I am an American living in Great Britain. This is why universal healthcare isn’t all roses and moonshine
Many Americans look enviously at Britain’s universal health care, while viewing the American system as greedy and ruthless.
But those who have actually moved to Britain and have first-hand experience of the National Health Service (NHS) paint a very different picture.
DailyMail.com spoke to US expats who felt ‘terrified’ about missing important screenings due to excruciatingly long wait times.
Many revealed that they were shocked by the fact that ‘free’ healthcare was not actually free, and that they were blinded by the high taxes and extra fees demanded by foreigners.
However, others told DailyMail.com that it made them feel more financially secure and less anxious about seeking care.
It comes at a time when the NHS faces grim approval ratings from British citizens, with less than a quarter of people claiming to be satisfied with their care.
The main complaint among British people is the waiting times, which have risen to record levels after the pandemic.
Andrea Jones – who lived in London for eight years – learned this firsthand.
The professional singer, 38, originally from California, injured her vocal cords and was told to wait six months for physical therapy.
Without it, she wouldn’t have been able to earn money, so she had to pay for private care out of her own pocket.
“I actually had to pay for someone myself because I didn’t have time to wait,” she told DailyMail.com.
Physiotherapy is not the only service with long waiting times.
A visit to the dentist takes about four months.
And for elective operations such as a knee or hip replacement, British patients can wait an average of four months, up to two years – while the average wait in the US is just a few weeks.
Additionally, recent NHS data showed that one in five patients waited up to six weeks after being referred for ‘urgent’ scans to detect cancer.
Nicole, a mother of three who has lived in several countries, said she had trouble getting a mammogram according to British screening guidelines, despite having a family history. She called the lack of preventive care ‘scary’
Despite this, Ms Jones noted that while there are pros and cons to each system, she misses the knowledge that she can always be covered by the NHS.
“There was the assurance that I could access care and pay for it,” she said.
A TikToker named Sean, who moved from the US to the UK in 2017, posted a TikTok in late 2022 saying that despite misconceptions from other Americans and Brits, the NHS is still expensive, especially for foreigners.
‘The NHS is not free. It’s actually very expensive,” he said. ‘When I say the NHS is expensive, it is expensive for the quality of service you get.’
Sean, who moved from the US to Britain in 2017, said NHS care is ‘expensive for the quality of service you get’, especially when the extra costs add up for foreigners
Total U.S. health care spending — including what the government, insurance companies and individuals pay for — exceeded $4.3 trillion in 2021, nearly one-fifth of the country’s annual GDP.
Sean, who moved from the US to Britain in 2017, said one of the main misconceptions among Americans is that the NHS is truly ‘free’.
He noted that most Americans are unaware that the NHS is paid for through taxes.
For example, someone earning £50,000 ($62,000) could be expected to pay eight to 10 percent – £4,000 to £5,000 ($5,000 to $6,200) – although the exact rate varies.
While in the US, health insurance is not tax-based, but is instead paid for by the individual, their employer, or by a state program such as Medicaid.
‘The NHS is not free. It’s actually very expensive,” Sean said in a 2022 TikTok video. “When I say the NHS is expensive, it’s expensive for the quality of service you get.”
In addition, Britain has a smaller variety of prescription drugs than the US, meaning patients are sometimes given cheaper and less effective versions.
This is because the NHS negotiates prices with pharmaceutical companies and has a stricter budget, meaning fewer drugs are approved and made available to the public.
For example, Ms. Jones noted that although she could have found a medication that worked for her ADHD, she would have had fewer options in Britain than in the U.S. if her medication had needed to be adjusted.
However, expats also had several advantages over the British healthcare system. For example, Ms Jones said the NHS allowed her to more comfortably see specialists who she would otherwise not have been able to pay for on US insurance.
“I was just happy that I was getting health care that I didn’t actually have to pay for,” she said. “I had a lot of stuff that I hadn’t really taken care of that I was able to take care of when I got there.”
Ms Jones estimates she had to pay an extra £1,000 ($1,200) as part of her visa, which was spread over two and a half years.
She noted that her GP in Britain was the first healthcare provider she had seen who referred her for tests and surgery to diagnose endometriosis, a condition in which tissue similar to the uterine lining grows in other places near the abdomen and pelvis grows.
This results in painful and heavy periods and fertility problems.
“If I had to do that operation (in the US) as a freelancer, I wouldn’t have been able to afford it,” she said. ‘In the US I saw a specialist but was never offered the procedure to diagnose endometriosis.’
Nicole, a mother of three from the US, noted that she had several positive experiences with the healthcare system.
One example she gave was that an ambulance ride for her son was fully covered and brought peace of mind.
However, she was ‘terrified’ by the lack of preventive screening for conditions such as cancer.
“As a woman, preventive healthcare is the most important thing for me, and in the UK you can only have a breast exam between the ages of 50 and 53,” she said.
Nicole said she wanted to get a mammogram at age 42 because her grandmother died of breast cancer. Even though she had private insurance, she was not allowed to be screened.
“To me, the fact that there is little preventive care is really scary,” she said. ‘I’m grateful, but I’m just concerned about the preventive care side of the NHS and why it’s falling so far short.’
US recommendations for breast cancer screening also generally start at age 50, although the US Preventive Services Task Force (USPSTF) last month suggested lowering that age to 40.
On average, cancer is diagnosed earlier in the US, with national figures pointing to an age of 66 in the US and an age of 70 in Britain.
Experts suggest this could be due to US screening for certain cancers at younger ages. For breast cancer, US screening starts at age 40, while UK guidelines start at age 50.
And screening for colorectal cancer, which is on the rise in both the US and Britain, starts at age 45 for Americans and at age 60 for Britons.
But American reveals why life in Britain is still better than in the US
Olivia Carney, originally from North Carolina, shared her experiences of living in Britain and using the NHS
Despite the NHS’s wake-up call for many Americans, one expat praised the British system.
Olivia Carney, who moved to Britain from North Carolina last year, said on TikTok: “Generally speaking, I prefer Britain to the US,” she said.
‘The most important thing I want to say here is that I prefer healthcare. I think that’s a given.’
“Everyone should know by now that American health care is insane.” She noted that although she had insurance through her employer in the US, it cost her $600 per month.
“That didn’t cover everything I went to the doctor for either,” she said.
“Being here, I paid a health benefit through the NHS to get in, and I also pay tax.”
‘I understand that I haven’t paid for it all my life, like all other British citizens, but I don’t use it for free. I paid for it, but I don’t get a bill every time.’
Ms Carney also praised Britain for feeling safer than the US, especially when it comes to gun violence, and for having fewer food additives.