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Matt Kelland of Winthrop is a consultant, entrepreneur, teacher and writer with 40 years of experience primarily in technology. He is originally from the UK, and now a proud U.S. citizen.
There’s currently a lot of talk about universal health care as a solution to our growing health care problems. As someone who has lived under such a system, I offer this perspective.
I lived in the UK for 45 years before moving to the U.S. 15 years ago, and in the early ’90s I worked for the National Health Service and various European health services. The NHS has its problems, mostly due to chronic underfunding of state-run providers, but it represents an entirely different way of looking at access to health care.
Every British taxpayer contributes about 4% of taxable income through general taxes to health care via the NHS — significantly less than the 10% to 20% we typically pay here. In return, every citizen or resident is entitled to free health care.
There are no deductibles and no co-pays (other than a nominal fee for some prescriptions). There’s no worrying about how much your treatment is going to cost, no haggling over price, no surprise bills, no prior authorizations, no fighting with insurance companies, and no issues with in-network or out-of-network providers. You never have to guess what level of insurance will give you the coverage you actually need each year, and there is no such thing as medical bankruptcy.
When you’re sick, you go to a doctor, they treat you, and you go on with your life. True, sometimes it can take a while to get seen, but as we all know, it’s often the same here in Maine. And this doesn’t cover some high-cost marginal treatments: for those, you usually need to go private. But on the whole, the system works adequately.
Part of the reason universal health care works is because it operates on a different business model. You pay into the system when you’re aged 20 to 60 and working, even though you’re probably relatively healthy so you’re not drawing much out. On the other hand, when you’re old or young and not working but are more likely to need care, you’re still covered. You’re also covered when you’re out of work because your health care isn’t tied to your employer. In other words, you’re buying health care for life.
In a private health insurance system, however, there’s no future benefit. It’s all often focused on this year. Each December you guess what health care you might need in the next 12 months, and then you may try to optimize your plan to get that level of coverage at the best price. If you’re wrong, you’re either wasting money or facing huge bills.
In addition, not having to deal with insurance companies reduces the cost of providing health care for one simple reason. You’re not covering the massive cost of all the people working in the insurance business or handling billing. Around 30% of what we pay for health care in the U.S. goes toward administration, twice as much as similar countries. When I was building NHS reporting systems in the 1990s, there were precisely three people handling billing for an entire county. It’s more bureaucratic now, but still far less administration than we have here.
It’s worth noting that universal health care is perfectly compatible with private health care provision. The only difference is that individual providers don’t have to negotiate network agreements, pricing and billing with hundreds of different insurance companies. The entire process is much more streamlined.
I believe we need to fundamentally change the way we see health care. It’s not a consumer product; it’s a human right. We need to stop asking how to make private insurance more affordable and start asking how we can build a system that bypasses insurance and prioritizes human health over shareholder dividends.