The Affordable Care Act has been a flashpoint for debate long before it was signed into law. Of course, it's still being contested and it's unlikely that all opponents or proponents of the act have all the facts straight.

One of the outcries often heard is that the act is an attempt to create a single-payer system similar to what Canada and the U.K. have. With that argument in mind, we reached out to Mike Pringle, an independent consultant representing DOTmed in the U.K. Pringle was born and raised in the U.K. and has been a beneficiary of that system. We wanted to get his take on the advantages and disadvantages of a single-payer system.

Customer satisfaction
While there's a wide range of opinions about the U.S. health care system, the services rendered and the experiences patients have, U.K. citizens are a little more united regarding their feelings about their level of health care coverage. "The National Health Service remains a loved system across the U.K.," said Pringle. "Across the spectrum, people think it's a good idea, but they're generally dissatisfied with how it's being managed."

Funding and organization are both big problems for the system. Money is short, management struggles and it's a very large and complex organization, Pringle said.

Although the idea of the system is well-liked, some U.K. citizens still opt for private insurance, with about 20 percent of the populace going that route. "Private plans have quicker access to personal care, direct access to consultants (senior doctors), access to a nicer hospital and generally, faster attention," according to Pringle. "Yet the reality is, if you're seriously ill, you go to the NHS because the best care is still there. If you want a private room, go see a consultant, and then you might have a private."

Pringle said the NHS has had serious funding issues for years. But as for the level of care, the plan outsources an increasing amount and creates partnerships with private groups, in some ways similar to what happens in the U.S. with Medicare. "Somewhere between 20 and 30 percent of the time, the care providers work with the NHS."

Change is a-comin'
The NHS is the largest employer in the U.K, with about 1 million collecting paychecks from it. Structurally, there has a been a back-and-forth between centralization and decentralization of the system depending on who the political power is in any given year. Among recent attempted reforms is the effort to give funds to general practitioner groups rather than hospitals. "So the groups will determine the care pathways and contract with the general hospitals," said Pringle. "This is a reversal to what has happened for years. The view is that people who are doing the best are the ones that get the money, but I don't know what the unintended consequences of this thinking will be."

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