The Affordable Care Act (ACA) or ObamaCare: A Prelude to a Socialized Healthcare Insurance System?

Healthcare has advanced in significant ways across the developed world. Medical care has advanced and investment in equipment and drugs has delivered unprecedented gains.  The quality of life and expectancy have been enhanced and treatments are safer and more effective than ever before.  The rapid growth of medical knowledge and technology made it harder for doctors and other healthcare providers to keep up to date. Virtually healthcare in every country in the world is now heavily influenced by government policy, in which professional monopoly of supply and strict top-down regulation is being fostered. In the United States, the Affordable Care Act (ACA) or ObamaCare might be the prelude to this country’s health insurance system in becoming a socialized system, similar to some European country, like the United Kingdom (UK).

The healthcare of the UK is a system that is heavily influenced by its government’s policy. Using the Donabedian Model as a framework, this paper’s focus is to provide information regarding UK’s health care system and the issues impacting its delivery in the form of rationing and waiting times. In addition, a comparison between UK’s healthcare system with that of the U.S. healthcare system will discussed and it will come in four installments. The Donabedian model is a framework for measuring quality of care developed by Avedis Donabedian in the 1980’s. Keys to his work are the concepts of quality assessment and quality assurance displayed through three ways of approach: structure, process, and outcome (Donabedian, 2003). 

United Kingdom Overview

England has been in existence and an entity unified since the 10th century.  The union between England and Wales begun in 1284 with the Statute of Rhuddlan and the union was formalized in 1536.  Scotland agreed to permanently join England to form a nation called Great Britain through the Act of Union in 1707.  Ireland joined Great Britain in 1801.  The union was named the United Kingdom of Great Britain and Ireland.  In 1921, the Anglo-Irish treaty has formalized the partition of Ireland.  Six northern Irish counties remained as part of the United Kingdom (Northern Ireland) .  Altogether, the formal  and current name  (officially adopted in 1927) is the United Kingdom of Great Britain and Northern Ireland (CIA , 2010).


The United Kingdom is a constitutional monarchy governed by two houses of representatives, the democratically elected members of the parliament (MPs) of the House of Commons and the hereditary and life peers of the House of Lords (Dixon & Robinson, 2002).  The chief of state is Queen Elizabeth II (since February 6, 1952) and the heir apparent is Prince Charles (the queen’s first son). The Prime Minister is the leader of the majority party and the thus appoints the cabinet of ministers.  The current Prime Minister is David Cameron and has been since May 11, 2010 (CIA, 2010).


At one point in time in the 19th century, the British Empire stretched to over one-fourth of the world.  Because of its involvement in two World Wars, UK’s domination has dwindled down in the first half of the 20th century.   UK rebuilt itself in the in the second half of the 20th century, dismantled the Empire in the process, and has become a modern and prosperous European Union (EU) member. Although an active member of EU, it chose to remain outside the Economic and Monetary Union.

Estimate of UK’s gross domestic product (GDP) in 2009 is $2,149 trillion (U.S. Dollars) as per CIA (2010).  Services, especially banking, insurance, and business services, account by far for the largest proportion of GDP.  UK went through a period of recession, recovered from it in 1992 and its growth has outpaced most of Western Europe nations.  In 2008, UK’s economy was hit hard by global financial crisis, pushing the economy into recession.  The last Prime Minister Brown, was forced to nationalize part of UK’s banking system, cutting taxes, suspending public sector borrowing rules, and moving forward with public spending (Dixon & Robinson, 2002; CIA, 2010).

United Kingdom’s Healthcare Overview

  The United Kingdom consists of four constituent countries – England, Scotland, Wales and Northern Ireland.  In all countries, healthcare is predominantly funded through national taxation.  The responsibility for purchasing health services is being devolved to local bodies: Primary Care Trusts in England, Health Boards in Scotland, local health groups in Wales, and Primary Care partnerships in Northern Ireland.   Hospitals are mainly owned by the public while private hospitals only provide for services to those who are insured privately and to those who elect to pay directly.   General Practitioners (GPs) are the gatekeepers for the primary care services.   As of 2007, UK’s percentage of GDP spent on healthcare is at 8.4 percent, up from 6.9 percent in 1997.  All national residents of the UK are entitled to cover under the UK National Health Service [NHS] (CIA, 2010).

The National Health Service (NHS) came into operation in 1948 following the provisions of NHS Act of 1946. NHS was implemented to provide health care for all of its citizens without regard for their ability to pay for services. The particular health care system that emerged in Britain was not a product of socialist ideology or deliberate policy but was instead a matter of wartime necessity.  During the war, the government began the national Emergency Medical Service to supplement the local services. Existing hospitals were surveyed and the survey revealed that essential services were missing or severely inadequate.  There were no laboratories, X-ray facilities, ambulances, care for fractures, and head injuries. The Ministry of Health was forced to upgrade the system and it became evident that a national system of health was necessary with nationally run hospitals, salaried doctors and free care for everyone (Dixon & Robinson, 2002).

The implementation of NHS was not without objections. Most notable objection was from The Royal Colleges, the professional bodies that represent different medical specialties led by consultants (specialists) and GPs who were afraid of losing their autonomy.  They did not approved of bureaucratic interference and were especially concerned of proposals that would have placed health service under local government governance.   It took skillful negotiations from the Minister of Health, Aneurin Bevan, to obtain support of a government run NHS with a number of concessions to demands for professional autonomy.   These conditions remained largely unchanged today, GPS were allowed to become independent contractors within NHS, while specialists (although salaried employees) were given the right to private practice alongside their work with NHS (OECD, 2000).