STIFF upper lip is not a medically recognised condition, but it seems to be endemic among British patients. The National Health Service (NHS) is one of the most poorly financed medical systems in the western world, with some of the longest waiting times for hip replacements and other “elective” treatments. Yet a new survey, conducted by Robert Blendon at the Harvard University School of Public Health, and the New York-based Commonwealth Fund, suggests that the British are much less unhappy with their health service than Americans, and see little reason to redesign their health-care system.

The study asked 1,000 adults in Britain, Australia, Canada, New Zealand and the United States about the accessibility, affordability and quality of their national health-care systems. All five countries have rejigged their medical services and reined in their spending over the past decade, trying to cope with the rising costs of high-tech treatment and an ageing population. Britain, Canada, Australia and New Zealand have chosen to stick to largely state-financed health systems; America has stuck with a largely private system—with almost three-fifths of its population covered by private health insurance (and more than a sixth with no coverage at all).

Britain spends a mere $1,347 per person on health care; America, $4,090. But as the poll shows, money can't buy you love: about a third of Americans and Australians think their health-care systems need radical reform, while only 14% of British people feel the NHS could do with major reconstructive surgery (see chart).

Moreover, the British are more confident of their future access to medical care than the patients of any of the other state-financed systems, and certainly a lot more confident than the 65% of uninsured Americans in the survey who fear for their future. Nor can money buy you much health. Although the United States spends 13.6% of its GDP on healthcare, its citizens do not live any longer, nor its infants thrive any better, than the British who spend a measly 6.7% of GDP.

It is ironic that American managed care, with its business-like emphasis on customer satisfaction, does a worse job of pleasing health-care consumers than the take-it-or-leave-it NHS. But perhaps not that surprising. Satisfaction is, after all, a child of expectation. Many Americans remember a time before the new emphasis on “managed care” schemes, when medicine was not so strictly rationed, and long for a return. But most British people have known nothing other than the NHS; as a result, they expect nothing more. Only 15% of British patients rate their treatment as excellent—while between a fifth and a quarter of respondents in the other countries reckoned they got top-notch treatment. Despite the NHS's solid showing in the Commonwealth Fund survey, British officials should remember that it is only a murmur, and not a roar, of approval they hear.