The NHS, a peoples covenant

Having just returned home to the UK after a lifetime of Ex-Pattery, I bumped into your site whilst browsing British Ex Pat sites looking for old friends.  My apologies for intruding but I felt compelled to offer a comment.
 It seems significant that the most vociferous American supporters of the NHS on the site are the people who understand what it is to be without access to health care, whilst the detractors seem to be those who have the luxury of being able to pay exhorbitant amounts of money for  relatively inconsequential medical  procedures,  a  position I might add that is becoming increasingly prevalent amongst  the self, self, self, BMW driving, little Tommy goes  to independent school, holidays in Bali section of the British population.
The NHS is not about tastefully decorated individual rooms, or the right to elective ‘C’ sections, or whether or not somebody was less than supplicant to your over inflated ego and sense of entitlement.  The NHS is not about you, about your wants, you can look after yourself. The NHS is about your child with a temperature but you are down to the  last £1 in your purse,  or for the elderly neighbour who has done his bit for his  country paid his taxes  is now poorly, has no family and needs some help,  or for the little old lady who fell over in the street and broke her hip but  doesn’t want to be any trouble.  The NHS is the bedrock on which our society is based, and is fundamental to our sense of fair play. When we are young and vulnerable, or old and weak, when we can no longer make provision for ourselves, when life has given us a raw deal, it is always there to help us pick up the pieces.  Many comments seem to be disparaging about the NHS, in a sort of ‘keep up with the Joneses’ game.  Are people really that shallow and uninformed, and to be honest extremely naïve to believe that paying huge amounts of money to mercenary medical professionals gives a better health outcome. If  that was the case the USA would be topping the list of health outcomes in the industrialised nations, not languishing near the bottom.
The men who marched off to war between 1914 and 1918 were promised on their return a land fit for hero’s.  Over  1 million of them  made the ultimate sacrifice,  and hundreds of thousands of others were maimed both mentally and physically.  On their return after the guns fell silent, these men together with the widows and orphans of the lost,  were abandoned to their fate as the establishment returned to  pre war business  as usual .  My grandmother  who lost my grandfather at Ypres in 1916, had  4 children under the age of nine and was abandoned  to her fate.  She lost one child from malnutrition, and by 1922 when a shamed government was forced to respond to this national betrayal, it was too late for  my grandmother, who had been forced by circumstances to give up her children  to fostering  in the hope they would have a better life.  My father never saw his mother again, and only met one of his sisters shortly before his death.
For my father and the sons of the lost generation growing up through the great depression, the poverty and betrayal was all around them, and when they answered the call to arms  in  1939 the sons of those sacrificed 25 years earlier would not be fobbed off with empty rhetoric.  When the wartime national government was dissolved,  and a general election called in July 1945. Churchill campaigned on the premise that we couldn’t afford the establishment of the welfare state, whilst Labour promised to implement the 1943 Beveridge report  with its promise of better housing, universal health care and welfare support.  Practically to a man British soldiers, sailors and airman, scattered across the world in their hundreds of thousands, many of them still fighting in the jungles of Burma,  and on their warships in  the Pacific remembered the betrayal of 1918 and were instrumental in rejecting Churchill.
My father was never a socialist and on many issues like me he was to the right of Ghengis Khan,  but to his dying day he said that the most important thing he ever did in his life was helping to sweep away the inequalities of the past. In voting for Beveridge they were voting for the families of the men who didn’t return home, and the many friends who had been disabled by war, they were voting  for their lost families, they were voting for the weak, the elderly , the disabled, they were  voting  for compassion, for community and for the greater good. To my father and his war weary friends aged beyond their years by 6 years of brutal war from the beaches of Dunkirk to the liberation of Bergen Belsen concentration camp, the establishment of the NHS and the welfare state was an article of faith, a covenant  by the people for the people.
Unless you can empathise with the sentiment above then you can probably never understand the significance of the NHS warts and all to the British people, it stands alongside the Magna Carta as a testament to a civilised society. Yes it has its problems, but it remains true to the ideals of the men who forced its birth, ensuring  that nobody has to suffer pain and the fear it brings alone. 

A very noble speech about the British Jack, but I hope you appreciate that while you have been away with your "lifetime of Ex-Pattery" and paying taxes to another country, the NHS has been kept going by those who pay taxes in the UK, including those who weren't born British?

Peter,

Not sure what your second point has to do with the sense of my text, but I will answer it anyway. Those who serve in the  military in this country pay UK tax whichever country they are in, and civilian Ex Pats, who wish to spend more than 90 days in the UK in any given tax year are also liable for tax on their worldwide earnings. I have always considered the UK my home wherever in the world I am, and despite rarely availing myself of the  NHS, I have always been happy to pay my share  for the benefit of those less fortunate than myself.

Jack,

Apart from its educational value about the political history that shaped the formation of the NHS, I struggle to see the benefit of your post to this forum, or to yourself.

This forum is primarily for Americans who are trying to learn about UK healthcare, or adapt to its use.  Yes, some are dual US-UK citizens, and some are hoping to become UK citizens, but many are not UK citizens.  That means the vast majority of people who read this forum do not vote in your elections--which means the readers of this forum have no means to have a say on how many pounds will be given to the NHS, or how they're spent.  Your comments belong at a Labour rally.  Americans who choose to agree with your sentiments tend to vote Democrat instead.  We are not a threat to you.

There are those of us who read this forum who are/will be part of British society because of family ties; for many others, our ability to participate in your society is based heavily on economic criteria, or its surrogate (education), as determined by the UK Border Agency.  In other words, our involvement in British society, per your elected officials, is largely an economic proposition.  I'm not complaining about this policy--I'm not a UK citizen, and I therefore don't have a right to complain about the price your government decides to set to sell a visa--but it is what it is.  If we want to be a part of UK society, we look up the economic/educational criteria on a Tier 1/2/4 visa application, and we choose to pay the price.

What this should tell you is that many of the readers of this forum are people of means.  Means enough, in fact, to shop in a global marketplace and make an economic case to live where we want.  Take a look at the top left of this website.  This forum is for Americans.  We do not have to be part of the social contract you describe.  We look at Britain and all of its wonder from the outside, weigh up the benefits and downsides for our individual lives, and, just like purchasing any other product or entering into any other relationship, we choose whether or not we want to be a part of it, *then* ask your government if we can join in.

If we're allowed to be a part of British society, it's a good economic deal for Britain.  Usually, an American immigrant has had an education that Britain didn't pay one pence for.  We pay taxes at the same rate at anyone else who lives or works in the UK, plus--if our income bracket mandates--taxes to the US as well.  We don't get access to a host of benefits that you do.  My wife attends a Scottish university and pays 20% more per year than the fees students are currently protesting about in England.  We get access to the NHS, but--unlike you--only for as long as we work or study, which doesn't make for a very good long-term disability plan for us.  If we, American expatriates living in the UK, choose to not partake in the NHS, we still have to pay for it.  Therefore, you should not be lecturing us about being critical of the NHS.  If we're so critical that we don't think the system is for us individually, your sense of fair play should prompt you to thank those of us living in Britain for still paying to support your beloved service despite having chosen to not use it. 

In my opinion, you have every right to be proud of your country's social covenant of healthcare you describe.  I'm proud to be a part of it, too, even as an immigrant employee of it.  However, your admonishment to those in this forum critical of the NHS is like a car salesman insulting a customer for thinking the Vauxhall's price is too high, when we've driven Ferraris in the past.

And make no mistake about it.  Having worked as an attending/consultant physician in both US and UK healthcare systems, the difference between the two systems is like comparing a Vauxhall to a Ferrari.  Yes, if you're a passenger patient, either will get you where you need to go safely, if you're in the hands of a knowledgeable, conscientious driver.  But the difference between the two is a lot deeper than public vs. private hospital rooms.  For specific healthcare tasks, both systems--UK and US--do a very good job of *not* measuring outcomes on people who fail to receive that specific healthcare task.  The next time you hear about an uninsured American without healthcare being turned away from an oncology clinic, think about that British compatriot of yours that didn't quite live long enough to survive the 18 weeks maximum turnaround time for an initial oncology appointment after a malignancy was discovered, and then ask yourself which oncologist on their respective side of the pond carries the black mark.  For that reason, the people who read this forum are right to ask hard questions to compare the NHS to what they know (the US healthcare experience), instead of putting their faith in flippant over-summarizing statistics like the ones you allude to.

As a physician, I identify with your sentiment quite a bit.  I'm not being glib--I took a massive pay cut to leave America and practice as part of a nationalized healthcare service, and I'm proud of it.  But this forum is not for you, and especially not for you to admonish the readers here for being critical of their UK healthcare.  If you've convinced one worried, scared patient who's living in an unfamiliar place to not ask questions, then you've done a disservice here. 

Oh, rsmd9!  I am glad you are still about on here, as I was wondering if you were just the other day.  Your contributions have been so helpful in the past. 

I must admit I was a bit puzzled by this thread too!  As rsmd9 pointed out, there are quite a few economic migrants on here, but many of the rest of us - like me - are married to Brits, and in my instance, I'm now a dual citizen - having spent the time & (lots of) money to get to the point of citizenship. 

And I think many of us - including me - think the NHS is amazing!  So my thought was just - hmmm, preaching to the choir, okay.

Both healthcare systems certainly have their strengths & weaknesses.  My experience of both is that, in either system, the patient (and his/her family) needs to be their own best advocate though.  And I think people are naturally going to relate their own experiences - good and bad - in both locations.

I am pleased and proud that the NHS offers a basic level of healthcare to all, including & especially the vulnerable - I 'get' it, that's the point of the NHS.  I too am quite happy to pay my share.  Also, I have been very happy with the care I have received here.  To be honest, my care here hasn't been appreciably different from that I received on an HMO in the US.  However, I have been close to those who fared much worse on the US system.  Might I feel differently (here) if I was on a long waiting list for some kind of specialised care?  Probably.

Also, I am wondering who are these forum members that are driving the BMWs, sending their kids to private schools, etc - lol!  Because I've not met any of those - I don't think they frequent this website.  Maybe they are out there, but most of the folks I know are struggling to pay for their visa & citizenship fees, or worried about what the new government is going to do - if they'll be allowed to continue as students or economic migrants, etc.  And meanwhile, very grateful that the NHS exists! 

So an interesting and moving manifesto indeed, but for this audience? - hence my puzzlement.

Even if there were a whole bunch of private school sending, BMW driving board members, the NHS IS for them as well. 

Or there is no point to it all.  It would just become a throw away thing that no one advocates for. 

Also, I thought the idea of a mass amount of elective c-sections was old and disproven, but keep on keeping on.  I think you will find a lot has changed in the UK since your lifetime away.

http://www.rhrealitycheck.org/blog/2008/06/27/the-myth-elective-csection

Even if there were a whole bunch of private school sending, BMW driving board members, the NHS IS for them as well.  

Or there is no point to it all.  It would just become a throw away thing that no one advocates for.  

Also, I thought the idea of a mass amount of elective c-sections was old and disproven, but keep on keeping on.  I think you will find a lot has changed in the UK since your lifetime away.

http://www.rhrealitycheck.org/blog/2008/06/27/the-myth-elective-csection

Who was talking about c-sections? Did I miss something?

What makes the people on this board exceptional is that we have experience with both the US and the UK healthcare systems so we can compare the good and bad points of both without having to rely on propaganda that we hear on TV or read in the papers.

For example, in the UK, I appreciate be able to quit a crappy job that I hate without having to worry about how I will pay my medical bills.

And I certainly appreciate being able to see a doctor the day I moved to the UK, before I even knew my way around my home.

From living in the US, I know what it is like to have to save money and do without so that just in case you become ill, you will be able to afford medical care. And I know that there are people who go without care because they can't afford it, or have gone bankrupt due to high medical bills.

On the other hand, preventive care was much better in the US.

For example, in the US I got a complete blood work every year. In the UK, I have been told that I really do not have to have my blood glucose, cholesterol or thyroid levels checked regularly, because I'm not fat - despite the fact that I have diabetes, very high cholesterol, heart disease and thyroid diseas in my family, and none of my relatives are overweight. Thin people have heart attacks, too.  My brother was just diagnosed as hypothyroid and put on Synthroid on the basis of a routine blood test - he wasn't complaining of any symptoms.

I was told by a GP that you normally don't get tested for diabetes until you fall ill from it.

Hasn't anyone told the NHS that diabetes and high blood pressure are known as "silent killers" because you can have them without feeling any symptoms until you end up needing hospitalisation?

Then there was the time I was given four different courses of antibacterial and antifungal medications for a rash before the doctor found one that worked - instead of just taking a culture and sending it to a lab.

Or having to go private to be treated for depression because there was at least a  12 week wait to see a counselor on the NHS. - A depressed person with no care could commit suicide in that time period.

Both the US system and the NHS ration healthcare. The US system rations it on the basis of wealth and occupation (those jobs that offer good insurance). The NHS rations healthcare based on perceived need, which is often based on statistics that don't take individuals into account .

If anyone understands the advantages and disadvantages of the UK and US systems, it is the people on this board. We don't need to be lectured to.

Who was talking about c-sections? Did I miss something?

He did, in his original post.  Saying the NHS isn't there for rich people wanting things like elective c-sections.  

The NHS is there for rich people. It isn't Medicaid, it is universal.  

The whole greedy, lazy women wanting elective c-sections is just another way to beat up a section of society.  If only all those rich women weren't draining all those funds, or all those immigrants taking all our jobs.  Blah.

The NHS is not about tastefully decorated individual rooms, or the right to elective ‘C’ sections, or whether or not somebody was less than supplicant to your over inflated ego and sense of entitlement.  The NHS is not about you, about your wants, you can look after yourself. The NHS is about your child with a temperature but you are down to the  last £1 in your purse,  or for the elderly neighbour who has done his bit for his  country paid his taxes  is now poorly, has no family and needs some help,  or for the little old lady who fell over in the street and broke her hip but  doesn’t want to be any trouble.  The NHS is the bedrock on which our society is based, and is fundamental to our sense of fair play.

Thanks bookgrl. I missed that.

I think that when people on this forum complain about the NHS, they are not whining about the lack of private rooms. They are complaining about long waits for treatment, lack of preventive care, illnesses going undiagnosed, etc.

Once again, I don't mean to say that the NHS is an inferior system. There are good and bad points to the systems in both countries. But please don't assume that the people on UK-Yankee are mostly a bunch of rich, spoiled Americans who don't know what it is like to not be able to afford healthcare. As Mrs. Robinson has said, that is most certainly not the case.

Thanks bookgrl. I missed that.

I think that when people on this forum complain about the NHS, they are not whining about the lack of private rooms. They are complaining about long waits for treatment, lack of preventive care, illnesses going undiagnosed, etc.

Once again, I don't mean to say that the NHS is an inferior system. There are good and bad points to the systems in both countries. But please don't assume that the people on UK-Yankee are mostly a bunch of rich, spoiled Americans who don't know what it is like to not be able to afford healthcare. As Mrs. Robinson has said, that is most certainly not the case.

I agree!

I don't think I have ever heard people complain about private room type issues.  They might complain that the large rooms were noisy, or they felt uncomfortable with having a male in the same room, but that isn't the same as demanding a private room.

Both systems are imperfect.  I work, my husband works, he took a new much higher paying job, I have several pre-existing conditions. My DH's new job doesn't offer insurance for the first 90 days.  We had to purchase temporary insurance or pay out over $1200 COBRA a month.  Problem?  There is no provision in temporary insurance for pre-existing.  Also, there is no guarantee even that his new insurance will cover the pre-existing.  My medically necessary meds are in the hundreds a month. (Still way under the $1200 though!)

Under the current system I would have to go 6 months with no insurance to qualify for any help.

So in this matter, at the moment... I'd rather be a hard working person in the UK that could pay for extra insurance to be seen faster or by who I want.

Instead I am a hard working person faced with forking out way too much money (money I'd rather give to my son or save) because I am cursed with genes that don't like me.

Yet, we choose to live in the US for now.  That said I have been fortunate in both countries to have found amazing GP's and amazing specialists. Now I have a great specialist that happens to be a Brit. He and his wife have the where to live debate all the time too. 

There are no great answers..... people have good and bad experiences every where.  
Mrs. R said it best though... where ever you live you have to be your own advocate.

I have always had a problem with those that 'latch onto' the sufferings and nobility of the past. It irks me. I find a lot of older folk do this, talk about how hard the great depression was and yet they were born in 1947. It leads to a sort of 'the world is going to hell in a hand cart because people today are sissies' kind of vibe which is really just conservatism veiled in bucolic claptrap.

One of my favorite quotes on the subject came from an older lady (92 at the time I think) who I got to know because she hung out at a park near my house. I said to her one day, 'It must have been tough back in the depression....'

She replied, 'We kept hearing about that depression thing up in New York. We were dead assed broke before the depression, during it and after. I'm still dead assed broke."

Her other quote, which I really like, one she used when somebody told her about a good bargain was, "If they were selling steamboats for a dime a dozen, all I could do is run up and down the riverbank yelling 'ain't that cheap, ain't that cheap'!"

My parents did live during the Great Depression and they  never went on and on about it.

It leads to a sort of 'the world is going to hell in a hand cart because people today are sissies' kind of vibe which is really just conservatism veiled in bucolic claptrap.

Heh. Reminds me of the time the ex and I were at a relatively nice motorway rest area (one that was new) where this elderly couple were getting coffee and sausage rolls. Is it Costa that's in those rest areas? I can't recall. Anyway, the man's cup had a small chip in it. Yes, not a good thing. But it set him off on a mini-tirade to the teenage manager about how 'this country was going to the dogs'. He finally sat down with his wife and they proceeded to read their respective copies of the Daily Mail and not speak to or look at each other the whole time they were there.

I am just a visitor of this site. Just curious about the UK.
I understand what Jack is trying to say but I wish both the US and the UK would take a look at how health care works in other countries. It doesn't have to be not affordable, but also it doesn't have to have long waiting times.
Here take a look at what this American lady in Germany says about health care in Germany. It works a lot better than the NHS but it is still affordable and covers all the residents.
http://www.amiexpat.com/2009/08/18/health-care-in-germany/ [nofollow]

 I hope you don't mind me intruding in here.