Thursday, August 27, 2009

McNulty on the British NHS

Aeon McNulty gives an in-country perspective on the failing British National Health Service.

Here are few excerpts from, "The Long Shadow of the National Health Service":
...There are countless reports, articles, essays and books that will give you all the statistics, anecdotes and arguments you could possibly want (please see the links at the end of this article). I don’t want to debate figures here; plenty of misinformation is swirling around on both sides of the political divide and I see no value wading in to fight over the shifting minutiae. I’m interested in exploring the underpinning ideas.

...The primary reason, however, that the NHS has a death-grip on the psyche of our nation is tied to its founding beliefs. It is no coincidence that the NHS was sold to the British public during wartime. In a country conditioned by emergency measures, nationalised industries and rationing the idea of an egalitarian "free" health service, based on need not ability to pay, struck a powerful chord. No-one would be left behind; everyone would be treated the same; we were all in it together.

The wartime spirit is palpable in NHS hospitals even today. Nowhere else in 21st Century British life do you feel this atmosphere. The staff seem to be constantly fighting a losing battle. As a patient you're a supplicant, not a customer, pathetically grateful for what you receive. You’re just one of the many faceless victims waiting to be treated. Waiting, for everything, is a matter of course. Queueing, filling in forms, being moved by harassed looking nurses, more waiting. But you mustn’t grumble; stiff upper-lip and all that.
The consequence of this is clear:
...People often assume that removing financial incentives encourages virtue and will somehow simplify the decision making process, but resources are limited and the need for medical care is infinite. If money is taken out of the equation other, less direct, constraints become necessary and the remaining incentives are twisted. Long waiting times, mushrooming administrative bureaucracy, rationing of care and lack of transparency are not simply a matter of insufficient funding; they’re inescapable components of this type of system.

Here’s an example. You come in for a check-up and your doctor notices a minor discrepancy. It's probably nothing but to eliminate all doubt she needs to order an expensive test. If you were paying for your healthcare, or had control over your insurance, she could explain the situation candidly and leave the decision up to you. You would need to balance the small risk against the expense, or -- depending on the nature of the potential problem -- a change in your lifestyle. You might even shop around for a cheaper kind of test; it's your money after all. But if your doctor is required to give you free treatment the situation changes drastically. She must now consider the fact that if she tells you the whole truth you will naturally demand the test. It doesn't matter to you how much it costs or how tiny the risk; you’re not paying for it. Your doctor, however, has to think about the hospital targets, the other patients waiting for tests and, if you're elderly, the effectiveness of continuing treatment considering your age.

As far as I can tell, most doctors maintain their integrity. They're honest with their patients and zealously fight their corner against the hospital managers. But what kind of system sets up a clash between the interests of the patient and the doctor? What kind of system punishes virtue?
I highly recommend reading the full essay.

McNulty's essay echoes this warning from British MP Daniel Hannan that America should not follow Great Britain down the road towards socialized medicine:

Let's hope enough Americans are listening.