The public policy from Britain that I think would potentially benefit the United States is the National Health Service (NHS), which was established in 1948. I will focus on the provision of universal health care and also the funding of the system. I will argue that the British policy would be more beneficial to the American people than the current health care policy, which is largely owned and operated by the private sector. I will also discuss how the transition of the American health care system from the private sector to the public sector would be an improvement for the United Sates.
For the system to work in America, the government would have to pass a similar act as the British National Insurance Act of 1911. This was introduced by David Lloyd George and the policy determines that health care would be paid for by money deducted from an employee’s weekly wages, along with contributions from the employer and the government. In return for these National Insurance contributions, the citizen would then be entitled to free medical care. If America adopted this same National Insurance policy it could in turn provide a similar public service as the NHS in Britain, where health care is free at the point of need. In order to be the same as the British system, it would involve the ‘nationalization of hospitals and the provision of free medical treatment.’ (Norton, 2001:49). It would be under this same principle of nationalization, bringing American hospitals into the public sector or state sector and the provision of free medical treatment, that I believe the health care of the United States would be able to change from its current private sector based service to a public sector. The focus would shift to its prime function being on health care and its provision rather than on profits and capitalism.
At the moment health care reform is a contentious issue among Politicians in the United States, but it has a long history of similar conflict between opposing parties. Both President Clinton and President Obama’s administration have put forward proposals for health care reform, but they have been met with opposition and a degree of controversy. It has been said that in American society ‘redistributive policies ultimately involve disagreements between liberals (pro) and conservatives (con)’ (Anderson, 1984: 18). I feel one reason for this conflict and contention is the money that’s at stake, not in regards to the cost to provide universal health care, but in the profits lost from private medical insurance and pharmaceutical companies who have the monopoly on the health care of American citizens. I feel that a National Health Service in America, based on the system used in Britain with funding coming from National Insurance taxation from employees along with contributions from employers and the government would eradicate the need for private medical insurance. In turn it would also release the grasp that the private sector has over the health care system in America.
This shift from private to public may be seen as a burden to the economy, but I feel if it is managed and run with the ethos of putting people and the level of service before profits, then there is no reason it cannot function in America. There are arguments from the right-wing in American politics, which see this as socialism and as a tax on the rich. The main bone of contention involves the fact that redistributive policies are ‘difficult to enact because they involve the reallocation of money, rights, or power’ (Anderson, 1984: 18). But as the system has proved in the United Kingdom, this reallocation or redistribution does not have to be a case of taking from the haves to give to the have-nots; it can instead strike a balance. I believe the introduction of a similar NHS to America would actually provide a more level playing field for all its citizens and it would no longer discriminate against those are most vulnerable, i.e. the poor. This would work by the same principles as the British system where everyone contributes a percentage of their wage via the National Insurance system and this in turn entitles you to free health care. There would no longer be a health care system in America based on your ability to pay medical insurance or to cover the costs of medical care; it would now be a service free at the point of need.
The eradication of medical insurance would also help to ease the financial burden placed on people, as this has been shown to have a major impact on the health of the nation as many cannot afford to pay insurance. Figures from the 2009 Census show that a staggering 16.7 percent of people in America are without health insurance. The figures show that the number of uninsured people increased to ‘50.7 million in 2009 from 46.3 million in 2008’ (Census, 2010: 22). The main reason people are uninsured is down to costs, many simply cannot afford to pay. But if America adopted the British system, the safety net would be in place to provide for the most vulnerable people. In relation to the British system this has been described as the state providing ‘something of a protective safety net from cradle to grave’ (Norton, 2001: 50). The NHS would be able to care for you at every stage of your life from when you are born to the day you die, with no discrimination based upon your ability to pay medical bills.
The reason there would be no discrimination at the point of service would be based on the fact that the citizen has contributed to their care based on their earnings. This general taxation is structured into salaries and the knock on effect to the American citizen would be that they greatly reduce their overheads. The National Insurance would be significantly more affordable than compared to paying a monthly bill or fee for medical insurance. The 2009 Census demonstrated this, as it showed it was ‘the first year that the number of people with health insurance has decreased since 1987, the first year that comparable health insurance data were collected.’ (Census, 2010: 22). This surely has to be connected with the economy and the current financial situation in America, with many people struggling to pay bills and perhaps choosing to cut what they feel are not essential everyday bills, such as health care. It demonstrates that people in America are currently choosing to gamble on saving money by not having insurance, in the hope that nothing happens to them. This is another reason why the introduction of the NHS would be an improvement to the United States, as it would remove this financial worry from people’s lives.
One of the main arguments against the introduction of a British style NHS to America would be the cost to the nation. Those who oppose the idea would state that universal health care would cripple the nation, but put into context I believe that compared with the government’s spending on such things as Defense, both at home and abroad, the cost would not be a financial burden. In relation to Britain, there have been times when the cost of the NHS has been called into question, but during times such as the 1960s ‘where economic conditions impinged on the ability to maintain the welfare state, it was essentially at the margin: Government imposed nominal charges for medicines obtained on NHS prescriptions’ (Norton, 2001: 51). This demonstrates that even during tough economic times, the government was still able to maintain the NHS, by simply introducing a nominal charge for medicines via a prescription charge. This charge could be raised or lowered in line with inflation or even to help maintain the cost. I’m sure compared with current costs of medicine; citizens in the United States would not be put off by having to pay around $10-$15 for their prescription. Even by the end the end of the 1990s in Britain when the political and economic landscape had changed, one thing remained constant ‘the popular attachment to the National Health Service…remained strong’ (Norton, 2001: 53). This again shows that with the turmoil that surrounds the changing of government, the principles based on the foundations of the NHS have not wavered, they have been maintained and updated throughout the decades.
If I was to highlight any downsides to a free universal health care system, it would be that even those who do not contribute, such as unemployed or drug addicts or homeless are all able to use the service. This may be difficult to comprehend for some people in America, thinking how they can get this service free when others pay for it. But I believe that society should be able to care for those unfortunate enough not to look after themselves and this extends to health care. The National Insurance contributions along with government spending covers the costs of the shortfall in those who contribute nothing, I believe that could also work here in America, as the contributions of the vast majority of its citizens backed by government spending would surely cover any short fall from those unable to pay.
In conclusion it can be argued that the introduction of the NHS, although contentious, it would benefit the United States. The introduction of an NHS system paid for by a National Insurance could be one of the policies that President Clinton has described as already existing in the world that would benefit the country. It might not be to everyone’s taste but after all Public policy will always divide opinion and it has been said that it ‘is full of competing, often contradictory presentations’ (Brigham, 1977: 12). But I believe the benefits outweigh any bad points to the system. I do not believe that the introduction of an NHS style system would have any major negative or unintended consequences except for those already discussed such as the system being used by those who do not contribute. It might also be argued that the system could be abused by people using valuable time and resources because they have free access to it, but again comparing this with the United Kingdom, most people do not choose to abuse the system that is available to them and instead they are thankful for it and the services provided by the countries Doctors and Nurses. I believe that America would benefit from introducing this Policy, as a global leader they should be at the forefront of such policies as health care instead of lagging behind countries such as Cuba and East Timor.
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