I've been watching from afar (am a Brit) the (increasingly firey) coverage regarding President Obama's plans to reform the US healthcare system.

Now, I have no desire to offer or exchange in any political views as this is most certainly not the place for it nor have I any interest in praising or otherwise the US system (which I know little about) - though I thought I'd share some experiences (good and bad) about the National Health Service in the UK as it's been something I've used heavily over the years - not least for my arthritis - and which, if the TV coverage is true (?!), could be an approximate model for any US system.

Firstly, how much does it cost? According to the NHS website (http://www.nhs.uk/NHSEngland/aboutnhs/Pages/About.aspx), the Service is funded via the government (from our taxes) so about £1500 per person annually (2007/8). As the funding comes from taxes, the unemployed, retired, children, etc pay nothing.  The system works on the premise that, no matter your age or wealth, you will be taken care of - including through Accident and Emergency.  Note that I have private healthcare also, which costs £200 ($330) a year.  This is voluntary as the NHS does have issues over waiting times, which vary from region to region, department to department.  I have had at least £1000 of treatment from this policy this year alone, with no hassles over getting approval from the insurer - though I've not had to use it for my arthritis.

Secondly, how does it work?  Probably like the US, you will visit a General Practitioner (ie, family doctor) who will examine you and refer you to a specialist if required.  All tests, scans/MRIs, x-rays, operations and most medication is free.  I say most because, in the case of the biologicals, such as enbrel, the cost is so great that only the most needy will be provided with it.  (A friend with v bad psoriatic arthritis gets terrible flare-ups from flying.  Knowing that he needed to be as bad as he could be on the day of assessment to determine whether he was a candidate for enbrel, he arranged a legitimate business trip to Singapore (from London) immediately in advance of his appointment.  He had a 45 min biz meeting (crazy, I know) and almost had to be helped off the plane when he arrived back in London.  The panel of consultants and docs saw him at his worst and he now has the meds he needs; they have transformed his life.  I hasten to add that he was very much in need of the meds generally; this was a legitimate if extreme manipulation.)  If a patient felt they needed it but couldn't get NHS approval, they would have to pay privately.

From an RA perspective, I have nothing but praise for the NHS hospital I am with.  It is a major teaching hospital in London (Guy's).  I can call a helpline any time and they always respond within less than 24 hours.  On my last visit, I saw a specialist nurse who spent masses of time with me (an hour, certainly), called in a consultant to have a chat about treatment (only a 5 minute wait) then gave me a deep-muscle steroid injection.  I see her again in a few weeks' time.  Also, on request, she prepared and gave me a letter to use when I go on holiday (to Australia: yippee!) in a couple of weeks' time - the reason being the temperature scanning at airports that's now taking place for Swine Flu; we need to show that, if it's up, it's prob RA and not Swine Flu.  NB: I'm no longer working so they're not getting any money from me.  Another time, I was on holiday in Scotland, and had a terrible flare-up; I was admitted to hospital within three hours of seeing a GP and was treated for two days.  (To be specific, steroids, methotrexate, hydroxychloroquine, sulfasalazine, azathioprine, etc ... all free with the NHS.)