British fear 'American-style' healthcare system

http://www.latimes.com/health/la-fg-britain-health-care-20110613,0,1237142.story

Reporting from London—
Two years ago, Britons were outraged when U.S. politicians like Sarah Palin, in the debate over healthcare reform, turned this country's National Health Service into a public whipping boy, denouncing it as "evil," "Orwellian" and generally the enemy of everything good and true.

It's time for some payback.

Britain is now embroiled in a healthcare argument of its own, prompted by a proposed shake-up of the NHS. And the phrase on everyone's lips is "American-style," which may not be as catchy as the "death panels" that Palin attributed to socialized medicine but which, over here, inspires pretty much the same kind of terror.

Ask a Briton to describe "American-style" healthcare, and you'll hear a catalog of horrors that include grossly expensive and unnecessary medical procedures and a privatized system that favors the rich. For a people accustomed to free healthcare for all, regardless of income, the fact that millions of their cousins across the Atlantic have no insurance and can't afford decent treatment is a farce as well as a tragedy.

But critics here warn that a similarly bleak future may await Britain if a government plan to put more power in the hands of doctors and introduce more competition into the NHS succeeds — privatization by stealth, they say.

So frightening is the Yankee example that any British politician who values his job has to explicitly disavow it as a possible outcome. Twice.

"We will not be selling off the NHS, we will not be moving towards an insurance scheme, we will not introduce an American-style private system," Prime Minister David Cameron emphatically told a group of healthcare workers in a nationally televised address last week.

In case they didn't hear it the first time, Cameron repeated the dreaded "A"-word in a list of five guarantees he offered the British people at the end of his speech.

"If you're worried that we're going to sell off the NHS or create some American-style private system, we will not do that," he said. "In this country we have the most wonderful, precious institution and also precious idea that whenever you're ill … you can walk into a hospital or a surgery and get treated for free, no questions asked, no cash asked. It is the idea at the heart of the NHS, and it will stay. I will never put that at risk."

Cameron's eagerly declared devotion to the NHS illustrates the totemic role it plays in British society, an institution so cherished that some describe it as the closest thing here to a truly national religion. Created in 1948, as the country struggled to rise from the ashes of World War II, the NHS is widely hailed as the welfare state's biggest triumph.

Since then, it has bloomed into a behemoth that gobbles up nearly $170 billion a year in taxpayer money — an amount set to grow along with Britain's aging population — and is one of the nation's largest employers.

Governments of all stripes have taken office pledging to reform the system, to streamline it and make it more efficient, but none has fully succeeded, knowing that they tinker with the NHS at their peril. The current Conservative Party-led coalition, which has embarked on the most radical public spending cuts in a generation, has promised not to take a penny from the health service.

To each other, Britons love to complain about the NHS, retailing gruesome tales of substandard care, of long waiting lists for simple operations like hip replacements, of snotty surgeons and naughty nurses. But when Americans began citing the NHS as the epitome of socialized medicine gone wrong, people here bristled.

Fear that Britain is becoming more like the U.S. extends beyond healthcare. "American-style" is also the epithet of choice to describe the direction of Britain's higher-education system.

To make up for lost state funding, many public universities, including Oxford and Cambridge, have decided to take advantage of a new law allowing them to charge students a maximum of $14,750 in annual tuition, nearly triple the current price tag. Shelling out huge sums for college may be part of the American way, but Britons don't like it.

Last week, well-known philosopher A.C. Grayling caused a stir by announcing the creation of a private university, featuring top British and U.S. academics, that will charge nearly $30,000 a year.

There have also been demonstrations over the proposed NHS overhaul. Britons are so uneasy about the changes that a sheepish Cameron was forced to put them on hold and ordered his ministers to go on a two-month listening tour to hear out voters.

"We recognize that many people have had concerns about what we were doing," Cameron said. "This has been a genuine chance for people … to work together to strengthen the institution we all love and hold dear."

The results of the review, and the government's expected concessions, are to be unveiled this week.

The changes will be debated in the public arena and fought over in Parliament. Doctors' groups will no doubt say one thing, patients' advocates another. In the end, lawmakers will probably approve a messy healthcare compromise that will anger many and please few.

Which just goes to show that maybe Britain and America aren't so different after all.

henry.chu@latimes.com