I’ve experienced life with both kinds of health care system. Living in the United Kingdom, I grew up with the ‘universal’ model: government health care, paid for by taxes and free at the point of use. And, for the past five years, I’ve been in the United States with its ‘insurance’ model, paid for by employers, government and individuals, depending on a patient’s age, employer, and many other factors.

The health care debate in the United States is characterized by a difference of opinion between liberals and conservatives as to the effectiveness of the U.S. health care system.

Liberals say it’s a bad system, leaving the poor and elderly vulnerable and many uninsured people woefully unprepared for sickness. They say it’s too expensive and lines the pockets of insurance companies. They say it discourages people from seeking care because of the cost.

Conservatives say it’s a good system, providing an excellent quality of care to everyone who wants it. They argue that the poor and elderly are already covered by government programs. They say private insurance offers the most flexibility and gives people options.

Actually, they’re both right and they’re both wrong. See, I’ve experienced both systems, and it is my observation that they are simply good at different things.

In the U.S., the quality of health care is fantastic. Doctors, surgeons, specialists etc. are among the best in the world. There are vast amounts of resources and technology available. Research is extensive and often well-funded. People who are diagnosed with a condition are treated quickly and usually very effectively. More of them survive than in most other countries in the world. Hospitals are comfortable and spacious. The United States has the Mercedes-Benz of health care. Unfortunately, not everyone can afford a Mercedes, so access is not very good. Yes, the poor and elderly are covered by Medicaid and Medicare and other programs. But millions of hardworking people who don’t fall under the programs and do have some form of insurance still fear their out-of-pocket costs, which can be enormous. This puts them off seeking help when they need it. Many are diagnosed too late. People with pre-existing conditions are refused by insurance companies. Health costs are the leading cause of bankruptcy, and one wonders how many people get sick from the stress of wondering how they’ll pay for the notorious costs.

The U.K. National Health Service, on the other hand, is good at access. People don’t worry about costs, because there are none (other than their taxes, which are comparable to those in the United States). Per capita, health care costs a lot less. Life may be slightly less stressful without the constant worry that one can’t afford to get sick. The U.K. has the Fiat 500 of health care. It gets the job done, but not as well. While people are taken care of, the quality isn’t as good. People wait for lengthy periods of time to get operations, to get lab results, to make an appointment. Hospitals are often overcrowded and uncomfortable. My wife’s experiences surrounding the birth of our son in a Belfast hospital are no advertisement for the ‘universal’ model.

So, different health systems are good at different things. America is lucky to have by far the most responsive system in the world. Brits are lucky to have great access while only spending 6 percent of GDP on health care. Where they fail, they fail in different ways. It is, therefore, easy to do as conservatives are doing and point out only the successes of the U.S. health system while ignoring its serious shortcomings, or as liberals like Michael Moore do by pointing out only the successes of the ‘universal’ model while ignoring its woeful inadequacies.

The fact is that both systems have desirable elements.*

So, health care reform in the U.S. is focused on making the health care system here more affordable. That is as it should be. The system needs reform, certainly. Perhaps the measures which are currently close to a Senate vote are a step toward improving a system which is already good in many ways, so good that people flock to America to take advantage of it. We don’t need to pretend that the whole system sucks to achieve some level of reform. And neither do we need to pretend that the system is great to oppose the adoption of the ‘universal’ model.

John Wright

* However, by at least one objective measure, the UK system is better for the overall health of its citizens than the US system is. The World Health Organization ranks the UK #18 and the US #37, a fact made more stark by the fact that the US pays almost three times as much per person. That’s not very good value for money.