drugs in exchange for longer duration patents help? The reduction in uncertainty for all sides can be a win-win.
    3. Transparency in pricing. Doctors and hospitals, ironically, are one of the few services where there is no overt price tag anywhere for the consumer. I hear it's actually illegal for them to list prices. Yet, insurance companies can and do negotiate lower rates with health-care providers, so price lists DO exist. Publicizing the rates charged for various procedures and such would foist competition onto the market, and lower prices.
    4. Perhaps some model of paying providers based not on the number of procedures, but rather on outcomes and patient satisfaction would reduce unnecessary procedures. Of course, such a model has to be carefully designed to avoid unfairly penalizing physicians who care for the sickest people.
  • beckycarr
    Amen to your comment about transparency in pricing! Price competition is one of the hallmarks of private enterprise. Of course not having it in the health care arena is bound to drive up prices!
  • christianhippy
    The Northern Social Care Health Trust which covers Co. Antrim in Northern Ireland, has to save approximately £15 million to finance free prescriptions in their board area through cutbacks. And has to make further savings of approx. £30 million over the next 3 years, and the C.E.O. resigned because this was an unobtainable target imposed upon her by civil servants.

    For instance low paid staff such as porters, domestics and catering staff coming mostly from areas such as Rathcoole, Monkstown and Cloughfern will lose their jobs at Whiteabbey Hospital or have their hours cuts to meet spending targets.

    Whiteabbey will be down graded from 160 beds to 60 beds to save money, wards 6,7, have already been closed wards 8, 4, will be closed within the next six months and the A & E will be down graded to a minor injuries unit. Ward 10 has been closed temporarily because no one wants to work in a hospital that is floundering.

    600 nursing posts in Northern Ireland will be lost to accommodate cut backs within the NHS in Northern Ireland over the next three years.

    Free health care comes at a cost to the vulnerable the alienated and the socially deprived, I have worked in the NHS for the past 31years as a low paid worker and trade unionist activist, the hospital that I originally worked in was closed to make cutbacks to provide so called care in the community amongst the elderly, which has been a failure.

    The NHS is a absolute failure. The cost is met through indirect taxation and National Insurance which falls short of what is needed to finance the NHS. The U.S. system is also a failure.
  • garethhiggins75
    Dear Christian Hippy - Thanks for your comment; and I sincerely appreciate the concerns you raise. The NHS is going through a challenging period, and is of course not perfect: but my key point was that even imperfect universal coverage is a safety net that most of us need. I completely agree that initiatives such as care in the community amongst the elderly have not succeeded; I'd be interested in your suggestions from your long experience of activism about alternatives that could make the system better. And I think I should state for the record that I don't think all health needs should or can be met through taxation - there is a communal responsibility for us to bear each other's burdens (and care in the community for elderly folk is a prime example of where that responsibility is frequently not being met). Thanks again for your comment; hope to hear more of your suggestions for change.
  • Trent
    Our local paper angrily reported today that wait times for our local hospital's emergency department were now averaging 8hrs (up from 4hrs). So apart from the wait - everything's free. Or if you want to you can can private cover for a few thousand a year - which is also heavily subsidised (30%) by our taxes. The dual system works well. Not all surgeries are covered - gastric bypass for example is not as it's currently considered cosmetic - but all life-threatening surgeries are. Medications are not free - but essential medications are subsidised for all and children or those with low incomes have further subsidied pharmaceuticals. Our hospital staff are highly unionised and our nurses are paid at well over the mean income.
    Our taxes are comparable to those in the US and we pay no state taxes as the bulk of state funding is from the federal taxes we pay. On an income of $70K I paid a total of $14K in taxes - less in tax than some US insurance premiums I've heard of.
    The big issue in Australia is that our medicare system doesn't cover dental.
    Well, it doesn't yet.
  • valeries2cents
    Trent, you make an excellent point that most Americans don't seem to have absorbed...

    "On an income of $70K I paid a total of $14K in taxes - less in tax than some US insurance premiums I've heard of."

    You are correct, my employer pays $11,000 per year for my insurance coverage. So when people ponder how we can pay for it, it really is quite simple... isn't it? We already are... and when the administrative costs across the nation for each of these individual plans are slashed because we don't need all the duplication, we will save even more.

    We already have the foundation in place... Medicare. Now we need to redirect some of the money spent on private plans into the Medicare system and we will be able to improve / expand the benefits to meet the needs of all Americans.

    Jesus never taught, nor would have encouraged the "pull yourself up by your bootstraps philosophy". Jesus was all about community, as was the early church.

    Thanks Gareth for your contribution!
    Valerie
  • mscynthia
    8 hours sure beats never any day in my book.
  • SisterMarie
    I just cannot abide the thought that now that I've finally reached the Medicare Age, everyone else might have the same health coverage that I waited 65 years to attain. If you are fortunate enough to make it to 65, congratulations. Otherwise, get in line and be sure to take your vitamins.
  • Bungarra
    Even the fairly bleak report from Australia did not mention that we can also buy private health insurance which does give some dental, optical and other assistance plus top up the Medicare refunds. It does allow for private selection of doctors etc. Even so, if you are in strife you get looked after quickly and it will not dissipate the family fortune.

    The problem we have here is that there are pressures from your companies and others who are attempting to destabilise the system here in the name of free enterprise and user pays. Hence some rationing of services. That tends to get fixed come the next election. I wish we could vaccinate against those debitating viruses (ideas). We did get rid of the last PM.

    Data I came across this (http://www.pbs.org/moyers/journal/index-flash.html )evening suggests that the average spend per person is about $3,000 per person in Australia versus $6,500 for the USA. If this is so, the USA should have the longest lived population in the world. I think that that may be Japan with Australia in the top 6-7.

    I would suggest that this is a huge rip off of the population. Time to carefully consider the concept of 'who is your neighbour.' The UN Charter of human rights should also be considered a guideline for the rights of citizens. Do we treat our livestock that badly?

    Why have so few been allowed to extort so many? A much greater spend should be on prevention not overpriced drugs or excessive legal insurance for possible mistakes by doctors. Limit damages as NZ has done who have reduced the legal profession input in the area of damages.
    Does fructose cause obesity and Type 2 diabetes?
    Could we stop the current flu pandemic spreading, No.
  • dunnbv
    My only concern is rationing....so if someone is 70 and needs a liver transplant...do they get it? Or needs Avastin to fight their cancer, who decides whether they get it? We are all paying for it now....but it is not rationed.
  • PastorJudy
    A few evenings ago I was having dinner with our local clegry and families. One couple began telling about their experiences with health care in England when they were students at Oxford. I would guess from their ages that their experiences were in the last 10 years. They told of a friend who was in a major accident. When they went to visit the friend in the hospital 4 days later the blood had not yet been cleaned off his face from the accident. They also reported that it was common in that hospital for the linens on beds to not be changed in between patients. Because of those incidents and others they decided not to have children until they returned to the US.
    Were their experiences anomalies? What is the quality of health care, in general, in the UK?
    For a few years my family was not eligible for health insurance through my church. My husband is disabled and we have two minor children. I was only able to work part-time. As residents of New York State we applied for Healthy Family and Child Health Plus through the state. We were able to do this because I was employed at least part-time. We were given a choice of insurance companies and plans that would cover us. Our premiums for my husband and myself were about 1/3 what my collegues in full-time ministry were paying the church sponsored plan. Each of our children was covered for $9 a month. We paid normal out-of-pocket expenses for the adults (medical and prescription drugs) and absolutely nothing beyond our premium for the kids. We kept our family doctors. Our level of care never changed.
    I don't object to the government helping people who need help with health care. However, I don't think the federal government is doing a very good job of running itself financially, and I hesitate to put it in charge of health care too.
  • vanzantshat
    I live in Northern Ireland. The picture you paint of the UK NHS is historic. True you can still receive free care, but as Christianhippy states (and u reply) the NHS is in a state of change and under severe pressure. We all hope for a return to "how it was" but that will not be possible without Christian intervention and a fairer society where people pay the taxes they owe irrespective of their income. Unfortunately too many high earners (> $150,000) exploit loop holes allowing them to contribute a disproportionately low amount of tax.
    Greater personal integrity is necessary for society as a whole to benefit.

    PS - people are already having to choose whether they look after their teeth. Dental care costs are extortionate, but still probably less than in the USA.
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