U.K. envoy not sold on U.S. health care

Sir Peter Westmacott, the British ambassador to the United States, said on a recent visit to Philadelphia that the volume of pharmaceutical advertising on American TV was a bit bizarre and that as national health policy goes, Britain would rather have its system than America's.

During a meeting with Inquirer business reporters and editors, Westmacott was asked whether hearing the ongoing debate in America about health-care costs and effectiveness made him appreciate Britain's National Health Service more.

"We look with admiration at some aspects of American health care because it is fantastic - but it is very expensive," Westmacott said, adding that there was something "a little bit bizarre" about the pharmaceutical advertising on television.

"I came here earlier this year in the middle of the presidential campaign," he said, "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."

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, in January, as U.S. ambassador.

This stop in Philadelphia was his first, and he met with business leaders and was the featured guest at the British American Business Council of Greater Philadelphia holiday lunch at the Ritz Carlton Hotel.

Like other aspects of the U.S.-U.K. 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 about 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 typical citizen costs less. Some health-care experts in America say the British system is better because it has many fewer holes in its safety net than the U.S. one. The basic idea is that NHS covers everybody, but not everything.

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.

For example, of the 34 nations in the Organization 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" percent, Westmacott said. The OECD numbers match Westmacott's figures.

He 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," Westmacott said, "trying hard to bring down the cost and minimize the bureaucracy."

He acknowledged that NHS had to look carefully at some treatments and wouldn't cover everything, but that private insurers in America have made the same calculation. He noted that some U.K. employers provided private insurance and services on top of those from NHS.

"The cost of it to employers," Westmacott said, "seems to be less than the sum of the normal full-paid, corporate health-care plan you have here."

Sir Andrew Witty, chief executive officer of London 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 drug-company CEOs have also complained about European governments hurting their revenue.)

As London's Guardian newspaper explained in October: In the U.K., 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 schedule for 2014, which is expected to include for the first time value-based pricing for all new medicines. Drugs would be assessed on the basis of how well they meet clinical needs and how innovative they are. Germany also has value-based pricing. The NHS spends about $14.6 billion a year on branded prescription drugs.

"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."

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