Yes, of course ‘Breaking Bad’ could have happened in the UK.
22 February 2016
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The US TV series ‘Breaking Bad’ is about a middle-aged high school teacher, Walter White, who is diagnosed with lung cancer, and who is unable to afford the treatment his doctor recommends. Out of desperation, he embarks on a criminal career in order to raise the money.
Since the streaming of the final series, a cartoon with the (attributed) caption ‘If Breaking Bad had been set in the UK’ has been making the rounds on social media. In the cartoon version, Mr White’s doctor simply informs him that he is entitled to free medical care, and Mr White decides to go continue teaching. Thus, the story ends, or rather, never begins.
The cartoon itself does not actually mention the UK (it just says “anywhere but America edition”). But when it comes to healthcare, there is a tacit consensus in the UK to pretend that there are only two health systems in the world to choose from, namely the NHS and the US system. Therefore the cartoon was quickly recast to be a strident defence of the NHS, with its universal coverage and free access to healthcare.
It is indeed quite conceivable that a British version of Breaking Bad would have been very short. But that is mainly because a British Mr White would probably have died soon after the diagnosis. The UK has the lowest lung cancer survival rate in the developed world. A British lung cancer patients only has a one-in-ten chance of surviving the next five years.[1] Patients in Latvia, Poland, the Czech Republic, Estonia, Slovenia and Slovakia face better odds, and the US survival rate is almost twice as high as the British rate. But forget the US. Survival rates in Italy, the Netherlands, Norway, Australia, Iceland, Sweden, Germany, Switzerland, Belgium, Canada, Austria and South Korea are also more than five percentage points higher than in Britain.
Given how common lung cancer is – about 45,000 new cases are diagnosed each year – a difference in survival rates of a few percentage points can translate into large numbers of lives that could have been saved through better and/or timelier treatment. Had the UK’s lung cancer patients sought treatment in France rather than on the NHS, there would have been almost 1,800 additional survivors. Had they been treated in the Netherlands, another 2,300 people could have survived; had they been treated in Australia, another 2,400 could have, and had they been treated in Switzerland or Germany, it would have been around 3,000.
So in short, yes of course there could be a British version of Breaking Bad. A British Mr White would try to raise money in order to seek treatment abroad.
But if the aim were to shoot a ‘boring’ version of Breaking Bad, one could have set it in, for example, Austria, which has a universal healthcare system, and where the survival rate is about the same as in the US. Unlike the American Mr White, an Austrian Herr Weiß would be protected against the risk of medical bankruptcy, and unlike a British Mr White, an Austrian Herr Weiß would also have a fighting chance of survival. What Austria does not have is state-run health service, nor is healthcare in Austria generally free at the point of use. In hospital care, the private sector – charities and for-profit companies – accounts for a market share of about one third. Co-payments and other forms of patient charges account for about 15% of total health expenditure (there are exemptions for poor people). This is not a free-market system; it is a private-public hybrid system with mixed funding and mixed provision. But still, imagine the howls of outrage that would ensue if a British politician proposed to move even half of the way towards such a system.
However, lung cancer is not a special case, and Austria is not a special case. It is generally true that countries with competitive, pluralistic systems such as Australia, France, Japan, South Korea, the Netherlands, Germany and Switzerland do well across a wide range of health outcome measures. It is also true that countries which have similarly uncompetitive systems, such as Ireland and Finland, often have problems that are similar to the NHS’s.
The smugness of NHS cheerleaders is therefore unwarranted. We should judge healthcare systems by their outcomes, not vague intentions or fluffy ‘founding ideals’. Judged in this way, it turns out that the NHS is a greatly overrated institution.
Dr Kristian Niemietz is the IEA’s Head of Health and Welfare, and a Research Fellow at the Age Endeavour Fellowship (AEF). He is the author of our ‘NHS tetralogy’:
· ‘Health check: The NHS and market reforms’
· ‘What are we afraid of? Universal healthcare in market-oriented systems’
· ‘A patient approach: Putting the consumer at the heart of UK healthcare’
· ‘Diagnosis: Overrated. An analysis of the structural flaws in the NHS’
This article was first published by the International Business Times (IBT).
[1] This is a so-called relative survival rate, which, roughly speaking, means that it strips out those who die with lung cancer, but not because of lung cancer.
Since the streaming of the final series, a cartoon with the (attributed) caption ‘If Breaking Bad had been set in the UK’ has been making the rounds on social media. In the cartoon version, Mr White’s doctor simply informs him that he is entitled to free medical care, and Mr White decides to go continue teaching. Thus, the story ends, or rather, never begins.
The cartoon itself does not actually mention the UK (it just says “anywhere but America edition”). But when it comes to healthcare, there is a tacit consensus in the UK to pretend that there are only two health systems in the world to choose from, namely the NHS and the US system. Therefore the cartoon was quickly recast to be a strident defence of the NHS, with its universal coverage and free access to healthcare.
It is indeed quite conceivable that a British version of Breaking Bad would have been very short. But that is mainly because a British Mr White would probably have died soon after the diagnosis. The UK has the lowest lung cancer survival rate in the developed world. A British lung cancer patients only has a one-in-ten chance of surviving the next five years.[1] Patients in Latvia, Poland, the Czech Republic, Estonia, Slovenia and Slovakia face better odds, and the US survival rate is almost twice as high as the British rate. But forget the US. Survival rates in Italy, the Netherlands, Norway, Australia, Iceland, Sweden, Germany, Switzerland, Belgium, Canada, Austria and South Korea are also more than five percentage points higher than in Britain.
Given how common lung cancer is – about 45,000 new cases are diagnosed each year – a difference in survival rates of a few percentage points can translate into large numbers of lives that could have been saved through better and/or timelier treatment. Had the UK’s lung cancer patients sought treatment in France rather than on the NHS, there would have been almost 1,800 additional survivors. Had they been treated in the Netherlands, another 2,300 people could have survived; had they been treated in Australia, another 2,400 could have, and had they been treated in Switzerland or Germany, it would have been around 3,000.
So in short, yes of course there could be a British version of Breaking Bad. A British Mr White would try to raise money in order to seek treatment abroad.
But if the aim were to shoot a ‘boring’ version of Breaking Bad, one could have set it in, for example, Austria, which has a universal healthcare system, and where the survival rate is about the same as in the US. Unlike the American Mr White, an Austrian Herr Weiß would be protected against the risk of medical bankruptcy, and unlike a British Mr White, an Austrian Herr Weiß would also have a fighting chance of survival. What Austria does not have is state-run health service, nor is healthcare in Austria generally free at the point of use. In hospital care, the private sector – charities and for-profit companies – accounts for a market share of about one third. Co-payments and other forms of patient charges account for about 15% of total health expenditure (there are exemptions for poor people). This is not a free-market system; it is a private-public hybrid system with mixed funding and mixed provision. But still, imagine the howls of outrage that would ensue if a British politician proposed to move even half of the way towards such a system.
However, lung cancer is not a special case, and Austria is not a special case. It is generally true that countries with competitive, pluralistic systems such as Australia, France, Japan, South Korea, the Netherlands, Germany and Switzerland do well across a wide range of health outcome measures. It is also true that countries which have similarly uncompetitive systems, such as Ireland and Finland, often have problems that are similar to the NHS’s.
The smugness of NHS cheerleaders is therefore unwarranted. We should judge healthcare systems by their outcomes, not vague intentions or fluffy ‘founding ideals’. Judged in this way, it turns out that the NHS is a greatly overrated institution.
Dr Kristian Niemietz is the IEA’s Head of Health and Welfare, and a Research Fellow at the Age Endeavour Fellowship (AEF). He is the author of our ‘NHS tetralogy’:
· ‘Health check: The NHS and market reforms’
· ‘What are we afraid of? Universal healthcare in market-oriented systems’
· ‘A patient approach: Putting the consumer at the heart of UK healthcare’
· ‘Diagnosis: Overrated. An analysis of the structural flaws in the NHS’
This article was first published by the International Business Times (IBT).
[1] This is a so-called relative survival rate, which, roughly speaking, means that it strips out those who die with lung cancer, but not because of lung cancer.
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Yes, judging by outcomes (rather than by ‘good intentions’) is critically important. I was telephone-polled over the weekend about ‘Brexit’. The one question I had some difficulty answering was about evaluating David Cameron’s efforts in his negotiations with EU leaders. I applaud the huge efforts he made, but deplore the insignificant results. Cost of inputs: very high; value of output:very low. I dare say his judgement was correct that there was no point ‘raising the bar’ higher in his ‘demands, since I gather that in preliminary discussions he found very little appetite among EU leaders for radical reform. So his argument that Britain would be better off in a reformed Europe is based on a false premise. We are not being offered a ‘reformed’ Europe;
though I hope that after a Brexit we can take a leading role in working with others to achieve just that..