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How Switzerland delivered health care for all — and kept its private insurance
In the United Kingdom, residents have long considered the National Health Service (NHS) one of the nation's greatest accomplishments. Across the Atlantic, U.S. Democrats have proposed a similar single-payer system for the U.S., but conservatives have raised alarms about access problems within the NHS. William Brangham reports as part of our series "The Best Health Care? America & the World."
We continue now with our series on universal health care.
Tonight, William Brangham and producer Jason Kane turn to the U.K., where its National Health Service covers everyone, while it sparks both inspiration and alarm in the U.S.
This story was filmed before the pandemic erupted.
Good morning to you! Did you have a good sleep?
Even with the help of his mom, Liam Murphy still struggles to wake up each day.
I thought you would be dreaming about Charlotte. Right? Why Charlotte?
Liam has Down syndrome, epilepsy and chronic lung disease. He's dealt with these since the day he was born.
The 11-year-old lives in Watford, England, with his parents, Gary and Angelina, and big sister Laura. They have to be constantly vigilant for trouble, like this seizure.
Don't start. Don't start. Don't start. Can you get the mask, please? No, I can't have that on — not on the… nasal cannula! Turn it down.
You're all right. Come on out of that. Come on out.
Dozens of times a year, episodes like this will send Liam to the hospital. He is always at risk of dying.
Liam's life, and the incredible care he gets, is a testament to the United Kingdom's National Health Service, known as the NHS. Residents of the U.K. pay taxes to the government that support the NHS.
The government is then the single payer for health care. It pays doctors and hospitals and covers nearly all costs. For Liam, that's all his medicines and hospitalizations. It pays for caregivers that come several times a week. The NHS even paid for this chair and standing frame to help him exercise.
So, he's been up for about half-an-hour now, hasn't he? So that's really good, Liam!
No one says, 'Well, that's going to cost too much, so we're not going to do it.'
You have never heard those words?
No. And if we call an ambulance, an ambulance will be here in five minutes to pick Liam up and take him to hospital. A specialist team will come out, pick him up, put him on their ventilators, take him to intensive care.
An intensive care bed will cost 2,000 pounds, so, $3,500 a night. No one mentions the money. They just do what you need to do. Without the NHS, we would be bankrupt. Liam would probably be not with us.
On July 5, the new National Health Service starts.
The National Health Service was built from the wreckage of World War II — something of a gift from the government to a battered and impoverished nation, which welcomed it.
And, today, it's still considered the U.K.'s great equalizer. Everyone, regardless of profession or income, has access to that system, from primary care, to, as needed, the full range of specialty services.
Do you ever think about how much things are going to cost when you come to the doctor?
No, it doesn't cross my mind. But the thing is, because I'm diabetic, in England, if you're diabetic, your prescriptions are free, so I don't have to pay for it anyway. So, it doesn't cross my mind.
Despite those benefits, per person, the NHS spends less than half what we spend in the U.S., including a lot less than we do on administrative costs.
And the NHS generally gets better health outcomes than we do. Life expectancy is longer here than in the U.S., in part because people in the U.K. suffer much lower rates of chronic diseases, like asthma, diabetes and hypertension.
It's hard to overstate just how beloved the National Health Service is here in the U.K. Some people have referred to it as the closest thing this country has to a national religion. In fact, in 2018, when the service had its 70th anniversary, they had a huge celebration here at Westminster Abbey.
When the pandemic hit, a big part of the government's stay-at-home appeal was: Protect the NHS.
We must be sure that the infection rate is falling.
Even so, disillusion has grown in recent years. In the rural town of Dorchester, England, I met 77-year-old Olive Parfitt.
I was supposed to have the operation in August. And 14 hours before the operation, they canceled it.
Parfitt needs to have her knee replaced, but she's been on a surgical waiting list for nearly a year. She said she took four painkillers just to make this short stroll.
Because I have walked so badly for over a year, I'm starting to throw the other knee out.
Oh, really? Because you're compensating?
Yes, so you wobble. So makes it difficult.
If I have a heart attack tomorrow, it's the best thing. They will take me in. They will do it. But when you have got what I call disabilities that are not life-threatening, they can't cope.
I was told six months, and that was a year ago. And now, last week, I was told, it's a year.
Parfitt has been a strong supporter of the NHS her whole life, but now, after a lifetime of paying in, she feels left out.
Suddenly, when you get to a certain age and you want to get it back out again, it's not there anymore.
An estimated 10 percent of U.K. citizens pay out of pocket for supplemental insurance, in part to avoid long waits. And these delays also cause tens of thousands of residents to seek some care abroad.
For people like Parfitt, it's dispiriting.
So, you just think, 'Nobody cares about me anymore. I'm an old girl. Probably, if you carry on long enough, she will pop her clock, and then we won't have to worry with her.' I do feel that you become invisible.
Funding for the NHS has been a constant problem and a political flash point. Different administrations fund the NHS at different levels, and the U.K.'s recent austerity measures have delayed upgrades, and made serious staffing shortages worse.
This has also led to a series of scandals, as seen in this 2017 BBC report. Emergency rooms were overflowing. And in recent years, after being rushed to the hospital, hundreds of thousands of patients were stuck in ambulances for over an hour.
Sir Andrew Dillon:
There are always choices, and, inevitably, and in every health care system, there are always limitations on what the system can do.
Sir Andrew Dillon was, until this spring, the longtime head of the National Institute for Health and Care Excellence, known as NICE.
It's a sweet acronym, but some conservatives in the U.S. liken its work to a death panel. NICE is one of the NHS' crucial cost-control mechanisms. It studies evidence to recommend which treatments and procedures give the most cost-effective benefit.
So, making sure that we really understand the benefits of one option over another, making sure we really understand the value for money, particularly in a publicly funded system that has to account for how money is used, is really important.
Sir Andrew says wait times for elective surgeries, like Olive Parfitt's, have improved. But funds aren't infinite.
Dr. Ashish Jha:
I love how open and explicit they are about the fact that there are always choices.
Dr. Ashish Jha studies health systems around the world. He's now the dean of Brown University's School of Public Health, and he's been a collaborator on this series with us.
It's not like, in the U.S., we're not making choices. We have rationing in the U.S. It's primarily based on your ability to pay and whether you have health insurance or not.
So, the National Health Service tries to make explicit the rationing choices it's making.
Jha says the U.S. could learn a thing or two from a fully funded version of this system — access for everyone, transparent cost controls, and people rarely going broke because they got sick.
It's really clear to me that we could not do a wholesale adoption. Where I think we get lost is the idea that somehow we could take the National Health Service and just import it into America.
And I think what's really lost is all that context — the history behind the National Health Service, the meaning people assign it. We don't have any of that.
But there is a lot we can learn. There are strengths of it, of the National Service that we could absolutely do better with in the U.S.
Since we first filmed with them back in February, Liam Murphy was hospitalized and in critical condition, this time right in the middle of the U.K.'s worst stretch of the pandemic. But he's back home now and doing OK.
The general ethos that I have experienced is that nobody has given up. And every time we have an episode where it could go either way, we come together and say, 'He hasn't given up, therefore, we aren't giving up.' And then the health professionals go, 'Good enough for me.'
The Murphys say the NHS isn't perfect, but it's given them more precious time with their son.
For the "PBS NewsHour," I'm William Brangham in Watford, England.
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William Brangham is a correspondent and producer for PBS NewsHour in Washington, D.C. He joined the flagship PBS program in 2015, after spending two years with PBS NewsHour Weekend in New York City.
Jason Kane is a PBS NewsHour producer, focusing on health care and national affairs.
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