Wednesday, July 14, 2010

Why Americans Dislike Britain's NHS

Cross-posted from Critical Condition on National Review Online.

Liberals find it odd, and perhaps slightly irrational, that Americans so heavily criticize the British National Health Service. This has been of particular relevance in light of Donald Berwick’s “love affair” with the agency.

The Conservative Prime Minister of the United Kingdom, after all, often talks “of how proud we in Britain are of the NHS.” Just as with Medicare in the U.S., British politicians who talk of dismantling the NHS get hammered in the polls. (Despite Her Majesty’s Government’s surprise announcement this week of incremental market-oriented reforms to the program, the Tories under David Cameron have repeatedly pledged to preserve its funding.)

But describing the NHS as “popular” with British voters is a bit like describing cocaine as “popular” with crack addicts. Once people become dependent on heavy state subsidies, it is natural for them to feel insecure at the thought of losing them. Tocqueville long ago articulated how this problem inevitably arises from majoritarian democracies. And people who live under a single-payer regime have no way, short of moving abroad, of appreciating that there are better alternatives.

Having said that, Britons are frustrated by the indifference and inhumanity of the National Health Service. Its problems are covered widely in the British press. Here are some examples (and readers are welcome to provide others):
  • NHS doctors routinely conceal from patients information about innovative new therapies that the NHS doesn’t pay for, so as to not “distress, upset or confuse” them.
  • Terminally ill patients are incorrectly classified as “close to death” so as to allow the withdrawal of expensive life support.
  • NHS expert guidelines on the management of high cholesterol are intentionally out-of-date, putting patients at serious risk, in order to save money.
  • When the government approved an innovative new treatment for elderly blindness, the NHS initially decided to reimburse for the treatment only after patients were already blind in one eye—using the logic that a person blind in one eye can still see, and is therefore not that badly off.
  • While most NHS patients expect to wait five months for a hip operation or knee surgery, leaving them immobile and disabled in the meantime, the actual waiting times are even worse: 11 months for hips and 12 months for knees. (This compares to a wait of 3 to 4 weeks for such procedures in the United States.)
  • One in four Britons with cancer is denied treatment with the latest drugs proven to extend life.
  • Those who seek to pay for such drugs on their own are expelled from the NHS system, for making the government look bad, and are forced to pay for the entirety of their own care for the rest of their lives.
  • Britons diagnosed with cancer or heart attacks are more likely to die, and more quickly, than those of most other developed nations. Britain’s survival rates for these diseases are “little better than [those] of former Communist countries.”
These problems are not an accidental side effect of socialized medicine—they are inherent to socialized medicine. Liberals who believe that technocratic experts can rationally allocate health care resources ignore the real-world examples, like Britain’s, of how that model fails in practice.

The American health care system has its flaws, and real reform is urgently needed. But the reason why Obamacare is so unpopular is that most people would never trade our approach, warts and all, for that of Donald Berwick’s NHS.

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