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The British National Health Service

 

There exists in England today a sometimes uncaring, often unresponsive and typically disrespectful health care system. This system, as well as other global socialized systems, not created in regard to the patient's best interest, continue to be considered as worthy of emulation by many in the United States government.  This continues to be a very much ill-advised initiative.  The latest "buzz" in health care is "evidence-based medical practice."  Well, let's examine the evidence:

There is little question but that the American health care system is inordinately expensive.  Perhaps value is being received because longevity and quality of life have progressively increased and patient satisfaction remains high.  There is also little doubt, however, but that we could do a much better job of improving service and decreasing overall cost by replacing HMOs with MSAs (Medical Savings Accounts) and getting serious about a paradigm shift to a truly preventive mode.  

Before rushing to adapt another failed system the United States needs to carefully assess what we have now.  "Queuing-up" has been part of the British persona for many decades.  It's not, however, part of the American mind-set.  Standing patiently in line for rationed goods and maintaining a "stiff upper lip" have been an unenviable "badge of courage" which has been the signature of our British cousins in the past.  There is also an almost unique phenomenon in Britain which relates to the remarkable degree of trust automatically given (traditionally) to all professionals (government, law and medicine).  In health care this explains a long-time supercilious attitude toward patients not counteracted by appropriate medical oversight.  The really tough question for the new millennium is: how long will England continue to tolerate the chronic disrespectful behavior and continually declining quality and service of its "Health Service"? 

The British prescription for health care continues to be typified by the phrase "Take A Seat."  There is a remarkable complacency among a population which readily accepts  the notorious British National Health Service (HNS) waiting lists for necessary hospital treatment.  As the 20th century ended there were 1.12 million ever-suffering souls patiently waiting for needed hospitalization.  This appears to be the price for "free care.  One usually gets what one pays for.  There is no doubt but that disabled Americans would be a great deal more impatient regarding their desire for prompt quality service than our British cousins.

The British Health Service continues to announce that the official list of those waiting for care is shrinking.  This is simply not so; what has happened is that waiting lists to get on waiting lists have been created.  After waiting to be seen by a family physician a British patient incapacitated with a spine problem may have to linger for more than a year to see a specialist.  It is up to the specialist to determine the urgency of the case and to order any specialized tests.  After the wait for the tests and the results (often a process of months) the next wait, of about a year, for surgery begins.  Are things getting better?  As of May, 2001 all indications were that the British National Health Service continued to "languish from bureaucracy, demoralization and capricious medical fads" (clearly not a formula for success). ( Lawlor S: Britian's Nationalized Medicine Needs Doctoring, The Wall Street Journal Europe, May 3, 2001).

Are things better in Canada?  A 1998 study by the Fraser Institute located in Vancouver suggests not.  Fortunately our Canadian neighbors have the opportunity to opt-out and "escape" their Federal Health Program by bolting across the border.  On August 30, 2001 the Wall Street Journal reported that the British National Health Service had nearly one million patients waiting for treatment (40,000 of these waiting for surgery for over a year) and they have officially announced that henceforth the NHS will start paying patients to travel across the English channel for treatment in the European Union countries.  

Socialized health care systems typically address the best interests of the state rather than the individual.  The urge by these political entities to cling to unworkable and discredited policies is the stuff of legend.  Tight financial controls in Japan have kept their medical costs to about 7% of their Gross National Product (GNP).  The Japanese, however, also only get what they pay for.  In the United States in 1996 26,200 patients were treated with defibrillators as a life-saving device.  Japan (with half of the United States' population) treated only 100 such patients because such devices are rare in Japan.  Many other important medical devices such as cardiac stents and other sophisticated implants are also not usually available.  Because of artificially low, government mandated, physician fees the Japanese medical profession has had to turn to other means of generating income by owning their own hospitals and being their own pharmacists.   In many countries today reasonable medical care is only available through the process of "black money" being passed "under the table."

Socialized systems do have some redeeming features which are worthy of emulation.  In the Russian medical care system "feldchers", who are similar to "junior" doctors are used to replace more expensive fully-trained physicians or specialists.  The Russian availability of free basic care for infants and children is certainly an important part of any valid health care system.

Every health care system in the world differs.  One can perform a quick assessment of a health care system by determining their degree of Restrictions, Regulations, Delays and the level of disrespect directed to patients.  The next assessment is that of the degree to which the system is oriented to the patient's best interest.  Quite frankly the Burton ReportŪ has not yet seen a health care system, primarily oriented to the patient's best interest, which also "makes sense" from the economic standpoint.  Americans are remarkable, we preach to the rest of the world about the merits of the free enterprise system and the importance of serving the patient's best interests but we are often guilty of ignoring our own rhetoric.  The real sadness is that common sense programs which reflect the patient's best interest, allow for latest technology, are a "true" health care system, and are cost-effective actually exist.  These programs are based on genomic screening, early detection and appropriate preventive care.  At this time no health care system has yet implemented such a common sense approach .

There are some indications (however slight) that the seemingly inexorable rise of the socialistic mentality (along with its more virulent cousins, fascism and communism) may have reached their "high tide."  Friederich von Hayek (1899-1992) Austrian economist who was a co-winner of the 1972  Nobel Prize in Economics and founder of the Mont Pelerin Society in 1947 may have been finally been taken seriously by at least one major player.  As privatization has replaced socialism throughout the world the British government (and others) is now turning to partial reimbursement for private health care in order to create a diversified market (
Bartley RL: About Freedom in the Free World, Wall St. Jour, October 14, 2002).  This represents a timid first step in a positive direction.