{"id":791,"date":"2009-08-17T13:17:19","date_gmt":"2009-08-17T12:17:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=791"},"modified":"2009-08-20T13:51:55","modified_gmt":"2009-08-20T12:51:55","slug":"richard-smith-asks-is-it-unpatriotic-to-criticise-the-nhs","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2009\/08\/17\/richard-smith-asks-is-it-unpatriotic-to-criticise-the-nhs\/","title":{"rendered":"Richard Smith asks: Is it unpatriotic to criticise the NHS?"},"content":{"rendered":"

\"Richard I\u2019m worried that in the highly charged atmosphere created by the extraordinary US debate on health care my published anxieties about the NHS might brand me as unpatriotic. Perhaps Fox News<\/a> or some equally evil, right wing American media outlet will track down my words in the Journal of the Royal Society of Medicine<\/a>\u00a0and broadcast them. I will be obliged to go onto television in Britain and tearfully recant, rather like a hostage asking for release, saying that I\u2019ve always adored the NHS and have no doubts that it is the best health care system in the world.
\nI certainly have little doubt that by some measures the US has one of the world\u2019s worst health care systems. It may not be as bad as that of Sierra Leone, but in terms of value it must be almost as bad. To spend 16% of one of the world\u2019s biggest GDPs on health care and have more than 40 million people excluded and infant mortality rates in some parts of the country little better than those of a developing country is very poor value. But if you have adequate health insurance and live near the Mayo Clinic<\/a> you can get some of the best care in the world\u2014and without waiting.<\/p>\n

Comparing health care systems is as pointless as asking whether Jimi Hendrix<\/a> made better music than old Bach<\/a> or whether rural Wiltshire is more beautiful than the Sahara desert. Health systems are very different, shaped by historical, cultural, political, and economic forces. The US couldn\u2019t adopt a system like the NHS even if wanted to, and nor is Britain ever likely to have a system like the US\u2014it would be like asking a cat to transform into a dog. WHO<\/a> probably did us all a great disservice when it put together apples, oranges, and melons to produce a league table of health systems, although I think the NHS coming 18th when the French system was first stirred ancient (and not so ancient) rivalries and added to the political momentum to up spending on the NHS dramatically. Similarly the somewhat dubious comparisons of the outcomes of cancer patients showing the NHS doing badly helped inspire the national cancer plan even if whatever difference there might be is probably attributable mainly to the greater inequalities in Britain.<\/p>\n

All health systems are deficient. They have to try and balance safety, quality, access, responsiveness, efficiency, and cost and fall short on all of them. There is no perfect health care system and never will be.<\/p>\n

It is possible to learn from other health systems\u2014but at a much more granular level. The populist in me believes that it should be possible for the whole country to debate health care\u2014particularly the relative importance of quality and quantity of life\u2014but what\u2019s striking to those of who\u2019ve spent (misspent?) our lives in the health debate is how uninformed it tends to be on both sides of the Atlantic.<\/p>\n

I\u2019m led to sympathise with politicians, particularly highly intelligent ones like Obama, Brown<\/a>, and Cameron<\/a>. They must inform their policies with data and evidence and at least aspire to the rational, but once the debate descends into the bear pit of public political discourse most of that is jettisoned. The Clinton<\/a> plan was said to have failed because it was a \u201ctechnical solution to an ethical problem.\u201d The skill of politicians is to find a compelling narrative to sell their policies and to put together enough votes in their legislative bodies to get them through\u2014much more of a problem in the US than the UK because of the \u201cseparation of powers,\u201d which may have separated them so far that major societal problems\u2014like health and the environment\u2014become insoluble.<\/p>\n

I hope that Obama can exercise his extraordinary political skills to get through a bill that can at least extend coverage even if it cannot reduce costs. He won\u2019t achieve it by ever mentioning the NHS, but could the message be about values rather than technicalities? I may have doubts about some of the mechanics of the NHS, but I have no doubt about its fundamental values\u2014universal coverage, free at the point of delivery, and equal quality of care for all. I don\u2019t care too much how they are achieved and by whom. Surely the Americans could agree on some values\u2014perhaps even the ones we agree on. After all most of the developed world does.<\/p>\n","protected":false},"excerpt":{"rendered":"

I\u2019m worried that in the highly charged atmosphere created by the extraordinary US debate on health care my published anxieties about the NHS might brand me as unpatriotic. Perhaps Fox […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955,1357],"tags":[1356,477,366],"class_list":["post-791","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith","category-us-health-care","tag-clinton","tag-obama","tag-us-healthcare"],"yoast_head":"\nRichard Smith asks: Is it unpatriotic to criticise the NHS? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2009\/08\/17\/richard-smith-asks-is-it-unpatriotic-to-criticise-the-nhs\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith asks: Is it unpatriotic to criticise the NHS? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"I\u2019m worried that in the highly charged atmosphere created by the extraordinary US debate on health care my published anxieties about the NHS might brand me as unpatriotic. 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