Moving full steam ahead towards the disastrous U.S healthcare model?

By Daniel Margrain

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The shocking indifference shown by Theresa May towards the plight of stroke victims in the NHS and the systems ongoing crisis in which patients have been photographed sleeping on a hospital floor, is indicative of a public service that the UK government is determined to break. As Dr Bob Gill cogently argued, the Tories are deliberately under-funding the NHS to erode public confidence in order to manufacture consent for privatisation. The governments aim is to reconfigure the service from a free at the point of use healthcare system, towards a fee-paying US model.

In their 2017 election manifesto, the Conservative government said they would increase NHS spending by at least £8 billion in real terms until 2022. But King’s Fund, Nuffield Trust and Health Foundation figures show that NHS spending per person is set to fall by 0.3% in 2018/19 compared to the year before. Research undertaken by the former, indicates that UK funding for the health service is falling by international standards.

The think tanks have argued that even based on the government’s current spending plans, there is likely to be a spending gap of over £20 billion by 2022/23. They have also said that the NHS will need an extra £4 billion next year alone “to stop patient care deteriorating”. In 2013, NHS England said it faced a funding gap of £30 billion by the end of the decade, even if government spending kept up in line with inflation.

Under-funding has inevitably impacted on staffing levels. The shortage of nurses within the NHS has reached dangerous levels in 90 per cent of UK hospitals, and the amount of doctors per capita is the second lowest among eleven European countries.

On six out of nine measures of varying sorts, the UK did worse than any other advanced country in the world. Under the Tories, the erosion of the principle of a free at the point of delivery service is undermining what Sir Michael Marmont refers to  as “the optimal allocation of resources.”

However, despite all the problems the government has thrown at the NHS, the UK is still ranked a relatively respectable 10th in the world in terms of efficiency compared to the U.S ranking of 44. The latter reflects the fact that the marketization of health care in the United States is long established.

Given the figures, one might reasonably ask why the UK government appears to be insistent on dismantling something that, despite its faults, essentially works for the mass of the population, by subsequently restructuring it in the image of a system that doesn’t? The answer to this rhetorical question is, of course, that the said restructuring is intended to maximize profits for the few.

Shortly after president Trump’s inauguration this time last year, UK Health Secretary, Jeremy Hunt made a fleeting visit to the U.S. It was rumored that Hunt took this opportunity to discuss with US financiers moves to carve up the NHS in order to bring it closer to the US insurance-based model.

The U.S model the UK is moving towards

The requirement of the US Affordable Care Act (which was signed into law in March 2010 but in reality is unaffordable for large swaths of the US population), is that people are forced to buy private health care insurance if they fail to qualify for public health programmes – namely Medicare and Medicaid. However, the insurers have created plans that restrict the number of doctors in hospitals.

These “ultra narrow networks” have resulted in the reduction of at least 70% of health facilities within communities throughout the U.S, thereby restricting access to care for people with serious health problems. This means that increasingly Americans are paying higher premiums but are not getting sufficient access to services they need. They are, therefore, having to find money upfront, largely because their insurance policies do not provide adequate cover for their injuries or illnesses.

So America is still seeing high rates of people who are either delaying, avoiding getting access to the care they need, or are being confronted with medical debts. Research shows that tax-funded expenditures account for 64.3 percent of US health spending, with public spending exceeding total spending in most countries with universal care. Yet, 33 million people in the US do not have access to health insurance cover.

The delivery of a NHS-style healthcare system in the U.S is hamstrung by the narrow commercial interests of the corporations who lobby Congress. The conflicting interests that a succession of American presidents face relates to the close relationship they have to members of Congress who need to get reelected. If Congress speak out against the interests who are funding their campaigns, they’re not going to get that funding.


Tiny efforts to try and patch together what is clearly a dysfunctional U.S healthcare system is further undermined by the Heritage Foundation. This conservative Think Tank came up with the model of forcing people to buy private insurance and to use public tax dollars to subsidize the purchase of this insurance. In other words, as a result of a process of publicly funded corporate welfare, billions of funds are shifted into the hands of private insurance companies.

America’s healthcare costs are the highest per capita of any country in the world with some of the worst outcomes. Attempts to reform the US system are undermined by the insurance companies whose only function is to be middlemen between the patients and the health professionals.

The U.S government’s treatment of healthcare as a commodity instead of a public good is out of sync with the rest of the developed world and illustrates the extent to which, more broadly, the giant corporations have usurped democracy in the United States.

Currently, the U.S is the only industrialized nation on the planet that has used a market-based model for healthcare. Alarmingly, whether the British public want to admit it or not, this is the direction of travel both the Tories and NHS England, under Simon Stevens, are taking the system of healthcare provision in the UK.

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