PS: The health-care debate, the UK and US

I’ve been getting a lot of feedback (relatively speaking) to last Saturday’s column. Most of the comments have been complimentary, which is gratifying — but also a little worrying. When I shipped the column to the paper, I didn’t think it was particularly strong or insightful. Saying people should treat each other with civility? (Hey, let’s try the Golden Rule!) should be a no-brainer. But it apparently struck a nerve. As much as I’d like to believe otherwise, I’m pretty sure that says more about the state of the debate — and maybe the culture — than about my acumen.

NPR’s Morning Edition ran an interesting segment today, an interview with Lord Ara Darzi, a surgeon and British government adviser, about Britain’s National Health Service, which you can read or listen to here. Darzi was debunking misinformation being circulated about the NHS by Sen. Charles Grassley of Iowa and the Club for Growth, a conservative group, among others. PolitiFact, which, as its name implies, tries to sort out political truth from fiction — and has a pretty good track record –  labeled the CFG ad “misleading.”

My family and I lived in England for five years in the 1980s, working in a church in the north of the country, near Manchester and Liverpool. This was during Maggie Thatcher’s years as prime minister, long before the reforms that took hold in the last decade. The NHS certainly had serious problems at the time. A woman in our church, for instance, waited three years for knee surgery.

Mrs. Thatcher, a Conservative (or “Tory,” in the jargon) set about “reforming” the system (along with other major industries and the whole economy), and there’s little doubt the NHS needed fixing. It was hemorraging money. There was a brain drain, with physicians leaving the country for better paying positions — in the U.S., for instance.

One of the loud social debates at the time was whether it was morally defensible for people to buy private supplementary insurance, which was just becoming commercially available at the time. Such coverage wouldn’t replace NHS coverage, but it was intended to help policyholders avoid situations like three-year waits for knee surgery. The question was whether we wanted a society where people could get better medical care just because they had enough money to pay for private insurance. It didn’t seem right to many people, including the majority in my part of the country, which was dominated by the Labour Party.

Even so, no major voices seriously proposed killing the NHS. Reform it, rebuild it — yes. Eliminate it — no way. It was a national institution, a social contract.

And I must say that, despite the problems even then — which I believe were much more serious than they are now — the NHS was a good service. Both our daughters were born there, and the prenatal (“antenatal”) care was superb and comprehensive, as was the care in the hospital and in the weeks following the births, with midwives and home health aides and even our GP (general practioner, our family doctor) visiting the new mother and babies at our home. Ordinary care, including dental, was at least as good as anything we experienced in the U.S.

We had no forms to fill out, after registering with the local health care authority. On our first few visits to the doctor or dentist, I’d offer to pay. We were guests, I reasoned, and not even asked to pay taxes to Her Majesty’s Inland Revenue. But I’d get strange looks from the receptionists. The first time I offered to pay at our dentist’s office, the woman behind the counter waved me off. “You live here,” was all she said.

Even in the worst days of the NHS while we were there, when I was a minister who performed almost three dozen funerals in less than five years and made more hospital and sick calls than I can recall — most of them on elderly people — I never once got a whiff of any NHS version of “death panels” or suggestions that we should “pull the plug on Grandma.” It’s just not part of the equation.

I don’t know what the American health care system should look like. (The status quo isn’t working well for far too many people.) Britain’s model may not be the right one for us. But at the very least, I hope we stop using the British system as a red herring, particularly since the fearful scenes painted by Grassley and the Club for Growth resemble the fiction of Stephen King more than reality.