Is it broken?

LONDON – When Penny Campbell fell ill after a routine surgery in March 2005, the 41-year-old mother did what many Britons are instructed to do to avoid clogging the country’s emergency rooms: She called a telephone help line staffed by doctors.

With worsening symptoms over the next four days, Campbell spoke to six doctors and saw two in person. When she was finally diagnosed with a blood infection, it was too late: Hours later, Campbell died from multiorgan failure.

A government report blames a “major systems failure” in the socialized health service’s ability to access care outside doctors’ normal working hours. The case stands in contrast to the praise lavished on Europe’s socialized health systems in Michael Moore’s new documentary, “Sicko.”

Yet Europeans remain largely convinced that while their health systems may be plagued with problems, they are still superior to what is available across the Atlantic. Here, free health care for all is a deeply rooted value.

“I wouldn’t want Penny’s case to be used as evidence that the National Health Service’s core principles are wrong,” said Angus MacKinnon, Campbell’s partner. “What we have in Britain is still a hundred times better than America.”

MacKinnon is convinced that what happened to Campbell is the fate of countless poor people in the U.S.

In Britain, “in one very important area of primary health care, things have obviously gone very badly wrong,” said MacKinnon. “But I am still very wedded to the idea of free health care, unlike what you see in America.”

A tripling of British government spending on health care in over the last decade to $187 billion (about $3,000 per person) has meant that patients are treated quicker. In the late 1990s, they routinely waited six months or more for nonessential operations. That wait has now dropped to about six weeks.

“The NHS provides a more uniform standard of care to everyone in Britain, so we get much better value for our money than the Americans,” said Dr. Brian Edwards, emeritus professor of health care development at the University of Sheffield.

By comparison, the United States spent $2.1 trillion, or about $7,000 per person, on health care in 2006, according to the Department of Health and Human Services.

Few deny that Britain’s health care system needs a lot of fixing. Nearly one million people are on treatment waiting lists, run-down hospitals from the 19th century need overhauls, and financial strains sometimes mean routine operations are suspended for months. Private health care is also booming; about 15 percent of the population now opts to pay for medical care.

Superbug infection rates have skyrocketed. In the 1990s, only five percent of in-hospital blood infections were MRSA, the deadly bacteria resistant to nearly every available antibiotic. In past years, that figure has jumped to more than 40 percent. Critics blame the rise on overstretched hospitals that do not have enough money or capacity to catch superbug infections early.

Access to lifesaving drugs across Britain can also depend on where patients live. Decisions on which drugs to buy are made by local authorities so that cancer drugs approved in one part of the country may not be available in another. That has led to what critics call ZIP code lotteries.

“The NHS is full of inequity,” said Dr. Karol Sikora, a professor of cancer medicine at London’s Hammersmith Hospital. “Whether or not you get cancer drugs to save your life can come down to where you live.”

France is considerably more generous on health care, spending about double what Britain does on cancer drugs – $1.8 billion a year. Expensive new drugs are paid for out of a central budget in France, sparing local authorities the need to pick between competing priorities.

In a report analyzing health care systems worldwide in 2000, the World Health Organization rated France as having the world’s best. Patients from across Europe regularly travel to France for treatment.

But France has its problems too. Critics say the system is wasteful, corrupt, and leaves patients waiting too long for treatment.

In the past several years, France has suffered a rash of highly publicized problems with its radiation treatment facilities, some of which have lead to deaths.

Still, free medical care is available to all EU citizens and anyone with a French residency permit. Even illegal immigrants have the right to special health care cards.

In Britain, about eight to 10 percent of taxpayers’ income goes toward the national insurance policy, including health services. And in France, up to 20 percent of taxpayers’ salaries goes into socialized health care.

Faced with mounting health care costs, Britain’s NHS is regularly advised on the cost-effectiveness of drugs by an independent body that regulates the use of prescription drugs. Last week, the body was sued by pharmaceutical companies and Alzheimer’s groups seeking to force the government to provide all patients access to three drug treatments for the brain-destroying disease.

Despite its problems, experts say the British model still works and that even the breakdown that led to Campbell’s death could be easily fixed.

“All you would really need to do is ask general practitioners to stay later in the evenings and open earlier in the mornings,” said Edwards. “If we think this is important, then it can be done quickly.”

After a government inquiry that condemned the systemic mistakes that led to Campbell’s death, Gordon Brown, then treasury chief and now prime minister, admitted that measures were needed to improve after-hours doctor availability.

“Penny’s death is a very good example of how creaky around the edges the NHS is, but it’s still doing well in carrying out its core functions,” said MacKinnon.

While the British acknowledge that their health care system is far from perfect, they maintain that its underlying principles are worth preserving. Most also say that the American system works just fine – except for the millions who are uninsured.

“Even if you are a refugee, there is nobody who cannot access health care in the U.K.,” said Edwards. “That is one of our biggest strengths. There is absolutely nobody outside the system.”