2010 July 25 Sunday
UK National Health Care Spending Cuts

The new Conservative/Liberal government of Great Britain, faced with large budget deficits as far as the eye can see, is planning cuts in the National Health Service. The government says spending will still go up faster than inflation. But with an aging population and more costly treatments available health care spending has to go up much faster than inflation to prevent cuts per person. No longer possible to do that in Britain.

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.

You might see this as an argument against more widespread government funding of medical care in the US. If the private sector funds it then government budget cuts won't cut care. But in the United States medical care for the 65 and older is already funded by the (ever more deeply in debt) US government and the pressure for cost cuts on medical care for old folks surely is going to build.

The US government will not be able to avoid cuts in quantity and quality of health care for old folks. If you want to get medical care as good as what your parents or grandparents are currently getting then substantially cut your living standard now and start saving more.

The British government plans to steer terminally ill patients toward dying at home rather than in hospital. I see that as a positive development. Taking a terminally ill cancer patient whose body is shot thru with cancer and whose whole body is in pain and keeping that person alive in an ICU war with intravenous drip and a ventilator is cruel. Hospice care is more humane.

The ability to pay out-of-pocket could make a big difference if you ever need to get surgery for obesity or a fast diagnosis of possible cancer.

* 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.

With over 17% of US GDP now going for medical care and the trend line headed much higher something has to give. The current system of incentives causes doctors to generate too much revenue for themselves with excessive numbers of tests, office visits, and procedures. But it is a difficult problem to solve because patients aren't in a position to judge what treatments are necessary.

My advice: expect less from government. Make more money, spend less money, and prepare to become more self-sufficient.

Update: Donald Berwick, Barack Obama's Administrator of the Centers for Medicare & Medicaid Services (CMS), sees the UK National Health Service as the ideal.

Cynics beware, I am romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country.

The NHS is one of the astounding human endeavours of modern times. Because you use a nation as the scale and taxation as the funding, the NHS is highly political. It is a stage for the polarising debates of modern social theory: debates between market theorists and social planning; enlightenment science and post-modern sceptics of science; utilitarianism and individualism; the premise that we are all responsible for each other and the premise that we are each responsible for ourselves; those for whom government is a source of hope and those for whom government is hopeless. But, even in these debates, you are unified by your nationís promise to make health care a human right.

Accumulate cash. Be prepared to spend your way around an increasingly government-controlled health care system. Your life may depend on it at some point.

Share |      By Randall Parker at 2010 July 25 08:54 AM  Economics Health

Black Death said at July 25, 2010 3:12 PM:

Randall, your advice is sound. Whether in the US, the UK or elsewhere, governments don't have enough money to provide all citizens with state-of-the-art health care. Plan on paying for a big chunk of it yourself. Here's another suggestion - if there's a top-notch medical school in your area, consider endowing a professorship there - go in with family members if you have to - for example, the Smith Family Chair of Internal Medicine (or whatever). Your concerns about access to high quality health care will be over. They will treat you like royalty. You will always get the best doctors they have, and, if you are hospitalized, the Dean and Chancellor will stop by for a visit. We are clearly headed toward a multi-tier health care system, in which the people who can afford to pay will get the best treatments. Don't depend on some underfunded, overburdened government system when your life is at stake.

In said at July 26, 2010 6:05 PM:

More advice along these lines: Avoid getting sick. Some may think it is futile and too hard, but not so. There are ways for the wise: http://www.youtube.com/user/lorax2013#p/u/2/iQ8jqHoyMgU

no i don't said at July 27, 2010 3:40 PM:

Of course governments don't have enough money. They were bought; they are now owned by huge private corporations like banks, oil companies, soda companies, etc. Presidents are now their CEOs. Money doesn't just vanish into thin air; it must be somewhere and in someone's hands.

We now have a new world-wide fascism that will be really hard to combat -if not impossible, because it is spread all over- The human species is severely screwed at this point. I don't know if that's the result of unrestricted capitalism, but I'm starting to think so...

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