The 1998 APHA Annual Lecture - What the UK can teach the US about health care

This paper was originally presented at the Annual Lecture of the American Public Health Association, 16th November 1998. As costs begin to rise again in the United States, where firm budgetary controls and long-term planning are not possible by design, and as the number of uninsured keeps rising by 100,000 a month past the 44 million mark, one might think that American policy makers might look at the world's largest (by far) managed health care system, known as the NHS, and see if they could glean any lessons for how to provide comprehensive services at reasonable cost. Of course, nothing of the sort is happening. Congressmen are almost obliged to repeat to each other and to the press the mantra that American health care is the best in the world, and Great Britain is held up as an example of just how bad 'socialism can get - making people wait for months to see a specialist and setting a legal age limit on who can get renal dialysis (Didn't you know? I even heard this received truth declared at a Harvard conference on international health care.). The formation and development of the NHS, in fact, could teach American policy makers a good deal about how to design and run a system, and in case they show an interest, it would be useful to set down some of the lessons. My choices emanate from being invited by the 50th anniversary committee to review the past and to think about the future of the NHS, an honour I shall always cherish. They naturally stem from my own reading and understanding of your history, which is limited, and you may well come up with better ones or corrections. © 1999, Sage Publications. All rights reserved.