Intended for healthcare professionals

Views And Reviews

In the US, even those with excellent healthcare insurance plans struggle

BMJ 2020; 368 doi: (Published 03 March 2020) Cite this as: BMJ 2020;368:m808
  1. Nora Ellen Groce, professor1,
  2. Nancy Groce2
  1. 1Department of Epidemiology and Health Care at University College London.
  2. 2Washington, DC, and New York City, USA
  1. nora.groce{at}

Twins Nora Ellen Groce and Nancy Groce compare the NHS with the US private insurance system

What the NHS will ultimately look like under the Conservative party has yet to be determined, but the potential impact of American private healthcare interests remains part of the discussion.1 During his visit last year, US president Donald Trump again raised the matter of opening the NHS up to the American private health insurance market,2 reviving debate around the benefits of universal health coverage systems like the NHS compared with the largely private, insurance driven US model.

While Americans are assured that they get the world’s best healthcare, evidence shows they often fare poorly compared with other high income countries, despite the US spending significantly more.34 There is mounting evidence, furthermore, that the US system can bankrupt even well insured people.5

There is little in the literature, however, to reflect comparative experiences of those using the two systems. That’s where we come in. Our experiences are highly idiosyncratic, of course, but we are identical twins who have both been treated for breast cancer within the past five years. Nora, a London based university professor, received her care through the NHS; Nancy, a US government employee with what is considered to be an excellent employer insurance plan, was treated there. We both had treatment at well regarded university teaching hospitals. Here’s our experience.

Medical history

Moving to the UK from the US in 2008, aged 55, Nora registered with the NHS with the understanding that, if needed, for-profit, private healthcare was available. This was not necessary. Nora reported a strong family history of breast cancer to her local GP at her initial check-up. This initiated a referral to a genetic counsellor and the local hospital’s breast clinic, where she received annual mammograms …

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