Guilty of loving the NHS

Abstract

Last month I visited Boston in the United States, and in particular the Beth Israel Deaconess Hospital. On a sample of one, it struck me that healthcare for those served by the US health system and for those who work in it is vastly different to the UK experience. A sense of calm and dignity pervaded the hospital. Staff, and even patients, smiled as you passed them on corridors and in lifts. A harpist strummed soothing melodies, and ‘public safety officers’ lurked discreetly in case the harpist's notes failed to keep the peace. A visitor might easily fall in love with US healthcare. But then the US system struggles to match UK health outcomes on around double the per capita spend. The US health system is ranked 50th for life expectancy and scores low on some measures of responsiveness and quality of healthcare. Just under 50 million people are uninsured and find healthcare hard to access. This blot on US healthcare's landscape is its most visible. US healthcare, then, is a story of success and failure travelling hand in hand. The success stories are instructive for health systems everywhere, indeed the obsession of UK health leaders for over a decade has been to seek guidance from their US counterparts. But the failures are an equally potent warning, a lesson in how not to do it. This month's issue carries several pieces comparing the US and UK approaches to disparities in healthcare – and healthcare more broadly. Just as economic arguments are now driving our healthcare agenda and further restructuring, the US debate is driven by economics. Should the state really bear the cost of universal coverage? While the UK's decision and passion has been that it should, the US has traditionally taken the opposite view. President Obama has now lurched towards better healthcare for the uninsured, a seismic shift in the US health system, and a legacy policy that will dominate history lessons about his presidency. Now the US debate has become even more passionate with Republicans defending the American Way to the last sharp intake of breath. It is in this political firestorm that a Harvard professor has become the focus of furious debate. Don Berwick, paediatrician and head of the Institute of Healthcare Improvement, is Obama's nominated head of the Centers of Medicare and Medicaid Services, a role that will be influential in US health reform. It is hard to criticize Berwick as a doctor, leader or champion of quality improvement. Yet Berwick has become a target for Republicans opposed to Obama's reforms. And Berwick's sin is a simple one: he once declared his love, albeit reservedly, for the NHS. Naughty man, I hear he also enjoys tea.