When I laud the benefits of ‘free’ British healthcare, people back home often respond with, ‘well, someone has to pay for it.’ Fine, I agree that calling any healthcare ‘free’ is a bit misleading since individuals either pay through income tax (UK) or through direct insurance payments (US). My argument is that in today’s unsure job market, publicly funded systems are much better for individuals since they get a fairer return for their investment both monetarily and through health outcomes.
Take my situation for example. For nine months I was employed with the Salvation Army UK where I paid an income tax rate of 20% (for a bit of analysis on comparing US and UK income tax rates see here). This tax rate of course was a substitute for insurance premiums and copayments that we would have incurred whilst in the US. After nine months of work, my contract ended, and I joined the unemployed masses of our generation. The silver lining? Even though neither David nor I are working, we still have the same access to National Health Service (NHS)! We won’t need to face the panic I felt last summer in the US when David sliced part of his finger off with a knife, and we had to make a very hard decision about seeking professional care without insurance. (If you are curious, we did end up going in to an Urgent Care Centre who charged us $70 for essentially Band-Aids.)
For the three years that we were employed in the US, David and I paid much more in insurance premiums than we ever withdrew in care. That over-expenditure did not benefit us when we were later unemployed and David’s finger was spurting blood. In essence, we lost the entire investment in our health while the insurance company benefited from our employer and personal payments. In the American system, even though my employer and I faithfully paid our monthly insurance premiums this investment was lost after I left my job. On the other hand, in the British system, I am still able to rely on my investment since my access to health care is not directly linked to my employment.
When Americans roll their eyes and tell me that ‘someone’ has to pay for healthcare what they don’t realize is that no one should ever need to pay as much as Americans do. Did you know that the US spends roughly $17.9% of GDP on healthcare while the UK spends only 9.6%?! And what does the ‘Land of the Free’ get for that massive expenditure? Among high-income countries, we have the highest prevalence of heart and lung disease, STDs, injuries, homicides, disability and obesity to name a few (see full report here). Last month’s New York Times noted that America’s maternity care is the costliest in the world with one of the highest rates of infant and maternal death among industrialised countries. American men don’t get off easy either since their life expectancy is lower than almost all of Europe, the Middle East and parts of Asia.
No matter what our political leanings, I think Americans can agree that our health system needs some serious resuscitation. The goal might not be ‘free’ healthcare, but maybe if we looked across the pond for some guidance, we could at least create ‘half-priced’ healthcare with better return on investment.