Why I Envy My Sister-in-Law (and Why You Should, Too)

Twenty-three years ago I married an amazing man who just happened to be Scottish. Real Scottish, as in, grew up in Glasgow and attended the university there. In the process, I gained a wonderful sister-in-law and, later, her husband (brother-in-law?).

She and her husband (and my mother-in-law, who is also pretty great!) live in picture-book-pretty idyllic Scottish towns complete with stone walls, sheep, cows, and salmon-filled streams for fly fishing. They also live in a country with nationalized healthcare, which, some would have us believe, is second only to nuclear war in terms of the horrific effects it would have if implemented here.

So when I was teaching a class on the US healthcare system this spring, I asked my sister-in-law for some insider information about the National Health System (or NHS as they fondly call it). Focus on your mother, I said, since she’s had some health problems in recent years. Here’s what she wrote me. . .

“Mum was taken to hospital around seven times in the space of two years. In total, she spent a few weeks in hospital. She didn’t pay anything, not for the ambulances, consultants, accommodation, food, drugs, x-rays, tests or nursing care. Nothing whatsoever. She also sees a consultant a few times a year for her rheumatoid arthritis.

“You hear a lot about some people waiting weeks or even months for an operation or treatment, but that has never been mum’s experience. She has always received a quick response from the NHS for any appointments or treatments she needs. There is an excellent out-of-hours service, mum had several home visits in the evening or at the weekend when the Health Centre was closed. Plus some home visits from her own doctor when she requested it.

“On the flip side, the local hospital in Dumfries is not the nicest you ever saw, she had to share a ward and a bathroom with 3 other women. The care she had was excellent, the food I thought looked dreadful, but she seemed to think it was fine. Again, in fairness, they are replacing that hospital in the next few years with a new one that will only have single occupancy rooms.

“At her local Health Centre, she can see a GP on the same day she calls for an appointment, all her blood tests, in fact all treatment and tests are free including physiotherapy, dental, psychology, eye tests, mammograms, bowel tests etc etc etc. even a podiatrist!

“Also, in Scotland, all our prescriptions are free, in the rest of the UK they pay a contribution of £8.05 for each prescription up to age 60, then they are free.

“Having said all that, you will already know this but it isn’t really free, we just pay for it in a different way. Everyone who earns over a certain amount pays National Insurance tax, over and above income tax, roughly 10% of gross salary, and of that, 60% goes to the state pension and 40% goes just to the National Health Service (NHS), this is compulsory, you are not able to opt out.”

So let’s recap. They pay nothing for timely, excellent health care (and I can point you to numerous studies showing that the outcomes in the UK far exceed those in the US for far less money). They pay taxes similar to those that we pay for Social Security and Medicare. And every single person has health insurance.

And yes, I know I’m focusing on a single anecdote but, studies find, my mother-in-law’s experience is far from unique in her country (or other countries with single-payer systems). Read this for an excellent point-by-point refutation of many of the accusations made about the UK system.

Ask the majority of health economists what is one thing that would provide the greatest improvement to our healthcare system and they answer immediately: a single-payer system. Well, we actually have one. It’s called Medicare. Because it controls so much of the healthcare dollar, it has the power to literally change the practice and delivery of medicine. It runs at far lower administrative costs than commercial insurers and it’s not stretching the truth to say that Medicare beneficiaries truly love it. A 2012 Commonwealth Fund study found that Medicare beneficiaries were far more satisfied with the care they received than people in commercial plans. Not only that, but they had better access to care and paid less out of pocket.

Hmmm. Anyone up for a trip to Scotland?