Fact Check: Trump’s Criticism of U.K.’s National Health Service

LONDON — In a tweet on Monday, President Donald Trump claimed that thousands of people in Britain were marching because their country’s National Health Service was “going broke and not working,” and that Democrats pushing for universal health care in the United States were pursuing a similar failed model.

Here is a closer look at his claims.

The National Health Service is certainly being stretched.

Since the start of this decade, budgetary austerity has kept annual growth in health spending at around 1.2 percent (adjusted for inflation) — significantly less than the 4 percent increases that were the historic norm.

Patients often wait months, even for essential procedures. Waiting rooms in doctors’ offices and in hospitals are often crowded.

Such crowding — and in particular immigrants’ use of the health system — was cited as a factor by some voters in Britain’s June 2016 referendum to leave the European Union. But paradoxically, the plans for that “Brexit” may have made the situation worse: Fearing that they will not have a long-term future in Britain, many skilled health workers, particularly nurses, have left the country, exacerbating staff shortages.

Meanwhile, strains on the system have been worsened by an unusually strong flu outbreak this winter that forced hospitals to cancel many elective procedures and, in some cases, delay surgeries for patients with life-threatening conditions like cancer and heart disease.

A shortage of beds has also resulted in delays to emergency services, with some patients waiting up to 12 hours in emergency wards before being seen.

Not at all. In fact, the thousands who marched in London on Saturday were there not to criticize the health service, but to urge the government to support it and give it greater funding to cope with the winter crisis.

Protesters carried banners with messages like “More Staff, More Beds, More Funds” and “Saving Lives Costs Money, Saving Money Costs Lives.” They chanted, “Keep your hands off our NHS.”

Created in 1948 during a bleak period after World War II, the National Health Service is seen as one of Britain’s most cherished institutions — a greater source of pride, according to some polls, than even the monarchy.

The service is known for its simplicity: It is free at the point of use to anyone who needs it. Paperwork is minimal, and most patients never see a bill. Almost no one in Britain is bankrupted by medical expenses, no one needs to delay medical treatment until they can afford it, and virtually everyone is covered.

To take one crucial measure, the United States spends more than all other rich nations on health care, but with decidedly mixed outcomes. According to the latest data from the Organization for Economic Cooperation and Development, the U.S. spent 17.2 percent of its economic output on health care in 2016, compared with 9.7 percent in Britain. Yet Britain has a higher life expectancy at birth and lower infant mortality.

Many observers noted that Trump wrote his Twitter post less than an hour after Nigel Farage — the former leader of the populist U.K. Independence Party and an ally of Trump — appeared on a Fox News program and claimed that the pressures faced by the NHS were caused by immigration.

“The big problem we’ve got is a population crisis caused by government policy on immigration,” Farage said. “We have a population of 65 million, but it’s increasing by half a million people a year. We just haven’t got enough hospitals, we haven’t got enough doctors, we haven’t got enough facilities.”

Farage also warned that if the United States introduced a universal health care system, it would become “politically impossible” to return to a private system or reduce the benefits.

“Let’s be in no doubt we’ve got a big problem, a really big problem with the NHS,” he said.

Britain’s political leaders were quick to answer Trump. Prime Minister Theresa May said she was “proud” of the service, and Health Secretary Jeremy Hunt, also a member of her governing Conservative Party, responded on Twitter by criticizing America’s health care system for not covering all of its citizens.

It depends. Many Americans — Democrats and Republicans alike — talk about support for “universal health care,” but that term usually refers to universal health insurance coverage, and there are competing visions of how to achieve that goal.

Public support for a single-payer system — one in which the government pays medical bills — has been growing, and politicians on the left like Sen. Bernie Sanders have urged American to “join every industrialized country and guarantee health care to all Americans as a right.” (The United States does have a single-payer system, Medicare, for Americans over 65.) Polls show that a plurality, but not a majority, favor such a system.

Before the Affordable Care Act was enacted in 2010, President Barack Obama expressed sympathy for the single-payer approach, but he ultimately went for a complex system of tax credits and legislative and spending changes to expand insurance coverage — bringing down the number of uninsured to 28 million in 2016, from more than 48 million in 2010.

Although a Republican effort to repeal the law failed last summer, the system remains on shaky ground. The Republican-led Congress recently rescinded the part of the law that requires individuals to hold health insurance, but companies with more than 50 people are still required to offer coverage for their workers.

For now, the system of subsidy payments to help low-income Americans get coverage remains intact, as does the system of exchanges from which people not covered through their employers can shop for a health plan.

Trump may have had a point — that many British people are unhappy with their National Health Service — but not one that supports his overall view.

Most British people want more funding to shore up their single-payer system, and support for getting rid of it is negligible.