Britain’s NHS to “decentralize,” cut services

posted at 2:20 pm on July 26, 2010 by Ed Morrissey

The last two days have brought contradictory and enlightening news about the favorite medical system of new CMS head Donald Berwick.  Over the weekend, the New York Times reported that Britain’s National Health Service would “decentralize,” a statement that some misunderstood as an end to the single-payer aspect of the system.  Instead of using committees to determine the use of resources, the new strategy proposes to put those decisions in the hands of general practitioners and patients:

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”

The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.

This plan does not transform the NHS into anything else but a single-payer system.  English citizens still have to get their health care from the government.  However, the plan removes the rationing boards that have clogged the decision-making process and allows GPs and their patients to decide on the best course of treatment.

While that sounds great, it’s a recipe for disaster.  In a closed system like single-payer, the resources are necessarily limited.  This will increase demand while doing nothing to increase resources, which will create a deficit bomb bigger than anything already at NHS.  That’s probably why another shoe dropped yesterday at NHS:

An investigation by The Sunday Telegraph has uncovered widespread cuts planned across the NHS, many of which have already been agreed by senior health service officials. They include:

* Restrictions on some of the most basic and common operations, including hip and knee replacements, cataract surgery and orthodontic procedures.

* Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, with dying cancer patients to be told to manage their own symptoms if their condition worsens at evenings or weekends.

* The closure of nursing homes for the elderly.

* A reduction in acute hospital beds, including those for the mentally ill, with targets to discourage GPs from sending patients to hospitals and reduce the number of people using accident and emergency departments.

* Tighter rationing of NHS funding for IVF treatment, and for surgery for obesity.

* Thousands of job losses at NHS hospitals, including 500 staff to go at a trust where cancer patients recently suffered delays in diagnosis and treatment because of staff shortages.

* Cost-cutting programmes in paediatric and maternity services, care of the elderly and services that provide respite breaks to long-term carers.

Dr. Donald Berwick proclaimed NHS a “treasure,” a comment that Republicans in Congress wanted to explore in Berwick’s confirmation hearing.  What would Berwick do under the pressures at NHS today, if such a crisis hit Medicare and Medicaid?  It’s no secret that both are facing these kinds of cost and resource issues.  Simply demanding more money won’t work, as the UK has discovered after sixty years of single-payer health care.

The best way to get pricing and cost equilibrium in the health-care market is to use competition and free-market economics.  That doesn’t mean the status quo ante ObamaCare, but an elimination of tax credits that favor third-party payers for routine care and the promotion of HSAs and full retail clinic pricing.  Until that happens, the governmental burdens will continue to create artificial shortages, and will mean higher costs, more government intrusion in our lives, and less accountability.


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Looks like that treasure that Obama, Berwick, and the rest of the Progressives thought they had found turned out to be nothing but fool’s gold.

kingsjester on July 26, 2010 at 2:23 PM

You know that movie? The one where the train is racing toward the guy, and instead of stepping to the side he runs down the tracks. I feel like we are that guy.

WitchDoctor on July 26, 2010 at 2:25 PM

Wake up America, before it’s too late.

Laura in Maryland on July 26, 2010 at 2:27 PM

Why in the world would you want to put a doctor in charge of a medical decision???

/libtard

CurtZHP on July 26, 2010 at 2:27 PM

That was basically the game plan in Canada. The then-Finance Minister, Paul Martin, aka Dithers, cut the federal money that trickled through to the provinces and then pointed the finger of blame for the results at the provincial politicians as the queues lengthened.

When the government oversees such a system, costs will inevitably go out of control, and the government is eventually required to make draconian cuts. Who’s stuck with both the horrendous tax bills and the horrendous waiting lists? Obvious.

In that kind of system, everybody’s in the charity ward.

Drained Brain on July 26, 2010 at 2:27 PM

I love government solutions to problems caused by government.

WashJeff on July 26, 2010 at 2:28 PM

WitchDoctor on July 26, 2010 at 2:25 PM

Don’t look back they may be gaining on you…

right2bright on July 26, 2010 at 2:28 PM

Treasures get plundered all the time…

Wyznowski on July 26, 2010 at 2:31 PM

Until that happens, the governmental burdens will continue to create artificial shortages, and will mean higher costs, more government intrusion in our lives, and less accountability.

I don’t think that these facts dissaude these folks from pursuing their socialist utopia. They justify it as an experiment, that we’ve already tried capitalism, we just haven’t had the “right people” do socialism yet. So, if we try it and it fails, then it fails, but it wasn’t because of us.
/typical leftie pedestrian thinker.

ted c on July 26, 2010 at 2:32 PM

A free round of DEATH PANELS for the whole bar, and a Shirley Temple for Barry.

portlandon on July 26, 2010 at 2:34 PM

I didn’t hear about this on any of the cables. It must be racist.

faraway on July 26, 2010 at 2:36 PM

But…but…our Progressives are smarter that Britain’s. Just ask them.

kingsjester on July 26, 2010 at 2:38 PM

I thought single payer was going to save this great nation? I’m so disillusioned.

ladyingray on July 26, 2010 at 2:39 PM

I can’t wait to see all that money we’re going to save here….surely, we can do it right….////

ted c on July 26, 2010 at 2:44 PM

Really OT, Ed, but this oil spill news is really important. The politicization continues by ObaMao until 2012 if need be. (I sent a tips on this one.)
http://spectator.org/archives/2010/07/26/obamas-gulf-drill

onlineanalyst on July 26, 2010 at 2:45 PM

I think the brits finally relaized they have jacked their system up so much that it was destined to fail at some point in the very near future. And now the government is getting out of the process so they can lay the blame squarely in the doctors/hospitals lap. It’s gonna get ugly rather quickly I would think. I can see some terminally ill patients with nothing to lose being denied care on the weekend(s) making a “political” statement or two.

Johnnyreb on July 26, 2010 at 2:48 PM

News from the future!

lorien1973 on July 26, 2010 at 2:51 PM

But…but…our Progressives are smarter that Britain’s. Just ask them.
kingsjester on July 26, 2010 at 2:38 PM

That would seem to be the only argument the Neo-Progressive Socialists have left around here.

They’ve lost the Racism argument electing Obama more because of his skin color than character (or experience) and more and more people realize that the second word in Nationalsozialistische Deutsche Arbeiterpartei is Socialist – that a majority of likely voters would apply to Obama.

So, it would seem like the only thing the Neo-Progressives on the left can do is claim that: This Time OUR version of Socialism will work!

Yeah, fat chance!

Fake8 on July 26, 2010 at 2:51 PM

The cuts are across the board. It is not just the NHS. These are pretty mild changes to the NHS and you are making much more out of it than you should. Changes put in place years ago are far more dramatic and the NHS does evolve over time.

The best way to get pricing and cost equilibrium in the health-care market is to use competition and free-market economics.

If that were true then health care in the US would be cheap and efficient. The facts don’t support your assertion.

lexhamfox on July 26, 2010 at 2:51 PM

If that were true then health care in the US would be cheap and efficient.

I didn’t realize the us market was truly free. It’s quite interfered with. What do you think our current government solutions are? Someone’s facts don’t support their assertions, but it’s not who you think.

lorien1973 on July 26, 2010 at 2:54 PM

Oy Vey

cmsinaz on July 26, 2010 at 3:03 PM

So people are going to lose jobs then???? The NHS is the biggest employer in UK.

xler8bmw on July 26, 2010 at 3:05 PM

God bless government for looking out for my best interests.

What could possibly go wrong?

listens2glenn on July 26, 2010 at 3:14 PM

Berwick loves the National Health System. Rationing, here we come.

hawksruleva on July 26, 2010 at 3:17 PM

I an no fan or defender of the NHS, but to say

“English citizens still have to get their health care from the government”

is not really fair or accurate. Unlike in Canada, where the Canada Health Act actually makes the private provision of many serious health services illegal, Britons are free to pay for any health service they wish to purchase – of course, that cost comes on top of their payment towards the NHS, which you cannot opt out of.

I happen to think that both the UK and Canadian systems are disasters, but they are not the same, and we should strive for accuracy, lest we turn into liberals.

holdfast on July 26, 2010 at 3:31 PM

Britons are free to pay for any health service they wish to purchase – holdfast on July 26, 2010 at 3:31 PM

Canadians are also free to purchase any health service they choose…across the border. US hospitals treat many, many Canadians. (And Brits & people from all over the world in fact.) We’ve been the international socialized health care systems’ pressure valve from their inception – a fact which has allowed for the distorted assessments of ‘successful’ foreign government-run health care for years.

That will change, of course once POTUS finishes destroying our system, chasing away the best & brightest from the field & ensuring that and all future doctors, nurses & researchers were are the sort who grew up dreaming of becoming DMV clerks and public school administrators.

When we’re all in the same sinking boat, there’ll be no sense in crossing the border for the sclerotic & incompetent bureaucrat-driven service you can all get at home.

leilani on July 26, 2010 at 4:10 PM

Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

Well, now they can become artists and performers, because they are no longer tied to jobs to get healthcare, plus, they can file for un-employment.

Oh wait….wrong country.

BobMbx on July 26, 2010 at 4:14 PM

I work in the N.H.S .
We have to have reform every few years,the N.H.S of the 40′s bares little resemblance of today.

It’s the tax payer that runs our healthcare,we whine about
it like the weather,but it is supported.

Posters seem unaware of what is covered and not,choice, how it is funded,the role of the private sector, british peoples views.
The U.S has a high infant mortality rate,everybody should be bothered about that and not our healthcare model posters don’t seem to know little about.

mags on July 26, 2010 at 6:24 PM