USA vs. UK: where do you want to be treated?

If you had MS where would you want to be treated? In the UK, under  the NHS, or the US? #MSBlog #MSResearch

“There have been numerous comments about the pros and cons of socialist healthcare systems, such as the NHS, versus private healthcare systems, as practiced in the US, for MSers. In the UK MSers have difficulty accessing early highly active DMTs whereas in the US if you can afford it you get what you want. The following article is an interesting one in that it acknowledges that both systems have positives, if only we could create a hybrid that will improve the care of all MSers.”


…. Strategic envy could be particularly useful in the United Kingdom and the United States, where critics cite the weakest aspects of the other country’s system — poor coverage in the United States and waiting times in the United Kingdom — to rationalize stasis in their own. But if we instead focus on the most positive aspects of each system, the characteristics that should inspire envy, we may find solutions to each country’s challenges just an ocean away…..

….. For starters, the United States should envy the United Kingdom’s commitment to universal access to health care, not because it suggests moral superiority but because it confers a strategic advantage. Only when societies commit to covering all their citizens with their limited resources do they take on the difficult work of improving the value of care. Thus, virtually every major study shows that systems that cover all citizens achieve better outcomes at lower cost…..

….. Universal coverage creates challenges — notably, the rationing that results from competition for scarce funds. But without commitment to universal coverage, it’s too easy to “solve” financial problems by not insuring or underinsuring people. Universal coverage forces discipline. It also shapes social solidarity, community responsibility, and even audacious aspirations. In U.S. institutions, for example, “stroke teams” think about giving great care to people who’ve had strokes. In the English National Health Service (NHS, which is administered separately in England, Northern Ireland, Scotland, and Wales) stroke teams do the same but also think about how to reduce strokes in a given population….

“Prevention is better than cure, which is why I am lobbying for a shift in focus to people at risk of MS.”

… The English, for their part, should envy Americans for their choices and the competition that drives health care organizations to respond to their needs and wants. U.S. reliance on market principles has created an enormous laboratory, with the best organizations defining what’s possible and “disruptive innovators” shaking up the marketplace….

“The NHS is like a lethargic slug. It is very difficult to innovate in the NHS. Managers keep moving the targets.”

…. The evidence favoring competition is increasingly inescapable even in England. Last year, the London-based Office of Health Economics concluded that competition can improve the quality of health care and that the entry of new providers “can be an important source of innovation.” England needs that innovation because the NHS lags in responsiveness to patients.Patients in England get what they are given: if their local hospital happens to be Stafford, where a recent investigation confirmed that the care was “appalling,” or they can’t get a general-practitioner appointment for a fortnight, that’s just bad luck…..

…. The best U.S. providers gain a large market share because they earn patient loyalty through great outcomes and service. We see no reason why universal access should conflict with choice and competition. More choice and competition would not undermine the commitment to coverage in the NHS, but it might improve access and quality…..

…. The overall U.S. system is weak but allows strong organizations to thrive; the English system is strong but weakens the organizations within it. In other words, the U.S. system is too “bottom-up,” and the English system too “top-down.” The U.S. system encourages providers to think outside the box, whereas the English system encourages providers to regard themselves as part of a broadly defined community, but one in which change is harder to imagine…..

…. Each country has strengths to be proud of and weaknesses that demand humility. Translating the best of each system need not mean transplanting the worst as well: a synthesis of the two systems could conceivably cover everyone, offer choice and competition, blend bottom-up creativity with top-down strategy, and integrate services so that patients get the right care in the right places. In the future, English and U.S. health care organizations could compete for patients on the basis of the integration of delivered care….

“I suggest reading the whole article. It is food for thought.”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Not sure your definition of the UK system as socialist is correct. We have a compassionate system where everyone regardless of their financial position etc has access to healthcare. We're not a socialist state in the mode of the former Soviet Union. Our police and fir service works in the same way, but aren't referred to as socialist. Perhaps introducing a socialist system in healthcare would be an interesting experiment – consultants, doctors, nurses, porters would all earn the same – they just do different jobs. The drugs companies would be nationalised therefore reducing excess drugs costs (also outlaw the fees / backhanders paid to consultants).

    • The UK system is not socialist, a word like communist that carries a stigma in the USA. It is like the US system except it has one insurer and everyone is insured. Therefore there is no conflict of interest between the insurer and the provider, there is no advantage in removing the sick from your insurance scheme and there is an advantage, for all, in avoiding illness and unnecessary treatments. The US system is the most inefficient and expensive in the world.

  • I have never been able to get anything remotely resembling adequate "care" for MS in the US. I have been uninsured for close to 15 years. Now that I have insurance, the care is not much better. I would rather be treated anywhere but here.

  • Personally, I don't want competition or choice, just access to decent medical treatment when needed. Surely the case for a NHS system free at the point of entry is unarguable in a civilised society.

  • The militaries of most countries, including the US, provide healthcare to soldiers, retirees and families. These systems do not provide much competition or choice, and still most recipients are still happy with the care they receive.

  • The U.S. system provides excellent care for the majority of patients (i.e. as long as your health is good). Patients with chronic disease causing them to leave the workforce and their private insurance are relegated to public health institutions – their choice is limited and waiting times are long. Current administration has started to address the most vulnerable patients at the tips of the curve. An example would be "Kids first" program where children can be treated at any hospital regardless of parent's insurance status. For any healthcare system practice of preventative medicine is important. When patients show up at the ER for non-emergency care because that's their only recourse, cost skyrockets and the system has failed.

  • The inherent vice of capitalism is the unequal sharing of the blessings. The inherent blessing of socialism is the equal sharing of misery. —Winston Churchill

    Personally, I like the US system better. At least there is the chance for better care (assuming what others have said about the NHS is true.) When politicians make the decisions there is virtually no chance of success.

    • You are assuming you are the privileged group of having private insurance, but with a chronic illness like MS at some point you will stop working and then you will suffering with the poor. All my treatments by the NHS have been excellent but I luckily have never tried the US system. To measure the inefficiency of the USA system consider that our (UK) travel health insurance goes up in price from, Europe, the rest of the world (not USA), the USA.

    • “This is not the end, this is not even the beginning of the end, this is just perhaps the end of the beginning.” Winston Churchill

      Does this sum up where we are with MS?

  • Having lived under both systems, I would choose the UK. In the US, even if you are working and insured, only 80% of costs are paid (unless things have changed) – this pushed many people into poverty and insolvency. Remember that the money spent in this sphere has to create profits for insurance companies, too – it isn't financially efficient. Yes, learnign from the best of both systems is an excellent idea. Roll on…

  • It seems to me that the US system pays top dollar for drugs. Does that impact other systems? Is the US subsidizing the drugs in other countries and for even our own poor? Or, if we refused to pay so much, would the pharma companies expect less overall?

    • The pharma companies will charge what the market will stand. if the US system was to reduce the amount it will pay for treatments then the price will go down. Trouble is the cosy relationship between US healthcare, the medical insurance industry and pharma is so entrenched that change is difficult if not impossible.

By Prof G



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