Sunday, July 29, 2012

The Olympics, Doctors, NHS, Transformation, and Heroes: Why the Difference between USA and UK?

I was surprised when the Opening Ceremonies of the Olympics in London honored two of my favorite institutions:  the National Health Service and the World Wide Web.  I was not surprised when LA Times sports writer Diane Pucin posted the following tweet: “For the life of me, though, am still baffled by NHS tribute at opening ceremonies.  Like a tribute to United Health Care or something in US.” @swaldman responded to the sports writer with “Well, maybe, if United Health Care were government-run and a source of national pride.” 

I was not surprised when Meredith Vieira and Matt Lauer of NBC admitted they had no idea why Tim Berners-Lee was being honored by sending out a tweet.  Ever since I read his book Weaving the Web:  The Original Design and Ultimate Destiny of the World Wide Web by Its Inventor (HarperSanFrancisco, 1999), Berners-Lee has been one of my heroes.  Finally locating my hard copy of the book in the guest bedroom where my son Colin used to sleep, I quickly located the marked passage I was looking for:

“People have sometimes asked me whether I am upset that I have not made a lot of money from the Web.  In fact, I made some quite conscious decisions about which way to take my life. These I would not change…. What does distress me, though, is how important a question it seems to be to some.  This happens mostly in America, not Europe. What is maddening is the terrible notion that a person’s value depends on how important and financially successful they are, and that that is measured in terms of money.  That suggests disrespect for the researchers across the globe developing ideas for the next leaps in science and technology.  Core in my upbringing was a value system that put monetary gain well in its place, behind things like doing what I really want to do.  To use net worth as a criterion by which to judge people is to set our children’s sights on cash rather than on things that will actually make them happy.”

I am certainly not alone in admiring Berners-Lee, as this passage from a blog by Daniel Nye Griffiths demonstrates:

With less of a commitment to openness, Berners-Lee could have used the Web to become a very rich man. Instead, he has used every accolade – Fellow of the Royal Society, Knight Commander of the Order of the British Empire, one of only 22 holders of the Order of Merit and recipient of enough honorary doctorates to fill a skip – as a lever, opening doors for his mission to keep the channels of communication open, accessible and affordable.
Looking to the future, he has championed the idea of the Semantic Web – a system of data tagging to help search engines to understand questions as well as find words. Closer to home, he has advised, and pushed governments past and present to make their data available for free. If you’ve looked at an OS map online recently, you have him to thank.” (
The Olympic Opening Ceremonies got me thinking about heroes, health care, doctors, and the struggle to transform the American health care delivery system.  Why is our delivery system such a mess?  Why aren’t Americans proud of their hospitals and doctors and sending out tweets like @MaxwellLeslie’s “The NHS is one Britain’s greatest & most loved institutions, reinforcing the ignorant American stereotype very well with that tweet” by the Southern California sports writer. 
Paul Levy, the former hospital CEO, discussed how Dr. Don Berwick’s praise for the NHS made it impossible for him to ever be confirmed by the United States Senate as the permanent head of CMS.  Levy quoted Berwick’s speech on the occasion of the NHS’ 60th birthday:
“The National Health Service is one of the truly astounding human endeavors of modern times.  Just look at what you are trying to be:  comprehensive, equitable, available to all, free at the point of care, and – more and more – aiming for excellence by world-class standards.  And, because you have chosen to use a nation as the scale and taxation as the funding, the NHS isn’t just technical – it’s political.” (
And Levy closed his blog post by writing, “In the former colonies (the US), we take on the task in a different way, but we face the same issues.  Indeed, as I have noted, ‘After all, the countries are dealing with the same organisms, both biologically and politically.’” (
Since the United States and the United Kingdom both have health systems that take care of humans and since both operate under similar democratic political systems, why are the results so different? 
In Part II of this blog post, we will try to answer this question.

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