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Why the ‘iron lady’ didn’t dismantle Britain’s universal health care system

Date Published: 03/22/2012

Author: Dane Smith, President


I’m holding two thumbs up and urging that history buffs and policy wonks get to a theater soon and see “The Iron Lady,” the movie that won a third Oscar for Meryl Streep.

She portrays Conservative British Prime Minister Margaret Thatcher, struggling in old age with a fading memory of her historic and mostly successful battle to revive an entrepreneurial and self-reliant spirit in a nation that had lost its empire, was riven by social and economic class division, and was drifting economically.

Though Thatcher challenged union power and pushed through privatization of utilities and energy industries, she did not fundamentally transform or even challenge the National Health Service, a highly popular system that guarantees basic health care and medical treatment to every citizen and is financed by taxes on businesses and individuals.

The United Kingdom’s system has flaws, as every system does, but it is arguably twice as efficient as America’s tangled and hopelessly complex system, which is marked by exorbitant profits and duplicative, inefficient private sector bureaucracies.

Health care spending consumes only 9.5 percent of the U.K. economy, compared to a staggering 17.4 percent in the U.S., which stands out among all the industrialized democracies as the most expensive system by far and the only one that doesn’t provide universal access and a unified system of national financing. And the more devastating statistic is that on measures of basic public health — longevity, infant mortality, disease rates — the United States typically ranks near the bottom among free-market democracies.

In a widely noted analysis published in 1985, British scholar Rudolph Klein noted that after four years in office, Thatcher boldly declared in the 1983 general election that “the National Health Service is safe with us [Conservatives],’’ despite the fact that replacing it was part of her party’s 1979 manifesto.

Klein noted one obvious reason for Thatcher’s support: The system had become wildly popular since it was launched in 1948 (three years after President Harry S. Truman proposed a similar national “public option’’ for the U.S.). Klein also theorized that conservatives left the British health system alone because it was “the best-buy model of health care in the Western world’’ and that it had a “unique capacity for controlling the rate of increase in spending.’’

Another theory for Tory support was offered in a 2003 research paper by U.S. health care expert and scholar Donald W. Light. Free market advocates in Britain and other nations accept and embrace their universal health care systems, Light wrote, because they “maximize the ability to exercise individual freedom and responsibility by enabling people to take care of themselves and be productive. Indeed, conservatives in every other industrialized country believe their values support universal access to health care.’’

Which brings us around to Minnesota’s health care policy options. The immediate future could involve full implementation of the welcome and necessary reforms contained in President Barack Obama’s Affordable Care Act, or the more or less complete rejection of those changes by the U.S. Supreme Court.

Either way, Minnesota is likely to be left with hundreds of thousands of children and adults (an estimated 262,000 even if ACA is fully implemented) without basic coverage. With or without the ACA, employers and insurers will be driving struggling middle-income families into more and more high-deductible plans. This will essentially result in a higher percentage of families who are, for practical purposes, underinsured — thus exacerbating increasing economic inequality and unequal health outcomes.

Regardless of the fate of ACA, Minnesota policymakers should press ahead in seeking our own solution to the lingering problems of access and affordability. We ought to at least consider becoming a nation-leading model of universal care under a unified system of financing.

We would not be alone. Governors, legislatures and grass-roots movements are pushing ahead with plans for universal state systems and unified financing in Vermont, Montana, Hawaii and Oregon. Minnesota Gov. Mark Dayton supports the concept of a universal coverage system, endorsing it specifically in his 2010 campaign. Universal coverage was the aspiration of Republican presidential candidate Mitt Romney when he was governor of Massachusetts, and the Bay State under so-called “Romneycare” is closer to that goal than any other state.

The model that emerges from these states will undoubtedly retain our private-public mix of hospitals and clinics rather than emulating the socialized British system, in which the government employs doctors and owns hospitals.

As the author T.R. Reid explains in his best-selling book “The Healing of America,’’ many international models present themselves for consideration by the states. Among them are the Bismarck model employed in Germany and Japan, which features private competing nonprofit providers and payers but a unified and universal public system of revenue collection and financing.

The thing to keep in mind, Reid noted, is that universal health coverage and unified financing systems don’t have to start at the national level, and if one or more of our 50 states were to press ahead, “the demonstration effect could spread across the United States.’’


A version of this column originally appeared in the St. Paul Legal Ledger Capitol Report on Thursday, March 22, 2012.

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