The Single Payer Presentation: Hidden Facts One Should Consider
Published May 13, 2011  printer-friendly
"Panic on the streets of London
Panic on the streets of Birmingham
I wonder to myself
Could life ever be sane again?
The Leeds side-streets that you slip down
I wonder to myself
Hopes may rise on the Grasmere
But Honey Pie, you're not safe here”
         Steven Patrick Morrissey 

         Week three of our Leadership class in the Spring of 2011 included a segment propagandizing the merits of a government-run single payer health care system. The U.S. system was described as broken and in desperate need of reform, while Britain’s system was mentioned as one of the ideals of a government-run health care system. If you only hear one side, however, there is no opportunity for reflection and understanding. Some data on the matter should help people reflect on just what kind of ideal Britain’s health care system represents.

      Ironically, the same week that Britain’s health care system was touted as an ideal at USC OT, the most prestigious medical journal in Britain, The Lancet, issued an editorial contradicting everything we were told, and warning readers that Britain’s health care system was in crisis because it could not meet the needs of patients. To quote the editors of The Lancet, “There is a crisis in the National Health Service (NHS) … Maintaining the status quo in the NHS is not an option. The NHS is not delivering the care that patients need."1 The picture painted by The Lancet is the complete opposite of the one that USC OT’s graduate student expert in public policy and a USC OT professor permitted to be painted in class. This not only sheds light on the reality of the British system, it also reflects poorly on USC OT for letting such a false portrayal stand only because this phony picture supported the department’s political bias.

      One of the reasons for The Lancet’s condemnation of the British system is Britain’s poor record in treating cancer. Britain’s health care system restricts the types of drugs doctors can use on their patients because they are considered too expensive.2 Furthermore, as late as 1991, Britain had the fewest oncologists of all Western European countries.3 Additionally, as late as 1994, it was reported that 40% of British cancer patients never see an oncology specialist.4 These conditions were reflected in Britain’s cancer survival rates when compared to that of the U.S. as is shown below.

      When you compare actual data of cancer survival rates between the system idealized by USC OT and the American system, it’s obvious that people are much better off being treated in the U.S. than in Britain.5 That is, when we deal with data rather than enthusiasm generated by political propaganda in the cheerleading session students were required to put on, you would not choose Britain’s system over America’s. Here are some results from a 2007 study in Lancet Oncology:

• The survival rate for stomach cancer in the U.S. was 25%; for England it was only 16.9% (an 8.1% advantage for the U.S.)

• The survival rate for breast cancer in the U.S. was 90.1%; but only 77.8% in England (a 12.3% advantage for the U.S.)

• The survival rate for prostate cancer in the U.S. was 99.3%. For Scotland the figure was 71% (a 28.3% advantage for the U.S.)

• The survival rate for cancer in the kidneys was 62.6% in the U.S. and only 46.7% in England (a 15.9% advantage for the U.S.)6

      The story is pretty much the same for all cancers. When comparing survival rates for all cancers combined, the U.S. survival rate for men was 21.5 percentage points higher than England’s and for women the U.S. survival rate for all cancers combined was 10.2 percentage points greater. The picture is clear – the U.S. does a better job of treating cancer than Britain.

      Not only are U.S. cancer survival rates higher than Britain’s, tests screening for cancer are also more common in the U.S. One study showed that 57% of American men were screened for prostate cancer versus only 7% of British men.7 The U.S. also had an advantage in the percentage of women who were screened for breast cancer.8

        For stroke, one OECD study of 17 countries found the U.S consistently ranked 1, 2, or 3 in just about every category, whereas Britain was consistently one of the worst if not the worst in every category.9 Here are some results of the study using Day 7 and Day 30 as cut-off points to measure the chances of dying in the hospital after a stroke: 

       *     Chances of dying by Day 7 for American men over 75 years old: 6%. For British men: 16%. An advantage for the U.S. of 10 percentage points.

       *     Chances of dying by Day 7 for American women over 75 years old: 8%. For British women: 19%. An 11-point advantage for the U.S.

       *     Chances of dying by Day 7 for American men ages 65-74: 4%. For British men: 13.9%. Nearly a 10-point advantage for the U.S.

       *     Chances of dying by Day 7 for American women ages 65-74: 4%. For British women: 17%. A 13-point advantage for the U.S. 

      *      Chances of dying by Day 30 for American men over 75: 9%. For British men: 34%. A 25-point advantage for the U.S.

      *      Chances of dying by Day 30 for American women over 75:11%. For British women: 37%. A 26-point advantage for the U.S.

      *      Chances of dying by Day 30 for American men ages 65-74: 6%. For British men: 24%. An 18-point advantage for the U.S.

      *      Chances of dying by Day 30 for American women ages 65-74: 6%. For British women: 24%. Another 18-point advantage for the U.S.

       So as with cancer, the U.S. system does better than Britain's in treating patients hospitalized for stroke.

      Nor is British dental care anything to smile about. A 2007 BBC News report titled “Many ‘Cannot Get Dental Care’” reports that 20% of NHS patients refused treatment because of high costs and 6% treated themselves. Eighty-four percent of dentists said their arrangement failed to improve patient access to dental care. The result has been long waiting times to see a dentist.11


      The picture above is of a British man who decided to pull out his own infected front teeth because he could not get an appointment with a dentist.12 Another British man said “I took out one loose tooth with pliers,” while one woman reported using glue to attach her crown.13 The problem of a dentist shortage also shows how quality suffers. With too many patients and very little time, health care providers are forced to limit the amount of time they spend with patients. One nurse for the British system said that the dentist she worked for would perform “cleanings in five minutes flat.”14 That is the result of an overwhelmed government controlled system that is not in tune with supply and demand dynamics that allow people to get shoes, cars, and television sets, etc. as they need them, but must instead follow the dictates of bureaucrats and politicians.

      And the practice of cutting down on time with patients is not limited to dentists in Britain. Although the British visit their doctor at almost the same rate as Americans,15 Americans were six times more likely to have a visit that lasted 20 minutes or more.16 One Commonwealth Fund report showed that in Britain 36% percent of those seeking elective surgery had to wait more than four months, whereas in the U.S. that number was only 5%.17 Another study in Health Affairs shows Americans also had more access to high tech equipment, more than double the rate of Britain for both MRIs and CT Scanners.18 According to the same Health Affairs study, patients in America were also more than three times as likely to receive dialysis, five times as likely to receive a coronary bypass and more than seven times as likely to receive a coronary angioplasty.19

      Many people feel that having a worse health care system is morally acceptable as long as there is equality and that treatment within the system is not based on one's ability to pay. But even by this standard, Britain’s system is a failure. Although those using Britain’s government controlled system have a so-called right to free healthcare, they still have to wait behind those who are willing to pay. One story in BBC News reported that because of long waiting periods, “more and more patients were realizing the only way they could get treatment was to pay for it themselves,” with some having to remortgage their homes to get an operation.20

      It’s important to note that Britain’s system has been in existence since 1948, when free medical care for all was established as a right and delivered through NHS. Yet Britain now has private insurance and it is increasing, precisely because NHS cannot deliver on its promise. So not only is it not meeting the needs of patients, as the editorial in The Lancet pointed out, it is still treating people who can pay better than those who cannot. This is known as the “postal code lottery” in Britain; that is that the quality of services you receive in Britain depend on where you live  (your postal code) because the system is not able to offer services equally to all.

      This alternative perspective shows that there is a lot to think about when deciding to change our healthcare system. No system will be perfect, and choosing to have a system that allegedly will make some things better will undoubtedly make other things worse. We should know what might get better and what might get worse and why. A system such as Britain’s whose own experts now claim is in crisis, which has lower survival rates for cancer and stroke, and lower rates of screening for breast and prostate cancer, where people are ripping out their own teeth because they cannot find a dentist, and where those with money are still treated better than those without it is not a health care system we should choose without a lot more research and reflection.


(Edited by M. Lovey.)

1. The Lancet, Vol. 377, Issue 9763, Page 353, January 29, 2011.
2. “UK Watchdog NICE Turns Down Four New Cancer Drugs,”
3. Medical Manpower and Workload in Clinical Oncology in the U.K. (London: Royal College of Radiologists, 1991) cited in Health Affairs (citation omitted).
4. Review of the Pattern of Cancer Services in England and Wales (London: Association of Cancer Physicians, 1994) cited in Health Affairs (citation omitted).
5. Britain actually has four separate systems, one for each region, England, Scotland, Wales and Northern Ireland. For simplicity’s sake I will just compare the results from England which performed better than the worst region but less well than the best region. In no case were any of the regions higher than the U.S. in the cancers listed here.
6. Arduino Verdecchia et al., “Recent Cancer Survival in Europe: a 2000-02 period analysis of EUROCARE-4 data,” Lancet Oncology, 2007, No. 8, pages 784-796.
7. Preston, S. and Jessica Ho, 2009. “Low-life Expectancy in the United States: Is the Health Care System at Fault?” PSC Working Paper Series PSC 09-03. Table 2.B pg 36.
8. See Preston and Ho Table 3 page 39.
9. Moon, Lynelle et al. “Stroke Care in 17 OECD Countries” found at pages 61-72.
10 Moon, Lynelle et al. “Stroke Care in 17 OECD Countries” found at pages 61-72.
11. “Many ‘Cannot Get Dental Care,’” BBC News, Oct 15, 2007.
12. Sarah Lyall, “In a Dentist Shortage British ‘Ouch’ Do it Themselves.” New York Times, May 7, 2006.
13 See “Many “Cannot Get Dental Care’” and Sarah Lyall.
14. See “Many “Cannot Get Dental Care’” and Sarah Lyall.
15. Gerard Anderson and Jean-Pierre Poullier: “Health Spending Access, and Outcomes: Trends in Industrialized Countries,” Health Affairs 18, no. 3 (1999): 178-92.
16. John C. Goodman, “Health Care in a Free Society: Rebutting the Myths of National Health Insurance.” Policy Analysis (Jan. 27, 2005).
17. Cathy Shoen, “Comparison of Health Care System Views and Experiences in Five Nations, 2001,”Commonwealth Fund, Issue Brief, May 2002.
18. Gerard Anderson, “It’s the Prices Stupid: Why the United States is so Different from Other Countries,” Health Affairs 22 no. 3 (May/June 2003) Exhibit 6, page 99.
19. Anderson, “It’s the Prices Stupid,” Exhibit 5.
20. “NHS Patients Opt for Private Surgery,” Tuesday January 15, 2002.


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