The American Interest
Analysis by Walter Russell Mead & Staff
Something's Rotten in Single-Payer England

Glove

The head of a British health care regulatory body is sounding warning bells about the drastic overuse of the country’s emergency rooms. The Daily Telegraph reports:

Too many patients — especially the elderly — are arriving in hospital as an emergency, when they should have received help much earlier, said David Prior, head of the Care Quality Commission (CQC).

As a result, he added, the healthcare system is on the brink of collapse and regulators cannot promise to prevent further scandals like Mid-Staffordshire.

In his first major speech since being appointed to lead the regulator earlier this year, Mr Prior called for large-scale closures of hospital beds and investment in community care….

“If we don’t start closing acute beds, the system is going to fall over.

Proponents of universal insurance often claim that it will reduce ER visits and encourage preventive care. But it isn’t working out that way in England right now. Something has gone wrong with the NHS.

Some of these problems may be attributable to human nature as much as to the incentives the British system sets up. People often leave things to the last minute. If they aren’t feeling catastrophically bad, they won’t go in for a checkup. And one of the problems with the NHS is that there are wait periods: you can’t always just drop in and get an appointment with a general practitioner. This exacerbates the human proclivity to not be proactive about health issues. Hospitals, on the other hand, have to take you in.

Either way, this story calls into question the narrative that the U.S. system is uniquely bad, and that we could save ourselves a lot of money and suffering by imitating European or Asian systems as much as possible. Clearly the story isn’t so simple. Every country has its own challenges and problems; single-payer systems are no silver bullet.

[Glove image courtesy of Shutterstock]

Published on May 9, 2013 4:10 pm
  • Andrew Allison

    The narrative is emphatically not, “that the U.S. system is uniquely bad, and that we could save ourselves a lot of money and suffering by imitating European or Asian systems as much as possible.” It is that the US system is uniquely cost-ineffective and in an era of increasing demand we could learn something from others.

  • wigwag

    “single-payer systems are no silver bullet.” (Via Meadia)

    This post is deceptive; no one ever said that the American system is uniquely bad. I haven’t heard anyone say, for example, that the system in India or Rwanda is better. What people have said is that for people who have health insurance, care is reasonably good; for people without health insurance, it isn’t as good. What everyone has said is that health care in the United States is uniquely expensive when compared to the rest of the Western world and that access is uniquely uneven.

    Despite the mealy-mouth protestations to the contrary that are found in the last few lines of Professor Mead’s post, the clear implication is that the problems of the UK are emblemmatic of the problems of single payer systems in general. This simply isn’t true (as the situation in France or Denmark demonstrates).

    This Via Meadia post doesn’t contribute to intelligent debate; it dumbs down the debate.

    • Jim Luebke

      In the comments of our host’s last post on the subject, commenters did indeed accuse the US’s system of being uniquely bad. This new post is largely a response to those comments.

    • TheCynical1

      The snotty tone of Wigwam’s comment hardly promotes “intelligent debate.”

  • http://www.facebook.com/people/Bill-Reeves/708763946 Bill Reeves

    It appears that UK GPs aren’t being thorough enough and are refusing to take after hours calls
    it is no voincidece that UK docs are salaried employees. When a doctor owns his practice every hour he works puts money in his pocket. You just work harder for yoursellf

    a

    • jtintokyo

      If UK doctors are salaried, then they have no incentive to work longer hours and see more patients. That could be a major part of the problem.

  • jtintokyo

    My experience after more than 20 years in Japan is that wait times to see doctors, especially to see neighborhood GP’s, are minimal. Doctors are reimbursed based on the number of patients they see; the more patients they see, the more money they make. As a result, neighborhood clinics are typically open from 8:30 AM to 8:00 PM Monday through Friday and half days on Saturday.

    Not surprisingly, access to ER’s in Japan is very reasonable. I recently went to an ER because I had been suffering from a headache for over a month. I waited for no more than 20 minutes at mid-day to see a doctor and it took less than 30 minutes more to have a brain scan (not an MRI but a more basic one). Another 30 minutes or so and the doctor told me that the scan was negative and, after asking a few questions, determined that the cause of the headaches was likely due to a virus. I was relieved to hear that the situation was far less serious than I had feared. As a resident of Japan I am a member of the national health care system and my 30% copayment for the treatment was about 10,000 yen or just a tad over $100.

    The thought of what the experience and cost of the same experience in a big city US hospital gives me the shivers, even if I was fully insured.

  • Lorenz Gude

    That’s right the US system is only uniquely bad in that it costs `16% of GDP as opposed to 8.5% of GDP in Australia where I live. The medicine is really good, with only slightly poorer health outcomes despite many people not being covered, I think single payer is a problem because it is a government monopoly. I know there is private medicine in the UK but I don’t know how much income you have make to have reasonable access to it. Because I am an American living in Australia where be have BOTH a universal public system and a private system I can tell you how the Australian system works. Like any public system our universal healthcare – also called Medicare – is very conscious of costs and works hard to keep them down. Consequently waiting lists arise as they always seem to do in socialized medicine systems. With private insurance which costs me about $2000 a year at age 70 I have access to any specialist I want and also incur the occasional small co-pay. In discussing a fairly significant heart procedure my heart specialist told me he wont work with any anesthetist that changes above what the government gives him – and that is in the private system! I have had one catheter ablation and 8 cardioversions to try to stop my irregular heartbeat and have had to pay about $30 out of my own pocket. Office visits cost me about $10 for my GP and $25 for the specialists. The secret of the Australian system containing costs is that they pit the public system against the private. When waiting lists get too long, people buy private insurance. But if the private insurers and private hospitals start charging too much people drop the insurance and rely on the public system. Of course it is not as simple as that, and of course there are problems here too, but having lived here for over 30 years I have seen successive governments – left and right – make significant improvements to the system. The left brought it in the 70s and the right at first tried to repeal it and lost government. The left made it hard for the private system and the right answered by providing a tax break for those who chose to buy private insurance – taking pressure off the public system. If you make a lot of money and don’t buy private insurance you get hit with a surcharge to the Medicare levy. Since I have private insurance I pay about $300 toward the public system annually when I file my income tax. As a privately insured patient I also have full access to the public system – so if I have a heart attack I will call an ambulance and then be taken to the nearest public hospital where i will be treated and, if necessary moved to the large public hospital best equipped to handle my condition. Same with a car accident. If it is feasible my private specialist will be consulted and brought into my treatment. American costs have gotten out of control after 70 year of prosperity. Small anecdotal example. Both my sister and I suffer from sleep apnea and use exactly the same mask. She lives in the US and is eligible for US Medicare. She pays $50 for a new mask from a government approved supplier. The government pays about $460 to that approved supplier. I pay from $50-$125 from Amazon or other suppliers who specialize in CPAP suppliers. What value does the government get by over paying something like $350? Plus how many bureaucrats are they paying to run the approval system? So, no, I wouldn’t emulate the UK – it is a mess and I know several English MDs who, even if they are socialist leaning in their politics, are much happier with the Australian system. There is one outstanding exception in America that I am aware of – the Mayo Clinic. They style themselves as a private institution dedicated to the public good and medicine is tops and from what I understand they control costs well. I think the vector American ought to be exploring is new relationships between private and public. You have pigs in the trough to the tune of about 7.5% of your GDP and you are getting nothing for it.