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from the cradle to the grave in the UKThose who like history might be able to guess about when government sponsored health care began in the UK ( 2). But we’d have to go back a few centuries earlier if we wanted to have a look at other ways that the state began to look after its subjects. And if the word “subjects” makes you think of “monarch” or “queen,” then you’re exactly right. The first of many Poor LawsPoor Laws was passed at the end of the reign of Queen Elizabeth IElizabeth I and provided support for the aged, the sick, and the poor organized at a local level ( 2). As poverty increased dramatically during the Industrial RevolutionIndustrial Revolution, other Poor Laws established work houses – those who enjoy reading DickensDickens, Charles will remember how cruel these could be. Attitude towards poverty changed in the 19^th and 20^th centuries from being a sign of laziness or immorality to being a social issue. And during the dark days of World War IIWorld War II some British leaders were making plans for a post-World War II society in which government would be looking after its citizens “from the cradle to the grave.”

The welfare system in Britain today consists of three main parts: social security, which provides unemployment and retirement benefits; social services, which provide care for the elderly and disabled; and the National Health ServiceNational Health Service (NHS) (NHSNHS).

National Health ServiceNational Health Service (NHS) (NHSNHS)The National Health ServiceNational Health Service (NHS) (NHSNHS) provides health care throughout the United KingdomUnited Kingdom in various ways. The central element is the system of family doctors, called GPs or general practitioners, who are the first point of contact for patients and who refer patients to other services, like specialist doctors or hospitals. All individuals must first of all choose a GP in their area of residence, and the GP must be willing to add the new patient to the list, which for some GPs can be very long indeed. The government pays the GPs according to the number of people registered with them. All services with the GPs are free of charge. Some charges must be paid for dental services, for medicine, and for eyeglasses depending on the age and financial status of the patient. Currently the NHS is almost entirely financed through general taxes, a small part of which (similar to GermanyGermany) is collected from both employers and employees and then paid into a National Insurance Fund. Private medical insurance is of course available but is expensive. The NHS sometimes makes the news with scandalous headlines about patients dying because the waiting lists for [92]patients prevented necessary surgery in time or about the numbers of GermanGerman doctors flying to Britain for lucrative weekend duty. These stories tend to eclipse – some would say unfairly – the successes of the NHS, which provides equal treatment to every citizen and visitor to Britain and which prevents the financial ruin that can result from a lack of insurance as was the case in the US before Obamacare. But waiting for treatment and the condition of some hospitals and the increasing costs of modern health care has put an increasing strain on the system.

With increasing devolutiondevolution ( 5) the once centralized NHSNHSNational Health Service (NHS) has been reorganized into four systems, one each for EnglandEngland, ScotlandScotland, WalesWales, and Northern IrelandNorthern Ireland with some differences in the scope of heath care in each nation. One major reform of the National Health Service in England took place in 2012, the Health and Social Care Act, passed by one of Britain’s rare coalition governments ( 5). Critics condemned the controversial legislation as the death of the NHS; supporters praised it as a necessary evolutionevolution. Effects of the reform are a restructuring of funding and responsibility and an increase of competition.

Fig. 3.1

NHSNHSNational Health Service (NHS), LondonLondon (taken from WestminsterWestminster Bridge). For many the NHS remains an old building under construction and in need of repairs.

While no one denies that the NHSNHSNational Health Service (NHS) is facing daunting challenges, and everyone expects further changes and reforms, the NHS still serves seventy years after its founding as one important [93]aspect of British identityidentity. One of the scenes of the opening of the 2012 Olympic Games in LondonLondon celebrated the NHS with dancing nurses and happy children jumping on moving hospital beds. The segment may have puzzled foreign audiences, but the illuminated NHS sign was immediately understandable to the British.

Exercises

Review the items analyzed in this chapter in terms of Britain and AmericaAmerica. Which country gets a more detailed treatment? Not so trivial question: Why?

Possible project:

Pick any of the issues we’ve glanced at in this chapter and formulate concrete questions that you’d like people in the US or in Britain to answer. Contact as many as you can and compare the answers you get with some of the generalizations given above.

Other topics would’ve also been interesting and relevant, maybe for a future much enlarged edition of this book:

the American ideal of beautybeauty, youth violence and knife cultureculture in Britain, poverty in the US, ghettos, homelessness in the UK and US, crime and punishment other than capital punishmentcapital punishment, teenage pregnancyteenage pregnancy, sexsex education and attitudes towards sexuality, the court system, behavior of British and American tourists abroad, the importance of privacyprivacy in British (and in American) life, the use of closed-circuit televisiontelevision systems in British public places, gangs, gated communitiesgated communities, footballfootball hooliganismhooliganism, binge drinkingbinge drinking, typically American or British diseases and ailments, obesityobesity and declining life expectancy in the US, challenges of the first ever huge generation of very old people, eldercareeldercare, …

We’ve now completed the appetizers in geography and history and have digested some of the things that could cause heartburn or stomachache for people not aware of unusually different aspects of Britain and AmericaAmerica. We’ll be needing these insights throughout the rest of the book and will be coming back to some of these details in later chapters. But now we should move on to the first main course, one of the classics on any menu of American or British StudiesBritish Studies: education.