I'm a UK citizen living in the USm abd have been here for several years. On balance, I think the US system is better overall, given the contributions are similar to both (I'm a type 1 diabetic, so a thorough user of both systems). Copayments exist in the UK too, though they are not called that. You have to pay a 'prescription fee' every time you get a script filled, which was (and I'm sure still is) comparable to the 25-30 dollar fee in the US. But the 2 things that beat the UK system to pieces are choice and availability. I get injutred in the UK, and need to see a doctor. Not as an emergency, but I'm suffering enough to go. I MIGHT get an aqppointment in a week, if I'm lucky. I need to see a specilaist, say I need a bupass. 3-6 months after getting into see a consultant I'll get the bypass, if I haven't died already. There a new drug out which would help me - ahh too expensive, you don't get to choose what drugs you take. And if I get to 75 I'll be too old to be treated(not worth it)

Steve, maidens, virginia

It would be nice if the choices were as simple as you outline. pay the taxes for healthcare or pay for your own policy. I went from being a full-time employee whose healthcare premiums ($500/month for myself only) were paid by my employer to a contract worker who has to pay for her own healthcare. For 18 months, I have stayed on my former employer's plan by paying the $500/month premiums (plus a handling surcharge) myself. The COBRA period has expired, and I have applied for and been turned down for an individual policy. Because of the HIPAA law in the U.S., the insurance company has to offer me coverage, but it's a policy with high deductibles and high copays, and they're charging me $746/month for it. That's right: $746/month for one person. Plus having the insurance doesn't mean the carrier won't refuse to pay for certain care. My health is good for my age, and I make a good living. Nonetheless, this increase in health costs means that I will probably have to sell my house and move.

Mary McClellan, Aptos, CA

Michael Moore stresses the advantages of having a system that offers healthcare free at the point of access and he’s correct to do so. Free healthcare at the point of access (as we have in the UK) is the only way of giving equal chances to all of being able to access healthcare. Having to pay for healthcare makes people delay treatment or choose not to seek healthcare at all. Poverty and ill-health are clearly related. Across the world people are driven into poverty because of unexpected and high healthcare payments. One of the biggest problems with private health insurance, as apparently favoured by the author of your article over the weekend, is that the sicker and older you are, the more you pay. Quite apart from the societal and economic benefits a healthy population brings, health is a basic human right and should be accessible to all - charging fees does not help to achieve this.

Alice Schmidt, Save the Children, London, UK

Something that bears remembering about the U.S. medical-care system is this: insurance companies are quite generous about covering preventive care -- routine visits to the doctor and dentist and many kinds of surgical and non-surgical procedures. What the insurance companies are not so willing to do is cover catastrophic situations.

I have what I think is good medical insurance, which covers, among other things, visits to the eye doctor and new glasses (lenses and frames) on a schedule. On the other hand, when my eye doctor prescribed an expensive medication to help remedy a dry-eye condition, the doctor herself had to contact the insurance company and insist that the medication was necessary for my condition. Only then would the nsurance company help pay for the medicataion.

What is needed in the U.S. is a system that provides a safety net for catastrophic needs, and that provides better for the not-for-profit hospitals to which the uninsured must go.

Michael, Powder Springs, Georgia, USA

My elderly father-in-law was taken ill recently. An ambulance was called and when it arrived was staffed by two very helpful and professional paramedics. He was taken straight to the local hospital where he was admitted to a ward within 30 minutes. He stayed in hospital for a week and was given a thorough examination which included blood tests and x-rays. He was attended to by nurses, doctors and a consultant and was allowed home after one week with two further appointments made with consultants. The cost at the point of delivery - nothing.
I have always been happy to pay into a system which provides a reasonable standard of health care to everyone in society and especially its more vulnerable members. Yes improvements could be made, yes there is waste and mismanagement, yes sometimes the service falls down, but this is true of any company I've ever worked for. I wonder how well your newspaper would perform if it was subjected to the same level of scrutiny as our health service?

Sonia O'Ned , Killarney, Ireland

First off, the lifespan of the UK person, according to Wikipedia, is 78.7, the lifespan of a US citizen is 78, not all that different, and if you take life expectancy from 65 on, the US lifespan is HIGHER. It's probably true we spend much more here for end of life treatment -such as cancer. This greatly increases our costs and perhaps in the end gaining only a few months for some people, but it’s what we feel is right to do.

As to US private insurance, I have found the premiums to be decent and the service good, with no waiting periods. I think it really depends on what company you get and where you live. Perhaps the waits are bigger in the largest cities, I don’t know. The premiums do rise as you age, but if you make it to 65, you are covered by Medicare, and if you are poor you get Medicaid, so it’s the 50 year, lower middle class person that has the problem. The premiums do not rise if you are sick, instead you just may be denied entry, so people can't switch job coverage.

Claudia, Atlanta, USA

Having lived in London myself I can safely say that another system looks grander when you don't understand the details.

Firstly many insured Americans know all to well of waiting list. I am insured through MediCal and I require a neurologist. IF I can find one who will accept MediCal and that is a big if, I can expect to wait months to see him or her.

Even worse troops returning from Iraq who are insured through the military or VA have to wait months to see a psychologist.

At least one committed suicide after repeatedly begging fro treatment.

Secondly, those copays you speak of are not minor at all. In the United States catastrophic illness always mean bankruptcy because of deductibles, copays and limits. A recent study showed that those with insurance actually ended up in more debt than not.

The average American dies bankrupt because of end of life health issues.

Robert Lee Hotchkiss, San Diego/Tijuana, CA USA/baja California/Mexico

I'm just an ordinary guy making about $50K per year in the USA. My wife also works. We have a typical family with two children. We have the best health insurance money can buy and most of the premiums are paid by my employer. My contribution is a little over $200 per month.

Our co-payments are $20 per visit to a doctor's office, and $10 per prescription filled. We also have a $500 deductible per year. That's all. When my wife had $10,000 worth of surgery, we paid $20 plus our annual $500 deductible, and $10 for each of the two pain medications.

Compare this to the $1,155 I'd be paying in taxes every month for the privilege of watching my lovely wife sit on a waiting list.

Waiting list? Outrageous. Barbaric. Unbelievable.

Please join the civilized world, my British brothers and sisters. Demand a privately funded health care system that is paid for by your employers. Allow NHS to go the way of the dinosaur and the dodo bird.

Dean, Chicago, Illinois

Mr Whittell needs to explain how, if the NHS is a rip off, the USA healthcare system manages to spend over 16% of GDP when the UK spends just over 9%. The results in the USA are not almost 90% better. In addition to the insurance premiums, deductibles and copays he mentions he would as a US tax payer be taxed to pay for the elderly, poor, research, medical education and public health. The NHS bill includes all of this. The tax burden for health in the USA is almost 8% of GDP. US GDP is also higher than the UK. Another key fact is that US employers are moving to other countries becuase of the cost of insurance, this is not the case in the UK. These simple facts make a nonsense of his argument and a couple of minutes on Google would have been helpful before he sat down to write.

Nigel Edwards, London,

Mr. Whittell,
I am not knowledgeable about the British Health Care System, but I do have knowledge about the Health Care in France. My son went to college in France and because he was a resident , he was entitled to FREE health care, FREE medicine, FREE eye care and FREE dental care. After he graduated and returned to the US
he was then entitled to NOTHING! Can you possibly remove your blinders and tell me what's wrong with this? Yes, in France they have a 40% income tax and I'll bet you most Americans would be willing to pay that for a system that was totally FREE for EVERYONE! And a free college education to boot. Perhaps you should not assume what the majority of Americans think or don't think or what they would or would not do but try wearing the shoes of one of those uninsured that you speak of ....like MYSELF!

Christina Poccia, Livonia, Michigan

I have a serious and disabling illness (Lupus) and had to wait three months to get an appointment with a doctor when I moved. I've also had to wait several weeks for simple procedures and tests. We, too, have wait times In the U.S. AND we get to pay premiums, deductibles, and copays.

My care is expensive; my medications alone cost more than $2,000/month. I had a decent health plan while working but when I became disabled, I was told I would have to wait 2 years for the government-provided Medicare. How can a government rule that a person is too ill to work and then deny health coverage? I believe it's called "thinning the herd." Indeed, many die every year while waiting; I pray I won't be one of them.

Mr. Whittell, try to find insurance in the U.S. that covers "pre-existing conditions." If you can find it, you wouldn't be able to afford it. Then what do you do, especially if the condition deteriorates and you can no longer work in a system that ties health coverage to employment?

Julia, Abilene, TX, USA

National Health system should be for Nationals. The huge reasons why Americans say hell no to socialized health care are 1. We don't want to pay for the healthcare of illegal aliens who already flock here to demand (and get) free health services(by not paying for their uninsured care at hospitals forced by our government to serve them) and 2 Even if our health system refused aliens, it can't be trusted not to milk every dollar when they are paid direct, much less when they are paid through the government! $5 for a tylenol, these are the kind of things American hospitals and doctors do to us!

Mike, greenville, TX

I have no idea of the exact figures for how many billions are spent on healthcare or what percentage of GDP the UK pays relative to the US, but I can only say that, while I am for universal medical treatment in principal (who the hell isn't?), my local NHS has let my family and me down more times than I can count.

Anyone who understands the law of diminishing returns knows that you can't make something more efficient just by blindly throwing money at it. The argument is that socialised healthcare is inefficient, but at least everyone receives the same inefficiency,(some just die before they ever see a doctor).

Oliver, Newcastle, GB

To JOAN OF ST. LOUIS.

You mentioned Walter Reed hospital in screaming bold letters. What that hospital represents is the "compassionate conservatism" of the Bush administration. You think you live in a democracy, but really it is a plutocratic, oligarchy with an addiction to manipulating and scaring the millions of political illiterates in your society and overt/covert imperialism.

I experienced the USA medical care sysytem for three years. I'm lucky to have escaped the farrago of copays, deductibles, exclusions, blatant , misleading pill pushing on TV adverts and buck passing on diagnosis as Doctors were scared stiff of litigation. I'm now living in Belgium, which is a mixture of free treatment with a modest insurance element. Halleluha!!!

Anthony Radbill, Antwerp, Belgium

Healthcare in the UK is getting less "free" by the day. I was recently turned down for an appointment with the nurse at our local GP practice on the bizarre (to me, but hey, what do I know?) grounds that it wasn't a "revenue-generating" complaint. The local practice limits its access to its staff to those complaints which attract additional Govt funding. Instead I was to be put on a four-week waiting list to get an appointment to see a District Nurse. Happily, I actually fall into a category of people who the GPs are paid extra money to advise on lifestyle and diet, so I was able to swing an appointment on those grounds instead. If not, I'd have been cutting my own stitches out before they went septic, and frankly I'm not good with sewing. Presumably the nurse wrote the appointment up in a "revenue-generating" way so they got their money.
I feel I'm being treated as a cashpoint by my local practice.

Jill, Eastbourne,

Your analysis is way off base. You may have problems in your system but they pale in comparison to ours. What you did not do is actually apply for the insurance policy. Had you done that, you would be required to fill out a form where you must identify all illnesses and treatments you and your family had over the last five years. The insurance company then decides whether they will cover you and at what rate. American medical insurance companies practice risk avoidance rather than risk mitigation.

Your system gives you longer average life spans and lower infant mortality rates at about half the cost of our system. Spend a little more money and fix your system. You still won't be close to what we pay in the US.

Jim Eastman, Lon,

First of all Euros, it's 15% here in the US without health insurance. I've seen 25% to 40% from you all. Get your US propaganda straight at least.

Then, lots of people without health insurance here are probably like me. They are young(ish) and healthy and just don't feel like paying. I've had health insurance for a while, and I found it good while I had it, but I just got tired of paying the premiums for nothing and just let it lapse. I could afford it if I wanted to, by cutting back on my extra TV and phone service and entertainment, but I choose not to.

I know it's a gamble. But there are ways around the gamble. Hospitals have to treat you for emergencies. And you have to hide any treatment you get by paying cash so you can lie about pre-existing conditions and then you can then quickly sign up for coverage if you need to. Yes it's devious, but that's perhaps why people are less concerned about their lack of coverage here than it would seem. A lot of us are just cheap.

SC, Atlanta, USA

It isn't clear at all that covering the uninsured or covering those who have pre-existing conditions in any way requires that the government take over health care for everyone, most of whom it works well for. But these are always touted as evidence that my healthcare has to be run by government, and I have suspisions that I will come out a loser in that bargain. Maybe that is why those who push single payer systems (even those who claim to be more objective that M. Moore) seem only to consider the existing system and a government run on.

David Summers, Menlo Park, CA, USA

When you get cancer many policies fail to cover you fully, so you have to sell the house!

martin, st loup, france

I´m an Argentine Cardiologist. And I see the same things all around, for instance, in Buenos Aires. The difference will not depend in Geographic but in Economic Systems. As long as we stay in the same circuit, everything will remain as it was described by other professionals.

Isidoro Ringelheim, Buenos Aires, Argentina

Mr Whittell

Your article is very timely. After living in the UK for the last six years and experienced the UK and NHS health system first hand, I am temporarily located in New York. Last night, I had the pleasure of experiencing the US health system first hand for a minor ailment. For a visit and prescription, it cost me $267 which is the equivalent of roughly £130 (and I must add that the quality of the treatment as well as the wait for the prescription was not worth the money) which is extorniate. Luckily for me my firm has worldwide health insurance but the most striking thought I had last night was for those who didnt have insurance. During both the visit to the doctor and pharmacy, I was quizzed about my insurance plan - it seemed very obvious that if you didnt have insurance, you werent getting treatment! QED. Mr Whitall- public health is a right, not a privilege. Not everyone is as fortunate to be able to either afford private health insurance or maintain good health.

Scott Robinson, New York, USA

Long live the NHS. Giles Whittell should note the insurance industry's desperate attempts to avoid paying out on their health policies

Bill Lawrence, Bristol, U.K.

True, NHS is not free. We can't even access the NHS dental service freely anymore. So where is the logic of free NHS treatment.

The government should issue voucher scheme so that the patient could redeem at a private or NHS dental place.

Vince, West Midlands,

The NHS is indeed expensive and inefficient, because unfortunately the present UK government hugely increased funding (correctly) but unfortunately without the essential reforms of a "Stalinist" system. However, to praise the US health insurance system is laughable - a country where 25% have no cover at all ! I live in France where we have the best health cover in the world - and no more expensive than the creaking UK system. But I sense that your reporter is one of the Eurosceptic primitives that cannot see any good the other side of little England's pathetic moat.

David, Ligneyrac, France

The article is useful and could have been better focused if it also indicated the areas of expenditure- drugs, clinicians, hospital stays, GPs etc and made comparisons. One of the larger costs for clinicians in the USA is professional insurance and litigation one that will be largely missing in the UK. This apparently forces clinicians to run a battery of tests rather than one or two to avoid a negligence claim bearing in mind that patients aren't always accurate enough in describing symptoms and that doctors don't always listen enough when they do. So medical insurance in the USA supports the healthcare, insurance and legal professsions.

The UK system has certain flaws.
In some areas you wait for 5 - 6 weeks to an appointment to see a NHS doctor to be examined to arrrange an abortion. Privately you phone and have the operation within the week.

As abortion is becoming a lifestyle option for many, in my opinion the NHS should introduce a copay.

DM, Eastbourne, UK

Here is a quote from a doctor in an article in the New York times today:

“It’s a simple fact that if we don’t get paid for something, our desire to do it is going to be much, much less,” Dr. Richard I. Fogel, a cardiologist at the Care Group in Indianapolis, said at the Denver meeting."

Let us hope that if you do become ill in the USA that the best cure for your illness is well paid for by the insurance companies to the doctors.

Nick, miami Florida, USA

You are healthy.

Try and get healthcare if you have a history of illness. Unless of course its provided by your company - thats why so many Americans are worried about losing their jobs..

Of course, the NHS could be better - Labour has spent alot and not got value for money. BUT it has improved significantly from my personal experience.

Should be more honest though, not all who work in it are down trodden, some are plain lazy and incompotent - maybe its just a London thing..

terry, London,

The utopian, British NHS is buoyed up by myth and wishful thinking. It is not free, patients are not people but units who get what care faceless public servants allow No amount of re-organisation and political chicanery is going to alter this.
The trouble is that the blinkers people and politicians choose to wear prevents them from facing up to this and achieving something better.

Dr J Findlater, Carnforth,

Mr Whittell, if you think a system like the NHS is bad because you personally don't get out of it what you pay into, you clearly haven't understood the concept of "solidarity" that underlays public health and welfare systems. Or maybe you have, and you're just being egotistical.

Matt, Wuerzburg, Germany

We should re-brand it to YOUR NHS, and give it back to people. Instead of it being controlled by some of the people working within, for their own benefit. Some massive pay awards have been allowed without much service improvement. Yet those at the sharp end aren’t being supported enough. Future generations will be paying back in taxes approx £7 for each £1 currently being spend on infrastructure, something’s dramatically wrong somewhere with those politicians decisions making .

Michael Maliin, Sheffield,

My mother waited nearly 2 years in the UK to get a scan for a painful knee problem that left her unable to walk. Both my parents have paid taxes all their lives. Access to healthcare in the UK is access to a queue. I went privately for a scan when I had an issue and got seen in 2 days.

Does anyone really belive the NHS carefully allocates its resources targeting patients?. Anyone who has worked in corporate companies sees waste but in the private sector the
bottom line drives efficiency esle the company goes bankrupt. No such discipline exists in the NHS and as try as governments might allocation of resouces by quango and committee will never work.

Michael, London,

Unfortunately the entire premise of this article falls apart when you discover that the US government spends more per head on healthcare than the UK, just to fund the non comprehensive medicare and medicaid programs. So in fact the insurance premium is paid on top of the tax contribution, making the US health system almost twice as expensive as the UK, while leaving 20% of US citizens with no healthcare whatsoever...

Mike, London, UK

Having spent 18 years living in the US, and another 18 in the UK, I have experienced both systems. In the USA, clean hospitals, professional staff, no waiting, excellent care. In the UK, filthy facilities, an incredibly long wait, very poor care (I had to have remedial surgery to correct what an NHS consultant did to my fractured hand), and an athmosphere of collusion amongst managers and despair amongst staff.

Give me the US system any day.

John Claro, Clifden, Eire

According to the World Health Organization, the UK spends $2560 per capita (8.1% GDP) on healthcare. The US spends $6096 (15.4% GDP). This is in spite of around 1/6 of their entire population being without coverage. We also live slightly longer and have a lower infant mortality rate. You will find similar results comparing Canada, Japan and pretty much all of Western Europe to America.

Waiting lists are the only advantage to the US system. Naturally, having to pay large sums for treatment will make you think twice about seeing your doctor, and so reduce waiting lists, but this can result in neglecting to check for things that, further down the line, will not only be far more expensive, but life threatening.

Of course, if the time you wait for non-critical treatment is your main priority, we still have the option of going private in the UK.

Donald, Dumfries, Scotland

As to the virtues of British " free" health care one important fact is omitted, namely we, in the USA, don't have murderous doctors, yet. Felix

Felix Dynin, Mountain View, USA/CA

I have worked in several health systems and I have always been surprised that people have portrayed the NHS as a) free, and b) a good deal. It is not a good deal. It is over-priced and very badly managed. We need to speak honestly about this. We do pay for the NHS, both in our general taxes, VAT and in National Insurance. Add that up, and it is a lot of money every month. Interestingly, social welfare in welfare states is not free. It costs us in many ways, from money taken out of our pockets to the perverse forces and consequences it causes (scroungers, yobs, medical incompetence, filthy hospitals, arrogant managers etc.). The system I have seen that works best is one where health costs through taxation are kept low, and where staff are directly held responsible for outcomes and performance and are fired straight away if they do not do the job.

Bob Macdonald, London,

The insurance costs quoted here do not tie up with what my friends tell me -- I think these figures are for the relatively young and relatively healthy. Some US friends say they are tied to their job by the fact that they cannot forego their medical benefits (admittedly one gets the impression that they are brainwashed into thinking they must see a specialist doctor about the slightest thing).

And what if you or your child are uninsurable?

vc, Norden,

I might point out that in 1982 when I worked in San Francisco, our 18 month old son got a splinter in his finger running almost it's length under the nail, so as we lived downtown my wife took him into the City hospital A & E where they cleansed the finger in discenfectant, chilled it slightly to reduce the pain, removed the splinter then charged us $82.

The charge cost included the rental of the room and it's equipment even though other patients were treated at the same time in the same room.

The NHS may have it's faults, nothing is perfect, but Mr. Whittel makes no mention of the fact that the massively expensive Social Care and Services for which this country is seen as a soft touch and a bunch of mugs, comes out of the same monthly stoppage per employee.

In the USA we had Blue Cross & Blue Shiled cover included in my contract, an awful lot of Americans do not.

Texas is even worse, so appreciate what we've still got left.

Ken.H, Harriow.,

Doctors are not supposed ot make money, they are supposed to save lives.

Anyone who doubts the usefulness of the NHS should jump in front of the car, and observe the world class medical attention you'll get as soon as an ambulance arrives.

The NHS has it's problems, but it's nothing that cannot be solved with working on efficiency and a little more tax on the rich. Not much extra mind you, just one less ipod a month.

gk, West Drayton, UK

While our U.S. health care system is dysfunctional on many levels, the NHS is no model to follow. Massachusetts is on the right path with requiring all to have health insurance, but two impediments loom large: (1) denial for pre-existing conditions, as already mentioned and (2) our insane medical malpractice climate. As a physician I can attest to how many tests, x-rays, MRI's, etc. are obtained simply to cover one's hind quarters. While law suits are overwhelmingly decided in favor of the physician, (indicating many frivolous suits flooding the courts), cases that are "won" by the physician are extraordinarily costly to the doctor and to the entire health care system. My brother, who holds a British passport, and his English in-laws have had health care experiences of shocking neglect in the UK that would have made him and his kin very, very rich in the USA. Sorry, Mr. Moore, there is no free lunch.

Heather Furnas, santa rosa, California

But the reality is that we don't all pay £577 per month. We pay differentially, according to what we earn. By this joint effort, we support a superb health service, which can then be used for free by anyone who does fall ill.

The whole reason the NHS was created was because of a national sentiment that nobody should be denied healthcare because they cannot pay. That is what happens in the USA - not to every family, but to the poorest, who could not afford the insurance you describe. You are arguing for that to be brought in here.

Very interesting facts from Andrew Clark, which shows that not only is the UK system fairer, it is also better value for money.

Josh, Ashford,

The statement "But that leaves more than 200 million fully insured Americans who’ve never heard of waiting lists" is just plain wrong.

A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada.

A recent letter to the New York Times from one of the fully insured Americans that Guy Whitell envies outlines one woman's two month wait to see a specialist and cited six months waits for mammograms.

Recent statistics from the Institution of Healthcare Improvement show people are waiting an average of about 70 days to try to see a provider in the USA.

Waiting times in U.S. hospitals and clinics are becoming so lengthy that even one of the nation’s biggest insurers, Aetna, has admitted to its own investors that the U.S. healthcare system is “not timely” .

Gerard Brogan, Leeds, UK

I wonder what Moore has to say about the bizarre practice in the UK of the Government (qualified babykissers all of them) owning and running hospitals, employing doctors. The NHS fails to the extent that government pokes its worthless snout into the running of the NHS. Government ought to be restricted to ensuring the bills are paid.

John Ledbury, Kings Lynn, England

I am a single man, am self-employed, and practice accountancy in New York. Health Insurance costs me $650 per month and I expect another 15% annual increase on my policy's upcoming anniversary date.
My coverage is expensive, yet excellent. And I do not 'wait' to see a doctor or receive treatment.

The problem comes about in that the system has, in general, placed the obligation to pay health insurance premiums upon employers.
As a 'little guy', this is a deal-breaker when it comes to hiring staff. I simply cannot afford the additional cost.

As an aside, a poorly-insured friend of mine survived a heart attack 8 months ago. The cost of his medication is excessive. To date, he has relied upon sympathetic doctors who give him pills that they receive as "Samples" to cushion the impact of this cost, but in the long-run, if there if a long-run, he's got a problem.

Jamie, Long Island New York, USA

The # 1 reason for bankruptcy in the US is because of medical costs. The fact that people lose their homes due to medical bills alone is well documented.
Mr.Whittell ,you take the easy road of twisting the facts and make personal attacks.I invite you come on over and go through the Kaiser Permanente system you boast about when your child is sick. While no system is perfect I'd take a socialized one where everyone is covered over one where only the well to do get the luxury of good health.

Teri, Euereka, CA

I would like to add that perhaps the best way to tinker with the US system for now is to mandate that all people with pre-existing conditions cannot be denied coverage. This could be paid for by establishing a fund paid by the government and the insurance companies to cover serious pre-existing conditions for the first one ot two year of insurance coverage, since they are generally not covered for one year.

This would take care of the most glaring obstacle to getting or changing health insurance for most people. I wonder how much this would cost us and would like to see figures on this.

Claudia, Atlanta, USA

The USA is not the best alternative example. In both the US and the UK, producer interest, restrictive practices, restricted access to medical school, lack of competition and lack of direct user awareness of costs, serve to inflate medical costs - against the public interest. That's why the US and UK have the best paid medics by far.

Better examples exist in other countries of value for money and service.

HJ, Reading, UK

Mr Whittel
The costs you mention for the NHS are shared by us all. Of course this is resented by some such as yourself.Try entering your details for a quote with Kaiser Permanente when you are older, have a chronic condition, or are terminally ill and then see what your US insurance quote is. Did this very elementary test not occur to you?You may also wish to consider what proportion of the health budget is spent on administrative costs in the two systems, and the proportion of GDP. I rest my case.

Robert Higgo, manchester,

What a bucketload of codswallop! The truth is that the US spends much more on health care in terms of GDP share and that many people are not covered. The NHS does a good job; in a sense it's a great equaliser, like death and desease, if you will. Rich or poor, you will be treated roughly the same. That is definitely not the case in the US. And No, I am not working for the NHS, I am just in the unfortunate position of having had to use it. Without the NHS, I would probanby be in a wheelchair and possibly dead. What about a reality check?

John, London, UK

An interesting piece, but the NHS does not exist for the benefit of the patient - anyone using it surely realises this - it exists for the benefit of the BMA, RCN, RCS, Unison, Glaxo, AstraZeneca, etc.

eddie reader, birmingham, uk

Two points to consider in the UK
1.Accountability in the NHS, which everyone might agree to be beneficial. This can only be achieved if everyone makes some payment each time. Even in my upper middleclass area the patient is made to feel a suplicant rather than a customer. It would also place a degree of welcome responsibility on the patient.
2.Private practice should be better regulated in the area of accreditation and fees so that patients can be assured of proper standards of training and not risk being ripped off. At present patients cannot be sure that a 'private specialist' has held a senior hospital post signifying proper training and is then charged an amount which the practitioner thinks he is worth and get away with.

Robert, London, UK

Not only are we paying to much for the NHS, we are also getting appalling service. On the NHS's own figures, 34,000 people die unnecessarily in NHS hospitals each year and another 25,000 are unnecessarily permanently disabled. (In comparison, 35,000 people were killed in Iraq on 2006 and we call that a "civil war") The NHS has 50 to 70 times as many hospital acquired infections as other European countries. Under New Labour the number of managers in the NHS has doubled from 20,000 to 40,000 and £12bn is being wasted on computer systems that don't even work. Our NHS has become a national disgrace and many people are now afraid to go into hospital.
Amanda Steane
Author: "Who cares?"

amanda steane, nuneaton, uk

The writer says that the NHS will cost each Briton £1,733 next year. The National Coalition on Healthcare says that in 2005 each American spent $6,700 on health. Its report predicted that that figure would rise to $7,500 (or £3,750) by next year.

Of course, one has to add in prescription, dental and private health insurance charges to create comparable figures, but it’s pretty clear that healthcare is much cheaper as well as fairer in the UK.

Peter, London,

Giles,

Of course the NHS isn't "free". That's an absurd suggestion - it costs money.

The point Moore was making was that it is free at point of need; and no number cruncher is going to ask about your bank balance if you chop off a digit with a chainsaw...

Read the comment again, dear, and see if you understand it this time...

G White, London,

When an emergency happens in Canada, the last thing I think about is calling my insurance company and hoping for 'approval'. I take the inefficient bureaucracy over for-profit insurance any day.

Michael, Vancouver, BC, Canada

How simple it is in the UK ... Pounds from each according to his ability; Health Care to each according to his need.

Maurice, Clifton, VA, US

Rachel

If you were illegal it would be free

Bonz, Tampa, Florida

Rachel
Is it humane to wait months to see a doctor, further months to get treated. Catch deadly diseases when you finally get into hospital.
In the USA the majority get a first class "health service" in the UK the majority get an expensive mess,

b samways, London, UK

If you are only budgeting a few hundred dollars for deductibles then you'd better hope you don't get properly sick. Plenty of health plans have deductibles of 20-30% of the cost of treatment. US health costs are by far the highest in the world, so a few hundred dollars wouldn't even pay the deductible for one MRI scan at about $2000 a go, before you've seen a consultant to go over the results. Most plans also cap pay-outs in particular areas - I get $1000 a year of prescription drugs. My migraine pills cost $200 for a packet of 9, so it wouldn't take long to use that up if my migraines got a bit worse. I, of course, am lucky, as migraines are merely unpleasant. Some people require expensive drugs they can't live without; they have to pay, or switch to a cheaper, less effective drug. Or move to Canada.

Instead of just browsing the website of one provider, maybe you should talk to some insured Americans to see if they're as happy with their coverage as you think they are.

James, New York City,

Giles Whittell: You have no idea what health care is like here in the US. I don't know what health insurance you found but most people in the US have deductibles, copays and exclusions. I am British and living in the US. Healthcare here is a NIGHTMARE. I recently had a baby. Despite having relatively good health care and a very easy birth with no interventions, I have paid more than $1,000 in copays and deductibles. The average American spends four times as much on healthcare, yet all health indicators show them performing nowhere near as well. Yes, you as a healthy young upper middle class man would probably be better off in the US. Most people wouldn't.

Rose, Princeton, New Jersey, USA

Perhaps Giles should do some more research before exposing his ignorance of the U.S. healthcare system. The sort of individual policy he speaks of is not available to anyone with a single pre-existing condition (even something as simple as having taken a prescription allergy medicine). No waiting lists? Simple Doctor visits are booked days or weeks in advance and seeing a specialist almost always takes months. The U.S. spends a far greater percentage of GNP on Health Care than any nation but ranks well down the charts on what it gets from it. Of course the real difference is that in paying for the NHS more of the burden is paid for by higher earners and access is more closely aligned to need. In the U.S. those with higher incomes have the most generous employer-paid plans and enjoy much better access than the working poor who have little coverage at all and pay far more for the care they do receive - not just as a percentage of income but in actual dollars at the point of delivery.

Andrew Clark, San Diego, CA

I pay £140/month for healthcare insurance for my family of 2 adults and 3 kids [WPA, with £1000 excess per annum] which covers me anywhere in the world. This is less than an average smoker spends on cigarettes.

lester wilson, harrow, middlesex

Give me a break Rachel! My husband and I pay for our own health insurance every month due to our small business. We pay out-of-pocket for a family of four for doctor visits, immunizations, precriptions, etc. up to our deductible of $5600! We do not go to the doctor very much b/c we are healthy. Our children are healthy and that is a blessing. I still do NOT want socialized medicine in this country. Sure, we get screwed b/c we are not part of a group plan, but it is still better than having to wait for simple procedures. We have British friends who have to pay for private insurance on top of the whopping taxes they pay for the NHS. It is NOT better. It is just as expensive, but now the government decides WHEN you receive care. FREE healthcare like the author states, does not mean you have access to care. You have access to a wating list and that is NOT healthcare. If you want the govt. in charge of YOUR healthcare, then great, but I do NOT. I have two words for you, WALTER REED!

Joan , St. Louis, MO/US

It's Orwellian, using "health care" in place of "medical care". A person who actually takes care of his or her health (health care) has less need of medical care -- what's needed for a lack of health.

Moore fails to blame the US government for the problems with medical care. Several thousand pages of Medicare and Medicaid regulations amount to a price-fixing scheme which drives up costs. No medical care provider can charge less than the government's fee schedules -- doing so will result in charges of fraud.

Few people recognize that you cannot expect the results of a capitalistic system by forcing any degree of socialist policy into the mix.

Tim, Manchester, TN, US

You don't mention additional dental charges . . .. what else is missing?

Stem, London, UK

The problem here in the U.S. isn't only the cost of health insurance and medical care. A more disturbing fact is the difficulty many people face in getting insurance coverage. The endless list of pre-existing conditions presented in the film is no joke; each one can bring about denial of a health insurance application. Even if one has a health plan, the exceptions to and criteria for coverage can be overwhelming. Land of the free? Try considering the effects of a job change on health benefits. It's a complicated system for such a basic need. Be thankful that all you have to worry about is when, rather than if. I imagine that equality isn't perfect, but at least it's humane.

Rachel, San Francisco, CA, US

The NHS is free for the people who most need it namely the
poor. They do not pay much in the way of taxes, many receive
benefits and tax credits. Rich people do pay the taxes which
are used to run the NHS for themselves and others. They
also pay for health insurance so that they get the best of
the NHS and the excellent private hospitals in the UK. It all
seems very fair and reasonable to me.

John, LONDON, ENGLAND

I think the point is not about the value of the UK vs US health system, but rather how British people assume the NHS is free as they don't have to pay for it at the point of use. In this sense we could be funding a deeply inefficient system without realising it.

Chris Harding, Coventry, UK

America already has socialized medicine. Medicare, Medicaid, government employees, the military etc all have their healthcare provided by the taxpayer.

In fact, government spending on healthcare in the US is slightly higher than in the UK, so the family premiums Giles Whittell calculated are on top of taxes for healthcare, not instead of them.

Tom, Swansea,

Mr Whittell, I agree with the general thrust of your article but in some aspects you're a little disingenious.

Not everyone pays the same amount for the NHS - some may pay nothing - and not everyone would pay for insurance if it were properly 'privatised'.

The NHS is a socialist ideal that distributes wealth so that everyone can have equal access to healthcare. Of course, there are questions as to how the money is spent.

Chris, Northampton,

Circular or chain, who cares? The point was made that a saw had taken off the fingers. The case being made is that the British NHS is free at the point of delivery, BUT that this lack of cost blinds the users to the fact that it costs the taxpayer £104bn every year. Can anything be done about that cost? Or will the cost of delivery keep being obscured by people who keep arguing that any attack on the cost base is an attack on the principle of free delivery? The debate about value for money can only be held by British taxpayers. The prize is probably around 30% of the current budget!

Frank Keegan, Alderley Edge,

Once again a gripe from someone who earns megabucks a week. I wonder what his attitude would be if he was on the minimum wage or over the age of 65.

IMACOMPUTERBUDDIE, ISLE OF CUMBRAE, SCOTLAND

Considering the huge amount of tax money that is used to pay for health care for those that are too selfish to pay their own way. I have seen the US, the British and the Canadian system at work and I will tell you that if you have a brain in your head then the you would choose the US system everytime. The other two are run by bureaucrats that are, quite simply, trying to prevent you getting the medical care you need. They simply go further by presuming to be the arbiter of what you need.

Martin Smith, Fort Lauderdale, Florida, USA

Yes I agree with Rachel in San Fran that the "pre-existing conditions" are the problem.

Every medical procedure you undertake here is theoretically I believe compiled into some central database here that insurance companies pay for, and as a health insurance agent explained to me recently, every person is assigned a "health score" just like each person has a credit score. (So much for medical privacy). You could attempt to pay for your own medical care out of pocket when you are young and healthy, but anything that comes up during that time may count against you later when you want to sign up for insurance. Also if you want to switch companies or lower deductibles.

That said, health insurance costs are not too terrible and can range from $60 for a high ($8,000/yr) deductible to about $250 a month for full coverage, $350 when you are in your 50's. And I've heard the horror stories about denying coverage and fraud in the major companies have decreased a lot in recent years.

Claudia, Atlanta, USA

British defenders of the NHS, especially politicians, always claim that the only alternative to the NHS is the "ghastly" US system. That is patently untrue. I live and work in Germany where they have what is called "social insurance". Everyone is covered, waiting lists are unheard of and healthcare is brilliant. This is one area where we could really learn from our continental cousins, instead of sticking with an outdated command and control system (which is what the NHS is - a Soviet experiment gone wrong).

Richard, Munich, Germany

The american healthcare system costs 18% of national
GDP the UK health system much less than half that ammount.

The USA spends more on health care than any other country
on earth. Despite this life expectancy and infant mortality are
higher than in the UK, Western Europe and Canada.

Mark Crombie, London, UK

£577 is the mean bill, not the median. An important difference, because a substantial chunk of it is paid by a few rich City types. Then of course a family with two healthy adults and two school-age children isn't going to need much healthcare. Which leads us to the second problem. Insuanace doesn't work because most health problems are chronic and predictable. Insurance is set up to pay out one lump sum after a car crash, not a few hundred pounds a week for ten years, to tens of thousands of Alzheimers' sufferers.

Malcolm McLean, Bradford, UK

sloppy logic. the proper comparison is us cost per person vs. uk cost per person. our cost on 2005 was $6,700, roughly doble the uk cost. of course, a healthy middle-class individual can buy insurance here. at a 'reasonable' cost--but such persons are not the cost drivers in the system (that 10% of the population that uses 40 or 50 percent of the costs). if you accept that the more fortunate have some responsibility for the rest of the population (as adam smith believed), then the uk system makes more sense than our 'unsystem'. further, the uk outcomes appear to be better than ours (expected length of life, for example).

bill copeland, tucson, arizona, usa

You had better plan on adding a few thousand to your deductible estimate for American healthcare, especially for any catastrophic incident such as a car crash. In addition, you might want to set aside a substantial chunk of change for all of the medications, procedures, and doctor's visits that your insurance company will not cover.

I was once among the 200 million fully insured Americans, and I had one of the "better" plans in the nation. In return for hundreds of dollars every month, my insurance company routinely denied me basic care and medications. Ultimately, my carrier dropped me, which is something I am fairly certain the NHS does not do.

meloukhia, Fort Bragg, California

It's a circular saw, not a chainsaw. So "Chainsaw Rick" is not really such a great nickname for him now is it.

Andy, San Francisco, USA

I understand the privately funded medical system of the USA is confusing to foreigners, but it should be understood that many of those 50 million 'uninsured' Americans are young adults who have consume few medical resources and prefer to pay as they go, while others are moving into and out of insured status as they change jobs.

I am 53 years old, I went to the doctor today for the first time in a year. Why shouldn't I have medical savings account that rewards my frugle use of medical resources?

I do believe every person should be insured, and as soon as we can figure out a way to do so that doesn't result in the rationed and therefore krappy care of the totally socialized systems, I will vote for it.

Brad Jensen, Tulsa, USA/OK

Did you even watch the movie? Fully insured Americans (I'm one of them) are subject to INFINITELY LONG waiting lists when their insurance companies refuse to cover critically necessary care. And there are plenty of good old waiting lists at the typical HMO; if I want to see my doctor for a physical, it's at least 3 months waiting.

The other thing you don't get is the huge amount of suffering caused by the COMPLEXITY of the American system. I can't make heads or tails of the mounds of insurance paperwork my elderly parents are subjected to, and I've spent hours and hours trying.

I think your NHS is a trememdous bargain, and would cheerfully pay that much in annual taxes if we could have it here in the USA.

Avo, Santa Barbara, California USA

Giles : half the NHS Docs are foreigners because they cannot get English Docs to do the dirty work at low pay.
The Aussies' rejects- middle eastern Docs whose qualifications didn't meet Aussie standards WERE accepted to work in the NHS and treat English patients.
Obviously , the English NHS accepts the world's dregs.
When native Canadian Docs refused to accept socialized medicine the Canadian Government went union- buster and opened the immigration floodgates, allowing Canada to be flooded with Pakistani Docs , thus forcing native Canadian Docs to be subjugated as government serfs. Where is Moore's take on the socialist press-ganging of UK & Canadian Docs ? Or does he share the Brits disdain of their sawbones ?
As for your exagerrated urban myth of "47 million uninsured "yanks, most of those are children of illegal immigrants who don't belong in the US in the first place.
Giles , your envy is well placed. Socialism sucks.

wilfred knight, orange county, usa california