For our 19th episode of the podcast, Logan and I sat down with Alastair Blake to discuss the U.K health system, and why Alastair is interested in health policy and consulting. Alastair is a British-trained physician who went to Cambridge. He performed his residency in London, and has worked in health policy for the NHS. He is currently a Wharton MBA student, and plans on working full time after graduation with the consulting firm, McKinsey.
Here are a few takeaways from the discussion.
1. There Are Very Few Clinical Voices Representing Physicians and Patients in Government and Industry
One thing Alastair was surprised to find when he was a fellow working with Professor Steven Field was just how few clinical voices there are the higher up you get in government and industry. Even when there were executives and high-ups in government with medical training, they had usually been out of practice for many years, and thus were likely out of touch with the issues of the modern day.
This reminded me of when a cardiology professor told us that he was learning about the Frank-Starling mechanism of the heart in the 60’s when the Beatles came to America. Think about just how long ago many of the current leaders in medicine studied and trained. Many did so before most of the major advancements we’ve seen in terms of drugs and technologies in the last number of decades. It’s important for junior physicians, and students even, to speak up and be a part of the discussion. We are uniquely poised to understand the challenges that come along with modern technologies and how they are impacting medicine and patient care.
2. Contrary to Popular Tropes, the U.K Healthcare System is Neither Perfect, Nor a Disaster
The NHS and the single-payer system in the U.K is often pointed to on both ends of the U.S political spectrum as either an ideal to aspire towards, or a socialistic disaster to avoid at all costs. Obviously, the truth is somewhere in the middle. Alastair believes that the systems of each respective country reflects their values, their history, and politics. There is no one-size-fits all system. Interestingly, the U.K system is actually starting to become more like the U.S system in some respects, and over time the U.S has been creeping towards a more U.K-like system, with the expansion of Medicare and Medicaid.
3. Every System Rations – We Just Do So in Different Ways
The U.K pays way less per-capita on healthcare than the U.S, but there is some rationing that takes place, and often times physicians and hospital systems feel financial pressures, and aren’t able to deliver care exactly as they see fit. There will be tradeoffs in every system – while the U.K rations based on effectiveness of treatments through NICE, we ration in the U.S based on an individual’s ability to pay for their insurance, or their care. Again, it reflects the values of the country, and what we are and aren’t comfortable with as a population.
4. “If you can find money to kill people, you can find money to help people” – Tony Benn
One thing that is notable about how the U.K got to single-payer, is that it was almost entirely based on historical happenstance. Large sweeping changes to something as big as healthcare come very infrequently, and require both a lot of political tact, as well as proper timing when the country is poised for change. For the U.K, this moment was after World War II, when England and London was left in ruins. Many came together and realized, if they could find money during the war to kill other people, why couldn’t they also find money while not at war to help their own people? This video from the movie Sicko features Tony Benn, who used to be a member of Parliament in the U.K. This simple idea has led to a lot of my own personal beliefs on the types of health policies that we should strive to.
A single payer system like in the U.K will not work in the U.S – at least not at the present moment. However, I do believe that in the coming years we will need to asses our values, and what we are an aren’t okay with as a population – the money is there, it’s how we choose to align our values and decide how to spend it. It will take future leadership to help steer the country toward such changes when the opportunities arise, and I hope to be one of those leaders. The only way to be ready to act is to learn now, and – like Alastair – study health systems, and get numerous experiences under our belts. I’m excited to see what happens in the coming years.
– Ryan is a second year medical student at the Perelman School of Medicine. He was the co-VP of curriculum for Penn HealthX in 2017, is the co-host of the Penn HealthX podcast, and founder/editor-in-chief of the Penn HealthX blog. You can contact him at ryan.o’firstname.lastname@example.org –