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The British way

Support remains steadfast for the UK health model despite it coming under US attack

An elderly man looking at a sign saying 'keep calm and carry on'As the House of Representatives in the US awaits the outcome of Senate deliberations on Obama's health reforms, debate rages over the question of whether there is a fundamental right of a patient to have access to healthcare. The US is the only industrialised nation that does not ensure all citizens have health coverage, while the number of uninsured citizens is rising without taking into account increasing levels of unemployment due to the recession.

According to the US administration, in a state like Texas, the percentage of non-elderly adults without health insurance increased from 27.8 per cent to 31.1 per cent between 2001 and 2008, and this doesn't take into account those who have recently lost health coverage through the recession or who have gaps in their coverage.

Universal access to healthcare, through stability and security for all Americans, does not sound that dissimilar to Your Health, Your Choices for the NHS. Indeed, Republicans opposed to Obama have used the NHS as an example of 'socialised' medicine, citing incidences of elderly people with chronic conditions being left to die for cost reasons, and the 'death panels' of NICE.

Daniel Hannon (Conservative MEP) claimed he supported some of these criticisms, stating on Fox News: "I wouldn't wish it [the NHS] on anybody. We have a system where the most salient facts of it are you get huge waiting lists, you have bad survival rates and you would much rather get ill in the US." He later claimed that these were his personal views and not those of the Conservative Party.

If we look first at the opinion of the US public, the movement appears to be towards opposing the reform proposals set before the Senate (45 per cent opposed in August 2009, versus 49 per cent in October). As in most US political decisions, it is the independents – the floating voters – who are making the difference. It is their view that has become decidedly more negative over this period of time (Table 1).


Table 1: As of right now, do you favour or oppose the healthcare reform proposals presently being discussed?

Oct 29 - Nov 1, 2009 Aug 27 - Aug 31, 2009
Favour 39% 40%
Oppose 49% 45%
Don't have an opinion 9% 14%
Don't know/not sure 3% 1%
Democrats: favour 62% 62%
Democrats: oppose 25% 18%
Independents: favour 29% 39%
Independents: oppose 53% 37%
Republicans: favour 14% 12%
Republicans: oppose 78% 81%

The findings of an Ipsos poll conducted October 29 to November 1, 2009. For the survey, a nationally representative, randomly selected sample of exactly 1,077 adults aged 18 and older across the United States was interviewed by Ipsos


One of the points being debated in the US reform is whether or not the government should create a public health insurance plan as an alternative to private insurance. This is the element which makes the reform seem closest to the NHS model. On this point, the US public are divided (Table 2) and as debate raged in August this year, Obama and his administration sought to distance themselves from an NHS-style, government-run alternative to private healthcare provision.


Table 2: Which of the following is closest to your opinion?

Aug 27 - Aug 31, 2009
It is necessary to create a public health insurance plan to make sure that all Americans have access to quality healthcare 49%
Access to quality healthcare for all Americans can be achieved without having to create a public health insurance plan 46%
Don't know/not sure 5%

The findings of an Ipsos poll conducted August 27 – August 31, 2009. For the survey, a nationally representative, randomly selected sample of exactly 1,057 adults aged 18 and older across the United States was interviewed by Ipsos


It would be a mistake to interpret the almost even division of US public opinion as voters sitting on the fence. The reform has been one of the most passionately and vociferously fought debates in recent history, with accusations of Nazism, disruptions of public meetings, flurries of hate mail and Obama's popularity hitting an all-time low (although this is inevitably the result of a number of things). Observing this from the UK, with its record-low turnouts for elections and increasing cynicism and distrust of politicians due mainly to their own actions, such as expense claims, we can only wonder where the passionate defence of our health system lies. Are the Daniel Hannons of the world right in their criticism of the NHS?

The US and the UK are divided in their expression of passion and approval. Support for the NHS in the UK is carried out in a very British way, without the mass hysteria and extreme actions seen in the US. Just because we don't express ourselves in the same fashion as our American counterparts, it does not mean that we don't support the NHS and everything it offers us as British citizens. We just don't feel the need to be out protesting on the streets about it.

To demonstrate this, we took an extreme statement and tested reaction to it among the Great British public: "To what extent do you agree that Britain's National Health Service is one of the best in the world?" The question is not about just being good, or being satisfied, but about being 'the best'. Between November 13 and 15 of this year, 72 per cent of the public agreed with the statement, only 13 per cent disagreed, and the rest neither agreed nor disagreed or didn't know; an overwhelming vote in favour of the NHS.

This isn't the reaction people would normally expect from the passive, non-engaged British public, but underneath there is a quiet passion for what the NHS stands for and offers that demonstrates that Mr Hannon et al are seriously out of step with the mood of the public.

This isn't a reaction to the debate in the US or public attacks on the NHS; the support and satisfaction with what the NHS stands for is long-held and runs deep. When we asked the same group of people whether their opinion of the NHS had changed at all in the past six months, the majority (68 per cent) said it had stayed the same. Only 10 per cent said it had got worse, while 20 per cent of people said it had actually got better. We haven't suddenly leapt to the defence of our 'beleaguered' healthcare system, we've felt this all along.

This may be explained by the level of trust that exists in the UK for doctors and surgeons. When asked which profession they most trust to tell the truth, doctors always top the list, above teachers and judges, with politicians and journalists at the bottom of the list.

And if we look at this at a political level, to understand the levels of satisfaction that exist with the actual running of the NHS, then 67 per cent of the public are satisfied with how it is being run today. While this may be a glimmer of good news for our current political leaders, they have to bear in mind that the running of the NHS isn't exactly high on the list of concerns at the moment – the economy tops the agenda by a significant margin.

While the US debate continues to divide opinion across the pond, we take quiet pride in the NHS and what it offers. General levels of satisfaction with the NHS are at an all-time high. We don't need to defend our NHS in the face of US attacks; we know it is the best and the Americans won't sway us.

The Author
Sarah Phillips is head of health at Ipsos MORI

To comment on this article, email

10th December 2009


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