How the NHS does treatments for nothing...

Me, or at least someone very like me,  in 1974

Dear American friends,

You keep asking me how the British National Health Service works. Well, it probably isn't what you think...

If you live in a country like the USA where you - or your insurance company - pays for health treatments, you'll know that each treatment comes with a price, and that price is high. In the UK there is no cost for treatments. Which sounds impossible - surely good health care is expensive and someone has to pay? So how do we Brits manage to get health care that's drastically better for half the cost? Let me explain...

I worked for years as an, albeit very junior, nurse in the British NHS. I've also, more recently, been (1) very successfully treated by the NHS for lung and colorectal cancer, and (2) been involved in management-level funding and economics, so I hope I can help explain how we pull of the magical trick of top-class health care for not much money.

The British public don't pay for health treatments, they pay for a health service. That is, they, all together, for about £1600.00 per person per year, through taxes, collectively pay for some hospital buildings, and some gardeners, and some surgeons, and nurses, and electricians and pharmacists and everything you need to run a health system. Once they're in place, those experts are all left to provide health services as they think best. They're audited, of course, to check they're doing things right, but, ultimately, every health manager, every General Practitioner, every surgeon and every midwife is free to act as they think best.

And, left to use their own skills in their own way, and patients free to go to the health professional they think best seems to work rather well. Nobody is going to get paid more by doing unnecessary stuff, and nobody needs bother about 'entitlement'.

We don't pay for health treatments, we pay for a health service. 

I remember while working in Accident and Emergency (that's ER to you) I treated a patient - an American visitor - who really was supposed to pay for treatment, and was happy to pay. But the department didn't have either any system for calculating how much the treatment cost, or any system for billing the 'customer', or any system for collecting the money, or for a system to pursue them if they didn't pay. So they didn't get billed. Which, surprisingly, is good thing. Because the cost of all the accountants and insurers and well-paid wotnots to do that billing and pursuing and deciding who must pay actually costs more than the health care.

Amazingly, it is vastly cheaper to just treat everyone, without limit, for anything, than it is to run a system of complicated checking into who's entitled to what. That's all. And this is the result...

On the other hand, the USA system does have the advantage, at least in some eyes, of (1) making lots of money for the rich , and (2) killing niggers, so, I suppose that's some sort of win-win for some bits of America.