February 7th, 1979: Nurses stand outside St Andrew’s hospital in Bow, East London holding placards during a four hour strike. They are members of the ‘NUPE’ union which is defending their wages claim. (Photo by Graham Turner/Keystone/Getty Images)

This week, as your resident Briton, I’m talking to experts on single payer healthcare and the UK’s National Health Service to find out what American advocates for single payer can learn from our very nice 69-year-old universal health system. (Read Part One and Part Two, too!)

For this installment, we spoke to Roona Ray, a family medicine doctor and board member of Physicians for a National Health Program.

Libby Watson: What do you think are the problems with the NHS that could be avoided in an American system?

Roona Ray: I think that some of the forces that the NHS faces are actually directly caused by the American health system and by the American model of healthcare. There are both specific American companies and ideology that has progressively tried to privatize the NHS over the last two decades, so I think that a lot of what the NHS is facing now is not because they are the NHS, but rather because they are facing economic ideology of privatization and austerity, and having to fight against that.

LW: What have been the negative impacts of privatization and austerity on the NHS?

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RR: I haven’t worked in the NHS or been a patient there, but I have followed closely the labor disputes between the junior doctors and the NHS. Tens of thousands of doctors through the British Medical Association, which functions essentially as a union, have been negotiating with the government, their employer, for three-plus years—both on their working conditions and terms of employment, but also on what the meaning of the NHS is and what the NHS will look like in the future. I think the pushback that they have gotten from the British government represents the idea of austerity, that the government should not be responsible for the health and welfare of its people. I’ve been very inspired to see the tens of thousands of doctors and citizens and other healthcare workers in the UK fighting both for better jobs, so that they can take care of patients better, and for a more robust NHS. And also for the reclamation of the ideology that one of the core functions of government is to take care of the public health and welfare.

LW: How can single-payer advocates in the US overcome the political power of private insurance companies? What needs to change?

RR: We’re already seeing some change. We need to have both people and politicians standing up and saying explicitly that government health policy should be for the people, and should not be for lining the pockets of wealthy insurance and pharmaceutical companies. I was at the [Bernie] Sanders event where he introduced his Medicare for All bill, and there was about maybe sixteen different senators there, and many of them spoke very clearly and challenged the power of the pharmaceutical and insurance industries. I think there hasn’t been really an organized force to challenge their power for many decades, so I’m glad that’s starting to happen.

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LW: There is this idea among American conservatives that everyone in the UK is waiting for ages to see a doctor, and they say this is what happens when you have single payer. Are those things intrinsic to a government-provided healthcare system?

RR: I don’t think they’re intrinsic to a single payer system or the NHS. They reflect budget priorities. People who are advocating for a well-organized, well-funded public health system would need to make sure that their budget priorities are heard; in the case of hospitals shutting down, that includes planning for what are our population’s needs and what are the training needs? I know in the UK there have been challenges and cutbacks to, for example, nurses’ training funds, and this will impact the health system.

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In order to have a well-functioning, well-planned health system, we need to have planning both for facilities that need to be open, based on epidemiology and disease distribution in populations, and also a healthcare workforce that looks at those numbers and that science and plans, through planned programming such as an education system that is free and easy to access for people who want to go into [the] healthcare field.

I think in the U.S., and likely in the UK, those budget priorities are being defeated by other entities who are more powerful politically and financially. For example, in the U.S., the defense budget takes up some gargantuan portion of the federal budget, and they do a great job planning for war, and for all the things that are associated with war. Why can’t we do the same thing for health? I think we can. We just need to be better organized. People in public health should be more organized. If that means challenging budget priorities that are currently taking up too much space, for example in the U.S. the defense budget, then we should have that conversation.

LW: Do you think that if we did manage to get a single payer system—let’s say, if Bernie Sanders’ law passed—would that perhaps kill two birds with one stone in reducing the power of insurance companies and fixing healthcare at the same time?

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RR: Definitely. Inherent to having a single payer system is that prices would be—well, number one, with the pharmaceutical industry, prices would be negotiated with one body.

I have colleagues who work in health centers that accept 52 different health insurances, and each insurance company negotiates its own prices and its own formulary for every procedure, every radiological test that there is. And obviously the companies who are on the other side negotiating, they take advantage of that chaos and try to charge as high as they can for each of those 52 companies, or more. When there is a single body negotiating, they will be able to negotiate with the power of the entire American people; pharmaceutical companies will have to negotiate and bring prices down, and they’ll also stop spending money on the lobbying and the ads that they do, which is where they waste their money. Hopefully out of that will come a research agenda that’s more based on public health needs and less on what drugs are profitable.

With respect to the insurance industry, the insurance industry will be nearly totally wiped out by single payer, as they should be; they currently provide no meaningful health services to anybody and are a totally extraneous middleman in the health economy. They will probably try to insert their hand into things and try to privatize whatever system comes along, as they have very successfully privatized the Medicare and Medicaid systems, which are not public systems because they’ve been privatized. It’ll require vigilance and good organization on the par of people who are advocating for single payer to say, no, there’s no need to privatize any part of this, the insurance companies are extraneous and unnecessary. But definitely, I think pharma and the insurance companies will lose power in this system, as they should.

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