An Open Letter To My American Friends About The NHS

I did want today to write something about comics, and I’ve also got a playlist I want to post, but I felt compelled to write this after various news reports over the last couple of days. Unlike most of my writing (to which I retain the rights for various reasons, I’ve decided to license this piece as Creative Commons Attribution-No Derivative Works 2.0 UK: England & Wales License because I want people to share this by whatever means. I’ve emailed the following to as many of my USian friends as I can think of and have valid email addresses for (and at least a dozen who it turns out I *don’t* have valid email addresses for, if the bounce messages are anything to go by…):

I am writing to you because you are a friend of mine, because of various statements that have been made by American politicians and journalists about Britain’s National Health Service.

I do not like to try to interfere in American politics, because how you run your country is your own business, but your politicians have been lying, and they have been lying about me and my wife and many of our friends and relatives, so I feel an obligation to set the record straight.

Many of your politicians and journalists have been saying things like “Ted Kennedy wouldn’t get treatment for his brain tumour in the UK because of his age” (a Republican senator called Chuck Grassley said that). Sarah Palin said that in the UK babies with Down’s Syndrome would have to go before a ‘death panel’. And so on. I’m sure you’ve all heard many claims like this yourself.

These claims are lies, pure and simple. They’re not ‘opinions’ that people can disagree about, they’re not things that can be debated, they’re not honest mistakes, they’re out-and-out lies.

Many of you will know that I worked for the NHS for about three years. Some of you will also know that Holly, my wife, still does. Do we strike you as people who would work for an organisation that killed people? Your politicians and journalists are accusing us of being knowing accomplices to murder.

According to the CIA World Factbook, British people live on average seven months longer than Americans. Now, that doesn’t say much about either country’s health-care system, especially when you take lifestyle differences into account, but what you *can* tell from that is that we’re not killing our old people – you don’t get a high life expectancy by killing people!

The tiny grain of truth in all of these lies is that in the NHS, an organisation called the National Institute for Clinical Excellence decides what treatments the NHS will and will not pay for. It does this by measuring how much extra healthy life a given treatment will give a patient, and how much it costs – just like your insurance company does. All healthcare systems have a budget – no system can spend an infinite amount of money, after all – so choices have to be made. The difference is, in your system, the choice is made based on whether you can afford to pay for it. Here, the choice is made based on how much you need it. If you’re 77 years old, like Ted Kennedy, and you have a brain tumour, you’ll get treatment so long as there’s a good chance of it working and giving you a few more years of good life. If there isn’t much chance of that, the government won’t pay it, that’s all. Just like your insurance company won’t pay for expensive treatments that won’t help you, neither will the British government.

And no-one is stopped from paying for treatment if it’s not funded by the NHS. People in Britain can still get private health insurance if they want to and can afford it, and can ask for treatments that the NHS don’t provide. Mostly they don’t, because it works for most people.

I know at least one homeless person who has been given treatment for cancer – and he was homeless before the treatments, not because of them – in Britain, if you’re sick you will get treated, no matter how much money you have. And no matter how old you are, or how disabled.

One American news source recently said that Professor Stephen Hawking would be allowed to die over here, because of his illness. In fact Prof. Hawking has lived in the UK all his life and has nothing but praise for his treatment by the NHS. Sarah Palin says people with Down’s Syndrome would be refused treatment – that would be news to the people with Down’s Syndrome I used to work with, many of whom had had heart operations on the NHS.

On average, people in the USA spend twice as much on healthcare as people in Britain – and more than any country in the world. Despite that, according to the World Health Organisation, the USA’s health system is 37th in the world, while the British one is 18th.

There are plenty of faults with the British health care system – and I hope that your legislators learn from them and get you a better system than we have – but it works. We do not kill old people. We do not kill disabled people. If we did, then Holly and I , instead of working for the NHS, would be fighting against it with every ounce of strength we have.

There are arguments that can be made against our system, just as there are arguments for it, and if you agree with those arguments then that’s fine – I have no intention to change your mind here. I am just trying to let you know that I am not an accessory to murder, and that anyone who says I am is a liar.

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144 Responses to An Open Letter To My American Friends About The NHS

  1. Holly says:

    Not only would I not be working for the NHS, I’d be hiding from it, as I am a disabled person myself!

  2. Paul C says:

    Brilliant – thanks for this. However I doubt it will make much difference to those who have already made their minds up…

  3. Leighann says:

    American politicians are just about useless. And, our health care system sucks unless you have good, expensive private insurance. We have insurance through Damon’s employer, but it costs us $150 PER WEEK. That insurance makes my Geodon, which I have to have in order to even function on a basic level, only $120 every 3 months instead of $1200. However, if I lived in GB, I believe I wouldn’t have to pay anything for that medication at all.

    All in all, I’d rather take your health system =P

    • Andrew Hickey says:

      To be fair and absolutely accurate, you would have to pay. You’d have to pay $12. Unless it counted as a ‘long-term condition’, in which case you might not…

      • Leighann says:

        It is a long term condition…schizophrenia isn’t exactly curable. Neither is depression. Hell, $12 isn’t bad at all, compared to $40/month. I don’t mind paying for the medicine, because it helps me, and because they have to research these drugs with some money. I do think the prices Americans pay for health care isn’t good for the quality of health care that most of us get.

        • Andrew Hickey says:

          What counts as a ‘long-term condition’ and what *is* one are two different things unfortunately ;)
          But yes, you’d be paying $12 every few months instead of $120…

      • Sara Schaefer Munoz says:

        Hi Andrew,
        I’m a reporter for the Wall Street Journal and I’m working on a piece about how US politicians have been attcking the NHS. I saw your open letter and would love to talk to you for my article about your defense of the NHS.

        I can be reached in London at 0207 842 9218. My deadline is later todau.

        Sara Schaefer Munoz
        The Wall Street Journal
        London bureau

  4. KendallJaye says:

    American girl here. My two big hangups about Nat’l Health Care:
    1-Our Government can’t pay the bills they already have. With no income, doctors will not be able to pay their own expenses and will be forced to close their doors. Thus causing a shortage of good doctors.
    2-My tax dollars being used to fund Ms. Crackhead-with-five-babies ER visit. When someone makes poor decisions regarding their health and their bodies, I do not feel it’s my responsibility to cover them.
    Now I may be reading all of this incorrectly. I hope there is a solution out there, and that we can find it. But I have not seen anything yet that makes sense to me.

    • Andrew Hickey says:

      1) The cost of national health care is actually *less* than the cost of the current American system.

      2) Is the whole *point*. *EVERYONE* gets care. But it still saves you money. You’d really rather both spend twice as much money *and* see someone else suffer – ‘bad’ decisions or not – than pay half as much money and see that person get treated?

      • KendallJaye says:

        I feel that health care is a benefit, not a right. People better themselves and get good jobs in order to get benefits. It goes back to the saying “Why buy the cow when you get the milk for free?”. People who work hard and administer PERSONAL RESPONSIBILITY for their actions will be shortchanged. Welfare is a broken system, and allows for rampant abuse. I would be afraid that the government’s check will bounce.

        • Andrew Hickey says:

          So you really *would* rather pay twice as much yourself just to punish other people for getting sick?

          Please come back when you get some morals, and an understanding of how the world works…

          • KendallJaye says:

            I apologize if I somehow mistakenly gave you the impression I am void of morals. This is very far from the truth.
            I applaud your compassion for the lazy and irresponsible.

            • Andrew Hickey says:

              Oh do fuck off and die. Anyone who would willingly *pay money to make others suffer* is as immoral as it is humanly possible to be. All further comments from you will be blocked.

            • Debi Linton says:

              I think what Andrew meant to imply was that while you might have morals, but if you genuinely believe that you have no moral obligation towards the sick and the impoverished, then you differ so much from him and we his readers that actual useful discourse might be nearly impossible.

            • This whole exchange is unfortunately precisely what I was getting at in my post here:


              and the further explanatory comment here:

              Americans who have embraced this idea will find the concept of socialized healthcare repugnant no matter how obviously better it is, and no matter how clearly you explain it. It’s an entirely different philosophy.

              Very very good post, though, Andrew.

            • RWood says:

              ugh..please…you are embarrassing me. I wish Americans like you, who have no compassion and see the world in extreme black and white, would NOT speak out so much.

              Just wait until YOU lose your job, ms. high-and-mighty. Or until something happens to you, or you find out that one of your loved ones is an addict. You’ll see then that compassion is called for, and that to slam doors on people because of “their choices” is an evil that this world does not need.

              I am thinking you are probably about 17 years old. That is something time will cure. It is not an excuse.

              Thank you, Andrew, for the informative post. I assure you, not all of us Americans are so limited in our thinking. >.< so embarrassing…

              • Andrew Hickey says:

                Don’t worry, I don’t think for a second that everyone in the US thinks that way – if I did, I’d not have any American friends to write to in the first place ;)

          • Holly says:

            I grew up hearing this sort of thing all the time. It’s one of the biggest reasons I’m glad I left. Not just when it comes to health care, but in all kinds of areas the attitude seems to be that if you’re poor or ill it’s due to bad choices you’ve made and thus no one should have any sympathy for you.

        • Paul says:

          Mmm, yes fine.

          What of those who get ill through no fault of their own? Cancer is not well known for being discriminating in who it targets.

          Does a CEO who gets pancreatic cancer deserve his treatment more than a laid of factory worker, just because the CEO can afford it more?

          Doesn’t the factory worker deserve to live too?

          What if your illness prevents you from bettering yourself and getting a job?

          And could an American who sees health care as a benefit not a right, and a nationalised medical system PLEASE explain to me why universal education is a right, not a benefit, and nationalised education is not evil?

          Even those who send their kids to private school still fund the state schools through taxes, so too with health care.

          And as Andrew has pointed out, do you really think spending at least double on your medical care to punish the fractional minority who get ill through their “own fault” is a better system than paying half as much and everyone gets a bite at the apple?

    • LemmusLemmus says:

      But you’re already paying for Ms. Crackhead’s visit to the ER, aren’t you?

      • KendallJaye says:

        I’m well aware that the Welfare section of America is being funded by me. And that does salt me. This country does nothing to encourage those people to take responsibility for their own actions. I think about my grandparents generation. They weren’t a bunch of whiny bitches that expected handouts. I’m not sure where today’s society gets the idea that things should be given to them instead of working for them.

        • Andrew Hickey says:

          You might want to take a few history lessons as well as the other suggestions I’ve made to you. Depending on the age of your grandparents, you might want to google “New Deal”, “WPA” or “Great Society”. You might also want to think about how far you’d have got in life without others helping you (clue – you’d have died very, very quickly).

  5. Zom says:

    Valerie D’Orazio’s post about her ex-employer’s willingness to use their healthcare plan to strong-arm their employees is yet another argument in favour of never adopting an American healthcare system, as far as I’m concerned.

    • Andrew Hickey says:

      Absolutely. And unfortunately that kind of thing is absolutely commonplace over there – “Terrible news about your kid’s heart condition. Wouldn’t it be terrible if anything… happened… to your health insurance? Oh, by the way, would you mind working an eighty-hour week this week?”

  6. pillock says:

    What if Ms. Crackhead gets hit by a drunk driver?

  7. Rob says:

    I don’t think you Brits understand American politics. Truth has nothing to do with it. By the end of all this crap we’re going through over here, the politicians will be claiming the NHS murdered everyone in the UK to save money.

  8. Zom says:

    What if Ms Crackhead’s kids need her? What if Ms Crackhead dies and all her kids end up in the care system? What if Ms Crackhead is a human being and not a stereotype?

    It seems to me that Kendall has hit upon a very real ethical difference of opinion between many folks in the US and many Brits. I understand how and why someone would want to make her argument, but it pretty much goes against all my moral instincts

    • Andrew Hickey says:

      Yeah – it’s always struck me as odd given how ostentatiously religious most USians are that the whole ‘helping the poor’ bit seems to have passed so many of them by…

    • Debi Linton says:

      There are many many Brits who also resent the idea that Ms Crackhead should be treated by the same health and social services that look after Decent Upstanding Folks that Pay Our Taxes. They read the Daily Mail and vote Conservative, a lot of them.

      • Andrew Hickey says:

        True. Oddly, they *also* tend to be more religious than the average Brit…

        • Debi Linton says:

          Actually, you’d have to show me figures to get me to believe that. I know many humanists and atheists who lean towards the right in this way.

          Not that they want the NHS abolished, but the thinking that poverty/ill health/familial situation is a result of “lifestyle choice” and therefore affects whether someone “deserves” help from Health of Social services is, in my experience, to be class linked, and there are lots of atheists and humanists in the upper middle classes.

          • Andrew Hickey says:

            Very true, but I don’t think there are that many atheistic Mail readers, given its constant “We are a Christian nation” stuff…

  9. Only a few months ago my Mother was receiving NHS care for a brain tumour at the age of eighty. (Unfortunately she didn’t pull through, but that was due to limits to medical treatment, nothing to do with age or finances.)

    I’d add two quick points to what Andrew’s said:

    i) If the Republican Party were ever to decide to stand in the UK it would have to publicly take a pro-NHS line or lose its deposit every single time it stood anywhere. The NHS is so popular amongst the British public no actual or wanna-be mainstream party could get away with challenging it, so none try. That’s the verdict of the people who use it every day. Do you imagine we’re all stupid or something?

    (Admittedly this public commitment doesn’t always translate into what they *actually do*, especially when they think no-one’s looking. But that’s another story.)

    ii) Why is this even an issue in America anyway? Obama’s proposals bear no relation to the British NHS model! They’re much more similar to the French or Canadian systems. The health insurance industry in America is using its wealth to propogate fraudulent stories to scare you off something that isn’t even being proposed anyway!

    • Andrew Hickey says:

      Sorry to hear about your mother…
      I think they’re not comparing it to the Canadian system all that much because many Americans *know* Canadians…

      • Thanks, Andrew.

        Or indeed even go there. Often because the healthcare is better. For that matter Americans in the Southern States often go to Mexico because the healthcare is better.

        However, I suspect Rob has the right idea about this ‘debate’. Those with the money to push their self-serving falsehoods will merely push fresh falsehoods, not stoop to anything so undignified as try to defend their first set,

  10. Thank you for bringing some truths and sense into the debate! :)

    I am, like you, not from the US – but from Denmark and I totally agree that we should not interfere with US politics. That’s up to the American people. But we can help bringing the truths to the table – and you’ve done well with this article! :)

    In Denmark our health care system is similar to yours and it’s not perfect at all either – but I do like that the right to equal treatment is a birth right here and not tied into your financial situation. Treatments are made on doctor’s judgment – not on insurance company’s. And you can’t loose your right to equal treatment.

    Yes, it’s a “socialized” system – but so is our (and yours in the US) military. If we can socialize “killing” people – why shouldn’t we do the same to heal our own?

    To me growing up with our health care system has provided me with comfort and a feel of security.

    I grew up in a middle class family with a very well organized father so under an insurance based health care system I would probably have been pretty well as well as a kid. But at other times – later in life, I was not so well organized myself and a lot “poorer” than now. At those times I would not have been protected under an insurance based system. But here in Denmark I have had the same protection throughout my life. It has been a good feeling. One less thing to be worried about.

    Later in life I got kids – I have two now (3 and 6), and at no time has the health care issues with getting them and bringing them up been a financial issue.

    And the result is not, as some Americans fear, that we are very poor here. In fact, Danes in general are very rich compared to just about any other nation. Also, like in the UK our health care costs are much lower than in the US. And our doctors actually make a really good living making more money than most here.

    All in all it actually works pretty well for us and it also shows. If you ask the Danish population (and I assume it’s about the same in the UK), almost 100% – from left to right wing – support the “socialized” health care system we have.

    Maybe we are just a bunch of old hippies here in Europe but I actually believe that it makes us all feel good that we can afford to take care of our own – that no one have to suffer from sickness just because they can’t afford the right treatment.

  11. Zom says:

    Good points well made, Gavin, and hello from a fellow brightonian

  12. Thanks. And hi

    (Slightly weird to phrase something for an American audience then get a reply from someone virtually down the road. But I guess that’s the wacky world of net-ness.)

  13. If Mr Crackhead is hit by a car and taken to casualty, under the NHS “you” foot the bill, in the sense that every month, some of the money that gets taken out of your pay packet in tax goes to pay the wages of the doctor who treated him. If you have a good job and he is out of work, then you pay quite a lot each month and he pays very little.

    If Mr Crackhead is hit by a car and taken to a private hospital, then when he’s been patched up, he gets sent a bill. Which, presumably, he can’t pay. So he gets sued, but he still can’t pay, so he’s declared bankrupt and the hospital has a bad debt. The hospital deals with the bad debt by either a: raising the fees it charges patients who can pay (costing them money) b: lowering the wages it pays its staff (costing them money) or c: simply making less profits that year (costing its shareholders money.)

    If Mr Crackhead is just left lying in the road where the car hit him, then all the other cars are held up, causing lots of people inconvenience and costing them money. If he dies, then either the body will rot in the street, causing some people to get sick (costing them and their employers money) or else someone will have to clear it away and arrange a paupers funeral (costing money.) His four orphaned children will have to be taken into care homes and fostered (costing money). Or else they can be left to roam wild, like in the good old days, where they will either die on the streets (causing more mess and cost) or else form gangs and steal rich folk’s handkerchiefs (costing money.)

    There isn’t a cost free way of dealing with the situation: one person’s bad choices end up costing other people money, however you figure it.

    It’s a little like state education. I don’t have kids, so you could say that a small part of my taxation goes to pay for “other people’s children” to go to school. But those “other people’s children” are also the ones who work for the NHS and take care of me when I’m ill; or who serve me my coffee in Starbucks; or come and fix my computer when it’s broken. They’ve all been taught to read and add up in state school, and my taxation has partly paid for that. So it’s benefited me, even if I chose not to reproduce.

    I suppose it is possible to imagine a Blade Runner universe in which much of the work is done by an underclass who can’t read or write and who are simply left to die when they get sick; everyone whose Mum and Dad can’t afford to send them to school automatically gets put into the underclass regardless of merit. But I don’t think that’s Republican Party policy, yet.

    (Anyway, I thought the objection to the Bizarroworld National Health Service was that we have committee deciding who lives and who dies? Does the US system have Death Boards deciding that Mr Crackhead is an unproductive citizen who should not be allowed to live? I’m guessing not.)

  14. Guess this link proves us doomsayers right.

    Precis: “Okay, you caught us lying. Why should that change anything?”

  15. I feel that health care is a benefit, not a right. People better themselves and get good jobs in order to get benefits. It goes back to the saying “Why buy the cow when you get the milk for free?”. People who work hard and administer PERSONAL RESPONSIBILITY for their actions will be shortchanged.

    First, I note you have shifted from arguing about expediency (price tags) to principle (‘benefits’ versus ‘rights’). You originally stated that the NHS was a bad idea pragmatically as it was unaffordable. Can we assume you are no longer arguing this?

    Either way, this idea that the current system best benefits the few who are in it is the most prevalent myth of all. I’m not a big fan of Michael Moore but he did expose this well in his film Sicko. At one point he interviews a rescue worker who got a chronic respatory illness for trying to rescue people from the Twin Towers, who had been paying into his medical insurance but was subject to endless delaying tactics over his treatment. He commented: “I realised they were waiting for something. They were waiting for me to die.” The NHS has queues due to underfunding, but that simply wouldn’t happen here.

    I’m not sure where today’s society gets the idea that things should be given to them instead of working for them.

    Probably from the previous President, I would imagine. This idea that society is just one big game of Monopoly, that we all start from Go with the same handouts, is patently absurd. And particularly so in America which has an even bigger income gap than the enormous one we have here in the UK. (No mean feat.)

  16. Zom says:

    Interesting that you should bring up ethics committees, Andrew R, as I’m going to link both to this post and to the BBC Radio 4 documentary series Inside the Ethics Committee when we linkblog tonight in an effort to get rid of some of this talk about Death Committees.

    Welfare is a broken system, and allows for rampant abuse.

    Whose welfare? To begin with welfare isn’t a monolith – their are as many different welfare systems as their are countries that operate said systems. Secondly, taken in context you would appear to be implying that the British NHS, as an element of a welfare system, is broken. The thing is, have you any idea how bizarre that kind of assertion sounds to people who have used the welfare system in question all their lives and benefitted enormously from it?

    As for Daily Mail readers, I’m of the impression that many of them like the idea of living in a “Christian country” or even identifying as Christian for all sorts of reasons that have very little to do with being religious.

  17. Zom says:

    Is ‘Christian’ not simply a codeword for ‘white indigenous Britisher’ in this context?

    In the context of the Daily Mail that’s a big old affirmative

    • burkesworks says:

      Is ‘Christian’ not simply a codeword for ‘white indigenous Britisher’ in this context?

      Indigenous? Britisher? Well that’s Daniel Hannan knackered then, seeing as he’s Peruvian-born of Irish descent. Wingnuts and glass houses and all that.

  18. Dan Howells says:

    Yes, a percentage of those who benefit from a socialised system of healthcare will not be net economic contributors to their society. Like children. And the severely mentally ill. And lots of drug abusers – classifying tobacco and alcohol abuse under this heading as well.

    So what?

    If a society has to spread its social safety net wide enough to catch the people who haven’t paid their way yet, in order to catch all the people who have – and they will be in the overwhelming majority – then that’s perfectly alright with me. I’d rather live in a society that looks after
    its “huddled masses, yearning to breathe free” than one that leaves them panicking about where their next asthma inhaler’s coming from.

    • I’m also amused by the notion that the only ‘contribution’ someone can make to society is economic. A full-time parent or carer is classed as ‘non-contributive’, while some berk who phones you up while you’re busy to flog you patio doors when you live in an upstairs flat is classed as ‘contributive’.

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  20. ZA says:

    As an American with a different view than the rather bitter one shared earlier in the comment stream, I feel compelled to share my views on the subject.

    I’ve been fortunate enough to experience Britain’s NHS, Canada’s (Alberta’s) medical system, and several HMOs in the US. In both preventative and emergency care, I received acceptable or excellent care in all these systems.

    I strongly believe in a single-payer healthcare system for my country, because of the many cash and health savings it will bring me personally for living in a healthier community. For example: I would rather pay into a broadly shared and publically-overseen system that gets an addict their treatment than to face the compound costs of damaged yard, broken-into car, stolen property, police investigation, insurance reports, possible arrest, trial, and perhaps treatment in a prison facility. It’d cost me a lot less stress too.

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  22. Dan G says:

    A quick glance at my blog will show that I’m probably a Christian. A bit more perusal and you’ll discover I’m an American. Some digging will show that I used to be quite the purveyor of Right Wing thought.

    Can I just say how immensely sad it makes me that I used to hold to the opinion that care and feeding should be given only to those who “deserve” it? And that those lazy slackers and crackheads had made their beds and now they might as well go lie in them and die and spare the rest of us their whining.

    You might find it surprising to learn that my journey leftwards (if you want to call it that) has been DUE to the teachings of Jesus. Giving people good things, even if they most assuredly did NOT deserve them was, after all, exactly the point of the whole exercise.

    • Andrew Hickey says:

      I don’t find that surprising at all actually – If you haven’t read his blog, you should read Fred ‘Slacktivist’ Clark, a USian evangelical Christian whose faith informs his left/liberal views. Andrew RIlstone, who commented in this thread earlier, is another very openly religious person on the side of good here. If you thought I was attacking Christianity, I apologise – I wasn’t. It’s the hypocritical pseudo-Christianity I find objectionable, the people who pretend to worship someone who said “Take what you have and give it to the poor” and “render unto Caesar what is Caesar’s” yet hate the idea of paying money to the government to help poor people…

      • Dan G says:

        Oh, no, I didn’t think you were attacking Christianity. I just know how we USian Evangelical’s are normally viewed in the wider world, so I always want to take the opportunity to point out that more and more of us are letting the actual teachings of Jesus inform our social and political views.

        Thanks for the blog tip. I think I’ll like this fellow. I’ve been a fan of Rilstone’s for awhile now.

        I appreciate the open letter by the way. Very much needed.

  23. Mike S says:

    although i agree with the you that america’s healthcare system is flawed, i still think more harm would come from an nhs like structure then good, at least to some of us. oh, and please correct any statements that are incorrect, i only know a bit about this issue. first off, my family is relatively well off, so we have always had insurance and never had to wait more then a week to see a doctor, or get treatment literally right away at urgent care(well, maybe 30min tops at urgent), so the idea that every jobless person, illegal mexican or what have you that hurts himself or his several kids gets treatment before me and makes me wait weeks/months for a doctors appointment or worse, several hours at urgent when me or my family are really sick really upsets me. not trying to be a dick, but a: this country is built on capitilism, sorry to say for those of you on hard times, but that’s just the way it is. you live here in america knowing that’s the case, deal with it or leave. and b: the illegals here shouldn’t be here in the first place. i live in arizona which is right next to the mexican border, and there are SOOOOOO many illegal mexicans here, that if we go nhs, the wait at urgent will go from 30min at most to SEVERAL hours, and i’m not ok with that. they shouldn’t be here in the first place. the fact is that when you live in this country, it’s a constant test. some make it, some don’t. my uncle went to NYC with $200 in his pocket and a beat-up truck, and 5 years later makes 6 figures a year. if you can make it, america is the greatest country in the world, and if not, either you didn’t try hard enough, or you were dealt a shit hand, but i don’t feel like having my money spent on illegals health care, or having my sister or mother die because they have to wait on a jobless drug addict to get treatment at urgent. sounds harsh i know, but it’s the way it is. and as i said, correct any incorrect statements i made.

    • Andrew Hickey says:

      Firstly, no-one in any country with a national health system has to ‘wait weeks/months for a doctors [sic] appointment’. I’ve only visited my GP twice in the last five years or so, but both times I phoned up and was seen the same day (this was for extremely minor problems where a few hours’ wait was OK). In British Accident & Emergency wards (your ‘urgent’) people are prioritised according to need – you only have to wait if you’re not especially ill.
      Secondly, there would be no point in Mexicans trying to use your system, because Mexico’s system is *better* than yours, to the extent that many Californian insurers insist on patients travelling to Mexico for treatment, and no matter what you do it will take years for you to catch up. Does that not profoundly *shame* you? That you live in the richest country in the world yet your third-world neighbour next-door actually has better health-care?
      And thirdly, if you really object so much to letting brown people or poor people share the same hospital as you, nobody is trying to stop you using private healthcare anyway.

      • Tilt Araiza says:

        Correct me if I’m wrong, Andrew, but isn’t it the case that somebody without legal resident status wouldn’t have a National Insurance number and so wouldn’t be registered with an NHS medical practice and that pretty much closes off NHS treatment?

        • Andrew Hickey says:

          Yes and no. They wouldn’t be able to go to a GP, but they *would* still receive A&E treatment. And asylum seekers can receive treatment even after their claim’s been turned down under some circumstances (we had a couple of patients like that on the ward I worked on at different times).

        • I suppose I probably counted as a legal resident, but as an American student at a UK university, I had the right to visit a GP and to get NHS treatment without charge. Of course I had never paid National Insurance at that point, and I didn’t have an NI number. They still treated me well, regardless.

    • > you live here in america knowing that’s the case, deal with it or leave

      I believe USA is a democracy, right … And apparently a majority of the American voters have just voted for an administration that want to change the health care system you have now.

      People can change how things are in a democracy. Isn’t that great? :)

      Your fears of our socialized health care system is just not in line with realities. Its just now how it actually works for us here. It works pretty well indeed.

      The major difference is that our system is a lot cheaper for everyone. I don’t understand why you do not want to save money (being a capitalist and all) when in fact you’ll get the same good service – or even better, for your money …

      • Debi Linton says:

        But, Mikkel, America was founded on the principle of “if you don’t like the way things are at home, up and leave.” Why should Mike have to adapt to a changing world now?

    • See what I mean? Disheartening, isn’t it? But these principles are part of the essence of the culture.

  24. Pingback: Top of the Blogs: The Golden Dozen #130

  25. bjm says:

    “you’ll get treatment so long as there’s a good chance of it working and giving you a few more years of good life. If there isn’t much chance of that, the government won’t pay it, that’s all.”

    Andrew, how does NICE define terms like “good chance”, “working”, “few more years”, “good life”? Because frankly, allowing a government entity to make those decisions sounds terrifying to me, even though you dismiss it as perfectly reasonable.

    Also, using inflammatory statements from 2 politicians and 1 reporter to marginalize the millions of people in the US who oppose this health care reform is not convincing.

  26. bjm says:

    That’s exactly my point. QALY is a fake formula based on unobservable variables. Subjective inputs create an inconsistent system. It’s meaningless, and ends up being a subjective judgement made by whoemver controls the funds.

    Pointing out that insurance companies currently do this is irrelevant; the question is how it gets applied, how much “rationing” is deemed necessary. The one “check” on rampant rationing is competition, which is why Americans largely fear the institution of single-payer health care.

    Also, what happens if the government controls health care, and then Palin and Grassley take power again? No thanks…

    • Andrew Hickey says:

      Except that no-one has ever suggested stopping competition – in every country that I know of with a government-run health system, there are still private health options available.

      And you already *have* ‘rationing’ – it’s just rationed by ability to pay, rather than by any (however inadequate) assessment of clinical need.

  27. bjm says:

    I live in the UK. And I have private med cover. But thanks for the condescension, I guess nobody in the UK ever criticizes the NHS, so I must be in the US?

    The short answer is not whether American health care is perfect. It’s that Americans look at the NHS and think “that’s not the solution we want”.

    And nothing in the British press makes me think otherwise.

    • Andrew Hickey says:

      It’s your repeated references to ‘the government’ as being the US government that made me believe you were in the US.

      And I’m not saying the US *should* go to a system like the NHS – it’s none of my business if they do or don’t. What I *am* saying – ALL I am saying – is that certain USian politicians are actively lying about this subject.

  28. bjm says:

    OK…ignoring the IBD editorial (a paper I had never heard of before this anyways), you have statements by 2 politicians which you classify as “out-and-out lies”.

    Here is your description of Kennedy’s situation were he in the UK: “If you’re 77 years old, like Ted Kennedy, and you have a brain tumour, you’ll get treatment so long as there’s a good chance of it working and giving you a few more years of good life. If there isn’t much chance of that, the government won’t pay it, that’s all.”

    Here is Grassley’s statement (his actual statement, not the misquote you have above): “I don’t know for sure,” said Grassley. “But I’ve heard several senators say that Ted Kennedy with a brain tumour, being 77 years old as opposed to being 37 years old, if he were in England, would not be treated for his disease, because end of life – when you get to be 77, your life is considered less valuable under those systems.”

    Sounds like you’re saying the same thing? Unless you are that sure that Kennedy would have had his treatment approved after a QALY assessment? Or am I missing something?

    • Andrew Hickey says:

      No, I’m not saying the same thing at all. Treatment is approved based on the efficacy of the *treatment*, not on a per-patient basis. If surgery or chemotherapy or whatever work for a brain tumour, you get them whether you’re 9 or 90, exactly the same.

      What a QALY assessment does is compare how many additional good years of life *a new treatment* will give *compared to the existing treatment*, for all patients on average. Once the treatment is approved, it’s given to any patient whose doctor thinks they’ll benefit from it, no matter what their age or other conditions. And the treatment is only ‘competing’ against existing treatments for the same disease – so a treatment for Alzheimers that gives one QALY over other treatments wouldn’t get turned down because a treatment for childhood leukaemia gives thirty QALYs…

  29. bjm says:


    Not to be picky, but that comment is a lot more informative than the entire post above, and a more effective rebuttal of the nitwit politicos. Even in the UK I didn’t understand how that worked.

    • Andrew Hickey says:

      Glad to help. The original post was written for a *very* broad audience, and was written to be comprehensible by everyone, which of necessity means using very broad-strokes descriptions. For many of the people I originally emailed (a group of *wildly* varying educational levels and levels of interest in current affairs, a detailed description of QALY measurements would be confusing and they’d just gloss over it, while “we don’t have death panels and it’s a bit like what your insurance companies already do” gets across the main points.

      I’m sorry if I seemed slightly aggressive in my previous comments, BTW – this article has received a lot of trolls (most now deleted) and my reaction now to anyone disagreeing with it is to give them rather less benefit of doubt than I otherwise would.

      As I said in my original post, I don’t think our system is perfect (though I think it’s infinitely better than the US system – my uncle put it best when he said to me “When you’re hungry, chicken soup isn’t much, but it’s a lot better than chicken shit”) and I *do* hope the US learn from our system and get one that’s even better (though I sadly doubt that that will be the case).

      And your image is randomly generated. If you don’t like it, you can get yourself a gravatar

  30. bjm says:


  31. bjm says:

    Hey…who picked my face? I look only slightly like that.

  32. “It’s that Americans look at the NHS and think “that’s not the solution we want”.

    “And I’m not saying the US *should* go to a system like the NHS – it’s none of my business if they do or don’t”

    I note with somewhat weary resignation that no poster on the “anti” side has acknowledged my earlier comment that nobody is suggesting the US get a system like the NHS – it’s in no way part of what’s being proposed, it’s a dream, a hoax, an imaginary story. This makes me wonder what all this sound and fury is actually about.

    It would be truer to say the proposals nudge the American system a bit nearer to the Canadian. As in the health system which Americans look at and then head over the border in an unseemly rush for treatment.

    Currently this debate is on the level of being offered carrots for dinner and saying “but I don’t like spinach.”

    • Andrew Hickey says:

      I think the sound and fury is down to the fact that enough Americans will know enough about the Canadian system that they’ll recognise the lies – a large proportion will have been to Canada or at least know someone from there or something, whereas a vanishingly small number will have been to the UK, so say any form of government-run (or -subsidised) healthcare = ‘socialised medicine’ = the British system = killing grandma, and hope no-one figures it out…

      • pillock says:

        Also possibly we’re getting a bit angrier about it these days — I know I am, anyway. I’ve already got a pack of mutant Tories eyeing privatization and licking their chops, and opposition parties who can’t seem to articulate why that’s a bad thing. It all got broken here with the word “reform” as applied to healthcare, way back when the real Tories (I mean, they were bad, but these guys are so much worse) got landslided out of power, and even contention…desperate, they started talking about “the need for healthcare reform”. Like, all the time.

        For some reason, no one chose to step up and counteract this. And so here we are, in a world where my largely-brainless provincial gov’t wants me to know how much of every tax dollar health care “eats up”. Terrifying language.

        So in this political climate, I could easily go apeshit on Americans criticizing the Canadian system (and have), because I don’t need their fucking spin infecting my country any more than it already is. After all that arm-twisting the Bush government tried to pull here, my temper’s still frayed…and I do think the U.S. should adopt universal health care anyway.

        Sorry, pre-coffee rant. But we have been getting these kinds of lies thrown at us for decades, actually, and it’s a real and ongoing fight. We get all their TV; if they escalated the propaganda to the point where they said we were killing old people, they’d really get it in the face, I wouldn’t be the least bit surprised if the whole thing morphed into a diplomatic incident, at that point. I mean we’d get MAD.

  33. The images are randomly assigned but you keep what you get? Or do I just continually come off with that slightly manic triangle? (I’m actually more of a sullen square sort of person.)

    • Andrew Hickey says:

      The images are generated based on your name, so anyone posting as ‘Gavin Burrows’ (whatever IP or email address) would have had that picture, but if you’d posted under a different name you’d have had another one…

  34. In Denmark Kennedy would have got just as well a cancer treatment as he did in the US with private insurrance. If our hospitals could not have provided it our health care system would have paid for him to go to another country and get treated there.

    People here do not get refused treatments just becaue they are too old and “unproductive”. Claiming that this will happen in a socialized health care system is just not truth.

    Just look at how old people get in countries with socialized health care and compare it with the US …

    The question is not if our healthcare system is good – it is, the question is if you Americans want to get the same quality at half the price + secure that all can get it. We do and it works great :)

  35. bjm says:

    Americans go to Canada for medical treatment? I know they buy their drugs there, but thats not a systematic advantage, its more of a border arbitrage (and essentially a subsidy from the Canadian taxpayer).

    Also, ANdrew you seem to be tapped in to stuff so I’ll ask you a question: are medical costs actually increasing in the US? I know “spending” is increasing, but that is sometimes the opposite of costs (for example, spending on flights and travel has increased in the past decades because costs have dropped; higher spending does not necessarily reflect higher costs, it can reflect lower cost combined with higher consumption). So what actually is becoming more expensive in the health care world?

    • Andrew Hickey says:

      I’m afraid I don’t know. Anecdotally, people seem to have increased healthcare costs, but that could be to do with any number of things. One thing that certainly doesn’t help is the level of advertising over there – especially of new, patented drugs which have no significant difference from older, generic ones…

    • Holly says:

      Functionally they are, yes. Not only for reasons like huge advertising budgets, but also because insurance companies are being more selective about what they cover, employment benefits are much less likely to include things like eye doctors and dentists than they used to, people’s insurance premiums are going up so their co-pays go up, and the rates at which prescription medications are charged at has changed so that expensive and rare drugs have become much, much more expensive in some cases.

  36. bjm says:

    Yeah, that seems feasible in some cases, but I can’t believe its endemic. I suppose there’s potential for reform in the patent system, but the US seems to do well enough turning out new drugs that you could argue the patent system works ok.

    I suspect the problem is not so much with rising costs for the same goods/services, but the desire to ALWAYS have THE BEST, THE NEWEST, blah blah blah…I mean, I bet it would be tough to convince an American consumer to accept a chemotherapy that was “cutting edge” in 2002, even if it is adequate, if there is a newer, albeit pricier, alternative.

    • Andrew Hickey says:

      If you can’t believe it’s endemic, you should look at US TV sometime. On some channels, literally half the advertising is ‘ask your doctor about’ [insert name of drug here]. Almost all of them statins (which don’t even work anyway, but a statin is a statin is a statin as far as its action on the body goes). People are being *bombarded* with commercials for this stuff, and told their life – literally – depends on it.

      • bjm says:

        Statins don’t work? I take statins, and my cholesterol has dropped considerably. Zocor, in the UK. Didn’t even know there was a controversy…

        Anyways…as I said the patent system may merit reform but most drugs never get advertised on TV. I would think promotions aimed at doctors are more relevant in most cases.

  37. pillock says:

    Americans do come to Canada for treatment: a lot of people come to Vancouver’s Children’s Hospital, for example. I’m not sure if we have some sort of “compassionate clause” or not, that may enable visiting patients to escape payment they can’t afford…but in any case, what things “cost” in Canada in terms of medical care is a lot less than what they cost in the States.

    You remember George W. told the American people that his government wanted to make sure Canadian drugs were “safe”? They’re the exact same drugs. They come in the same bottles and everything, with the same labels, from the same factories, factories that are in the United States.

    I was pissed at him, for that one.

  38. bjm says:

    I’m under the impression that a lot of Canadians also go to the US for treatment. In fact, I thought it was more people heading South for treatment than North due to waiting lists etc…

    But presumably Vancouver has better maternity/pediatric care than Seattle. Not sure what all this says on balance.

  39. “I’m under the impression that a lot of Canadians also go to the US for treatment”

    In some instances, yes, though its wildly out of proportion. There’s also an emerging trend in the US for companies to insist their employees travel abroad for treatment, because even with travel costs it comes in so much cheaper. The link below mentions sending people to India.
    “In fact, I thought it was more people heading South for treatment than North due to waiting lists etc…

    Not unless you’re thinking of Americans visiting Mexico.

    Pillock, you may have missed the gun on that getting angry business…

    As a truck driver that ran to Canada for 5 years back and forth from Indiana I personally asked every Canadian I met what they thought of their health care coverage compared to ours. With absolutely no dissent they all thought we were the stupidest people on earth for having private insurance companies running our health care. All the bs you receive from the likes of fox (faux) news, Rush, and other talking heads they laugh at how foolish we are. How any American who has had any sort of a major illness or accident and had to deal with getting the insurance to pay the bill should in a heartbeat want national health care. But to want to disallow the public option is even more foolish

  40. pillock says:

    Have to be bloody desperate to go south for care…and there are a few people who do it, but the thing is they have to take out a second mortgage for it.

    Naturally the slanderers seize on waiting lists, because they do exist and they’re hard to explain in three sentences — with the consequence that the shortest distance between two points is to say “everybody’s waiting all the time.” Well, no: they aren’t. “Are you denying there are waiting lists?” Well, no: I’m not. I wouldn’t. But the mental image conjured up by the term “waiting list” isn’t in line with the reality of the situation, the flaws in the system which are detailed and specific, and can only be understood in a detailed and specific way.

    Which is why everyone trying to demonize our system is always talking about them. A transparent trick, especially since who can afford American care, without American insurance? Americans can barely afford it with their insurance. Canada has a fair number of millionaires, but we don’t have that many…

    • pillock says:

      And I suppose it hardly needs saying, but the reason so many people are under the impression Canadian patients are flocking south in droves is because the anti-medicare morons we have in Canada delight in feeding their right-wing brethren in the States misinformation, that other Americans can’t easily call bullshit on since it comes from here. So there’s a sort of apparent consensus in the States about what Canadians are doing. In Canada, though, the consensus goes totally the other way. But we don’t challenge the apparent American consensus, because it isn’t part of our own national conversation — no point having special reports from the CBC about what everyone already knows, and we can only get on American TV when we’re invited.

      The thing about these idiots is that they’re organized, see? They travel in packs and move in lockstep, and so they’re doing a good job of convincing Americans that there may be some truth to their story. I get emails from worried left-leaning American pals all the time, asking “is it true?” I tell them it isn’t. But I can hardly spam everyone I know with such information without them asking, can I? And of course it isn’t that it just “isn’t”, it’s that there are waiting lists, but they work like this, and this is why they’re there, and this is who gets affected by them and why, and oh please let me give you a complete rundown of how Canadian intergovernmental politics works while your eyes glaze over. And that’s the problem in a nutshell.

      (On the Children’s Hospital thing…I can never figure that one out, Seattle is a much bigger city than Vancouver so you’d think they’d have all the pediatric bells and whistles…I mean obviously there could be a few different reasons why someone from Seattle would seek care in Vancouver, but it’s not like those reasons ever get tallied for the casual news-consumer…)

      The other unfortunate effect of this organized idiocy is that people like me get exhausted just thinking of all the words we’d have to type to really get at the source of the misunderstandings and clear them up…and it isn’t even just the typing, it’s the damn editing we’d have to do, to get it short enough for a readable blog post or comment without leaving out essentials and raising more questions than we answer. It’s actually a hell of a job, and speaking for myself I’m not usually up to it…I almost left about twenty comments on this post of Andrew’s in knee-jerk response to the Canadian references, but they were all six thousand words long…that’s what happens when you have the bad guys so aggressively muddying the issue, it’s easy to make tangles but it isn’t easy to brush them out. So it’s hard to wade into it all on your lonesome.

      There, whew…that’s the most I’ve committed to a public discussion of these misconceptions in years.

      • pillock says:

        And even so, look! It took me over a hundred comments by other people just to get around to doing it.

        I don’t think I’m the only one who reacts this way, either.

        • bjm says:

          Grrr…good guys, bad guys…where are the Superfriends when you need them???!!!

          • pillock says:

            I’m not sure if you’re objecting to my use of “bad guys” or not, BJM…but let me assure you in any case, that for the homegrown ideologues who seek to undermine our system by spreading disinformation about it abroad…yeah, it’s a label I’ll stand behind.

            • bjm says:

              So do you think any informed, intelligent people would oppose a transition to a Canadian-style health care system? Or is it just the nefarious community organisers and their sheep-like mouth-breathing followers?

              • anonymous coward says:

                There are some informed, intelligent people who are also fundamentally selfish, so that group probably would oppose such a transition.

                • Andrew Hickey says:

                  I’ve let that one through , but in general there *is* a reason you have to give a screen name – now I have to create a specific rule blocking ‘anonymous coward’ because otherwise all such posts would be auto-approved…

                  (Let it through because I know who you are from your IP address , and know you’re not a spammer

            • bjm says:

              Sorry, “community organiser” only refers to Democrats…I should have said “right-wing corporate astro-turfers”…

              • Andrew Hickey says:

                Please try to discuss things in good faith. Pillock has clearly stated that his objection is to Canadian politicians who are *spreading lies*.

                Given that such people exist in Britain (e.g. the egregious Daniel Hannan) I have no doubt he is correct when he says they exist in Canada too.

                Spreading deliberate lies and disinformation does actually qualify one as one of ‘the bad guys’. In fact many would go so far as to say that spreading malicious lies about one’s own country to foreign media counted as treason…

                Pillock here isn’t attacking those who have different views – he’s attacking those who use deliberate misinformation to advance those views, and I know from your other posts that you’re capable of comprehending this point.

  41. Your argument here being ‘you’re too narrow-minded to see that it’s me who’s completely right’?

    Generally on Andrew’s blog we play the ball, not the man.

  42. bjm says:

    Nh…h jst ss wrds lk “slndrrs”, “dmnz”, “rgnsd dcy”…n hs vw, t sms tht n hnst prsn cn dsgr. thr y r slndrr, r y r nfrmd by th slndrr (.. msnfrmd).

    nd ‘m nt sr wht ‘m cmpltly rght bt… dn’t rlly hv hg x thr wy. d knw tht thr r sm prtty strng rgmnts gnst th Cndn systm, md by nthr slndrrs r dts.

    • Nah…he just uses words like “slanderers”, “demonize”, “organised idiocy”…i

      Nah, he used other words too. Check back over his posts if you don’t believe me.

      You previously mentioned currently being based in the UK. So would you say “death panels’ exist here as part of the NHS, or would you agree with those of us who would describe that as slander.

      And I’m not sure what I’m completely right about…I don’t really have a huge axe either way. I do know that there are some pretty strong arguments against the Canadian system, made by neither slanderers or idiots

      Do tell.

    • Andrew Hickey says:

      You are treading on very fucking thin ice here. I do not like it when people come onto my blog and start assuming bad faith of my friends, without a scrap of evidence to back it up.

      You are a) claiming to know what ‘his view’ is, b) trying to argue that he must be mistaken about a subject he knows more than you about, without backing up your statements, and c) dismissing my own interpretation of what he posted (based on knowing pillock for a couple of years now) with the single word ‘nah’.

      Were it not for the fact that you’ve got pillock so angry that he *WANTS* a fight at this point, I would have banned you from commenting for this post. Any more like it, and you get banned, and this post and any others in the same vein get disemvowelled.

      • pillock says:

        It won’t be a fight. He doesn’t have the goods. THEY DON’T EXIST. Also I’m fairly sure he doesn’t even know what the argument is.

        No offence there, BJM. But seriously, check out WHAT ANDREW’S POST WAS ABOUT IN THE FIRST PLACE, know what I mean?

  43. pillock says:

    BJM, you’ve got a lot of nerve trying to get into it with me about my goddamn DOMESTIC POLITICS, eh?

  44. pillock says:

    Oh, you’ve got to be kidding me. GIVE THOSE ARGUMENTS, NAME THOSE WHO MADE THEM. Jesus, you are trying to get into it with me about my domestic politics! Okay, if you think you’ve got the goods, fire away. Holy mackeral, this oughtta be something to see.

  45. bjm says:

    He used “slanderers” in the absence of any reference to Canadian politicans. So I didn’t see it as exclusive.

  46. pillock says:


  47. pillock says:


  48. bjm says:

    Yeah, I re-read it after the CAPS LOCK ATTACK…you mention “slanderers”, didn’t know you were being so specific. You started in on domestic politics later on.

  49. bjm says:

    OK…well I just read that the incoming head of the CMA said some pretty foreboding things about Canadian Medicare.

    “We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize”…maybe she’s a slanderer? Dont know…you tell me.

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