Views & Reviews From the Frontline

Lessons from America: primary care

BMJ 2012; 344 doi: (Published 01 February 2012) Cite this as: BMJ 2012;344:e760
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

If you think NHS reforms are complex, try looking at the organisation of healthcare in the United States. Contrary to our perceptions, the US government does care about its poor, young, and old. Through programs like Medicare and Medicaid the government is, in fact, the biggest provider of healthcare in the US. For those not covered by the state, there are a vast array of medical insurers and plans. But despite free market “competition,” insurance remains unaffordable to many middle income families. These companies have dividends to pay, and this leaves 50 million US residents without adequate …

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