Americans and Britons differ societally in many ways. Perhaps one of the starkest — and most baffling to the British — is the difference in handling health care. To see how perspectives on the British socialized health care system and the United States' largely privatized system have changed over the last 10 years, YouGov asked a series of questions — some old, some new.
Americans' view of the U.S. health care system has grown significantly more positive over the last decade, according to the recent YouGov polling. At the same time, Americans have grown mildly more favorable toward the British health care system. Americans have become a bit more likely to see their health care system as one of the world's best. That's a rarer view across the pond: About half of British people consider the U.S. health care system to be among the world's worst.
Comparing British and American views of each nation's health care system
The British have a nationwide, socialized health care system that is overseen by the U.K. government and primarily funded through taxes. When British residents go to the hospital or a doctor's office through the national system, they are not charged an additional fee for their health care. A relatively small share of the British population purchases voluntary health insurance, which provides supplementary benefits to the nationalized system.
In contrast, the U.S. does not have a national health care system. The American system is insurance-based, which means that health insurance plans are often purchased in a private marketplace by a person or their employer. Depending on an American's plan, they may be charged the partial cost of health care they receive — a co-pay — or be required to pay the full cost until their total outlay for the year exceeds a minimum requirement and insurance benefits kick in.
The British clearly prefer their system. Nearly half of Americans (49%) today have a favorable opinion of the U.S. system, compared to just 9% of British people. In contrast, 78% of British people have a positive perspective of their national health care system, and so do 35% of Americans. About half of Americans have no opinion (47%) on the British health care system, and the share with a negative view is just 19%, meaning the British system has a +16 net favorability in the U.S. — double the American system's +8. Britons have a higher net favorability of their own national health care system than Americans do: They're 62 percentage points more likely to have a favorable than unfavorable view of their system.
Americans' views of their own health care system appear to have improved in the past decade. In a similar YouGov poll from 2012 — conducted as the Supreme Court debated (and before it upheld) the constitutionality of the ACA's individual mandate — a majority of U.S. adults had an unfavorable (57%) view of the U.S. health care system while 34% were favorable. The share of Americans without an opinion on the system (9% then, 11% now) has remained relatively unchanged. American opinion of the British health care system ticked up, with 29% viewing it favorably in 2012 and 35% today. The highest share of Americans — then and now — had no opinion of the British system. (The 2012 poll was of U.S. adults, and the 2022 poll was of adult citizens, which might account for some of the difference.)
How do Americans and Brits think the U.S. system stacks up?
About one-third of Americans (34%) today believe that the U.S. health care system ranks as the world's best or among the best — up 7 percentage points from a YouGov poll conducted in 2014. Just 26% now consider it to be the world's worst or among the worst systems, which is down 9 points from 2014.
While many more Americans have views of their own health care system than of other countries, by one summary of the polling data they have a more favorable view of several other countries' systems than of their own. That summary measure is net scores: the result when subtracting the share that say a health care system is the worst or among the worst from the people who say it is the best or among the best, and not counting people who see a system as about average or don't know. By net scores, Americans are +8 on the U.S. system: 8 percentage points more likely to view it positively than negatively. Americans rank it below the Canadian health care system (+19), the German system (+15), and the British system (+13). The Chinese health care system is the only one of the five polled that Americans are more likely to say is near the bottom than the top of world rankings (-7). On each of the four non-American systems polled, at least one-third of U.S. adult citizens have no opinion of it, with the highest uncertainty level for China (61% said they did not know).
The British view of their own health care system is much more positive than Americans' about the U.S. system A 54% majority of Brits call their system either the world's best (12%) or among the best (42%). They are 46 percentage points more likely to view their own health care system as among the best than as among the worst, higher than the net scores among Britons for the systems in Germany (+37), Canada (+29), and China (-8). The U.S. system scores the lowest for Brits: 46% call it one of the worst in the world, if not the worst. Just one in 10 British adults consider it to be among the best systems, adding up to a paltry net score of -36.
In the U.S., Republicans (50%) are more likely than Democrats (29%) and Independents (28%) to consider the American system either the best or among the best in the world.
By net scores, Democrats give the health care system in each of Canada (+43), Great Britain (+33), Germany (+23), and China (+6) higher net scores than they do the U.S. (-1). Republicans give the system in the U.S. by far the highest net score (+38) of the countries asked about, well ahead of Germany (+5), Canada (-5), the UK (-1), and China (-23).
What do Americans and Britons think about each others' health care systems?
When the 49% of Americans who have a favorable view of the U.S. healthcare system are asked in an open-ended question why they have this opinion, many say that the system is the only one they have known and it works for them. Others say that they had either personally experienced or heard of friends having negative health care outcomes in other countries, and therefore believe the U.S. system is superior. Among the 40% of Americans with unfavorable views of the U.S. system, many cite the lack of transparency in health care costs, a lack of preventative care, and the wide variety of health care outcomes for people without insurance.
The slim 9% share of British people who have a favorable opinion of the U.S. system often cite Americans' access to better medical technology and treatments from the privatized system. Others say that the health care system is good for people who can afford it. The cost of health care in the U.S. comes up as a common caveat even for Brits who view the U.S. system in a positive light. Among the 71% of British people with an unfavorable opinion, many cite how expensive the system is and the share of Americans who cannot afford treatment.
- "I don't really know about health care systems in other countries, but I do know that in my lifetime, I have been fortunate to have great medical care and good providers and am lucky to have paid medical care."
- "As long as I don't have any serious health issues, my insurance appears to cover the majority of my costs."
- "Because it is the best. When rich people around the world need care, where do they go? The U.S."
- "I have almost always received good care from the doctors I've chosen and the few times I've been hospitalized."
- "I have friends using socialized health care and they don't receive the best care and it is not always timely."
- "I have lived in countries with socialized medicine and it is horrible! As of right now, the American system is still competitive although it is heading towards socialized medicine."
- "I've always had great care. Most of my providers have listened to me and taken care of what my needs actually were. Also, I've been able to get in relatively quickly. I like my health insurance; they strive to be easy to work with."
Among the 40% of Americans who have an unfavorable view of the U.S. health care system:
- "Healthcare should be a guaranteed human right. We are paying the most for health care in the world, yet receiving some of the worst results."
- "They always tell us we don’t want government-run health care because we would have to wait too long for services and it would cost too much. In my opinion it would be better. We are already waiting too long for services and it is already too expensive!"
- "ACA removed my ability to choose a plan that fits. It also raised my out-of-pocket expenses greatly."
- "Everything seems designed to obfuscate the true cost of a service, patients have little control in keeping costs down on a visit, and hospitals seem far more preoccupied with collections than treatment. It’s designed to make me worry and think twice about going to the hospital, even if it could save my life."
- "It usually doesn't cover cheaper preventative care, which could prevent people from needing more expensive medical care in the future."
- "I have been in and out of hospitals my whole life and I have had the best doctors and the worst doctors and it’s the luck of the draw pretty much. It shouldn’t be like that."
Among the 9% of Britons who have a favorable view of the U.S. health care system:
- "Even though it costs money and isn’t always accessible, they have a wider variety of teams and specialists available to them and are easily able to move hospitals.
- "It appears to provide good health care but I'm not sure what happens to patients who do not have health insurance."
- "I think that they are up to date with technology, medical advancements, and research, and Americans accept they have to pay for it."
- Because it is privately funded through insurance, patients receive care more quickly; when a consumer pays they expect to get their money’s worth."
- "From what I know, they don’t have the horrendous waiting lists we have."
- "I have known several people who have saved up to get medical treatment in America for cancer and it has saved their lives, however at massive expense. But they could not get the same life-saving treatments here."
- "Their system seems to be more modern and up-to-date. I realise that American citizens have to have insurance to cover their care but when doing so the care is better."
Among the 71% of Britons who have an unfavorable view of the U.S. health care system:
- "A lot of people do not have access to health care because it is too expensive. They have to have insurance, which is often attached to a job, so the poor and unemployed are buggered."
- "Access to the American health care system is not universal; many people don’t have health insurance and are unable to afford treatment."
- "Americans pay more for their health care than in any other developed country, yet receive poorer care and have worse outcomes. They have the worst life expectancy of comparable countries."
- "Americans have to take out loans to cover the cost of their health care which has plunged a lot of them into debt and an endless debt cycle. It shows that the government really doesn’t care about them."
- "I think American insurance companies are ripping off their customers and the system fails a large proportion of their population. Don't become unwell in the USA; you don't stand a chance!"
- "It is capitalism taking advantage of things people cannot help, and it preys the most on disadvantaged people like people with disabilities. It is an obscene way for the rich insurance companies to exploit the general population."
— Taylor Orth and Carl Bialik contributed to this article
Related from 2012: Socialized health care: comparing British and American attitudes
This poll was conducted on July 22 - 25, 2022, among 1,000 U.S. adult citizens in the United States and on July 21 - 22, 2022 among 1,692 Great Britain adults. Explore more on the methodology and data for these polls.
Image: Adobe Stock (Blue Planet Studio)