To Get Perspective on America’s Broken Health Care System, Talk to a British Doctor

As a Brit, there are many things about the U.S. I’m only too willing to get behind. Pizzas the diameter of a trampoline, for instance, and the fact you’re never more than a few sweaty footsteps away from air-conditioning. Equally, there are some things I struggle with. It’s alu-MIN-ium not ALOO-minum. Your right to bear arms is about as wise as the right to arm bears. Those inexplicable gaps in public toilet doors. But my biggest hang-up isn’t even the orange nightmare you’ve somehow let into the White House—it’s the fact you seem totally fine with just letting people… die.

What precisely is your aversion to universal healthcare? To me, the idea that medical attention should be free at the point of access and based on clinical need (not on bank balance), is a good thing. Why are you so enamored with the idea of a health insurance policy which may or may not be of any use to you should something terrible happen? Is it an attempt at population control? There are rather a lot of you, I guess. Or is it some kind of kink? Do you like the danger? Perhaps the possibility of instant, irrevocable poverty is all the incentive you need to not break your leg or get cancer. How’s that working out for you?

Things aren’t like that in the UK. Sure, we have many of the same problems you do: a population getting fatter faster than you can say “diabetes” and a government that treats running a country like a lawless game of Monopoly. But when it comes to health care, we’ve got, if I may be so un-Britishly bold to say, the right idea. The National Health Service (or NHS, to make it sound less Orwellian) has been a fixture of our lives for 71 years, and it’s close as we’ve got to a national religion. I’m not saying it’s a perfect system by any means, but I’d drag myself out of a coma to say there’s no set-up that’s fairer.

Whether you have heartburn or a heart attack, whether your baby has meningitis or you need a liver transplant, whether you’re walking down the road to your family doctor or an air ambulance is scraping you off the side of a mountain to get you to a trauma center, no one will ask for your credit card or insurance details—it’s already been paid for through your taxes. No questions. No exceptions. No deductibles. No weighing up whether it’s more important that your children eat than you investigate your shortness of breath. And if the very worst happens, your family won’t be left with a bill for your death.

With that in mind, I find it utterly baffling that universal healthcare is such a political hot potato on your side of the pond. I hear arguments that your government can’t afford it, even though current UK spending on healthcare is $4,000 per head compared with your $10,000. I even hear untrue, outrageous, outlandish statements about “death panels” from political fear mongers, presumably with financial skin in the game, that are utterly alien to anyone with experience in the NHS system. And yet conversely, Gallup reports for the fifth year in a row that the availability and affordability of healthcare is the single biggest concern for Americans, with 55% worrying about it “a great deal.” Even the most conservative estimates of the number of Americans declaring bankruptcy due to health care bills sits in the hundreds of thousands per year. In the UK, you can count the number of health care bankruptcies on the fingers of, at worst, a hand.

And the system works—our life expectancy is two years longer than yours, for starters. I won’t pretend the NHS is some kind of medical utopia. I should know—I worked as a doctor there for seven years. It’s been systematically underfunded for years, its precious resources stretched gossamer thin. There are waiting lists, hospitals in need of redecoration, equipment that needs replacing and doctors with bags under their eyes like leather totes. The cost of the parking meters outside the hospital was more than I made per hour. But it’s still far better than the alternative.

The NHS is a promise, an assurance that it will do its best by you—not because you are rich or have the right insurance but because it’s the right thing to do. The only criterion for accessing the NHS is that you need it. And if don’t need it, you sleep better, knowing that it’s there. Its sheer existence is all the insurance you ever need. Much like ant-egg soup, don’t knock it until you’ve tried it.

This is Going to Hurt: Secret Diaries of a Medical Resident by Adam Kay will be published by Little, Brown Spark on Dec. 3, 2019.