Casa · B2 Upper Intermediate · Lesson 14 of 20 · Step 2

Health Systems

Healthcare access and ellipsis and substitution

Use ellipsis and substitution to avoid repetition in conversation
Produce structures such as 'So do I', 'Neither can she', 'I think so', 'I hope not'
Discuss healthcare systems, access, and public health policy

Words · tap a card to see it used

Grammar

Ellipsis and substitution

To avoid repetition, English uses ellipsis (leaving words out) and substitution (replacing words with shorter forms). Agreement: 'So do I' / 'So can she' (positive). 'Neither do I' / 'Neither can she' (negative). Substitution with 'so', 'not': 'I think so', 'I hope not', 'I'm afraid so', 'I suppose not'. With 'one/ones': 'I'd like the blue one.'

'I support universal healthcare.' — 'So do I.'

'She can't afford private insurance.' — 'Neither can he.'

'Do you think the policy will change?' — 'I hope so.'

'Will the waiting times get worse?' — 'I hope not.'

Exercises · type, then check

1. Complete each response using an appropriate ellipsis or substitution structure.

1.'I believe healthcare should be free.' — ' do I.'

2.'She doesn't have health insurance.' — ' does he.'

3.'Do you think the hospital will close?' — 'I hope .'

4.'Will the government increase funding?' — 'I think .'

5.'I can't understand this medical report.' — 'Neither I.'

2. Choose the correct response.

1. 'I've never been to a private hospital.' — '___'

2. 'She thinks the system needs reform.' — '___'

3. 'Will the new policy help patients?' — '___'

4. 'I can't afford the treatment.' — '___'

5. 'Do you think waiting times will improve?' — '___'

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Reading

Two Systems, One Goal

The United Kingdom and the United States take fundamentally different approaches to healthcare. The UK's National Health Service provides universal coverage funded through taxation. Citizens do not pay at the point of care, and neither do long-term residents. The US, by contrast, relies heavily on private insurance. Many Americans believe the system encourages innovation, and some economists think so too. However, critics point to the millions who lack coverage and say that a wealthy nation should not tolerate such disparity. Supporters of the UK model argue that universal access reduces long-term costs because preventive care catches problems early. Opponents worry about long waiting times, and some patients think so too. The pandemic tested both systems severely. Hospitals in both countries faced triage crises, and neither system proved immune to overwhelm. Whether a nation should prioritise universal access or market-driven efficiency remains one of the great policy debates of our time. Most health professionals hope the answer lies somewhere in between — and so do many citizens.

1. What is the fundamental difference between the UK and US healthcare systems described in the passage?

2. How did the pandemic affect both systems?

Speaking · say it out loud, with a partner or alone

1Debate: 'Healthcare is a human right, not a privilege.' One partner argues for, the other against. Use ellipsis and substitution in your responses (e.g., 'So do I', 'I think so').

2Discuss: What are the advantages and disadvantages of universal healthcare? Do you think your country's system works well? Why or why not?

Writing

Write a dialogue (10–12 exchanges) between two people who disagree about how healthcare should be funded. Use at least four examples of ellipsis or substitution (e.g., 'So do I', 'I hope not', 'Neither can we').

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Finished?

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