As the GOP’s latest, half-hearted effort to repeal the Affordable Care Act crashed and burned this summer, the Left celebrated. President Obama’s signature policy lives. Still, it’s not at all certain that it won’t soon succumb to natural causes. As insurers continue to flee the Obamacare markets, choices are reduced, plans are canceled, and premiums skyrocket, we’re left with a status quo that appears unsustainable.
If replacing Obamacare is not a matter of “if” but “when,” the billion-dollar question is: what will that replacement look like? With Republicans floundering and much of their congressional delegation too cowardly to give free-market reforms a chance, liberals are far more united and dedicated to principle: they want single-payer.
The more Obamacare goes down in flames, the more progressives—and even some who call themselves conservatives—will increasingly push for full-fledged socialized medicine. The American Conservative recently attempted to make a “conservative case for universal healthcare” and boldly predicted that “within five years, the American Right will happily embrace socialized medicine.”
If socialized health care is so very inevitable, perhaps we Americans should get a clearer picture of what it really entails. While both sides of the argument can present data, models, and statistics until their listeners’ eyes glaze over, most Americans just want to know: what would this look like? How would it affect my life?
One Family’s NHS Ordeal
We might ask that question of Peter and Kim, a young married couple living near Liverpool, England. Unlike most of us, they’ve experienced both American health care and Britain’s fully socialized National Health Service: Peter is English by birth, and Kim is American. They met when Peter came to work in the states, and they lived in America for more than a decade, marrying and having four of their five children here. They returned to the United Kingdom in 2014 as bi-vocational missionaries: Peter is a civil engineer, while the couple is also working to plant a church.
Last summer, Peter and Kim were in the United States, visiting family and supporting churches. While here, Kim experienced her first-ever kidney stone attack, landing her in the emergency room. The doctors recommended immediate surgery to remove the stone, but since the couple no longer carried American health insurance, they opted to wait until their return to England the next month.
Once she got home, Kim was referred to a urologist, whom she finally saw in October. She was scheduled for surgery eight weeks later, on December 14. By the date of her surgery, she had already been living with a stone stuck in her ureter for five months, but says she was still feeling fairly positive. “I wasn’t in terrible or constant pain at that time, just uncomfortable,” she remembers.
On the morning of Kim’s surgery, she got a surprise. A precautionary pregnancy test came back positive, leading the surgery to be canceled. Sadly, she went on to miscarry in late January. “Circumstances contributed,” Peter says, “but we do wonder if the stone had been removed sooner whether we would still have lost the baby.” Around the same time she miscarried, Kim’s health also took a turn for the worse: the pain increased, and she began to suffer one urinary tract infection after another.
Because she was no longer pregnant, Kim immediately tried to get back on the waiting list for surgery. The NHS responded with unwelcome news. “I was told that I would have to start the process all over again,” Kim says. “Wait until May to see the urologist again, and then get put back on the list so I can wait eight more weeks to get the surgery.” Britain’s socialized health service was planning to make Kim wait for surgery until July: more than six months since her first surgery was canceled, and a full year after her first kidney stone attack.
While She Waited, Kim Suffered
In the meantime, her health went from bad to worse. She was in and out of urgent care and the general practitioner’s office for continual infections: “I had four UTIs in the eight weeks between February and March.” The doctors struggled to find antibiotics strong enough to treat them. Meanwhile, the mother of five was very limited in her daily life. “I had attacks every three or four days. There were days when I just had to stay on the couch all day. I couldn’t exercise. I couldn’t go anywhere where there wasn’t a toilet.” She continued calling the urologist to try to get an emergency appointment, without success. “I called the urologist’s secretary three times over an eight-week period.”
The couple began asking their friends and supporters for prayer. On April 2, Peter wrote: “We are seeing progress. Kim managed to get past the secretary at the urologist—they are like impenetrable gatekeepers. I think she spoke to a friendly one who passed her x-ray to the doctor. The doctor called her and has given her a CT scan appointment for Tuesday (normally you have to wait several weeks).” When I asked later about these “impenetrable gatekeepers,” Peter said the secretaries are not to blame: “They are simply doing their best in a system that is collapsing under its own weight.”
Thanks to the friendly secretary and some help from a private urology consultant the couple had paid to visit, Kim finally got her CT scan. “I was in so much pain I didn’t think I could go through with it,” she says. Upon returning home that day, her long ordeal finally ended, no thanks to the NHS: she passed the stone. When I spoke with her a week later, the doctor still hadn’t called her with the results of her CT scan—but she was planning to keep her long-awaited appointment in May.
In contrast to this ordeal, I offer my own story from middle-class America: last year, my husband had a kidney stone. I called a urologist and easily got an appointment the next business day.
America Versus Great Britain
Through this experience, Peter and Kim say they saw the shortcomings of both the British and American systems. “When we lived in the States, as insured people, we had no complaints,” Kim says. “If you’re insured, everything works fine and the system is great, so you can ignore the fact that a lot of money is being wasted.”
As British residents, however, they were no longer insured when they visited America last July, and they saw the other side of the system. While at the American ER for Kim’s kidney stone, they repeatedly asked what the visit and various services would cost, but no one could tell them. “The doctor said we should just not pay,” Kim says. “That’s something that we were unwilling to do.” When the bill finally came for their three-hour ER visit, it was a staggering $6,000.
In the UK, all costs are covered up-front through taxes, and it’s no small amount. The NHS is the fifth-largest employer in the world, behind only McDonald’s, Walmart, and the militaries of China and the United States. But the resulting system is nothing like America’s in quality and accessibility of care. It’s just that the British have grown accustomed to their form of health care. Peter and Kim both told me that British people tend to be very defensive of their health service. “People don’t complain much about the NHS,” Peter admits. “They think it’s wonderful. People have been conditioned so they’re okay with waiting a long time. The standard is different.”
The couple describes pressure from doctors not to seek medical care for smaller problems. “I often have a sense of guilt going to the doctor if it’s something minor,” Kim says. “For instance, my wrist hurts—it’s been hurting for a while now—but I’m just living with it, because they make you feel kind of bad for going in for silly things.”
“I went to the doctor because of my knee a few weeks ago,” Peter adds. “He laughed at me and told me I was too old to play soccer—I am 42. Because I am not a mailman or something like that, my knee problem is not a high priority.” On a more serious note, Peter cited his own father, who was recently treated for cancer. “To determine who gets what treatment, they have a formula to determine who has the most useful life left in them. Luckily for my dad, he’s in his 60s and is strong and healthy. But in the U.S. they would have just done it anyway.”
“It’s rationing, isn’t it?” he concludes. “That’s the reality of it. The doctor is in a very powerful position: he has to determine who is the most worthy of these resources.”
Socialism: Delivers on Scarcity, Fails on Equality
Kim’s long wait time for medical care is not an aberration; it’s the norm in the UK. In May, the BBC reported that “hospital waiting times in England have deteriorated markedly in the past five years,” adding that “last year the NHS missed all three [wait time] targets for the first time in its history.”
The Guardian published an op-ed this January saying, “Our health system is under pressure like never before.” The article goes on to describe emergency rooms that sometimes turn patients away, ambulances that don’t arrive on time in one-third of cases, and general practitioners who are leaving the NHS without being replaced. While these news outlets favor taking more money from taxpayers to “save” the NHS, Peter says the problems are nothing new: “It is always bad, even when socialists are in power and pour loads of money into it.”
Last year, Forbes Magazine and other media outlets reported on the NHS’s decision to outright deny knee and hip replacements to certain patients, based on weight and smoker status. It’s just one of many examples Forbes cites of rationing in response to shortages—an old and predictable tale in every socialist system.
While socialism reliably delivers on scarcity, Peter says it often fails to deliver on its central promise: equality. He and Kim lived in a poor area of Scotland before moving to England, and they found that the ideal of “equal care” falls short in practice. “The access to health care we have now is so much better than it was when we lived in a poor area,” Peter says. “The care is very uneven based on where you live. When we first moved here, I had to coach Kim on how to handle herself when she went to the doctor. You have to know what you need and demand it. You have to be tough,” he laughs, “or else you could end up dead.”
‘The Best in the World’
Very few people would argue that America’s health-care system doesn’t need reform. Peter and Kim’s experience as uninsured patients at the ER—and the experience of countless Americans, both insured and uninsured—bears that out. Certainly, multiple factors contribute to our out-of-control costs. Common sense suggests that when prices are so obscured that direct inquiries about the cost of major services cannot be answered, providers have little incentive to keep costs down. Reforms are badly needed to put free-market economics to work in lowering costs across the board.
Still, we would be foolish not to acknowledge or preserve what America’s system does well: deliver quick access to a wide range of high-quality care. Peter and Kim’s experience with the NHS—while far from as dramatic as the harrowing story of Charlie Gard—gives us a taste of what ordinary socialized care might look like: long wait times, difficulty in gaining access to specialists, and a limited range of options.
If this is what socialized care looks like in a nation of 65 million people, one can only imagine the unresponsive behemoth it would become in the United States, with nearly five times the population. When asked about those who push socialized medicine as the solution to America’s healthcare woes, Peter shakes his head. “They need to live here. Come visit, get sick, and go to the doctor. By comparison, it’s just rubbish.”
“The American health-care system is the best in the world,” he concludes. “It’s gotten too expensive, hasn’t it? But If I were sick, that’s where I’d want to be.”