‘What’s Not to Like?’ A British Nurse, Recently Treated for Cancer, Weighs In on U.S. Health Reform

Here’s a little perspective on health care reform in the U.S. from AJN’s contributing editor on international health. Jane Salvage, RGN, BA, MSc, HonLLD, FQNI, is a visiting professor at the Florence Nightingale School of Nursing and Midwifery, King’s College, London, and recently spent a year on the Prime Minister’s Commission on the Future of Nursing and Midwifery.

At 10 Downing Street

Just two weeks ago I learned I had a stage 1 endometrioid adenocarcinoma—a cancer in the lining of my womb. In many other countries today, and in the UK until recent years, this would eventually have killed me. But here I am today, happily home after a hysterectomy, probably cancer-free, thanking my lucky stars and our British National Heath Service (NHS).

My life has been saved by an army of people, from nurses and doctors to lab assistants, many of whom I’ll never meet. All my high quality care was free at the point of delivery, efficiently funded from my taxes instead of boosting the profits of insurance officials or millionaire surgeons. And I am pleased that my taxes have also subsidized the care of the demented, impoverished old lady in a nearby bed, even though her hollering and howling kept us awake most of the night.

What’s not to like? A great deal, you’d think from the nonsense talked about our UK NHS during your U.S. health reform debates. Last September, visiting the Robert Wood Johnson Foundation Initiative on the Future of Nursing, I stayed at the same Washington, DC, hotel as a group of anti-reform protesters. They seemed full of hate, for the world as well as for President Obama, and their ignorant, implacable opposition astonished and scared me.

Just before I went into hospital earlier this week, I cheered at the news of the passing of Obama’s health care bill. By the time I came out less than 30 hours later, the Republicans were already busily trying to sabotage the reforms, as they will continue to do. Fellow nurses, don’t let them do it. Fight them all the way. You need all the help you can get—let us know what we can do.

And please don’t believe the lies told about the NHS on Fox News by minor right-wing British politicians who have zero credibility back here. To be sure, there’s plenty that needs fixing in our system, and we’re working on it. I’ve spent the past year on the Prime Minister’s Commission on the Future of Nursing and Midwifery in England, identifying problems but also widespread good practice. We suggested some ways forward in our final report, launched on March 2. Drafting this report and then unexpectedly becoming a patient myself—seeing things from the other side of the fence—has reminded me, in a humbling way, of the greatness of our NHS. For all its faults it remains a brilliant system, and you’d be hard put to find a British nurse, doctor, or patient who isn’t a staunch supporter.

If ‘socialist  health care’ means supporting your family and fellow citizens and ensuring no one dies of undetected cancer or bankrupts themselves having treatment, I’m all for it.

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Ariza Granada November 21, 2011 at 10:30 am

    As a student nurse in the US, I could not agree more with this post. Although taxes would rise drastically, I would much rather pay for the expenses now and as a community than later and on my own. Most people oppose to the reform, because they don’t want to pay for other people’s expenses. Well, we all do age and life does happen. It’s just a matter of when it’ll happen to you and your loved ones. I think if we were to adopt the same concepts that have worked successfully for other countries such as England, Canada, France, etc. we would have a much better sense of unity and less problems if we can take care of the simple matters like our health especially on a preventive approach. My only concern on this reform would be the actions taken towards it. it’s already almost the end of 2011 and I have yet to see any changes.

  2. derek malley April 19, 2010 at 12:45 pm

    I have extensive experience of working in both systems in critical care, there is a great deal of ignornance on both sides but interestingly enough seem to be moving closer together from a business standpoint. What is required in proper factual debate which should be started in nursing forums from nurses around the world, we may then attempt to exert some form of influence.
    A great part of how civilized you are lies in how you look after your sick, most contributers to this blog are fortunate to be lying on the right side of the tracks, as a healthcare professional i trained in a large teaching hospital in glasgow scotland where you could have a skilled professional next to a homeless person, they received the same care. If my tax dollars are increased to provide better care for all i’ll take it, we never know they day when it may save our lives .
    Some form of hybrid system might be the answer, media hysteria is most certainly not

  3. jm April 19, 2010 at 11:01 am

    Kathleen: It is simply inaccurate to suggest that wealthy countries that have chosen to provide their citizens health care are not capitalist countries. Many of the most powerful companies in the world are based in countries like Germany, Sweden, and Japan. Surely you are aware that these are not socialist countries, nor are their citizens in mass revolt against the tax systems, nor do polls suggest that their citizens would like their health care safety nets dissolved. Please don’t use this blog to manipulate the facts, which are already complex enough when we speak about health care. There is a great deal to debate about and discuss, and we need accuracy when we speak. This blog is not a place for the broadcast of reductive talking points.
    -Jacob, blog editor

  4. Kathleen Drozdowski, RN April 17, 2010 at 8:58 pm

    To compare the systems that are used in Europe with the US is absurd. Be prepared for the tax rate that Europeans have to deal with. I for one am not prepared for the Universal ID card that will come with this also. This is turning into class warfare as well? Lets vilify anyone who has any wealth across the board. I still prefer to live in a capitalist culture with all its warts. Visit me in jail when I don’t buy the feds insurance. What constitution? What freedom?

  5. carolyn RN April 16, 2010 at 10:03 am

    I am in aggreement that something needs to be done. One the biggest problems is the lobbing of millionaire MD’s and there associations and the insurance aggencies that also get fat. iI personally have a friend that is an insurance agent and he has a huge house and property worth more tha 450 uro. He is not for it . I am because I get tired of md’s pushing patients away that have no insurance, nursing homes and rehab centers refusing patients because they have no insurance or funding.

  6. Diane Frezzo April 16, 2010 at 8:29 am

    This is not the first time I have heard good things about universal health care in the UK and in Ireland. What we will have is not universal health care and I am not so sure I am in favor of the reform as it was passed in the US. How do we get the word out?

  7. William April 12, 2010 at 10:27 am

    Had you read the bill when they passed it? Right. Neither had they. Therein lies the crux of this problem. Few over here will argue that our healthcare dose not need reform. The problem comes in how to do so. It is not our federal government’s job (per our Constitution) to meddle in private affairs. That is left to smaller State governments (many of which are the size of small countries in their own right), per our social contract. This is the main problem.
    William sends

  8. RehabRN March 30, 2010 at 10:20 am

    Well spoken…and unfortunately, true.

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