Decisions, decisions....

Yes, healthcare again.  NO, DON'T HANG UP!  THIS IS ACTUALLY PRETTY INTERESTING.

Congress (the House of Representatives) should be taking a vote this week on whether they'll be adapting Ryan/TrumpCare or sticking with ObamaCare, which it seems all agree will soon be/is on life support.  The Right is hoping for the former, and the Left (Bernie & friends) would prefer something more like the single-payer (universal) healthcare system they've had in the United Kingdom since 1948.

So what exactly is the UK's system (the NHS) like?  I'd heard the doctors and nurses, the technology, and the facilities are all first rate, but the wait time to be seen by a doctor was very long.  To get to the bottom of it all I corresponded with a British friend* and asked him to give me a quick overview.  I trusted him implicitly and knew he would give me the unvarnished truth to the best of his knowledge.  His response:

First, the NHS is a mandatory insurance scheme paid for by National Insurance contributions, a tax for all intents and purposes.  Almost all prescriptions are included for a flat fee of approx $10US each, with exceptions for the young (<16) and the "more mature" (>60), with a few other special exemptions, too.  One option is a Rx pre-payment plan costing roughly $125 per year which covers all your meds, regardless of how many you might have.

All doctor and hospital treatment is included, as are many optical and dental services.  Doctors, dentists, and "opticians" (optometrists) are all self-employed and may be either working entirely for the NHS under contract, entirely private, or a bit of both.  About 8% of the population also has private insurance over and above their NHS coverage, which generally gets them perks like quicker consultations, private hospital rooms, etc.  (He said it really amounts to not having to rub elbows with the common folk in the waiting rooms.)  Almost all feel there is no difference in the care received, although a few would debate that.  If a doctor has a good reputation and a thriving practice serving the 8%, he can probably make more $$$ by going entirely private than with a NHS contract.

The biggest grumble is indeed the wait time to be seen.  Of course all patients are prioritized, just like here, so emergencies get immediate attention while non-emergencies could be in for a fair wait.  Elective surgeries can take (many months) longer to schedule than here, so you might be hobbling around a lot longer on a bum knee, but at least there will be $0 due when you're finally patched up.  

Another common complaint is that the NHS is in places understaffed.  All this varies depending on where you live, just like service in the US varies depending on if you live in a big city or a smaller town.  On the plus side, paperwork there is nil....just show your eligibility card.  That's it!  *take note Aetna!*

My friend pointed out that, essentially, National Insurance and the NHS is a non-profit system that covers everyone.  The nature of the system means that drug manufacturers have to reach agreement with the NHS about what their prices will be, and as a near-monopoly the NHS can haggle for better prices than private hospitals or doctors can here.  This is largely why treatment costs there are so much lower....the non-profit side combined with the fact the NHS dominates the market.  In the US a very large portion of the money we pay goes to the sort of overhead that any privately-run system has....large salaries for health insurance and pharmaceutical company execs, dividends to shareholders, medical billing and the inevitable write-offs, and so on. 

Now for some numbers** :  The United States spends approx 17.1% of its GDP on healthcare (public and private combined), or about $9,403 per person, which still leaves us with about 12% who have the only option of going to an emergency room for care, which they will likely never be able to pay.  The United Kingdom spends approx 8.8% of its GDP on healthcare (public and private combined), or about $3,377 per person, which includes care for every legal resident.  

On a parallel track, the total tax burden on the average American is 26% of his income, and 32.6% for the average UK resident.  Essentially the top income earners here would come out ahead paying a lower tax rate, while the rest of us would probably do better paying higher taxes but receiving all-inclusive healthcare. 

Just as there is considerable political pressure to cut healthcare costs here, the same applies there.  The Republicans here and the Conservatives (Tories) there are looking to reign in costs (ie: coverage).  Both are having some success, taking some services off the table, although incurring the wrath of many voters in the process.  I will say that every single Brit I have ever heard discuss their system said they were overall "satisfied" or "very satisfied" with it.

It seems to me that if you have coverage here in the US (subsidized) by your employer, if you have ample financial liquidity to pay for all your prescriptions, the ever-increasing co-pays, deductibles, and out-of-pocket expenses, and if you believe your job is rock-solid stable (is there such a thing anymore?), you might want to just leave things alone.  But if your situation is anything other than that, the security of a British-style system might look very enticing.  Also be aware, as I understand it, those here over the age of 47 will be especially hard hit by the proposed Ryan/TrumpCare, so be prepared.

Finally, I ran across this article while doing my research comparing the UK and US systems by someone who has used them both.  It's definitely worth a read....very interesting.

Just something for you to think about.

S

* Thank you, Sir, for your invaluable insight.  :)

**  Exact numbers are hard to compare.  US, EU, various research groups, etc, differ slightly.  Some numbers, for example, are from 2015, and some from 2016.  Still, the variations are minor.  Tax liability numbers are as close to "apples-to-apples" as I can find.