By now we all know America’s new, recess-appointed head of Medicare and Medicaid, Donald Berwick, once described his affection for Britain’s National Health Service (NHS), for whom he was a leading consultant, as “romantic.” He said, “I love it” and has branded the system a “global treasure” while deriding U.S. health care.
One wonders what Berwick’s reaction would be to the announcement of new reforms for the NHS, described in UK newspapers as a sweeping pro-market agenda designed to make the oft-criticized system more accountable and increase the authority of family doctors. And what he thinks of a report last week in The Independent that the UK has spent millions of pounds on gag order deals to keep doctors from telling the full story about how bad patient care is under the NHS.
Although not as significant as the newspapers claim, these new reforms chip away at a system Berwick helped build and sees as a model for the United States. They mark a rejection of Berwick’s profound distrust of the ability of consumers to make choices in the free market and his insistence on regulation and management by unelected bureaucrats.
“Please don’t put your faith in market forces,” Berwick said. “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 do not agree. I find little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors’ fighting it out, leads to the health care system you want and need” (emphasis added).
The real-world outcomes of Berwick’s “global treasure” are appallingly poor. The NHS’s system of state-controlled rationing turns treatable diseases into death sentences. UK cancer survival rates are near the bottom for all of Europe according to the first worldwide study of cancer survival rates (published two years ago in Lancet Oncology). Women who contract breast cancer there have a 46 percent mortality rate, compared with only 25 percent in the United States. Only 19 percent of American men who get prostate cancer die of it, but in Britain it kills 57 percent. The U.K.’s overall cancer mortality rate is more than 38 percent higher than America’s.
These are real people who are dying unnecessarily thanks to the “global treasure” Berwick wants to institute here.
Incapacitated NHS patients in need of hip surgery must wait nearly 11 months, while those hoping for knee surgery wait nearly 12 months. Typical wait times in the United States for such procedures are less than one month.
Three years ago, Britain’s National Institute for Health and Clinical Excellence (NICE) decided the system would only reimburse an innovative but costly new treatment to restore sight for the elderly if a patient was already completely blind in one eye (one being enough, according to the Leaders with Plans). And in a letter to The Daily Telegraph last year, leading health experts claimed terminally ill NHS patients are being falsely categorized as “close to death” in order to justify cutting off life support—which is, after all, awfully expensive.
These hideous problems are rendered even more disturbing by the fact that Britons who go outside NHS and purchase their own drugs and treatment are forever banned from using the system their taxes pay for.
It’s important to understand that from the perspective of those like Donald Berwick, this is a feature, not a bug. He says the best way to an efficient, humane health care system is “rational collective action overriding some individual self-interest.” This is fine, I suppose, as long as the “individual” being overruled is someone else, ideally someone you don’t know.
The American people are smart enough to recognize such centrally managed systems are dangerous and foolhardy. A recent Rasmussen poll reported 75 percent of U.S. residents believe the free market is a better choice than government management of the economy. It’s true that the current U.S. health care system, with its government-encouraged third-party payer systems, is confusing and difficult to navigate. But the answer is not more government intrusion; it’s a healthy dose of Adam Smith, of pro-market reforms that give doctors and patients real choices.
Berwick and his big-government allies can take solace in one new statistic. This month the Economist Intelligence Unit found that, thanks in large part to the abundant provision of painkillers, the NHS ranks at the top in one category: quality of death.
It’s nice to be good at something, after all.