I live in the UK, where we have the National Health Service (NHS), and it is in no way a 'black and white'. It is free at the point of use, and not means tested, with the exception of a modest 6UKP charge per item for a months supply of a prescription drug.
This article in Wikipedia covers most of the history and technical background of the NHS better than I could in this short post.
http://en.wikipedia.org/wiki/National_Health_Service
The cost of the NHS
The NHS is funded 100% from taxes, at an estimated cost of 92-104 billion UKP a year. There are 60M people living in the UK, around 50% of that are paying Income Tax and NI. So I estimate the average cost to be around 3,400 UKP a year per tax-payer.
I have mixed feelings on the NHS, I am 33 years old and a higher-rate tax payer, so I pay a lot in tax, much more than the average. I also have private medical insurance, although despite this I used the NHS for two operations that required general anesthetic, which I will get to later.
The NHS and social security is supposed to be payed for by a tax called National Insurance (NI). I see a deduction of around 3,500 UKP a year as a 'employee NI contribution', this is the upper capped rate.
However there is an additional 'employer contribution' which does not appear on my wage slip, and is not capped, it is payed at 12.8% of income. So I am really paying about 11,500 UKP a year in NI.
This is in effect a trick to hide to true cost from people, as if my employer did not have to pay that tax it could be in my pocket.
In addition to NI, I pay Income Tax of around 18,000 UKP and local tax of 1,400 a year.
So if I look at is in pure personal value for money terms, I can't say I am getting value for money, as I am paying a great deal for others in addition to myself.
My Experience of using the NHS.
I will give you an account of my most serious use of the NHS, which started with a retinal detachment, forgive me if this is a bit TMI. I went to see a private practitioner who diagnosed the problem, he asked me if I had insurance, which I did. However he told me in his option private sector care would probably not be up to the standard Moorfields, a NHS specialist eye hospital in London could offer.
He called the hospital and after some telephone battles and being bounced from person to person got me admitted.In retrospect I would be quicker if I had just walked into the A&E department at Moorfields.
After some tests they told me that the retina had detached due to over-pressure in the eye that had been present for quite some time, and that a second operation was likely to be required. I stayed overnight and they operated within 12 hours saving most of the sight in my right eye. A month or so later I had the second operation. On both occasions, I did not have to part with a penny except for some eye-drops, which I paid the standard 6ukp prescription charge per item. I would not have paid if I were on a low income. I did lookup the drugs on the internet and found they retailed for an average of 30 ukp each.
A visit to my local doctor is free, although its quite hard to find a NHS dentist, and the work they will do on the NHS is limited. Yes, I know what you Americans think about the general state of British teeth!
My thoughts
Politically most Brits would consider me right of center, but I think taking into account the political relativity of UK/US politics, most Americans would consider me centre/left. I don't object in principle to my taxes paying for others, but there are limits, I want to see them used efficiently and where there is a genuine need. I have a lot less of a problem with paying for health and education than I do with welfare.
Access to NHS is not means tests, so I can benefit from what I pay in, and have.
In general the NHS offers an excellent clinical care. The British media loves to pick fault with everything, so the picture you get from the media is a lot poorer than you would get from people that have actually used the NHS.
The problems facing the NHS are mainly to do with efficiency and finance. The NHS is an administrative behemoth, the 3rd largest employer in the world. Far the greatest criticism I level at the NHS is that it is over-centralized and bureaucratic. Ask any clinical practitioner in the NHS and they will tell you that there are a dozen things that could be done to improve efficiency, but can't be done without central approval, which is near on impossible to obtain.
There is great concern over the sustainability of the NHS in its current from, health tourism and bureaucracy is putting tremendous pressure on the NHS.
I don't think you can directly compare the NHS with the health care in America. They have developed in a significantly different way over the last 60 years, and the situation of the ground is profoundly different.
The existence of the NHS has had a profound impact of the development of private sector medical care in the UK, which is no where near the standard of that in the US. The UK private sector tends to be good at providing diagnostic procedures such as scans, tests, elderly accommodation and high standard ward care.
There can be long waits for some procedures on the NHS. Many people that require a complex procedures that are to be privately funded, travel outside the UK, most notably to the US.
The NHS is able to provide care at approximately half the overall cost of that in the US, which I put down to the absence of insurance companies in funding, and the immense purchasing power the NHS has with the drug companies. Drugs make up over half the cost of running the NHS.
I really don't see how Hillary's proposals will lower the cost of health care in the US.
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