US takes aim at the UK’s National Health Service

There are fears a US-UK trade deal could open the NHS up for privatization and raise drug prices.

Few issues trigger such a national outcry in the U.K. than attacks on the country’s sacred National Health Service.

Yet the U.S. has chosen that fight.

U.S. President Donald Trump on Tuesday said that everything including the NHS would be on the table in a trade deal with the U.K.

In a press conference with Prime Minister Theresa May, Trump said: “I think we’re going to have a great and comprehensive trade deal.” When asked if this would include the NHS, he said: “When you’re dealing in trade everything’s on the table, so NHS or anything else… but everything will be on the table, absolutely."

May responded quickly to state: “The point about making trade deals is of course that both sides negotiate and come to agreement about what should or should not be in that trade deal for the future,” she said.

“A trade agreement with the United States will not force the U.K. government to privatize any service" — US official

Health Secretary Matt Hancock, who has thrown his hat into the Tory leadership contest, tweeted in response to Trump’s statement: “Dear Mr President. The NHS isn’t on the table in trade talks — and never will be. Not on my watch.”

Ahead of Trump’s state visit, U.S. Ambassador to the U.K. Woody Johnson said a post-Brexit trade deal would require giving the U.S. access to the U.K.'s health sector.

Cue the health secretary, foreign secretary, other politicians and numerous health care organizations coming out in defense of the U.K.’s social health care system and the need to protect it from U.S. privatization.

But with American companies already providing some services in the NHS, what does the U.S. actually want?

Matt Hancock, the U.K.'s health secretary | Isabel Infantes/AFP via Getty Images

There are a couple of issues at play here. Brits fear more American companies bidding to provide health care services in the U.K. will lead to privatization of the NHS. But American companies can and do already bid to provide NHS services. Like all firms, they need a local subsidiary and must be registered with the care watchdog, the Care Quality Commission.

They are also working with the NHS in other ways: HCA (Health Corporation America) is a big U.S. firm running some private services from NHS hospitals and in return providing extra beds, for example.

However, it seems few U.S. companies are aware of these opportunities, in part because the rules around tendering are so complicated and opaque, according to Catherine Davies, managing partner at health care advisory consultancy Monticle.

There are fears a U.S. trade deal would shine a light on the issue, and American companies could sue the NHS if services are not put out to tender; fears that played out in the U.K. as the EU sought to secure a trade deal with the U.S. in 2016.

Niall Dickson, head of NHS Confederation, representing NHS managers and providers, said Americans are pushing for access to the NHS because they “don’t understand the social health care system.” He told the BBC Radio 4 "Today" program this morning that privatization won’t happen. “I think it is a fuss about nothing,” he said.

A U.S. official told POLITICO: “A trade agreement with the United States will not force the U.K. government to privatize any service, or prevent the U.K. government from expanding the range of services it supplies to the public."

A woman holds a copy of the "The NHS Long Term Plan" booklet | Anthony Devlin/AFP via Getty Images

The second issue concerns U.S. pharmaceutical companies failing to get their products approved for NHS reimbursement (like Vertex and its cystic fibrosis drugs). Britons fear that U.S. meddling in processes that limit the amount the NHS pays for medicines — health technology assessments that compare the added benefit of drugs versus their cost before paying out — could hit the U.K.’s drugs bill hard.

Many other countries have also either copied the U.K. or directly rely on Britain’s assessments for their own decisions on state-financed drug reimbursements.

“The U.S. has long taken issue with the fact that the NHS’s approach to drug procurement… pulls down prices worldwide,” said Sam Lowe, senior research fellow at the Centre for European Reform, in an op-ed.

“The U.S. wants to put this issue on the table" — Holger Hestermeyer, trade lawyer at King’s College London

The U.S.’s objectives for a U.K. trade deal published in February explicitly mention the U.S. would “seek standards to ensure that government regulatory reimbursement regimes … provide procedural fairness … and provide full market access for U.S. products.”