Britain’s National Health Service, Praised by Obama’s Medicare Chief, To Undergo Cost-Cutting Overhaul

By Matt Cover | July 26, 2010 | 7:12 PM EDT

( – Britain’s National Health Service (NHS), which rations basic health care services to control costs, will undergo major budget cuts and restructuring ostensibly to make the government-run system less bureaucratic and more decentralized, according to detailed news reports over the weekend from the United Kingdom.
Dr. Donald Berwick, who was recently given a recess-appointment by President Barack Obama to run the federal Centers for Medicare and Medicaid Services in America, has praised Britain’s National Health Service, saying he loves the single-payer system.
In a July 2008 speech commemorating the 60th anniversary of the NHS at Britain’s Wembley Stadium, Berwick said, “Cynics beware, I am a romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country. The National Health Service is one of the truly astounding human endeavors of modern times.”
Berwick also said, “Do not trust market forces to give you the system you need. … I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”

Dr. Donald Berwick, nominated by President Obama to head the Centers for Medicare and Medicaid Services, is expected to get the job through a recess appointment on Wednesday, July 7, 2010. (AP Photo/Goodman Media International, Inc.)

In that same speech, Berwick told the audience, “You could have had a monstrous insurance industry of claims and rules and paper-pushing instead of using your tax base to provide a single route of finance. You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker. And that any health care funding plan that is just, equitable, civilized and humane must – must -- redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional. Britain, you chose well.”
Currently, however, Britain is reforming the NHS that Berwick said he was romantic about. In a July 2010 white paper, British Prime Minister David Cameron and Deputy Prime Minister Nick Clegg outlined their plan to reform the NHS into a “bottom up” system influenced more by doctors and less by bureaucrats.
“We will make the NHS more accountable to patients,” they state. “We will free staff from excessive bureaucracy and top-down control. Healthcare will be run from the bottom up, with ownership and decision-making in the hands of professionals and patients.” 

To do this, Cameron and Clegg propose to give more control over health care decisions to local health care providers, taking clinical decisions out of the hands of government bureaucrats – a practice that often led to rationing and complaints by patients.
“Over the next four years we will reduce the NHS’s management costs by more than 45%,” said Cameron and Clegg. “The Department [of Health] will radically reduce its own NHS functions. Strategic health authorities will be abolished.”
“[I]t has rapidly become clear to us that the NHS simply cannot continue to afford to support the costs of the existing bureaucracy; and the Government has a moral obligation to release as much money as possible into supporting front-line care,” the white paper states.

New British Prime Minister David Cameron arrives for his first full working day at 10 Downing Street in London on Wednesday, May, 12, 2010. (AP Photo/Lefteris Pitarakis)

“We are moving to a system of control based on quality and economic regulation, commissioning and payments by results, rather than national and regional management,” they write.
Dr. Berwick, who spent many years as an advisor to the NHS and was knighted by Queen Elizabeth II for his work, praised the NHS for being highly redistributive.
As he said in his 2008 speech at Wembley Stadium, “You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate.”
Cameron and Clegg propose to make the system affordable by reducing government regulations and bureaucracy.
“[W]e are committed to reducing the overall burdens of regulation across the health and social care sectors,” they write. “We will therefore undertake a wide-ranging review of all health and social care regulation, with a view to making significant reductions.”
Even this revised version of NHS has not eliminated concerns over health care rationing, this time of more basic, locally provided services. According to a July 24 report in the Daily Telegraph,  for example, some patient advocates worry that Cameron and Clegg’s reforms could lead to more, not less, rationing.
“Some of the most common operations — including hip replacements and cataract surgery — will be rationed as part of attempts to save billions of pounds, despite government promises that front-line services would be protected,” the report states.
It continues: “An investigation by The Sunday Telegraph has uncovered widespread cuts planned across the NHS, many of which have already been agreed to by senior health service officials.”
Among the plans by local Primary Care Trusts (PTC) – the local arms of the NHS – are  plans to admit less terminally-ill patients to hospitals and sending the dying home to die.

“On Thursday, the board of Sutton and Merton primary care trust (PCT) in London agreed more than £50 million of savings in two years,” reported The Telegraph.  “The plan included more than £400,000 to be saved by ‘reducing length of stay’ in hospital for the terminally ill.”

“As well as sending more patients home to die, the paper said the savings would be made by admitting fewer terminally ill cancer patients to hospital because they were struggling to cope with symptoms such as pain,” The Telegraph reported. “Instead, more patients would be given advice on ‘self management’ of their condition.”

Requests for comment sent to the Department of Health and Human Services, which oversees the Centers for Medicare and Medicaid that Dr. Berwick runs, were not returned.