Two countries divided by a common language: Health systems in the UK and USA

Abstract

Despite the historic significance of the healthcare reform bill that was passed into law by President Obama in March 2010, the debate still rages. The UK National Health Service (NHS) has featured prominently in the current American debate on healthcare reform, with critics calling attention to its perceived shortcomings. Some of these, such as the existence of 'death panels', can easily be dismissed, but others, such as the cancer survival deficit, cannot. This paper reviews the evidence on outcomes from cancer and other chronic non-communicable diseases, the two leading causes of death in both countries. The headline figures showing better cancer survival in the USA are exaggerated by methodological issues, but a gap remains, due in large part to better outcomes among older people. Outcomes among younger people with chronic disease are, however, much worse in the USA. Paradoxically, given the nature of the debate in the USA so far, those parts of the US health system that get the best results, such as the Veterans' Administration, or the elderly on Medicare, are those that most closely resemble the British NHS - but which are funded somewhat more generously.