The urgent lessons the US must learn from the British system's scandalous failures.
There is more than a little irony attached to the Obama administration's determination to pursue socialist, EU-style "solutions" to America's problems, even as the European Union is coming to grips with the bitter realities such socialism produces. And while Greece and its financial problems receive some media coverage in the United States, there is a much bigger story flying under the mainstream media radar: in Britain, Prime Minister David Cameron has introduced a bill seeking to partially privatize the National Health Service (NHS). Why? Because the British government is "hoping to avoid a Greek-style financial meltdown."
The system's defenders are upset. The Times of London is reporting that Health Secretary Andrew Lansley is in the eye of the storm. “Andrew Lansley should be taken out and shot," said an unnamed "Downing Street source." "He’s messed up both the communication and the substance of the policy.” The source further contended that Lansley was “a disaster” and “a law unto himself.” The British Medical Association and the Royal College of Nursing also want the bill withdrawn, as do members of the Royal College of Pediatrics and Child Health, the Royal Medical Colleges, including the Royal College of GPs. Unions, including the Royal College of Midwives, want to "kill the bill" as well, while Labor Party leader Ed Miliband accused Mr. Cameron of failing to listen to the experts.
Cameron refuses to back down, insisting there's too much bureaucracy in the system, and that it interferes with patient care. "If we were as good at treating cancer as the average European country, we would save 5,000 lives a year," he contended. He further noted that reform will create "a fair system that stops the private sector from picking off contracts and the public sector from providing an inflexible monopoly." Yet he insisted that "health care for all, free at the point of use, unrelated to the ability to pay" will remain the animating features of the system.
Such euphemisms are at odds with reality. Last November, the NHS's Hinchingbrooke Hospital in Cambridgeshire, running at a loss of $8 million a year on revenues of $143 million, was given over to Circle, a private health care company. Circle was brought in to cut bureaucracy and improve efficiency, and it is the first private company to take over an entire British hospital. Earlier this month, an NHS "watchdog" at the National Institute for Health and Clinical Excellence (NICE) ruled that a breakthrough drug used to extend the lives of men with late-stage prostate cancer was too expensive to be included in the system. NICE makes calculations based on the "cost of the drug to the NHS according to the number of men likely to be treated." NICE will pay for some end-of-life drugs for rare diseases. But the current, though unofficial, threshold for QALY (quality-adjusted life year) drugs has been $80,000 for renal cell carcinoma. "Therefore the £63,200 ($101,000) cost per QALY for abiraterone would still not be deemed a cost effective use of NHS resources," said a NICE statement.
Such rationing--and it is rationing--is nothing new. A 2011 report revealed that independent medical providers were experiencing a growing number of patients choosing to pay for their own care after having treatment delayed or denied altogether by an NHS primary care trust (PCT). A survey of 101 influential industry figures revealed that 34 percent believed "budgetary pressure in the NHS" was the principle cause. At the annual meeting of the Chartered Society of Physiotherapy (CSP) earlier this month, members contended that they were "increasingly being asked to make decisions based on financial rather than clinical reasons and to ration their care," further noting that such rationing "was on a scale that had never been seen before across both acute and non acute NHS services."
Last November, such rationing reached a scandalous level. A study by the Co-operation and Competition Panel (CCP) revealed that Primary Care Trust (PCT) heads were imposing arbitrary spending caps, denying patients treatment for procedures such as hip replacements and cataract removals--and that waiting times for services were being deliberately extended "so that patients would go private or die before they were seen" to slash costs. Secretary Lansley was furious. "For too long, Labour turned a blind eye to unfair practices within the NHS which harmed patients," he said. "No right-thinking person could possibly understand how anyone could delay a patient's treatment unnecessarily. If patients need treatment, they should get it as soon as possible, and where they choose."
"As soon as possible" is yet another euphemism. Brits have a legal right under the NHS Constitution to start their hospital treatment--within 18 weeks after a referral by a GP. Yet referrals require diagnoses, and the wait for those is increasing as well. The Guardian reports a 92 percent increase compared to last year in the number of people waiting more than the NHS's recommended six-weeks for a diagnostic test at an NHS hospital. In other words, even under optimum conditions, people suffering from afflictions such as heart disease and cancer will face more than a five-and-a-half month wait before getting the treatment they need.
Such waiting times have their consequences. A London School of Hygiene and Tropical Medicine study released last June revealed that British women have the lowest breast cancer survival rate among Europe's richest nations. Furthermore, cancer survival rates in general continue to lag behind other EU nations, despite ten years of efforts to improve them. And for some cancers, such as lung cancer, the gap is actually widening.
All of the above is what is currently driving David Cameron towards outsourcing medical services to private providers. He has convened a healthcare summit taking place today, and he is currently under attack for not inviting several of the professional medical societies and other health workers to the meeting. In a bit of unintended irony, left-wing newspaper The Guardian has a headline claiming the Health and Social Care Bill currently under consideration will spell the end of "health care services as we know it." Shadow Health Minister (the opposition party's counterweight to the acting Health Secretary) Andrew Gwynne is apoplectic, noting that no national healthcare standards could lead to "variations in every part of the country in terms of what care you actually receive," that Brits "could even find ourselves in the horrendous situation of people having to pay for services that are completely free in other areas," and that reform will take the country back to the "failed free-market ideology of the 1980s..."
Better to be equally miserable, apparently.
UK healthcare costs are currently $194 billion per year and consume 18 percent of the UK's budget. The projected "cuts" in spending for 2013 that have people up in arms? As of now, a $6 billion increase in spending to $200 billion. Much of the animus likely stems from the fact that Britain has grown used to massive amounts of healthcare spending that can no longer be sustained: between 2000 and 2010, the NHS budget doubled in real terms. Furthermore, British debt as a percentage of GDP was almost 80 percent in 2010.
Which brings us across the pond, so to speak, where America's debt level reached 102 percent of GDP last year, long before the full effects--and true costs--of our own stab at government-run healthcare have yet to be realized. Joseph A. Morris, a former Reagan White House lawyer who now serves on the board of the American Conservative Union, explains what Americans should infer from Britain's travails. “Europe’s message to the world is no longer that the socialist dream of the cradle-to-grave welfare state is an easy achievement,” he said. “Rather, it is the shouted warning that it is a fool’s paradise. The bills are coming due and the only real alternatives--serious financial reform of government or national bankruptcy--are not pleasant.”
The president isn't listening. The total dismissal of such "unpleasantness" was epitomized by Mr. Obama's release of a $3.8 trillion budget, a document so unserious that Senate Leader Harry Reid won't even bring it up for a vote this year. As for the "revenue-neutral" healthcare bill this administration has long touted, the Heritage Foundation found $700 billion in additional, guaranteed costs. As for "unanticipated costs" (progressive-speak for costs that should be anticipated)? If a large number of businesses choose to cancel coverage and dump their employees into the public exchanges, another one trillion dollars could be added to the cost of the bill. Furthermore, it must be noted that one part of it, the CLASS Act, has already been dumped, due to its fiscal unsustainability.
So why would we continue to pursue such an approach to healthcare, even as the latest cautionary tale from the European Union emerges? Sally Pipes, an American health policy expert who leads the Pacific Research Institute in San Francisco put it best. "They [President Barack Obama, Senate Majority Leader Harry Reid, and House Minority Leader Nancy Pelosi] are ideologues,” said Pipes. “They don’t care whether the system really works or not. They have an ideological goal in mind.” One this troika seems doggedly determined to pursue, even if it drives the country bankrupt in the process.
That's not ideology. That's insanity.
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