Sir Peter Westmacott, the British ambassador to the United States, was in Philadelphia last week and spoke with reporters and editors from the Inquirer business section. Later that day, Westmacott was the featured guest at the British American Business Council of Greater Philadelphia holiday lunch at the Ritz Carleton Hotel.
A foreign service veteran, Westmacott was posted to Washington in the mid-1990s as the embassy's counselor for political and public affairs. He was ambassador to Turkey and then France before starting as U.S. ambassador in January of 2012.
Like other aspects of the US-UK friendship, the health-care systems are sometimes compared.
America still largely has a fee-for-service system, with private insurers, companies, taxpayer/patients and the government paying the bills. For highly technical, specialized surgery, there is no place better. But the system left some 40 million people without coverage before the 2010 Patient Protection and Affordable Care Act.
Britain's National Health Service is run by the government and funded by taxpayers. There are some private services on top of NHS care, but care for the average citizen costs less. Some health-care experts in America say it is better because it has many fewer holes in its safety net than the U.S. system. The basic idea is that NHS covers everybody, but not everything.
We asked Westmacott if hearing the on-going debate in America about health-care costs and effectiveness made him appreciate NHS more.
"We look with admiration at some aspects of American health care because it is fantastic, but it is very expensive," Westmacott said, adding there is something "a little bit bizarre" about the pharmaceutical advertising on television. "I came here earlier this year in the middle of the presidential campaign and more than half the commercials in prime time were from drug companies telling me about things I didn't even know I had, and encouraging me to tell my doctor to prescribe for me drugs that it's his job to prescribe, not for me to demand."
Americans tend to think the U.S. system is the best in the world, but aside from the high-tech surgery, the numbers often don't bear that out.
Of the 34 nations in the Organisation for Economic Co-operation and Development (OECD), only Turkey and Mexico have higher infant mortality rates than the United States, using 2010 figures.
"You spend about 17 or 18 percent of GDP on health care, and we spend about 8 or 9," Westmacott said, getting the OECD figures spot on.
Westmacott noted the demographic problem that affects Britain and the United States. In part because of better health care, people are living longer, which increases the cost of paying pension benefits and medical bills.
"We hang on to our wonderful NHS, of which we are very proud, trying hard to bring down the cost and minimize the bureaucracy," Westmacott said.
Westmacott acknowledged that NHS has to look carefully at some treatments and won't cover everything, but private insurers in America make the same calculation. He noted that some employers provide private insurance and services on top of those coming from NHS.
"The cost of it to employers seems to be less than the sum of the normal full-paid, corporate health-care plan you have here," Westmacott said.
Sir Andrew Witty, the chief executive officer of London-based drugmaker GlaxoSmithKline, which has a big presence in the Philadelphia area, has taken the lead among European CEOs in decrying the drug price reimbursements paid by governments. (American-based drug CEOs have also complained about European governments hurting their revenues.)
As London's Guardian newspaper explained in October:
In the UK, drugmakers set their own prices but there is a profit cap. Every five years, guidance for pricing is established through the Pharmaceutical Price Regulation Scheme, a voluntary agreement between the government and the industry. They are currently thrashing out a new regime for 2014, which is expected to include value-based pricing for all new medicines for the first time. Medicines would be assessed on the basis of how well they meet unmet clinical needs, and how innovative they are. Germany also has value-based pricing. The NHS spends about £ 9bn a year on branded prescription drugs."
The 9 billion pounds translates to about $14.6 billion.
"What we're doing with the NHS," Westmacott said, "is trying to ensure that the taxpayer and the patient get the best possible value for their money. We're moving toward something called value-based pricing in the NHS. Some of the pharmaceutical companies don't like that because they think it is going to squeeze their margins. Many of them that I've talked to are not that glum about it. They feel they've had their say about things that really concern them....They do understand that we just have no choice but to get the costs under control."