Will the NHS medal?

I am guessing that many Americans who watched the opening ceremonies of the Olympics were, at best, confused by the presence of National Health Service nurses during the choreography.  Here's a video of a portion of the show:



Indeed, Los Angeles Times sports writer Diane Pucin tweeted, "For the life of me, though, am still baffled by NHS tribute at opening ceremonies. Like a tribute to United Health Care or something in US."

This prompted a response by @swaldman: "Well, maybe, if United Health Care were government-run and a source of national pride."

And another by @MaxwellLeslie: "The NHS is one Britains greatest & most loved Institutions, reinforcing the ignorant American stereotype very well with that tweet."

Remember when Don Berwick was nominated to head up CMS, the US Medicare agency?  One of the strikes against him by conservative opponents was that he had expressed admiration for the British health system.

This is what Don actually said on the occasion of the NHS' 60th birthday:

The National Health Service is one of the truly astounding human endeavors of modern times.  Just look at what you are trying to be: comprehensive, equitable, available to all, free at the point of care, and – more and more – aiming for excellence by world-class standards.  And, because you have chosen to use a nation as the scale and taxation as the funding, the NHS isn’t just technical – it’s political.  It is an arena where the tectonic plates of a society meet: technology, professionalism, macroeconomics, social diversity, and political ambition.  It is a stage on which the polarizing debates of modern social theory play out: between market theorists and social planning, between enlightenment science and post-modern skeptics of science, between utilitarianism and individualism, between the premise that we are all responsible for each other and the premise that we are each responsible for ourselves, between those for whom government is a source of hope and those for whom government is hopeless.  But, even in these debates, you have agreed hold in trust a commons. You are unified, movingly and most nobly, by your nation’s promise to make good on an idea: the idea that health care is a human right.  The NHS is a bridge – a towering bridge – between the rhetoric of justice and the fact of justice.

And then he moved on to say:

Is the NHS perfect?  Far, far from it.

[I]n improving its quality, two facts are true: the NHS is en route, and the NHS has a lot more work ahead. 

How can you do even better?  I have ten suggestions:

And then he went on to outline those, summarized by columnist Ezra Klein, as follows:

Conservatives have convinced themselves that the NHS is a terrible system, which I guess is their right. But insofar as Berwick is actually offering recommendations to government-run health-care systems -- and that's what he's doing here, and what he'll be doing at CMS -- his guiding principles seem fairly inoffensive.

What were those radical suggestions?  Well, as I read them, they would apply just as well to the health system of the United States and every other developed country I have visited:

1.  First, put the patient at the center – at the absolute center of your system of care.

2.  Second, stop restructuring. 

3.  Third, strengthen the local health care systems – community care systems – as a whole.

4. Fourth, to help do that, reinvest in general practice and primary care.

5.  Fifth, please don’t put your faith in market forces. 

6.  Sixth, avoid supply-driven care like the plague. 

7.  Seventh, develop an integrated approach to the assessment, assurance, and improvement of quality. 

8.  Eighth, heal the divide among the professions, the managers, and the government. 

9.  Ninth, train your health care workforce for the future, not the past.

10.  Tenth, and finally, aim for health.

So, my take is like Don's.  Both beloved and berated by the British citizenry, the NHS is a marvelous social experiment that is nowhere near the finish line.  With a most dedicated and caring staff and bureaucratic beyond belief, both, it carries the torch forward.  In the former colonies (the US), we take on the task in a different way, but we face the same issues.  Indeed, as I have noted, "After all, the countries are dealing with the same organisms, both biologically and politically."   The two types of systems have a tendency to converge in many ways, "Suggesting that -- in all systems -- a concerted focus on quality, safety, transparency, and process improvement would be well worthwhile."