Britain Moves toward Doctor-Patient Control

Britain’s new coalition government is proposing a major transformation of its socialized health-care system to give doctors much more authority over decisions involving their patients’ care.

This most entrenched of government-run health systems is recognizing the importance of the doctor-patient relationship just as the United States is taking a sharp left turn toward more centralized government control over health care.

Is the world turning upside down?

The New York Times examines the plan “to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level,” calling it “the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.”

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.

Britain is trying to find a way to respond to the growing wave of consumerism sweeping Europe. Better-informed patients are demanding more control over health-care decisions and are increasingly fighting the authority of large, centralized bureaucracies to make decisions about their care.

Not surprisingly, the British government’s proposal is facing strong opposition from entrenched interests. “Many critics . . . doubt that general practitioners are the right people to decide how the health care budget should be spent,” the Times reports. One of these critics is David Furness of the Social Market Foundation, a London think tank. He calculates that the plan would make every general practitioner (GP) in London responsible for a $3.4 million budget. GPs would band together in regional consortia to buy services from hospitals and other providers.

“It’s like getting your waiter to manage a restaurant,” Furness said. “The government is saying that G.P.’s know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.”

He disparages doctors at his peril.

Under the proposed plan, hospitals would escape some of the bureaucratic micromanagement that binds them in red tape. They would become “foundation trusts” with much more independence, somewhat like charter schools in the U.S.

British health secretary Andrew Lansley is straightforward about the rationale for his proposal. His government’s white paper explains: “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.”

Opponents are sounding alarms that the changes mean the terminally ill won’t get adequate care and that waiting times will be even longer for surgeries like knee and hip replacements.

There always is a risk with any government rationing system that more care will be provided to the healthy majority of patients who vote, leaving less for those who are older and sicker. But is it safer to give the relevant decision-making authority to doctors, or to bureaucrats and politicians? If there is less money for administrators, there will be more money for patients.

The labor unions and the bureaucrats are, of course, apoplectic about the loss of some of the bureaucratic jobs that have swallowed up most of the money from a tripling of the NHS budget since 1998.

Robin Durie, a senior lecturer in politics at the University of Exeter, wondered how the government would be able to “give patients more choice — a promise that seems to require a degree of administrative oversight — while cutting so many managers from the system?”

You can’t make this up. Britain’s coalition government is getting it right. Bureaucrats don’t deliver care; doctors do. Sixty-two years after the founding of the NHS, the British government recognizes it has no choice but to give doctors and patients more authority over health-care decisions.

The complex plan — which would affect only England — will need legislative approval to be enacted, but we should expect some version of it to pass, because it reflects a growing awakening in Europe to the importance of consumer control and choice.

For example, during a conference in Paris in late May, organized by the European Union of Private Hospitals, there was broad agreement about the value of consumer choice, competition, and portability in health care, and about the essential role that private providers play in European health care. More than 400 people attended the conference, including members of the European Union parliament, former health ministers, and many corporate CEOs.

John Bowis, former U.K. minister of health, spoke about the importance of allowing “patients to be partners in managing their care,” and stressed that “information is key to empowering patients.”

Throughout Europe, a network of private hospitals is growing. Government officials say private hospitals serve as a safety valve for public health systems; they allow people to escape waiting lines that would be even longer without their services. Many believe the private hospitals make public hospitals better by providing competition. How tragic, then, that the recently passed health-overhaul law in the U.S. effectively prohibits new physician-owned private hospitals from opening. Physician Hospitals of America has rightly filed suit, challenging these provisions.

Clearly, Europeans have come to these conclusions based upon long experience with government-controlled, bureaucratically run health systems. Such systems don’t work, especially with something as personal as health care. And yet, the U.S. has adopted “reforms” that will reduce genuine competition and put more control over health-care decisions in the hands of government bureaucrats.

We should also note that President Obama has bypassed the constitutionally required Senate confirmation process to put Dr. Don Berwick — who is in love with Britain’s socialized health-care system — in charge of implementing key parts of his health-overhaul law. When Berwick appears at some point before a congressional committee, members might want to ask him what he thinks about Britain’s move to give doctors and patients, not bureaucrats, more authority over health-care decisions.

As Rep. Paul Ryan (R., Wis.) said at a recent Galen Institute conference, Obamacare “will not stand.” The political system, the courts, or the American people — and probably all three — will get us back on the right path.

Going Forward to the Past in the UK

From the New York Times: Britain plans to decentralize health care.

Perhaps we can avoid their troubles by skipping the centralization bit.

CastroCare in Crisis: Lessons from Single-Payer Health Care

Although Cuba’s government commits 16 percent of its budget to health care, the communist dictatorship’s real health-care “system” is dedicated to serving cash-paying customers from Canada and other countries. This comes from a fascinating article in the latest issue of Foreign Affairs, “CastroCare in Crisis,” by Laurie Garrett of the Council on Foreign Relations.

It’s not news that The Castro brothers profit from medical tourism. Michael Moore infamously shilled for the enterprising Havana Hospital in his movie, SiCKO, where he brought 9/11 Ground Zero rescue workers to be treated. The Havana Hospital appears to be a more competitive, patient-centered enterprise than any American general hospital I’ve seen: It posts prices for its services, reports testimonials, and can schedule surgeries on short notice (three days for open-heart surgery)!

Garrett explains that the hospitals that serve foreigners are owned by a government-owned tourism conglomerate, and serve patients from 70 different countries. Canadians are significant customers. Like Cuba, Canada controls access to medical services through a government monopoly, so citizens cannot get timely care. Unlike Cuba, Canada allows the rest of the economy to operate freely, so Canadians are rich enough to be able to pay just under $7,000 for knee replacements in Cuba (instead of waiting for months in Canada).

But what will happen when the Castros are gone? Two competing effects, according to Garrett: An influx of U.S. patients who will be free to travel to Cuba for treatment, but an exodus of physicians who will be free to emigrate to the U.S. Plus Cuba has the second oldest population in the Americas, with only one quarter of the population under 40 years of age. Once the Cuban people are free of communism, their pent-up demand for medical care will also explode. Cuban patients (as opposed to Canadian patients in Cuba) already have to provide their own syringes, sheets, and towels. Soap, disinfectant, and sterile equipment are rare. (See John Goodman’s previous post here.)

Unfortunately, Garrett does not consider the consequences of ObamaCare, which will likely accelerate the international travel of U.S. patients, while minimizing the emigration of Cuban doctors. If Cuba becomes a free society that welcomes foreign capital, American investors will soon decide that investing in hospitals that serve U.S. and other foreign patients is a good bet. There will be plenty of opportunities for Cuban surgeons who stay at home.

Go for Dental Work, Get HIV Free of Charge

Here’s a great moment in government health care: “A Missouri VA hospital is under fire because it may have exposed more than 1,800 veterans to life-threatening diseases such as hepatitis and HIV.”

CNN has more.

How Fanatic Can You Be About Single Payer?

How fanatic can one person be about single-payer health “care”?  I think today’s New York Times suggests that there’s no limit.

Witness Donald G. McNeil, Jr, a reporter who believes that any nation can achieve “universal” coverage if the government exercises enough willpower.  His example for the United States? Rwanda, for pete’s sake: ”A dirt-poor nation, with a health plan.”

Sure, women give birth in clinics with dirt floors, and there are only three cardiologists and one neurosurgeon in this land of almost ten million people.  Nevertheless, according to a local doctor approvingly quoted by Mr. McNeil:

Rwanda can offer the United States one lesson about health insurance: “Solidarity — you cannot feel happy as a society if you don’t organize yourself so that people won’t die of poverty.”

You don’t just get these calls for “solidarity” from countries whose citizens slaughtered a million or so of their fellows a few years ago.  Even single-payer advocates in developed, otherwise free countries with ”universal” health care find things to admire in third-world health systems.  Carolyn Bennett, MD, a Canadian Member of Parliament, has spent years encouraging Canada to adopt the best features of the Cuban health system.

I’ve often cautioned fellow conservatives not to go overboard in describing single-payer systems in terms normally used for North Korean labor camps.  Maybe I’m too complacent.

Government Health Plan Let You Down? There’s Always Wal-Mart

Government action always has unintended consequences, but some of them are positive – as long as they are brought into effect by the private sector.

In Great Britain, the National Health Service is infamous for denying cancer patients access to the most innovative drugs.  So, ASDA, which is Wal-Mart’s British subsidiary, has decided to sell those drugs at cost.  Competitors quickly followed suit.

Oops: I thought competititive markets don’t work in health care.  I guess they do if the government allows them to.

What’s interesting about this phenomenon is that British cancer patients, who generally have no private insurance, will benefit from price transparency, whereas U.S. cancer patients with private insurance have no similar opportunity.  They still have to launder their claims through an insurer, adding friction and bureaucracy for little value.

But be prepared: If ObamaCare is not repealed, U.S. patients will face similar challenges and opportunities starting in 2014,  because private insurers will become utilities merely delivering limited, government-defined benefits.

The lesson? Even with catastrophically expensive conditions, like lung cancer, competition works.

How NICE of You to Set Up a Death Panel for Me

Michael D. Tanner examines the record of the man President Obama wants to head up the Medicaid and Medicare agency, and concludes, “Maybe those worries about death panels weren’t so crazy after all.”

Great Moments in Government Health Care: The Wrong Disorder

A 14-year Army veteran submitted a claim for treatment, and got more paperwork in return. The form said “We are working on your claim for menstrual disorder.”

One problem: The soldier is a man.

A watchdog of the VA says this snafu is symptomatic of the VA: “There are 57 regional offices and every one is operating in total chaos and in crisis. Full frontal mass chaos. Every day.”

For the sake of the millions of people who will now enter Medicaid as a result of the health “reform” law, I hope state Medicaid offices are better run than the VA.

Canadians Say, “Where Will Americans Go Now?”

In a post titled, “We should not kill Canadians,” one of our bloggers, Dr. Donald May, warned, “we allow our remaining private health care to be replaced with socialized health care, our Canadian neighbors will lose their access to the high quality medical services presently still available in the United States. Many will unnecessarily suffer and some will prematurely die.”

And sure enough, now some Canadians are wondering what U.S. citizens will do: “So, if Americans cannot travel to Canada to get private care where will you go?  Mexico? China?  India?”

Given the hassles of increased government involvement in health care, I wouldn’t be surprised to see an increase in “medical tourism,” whereby Americans travel elsewhere to get elective surgery done.

And on the subject of people in countries where health care is a “right” getting treatment, take a look at this woman in the UK being denied surgery in her “free” health system. Her offense? She opted to pay a doctor with cash rather than waiting to see someone on the schedule laid down by the National Health Service. The comments in the Times of London web site go after Jenny Whitehead for “queue jumping,” an admission that government health care isn’t about health care, but about a deadly egalitarian vision of society.

Italian Lessons for U.S. Health Care?

California governor Schwarzenegger visited the Italian region of Lombardy recently, and urged the U.S. federal government to “look at the entire world, including this region here” for ideas on successful health reform, acccording to an article in the Wall Street Journal.

It looks like he learned the wrong lesson from his visit.  In the world of politicians like Gov. Schwarzenegger or President Obama, the solution to every problem is not only to demand that government solve it, but that the most remote level of government solve it.

But while Americans have been losing control of their health-care decisions to the central government (which I can no longer bear to call “federal”), Italy has been decentralizing decision-making.  This is within a single-payer system.

According to the article, Italy gave regions control of their own health budgets in 1997, and Lombardy decided to allow private hospitals to compete against public ones.  Unsurprisingly, this forced public hospitals to improve their quality of care.

(Although today’s ObamaCare doesn’t create public hospitals, government take-over – and public-sector unionization – of hospitals is a key element of the single-payer system that the president and his closest allies hope to eventually achieve.)

In another twist, Italy allows patients the choice of going anywhere in the country for treatment (although they have to pay their travel costs).  Don’t try that in Secretary Sebelius’ “exchanges”!  Heck, you can’t even choose a school for your own kids in most of the U.S.

The result? Intra-national medical tourism, as Italian patients exercise their “rights” to go to Lombardy for treatment.  La Dolce Vita!

Will the U.S. have to wait decades after the imposition of ObamaCare to learn what Italy finally did in 1997 – that competition and choice work?  Let’s hope not.