What people don’t know about the NHS

… is that it is incredibly cheap. I was speaking recently with a British colleague, who asked how I liked being back in the UK after a year on sabbatical. I mentioned that there are things I really appreciate about living in California, but one of the things I like best about the UK is the NHS. Even without any significant health problems in the family, the incomparable irrationality of the US healthcare system (though even calling it a “system” seems overly generous) is palpably unnerving, at the very least since you’re occasionally confronted with the question of whether this or that problem is significant enough to go to the hospital for, and then you have to consider whether it’s worth entering into a multiyear negotiation over fictional bills for thousands of dollars.

Anyway, I remarked that I wish the UK would just raise its health spending to the European average, that it would be far and away the best in the world, as opposed to limping along as it does now, being the best for equality, but clearly overstretched, and not quite matching the top national healthcare systems. I thought this was simply a platitude, but he seemed genuinely surprised by the claim. On further questioning, he said that he would have thought the NHS was relatively expensive compared with healthcare in western Europe generally.

In fact, UK health expenditures are low, not just compared with the wealthy countries of western and northern Europe, but with respect to the EU generally — including the relatively poor countries of eastern Europe. They would have to spend an additional 6 billion pounds — about a 5% increase — to match the EU average. In 2011 the UK was below average healthcare spending for the OECD, and was still only average after removing the exceptionally high spending USA. (The US, despite the notoriously expensive private healthcare system of which its right-thinking populace is so proud, has considerably more public healthcare expenditure per capita than the UK, on top of the private system. And life expectancy is still several years shorter.)

I wonder if the public would demand more spending on the NHS, rather than accepting the government line about necessary efficiencies and the magic of privatisation, if they knew how efficient the NHS already is, and how little they are spending on healthcare compared with their European neighbours, not to mention the profligate Americans and Canadians.