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The United Kingdom’s National Health Service is in trouble. ”N.H.S. Overwhelmed in Britain, Leaving Patients to Wait,” read a New York Times headline earlier this week.
The situation sounds dire:
At some emergency wards, patients wait more than 12 hours before they are tended to. Corridors are jammed with beds carrying frail and elderly patients waiting to be admitted to hospital wards. Outpatient appointments were canceled to free up staff members, and by Wednesday morning hospitals had been ordered to postpone nonurgent surgeries until the end of the month.
Over the past week, hospitals have increasingly declared “black alerts,” an admission that they are unable to cope with demand, the health service confirmed, without releasing numbers. Most hospitals have been unable to meet emergency-ward targets of seeing patients within four hours because of a shortage of beds and staff.
With all due respect to our UK readers — obviously, the foremost concern is whether Brits can get access to the health care they need — I couldn’t help but wonder how this kind of headline would influence the US debate over single-payer health care, if we ever have one.
(A note: The United Kingdom technically goes beyond single-payer, where all health care is paid for by the government, to a more comprehensive system where not only does the government fund everything but doctors and hospitals are also employed and owned by the government.)
Sarah and I, as we’ve mentioned before, participated in some focus groups late last year in which opinion researcher Michael Perry asked some Donald Trump and Hillary Clinton voters how they felt about Medicare-for-all.
One thing that came up again and again, with both groups, was horror stories they had heard about single-payer programs in other countries. About long lines and people having to wait months or even years for care.
”I was just in London last month,” Richard C., a 38-year-old veterinarian who voted for Clinton, told us. “You will wait a year to see a specialist, you will wait two years for a surgery, and that to me is just as crazy just in a whole other way. ... The grass is not always greener.”
You’re going to hear that from the concept’s opponents too. The Washington Examiner’s Phil Klein, who I don’t think would mind my describing him as a vehement single-payer critic, flagged the news about the UK as a ”socialized medicine update” this week.
But what is actually going on here? I shot some emails today to researchers at the Nuffield Trust and the Health Foundation (think of them as kind of the Kaiser Family Foundation or Urban Institute but for Britain), asking them to explain this whole situation to an American.
Nothing in health care is simple, as you know, but this seemed to be the story:
- The cold and flu season is hitting Britain hard, and that is putting a strain on the system.
- But, perhaps more importantly, the NHS is enduring a prolonged period of austerity that has dampened its ability to handle the influx in patients that comes every winter.
”What has changed? The NHS has not become more socialised, but it has experienced several more years of near-flat funding falling behind rising need for care,” Mark Dayan, an analyst at the Nuffield Trust, told me.
The staff at the Health Foundation told me “this decade will see the lowest rate of health service funding growth since the NHS was founded 70 years ago.”
While NHS funding has increased, the foundation said, it is growing at about half the rate of what is needed when you account for Britain’s aging population, chronic diseases, and the costs of new treatments.
You might wonder, as conservatives will surely suggest, if that means socialized medicine is simply not as cost-effective as its supporters claim. But according to the Health Foundation, the UK spends comparatively less than France, Germany, or Sweden on health care.
”The NHS is actually outperforming the rest of the UK economy in terms of being efficient,” the foundation staff added. “The idea that it’s not efficient enough is not backed up by the evidence.”
Instead, they concluded:
Seven years of austerity and rising demand for services is taking a mounting toll on patient care. Waiting times are rising, access to some services is being restricted and access to family doctors, mental health and community services are under huge pressure.
It is true, as Klein noted, that the British system allows the government to unilaterally postpone non-emergency surgeries if circumstances demand it.
But whether this is an indictment of a more progressive health care system, or simply a reflection of what happens when you try to impose austere government spending limits on social programs, is probably the more salient debate if and when we begin to consider moving to a more socialized system in the United States.
Paragraphs of the Week
Over the past few months, I talked to experts who’ve researched 12-step facilitation treatment and AA, as well as people who attended the programs. My goal was to see whether the 12 steps really do help people overcome their alcohol addictions.
The answer: It’s complicated.
The simplest explanation is that 12-step treatment and AA meetings work for some people but not for others. J. Scott Tonigan, a researcher at the University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions (CASAA), said the research supports a “rule of thirds”: About a third of people maintain recovery from alcohol addiction due to 12-step treatment, another third get something out of the treatment but not enough for full recovery, and another third get nothing at all.
The truth, such as it is, about Alcoholics Anonymous. If you missed it as you were getting your work muscles going again after the holiday, you should go back and read this thoughtful and authoritative piece by Vox’s German Lopez about the efficacy of Alcoholics Anonymous. His conclusion is above, but German deftly goes through decades of medical research as well as his own reporting with real people to grapple with a topic that has no easy answers.
With research help from Caitlin Davis
Today’s top news
- “Trump administration proposes rules for health plans without certain ACA protections”: “The Trump administration proposed new rules on Thursday to make it easier for small businesses and individuals to buy a type of health plan long favored by conservatives that could bypass some of the insurance protections built into the Affordable Care Act.” —Amy Goldstein, Washington Post
- “Susan Collins Moves The Goalposts (Again) On Her Health Care Demands”: “In an interview with Inside Health Policy published Thursday, Collins said she hopes the policies she proposed will pass and be implemented before 2019, when the repeal of the individual mandate is expected to shrink the individual insurance market by several million people and drive up premiums by at least 10 percent.” —Alice Ollstein, Talking Points Memo
- “Medicaid expansion fight looms after Virginia statehouse drawing”: “A showdown over Obamacare’s Medicaid expansion pitting Republican lawmakers against Virginia’s newly elected governor is almost certain following the GOP victory in a drawing to decide control of the state’s House of Delegates.” —Rachana Pradhan, Politico
Analysis and longer reads
- “A New Strategy for Health Care”: “A new Democratic administration should focus on one or two signature health-care proposals that advance the long-term objectives of universal coverage and cost control and respond to people who have insurance but still face financial stress from medical bills. Two ideas could meet these criteria: making available a new Medicare plan for people aged 50 to 64 — a program I call “Midlife Medicare” — and directly attacking America’s excessive health-care prices.” —Paul Starr, American Prospect
- “Why drug deaths keep rising even in healthy states”: “In the past year, the rate of drug deaths has continued an upward trend, increasing by 7 percent to its highest level since the report began 28 years ago. More than six out of 10 drug deaths involve an opioid, primarily prescription pain relievers such as morphine, oxycodone and hydrocodone, or heroin.” —Susan Morse, Healthcare Finance
- “Maine Voters Chose Medicaid Expansion. Why Is Their Governor Resisting?”: “Even though voters here in Maine decided to expand Medicaid, the law’s fate is unclear. Republican Gov. Paul LePage has said that opening up the program to more poor adults threatens the state’s financial stability and that lawmakers shouldn’t raise taxes to pay for it.” —Sarah Varney, Kaiser Health News
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