National Health Service

I have avoided sticking my hand into this hornets nest for the longest time. But as the topic of a national health plan is being hotly debated back in the States, it is as good a time as any to put my two cents worth in. Let me state, right from the start, that I do not have a definitive answer to the U.S. healthcare question that decidedly needs one. I do have direct experience in different national health services, self-insured companies, private health plans and public clinics.

Important to remember is that a National Health Service is the ultimate in managed care. Think: the mother of all HMOs. An NHS cannot be all things to all people. It tries to do the best it can with what it has to work with, both in resource and population. Which is why no two Services are alike despite the fact that they are all in the health care business.
For example:
In Australia, hospitalization is free (except for Workers Comp claims which are covered by employers private insurance.) This is nice for me at 3a.m. suffering from a kidney stone. Ultimately, it is better for OZ as hospitalization is cheaper than lifelong acute maintenance of
an untreated population. Doctors appointments are entirely different: you pay the doctor up front ($55) and then apply to Medicare for a predetermined refund ($31), you pay for the special diagnostic work ($390) at time of service and get rebated afterwards ($205)-every time, there is not a deductible amount before a higher benefit is reached. Private insurance is strongly recommended by the government with disincentives for delaying its purchase. Medicare does not cover glasses, teeth, feet or alternative medicine like chiropractic. And doctors say with some pride that they are not Canada.
Canada, free hospitalization and free doctor visits at all NHS facilities. Woo hoo, sounds great. But there are trade-offs here. The waits for appointments and diagnostics can be a whole lot longer than Americans are accustomed to, doctors have salary caps (which sends many of the high-specialty docs south of the border for big bucks) and there is rationing of services based on resources and demographics (100 hip replacements per year in Winnipeg, I believe. Mr. 101 has a long painful wait for the new year.)
In Korea, I was fairly fortunate. The polluted air gave me chronic bronchitis. The doctor I went to gave me three days worth of medicine-as a courtesy to a foreigner-whereas natives also on the national plan had to come in daily. A mild hemoturic condition of mine was a problem for the government immigration office (but not for me personally) which could have been a pain dealing with the not-quite-Western-sterile hospital. My assigned urologist happened to be a student of mine and the "problem" was dispatched in a flash.
Of course, we have all heard of the famously comprehensive national health scheme enjoyed by Cubans (who enjoy precious little else) and the infamous dirty sheets & one needle for the entire ward care given in Russian hospitals.

So why do I mention all of this? Am I anti-national health insurance? No. Although I think putting the entire U.S. on a NHS unfeasible and undesirable. Have I languished for hours in public clinics/hospitals waiting for whatever service I can get? Yes. Have I had incredibly good health insurance coverage at low cost with small payments and zero deductables? Yes and didn't appreciate it as much as I should have.

My point is that my fellow Americans should really give a great deal of thought as to what kind of healthcare they feel is imperative, what can be dropped to a lower tier of importance, how much inconvenience they are willing to incur and, as medical care is not cheap regardless of who pays for it, what they are willing to pay for it. My fellow citizens might also stop awarding & applauding high court settlements for minor medical mishaps--malpractice insurance is driving those healthcare costs to the moon. Do your research and then get to a town hall meeting near you with real, constructive input.