Tuesday, July 13, 2010

The U.K. Revamps the NHS

According to today’s WSJ, the British government has decided to make the biggest changes in the NHS since its inception in 1948.

Here is the WSJ reporters describe this turn of events.

“The U.K.'s new coalition government, grappling with weak public finances and rising health-care costs, announced an overhaul of the state-funded health system that it said would put more power in the hands of doctors and save as much as £20 billion ($30.12 billion) by 2014. “

“The revamp essentially involves cutting huge swaths of bureaucracy and reinvesting the savings in urgent health-care services. As a result, the government said, it will still increase National Health Service spending in real terms every year for the next five years.”

“In one of the biggest changes, the government said it plans to eliminate a layer of financial managers and ask doctors instead to decide how the bulk of the National Health Service's £105 billion the NHS simply cannot continue to afford to support the costs of the existing bureaucracy; and the government has a moral obligation to release as much money as possible into supporting front-line care."annual budget should be spent. “

Put more money in the hands of doctors? Cut huge swaths of bureaucracy? Eliminate managers?

This is radical stuff, indeed. It is tantamount to decentralizing the national health service. Next thing you know, the Brits will decide to set aside rationing, now conducted by NICE, the National Institute of Clinical Excellence.

I can’t help but wonder what Donald Berwick, MD, President Obama’s appointee to head CMS, the Center of Medicare and Medicaid Services would think of this announcement of the revamping of the NHS.

If you can judge from his statements, Berwick believes wholeheartedly in centralized government control of health care, in rationing of care, in the evils of market-driven care, and in the moral superiority of the British system. He seems to like the NHS just as is. For the British government to say the NHS after 62 years isn't performing well must be unsettling to Dr. Berwick. The NHS has had ample time to work out the kinks.

Here, in his own words, are a few examples of the Wit and Wisdom of Donald Berwick.

“I am romantic about the NHS. I love it. All I need to do to rediscover the romance is to look at health care in my own country.”

“Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leads to the health care system you want and need. In the US, competition is a major reason for our duplicative, supply driven, fragmented care system.”

“In America, the best predictor of cost is supply; the more we make, the more we use — hospital beds, consultancy services, procedures, diagnostic tests, Here you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too little of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.”

“Cynics beware, I am romantic about the National Health Service; I love it. … The NHS is one of the astounding human endeavours of modern times. It is a national treasure. It is an international treasure.

“It’s not a question of whether we will ration care. It is whether we will ration with our eyes open.”

Any health care funding plan that is just, equitable, civilized and humane, must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”

We shall see if Dr. Berwick can reconfigure CMS to mimic his beloved NHS, if Obamacare will save money, if it proves to be morally superior, and if it leads over time to a single payer system he admires so much.

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