England's Healthcare Crisis Sends a Warning to the Colonies

The government solution to a problem is usually as bad as the problem.

Milton Friedman

I thought I would share this article out of England (Laura Donnelly, "Axe-falls-on-NHS-services," Sunday Telegraph, July 24, 2010). Despite having the ultimate "public option" the British are facing a cost crisis of their own. The choices they are making carry worrying implications for us.

England nationalized health care during the second world war, and is a paradigm for what is both good and bad about government controlled health care. Funding comes from the government, and local entities decide how to spend it. Everyone is insured, but what is actually covered is determined by committees using the money available. Faced with an unprecedented financial crunch, the government has decided to severely limit health care funding. Quoting from the article

• Restrictions on some of the most basic and common operations, including hip and knee replacements, cataract surgery and orthodontic procedures.


• Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, with dying cancer patients to be told to manage their own symptoms if their condition worsens at evenings or weekends.


• The closure of nursing homes for the elderly.


• 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.


• Cost-cutting programs in pediatric and maternity services, care of the elderly and services that provide respite breaks to long-term carers.

Such dramatic cuts are disturbing on many levels. Many of the services, including joint replacements, nursing homes, and terminal care would be considered mandatory for any basic healthcare plan in this country. But far more important is the manner in which the decisions were made.

From the article "The Sunday Telegraph found the details of hundreds of cuts buried in obscure appendices to lengthy policy and strategy documents published by trusts. In most cases, local communities appear to be unaware of the plans."

It appears bureaucrats made decisions impacting millions of people in secret, with little or no disclosure. This is the exact procedure used when Ms. Pelosi and Mr. Reid rammed through Obamacare, with the vote coming before the actual bill was available for review.

I am well aware that society must make difficult choices about how to allocate limited funds for competing and often irreconcilable demands. I also believe that health care must be rationed in some way, or no money will be left for anything else.

However, the experience in England and with Obamacare demonstrates that governments are unwilling and unable to openly and honestly debate these issues. Our elected representatives are so fearful of the populace that they cannot face the harsh light of day.

Governments are simply not very good at making health care decisions. Allocations will be made based on political donations and lobbying efforts. It is not hard to imagine Plastic Surgeons coming out ahead in the votes of this Congress. The "scooter store" is a perfect example I will discuss later.

Many voices in this debate use these argument against any government involvement in health care. Although alluring, such Utopian fantasies are not realistic, our government must be involved. I feel some combination of basic, limited government coverage for everyone, combined with market driven choice based supplemental care, offers the optimal solution for our country.