Moral Low Ground

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Interview with British Medical Journal Editor-In-Chief Dr. Fiona Godlee

(World Health Organization Europe)

(World Health Organization Europe)

Troubled as it may be, Britain’s National Health Service is beloved by many of those who depend upon it and staunchly defended by Britons of all political stripes.

As Americans continue to debate what role, if any, government should play in managing and delivering health care to the masses, special interests (mostly of the corporate variety) and allied politicians and pundits blast publicly-funded health care systems like the NHS as “socialized medicine.” They disseminate horror stories about rationed care, “death panels” and dangerously long waiting times. Meanwhile, the US remains the only Western nation without some sort of publicly-funded universal health care system, and all the other nations that deliver universal care are achieving demonstrably superior outcomes at a much lower cost.

As part of a series on global health leaders’ reactions to America’s rejection of ‘socialized medicine,’ Moral Low Ground editor Brett Wilkins recently interviewed Dr. Fiona Godlee, editor-in-chief of the British Medical Journal and a Fellow at the Royal College of Physicians in London, about differences in health care attitudes and actions in the US and Britain. The San Francisco-born physician has a “terrific fondness for America,” having spent a year at Harvard as a Harkness Fellow, and wants Americans to wake up to the reality that access to health care for all is “enormously important.”

Moral Low Ground: What does the NHS mean to Britons? Could you ever imagine reverting to US-style, for-profit medicine?

Dr. Godlee: I can’t imagine life without the NHS. In Britain, we can’t remember a time when you’d live in fear you’d get ill, or someone in your family would get ill, and you’d have to pay for that out of your pocket. That’s something we never experience.

MLG: I’ve noticed that even Conservative politicians support the NHS. Endorsing ‘socialized medicine’ is anathema to US conservatives, even though many do ironically support publicly-funded health care programs such as Medicare.

Godlee: [UK] general elections are fought time and again on how good is the government going to be at protecting the NHS. In an almost kind of religious way, people remain terrifically wedded to the idea of the NHS, even though it is kind of struggling. The people have made this absolutely clear to any politicians who dare say we don’t need the NHS. The NHS is a bit like God in America, it’s like our version of Christianity.

MLG: Why do you think so many Americans reject ‘socialized medicine,’ even when presented with statistics showing better outcomes at lower costs?

Godlee: It comes down to differences in culture and character. In America, you’ve got this sense of individualism and Darwinian survival and opportunity to win, but therefore also the opportunity to fail and to lose, and the idea of providing people with “something for nothing” is anathema. Lots of Americans seem to feel this in their hearts.

In the UK, we have this very strong sense… that we have to provide for the weaker in our society. There’s a shared sense of responsibility. We decided long ago that a shared response to fear of poverty and illness was the way forward.

When Americans look at our system, many are horrified at the idea that one would provide people with health care, even though they haven’t “earned it.” And when the British look at that mentality, we think, “How bizarre, how extraordinary.”

MLG: Extraordinary indeed. Meanwhile, the US ranks 51st in global life expectancy, one in six Americans lacks health insurance and unpaid medical bills are the leading cause of bankruptcy. Yet ‘socialized medicine’ scares us more than those statistics. What about those health care horror stories we keep hearing about “death panels,” rationed care, long waits, and all that?

Godlee: Right. When people talk about death panels and long waiting time, those things are a function of the degree to which we’re willing to fund health care. The UK health care system is far and away more cost-effective than many others, certainly more so than America’s.

MLG: Do you see any role for the private sector in delivering health care?

Godlee: If you’re having selective procedures, then the private system works great. But if you’re really ill, you need the NHS.

[In America], people talk about the Mayo Clinic (a Minnesota-based non-profit medical practice and research group) as being such a marvelous model, and it is, but it’s only marvelous if you can get in.

MLG: I often argue the need for publicly-funded universal health care with Americans, most of whom lack a global perspective on the issue. Many, even physicians (who ought to know better), claim the US has the best health care in the world. My conservative brother-in-law does not refute the facts, but rather argues that while universal care may be attainable in nations with relatively small populations, it could never work in a country as populous as America. Your thoughts on that?

Godlee: Is there any evidence that supports that view? (She then mentioned Japan as a large-population nation with a robust universal health care system).

MLG: Finally, what would your message be for Americans who oppose publicly-funded universal health care?

Godlee: I think it’s misguided to not realize that access to health care is an enormously important thing in any fair and civilized society. In the UK, I am worried that the idea of the collective public good is being eroded because people are saying it’s not affordable. But actually, the evidence suggests that all the alternatives are more expensive.

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