Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How to fix the NHS. And what the United States can learn from it.

Suneel Dhand, MD
Policy
March 25, 2017
Share
Tweet
Share

I grew up in the United Kingdom and have friends and family who rely on the National Health Service. I’ve written previously how I believe that, despite the idea of a completely free at the point of use health care system sounding very noble — and there are certainly many great things about the NHS — it’s not a model that has been copied in any other country.

As someone who also has lots of friends and former colleagues working in the NHS, I regularly hear stories about how that system is completely at breaking point. The British media also regularly communicate this message, and the NHS undoubtedly relies on a huge amount of good will.

The ideal health care system probably resides somewhere in between this type of completely centralized socialized system, and a private insurance-based one. Out of all the systems, I’ve experienced, Australia comes pretty close to this mid-point: a system I’ve worked in myself during my final year of medical school.

Following the Australian model, here is what the United Kingdom should do, summed up in 2 straightforward steps:

1. Keep the NHS in place as is.
2. Encourage everyone who can afford it, to take out their own private health insurance, and then give them a tax rebate for doing so.

This would be an ideal solution, because great swathes of the middle classes and wealthy will likely leave the public NHS, thus relieving pressure on the system. If, for any reason, they aren’t happy with their insurance-based system or coverage, they can always go back to the NHS. Sounds simple, right? Back to reality. Here is what’s blocking such a good idea from happening in Britain:

1. British psyche. I’m afraid it is so ingrained in the national psyche that “health care must be free,” that any such proposal to encourage people out of the NHS, would likely cause a national uproar among large swathes of the population — however sensible it sounds

2. Political tool. Whichever political party proposes the above, would likely be annihilated with screams from opposition parties that they want to “privatize the NHS” (when actually no such thing is happening). We are just being pragmatic and realistic, and if someone leaves the NHS, it’s only fair that they should get some tax back, like in Australia. There would also be talk of a two-tier system. So what? That’s life, as long as the public system is still excellent. Doctors could have it written in their contracts that they must do a certain amount of work in the NHS, so they don’t leave it completely.

Because of the above issues, the Australian model, which would probably work so well in a prosperous nation like the UK, seems like a pipe dream.

As for America, if we are approaching this type of health care system from almost the opposite end of the spectrum, why not have this scenario:

1. A single-payer type system for anyone who desires it (Medicare available to all, or at least lower the current age of eligibility).

2. A private insurance-based system with tax breaks for anyone who can afford it, and offered by employers as a job benefit.

Having a basic “fall back” in place for everyone to access health care should not be as unpalatable for the “anti-big government” folk as some may think. If it was coupled with the right tax incentives to encourage people and employers to purchase their own private insurance, it could actually produce significant long-term cost savings, while also allowing a free market competitive insurance system. In a consumerist society like the United States, anyone who could afford it would want to enter the insurance market to give them more freedom and choice over their health care options, and not rely totally on the system that was offered by the government, with all the associated control and restrictions.

ADVERTISEMENT

The great elephant in the room with health care and only offering coverage in a free market environment, is that there are unlikely to be any realistic scenarios in which insurance companies will be competing to insure the 52-year-old longstanding diabetic with heart disease (the people who need health care the most). One way or another, if these people have no insurance, society is going to end up paying for their care in the end.

The more this health care debate continues, and politically turns into a mess, the more I’m convinced that some type of single-payer system will ultimately be the one that’s put in place. The only question is, how long it takes to get there and what steps the government takes to encourage people to only use it if they absolutely can’t afford anything else?

In health care, things that sound so straightforward and obvious, seem all too hard to come by.

Suneel Dhand is an internal medicine physician and author of three books, including Thomas Jefferson: Lessons from a Secret Buddha. He is the founder and director, HealthITImprove, and blogs at his self-titled site, Suneel Dhand.

Image credit: Shutterstock.com

Prev

How peer-to-peer review helps hospitals

March 25, 2017 Kevin 0
…
Next

Administrators don't want to hear what physicians have to say

March 26, 2017 Kevin 5
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
How peer-to-peer review helps hospitals
Next Post >
Administrators don't want to hear what physicians have to say

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Suneel Dhand, MD

  • The dream patient that makes a doctor very happy

    Suneel Dhand, MD
  • When the family wants to speak to the doctor

    Suneel Dhand, MD
  • 3 reasons why patients are unhappy

    Suneel Dhand, MD

Related Posts

  • What health reform can learn from United Airlines

    Brian C. Joondeph, MD
  • Why is health care so expensive in the United States?

    Scott Treutlein, MD
  • What we can learn from England about universal health care

    Naveen Kumar Reddy, MD
  • Why nurses must help lead the NHS

    Dr. Ben Janaway
  • The health care systems in the United States and Canada are failing

    Tomi Mitchell, MD
  • What health care can learn from Game of Thrones

    Robert Pearl, MD

More in Policy

  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...