Opinion: U.S., U.K. health care systems share a fatal flaw

Community activities such as lunch gatherings in Liverpool, mother-and-baby play groups in Sunderland, and a new football pitch in Leicester are everyday relational support that keeps people healthy but remain peripheral to health care funding and debate. The piece argues that both the U.S. and U.K. systems are shaped by the same biomedical mandate that privileges hospital-based, clinical interventions over community-level generalist support.

In the U.S., fee-for-service payment rewards clinical activity over prevention, incentivizing tests and treatments of dubious value because they generate billable work, and hospitals, insurers, pharmaceutical companies, and manufacturers all benefit from diagnosis and treatment. The U.K.'s NHS, despite a public mandate and explicit commitment to prevention, has seen the hospital share of its budget rise from 47% in 2006 to 58% in 2022, because centralized performance management prioritizes short-term outputs like diagnoses and operations over outcomes, concentrating power in clinical work and pulling resources toward hospitals.

The clinical model's limits are evident in both countries: aging populations and chronic conditions strain budgets, life expectancy stagnates in the U.K. and lags in the U.S., and deaths of despair and demand for mental health services have soared. Former U.S. Surgeon General Vivek Murthy warns of an 'epidemic of loneliness' from declining social connectedness, and the piece contends both systems default to biomedical treatment rather than addressing these root causes.