In the Toilet' -- British NHS Today; U.S. Healthcare Tomorrow

A September 6, 2014 headline in Great Britain’s Daily Mail announced, “Now NHS lets you jump the queue for routine surgery... if you'll pay for treatment yourself.” The article proves that Britons are trapped in a healthcare system that is now in the toilet -- failing both medically and financially.  

What is happening in Great Britain’s vaunted in NHS (National Health Service) is of vital interest to Americans. Dr. Donald Berwick, one of the prime designers of the Affordable Care Act, proudly said in 2010 that the NHS was his model for our ACA. By seeing where the NHS is today, we can foresee where U.S. healthcare is headed tomorrow.

To reduce the escalating costs of their healthcare system, the NHS has been rationing care, either by stating what care will be denied or by restricting how much money is allocated and thus limiting the supply of authorized goods and services. That is why people wait forever for care. When not enough money is expended to pay doctors, to buy MRI scanners, or to construct operating room and burn units, what happens? People die by queueing. American veterans know about this up close and personal.

According to official British government statistics, in August 2014, there were 3.2 million Britons – 5% of their total population! -- awaiting surgery. Some – 189,571, to be precise -- had already waited for more than four months!

To get paid at all, and to try to get patients the care they need (before they die while waiting, like U.S. veterans and Canadians), British hospitals have begun advertising that self-funded patients can move up the queue, or they can get care that is denied by NHS rationing. In other words, those with money, who already paid for their health care through taxes, can get the care they need by paying (again) out of pocket. Those without sufficient resources to pay double are moved even further down the queue and are unlikely ever to get care.

Over the years, NHS medical rationing has gotten more and more severe. Early on, it was things like no transplants over the age of 70. Then, they denied heart surgery over 65. Next it was no kidney dialysis over age 55. Now, rationing is draconian: hip replacements, arthritis injections, and cataract surgery deferred, delayed, or denied -- the three “D” strategy most hated by Americans when used by U.S. insurance companies.

The Daily Mail has confirmed the worst fears of public policy analysts regarding single-payer systems. They fail to provide timely care or care at all. They try to control costs using medical rationing … and fail. They do not even distribute equal amounts of misery.  (Winston Churchill: “The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries.”) Just as in market-based systems, the affluent in single-payer systems can get care that is denied to the less fortunate.

For those who say this ‘worst of all possible worlds’ can’t happen in the U.S., let me offer evidence that it can, will, and is already happening.

What is the mission of ACA’s IPAB (Independent Payment Advisory Board, renamed for purposes of disguise as the HTAC, Health Technology Assessment Commission)? It is a rationing agency. It says what treatments will be classified as “Not Cost Effective,” meaning too expensive for the budget, and therefore doctors cannot use them. Even though medical care may be effective, it won’t be available just as the British have done with kidney dialysis.

For IPAB and all single payer systems, death is the preferred (read: cheaper) solution for those with chronic (read: expensive) illnesses.  

So, Americans already have the medical half of the worst of all possible worlds: health care that is medically effective but is withheld from us by being classified as “Not Cost Effective.”

The first word in ACA is affordable. Why is the cost of insurance going up, not down – an average rate increase of 49%, and we couldn’t afford to pay the premiums before ACA?? Why are insurance companies cancelling insurance policies in the millions or getting out of selling health insurance altogether?

Why is our government taking money from our needed health care, i.e., $716 billion cut from Medicare services? You know the answer: to defray the massive bureaucratic costs of ACA, estimated at $1.76 to $2.7 trillion. At the higher number, the U.S. will spend more just on the ACA than the entire GDP of every nation on earth except China, Japan, and Germany. ACA will consume more dollars than the entire British nation produces in a year.

Do you consider it affordable when your government has to take money from your care, print new dollars, add trillions to the deficit, and shackle our children with future debt?

In both Great Britain and here:

  • Out-of-pocket costs are up, not down, and certainly not “affordable”
  • National spending is increased, not reduced
  • Money is taken from doctors and nurses to pay lawyers and bureaucrats
  • Economic growth is being suppressed
  • Access to medical is delayed, deferred, or denied
  • Care is “free” to a minority and hyper-expensive for the majority
  • Medical rationing is the law of both lands

The NHS and the British populace are truly “in the toilet.” The U.S. and all Americans, especially with some still advocating single payer system, are headed for a similar watery destination. 

Dr. Deane Waldman MD MBA, is author of The Cancer In Healthcare; Host of We The Patients Newsletter-&-Forum; member of the Board of Directors of the New Mexico Health Insurance Exchange; Adjunct Scholar for the Rio Grande Foundation; and former Emeritus Professor of Pediatrics, Pathology, and Decision Science.