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How The United Kingdom's Health-Care System Works

Super Tuesday came and went and the Democraticpresidential race is narrowing to two very different candidates, far left Bernie Sandersand the more moderate Joe Biden.

Biden and Sanders have clashed on the bestapproach to reforming U.

S.

health care.

Sanders wants to get rid of private insurancealtogether.

While Biden proposes building on the frameworkleft over from Barack Obama's Affordable Care Act.

Bernie says that you have to bring peopletogether and we have to have Medicare for all.

But Bernie says and he says he wrote the damnthing, but he's unwilling to sell with the damn thing's gonna cost.

The idea middle class taxes aren't going togo up is just crazy.

What Medicare, after all, will do is savethe average American substantial sums of money.

The U.

S.

already spends more money on healthcare than any other developed country.

There's one country that spends less thanhalf what the U.

S.

does on health care.

And people generally don't pay anything outof pocket when they go to the doctor.

The United Kingdom and out of all the healthcare systems we've looked at, the U.

K.

appears the most socialist.

The government effectively runs the wholething.

Right now, the U.

K.

is having its own debateover how to reform the National Health Service.

So how does the U.

K.

system compare to theU.

S.

and what reforms may be coming? In 2018, the United States spent around tenthousand five hundred U.

S.

dollars on health care for each of its residents.

The United Kingdom spent around 4000 U.

S.

dollars.

That means the United Kingdom spends 9.

8 percentof its GDP on health care, while the U.

S.

spends 16.

9 percent.

Despite spending less, the United Kingdommanages to have healthier citizens who live longer and are less likely to die in childbirth.

In 2017, life expectancy in the U.

K.

was 2.

7years higher than in the U.

S.

, and the U.

K.

has roughly 1.

5 times fewer deaths that couldhave been avoided by access to better health care.

The infant mortality rate is lower in theUnited Kingdom, with 3.

9 deaths per 1000 live births as opposed to 5.

8 in the United States.

And the maternal mortality rate in the U.

S.

is nearly 1.

5 times higher than in the United Kingdom.

So how is the U.

K.

system structured so thatit gets these results while spending significantly less than the United States system? The National Health Service is a case wherethe British decided right after World War 2 that health care should be government'sjob, like paving the streets, putting out fires, running a library, running the parks.

That's T.

R.

Reid, author of the book The Healing of America.

He traveled the world exploring differentcountries' health care systems.

It's a service you get when you need it andyou never get a bill.

It's like going to the library.

They don't charge you to check out a book.

He's saying that the NHS is it's a risk sharingsystem, so everyone pays into it through their tax.

If you need to use it, you don't have to payanything else.

So in a sense, it's not free because is paidas of taxation.

Dr.

John Puntis is a pediatrician who recentlyretired from the NHS.

He is also co-chair of an organization calledKeep Our NHS Public.

All of his comments are reflective of theorganization and not his personal views.

It's a fair system in that the more moneyyou earn, the more tax you pay, the more you contribute.

But there has been discussion about whethertax should be increased to pay for sorting the NHS out in terms of the current deficienciesand problems, and that that is controversial.

I think a lot of people favor some tax increase, but then there are other people who say, well, maybe the focus should be on companies thatdon't pay tax and people who don't pay tax as the first step.

I would call that socialized medicine.

Government provides that care.

Government pays for the care it's paid forthrough taxes.

Everybody's covered the same.

To me that sounds like socialized medicine.

The term socialized medicine has become apolitical football, especially in the United States.

The NHS is socialized medicine.

It's great.

And we hear this term mainly coming from theUS where it's used as a as scaremongering.

I would say if the NHS is socialized medicine, we like it and most people are still very, very supportive of the concept of of of anational health service.

Each of the u.

k.

's four constituent countrieshave their own branch of the NHS, so rules differ slightly between them.

But all of the branches operate under thepurview of the U.

K.

parliament.

There are some services that require patientsto pay something out of pocket, such as dental, eye care and certain prescription drugs.

But those fees are low compared to the U.

S.

and vary by NHS branch.

By one estimate from a data analytics firm, prescription drugs cost 57 percent less in the U.

K.

than they do in the U.

S.

Unlike withother universal health care systems that are only publicly funded, the government alsoruns the NHS.

That means doctors that work in public NHSfacilities are employees of the government.

Most Britons receive their primary care throughgeneral practitioners who are frequently referred to as GPs.

They typically act as gatekeepers for secondarycare.

The problem is that people are experiencingthe moment as is taking longer to see your general practitioner.

If you want to see them.

Most GPs are private contractors with theNHS.

They don't charge patients for care.

Instead, they earn money directly from theNational Health Service.

Many GPs negotiate contracts with the NHSto determine how much they can charge the government for their services.

GPs may fund their own general practice facilitiesor they can rent them from the NHS or private companies.

One paper from the Journal of the Royal Societyof Medicine found that GPs faced many issues because of how general practices are fundedin the U.

K.

Some GPs, I think increasingly don't wantto take on the running of business aspects of general practice, and so there are lotsof GPs who are salaried partners, so they are paid by the practice to come in and workas a GP, but they don't do any of the business side of this stuff.

There's also a private sector in the u.

k.

'shealth care system.

It's funded from a combination of out-of-pocketpayments, private health insurance and the NHS itself.

The private sector is growing because is beingconsciously promoted by government and the boundaries being blurred.

But I think the private health care has beengrowing at a very rapid, steady pace in the United Kingdom for the course of several decades.

That's going to continue.

That's Nile Gardiner.

He's the director of the Thatcher Center forFreedom at the Heritage Foundation.

With regard to the National Health Service, I mean, there's no there's no sign at this stage that the U.

K.

will be moving to a differentsystem to the National Health Service.

All British parties all committed to the NationalHealth Service.

I think that's more or more Britons will beopting for private healthcare in the coming years and decades, not least because thereare long waiting lists with regard to the National Health Service.

And analysis from the London School of Economicsfound that in the 2018 to 2019 fiscal year, NHS England spent around 18 percent of itstotal expenditure on the independent sector.

There's been a blurring of the boundaries, if you like.

For example, cataract surgery is the mostcommon operation done under the NHS.

Increasingly, it's being provided in the independentsector and the NHS, as has contracts with the independent sector to do that work.

There are implications in terms of staffing.

Private sector doesn't train its own staff, it takes it from the NHS.

It cherry picks, takes the low risk patients, not the high risk patients.

It has an impact on training NHS staff andthis is one of the problems with cataract surgery.

If they're all going to the private sector, hospitals and the NHS staff don't become experienced in doing cataract surgery.

And then along the line you find it's moredifficult to staff your NHS unit.

So it's not without negative consequence.

And we are paying private companies increasinglyto do work for the NHS, including American companies.

And they're very well established now, particularlyin the back office functions and providing advice on commissioning support, this kindof thing.

They're very involved and unfortunately that'slikely to increase and something which campaigners are extremely worried about.

I don't think anyone really believed thatU.

K.

voters would decide to Brexit.

The news that the United Kingdom voted toleave the European Union shocked the world.

The NHS was a big part of the Brexit mediadiscourse, with the Leave campaign famously claiming that the U.

K.

would take back 350million pounds a week that could then be funneled into the NHS.

The U.

K.

Statistics Authority has since saidthat the claim is a quote, clear misuse of official statistics.

My name is Holly Jarman.

I'm an assistant professor in the Departmentof Health Management and Policy at the University of Michigan.

Those promises really did hit home for a lotof people.

The idea that money would come back from Europeto the U.

K.

was a very powerful symbol.

It's not actually true.

That wasn't really how EU financing works, but we still saw that that was a big part of the media discourse and most likely partof people's judgment when they were casting their vote.

The U.

K.

officially left the EU three yearsafter the original Brexit vote.

Entering a transitory period through the endof 2020, while the U.

K.

government negotiates international trade deals, the concerns aboutprivate American corporations engaging more with the NHS came up during the discussionof the post-Brexit trade talks with the United States.

When you're dealing in trade, everything'son the table, so NHS or anything else are a lot a lot more than that.

Backlash to President Trump's comments onthe NHS led to many British politicians assuring their constituents that the NHS was not goingto be a part of the trade talks.

The NHS is in no way on the table.

President Trump and backtracked on his comments, saying he wouldn't consider the NHS as part of the trade deal.

A lot of trade negotiations are actually quitesecretive by nature.

The two sides don't really want to reveala lot about what they're looking for in a deal.

Our concern really as health researchers isthat the NHS really won't be accounted for in that deal, that the U.

K.

government's preferenceshave been shown to be largely economic and not so much on the focusing on the healthof people in Britain.

The problem is that the NHS is is alreadyon the table.

It has been for a while.

The politicians who are now going to be negotiatingthe trade deals, you know, it's going to be across many fronts.

Campaigners were saying, okay, put your moneywhere your mouth is.

If if you're saying the NHS won't be in atrade deal, then let's see legislation that sets that out says cast in stone.

And they haven't rushed to do that.

Trade negotiations, cover everything at once.

And it's difficult to tell how they are goingto be pushing for the liberalisation of drug regulations and to what extent the Johnsoncabinet would actually agree with any changes that would be proposed to the way the U.

K.

regulates pharmaceuticals.

It's really a central government led process.

That's not that democratic and does representbig business.

And I think that's why a lot of people getvery concerned and anxious around trade agreements.

There are some who say the NHS won't be harmedby Brexit, even in the event a trade deal with the EU isn't reached by the end of theyear.

I don't expect that we're going to see hugechanges actually in the Brexit era with regard to the to the National Health Service.

And so I think with with regard to the NHS, we're not likely to see a significant impact as a result of of Brexit.

I think the free trade deal will be largelyfocused upon the service industry, which of course is now the largest part of both theUS and British economies.

Whatever effect the trade deals end up havingon the U.

K.

, reforming the NHS will continue to be a big part of the country's politicalconversation.

People's support for the NHS in the U.

K.

isvery strong.

There's no other country that when we hostedthe Olympics in London, we had nurses jumping on beds and the NHS was actually a part ofthat ceremony and a part of that national celebration.

The U.

K.

's NHS is very important in Britishpolitics.

It's an important symbol of Britishness inthat context.

.

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