Cover Story

Die in Britain, survive in the US

12 February 2005

James Bartholomew says American healthcare is an expensive muddle that leaves millions unprotected, and yet it delivers much better results — for everyone — than the NHS

For goodness’ sake, the American system is so bad that even Americans — plenty of them anyway, if not all — want to give it up. They want something more like the Canadian system or our own National Health Service. That is what Hillary Clinton wanted and there are still plenty of people like her around. Tony Judt, in a recent edition of the New York Review of Books, was damning about American medical care and glowing about European healthcare. Think of all the money that is wasted in America invoicing patients and administering lots of separate, independent hospitals.

At the same time, we can’t help being aware that back here in Britain the NHS is not exactly perfect. The waiting lists have come down, according to the government. They have probably come down somewhat in reality, too. But they still exist and, come to that, there is the worryingly high incidence of hospital infections. So is British healthcare better than American? Or the other way round? And how do you judge?

Let’s try the simple way first. Suppose you come down with one of the big killer illnesses like cancer. Where do you want to be — London or New York? In Lincoln, Nebraska or Lincoln, Lincolnshire? Forget the money — we will come back to that — where do you have the best chance of staying alive?

The answer is clear. If you are a woman with breast cancer in Britain, you have (or at least a few years ago you had, since all medical statistics are a few years old) a 46 per cent chance of dying from it. In America, your chances of dying are far lower — only 25 per cent. Britain has one of the worst survival rates in the advanced world and America has the best.

If you are a man and you are diagnosed as having cancer of the prostate in Britain, you are more likely to die of it than not. You have a 57 per cent chance of departing this life. But in America you are likely to live. Your chances of dying from the disease are only 19 per cent. Once again, Britain is at the bottom of the class and America at the top.

How about colon cancer? In Britain, 40 per cent survive for five years after diagnosis. In America, 60 per cent do. With cancer of the oesophagus, survival rates are low all round the world. In Britain, a mere 7 per cent of patients live for five years after diagnosis. In America, the survival rate is still low, but much better at 12 per cent.

The more one looks at the figures for survival, the more obvious it is that if you have a medical problem your chances are dramatically better in America than in Britain. That is why those who are rich enough often go to America, leaving behind even private British healthcare. One reason is wonderfully simple. In America, you are more likely to be treated. And going back a stage further, you are more likely to get the diagnostic tests which lead to treatment.